The authors carried out clinical observations on 313 cases of the stricture of the urethra occurring in the Tokyo Akutsu Hospital, from which the following conclusions were drawn:
(1) Their results agree on the whole with the views of previous investigators concerning the causes, ageal connections, seventies and sites of the stricture, except the traumatic stricture, in which the foci occur mostly at a portion a little distal to the bulb in the perineal region.
(2) In the treatment of permeable stricture, gradual dilatation was tried but the traumatic cases often proved futile. In order to attain the dilatation up to Charrière's No. 21, it took on an average one month or above, while No. 26 or above, three months or above of constant treatment. To ensure a better result, a thicker bougie, e. g. No. 28, being taken as the ultimate goal, a continual treatment for two years or more, in which case a pause may be allowed between the yearly repetition of the treatment.
(3) In a severe case of the stricture, if it be perfectly free from inflammatory or abscess complications, incision will often give a good result. They have experienced a very good result to be attained by applying besides the internal urethrotomy, a simultaneous surgical operation of urinary fistula or resection of cicatrix or incision of abscess, which allowed the dilatation of the stricture. In these cases, they could give a very good result without applying the external urethrotomy. They are rather inclined to believe that the range of indication for external urethrotomy is not so wide as was generally considered. There occurred no case in which vesical puncture was considered necessary.
(4) The severity of the stricture, aims of the internal urethrotomy and complications are responsible to the sizes of Maisonneuve's urethrotomes, which were employed by the authors, In the practical uses, however, a very large one was not necessarily employed, because by the post-operative treatment, further dilatation might be possible. No danger occurred by applying permanent, catheter of nelatone for several days from immediately after the operation, but it rather acted favourably in establishing improvement of cystitis, suppression of hemorrage, protection of the wound from urinous infiltration and by a continual oppression over the cicatrization processes of the stricture, which will result in the development of reactive infammation and serve in effecting the softening and absorption.
(5) The internal urethrotomy could successfully be applied not only to the pars pendula but also to the pars perinealis, pars bulbosa, and pars bulb.-membranacea, without incurring any dangerous effects. They broadened the scope of application of the internal urethrotomy, besides they contributed something to the real benefit of this method of treatment.
(6) They also experienced that by applying internal urethrotomy and post operative application of permanent catheter to periurethral abscess, urinous infiltration or urinary fistula, not only they could obtain a very good results without the least unfavourable contamination and shorten the days of treatment, but also they could remove the causes of periurethritis.
(7) The disadvantages which are met with after the surgical treatment of the stricture of urethra, are: that a remarkable narrowing will often be met with after one-half to one year, which would be more remarkable after more than one year, even so remarkable as the second dilatation-treatment will be difficult to be secured The patient will be disappointed of being treated and therefore the post-operative treatment is the matter of especial notice in the application of the internal urethrotomy.

抄録全体を表示

Verf. entfernte grösse Steine aus 2 Fälle von Manner durch die Sectio alta und beide Kranke mit glücklichen Ausgänge entnommen hatte.
Fall 1. 40 jähriger Mann.
Der Stein wog 675gr, ist 11.5c.m lang, 9.5c.m breit, 7.5c.m dicke.
Der Stein besteht aus 10 Schichten und erwies sich um einen Centrum aus phosphorsaurem Ammoniak Magnesia und oxalsaurem Kalk, die obere aus oxalsaurem Ammoniak, phosphorsaurem Kalk und harnsaurem Kalk.
Fall II. 33 jahriger Mann.
Der Stein wog 268gr, ist 8.5c.m. lang, 6.8c.m. breit, 4.8c.m. dicke.
Der. Stein war aus 8 Schichten gelagert, Kern erwies sich aus hauptsächlich harnsaurem Kalk und phosphorsaurem Ammoniak-Magnesia, die obere aus oxalsaurem, kohlensaurem und phosphorsaurem Kalk zusammengesetzt waren.
Verf. glaube es, dass der erste Blasenstein ist am grössten bisher bekannten in Japan.

抄録全体を表示