間欠自己導尿患者における塩酸オキシブチニン膀胱内注入療法について

Abstract

難治性の尿失禁を有する神経因性膀胱症例9例に対し塩酸オキシブチニンの膀胱内注入療法を施行した.注入1ヵ月後に最大膀胱容量は128mlから212mlへと増大したが, 有意差は認められなかった.過活動型膀胱には平均175%の膀胱容量の増加が認められたが, 低活動型では平均13%であった.又, 無効例では尿道閉鎖圧の低い症例が多かった.現在2例のみが膀胱内注入を継続している

Nine patients with persistent urinary incontinence due to neurogenic bladder and intolerable systemic side effects on oral anticholinergic agents were treated with intravesical instillation of oxybutynin hydrochloride. Two tablets (6 mg) dissolved in 10 ml of physiological saline or sterile water were instilled into the bladder two times daily via self intermittent catheterization. The mean bladder capacity increased from 128 to 212 ml 1 month after intravesical instillation of oxybutynin hydrochloride, although this difference was not significant. The bladder was augmented more efficaciously in patients with overactive detrusor than patients with an underactive detrusor. Subjective improvement was recognized in 4 patients. Among 5 patients who discontinued therapy due to ineffective results, maximum urethral closure pressure below 50 cmH2O was seen in 4. Intravesical instillation of oxybutynin hydrochloride was considered to be ineffective clinically in patients with underactive detrusor and low urethral closure pressure. Although no systemic side effects were observed, a decrease of bladder capacity was recognized in 2 patients.