水腎症の臨床的知見の補遺

殊に拡張せる上部尿路腔縮小の可能性並びに腎動脈像の腎保存的手術適応決定上の価値

抄録

In 1963, I made a report (Jap. J. of Urol. Bd. 54, p. 721) considering the indication for kidney conservative operation in clinical hydronephrosis. In this report another supplemental studies will be added.
First of all, I introduce some statistical data of hydronephrosis treated in my clinic during past 5 years, 1959-1963 (Tab. 1-Tab. 5). Urinary calculus and aquired ureteral stricuture have played a major role in establishing hydronephrosis. Aquired ureteral stricuture shows higher hydronephrotic changes than ureteral stone. It is of much interest that not a few cases of congenital megaloureter show relatively slighter hydronephrotic changes, though the ureteral dilatation is severe.
The results of functional improvement of hydronephrotic kidney after conservative surgery are as follows. In C and D degree hydronephrosis much improvement are guaranteed. Even in E degree a fair improvement can be noted, but in F degree the results are pessimistic. Tab. 6 summarises results in F, E degree hydronephrosis.
Dilated renal pelvis and ureter can be spontaneously reduced in considerable amount after simple removal of ureteral obstruction. Renal function are improved and co-existing infection are removed with it.
Tab. 7 shows values of pyelographic measurements in normal adults. For numerical description of the amount of dilatation, area of pyelogram is considered. In Tab. 8 reduction of size in pyelographic shadow, improvement of renal function and the fate of local bacterial infection are shown after releasing the ureteral obstruction in E, F degree hydronephrosis. Considering the reduction in pelvic dilatation in two divided parts (upper and lower), as in Tab. 9 is shown, the lower half does not always show its minority. Ureteral dilatation in moderate degree returnes to normal after releasing the obstruction. In highly dilated ureter considerable reduction is also noticed, but not perfectly. Renal function improves together with it and stabilized, at that. This fact proves that, inspite of remaining of some dilatation, the ureter gains its proper action, transportation of urine.
From above mentioned data, I think the excision of the wall of the dilated upper urinary tracts is not always necessary, if one aims at the functional recovery of the kidney.
As to renal aortograms in hydronephrosis, here in this report, I have measured the internal diameter of the renal artey and that of abdominal aorta on the film at the site shown in Fig. 1, for the purpose of studying on the indication of the kidney conservative surgery. Tab. 11 shows the thickness (internal diameter) of renal artery, that of aorta and ratio of the former to the latter in normal adults. Tab. 12 shows those values and postoperative improvement of renal function in E, F degree hydronephrosis. The data strongly suggest us that the results of kidney conservative surgery are poor or none in such a case, in which the internal diameter of renal artery is les than 3. 5 mm or so and ratio of renal artery to abdominal aorta is within 20%, at that.
By the way, in no later than 5 months, in the half of six cases (Tab. 13) there can be seen much improved blood flow in the kidney, which is obvious from increase in diameter and ratio to aorta of the renal artery.