腎不全を伴った前立腺肥大症患者に対する手術経験 - 術前および術後の管理を中心として -

Abstract

We present three cases of benign prostatic hypertrophy associated with chronic renal failure for three years from 1982 to 1984. Endogenous 24-hour creatinine clearance (Ccr) on admission ranged from 8.7 to 29.4 ml/min. Temporary hemodialysis treatment was required in one patient at the beginning of hospitalization. Indwelling intraurethral catheterization for 3 months or more improved the renal function in one patient, but brought troublesome complications of gross hematuria, intractable urethral pain or recurrent pyelonephritis in the other patients. These complications might arise from strong uninhibited detrusor contractions triggered or accelerated by stimuli and/or urinary tract infection induced by urethra-indwelt catheters. Intermittent self catheterization reduced these complications in one patient. In two patients, Ccr increased beyond 30 ml/min as a desirable standard level for safe operations. Suprapubic prostatectomy was successfully performed in all the patients. However, severe gastric ulcer or fatal duodenal ulcer occurred in two patients. Hypoproteinemia and/or urinary tract infection was thought to be highly related to ulceration. In conclusion, we would like to emphasize that a Ccr of more than 30 ml/min is needed for safe operations concerning renal function in patients with benign prostatic hypertrophy associated with chronic renal failure.