多発性硬化症(MS)における排尿障害の検討

Abstract

12例のMSに対しurodynamic studyを施行した.overactive bladder (bl) 4例・normoactive bl 5例・underactive bl 3例であった.4例には排尿筋括約筋協調不全(DSD)を合併していた.重症例にはoveractive bl症例及びDSD合併例が多い傾向にあり, α-blocker・choline作動薬などの使用, 間歇導尿などが行われ, 良好な排尿管理が可能であった

During a period of 4.5 years, neurological and urodynamic evaluation was done on 12 patients with multiple sclerosis between 20 and 67 years old with an average age of 47.6 years. Pyramidal dysfunction (100%), sensory disturbance (100%) and brain stem dysfunction (60%) were common neurological signs. All patients were assessed by the Kurtzke's rating of neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Of the 12 cases 6 were diagnosed as severe multiple sclerosis (EDSS greater than or equal to 4.5) and the remainders were diagnosed as relatively mild (EDSS less than 4.5). Neurourologic evaluation was performed by rapid filling carbon dioxide cystometry and sphincter electromyography. Cystometry revealed overactive bladder in 4 (33%), underactive bladder in 3 (25%) and normoactive bladder in 5 (42%) of the 12 cases. Of the 6 severe cases of multiple sclerosis, 3 (50%) showed overactive bladder, while only 1 of the 6 (17%) mild cases showed overactive bladder. Detrusor sphincter dyssynergia (DSD) was observed in 4 of the 9 (67%) severe cases and none of the 6 mild cases. The presence of overactive bladder or DSD seems to correlate with the severity of multiple sclerosis.