Shafik法による尿路変更の術後経過

Abstract

1. Six patients with bladder cancer and three patients with vesico-vaginal fistula underwent operation with this technique. The 5 male and 4 female patients ranged in age at the time of surgery from 44 to 66 years. The patients were followed for 3 to 37 months. 2. There was no operative mortality. But 5 patients died subsequent (beyond 30 days) to this urinary diversion. Two of five patients died of cancer recurrence, I of cardiac infarction, and 2 of electrolyte imbalance that might be considered as a result of inappropriate postoperative care. 3. No significant changes in serum sodium and BUN occurred. Serum potassium level varied with the case and should be watched periodically following the diversion. All of the patients experienced hyperchloremic acidosis, so it seemed necessary to give oral bicarbonate therapy consecutively. 4. Three of 9 patients had experienced episodes of pyelonephritis during the first postoperative month. But no recurrent bout was encountered in the late postoperative period. 5. Of eleven renal units with normal preoperative pyelogram, 3 remained normal postoperatively. Of eight deteriorated renal units one improved. 6. Urinary frequency of the patients after operation was 5-15 times by day, and 2-5 times by night. Urine and stools were passed separately in 5 patients. 7. Although this urinary diversion have seemed to be not so satisfactory method in our series, we feel that long-term evaluation of this technique in a larger number of cases is necessary to definitively assess as the preferred method of diversion.