泌尿性器外傷にかんする研究 尿道粘膜の再生力を利用した尿道形成術いわゆるintubated urethrotomyにかんする実験的ならびに臨床的研究

Abstract

The end-to-end anastomosis which has been generally employed in the surgical treatment of the injury or stricture of the urethra has, however, its disadvantages. In order to avoid these disadvantages Weaver (1956) invented intubated urethrotomy, utilizing regeneration of the urethral mucosa, and this technique brought us sufficient results. Having good clinical results of this procedure on the patients, the following animal experiments were made to confirm the superiority of this procedure. I. An artificial defect of the urethral mucosa was made in adult male mongrel dogs under intravenous anesthesia. The dogs were devided into four groups according to the size of the defect and whether a splint catheter was used or not. Serial urethrographic and histological studies were made and the following results were obtained. 1) In 8 of 14 animals with splint catheter, the urethral mucosa was completely regenerated within 2 to 6 weeks after the operation regardless the size of the defect. 2) In the groups with splint catheter, inflammation, an inhibiting factor for regeneration of the mucosa, was slighter than in the groups without catheter. 3) Regeneration of corpus spongiosum was observed in 3 dogs with splint catheter and in 1 dog without catheter. 4) In many cases, the submucosal connective tissue refilled the area of lack of the mucous membrane even without regeneration of the corpus spongiosum. 5) The urethral lumen was markedly narrowed in 2 cases without catheter. An abnormal protrusion of the regenerated mucosa into the urethral lumen and or overgrowth of inflammatory granulation caused by infection were supposed to have caused stricture. II. Long-term follow-up study of intubated urethrotomy showed the facts as follows. 1) Intubated urethrotomy was applied on 15 cases of urethral stricture. Time after the operation ranged from 6 months to 4.5 years. Sufficient results were obtained in 11 cases. Postoperative urethral dilatation was not necessary in 9 cases. 2) The operation was technically easier than the end-to-end anastomosis. Intubated urethrotomy should be highly evaluated from this clinical study as well as from the theoretical point of view.