経尿道的前立腺切除術前後の尿路感染の管理法の検討

Abstract

In order to approach the problems of urinary tract infections before and after transurethral resections of the prostate (TURP), the medical records were investigated on 48 patients undergoing TURF in the last one year and five months. These patients were divided into 4 groups of A, B, C and D. A group of 8 patients is control one receiving neither antibiotics nor intravesical treatment with antibiotics. B group of 10 patients received intravesical irrigation and instillation with a dilute carbenicillin (CBPC) solution (2 gm in 200 cc saline solution for irrigation and 2 gm in 30cc saline solution for instillation). C group of 12 patients was given 4 gm of CBPC intravenously. D group of 18 patients received intravesical local treatment and intravenous injection of CBPC, and a dilute CBPC solution was similarly in 10 patients and a dilute polymyxin B solution (l00 mg in 200cc saline solution for irrigation and 50 mg in 30cc saline solution for instillation) was used in 8 patients for intravesical treatment. For purposes of this study, data of urine cultures (preoperative, I and 5 day postoperative), presence or absence of postoperative fever and 2 weeks postoperative pyuria were checked. All patients with bacteriuria on the first postoperative day were included in the patients with preoperative bacteriuria. The patients with preoperatively sterile urine in Band D group showed bacteriuria in respectively 0% and 20% of these patients 5 day postoperatively, whereas A and C group showed bacteriuria in respectively 60% and 50% of preoperatively sterile patients. Preoperative administration of antibiotics showed statistically no significant effect on the incidence of postoperative fever. The incidence of postoperative fever over 38°C was 25% of the patients with preoperative sterile urine and 58% of the patients with preoperative bacteriuria. This difference is statistically significant. Intravesical treatment with antibiotics reduced the incidence of postoperative fever in preoperatively sterile patients. Lastly, relations between 2 weeks postoperative pyuria and duration of indwelling catheterization after TURP, resected weights of prostate and preoperative bacteriuria were studied.