出生後早期より尿路管理を行ないVURの消失をみた二分脊椎の1例

Abstract

A case of secondary VUR in neurogenic bladder with meningomyelocele treated successfully with urethral catheterization is reported. A 4-month-old girl was introduced to our clinic for the management of incontinence following the closure of the meningomyelocele (below S1 level). Anal sphincter and bulbocavernous reflex was almost normal. Since the IVP revealed right hydronephrosis, an urethral catheter was indwelt immediately in order to decompress the vesical pressure. Three weeks later, the right hydronephrosis improved, but the cystogram revealed right vesicoureteral reflux. The urethral catheter was left for the conservative management for 20 weeks. VUR had disappeared on the cystogram and right hydronephrosis returned to normal. Thereafter, the treatment was changed from indwelling catheter to clean intermittent catheterization by her mother. No urinary tract infection has occurred. The necessity of early management, especially decompression of the vesical pressure, for patients with neurogenic bladder associated with meningomyelocele is discussed.