尿管逆流防止術(Lich-Gregoir法)術後膀胱機能の検討

Abstract

Postoperative vesical functions in 18 patients who underwent the Lich-Gregoir antireflux plasty at our Department were studied during the 11 years from 1970 to 1980. The vesical functions were analysed on the basis of subjective complaints, urinary flow rate, residual urine, cystometrography and voiding cystourethrography. Three of 9 patients who underwent bilateral ureteroplasty had some complaints such as residual urine, protraction, retardation, loss of sensation to void, sense of retention and dysuria over a transient postoperative period. In all patients, these disorders completely disappeared within 2 to 4 months. None of the 9 patients who underwent unilateral ureteroplasty had any complaints of urinary distarbance 3 weeks after operation. A cystometric study showed an autonomous pattern in 3 patients who had difficulty in urination more than 3 weeks after the operation. The cystometrograms of these patients showed a normal pattern within a subsequent 3-week period, although the maximum voluntary voiding pressure was still low. In patients with urinary complaints, more than 3 weeks after operation, a cystometric study should be considered. A urinary flow curve with a prolonged plateau phase at the maximum flow rate was observed in 2 boys over a transient postoperative period. However, this finding disappeared spontaneously after 4 months. From these data, the urinary flow rate is believed to be a simple and useful parameter in the diagnosis of postoperative vesical dysfunction, particularly in children, and the Lich-Gregoir plasty was considered to be an excellent technique with little risk of substantial complications. Key words: Anti-reflux operation, Neurogenic bladder.