尿閉を主訴とする高齢前立腺肥大症患者に対する尿道内留置用Stentの長期使用とその適応

Abstract

平均80.5±5.7歳の前立腺肥大患者で尿閉を呈する32名にintraurethral catheter(IUC, Angiomed, Germany)の長期留置を試み, urodynamicの面から検討した。結果としてunderactiveでない膀胱では尿失禁および尿路感染なしに, 6ヵ月以上留置可能であり, overactive bladderでは15/16例(93.8%)と有意の成功率であった(p<0.025)

Thirty-two elderly male patients with benign prostatic hypertrophy complaining of urinary retention were treated by polyurethane intraurethral stents. All of them were unfit for prostatic surgery due to the presence of several complications, and had been indwelt with a urethral balloon catheter. Cystometry before stent insertion was performed in 23 of the 32 patients. Eleven patients showed overactive bladder, 5 patients normal bladder, and 7 patients underactive bladder. Duration of stent indwelling ranged from 2 days to 22 months (mean 6.7 months), and stent could successfully function for more than 6 months in 20 of the 32 patients (62.5%). Nine of these 20 patients (45%) could keep continence of urine, and urinary tract infections improved in 7 of these 20 patients (35%). The stent failed in 4 of the 5 patients who had had previous operations for prostatic hypertrophy. In a comparison of the findings of urodynamic study prior to insertion of stent with the results of the stent, the results were significantly better in the patients with overactive or normal bladder than in those with underactive bladder (p < 0.05, chi-square test). Bladder stone formation was found in one patient and was the only complication among the 32 patients. In conclusion, stent placement without incontinence or urinary tract infection can be successful for more than 6 months in patients who do not have an underactive bladder and who had not had a previous prostatic operation.