下部尿路損傷の臨床的検討

Abstract

1985年1月～1995年6月に, 奈良医大泌尿器科ならびに関連施設で入院治療した下部尿路損傷61例について臨床的検討を行った. 1)膀胱挫傷は保存的治療を行い, 膀胱破裂は早期の外科的治療を必要とした. 2)尿道損傷については出血, 著明な尿の溢流等がない場合, 膀胱瘻の設置にとどめ, 積極的な治療は骨盤骨析等の合併損傷の安定をみてから尿道形成を行う方が, 尿道狭窄等の合併症の発生頻度が低くなると考えられた

A total of 61 patients with lower urinary tract injuries were treated at Nara Medical University and its affiliated hospitals, between January 1985 and June 1995. There were 9 patients with bladder injuries and 52 patients with urethral injuries. The main cause of bladder injury was a traffic accident sustained in 4 patients (44.5%) and that of urethral injury was an occupational accident sustained in 27 cases (51.9%). The major associated injuries were a bone fracture seen in 45 patients (73.8%) and an intrascrotal hematoma seen in 28 patients (45.9%). Posterior urethral injuries associated with pelvic bone fractures were classified into 3 types according to the classification reported by Colapinto et al.; 8 patients (32.0%) into Type I, 8 (32.0%) into Type II and 9 (36.0%) into Type III. Of the 25 patients with posterior urethral injuries, 8 (32.0%) underwent immediate surgical treatment, 12 (48.0%) underwent initial cystostomies and delayed surgical treatment and 5 (20.0%) received indwelling of urethral catheters. Postoperative complications of urethral injury included urethral stricture in 30 patients (57.7%), incontinence in 3 (5.8%) and impotence in 3 (5.8%). A significant relationship between the duration of cystostomy and the incidence of postoperative urethral stricture was observed in our patients. Therefore at least three weeks of cystostomy will be necessary in the management of patients with complicated urethral injuries.