Interviews were conducted with 13 male ostomates under the age of 70 years to investigate the sexuality and marital relationships of male ostomates．The aim was to consider ways to support male ostomates who have sexual dysfunction and their spouses．From the interviews,8 categories expressing the sexuality of male ostomates were extracted：unstable selfperception,acceptance of one's current situation,bonds of matrimony,things that provide support,difficulty of talking about the sexual act,fluctuations in husband-wife intimacy,thoughts toward the sexual act,and sense of values with regard to the sexual act．The marital relationship tended to be unchanged by changes in sexual function；rather,the bonds were maintained by support from the wife．In the future,family education that can promote language and behavior by the wife to support the ostomate is needed．In addition,sensitive awareness of sexual concerns and method of expression counseling,as well as coordination as an intermediary between the ostomate and his wife will be necessary．

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A survey on consciousness about aging and anxiety was performed in 953 home-staying elderly ostomates aged 60 years or above．
［1］The consciousness about aging in home-staying elderly ostomates were lower than those in the population without stomas,indicating the possibility that inspire ostomates themselves to withstand vague anxiety about future inability of performing their own stoma cares due to aging．
［2］ln the elderly persons at the latter stages,aging-related phenomena such as their own health（72％），bedridden conditions（41.1％）and senility（36.9％）predominated as anxiety related to aging while in the elderly persons at the former stages,a number of them were related to economical problems including annual pension（39.2％）and tax issures（15.1％）．
［3］Aging anxiety of female ostomates was higher than that of male ostamates．And male ostmates prefer to committing exchange of ostomy appliance to better halves in the future（68.5％）whereas females（24.3％）prefer husbands for such assistance,indicating significant difference．
［4］Guidace or care for aging should be positively taken into consideration in stoma rehabilitation in the future.

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Because of intersphincteric resection(ISR),Sphincter saving recection was increased for rectal cancer treatment．However indication of ISR is variable．ln Shizuoka Cancer Center，195 patients with lower rectal cancer curatively underwent rectal resection,and anal sphincter was saved in 77％,ISR was performed in 22％．Cumulative 3 year disease free survival rate was 86％(Stage I：96％,Ⅱ：88％,Ⅲ：73％)．Bowel movement within 3 times after ISR was 41％ patients．However soiling was seen more than half patients．QOL of bowel movement was worse in sphincter saved patients than APR patinets．Which general QOL is better is controversial．Procedure should be decided based on curability,also patients character and postoperative life．

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The purpose of this study was to clarifying the details of the bowel movement pattern that the patients who had been operated low anterior resection．
The Research dates were “Bowel movement diaries” and interviews about 3 cases which showed a characteristic bowel movement pattern．
They have the sense that remain feces,and feel a need to evacuate one's bowels,although they have bowel movement．A case was not enough sleep,because of the night bowel movement．
The bowel movement number of times and the rhythm depended on the day and depended on the case,too．
They took cathartic,bacause of the fear to ileus．Although they had bowel movement frequent．And then they had more tender feces and becoming increased bowel movement,and soiling．They gone to restroom frequently,and keeping strain,it was from the wrong recognition to become ileus when not having a bowel movement immediately if feel a need to evacuate bowels．
It was suggested that they can miss a feeling to evacuate bowels when they were not “the convenience” place like home,which can always run into the restroom．

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Porpose：To compare differences in health related quality of life（QOL）between two types of urinary diversion,orthotopic neobladder and cutaneous diversion（ileal conduit and cutaneostomy)．Patients and Methods：We surveyed a total of 35 patients consisting of 21 orthotopic neobladder patients（19 males,2 females）and 14 cutaneous diversion patients（11males and 3 females)．The questionnaires used were Functional Assessment of Cancer Therapy-Bladder Cancer（FACT-BL）and SF-36．Results：Physical condition and activities of orthotopic neobladder patients were superior to those of cutaneous diversion patients according to FACT-G．Only the cosmetic issue of neobladder was superior to that of cutaneous diversion according to the FACT-BL．As for SF-36,general health perceptions,vitality and mental health of neobladder patients were superior to those of cutaneous diversion．Conclusion：Differences in health relatd QOL between orthotopic neobladder and cutaneous diversion were examined．ln saveral categories,the QOL of neobladder patients was superior to that of cutaneous diversion patients．

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The aim of the present study is to make sure the influence of “the intension of operator” at the selection of urinary diversion in the patients who will undergo total cystectomy for locally advanced bladder cancer．We reviewed hospital chart and analyzed the numbers of urinary diversion performed in our institute．Previously,we considered that the QOL of both continent veservoir and neobladder was much better than that of incontinent urinary diversion．QOL study performed at 1995 disclosed continent reservoir had worst QOL among three urinary diversion methods．Thereafter,we ignored the continent reservoir and recommended neobladder or incontinent urinary diversion methods to patients．QOL study at 2003 denated that postoparetive QOL scores among patients who underwent neobladder were significantly higher than Norm-based scoring(NBS)．Recently performed QOL study again confirmed these results．From the recent study,we concluded that “the intension of oparator” had major effect on the selection of urinary diversion method．On the other hand,“the intension of operator” was also influenced by the results of QOL study performd with patient-based outcome．

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There are so many cause concerning defecatory didsorders that the systematic understanding is perplexing．We established the assessment ladder for the management of those problems．ln this concept,the factors those affect bowel habits are classified into four majors,as follows．Ⅰ．anorectal function,Ⅱ．gastrointestinal function,Ⅲ．systemic factors,and Ⅳ．social factors．Anorectal function is divided both storage and evacuating function at anorectum．Gastrointestinal function means the role of digestive tract that is expressed as digestion,absorption,and motility．Systemic factors are defined as systemic disease or medical history．Social factors consist of facilities and circumstances of lavatory．Dietary custom or way of life is also social factors．Anorectal function affects the disorders directly on the other hand social factors make obscure influence onto defecation．ln addition each factor has some relation among them．The problems should be evaluated according to each factor and the step may clear up which factor is significant．Since this method is unnecessary for special examination such as monometry, defecography,any medical staff can develop a practical care plan．This comprehensive model may be helpful for the assessment of the patient who has defecatory disorders．

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To analyze current practices in our defecatory disorder outpatient clinic,chart records of patients who visited the outpatient clinic in 2005 were reviewed retrospectively．There were 251 patients（77 men and 174 women),with a mean age of 62．One hundred eighty-six patients（74％）complained of fecal incontinence．Among these patients,the mean maximum resting pressure was 38mmHg,and the mean maximum squeeze pressure was 112mmHg．The role of WOC nurses in these cases has included 1)interview and assessment,2)bowel habit control advice,3)skin care,4)biofeedback training,and 5)counseling．Most parients are very anxious about their defecatory symptoms and need assistance from the nurses．Providing such counseling and care is necessary to help patients improve their quality of life．

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