前立腺肥大症手術後の尿失禁に関する臨床的検討

Abstract

1985～1989年の間のRPP(恥骨後前立腺摘除術)163例とTURP(経尿道的前立腺摘除術)30例で検討した.術後の尿失禁発生率はRPPで17.2%, TURPで33.3%であった.術後の失禁は1週間以内に半数で消失したが, RPPの4.9%及びTURPの3.3%では1ヵ月以上持続した.術前の膀胱内圧測定結果の解析上, 最大尿意容量は切迫性尿失禁の症例では失禁がない症例に比し有意に小さかった.最大尿意容量に対する初発尿意容量の比率(尿意切迫度と呼称)は, 切迫性尿失禁の症例では尿失禁のない症例に比し有意に高かった.尿意切迫度が70%上り高値であれば, 有意に術後の尿失禁発生率が高いことが明らかとなった

Postprostatectomy incontinence was evaluated in 193 patients, who underwent retropubic prostatectomy (RPP) or transurethral resection of the prostate (TURP) during the past 5 years from 1985 to 1989 at the Kyoto Prefectural University of Medicine. The occurrence rate of postprostatectomy incontinence was 17.2% in the patients who had undergone RPP and 33.3% of those who had undergone TURP. Although postprostatectomy incontinence disappeared within one week in half of the patients, postprostatectomy incontinence remained for more than one month in 4.9% of the patients who had undergone RPP and 3.3% of those who had undergone TURP. The incidence of postprostatectomy incontinence tended to be high in the patients of advanced ages. Postprostatectomy incontinence recognized in this series was classified into stress incontinence and urgency incontinence groups. An analysis of the results of cystometry performed before the operation showed that the volume of maximum desire of voiding in the urgency incontinence group was smaller than that in the group without postprostatectomy incontinence. Furthermore, supposing the urgency degree as a new parameter, which is defined as a ratio of first desire of voiding to maximum desire of voiding, the urgency degree of the urgency incontinence group was higher than that of the group without postprostatectomy incontinence. Patients with an urgency degree higher than 70% were found to have a high probability of urgency incontinence. These findings suggested that advanced age was the risk factor of postprostatectomy incontinence and that a small bladder capacity and high urgency degree were the high risk factors of postprostatectomy urgency incontinence.