二分脊椎症例の尿路管理における手圧排尿と腹圧排尿の臨床的意義に関する比較検討

Abstract

手圧排尿を施行した1群56例と, 腹圧排尿を施行した2群22例に大別した.尿管理開始年齢は1群で0～31, 平均2.1歳, 2群で0～20, 平均4.5歳であった.1群の17例及び2群の13例は平均でそれぞれ14.6及び13.7年追跡した.1群の3例及び2群の1例は膀胱変形の進行を示した.2群の1例で膀胱尿管逆流が新しく現れた.2群の3例で水腎症, 3例で水尿管, 1例で膀胱変形, 及び1例で膀胱尿管逆流の消失・改善がそれぞれ認められた.1群では1例での膀胱尿管逆流の消失を除き, これらの病的状態の消失・改善は見られなかった.尿路の保存上腹圧排尿の方が優れていることが示唆されるが, 両群間の差異は推計学的に有意ではなかった

Retrospective analyses were performed to elucidate the clinical significance between Crede voiding (n = 56) and Valsalva voiding (n = 22) in the urological management of spina bifida patients who do not match the indication of clean intermittent catheterization. The age at initiating the urological management ranged from 0 to 31 years old (mean 2.1) in the Crede voiding and from 0 to 20 years old (mean 4.5) in the Valsalva voiding group. Seventeen patients in the Crede voiding group and 13 in the Valsalva voiding group were followed up for more than 10 years with a mean follow-up period of 14.6 and 13.7 years, respectively. Three patients in the Crede voiding group and one in the Valsalva voiding group showed progression of bladder deformity. In one patient in the latter group, vesicoureteral reflux newly appeared. In the Valsalva voiding group, disappearance or improvement of hydronephrosis was seen in three patients and that of hydroureter in three, bladder deformity in one, and vesicoureteral reflux in one. On the contrary, no patients in the Crede voiding group showed favorable changes in these pathological conditions except for disappearance of vesicoureteral reflux in one patient. Although these findings suggest possible superiority of Valsalva voiding over Crede voiding in the preservation of urinary tract, the differences between the two groups were not statistically significant. The clinical significance of Valsalva voiding remains to be elucidated through further study in neurogenic bladder patients.