最近尿路感染症は老年病領域でも合併症あるいは二次感染症として発生頻度の高い疾患にあげられ, 注目されて来ている 1956年 Kass が尿細菌定量培養法の意義を報告して以来, 多くの報告があるが, いずれも若年者, 妊婦における尿路感染症に関するものばかりで, 老年者についての報告は数少ない. また老年者では細菌尿の頻度が高いといわれているが, 臨床細菌学的に検討した成績も少ない. 著老らは老人ホーム入所例 (主として脳血管障害例) を対象として, 昭和46年より3年4か月間臨床細菌学的見地から尿路感染症の原因菌, 薬剤感受性について統計的に検討した.
臨床所見あるいは尿沈渣白血球所見より尿路感染症が疑われた尿95件のうち63件 (67.4%) に細菌尿陽性となった.
分離菌のうち1菌種単独で検出されたのは60.3%, 2菌種以上混合菌は39.7%で, 老人ホーム例は一般病院例より混合感染の頻度が高い. 分離菌別ではE. coli, が最も多く, 次いで Proteus, Enterococcus, Klebsiella の順で, Staphylococcus, Pseudomonas の検出率は低かった. なおE. coli は年毎に増加傾向がみられた.
E. coli の薬剤感受性はKM=CL>AB-PC=CP>CER>NA>SM>TC の順に高く, Proteus の場合はSM=AB-PC>CP>CERの順に良い感性を示した.
細菌尿陽性例の臨床症状はいわゆる膀胱炎症状を訴える例が多い. しかし全く症状を訴えない無症候性細菌尿例が39.7%にみられた.

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The principle of treatment for staghorn calculi and the indication of nephrolithotomy have been described. In nephrolithotomy, operative technique, especially the method of parenchymal suture, has several variations but there is no convulsive method.
In 1967, Dr. Taguchi originally designed a new method of parenchymal suture and he has performed it in more than 50 patients with good result. In his operation, closure of the renal parenchymal incision is made with one layer interrupted suture from pelvic mucosa to renal capsule by 2-0 plain cat gut. Hemostatic suture or ligation and the suture of pelvic mucosa are not necessary. Therefore, the operative technique is very simple and the clamp time of renal pedicle can be shortened.
The ways of renal parenchymal suture in nephrolithotomy were classified into 6 groups. They were:
1. The method without suture at all
a) sutureless nephrotomy
b) wrapping kidney in Oxycel gauze
2. The method of capsular suture
a) interrupted or continuous suture of renal capsule only
b) subcapsular circular suture
3. The method of interposition of muscle, fatty tissue or others
4. Mattress suture and its variations
a) horizontal mattress suture
b) vertical mattress suture
c) plate suture
5. The method of parenchymal suture other than mattress suture
a) U-shaped suture in margin of renal incision
b) interrupted suture of renal parenchyma
6. Anatrophic nephrotomy (by Boyce, W. H. et al)
One layer interrupted suture of renal wound originally designed by Dr. Taguchi belongs to the group 5-b, but it is considered the simplest and the most advanced technique.

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There were 151 patients of staghorn calculi in our department from 1955 to 1971. Sixty-four cases underwent nephrolithotomy. After April 1968, the continuous pelvic irrigation method was performed on 17 patients after the nephrolithotomy of staghorn calculi. The technique of this irrigation is shown in Fig. 1. The solution used for the irrigation was normal saline 1, 000ml-2, 000ml containing Cephalothin (abbreviation: CET) 1.0g-2.0g per day. The purpose of this procedure is to prevent post-operative complications, such as renal infection, secondary hemorrhage, persistant urinary fistula, secondary nephrectomy, etc.
Of 47 cases without the continuous pelvic irrigation after nephrolithotomy from January 1955 to March 1968, 2 cases of secondary hemorrhage, 7 cases of persistant urinary fistula and 1 case of secondary nephrectomy were observed. But no post-operative complications were seen in 17 cases with the continuous pelvic irrigation after operation.
To evaluate the clinical effects of this method, the following studies were carried out. Continuous pelvic irrigation with normal saline containing CET or Gentamicin (abbreviation: GM) was performed for 24 hours on the left kidney of dogs with bilateral ureterostomy. The urinary recovery of antibiotics from the right kidney, the serum level, the concentration of drugs in the bilatenal renal tissue after irrigation and histological influences on both kidneys were examined.
In group I (normal kidney, CET 1.0g), urinary recovery rate of CET was 0.12% of dosage administered. In group II (experimental Proteus mirabilis pyelonephritic kidney, CET 1.0g), urinary recovery rate was 0.59% of that, which was about 5 times as much as group I. In group III (normal kidney, CET 10.0g) and IV (normal kidney, GM 1.0g), urinary recovery rate was more than that of group I and less than group II. The serum levels of drugs at the end of the irrigation ranged between 0.54mcg/ml and 1.1mcg/ml and the concentration of drugs in the renal tissue at the same time was determined as between 0.36mcg/g and 2.9mcg/g in group III and IV.
Histological examinations of specimens from the irrigated kidneys showed that the moderate degenerative changes of epithelium of tubules were observed in cases of group III (CET 10.0g) and IV (GM 1.0g), but these pathological changes were not observed in the irrigated kidneys in cases of group V (irrigation with normal saline). It may be possible that these changes of tubular epithelium were caused by the pharmaco-dynamic influence of applied antibiotics, the excessive pressure and speed of irrigation or the osmotic pressure of solution.
Nephrotomy with or without the continuous pelvic irrigation was performed on the experimental Proteus mirabilis pyelonephritic kidney in dogs, and the courses of these cases were followed up and examined histologically. Group A: the continuous pelvic irrigations with the normal saline containing CET 1.0g per 1, 000ml were done for 24 hours after the nephrotomy of experimental pyelonephritic kidney. In this group, histological examinations of operated kidneys revealed that pyelitis and the wounds of tissues were apparently improved. Group B: the continuous irrigations with normal saline without antibiotics were done for 24 hours after the operation. In this group, histological examinations revealed that pyelitis was improved, but the wound was less recovered than in group A. In these two groups, post-operative specimens showed that the pre-existing infection did not spread into the parenchyma after the operation. Group C: nephrotomies without the continuous pelvic irrigation were carried out. Histological examination revealed that both pyelitis and inflammation in the renal parenchyma were worsened.

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