尿道ステントの臨床評価 短期成績について

Abstract

22例の症例についてmetallic spiralを用いた治療を試みた.その年齢は56～91歳(平従76.6歳)で, 原疾患としてはBPHで, 直腸癌術後および糖尿病性神経因性膀胱を合併したのがそれぞれ1例, 脳梗塞後が2例いた.それら症例の治療前の排尿状態は, 尿閉のため留置カテーテルがあった症例は16例, 排尿障害のある症例は6例であった.治療後の尿流量面からの評価では, 排尿量100～230 ml(平均172 ml), MFR 13～21 ml/秒(17.3 ml/秒), AFR 4～12 ml/秒(8.2 ml/秒)で, 残尿量も30 ml以下が20例, 200 mlが1例であった.このうち留置ステントの膀胱側への移動は6例見られたが4例は再度留置した.尿道ステントに伴う会陰部不快感は3例に見られ2例は抜去せざるを得なかった.尿失禁, 膿尿の持続や尿路感染症, 結晶の付着など特に治療を必要とする症例は観察されなかった

Treatment using a metallic spiral was attempted on 22 patients. They had urinary retention in 16 cases and dysuria in 6. In 21 of them, the spiral was successfully placed under transrectal ultrasound control. In all 21 patients, voiding was possible immediately after placement of the spiral. As for urodynamic study, urine volume was 100-230 ml (mean: 172 ml), maximum flow rate was 13-21 ml/sec (mean: 17.3 ml/sec), and average flow rate was 4-12 ml/sec (mean: 8.2 ml/sec). Residual urine volume was less than 30 ml in 20 patients and 200 ml in one. As for complications, proximal migration of the spiral was observed in 6 patients. In 4 of them, the new spiral was placed. Perineal discomfort was seen in 3 patients, in 2 the spiral was removed. Pyuria associated with bacterial infection did not continue after the treatment in patients having a catheter. Severe urge incontinence and encrustation were never seen. The above findings suggest that, though a longterm study has not done, this treatment could be an effective treatment particularly for the elderly patients with general complications and/or who require removal of an indwelling catheter for clinical or social reasons.