夜間多尿を伴なった膀胱機能障害における夜間尿道留置カテーテル : 女性3例での有用性

Abstract

夜間多尿を伴った膀胱機能障害に夜間尿道留置カテーテルが有用であった3例を経験した.症例1は45歳女性.てんかん発作で精神科入院中に尿閉となり, 退院後に排尿困難で受診した.尿意低下を認め, α遮断薬投与で自排尿可能となったが, 起床時残尿が多く, 間欠式バルーンカテーテルの夜間尿道留置を開始し, 残尿はほぼ消失した.症例2は28歳女性.出生直後よりL2以下の二分脊椎による排尿機能障害で, 12歳時に左膀胱尿管新吻合術施行後も夜間の尿失禁と頻回の腎盂腎炎を繰り返していた.24時間排尿記録で夜間多尿が判明し, 日中のCICに加え, 間欠式バルーンカテーテルの夜間尿道留置を行い, 腎盂腎炎の再発はなく夜間の尿失禁は消失した.症例3は66歳女性.多発性脳梗塞と同時に便・尿失禁, 排尿困難が出現し, 夫によるCICでも夜間多尿があり, 間欠式バルーンカテーテルの夜間尿道留置を行い, 尿失禁は消失した

Clean intermittent catheterization is a well-known procedure of urinary drainage for patients who are unable to empty the bladder sufficiently. However, some patients with bladder dysfunction and nocturnal polyuria fail to obtain the benefits of intermittent catheterization and have annoying symptoms of nocturnal incontinence and low-compliance bladder, which threaten both their quality of life and renal function. We report the usefulness of nocturnal urethral indwelling catheterization using a specially designed catheter to treat patients (three women) with lower urinary tract dysfunction and nocturnal polyuria. Case 1: A 45-year-old woman with mental retardation suffered from difficulty of micturition and residual urine. A nocturnal urethral indwelling catheter freed her from difficulty with micturition and residual urine. Case 2: A 28-year-old woman with spina bifida and neuropathic bladder dysfunction suffered from urinary incontinence and recurrent pyelonephritis. The recurrent pyelonephritis was prevented and bladder compliance was improved with use of the nocturnal urethral indwelling catheter. Case 3: A 66-year-old woman with cervical myelopathy and multiple episodes of cerebral infarction suffered from nocturnal urinary incontinence. She underwent clean intermittent catheterization by her husband. Use of the nocturnal urethral indwelling catheter solved the problem of her nocturnal incontinence and relieved her husband of her nocturnal care. Nocturnal urethral indwelling catheterization is useful for treatment of nocturnal incontinence and recovery of bladder compliance in patients with lower urinary tract dysfunction and nocturnal polyuria.