尿路結核症の治療成績 (シンポジウム: 尿路性器結核の昨日・今日・明日 第22回日本泌尿器科中部連合地方会 )

Abstract

The clinico-statistical observations were made on urinary tuberculosis in our clinic for periods from 1963 to 1972. 1) The incidence of urinary tuberculosis in total outpatients was about 1.0% and it appeared to have decreased in recent years. There were 124 males and 94 females. The age distribution was 10.4% in under 20 years old, 28.9% in the third decade, 28.5% in the forth, 17.7% in the fifth, and 14.5% in over 50 years old. 2) The chief complaints were various; bladder symptoms (51.7%), general symptoms such as general fatigue and fever (21.5%), flank pain (8.1%), abnormal urine (15.5%), and others (3.2%). 3) The typical cystoscopic findings were present in 24.3% and tuberculous bacilli in the urine were detected in 36.5% by cultural and 32.1% by microscopic examination, respectively. 4) The tuberculous lesions in pyelogram were minimal in 38.1%, moderate in 17.3%, advanced in 22.7%, and non-functional in 21.6%. 5) One hundred and eighty cases in these 218 patients were treated in our clinic. Seventy-six patients (42.2%) were treated only with chemotherapeutics, fifty-three cases (29.4%) were nephrectomized, and in eleven (6.1%) partial nephrectomy or cavernotomy was performed. Transient urinary diversion was made in nine (5.0%) and permanent nephrostomy in six (3.3%). The conservative operation for ureteric stenosis or contracted bladder as performed in 19 cases (10.6%). The six uremic patients (3.3%) required peritoneal- or hemodialysis. 6) The renal angiography and Xe[133] wash out were useful to evaluate the treatment and the prognosis for urinary tuberculosis. 7) Above results indicate that chemotherapy is effective for early stage of urinary tuberculosis, and that surgical treatment with chemotherapy is required for advanced ones. We should make an effort to find out the incipient patients as early as possible.