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2007年1年間に施行した尿路内視鏡手術114症例, 清潔手術92症例, 準清潔手術20症例に対し, 周術期感染症阻止薬の術前単回投与を行い, 手術部位感染(SSI), 尿路感染(UTI), 遠隔感染(RI), 術後合併症の発生頻度を前方視的に調査した。その結果, 尿路内視鏡手術ではUTI発生率が2.7%で, RIは認めなかった。清潔手術での発生率はSSI:1.1%, RI:2.2%, UTI:0%, 準清潔手術ではSSI:5%, RI:0%, UTI:5%であった。よって, 泌尿器科領域における尿路内視鏡手術, 清潔手術, 準清潔手術に対する周術期感染症予防抗菌薬の効果は, 術前単回投与で十分に期待できると考えられた。, A single-dose ofantimicrobial prophylaxis (AMP) was administered parenterally for prevention of perioperative infection in a total of 206 urologic surgeries including 114 endoscopic-instrumental, 92 clean, and 20 clean-contaminated procedures between January and December, 2007, and surgical site infections (SSI), urinary tract infections (UTI), and remote infections (RI) were prospectively surveyed. The definition of a single-dose of AMP allowed the administration of a second dose of an antimicrobial during a surgical procedure that exceeded 3 hours but not parenteral or oral administration at the end of the procedure, in the recovery room, or at a later time over a period of more than 24 hours. UTI was observed in 3 cases (2.7%) after endoscopic-instrumental procedures and in 1 case (5%) after clean-contaminated procedures while no case was associated with UTI in clean procedures. SSI was seen in 1 case each after clean procedures (1.1%) and after clean-contaminated procedures (5%), and RI was seen in 2 cases (2.2%) after clean procedures. A single-dose regimen of AMP was effective for prevention ofperioperative infections including SSI, UTI, and RI in endoscopic-instrumental, clean, and clean-contaminated surgical procedures in urology.

「手術関連死に関するインフォームドコンセントの現状と泌尿器科医師の考え方」を調査するため, 東北大学と弘前大学, およびその関連施設にアンケートを送付し, 大学病院を含む総合病院32施設, 開業医6施設から回答が得られた。1)手術関連死について「必ず説明している」または「説明していることが多い」と回答した施設が半数を越えたのは, 下大静脈への腫瘍塞栓を伴う腎摘出術だけであった。その他の手術では「リスクが高い場合のみ説明する」, あるいは「説明しない」施設が多くを占めていた。2)経尿道的手術, 前立腺生検, extracorporeal shockwave lithotripsy等の比較的侵襲の少ない手術や検査では, ほとんどの施設が死亡の説明がされていなかった。3)死亡の説明を行うかどうかの判断は良性や悪性等の疾患の種類ではなく, 年齢や合併症の有無等の患者の状態と手術の難易度に基づいたリスクレベルに応じて, それぞれの医師が自身の判断で行っている現状が明らかになった。, A questionnaire about informed consent of operative death was mailed, and a total of 38 institutes answered the questions. Informed consent of operative death was likely to be obtained from only when the operation had been considered at high risk. Most of the urologists surveyed never obtained such informed consent for transurethral resection, prostate biopsy, extracorporeal shockwave lithotripsy, and nephrostomy. About half of them did not consider it necessary to explain the operative death of these procedures to patients in future. The percentage of death was informed to patients only in one institute. Japanese urologists seem to obtain informed consent of operative death at their discretion, according to the risk of each procedure. These results will provide important information about informed consent of operative death.

泌尿器科周術期における抗菌薬の使用方法についてのアンケートを報告した.対象は, 全国242施設の泌尿器科医局で, 周術期の抗菌薬使用方法についてアンケート調査を行った.その結果, 149施設149名より回答(61.6%)を得た.149名の経験年数は平均18.9年, 149施設の泌尿器科病床数は平均22.4床, 泌尿器科常勤医師数は平均2.6人, 45施設(30%)で「周術期感染症阻止薬プロトコール」が規定されていた.抗菌薬投与のタイミングは「手術開始30分前～開始直前」が92%, 「術中の追加投与」は44%であった.抗菌薬はペニシリン/第1・2世代セフェムを第一選択としたのは消化管利用手術で78%, 他の術式で約90%, 投与期間は3日以内が60～90%であった.内服抗菌薬の追加投与は50～60%, 投与期間は消化管利用手術で7日以上, 他の術式では5～7日であった.以上, 泌尿器科医師の周術期感染阻止薬に対する意識は標準化されてきたと考えられた, In order to establish an acceptable guideline for prevention of perioperative infection following urologic surgery, a questionnaire survey on the theory of antimicrobial prophylaxis (AMP) was conducted among urologists in Japan in February 2004. A reply was obtained from 149 urologists working for institutes located all over Japan from Hokkaido to Kyushu areas. Ninety-two percent of the urologists agreed that AMP should be administered 30 min before an incision, and 44% replied that an additional dose of AMP is required in the case of prolonged intervention. Penicillins or the 1st or 2nd generation cephems were used by 89 to 93% of the urologists in operations not including bowel segments, while 78% preferred such AMP agents in the procedures including bowel segments. AMP was terminated within 3 days in 87% for genital operations, in 70 to 76% for laparoscopic operations, in 54 to 65% for other clean or clean-contaminated operations, and in 24% for operations without the bowel segments. Especially, 58% of the urologists continued AMP for more than 5 days after operations with urinary diversion using the intestine. When compared with the previous questionnaire survey by Shinagawa et al, our survey demonstrated that standard consensus of AMP has spread widely among urologists in Japan, although the recommendations published in Europe and United States are still controversial in Japan. Thus, further well-designed clinical trials are required to establish original guidelines in Japan.

To obtain data for promoting autologous transfusion in urologic surgery, the cases of perioperative homologous transfusions in the past 5 years are reviewed. Although the mean perioperative homologous blood transfusion rate was not so high (10.2%), the rate in common urological surgery was comparatively high (eg. radical nephrectomy 39.4%, simple or palliative nephrectomy 21.6%, total nephroureterectomy 33.3%, renal allotransplantation 82.8%, total cystectomy 96.2%). Mean homologous transfusion volume in these surveys was 982 ml. Two successful cases of autologous blood transfusion by the predeposit method or intraoperative collecting method are presented. Transfusion-associated adverse effects, especially viral infection and immunosuppression, were discussed and the value of autotransfusion was stressed.

四百数十例についての経験で, 本剤は表題手術径路の如何を問わず, 非投与に比べて排ガスまでの時間を短縮させた, The clinical effectiveness of prostaglandin F2 alpha (PGF2 alpha) injection on postoperative bowel movement was studied in 455 patients who underwent transurethral and transretroperitoneal operation. The patients were divided into two groups, 417 patients with PGF2 alpha injection and 38 without injection. 1, 000 micrograms of PGF2 alpha were infused twice a day postoperatively until the onset of active flatus. The onset of flatus was recorded in each group. The onset of flatus after operation was 15 hours and 47 minutes for the injection group of 194 patients operated transurethrally, which was shorter than the 21 hours and 50 minutes for the uninjected group (p less than 0.01), but the onset of flatus was not significantly affected by the injection in the patients operated transretroperitoneally. Postoperative PGF2 alpha infusion facilitated flatus in the patients undergoing transretroperitoneal urologic surgery which took 1 and a half hours or more in doing so (p less than 0.05). Generally, postoperative paralytic ileus was milder after urological surgery than after bowel surgery, but PGF2 alpha injection was effective clinically both in transurethral surgery and transretroperitoneal surgery.