上部尿路瘻術後の経過と管理

Abstract

A late result of the external diversion of the upper urinary tract for carcinoma of the bladder, uterus cancer, renal tuberculosis and miscellaneous disease was studied. And an aftercare of this type of urinary diversion was briefly discussed based on the results. In early several years, the prognosis of cancer groups was worse than that of another 2 groups because of the more extensive operative attack or the malignancy of the primary disease. The renal function was not so important factor for prognosis unless severely impaired, while it depended on the state of the primary lesion. In tuberculosis group renal function was worse than other groups. From an early period a urine culture showed abundant Gram negative rods in all cases, especially E. coli, Pseudomonas, Proteus and Klebsiella which were resistant to antibiotics. In some cases, the complications such as stone formation, ureterointestinal fistula and/or difficulty in changing catheter began to occur and renal function decreased gradually in the course of several years. About 10 years later, chronic renal insufficiency killed a few patients in uremia. The method of urinary diversion is to be selected in such a fashion not to kink the ureter. Catheterization should not be forcefully performed. Urinal is to be low enough to keep good drainage for day and night. A continuous irrigation 4 hrs a day for 4 days with 0.02 % chlorhexidine solution proved to keep bacteriuria under 10[3]/ml. Therefore, the continuous irrigation may be of use and it is desirable that antibiotics may be reserved for acute attack of infection.