二分脊椎に起因する神経因性膀胱に伴うVUR についての考察

Abstract

逆流防止術を13例の患児に施行した.1) 1例2尿管にPolitano-Leadbetter法を施行し, 12例18尿管にCohen法を施行したが, 20尿管中17尿管の成功率であった.2) VURは低活動性利尿筋-活動性括約筋のパターンを有する症例に多く, それはdetrusor-sphincter dyssynergiaが大きな原因を占めているものと考えた.したがって, 低活動性利尿筋-活動性括約筋のパターンを有する症例の上部尿路変化については, VURの精査を十分にする必要がある.3) VURの治療に関して, 腎機能の保存のためには, 長期の保存的治療より, まず逆流防止術の適応となる症例に対しては積極的に施行する必要がある

Thirteen cases (20 ureters) of vesicoureteral reflux (VUR) associated with neurogenic bladder, treated with anti-reflux operation are reviewed. Twelve of the 13 cases had meningomyelocele and 1 had spina bifida occulta as an underlying disease. The type of neurogenic bladder was hypoactive detrusor-active sphincter in 11 patients and hypoactive detrusor-hypoactive sphincter in 2 patients. They were treated with an anti-reflux operation, 2 ureters by Politano-Leadbetter method and 18 ureters by Cohen method. The results were successful (success rate 85.0%). Therefore, we concluded that in neurogenic bladder patients especially with the hypoactive detrusor-active sphincter, the cause of their renal deterioration is mostly VUR. Thus we should examine such patients for VUR. On the other hand, when the renal deterioration of VUR patients cannot be improved by conservative treatment for example clean intermittent catheterization or indwelling catheter, we should perform an anti-reflux operation.