神経因性膀胱69例についての臨床的検討

Abstract

1)対象症例は脳疾患27例, 脊髄疾患18例, 末梢神経疾患13例, 混合型3例, 不明8例であった.2)排尿動態はunderactive detrusor 42例, overactive detrusor 21例, normal detrusor 6例で, そのうち排尿筋括約筋協調不全(DSD)を示したものは29例であった.3) DSDの発生頻度は脳疾患40.7%, 脊髄疾患44.4%, 末梢神経疾患46.2%であった.4)治療はおもに内科的治療(清潔間欠導尿, ブジーを含む)で, 7例にのみ外科的治療を行った.5)治療による自覚症状の改善率はoveractive detrusor 85.7%, underactive detrusor 64.3%であった.6)尿路感染症の改善率は63%であった

Clinical evaluation was made in 69 cases of neurogenic bladder experienced during the past 3 years. Thirty seven of the patients were male and 32 female, and they ranged in age from 4 to 88 years with an average of 63.2 years, The basic diseases of neurogenic bladder were brain lesions in 27 cases, spinal cord lesions in 18 cases, and peripheral nerve lesions in 13 cases. Three cases were of the mixed type and the basic disease was unknown in 8 cases. Cerebrovascular diseases were the most frequent, followed by spinal cord injuries and intrapelvic operations. Duration from the onset of urological symptoms to the first visit to our clinic was less than 1 month in half of the patients. The chief complaints at the first visit were pollakisuria in 25 cases (25.8%), incontinence in 18 cases (18.6%), urinary difficulty in 25 cases (25.8%) and urinary retention in 13 cases (13.4%). Urological conditions at the first visit were spontaneous urination in 53 cases (76.8%), indwelling catheterization in 12 cases (17.4%) and clean intermittent catheterization in 4 cases (5.8%). Urological complications seen at the first examination were urinary tract infections (UTI) in 27 cases (39.1%) and chronic renal failure in 2 cases (2.9%). The patients were classified by cystometrography into 3 patterns: 42 cases (60.9%) with underactive detrusor, 21 cases (30.4%) with overactive detrusor and 6 cases (8.7%) with normal detrusor. Detrusor sphincter dyssynergia was observed in 29 cases (42.0%), 40.7% had brain lesions, 44.4% spinal cord lesions, and 46.2% peripheral nerve lesions.(ABSTRACT TRUNCATED AT 250 WORDS)