小児神経因性膀胱にともなうVURの治療 --逆流防止術の検討--

Abstract

1)表題機転のために腎障害が進行する症例, 尿路感染のコントロールが困難な症例(小児11名, 成人4名)に施行したが, 結果的には主として排尿筋反射亢進, あるいは機能的下部尿路閉塞症例に手術を適応したことになった.2) Politano-Leadbetter法とGlenn-Anderson法を併用した術式を小児8名, 成人3名に, Cohen法を小児3名, 成人1名に適用し, 子宮全摘術後の成人例を除いて全例で成功した.術後は1例を除いて臨床上腎盂腎炎が消失した.3)無抑制膀胱に伴ったVUR(小児7名)には抗コリン剤または経皮的電気刺激で治療し, VURの消失または軽症化と, 1名を除いて尿路感染の再発防止に成功した

During the last 3.5 years, 18 children and 9 adults with vesicoureteral reflux and neurogenic bladder dysfunction were seen at our hospital, and 11 children and 4 adults required antireflux surgery. The criteria of repair were progressive renal deterioration and/or uncontrollable urinary infection. Surgery was applied mainly to the conditions of detrusor hyperreflexia and/or lower urinary tract obstruction. The combined technique of Politano-Leadbetter and Glenn-Anderson was used in 8 children and 3 adults, and the Cohen technique was used in 3 children and 1 adult. Surgery was successful that is, cessation of reflux and no obstruction, was achieved in all but one patient, who had received radical hysterectomy previously. Though recurrent episodes of lower urinary tract infection persisted in some cases after operation, over-all usage of antibiotics was reduced. Seven children with reflux and uninhibited bladder, though some of them with high grade reflux, were managed successfully by anticholinergic drug or transcutaneous electrical stimulation.