脳卒中患者の尿路管理におけるTUR-Pの検討

Abstract

1)保存的療法のみでは排尿障害の十分な改善がえられず, BPHやBNcによる下部尿路閉塞を認めた慢性期の初発脳卒中症例40例に対しTUR-Pを施行し, 術後の排尿自立について検討を行った.2)術後約6ヵ月後の評価では, 脳幹部梗塞再発作によりやむなく留置カテーテルとなった1例を除く39例のうち36例(92%)に排尿自立がえられ, 新たに尿失禁が出現した例はなかった.3)術後も介助, 集尿器を必要としたのは3例で, うち2例は移動能力あるいは下肢機能が低く, 1例は痴呆が高度な症例であった

We discuss the transurethral resection of the prostate (TUR-P) on 40 patients in the chronic stage of stroke, all of whom were refractory to conservative managements of urinary disturbance. All patients, between 35 and 89 years old (mean: 52.6 years), had only one episode of stroke and were diagnosed as benign prostatic hypertrophy or bladder neck contracture that appeared to cause urinary disturbance in these patients. At six months after TUR-P, all except for one patient, who needed an indwelling catheter due to a reinfarction, were catheter free. Of these cases 36 (92%) obtained independent micturition and did not develop urinary incontinence except transiently postoperatively. Two cases with impaired mobility and one case with progressive senile dementia required helpmates and/or a commode and so forth postoperatively. It is concluded that in chronic stroke patients TUR-P is recommended for those with benign prostatic hypertrophy or bladder neck contracture.