羊子 吉川’s scientific contributions

(健康増進) 理学療法学. v.29, n.Supplement 2, 2002, p.340

Excretory urography was performed using iohexol (Omnipaque 300 and Omnipaque 350) on 388 patients requiring urography in the Department of Urology, Nagoya University School of Medicine and 10 affiliated hospitals. Adverse reactions were observed in 3 cases (0.8%), but they were all mild. Good image efficacy was obtained in more than 95% of the patients injected 20 ml, 40 ml, and 100 ml of Omnipaque 300 and 40 ml of Omnipaque 350. There was no difference in the results of image efficacy between 40 ml (Omnipaque 300) and 100 ml (Omnipaque 300) groups. Therefore, the use of 40 ml of Omnipaque 300 for excretory urography was considered to be a very useful screening method for the urinary tract.

著者らは1999～2004年の間に,術前診断で腎癌を疑い,腹腔鏡下腎部分切除術を24例に施行した.その手術方法について解説した.1)腫瘤径が小さく,腫瘤と腎杯,腎洞との距離が1cm以上ある場合は,超音波メス等の道具を用いて腎動静脈の血流遮断を行わずに腫瘤を切除し,12例中10例で成功した.2)腫瘤と腎杯,腎洞との距離が1cm未満で腎杯を切開する可能性が高い症例に対しては,腎血流を遮断した後に腫瘤を切離し,必要に応じて腎杯縫合,腎実質縫合を行った.3)血流遮断を行った症例での平均阻血時間は26分で,imperative caseでも術後の腎機能の低下は軽度であった.4)病理診断が腎癌であった症例の予後は,elective case 11例では再発はみられず,imperative case 6例のうち2例で局所再発を認めた We retrospectively reviewed the clinical results of 24 patients who underwent laparoscopic partial nephrectomy by a diagnosis of renal cell carcinoma (RCC) between 1999 and 2004, including 16 elective cases and 8 imperative cases. Twenty-two were successfully treated laparoscopically; two cases in the imperative group required conversion to open surgery because of uncontrollable bleeding. A vascular clamp was used in 12 cases for an average of 26 minutes. The creatinine clearance changed from 98 to 93 ml/min in the elective cases and from 49 to 44 ml/min in the imperative cases. Pathological evaluation revealed RCC in 10 elective cases and 6 imperative cases. Local recurrence (renal hilum lymph node and ipsilateral kidney) was found in 2 patients in the imperative group. Although laparoscopic partial nephrectomy is useful, long-term follow-up is necessary for evaluating the tumor control.

腹腔鏡下根治的前立腺摘除術を行った80例を対象に, 術前後の尿流動態検査より排尿筋低活動の発生について検討した。その結果, 1)術後に排尿筋低活動は6例(7.5%)で認められた。この6例全例とも術前排尿筋収縮は良好で, 術中操作により排尿筋低活動が発生したと考えられたが, 発生原因は特定できなかった。2)全例, 排尿は腹圧により代償され, 残尿は認めなかった。初発尿意容量, 最大尿意容量, 最大尿道閉鎖圧は術前後で変化はみられず, また蓄尿機能も変化はなく, 1例で軽度尿失禁を認めたものの, 他の5例は尿失禁を認めなかった。 Strain voiding has been reported to be a frequent symptom following radical prostatectomy. However, pathophysiology of vesicourethral function underlying voiding difficulty has not been well studied. In the present study, we investigated detrusor underactivity following radical prostatectomy. The records on urodynamic study (pressure-flow study, urethral pressure profile) were retrospectively investigated in 80 patients undergoing laparoscopic radical prostatectomy and all urodynamic studies pre- and post-operatively. We extracted the cases with detrusor underactivity according to the criteria of overt strain voiding pattern on post-operative pressure flow study; detrusor pressure at the maximum flow rate (Pdet Q(max)) of less than 10 cmH2O in conjunction with an increase of abdominal pressure. Of the 80 patients, 6 (7.5%) were found to have detrusor underactivity. In all patients, good detrusor contraction was confirmed on the pre-operative urodynamic study performed before surgery. On the voiding phase of pressure-flow study in these patients, mean Pdet Q(max) showed a significant decrease postoperatively from 58.5 cmH2O to 3.0 cmH2O (p < 0.01), although mean abdominal pressure at Q(max) significantly increased from 24.2 cmH2O to 105.8 cmH2O (p < 0.05). Mean Q(max) on free uroflowmetry showed a significant increase from 12.8 ml/sec to 22.1 ml/sec (p < 0.05). No patient had significant post-void residual urine. On the storage phase of the study, however, maximum cystometric capacity, maximum urethral closing pressure showed no significant change between pre- and post-operative studies. Five patients acquired continence and one had mild urinary incontinence using one pad a day. The present study showed that detrusor contaractility could be impaired during radical prostatectomy, but, no apparent operative procedure related to detrusor dysfunction could be identified in the present patients.

