経尿道的前立腺切除術後の持続膀胱洗浄  [in Japanese] CONTINUOUS BLADDER IRRIGATION FOLLOWING TRANSURETHRAL RESECTION OF THE PROSTATE (TURP)  [in Japanese]

(目的)経尿道的前立腺切除術(TURP)後,持続膀胱洗浄を行うことにより,血尿によるカテーテル閉塞の頻度を低下させることができたかどうか検討した.(対象と方法)2001年から2003年までに,厚生労働省長寿医療委託研究「TURPのクリニカルパス多施設共同研究」に登録された患者761例を解析した,施設間における症例の背景,切除重量,手術時間,発熱の頻度,血尿によるカテーテル閉塞の頻度,術後止血術の頻度の差異を比較した.また,カテーテル閉塞に影響する因子を検討するとともに,持続膀胱洗浄の意義を考察した.(結果)TURP後90%以上の症例で持続膀胱洗浄を行っていた4施設での術後カテーテル閉塞の頻度は,血尿の程度から症例を選んで持続膀胱洗浄を行っていた3施設より,有意に低かった(4.4%VS12.9%,p<0.001).発熱頻度,止血術の頻度には有意差を認めなかった.ロジスティック回帰分析では,カテーテル閉塞に影響を与えていた因子は持続膀胱洗浄の有無,切除重量,術前尿路感染症の有無であった.(結論)TURP後ルーチンに持続膀胱洗浄を行った方が,症例を選んで行うよりも血尿によるカテーテルの閉塞は少なかった,しかし,持続膀胱洗浄を行うかどうかは,施設におけるカテーテル閉塞の頻度や安全性,持続膀胱洗浄にかかる労働力や費用を考慮して,検討した方がよいと思われた.

(Purpose) We investigated whether continuous bladder irrigation after Transurethral Resection of the Prostate (TURP) would prevent catheter obstruction by the clot. (Materials and methods) We analyzed data from 761 patients registered in "a multi-institutional study of TURP clinical pathway" sponsored by the Ministry of Health, Labor and Welfare between 2001 and 2003. The difference of clinical backgrounds of the cases, resected weight, operating time, risk of being feverish, risk of catheter obstruction and chance of postoperative Transurethral Fulguration (TUF) between each institution were investigated. The risk factor of catheter obstruction is characterized and the significance of continuous bladder irrigation is discussed. (Results) The incidence of catheter obstruction in the four institutions, in which 90% or more of patients underwent continuous bladder irrigation, was significantly lower than that in the three institutions, in which continuous bladder irrigation was performed in selected patients whose hematuria was severe. (4.4% VS 12.9%, p<0.001) There was no difference in the frequency of either pyrexia or postoperative TUF. Logistic regression analysis showed that significant factors for catheter obstruction are continuous bladder irrigation, resected tissue weight and preoperative urinary infection. (Conclusions) Routine continuous bladder irrigation achieved a lower incidence of catheter obstruction. However, we recommend that urologists should decide whether to perform routine continuous irrigation, considering the frequency of catheter obstruction, safety, labor and cost.