Managemant of Post-operative Bladder Dysfunction Associated with Radical Surgeries of Carcinoma of the Rectum

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概要

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• Post-operative bladder dysfunction following various types of radical surgeries on carcinoma of the rectum was reviewed on 181 patients.<BR>For better understanding of post-operative dysuria, physiological voiding mechanismus was discussed with special reference to currently advanced idea of autonomic neuroreceptors and their distribution in the lower urinary tract. Role of sympathetic nervous system on sustaining urinary continence was clarified.<BR>Post-operative neurogenic dysfunction was found in 54.2 % with the patients underwent radical lymphnode dissection associated with the rectal surgery. Incidence of the occurrence were 78 % with sacroabdominal approach, 60.5 % with Miles' procedure, 47.1 % with pull through and 20.7 % with anterior resection.<BR>Urodynamic studies including CMG, UPP, Uroflowmetry with simultaneous recorcing of EEG of the external urethral sphincter disclosed impaired detrusor function with sensory loss resulting increase of the urethral pressure. Detrusor-sphincter dyssynergia observed to be the main cause of post-operative dysuria and was found in 77.7 % of the patients with urinary retention.<BR>To cope with post-operative bladder dysfunction, Lapides' non-sterile clean intermittent self catheterization has been practiced together with cholinergic stimulator (Bethanechol chloride) and alpha-blocker (phenoxy-benzamine) on 55 patients as soon as perineal wound healing with minimal complications. The procedure was proved to be simple, safe and can be done easily at home even with prolonged period of urinary retention. Urinary infection was well controlled, no deterioration of the renal function was noted and improvement of hydronephrosis and VUR were noted. .<BR>A blief comment on surgical treatment was made based on the literatures.

• 日本大腸肛門病学会の論文

著者

• 宮井 啓国

  横浜市立大学医学部泌尿器科教室

• 宮井 啓国

  横浜市立大学泌尿器科

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