前立腺肥大症に対するPorges社製尿道スパイラルステントの使用経験

Abstract

前立腺肥大症60例に対しPorges社製尿道スパイラルステントの留置を試みた。1) 57例に留置可能で40例は3ヵ月以上の継続留置が可能であった。2)留置3ヵ月目の自覚症状スコアの改善度は, 尿閉群81.2%, 排尿困難群70.4%で, 特に閉塞症状の改善が良好であった。自覚症状において, 尿閉群41人中29人(70.7%), 排尿困難群13人中6人(46.2%)に有効性を認めた。3)他覚所見は, 尿閉群41人中22人(53.7%), 排尿困難群13人中4人(30.8%)に有効性を認めた。4)合併症は, 尿失禁, 排尿痛などが多く, 4症例に移動を認めた。5)神経因性膀胱合併の4例を除く評価可能50例のうち28例(56.0%)が, 尿道ステント有効と考えられた

The Porges Urospiral, a urethral spiral stent made of stainless steel wire, is designed for patients with benign prostatic hypertrophy. To evaluate the safety and efficacy of the stent, a prospective uncontrolled study was performed on 60 patients who complained of urinary retention (48 patients) or severe dysuria (12 patients) due to prostatic hypertrophy. Four patients had neurogenic disorders resulting in bladder dysfunction. The average age of the patients was 77.4 years old, ranging from 61 to 91 years old. In 48 patients, the stent was used instead of transurethral resection of the prostate (TUR-P) because of the patients poor general conditions, while in 12 patients the stent was transiently used until TUR-P. Subjective symptoms, according to an original scoring system, and objective signs, uroflowmetry measurements and residual urine volume, before and 3 months after stent insertion were compared. The stent was indwelt for more than 3 months in 40 of the 57 patients in whom the stent could be inserted. Out of 37 evaluable patients, subjective symptoms improved in all the patients and objective symptoms improved in 26 patients (70.3%). Complications included urinary incontinence, urination pain, urethral pain, gross hematuria or migration of the stent. Although these complications disappeared in a few days after the insertion of the stent in a majority of the patients, the stent was removed in 17 patients due to complications within 3 months after insertion. The overall clinical efficacy of this stent was 56% in 50 evaluable patients who had no neurogenic disorders.(ABSTRACT TRUNCATED AT 250 WORDS)