外傷性脊髄損傷患者の泌尿器科学的研究 第1報: 臨床的観察並びに神経学的検査成績について

Abstract

Examinationso f various neurologicalt ests and observations o f the ways of urination were performed in a total of 55 patients with traumatic spinal cord injury. Dependingu pon the extent and localizationo f the lesion o f the conus, which were determined by the results of such neurological tests as anal reflex, bulbocavernosus reflex and ice water test, all the patients were classified into four groups : (1) 32 with complete upper motor neuron lesions. (2) 14 with incompleteu pper motor neuron lesions. (3) 20 with complete lower motor neuron lesions. (4) 8 with incomplete lower motor neuron lesions. Desire to void or so-called compensatoryd esire to void were well retained in all of the patients with incomplete lesions but were absent in 17 out of 33 patients with complete lesions. For the initiation of micturition, tapping the suprapubic area or manual suprapub i cc ompression were commonly used by the patients with upper motor lesions and abdominal pressure or/and suprapubic compression by those with lower motor neuron lesions. As a posture for urination, sitting or supine position was pre f ered by a majority of the patients. Incontinence (mostly stress incontinence) was present in 42 patients, 70.9 per cent of the total, while no incontinence with voluntary control was proved to be present in 13 patients who were mostly with incomplete lesions. "Balanced bladder" was notice d in 53 per cent of the complete lesion groups and "inbalanced bladder" in 33 per cent of the incomplete lesion groups, The former was more frequent in the neurogenic bladders of long duration for more than 4 years after injury and the latter in those within 4 years.