男性頸髄完全損傷患者の尿路管理における経尿道的外括約筋切除術に関する考察

Abstract

男性頸髄完全損傷症例16例を対象とし, 経尿道的外括約筋切除術(TUR-sph)施行前後での残尿率, 排尿時血圧, および排尿時血中ノルアドレナリン値の変化につき検討した結果, 男性頸髄完全損傷例の尿路管理におけるTUR-sphは, 排尿効率の改善をもたらすだけでなく, detrusor-sphincter dyssynergiaによるautonomic dysreflexiaに対するsafety valveとしての効果をもたらすものと考えられた

Transurethral electroresection of external urethral sphincter (TUR-sph) was performed in sixteen male tetraplegics to obtain good voiding efficiency and to prevent autonomic dysreflexia due to detrusor sphincter dyssynergia. Ratio of residual urine as a parameter of voiding efficiency and blood pressure and plasma noradrenaline level during voiding as parameters of the significance of autonomic dysreflexia were evaluated before and after TUR-sph, and all these parameters had significantly improved after TUR-sph. After discharge from the hospital, all patients urinated comfortably with the maneuver of suprapubic percussion by themselves and/or their helpmates, and no patients complained of any inconvenience due to urinary incontinence. Moreover, no patients had the episode of autonomic dysreflexia in daily life except for one patient who had it once with urinary tract infection. TUR-sph brings not only the improvement of voiding efficiency but also the effect as a safety valve against autonomic dysreflexia by means of preventing the occurrence of autonomic dysreflexia due to detrusor sphincter dyssynergia.