UROLOGICAL TREATMENT IN THE SPECIAL WARDS FOR SPINAL CORD INJURY, KANAGAWA REHABILITATION HOPITAL.

IR Web Site

Bibliographic Information

Other Title
  • 神奈川リハビリテーション病院脊髄損傷病棟における泌尿器科の役割について
  • カナガワ リハビリテーション ビョウイン セキズイ ソンショウ ビョウトウ ニ オケル ヒニョウキカ ノ ヤクワリ ニ ツイテ

Search this article

Abstract

神奈川リハビリテーション病院には脊髄損傷病棟が設置されている.今回我々は2001年4月から2003年9月の間に神奈川リハビリテーション病院脊髄損傷病棟に入院した患者のうち,泌尿器科受診患者のべ2,194人について入院目的,治療内容,手術内容について集計した.また1982年から2004年までの手術内容の変遷につき,10年毎3年間ずつの期間で比較検討した.結果は,脊髄損傷病棟における泌尿器科関与の症例は,急性期・回復期の排尿方法決定等と慢性期の合併症加療がほぼ半数ずつであった.排尿方法は上肢機能残存患者で基本的に間欠導尿を選択,導尿自立困難例では症例にあわせて自己導尿以外の排尿方法を選択している.この20年間で内視鏡的括約筋切開術は減少し間欠導尿を推奨し,また留置カテーテルフリーとする方向へ向かっていることが分かった.以上の傾向が膀胱尿管逆流症,膀胱高位切開術を要するような大きな膀胱結石の発生率を低下させており,尿道皮膚瘻などの合併も減少してきた.膀胱結石の発生率は依然高いが,早期発見によりほとんどの症例で内視鏡による治療が可能になっている.

We made a statistical survey of urological treatments in the special wards for spinal cord injury, in Kanagawa Rehabilitation Hospital. Purpose of admission, treatment modality, management of urination, and types of surgical treatment were examined in 2,194 patients who had been to the hospital from April 2001 to September 2003. In particular, surgical treatment modalities were compared among 33-year periods, 1982 - 1984, 1992 - 1994, and 2002 - 2004, to elucidate the changing trend in choice of treatment. Through this survey, it became clear that the main role of a urologist in the wards was to give advice on management of urination and to treat urological complications of spinal cord injury. As the best management of urination, we recommend intermittent catheterization for patients able to use their arms. For those who are not able to do intermittent catheterization, several other options, such as cystostomy, were chosen. A comparative study of surgical treatments performed during last 20 years demonstrated a decrease in the use of endoscopic incision of the urethral sphincter muscle. This trend corresponded with increasing demand for intermittent catheterization that aims at a catheter-free state of the patients. These changes in the concept of treatment in fact decreased the incidence of complications such as large bladder stones and urethral fistula. Although bladder stone formation is still a common complication, they can be treated endoscopically if they are diagnosed at an early stage.

7

KJ00004192687

原著

ORIGINAL ARTICLE

Journal

Keywords

Details 詳細情報について

Report a problem

Back to top