尿道狭窄症ノ統計的觀察ヨリ治療法ニ及ブ

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The authors carried out clinical observations on 313 cases of the stricture of the urethra occurring in the Tokyo Akutsu Hospital, from which the following conclusions were drawn: (1) Their results agree on the whole with the views of previous investigators concerning the causes, ageal connections, severities and sites of the stricture, except the traumatic stricture, in which the foci occur mostly at a portion a little distal to the bulb in the perineal region. (2) In the treatment of permeable stricture, gradual dilatation was tried but the traumatic cases often proved futile. In order to attain the dilatation up to Charriere's No. 21, it took on an average one month or above, while No. 26 or above, three months or above of constant treatment. To ensure a better result, a thicker bougie, e.g. No. 28, being taken as the ultimate goal, a continual treatment for two years or more, in which case a pause may be allowed between the yearly repetition of the treatment. (3) In a severe case of the stricture, if it be perfectly free from, inflam matory or abscess complications, incision will often give a good result. They have experienced a very good result to be attained by applying besides the internal urethrotomy, a simultaneous surgical operation of urinary fistula, or resection of cicatrix or incision of abscess, which allowed the dilatation of the stricture. In these cases, they could give a very good result without applying the external urethrotomy. They are rather inclined to believe that the range of indication for external urethrotomy is not so wide as was generally considered. There occurred no case in which vesical puncture was considered necessary. (4) The severity of the stricture, aims of the internal urethrotomy and complications are responsible to the sizes of Maisonneuve's urethrotomes, which were employed by the authors, In the practical uses, however, a very large one was not necessarily employed, because by the post-operative treatment, further dilatation might be possible. No danger occurred by applying permanent. catheter of nelatone for .several days from immediately after the operation, but it rather acted favorably in establishing improvement of cystitis, suppression of hemorrhage, protection of the wound from ruinous infiltration and by a continual oppression over the cicatrisation processes of the stricture, which will result in the development of reactive inflammation and serve in effecting the softening and absorption. (5) The internal urethrotomy could successfully be applied not only to the pars pendula but also to the pars perinealis, pars bulbosa, and pars bulbmembranacea, without incurring any dangerous effects. They broadened the scope of application of the internal urethrotomy, besides they contributed something to the real benefit, of this method of treatment. (6) They also experienced that by applying internal urethrotomy and post operative application of permanent catheter to periurethral abscoss, ruinous infiltration or urinary fistula, not only they could obtain a very good results without the least unfavorable contamination and shorten the days of treatment, but also they could remove the causes of periurethritis. (7) The disadvantages which are met with after the surgical treatment of the stricture of urethra, are: that a remarkable narrowing will often be met with after one-half to one year, which would be more remarkable after more than one year, even so remarkable as the second dilatation-treatment will be difficult to be secured The patient will be disappointed of being treated and therefore the Post-operative treatment is the matter of especial notice in the application of the internal urethrotomy.
社団法人日本泌尿器科学会の論文

尿道狭窄症ノ統計的觀察ヨリ治療法ニ及ブ

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