尿失禁を伴う下部尿路畸型の4例(症例並びに遠隔成績)

Abstract

We reported three cases of congenital extrop h y of the bladder, and one case of epispadia with urinary incontinence. Two of the former were treated by uretero-sigmoid anastomosis for their urinary incontinence, and one, the case with incompletely extrophied bladder by the direct closure of the bladder wall because of the complication of the anal anomaly. But the result was unsatisfactory about the latter, we had a fairly good result by the modification of the plastic operation of the bladder neck described by Young. We summarized 39 reported cases of the extrophy of the bladder in ou r country. The review of the literatures has revealed the following methods taken for the treatment of the extrophy of the bladder : 1) the plastic reconstruction of the bladder neck, and 2) uretero-sigmoidstomy and the modification of Gersuny's operation for urinary diversion. Although we can not determine which method is the best, it may be reasonable that the plastic operation of the bladder neck is performed first and when it fails the urinary diversion is attempted as the next step. We could find six reported cases of epispadia in this country. For the treatment of the urinary incontinence in epispadia the plastic operation by Young or its modification was performed and good results were obtained in many cases. Accordingly, we should first attempt the plastic operation for the treatment of urinary incontinence in epispadia, not the urinary diversion.