過去10年間の小児先天性神経因性膀胱症例に関する臨床的検討

Abstract

男13例, 女9例に先天性神経因性膀胱22例を経験した.1)経過中12例に尿路感染を認め, 男38.3%, 女88.9%であった.2)膀胱内圧所見は過反射型3例, 無反射高緊張型6例, 無反射低緊張型8例で, 過反射型3例, 無反射高緊張型6例中感染のなかったのは1例のみで, 無反射低緊張型は8例中5例であった.3) 13例のUP maxは過反射型では正常かそれ以上で, 無反射型では低値であった.4) 9例のVURでは6例9尿管に逆流を認めた.5)排泄性腎盂造影で, 22例中6例に腎障害を認め, 水腎症が4例, 腎杯の破壊像が2例であった.6)尿路管理の方法とし, 1例に回腸導管2例に自己導尿を行い, 他の19例にはCrede法や薬物療法を行った.興味ある例として4例を選び, 自己導尿, VURに関する問題につき考察した

During the past 10 years, 22 children (13 males and 9 females) had been treated for congenital neurogenic bladder at our department. These cases were reviewed for urinary tract infection, urodynamics, vesicoureteral reflux and renal deterioration. Urinary tract infections were observed during the follow-up period in 12 of the 22 cases (54.6%). The incidence was 38.5% in males and 88.9% in females. Cystometric findings were arbitrarily divided into 3 types; hyperreflexic type, areflexic hypertonic type and areflexic hypotonic type. Of the 17 cases examined, 3 cases were of the hyperreflexic type, 6 cases the areflexic hypertonic type and 8 cases the areflexic hypotonic type. Urinary tract infections were not observed in 5 of the 8 cases categorized as the areflexic hypotonic type compared to one of the 9 cases of the hyperreflexic and areflexic hypertonic types together. UPP was examined in 13 cases. UP max values were lower than normal in the areflexic type cases, but were normal or higher in the hyperreflexic type cases. Vesicoureteral reflux was examined in 9 cases. Reflux was observed in 9 ureters of 6 patients. Renal deterioration was observed in 6 cases; 4 cases of hydronephrosis and 2 cases of pyelonephritis. Management of 22 cases consisted of ileal conduit (1 case), clean intermittent self-catheterization (2 cases) and Cred e maneuver and/or pharmacologic treatments (19 cases). The usefulness of clean intermittent self-catheterization and management for vesicoureteral reflux were discussed centering on 4 selected cases.