清潔間欠導尿法の臨床的検討

Abstract

難治性排尿困難患者に対しCICを指導した120例について臨床的検討を行った。1)CIC経過中, 尿路感染を認めなかったのは早期治療例は65%, 陳旧例は20%であった。無症状の尿路感染症に対しては, 特に抗菌剤の投与は不要と考えられた。2)CIC前に水腎症を認めた20例うち, CICにより18例が改善し, 悪化した症例は認めなかった。3)骨盤内臓器摘出術後の神経因性膀胱のCICの離脱時期は, 早期治療例は3ヵ月以内が45%, 時期の差はあれ84%が離脱できた。陳旧例は, ほとんどの症例で継続中である。残尿が100ml以下であれば, 定期的観察を行うことによりCICは不要と考えられた

We evaluated 120 patients with neurogenic bladder treated by clean intermittent self catheterization (CIC) in our department. These cases were divided into 2 groups: early treatment cases in which CIC started within 1 year after onset of dysuria, and late treatment cases in which CIC started after more than 1 year. Urinary tract infections (UTI) were recognized in 35% of the early treatment cases and 80% of the late treatment cases in the subsequent period. Pyelonephritis was experienced in 4% of the early treatment cases and 12% of the late treatment cases. Antibiotics therapy was considered unnecessary for asymptomatic UTIs. After CIC treatment, hydronephrosis detected by intravenous pyelography (IVP) and ultrasonography was improved in 18 of the 20 cases, and no cases showed deteriorated renal function. In the cases with neurogenic bladder after radical operations of the uterus or rectum, 45% of the early treatment cases have become free from CIC within 3 months postoperatively, and 84% eventually became free. Most of the late treatment cases have been continuing CIC. We considered that CIC was unnecessary when the residual urine was less than 100ml based on the periodical urinalysis and observation of renal function.