新生時,乳児期の機能性下部尿路通過障害 - 新生児, 乳児期の膀胱内圧測定 －

Abstract

対象は二分脊椎と診断された38例で, MMC 18例, SBO 20例であった.1) MMC:全例手術後1～5ヵ月に膀胱内圧測定が施行された.17例は何らかの異常を呈し, 低緊張性6例, 低コンプライアンス8例(Sidiらの分類)で, 反射性膀胱1例, 判定不能2例であった.膀胱造影では低緊張性膀胱の6例は容量は明らかに少なく, 1例に膀胱の変形を認めた.低コンプライアンス膀胱では80 cm水柱を越える高圧膀胱の4例で同様の変形があり, 1例では肉柱形成を認めた.2) SBO:全例手術前に膀胱内圧測定が施行された.施行年齢は13日～9ヵ月で, 20例中正常と判定されたのは14例, 低緊張性1例, 低コンプライアンス4例で, 1例が判定不能であった.膀胱造影は正常膀胱の6例で施行され, 5例は正常であったが, 1例は変形を呈した

We examined 38 neonates and infants with spina bifida using cystometry and cystography. Among 18 cases with myelomeningocele, only 1 case was evaluated as normal, 15 cases were abnormal on cystometry and 2 cases were unable to be evaluated. In the 15 abnormal cases, 8 had low-compliance and high pressure pattern which suggested future deterioration of upper urinary tract. Clean, intermittent catheterization was started in 3 cases. In 20 cases with spina bifida occulta associated with lipoma, 14 were evaluated as normal but 5 were abnormal and 1 case was unable to be evaluated. One of the 4 cases with low-compliance and high pressure was treated with clean, intermittent catheterization. Cystometric examination is a simple and useful modality in neonates and infants with neurogenic bladder not only to evaluate the function but also to predict the future deterioration of the upper tract, and to select the proper treatment.