外傷性脊髄損傷患者における膀胱変形について

Abstract

過去10年間に当科を受診した脊髄患者89例のうち, 死亡, 追跡不能, カテーテル留置例をのぞく59例につき膀胱変形と上部尿路合併症との関連性, 成因と予防法について検討した.膀胱変形の程度をgrade 0(なし), 1(軽度), 2(中等度), 3(高度)に分類した.上部尿路合併症の割合は, grade 0で16例中0 (0%), 1は22例中7例(32%), 2は10例中8例(80%), 3は11例中9例(82%)で, 膀胱変形との間に相関が見られた.高度膀胱変形(grade 2以上)の頻度は, 完全損傷群に多く, 低コンプライアンス, 尿路感染群に多かった.高度膀胱変形は間欠的導尿プログラム施行群では31例中3例(9.7%)であったのに対し, 非施行群では28例中18例(64.3%)であり, 同プログラムが膀胱変形の予防に有効であることが示唆された

Fifty-nine patients with traumatic spinal cord injury were subjected for the analysis of bladder deformity. Bladder deformity means bladder trabeculation and deformity of bladder shape such as pine tree shape. We classified bladder deformity into grade 0 (none), grade I (mild), grade II (moderate) and grade III (severe). Upper urinary tract deterioration was found in 0% of grade 0 (16 pts.), 32% of grade I (22 pts.), 80% of grade II (10 pts.) and 82% of grade III (11 pts.). We suggested that bladder deformity was one of the risk factors of upper urinary tract deterioration. High grade (greater than grade II) bladder deformity was found more frequently in complete injury than in incomplete injury. There was no differentiation between overactive bladder-overactive sphincter and underactive bladder-overactive sphincter. All patients with low compliance bladder had a high grade bladder deformity. There was a significant relationship between severity of urinary tract infection and severity of bladder deformity. Intermittent catheterization program was effective for preventing bladder deformity.