泌尿器の外傷について

Abstract

One hundred and forty-three urinary tract injuries were experienced during ten years of 1958 to 1967, and statistical observation of them was done along with discussions on some present-day problems. 1. Statistics. 1) 0.8% of total out-patients had urinary tract injury, and 0.5% had injury of genital organ. 2) As to location of 88 urinary tract injuries, 36 (40.9%) had the upper and 52 (59.1%) had the lower tract injury being 1 1/2 times as frequent as the former. 3) Kidney injury showed a peak in 1966. Injury to the urethra and that to the genital organs have been yearly increasing. 4) As to age the third decade was the first victim with striking increase of the second decade in recent years. 5) Cause of the injuries could be tabulated as follows: 6) Degree of injuries could be summarized as follows: i) Kidney-light 47.2% moderate 27.8% severe (complete fissure of the parenchyma) 25.0% All of them were closed and non-penetrating injuries. ii) Urethra-complete rupture 30.6% incomplete rupture 32.3% partial rupture 14.3% iii) Genitalia-testicular contusion 30.6% peno-scrotal contusion 29.1% ruptured tunica albuginea of testis 18.2% laceration of testis 9.1% genital skin ablation 3.6% 7) Urethral injuries could be tabulated as follows: 8) Associated injuries frequent in renal injury were fracture of rib, mesenteric hematoma, and pelvic fracture in order. Fracture of the pelvis was most common in injury to the bladder and urethra. 9) As to treatment, renal injuries were treated by nephrectomy in 36.1%, conservative surgery in 11.1% and non-operatively in 52.8%. Urethral injuries were treated by pull-through operation in 34.7%, urethrorrhaphy in 30.6%, and conservatively in 26.5%. 10) As late complications of the urethral injury, stricture of the urethra (S) and impotence (1) were seen in the incidence as follows: II. A few problems in urinary tcact injury. 1) In order to determine degree of traumatic shock, blood pH, pC02, p02, hematocrit, circulating blood volume, electrolytes, base excess, BUN, lactic/pyruvic acid ratio, O2 deficit, extra-cellular fluid volume, and central venous pressure should be measured. Lactic/pyruvic acid ratio over 20 or O2 deficit below 120ml/kg might indicate an irreversible shock. 2) In this article, usefulness of diagnostic methods for renal injury were discussed, particularly on those we routinely perform as KUB, IVP, drip infusion pyelography, renal angiography, drip infusion nephrotomography, and ultrasonic study. 3) Anyone of the following conditions was regarded as indication for operative treatment of injured kidney. a) Marked gross hematuria continuing more than 24 hours. b) Abdominal mass progressively increasing in size or presence of urine infiltration. c) Low blood pressure not improved by repeated blood transfusion. d) Marked deformity on IV pyelogram and presence of massive extravasated dye. e) Gross injury of the renal pedicle or intrarenal vessels revealed by renal arteriography and/or drip infusion tomography. Severe fissure or laceration disclosed by the same study. f) Open injury or possible presence of associated injury of other abdominal organs. g) Infection or traumatic renal infarction. III. Experimental study on the change of leucine amino-peptidase (LAP) at the time of renal injury showed that LAP in the kidney tissue got released into blood within a few, hours after injury and LAP-activity of the dissected renal tissue was lowered with course of time. Further study on LAP isozymes might be necessary. IV. In a case of impotence of organic cause after injury, a new prosthesis, similar to that developed by Pearman (1966), was surgically placed with success.