鎖肛根治術後の泌尿器科的合併症
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概要
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In the past 9 years, we treated 39 patients of various urological complications caused b the radical operations of imperforate anus. While associated anomaly of the genitourinary tracts and vertebral column are more or less evenly distributed between both sexes and between high and low type rectal anomalies, the complications of pelvic surgery were 5 to 7 times more common in the male and in high type. Analysis of the patietns showed the urological complications to fall into 3 main groups, urethral fistula and diverticulum, urethral stenosis, and neurogenic dysfunction. 1) Urethral fistula was detected in 3 children, and urethral diverticulum in 10 children. The problems arised from recanalization of rectourethral fistula or injury of the urethra other than the rectal fistula. Perineal extirpation was performed in 6, and one large diverticulum, which exceeded the bladder neck, was operated on through abdomino-peri-neal approach. 2) Among 15 children with organic urethral stenosis, 3 had the history of urethral resection during the radical operation. For these strictures, optic internal urethrotomy was the first choice of operations. One child of severe stricture was treated by Johanson procedure. Neurogenic dysfunction is likely to accompany in 4 children who showed no imporvement after the urological operations. 3) On cystometric examinations, 70% of the patients showed abnormal intravesical pres-sure. About half of the high type anomaly revealed hypotonic pattern, which implies detrusor hypotonia from pelvic nerve injury. From EMG test of external urethral sphincter, 45% exhibited silent or low amplitude activity, which can result from pudendal nerve injury or organization of the sphincter through pullthrough procedure. Some typical cases were presented.
- 1983-12-20
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