脳血管障害による排尿障害の臨床的観察

Abstract

過去4年間における脳血管障害発症後1年以内の排尿障害患者41例(男性29例, 女性12例)を対象とした.1)症状では切迫性尿失禁14例, 頻尿10例, 排尿困難17例であった.膀胱内圧型では高活動型31例, 正常型5例, 低活動型5例であった.尿失禁および頻尿群では1例の正常型を除きすべて高活動型であり, 困難群では3型が認められた.2)尿失禁群の膀胱容量は高活動型の困難群のそれに比して, 明らかに小さい値を示した.また尿失禁群の最高尿道内圧は高活動型の頻尿群および困難群のそれに比して, 有意の低値を示した.3)大脳皮質病変患者の6例は高活動型を, 4例は尿失禁症状を示した.大脳病変と高活動型を示す患者で, 尿失禁群の最高尿道内圧は頻尿, 困難群のそれに比して, 低値の傾向を示した.視床病変患者の大多数は高活動型膀胱と正常の最高尿道内圧を示し, 困難症状であった.橋病変患者では低活動型膀胱を示した

Cystometry and urethral pressure profile were determined in 41 patients (29 males and 12 females) with voiding disorders resulting from cerebrovascular accidents within one year after the episode. By clinical symptoms, they were classified into 3 groups, urge incontinence (14 patients, 34%), pollakisuria (10 patients, 24%) and dysuria (17 patients, 41%). Cystometrogram were classified into 3 types, hyperactive bladder (31 patients, 76%), normal bladder (5 patients, 12%) and hypoactive bladder (5 patients, 12%). All patients in both groups of incontinence and pollakisuria showed hyperactive bladder except one normal bladder, while in the group of dysuria 3 types of cystometrograms were observed. Bladder capacity in incontinence group showed tendency to be smaller than that in dysuria group who had hyperactive bladder. Maximum urethral pressure in incontinence group was significantly lower than that in pollakisuria group and dysuria group who had hyperactive bladder. Ten patients with cerebral cortical lesions (80%) showed hyperactive bladder and 60% of them showed incontinence. In patients with cerebral lesions who had hyperactive bladder, the maximum urethral pressure of patients with incontinence showed tendency to be lower than that of patients with pollakisuria and dysuria. The majority of 7 patients with thalamic lesions showed hyperactive bladder and normal urethral pressure, and had dysuria. Two patients with pontine lesions showed hypoactive bladder. These findings suggested that urge incontinence resulting from cerebrovascular accidents was due not only to hyperactive bladder but also to lower urethral pressure.