We report on a case of iatrogenic obstruction of the vas deferens following herniorrhaphy, successfully treated by vasovasostomy after an obstructive interval of 31 years, with his wife achieving pregnancy.

Emphysematous cystitis is a rare but interesting disease. A case is reported of cystitis emphysema with acute pyelonephritis and uncontrolled diabetes. The patient was a 54-year-old woman complaining of gross hematuria and fever. A submucosa emphysema in bladder was found by cystoscopy . Radiography showed the gas around the bladder. The patient was administered antibiotics, then symptoms was improved. We reviewed 12 cases of emphysematous cystitis reported in Japan and summarized the pathophysiologic features of this entity.

訪問看護ステーション40施設とその利用在宅高齢者2322名(男1023名,女1299名).尿道カテーテル留置者は225名(男97名,女128名)で,理由は尿排出障害62.5%,尿失禁25.3%であった.おむつ使用者は1301名(男533名,女768名)で,使用開始時期は在宅看護開始前が79.9%,理由は尿失禁11.6%,寝たきり67.0%,痴呆8.8%,尿失禁予防12.3%であった.清潔間歇導尿施行者は36名(男23名,女13名)で,理由は尿閉・残尿が88.9%,施行者は家族・介護者が63.9%であった.カテーテル留置の決定は医師84.7%,看護婦・保健婦30.6%で,清潔間歇導尿では医師86.9%,看護婦・保健婦21.8%であった.おむつ使用の決定は医師11.4%,看護婦・保健婦27.3%,家族64.2%,被看護者本人18.3%であった.専門家への受診は191名で,排尿管理別の受診割合はカテーテル留置者39%,おむつ使用者5.8%,清潔間歇導入施行者77.8%であった.専門医受診依頼は一般医よりなされるのが52%,ケースバイケースが36%であった A fact-finding inquiry was made on elderly people in home care, in order to investigate urinary management. A questionnaire survey was performed on 2,322 elderly people (1,023 male and 1,299 female) cared at home by 40 home nursing stations in Aichi prefecture. The survey focused on the urinary management and the practical problems at home. The number of the elderly managed by an indwelling catheter was 225 (9.7%) and 1,301 (56.0%) of the elderly wore diapers. The rates of the people managed by an indwelling catheter or diapers widely varied among the home nursing stations. In 25.3% of the people managed by an indwelling catheter, the catheter was used because of urinary incontinence, which should not normally be indicated. Diapers were unnecessarily used in 23.9% of people mainly for a protective purpose. The majority of the people whose voiding dysfunction was managed either by an indwelling Foley catheter or diapers had had this treatment started before discharge from hospital. Only 5.8% of the elderly wearing diapers received consultation from medical specialists. Intermittent catheterization was performed in 36 people (1.6%), and in 23 (63.9%) the catheterization was carried out by the care givers. We conclude that the urinary management in the elderly cared at home is insufficient and that standardization of the urinary management and creation of a network of care givers, nurses, general physicians, medical specialists and government representatives should be urgently needed to improve the quality in urinary management in the elderly.

A 34-year-old man was admitted with pain on urination, pollakisuria and left inguinal hernia. He had undergone a surgery for the left inguinal hernia 3 times, about 30 years, 28 years and 14 years earlier. Physical examination revealed that there was an elastic soft mass in the left inguinal region. Cystoscopy and cystography showed the bladder herniation and left vesicoureteral reflux (Grade 1). Radical surgery for the hernia of bladder was not performed. The literature on the hernia of the bladder in Japan were collected and discussed.

A case of vesical endometriosis with unilateral renal agenesis is reported. A 13-year-old girl complained of difficulty in urination and lower abdominal pain during the menstruation. Detail urological examinations revealed left renal agenesis and intravesical cystic mass. The mass was located in the left vesical lateral wall, obstructing the vesical outlet and containing dark-brown-coloured fluid in it. She finally suffered from urinary retention following the menstruation and underwent a resection of the mass together with a part of the vesical wall. During the operation, the uterus was found to be a bicornate one. The resected mass was diagnosed as an endometriosis based on the histological findings. Eighteen months after the operation she is free from any symptoms during the menstruation and recurrence of endometriosis.