排尿障害に対するダブルマレコー型尿道内留置ステントの使用経験

Abstract

尿道内留置ステントをpoor riskの前立腺肥大症7例, 低緊張性膀胱2例, 過活動膀胱1例に使用した。経過は前立腺肥大症のうち2例が手術に移行し4例は継続中であり, 1例は全身状態の悪化に伴い尿道カテーテルに変更した。神経因性膀胱の3例は自己導尿, 膀胱瘻あるいは薬物療法に移行した。ステント留置による副作用としては, 留置時の尿道出血が4例, ステント内の結石形成2例を認めた

We reviewed our experience of using double Malecot polyurethane intraurethral catheters (IUC). Ten patients with dysuria were treated between April 1991 and April 1993. Seven patients with benign prostatic hypertrophy (BPH) were judged as in a high risk group for operation. The three other patients had neurogenic bladder (two had underactive bladder and 1 had overactive bladder). Under local anesthesia, 150 ml of 0.1% Povidone iodine solution was infused into the bladder through a Nelaton catheter. Under guidance by ultrasonography, an IUC was placed into the bladder neck and posterior urethra using the specially designed introduction set. An long-term follow up of the BPH patients, two IUCs were removed for operation and one was exchanged for an indwelling catheter because of deterioration in general condition. In the neurogenic bladder patients, all IUC were removed because of the increase of residual urine, formation of a pseudourethra, or dislocation into the bladder. Side effects were observed in 6 patients such as, urethral bleeding and stone formation in the stent. Erosion and bleeding tendency in the urethral mucosa were shown in the prolonged duration cases. We conclude that a urethral stent is an effective devise for a high risk patient with benign prostatic hypertrophy but we must keep each patient under strict observation for complications during IUC placement.