全身性エリテマトーデス(SLE)に合併した脊髄障害による膀胱機能障害に対して膀胱拡大術を施行した1例

Abstract

39歳女.患者は17歳の時, 関節炎および蝶形紅斑, 発熱で発症し, 23歳時に全身性エリテマトーデス(SLE)と診断された.プレドニゾロンの内服治療を受けていたが, 発熱はじめ両下肢の脱力とともに排尿困難感を自覚した.更に呼吸困難, 全身の筋肉痛が出現, 3ヵ月後の退院時には排尿状態は自排尿可能であったが, 尿失禁を認めた.以後, 全身性浮腫が出現し, 腹部CTにて両側水腎症を認めた.腎盂腎炎を繰り返し, 膀胱尿管逆流, 膀胱憩室を認めた.膀胱憩室切除術, 回腸利用膀胱拡大術を施行した結果, 病理組織検査では, 高度の炎症細胞浸潤と肉芽組織の形成を認め, 膀胱憩室炎の診断であった.術後3ヵ月で水腎症, 尿失禁は完全に消失し, 膀胱容量は300mlまで増加した

A 39-year-old female with systemic lupus erythematosus (SLE) with a neurogenic bladder is described. She developed voiding disturbance with paraplegia and sensory disturbance on her inferior limb. Clinical findings suggested elevated activities of SLE with transverse myelitis. Although her symptoms were improved after one course of methylprednisolone pulse therapy, clean intermittent catheterization was required for urinary incontinence and residual urine. One year later, bilateral hydronephrosis and vesical diverticulitis developed, and thus augmentation ileocystoplasty was performed. After three months of the operation, hydronephrosis and urinary incontinence resolved with frequent clean intermittent catheterization. We should not overlook lower urinary tract symptoms in patients with SLE. We advocate performing a surgical procedure in cases in which conservative treatments are not effective.