前立腺肥大症及びその類症
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概要
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From August, 1949 to February, 1954 one hundred patients with prostatic hypertrophy or prostatism were operated on in our clinic. Sixty-seven of them were clinically diagnosed as, benign prostatic hypertrophy and the rest as prostatism. According to Guyon's clinical classification, twenty-four of them were found to be in the first stadium, thirty-nine in the second and thirty-seven in the third. As to the ages of the patients with prostatic hypertrophy, the youngest was 52 years old and the oldest 83 years old. While the average age was 67.7. The patients were most frequently seen in the sixties (thirty-two cases or 47.8 %). The ages of the patients with prostatism ranged from twenty-six to seventy-eight, the average being 55.7. And also in the series of the prostatism most of the patients (twenty-one cases or 63.6 %) were older than fifty years. The past history of gonorrhea was recorded in nineteen patients with prostatic hypertrophy and thirteen with prostatism. As the initial symptoms in cases of prostatic hypertrophy, frequency and retention of urine were most commonly seen, while in the majority of the cases of prostatism frequency and pain on urination were the most predominant. The time elapsed before the patients with these symptoms visited our clinic spread from ten days to ten years. While most of the patients with prostatic hypertrophy (thirty-four cases or 50.7 %) called on our clinic within one to three years after the appearance of the first sign, twenty patients (60.6 %) with prostatism visited our clinic within three months. The cystoscopic examination revealed the trabecular formation in 92.9 % of the patients. Abnormal elongation of the prostatic urethra was proved in 73 % of the patients with prostatic hypertrophy and 9.5 % of the patients with prostatism on urethrograms. Prominence of the prostate was proved in 96.2 % of the patients with prostatic hypertrophy and 4.5 % of the patients with prostatism on cystograms. The renal function tests which were carried out in these patients include the following: 1) Intravenous pyelograph 2) Water test (Dilution and concentration test) 3) Phenolsulphonephthalein excretion test (P.S.P. test) 4) Indigo-carmin excretion test The examination shows the existence of the disturbance of the renal function in most of the cases (Table 1, 2). [table] The types of the operation performed in this series were: Suprapublic prostatectomy (fifty-two cases) retropublic prostatectomy (fifteen cases) for prostatic hypertrophy and suprapublic transvesical internal sphincterotomy (thirty-three cases) for prostatism. The patients who had been previously vasectomised before the surgery never developed acute postoperative epididymitis, while in the nonvasectomised group 16.0 % of the patients developed acute epididymitis in their postoperative stages. The average numbers of the postoperative days drained by the urethral catheter were 13.4 days (65.3 % were within 14 days) in suprapubic prostatectomy, 8.2 days (7-10 days) in retropubic prostatectomy and 11.2 days (69.7 % were within 10 days) in suprapubic transvesical internal sphincterotomy. The average numbers of the postoperative days before discharge from the hospital were 21.9 days (80.8 % were within 30 days) in suprapubic prostatictomy, 14.0 days (78.6 % were within 11 days) in retropubic prostatectomy and 15 days (84.9 % were within 20 days) in suprapubic transvesical internal sphincterotomy. There was one patient who died from hemorrhage on the nineth postoperative day resulting in the mortality of 6.6 % retropubic prostatectomy. Except for this untoward case, howeve, there occured no significant postoperative complications, such as pubic osteitis, contracture of vesical neck, persistent fistula and incontinence of the urine. And the postoperative renal function test showed marked improvement in all of the cases. Specimens of the enucleated prostate averaged 36.5g. in weight. Histologic examination of the specimen revealed adenomatous hypertrophy inthirty-five cases (63.6 %), fibromyomatous hypertophy in four cases (7.3 %), mixed form in twelve cases (21.8 %). and carcinomatous changes in four cases (7.3 %) of the series of the prostatic hypertrophy. However, in the series of the prostatism two cases (12.5 %) showed carcinomatous change and the other the picture of hyperplasia of connective and muscular tissues.
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