間質性膀胱炎患者に対する麻酔下水圧療法の臨床的効果と生検組織免疫染色との関連

Abstract

対象は1996年5月～2005年5月に泌尿器科を受診し、間質性膀胱炎を疑った男4例女23例の27例(平均54.3歳)。間質性膀胱炎の診断は自覚症状と過去の治療歴(抗コリン薬や消炎鎮痛剤による治療で改善なし)に基づいた。尿細胞診にて異型細胞を認めないことを確認し、選択基準である膀胱鏡で点状出血、ハンナー潰瘍、膀胱痛、尿意切迫感を認める点は全例に当てはまった。22例に水圧療法前の膀胱内圧測定が可能で、初発尿意時の膀胱容量は75.2±46.3ml、最大膀胱容量は208.4±121.0mlで、注入中強い膀胱部痛を認め排尿筋活動は認められなかった。potassium sensibility test(PST)は13例に実施し11例が陽性であった。麻酔下膀胱鏡所見はハンナー潰瘍3例、点状出血26例、粘膜亀裂を10例に認めた。水圧療法の合併症で水圧療法中の膀胱破裂と急性腎盂炎が各1例にあり、膀胱破裂は小切開でのドレナージと7日間の尿道カテーテル留置、急性腎盂炎には輸液と抗菌薬投与で軽快した。

We retrospectively analyzed the clinical relevance of hydrodistention under anesthesia for patients having urgency and/or lower abdominal pain who were clinically diagnosed as having interstitial cystitis (IC) from May 1996 to May 2005. Their symptoms were refractory to anticholinergic or antiinflammatory agents. Hydrodistention was performed under general or spinal anesthesia with direct vision by cystoscopy and irrigation fluid was instilled into the bladder at a pressure of 80 cmH2O. Cystoscopic findings revealed glomerulation in 26 patients (96%), cracking in 10 (37%) and Hunner's ulcer in 3. Twenty-four patients (89%) obtained improvement of the objective symptoms after treatment. However, symptoms soon deteriorated in 16 patients, and the average duration of efficacy was only 4.7 months (SD; +/-3.7). There were two episodes of complication in this treatment. Bladder rupture occurred during hydrodistention, but was successfully managed with simple percutaneous perivesical drainage. One patient with acute pyelonephritis was treated with an antimicrobial agent without any additional treatment. Although bladder specimens were examined by immunohistochemistry, tryptase and c-kit were not linked with the mast cell count, severity of symptoms or treatment efficacy. Hydrodistention of the bladder may be recommended as the first treatment choice for patients with IC because it provides relatively high efficacy. However, the short duration of the efficacy requires a second-line treatment option for better management of patients with IC.