尿路変向の現況と問題点 2.術式選択Reservoir

Abstract

1)Kock pouch12例, Indiana pouch14例の手術成績について検討した. 2)術後合併症のおもなものはkock pouchで結石形成(5例), Indiana pouchで初期症例における創感染(4例)及び導尿困難(4例)などであり, 特にKock pouchの異物結石の形成は大きな問題であった. 3)術後のアシドーシスを認めた症例は2例のみであった.又, 何れの術式でも正常範囲内ではあるが有意の血中尿素窒素の上昇, 尿中pHの上昇を認めた. 4)26例中22例に無症候注の持続する細菌尿を認めたが, 膿尿を認めた症例は5例のみであった

The Kock continent urinary reservoir was constructed in 12 patients from 1988 to 1990 followed by the Indiana continent urinary reservoir in 14 patients thereafter. There were no perioperative death in either group. The period of postoperative follow-up was 11 approximately 70 months, with a mean of 58.9 months. Several modifications of the operative technique were made to the original Kock pouch, but stone formation was observed in 5 patients (42%), resulting from foreign materials permanently in contact with urine. In the Indiana pouch group with a mean postoperative follow-up period of 26.8 months (range 11 approximately 43 months), wound infection occurred in the initial 4 patients and difficulty of catheterization in the other 4 patients. The serum electrolyte values were found to be within the normal limits during the follow-up period in both groups, but, mild acidosis occurred in 2 patients. Patients with urinary diversion demonstrated mild azotemia (P = 0.02) despite similar serum creatinine levels and an increase in urine pH (P = 0.006) postoperatively. Asymptomatic bacteriuria was demonstrated in 22 of the 26 (83%) patients with the reservoir, but only 5 patients had significant pyuria. Our clinical experience suggests that the Indiana pouch is a more reliable method than the Kock pouch to construct a continent urinary reservoir.