尿閉を来たしたハイリスク患者に対する尿道ステント(アンジオメッドメモサーム)の使用経験

著者らは, 尿閉を来したハイリスク患者に対して, 尿道ステント(アンジオメッド・メモサーム)留置を試みて, 良好な結果が得られた.対象症例15例のうち, 2名は再度尿閉を来し, 1名はステントへの結石付着が原因でステントを抜去せざるをえなかったが, 残る12名はステント留置後から良好な排尿状態を保持することができた.また, BPHだけでなく, 原疾患がNGBと思われる症例に対しても効果を期待できることが確認できた.以上, 非侵襲的で簡便なこの手技は, 本来尿道カテーテルを留置されるべきハイリスク患者に自排尿を促せる, すなわちQOLを高めることのできる優れた手技であると示唆されたTransurethral resection of the prostate (TUR-P) has been established as the golden standard for the treatment of urinary retention in patients with benign prostatic hyperplasia (BPH). However, TUR-P is not performed on patients with certain high-risk complications. We have obtained favorable results using urethral stent (Angiomed-Memotherm) implantation to treat high-risk urinary retention patients. Here, we review the results obtained on 15 patients treated using this procedure. Two patients experienced recurrent urinary retention; in one patient, the stent had to be removed due to stone formation; in the remaining 12 patients, urination was favorable after stent implantation. Also, urethral stent implantation was found to be useful in 4 of the 7 patients with neurogenic bladder (rather than BPH) as the underlying disease. The present technique is convenient and noninvasive, and we strongly believe that it can improve the patient's quality of life (QOL) by facilitating urination in high-risk patients who would otherwise require urethral catheterization

異所性抗利尿ホルモン産生を呈した前立腺癌の1例

88歳男, 尿閉を主訴とし, 前立腺特異抗原(PSA)値, 直腸診所見から前立腺生検を施行し, 低分化型腺癌と診断された.血液生化学検査の結果, 抗利尿ホルモン(ADH)分泌異常症候群診断基準を満たしていた.また血中及び前立腺癌組織中のADH値の上昇を認め, 免疫組織化学的検査において腫瘍細胞はPSAに陽性で, ADHに対しても軽度陽性であった.酢酸リュープロレリンとフルタミドによる抗アンドロゲン療法に反応し, 90日後には血液生化学所見も正常となったが, 治療開始6ヵ月後に胃潰瘍からの大量出血により死亡した.異所性ADH産生性前立腺癌症例は本症例を含め10例目の報告であるAn 88-year-old patient with a poorly differentiated adenocarcinoma of the prostate gland was found to have all cardinal findings of syndrome of inappropriate antidiuretic hormone secretion (SIADH). Elevated levels of antidiuretic hormone were found in the patient's serum and in the prostatic tumor and the cytoplasms of the tumor was positive for prostate specific antigen and was faintly positive for antidiuretic hormone (ADH). He responded well to combination therapy of androgen blockade with leuprorelin acetate and flutamide, and laboratory findings of SIADH and serum ADH level returned to normal. However, he died of sudden profuse bleeding caused by gastric ulcers 6 months after the therapy. Ten cases of SIADH caused by prostatic cancer have been reported including the present case