[一例在 19 岁时发现的因脊柱裂闭锁导致的神经性下尿路功能障碍病例,并通过多学科疗法成功治愈]。

Q4 Medicine Acta Urologica Japonica Pub Date : 2024-02-01 DOI:10.14989/ActaUrolJap_70_2_55
Ippei Muranaka, Yuki Kyoda, Seisuke Nofuji, Nobuo Shinkai, Kohei Hashimoto, Ko Kobayashi, Toshiaki Tanaka, Naoya Masumori
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引用次数: 0

摘要

一名 19 岁的男子从小就有排尿困难和尿失禁的症状,但没有就医。他被诊断为急性肾盂肾炎,原因是下尿路功能障碍伴有脊柱裂和脊髓脂肪瘤导致的系带综合征(TCS)。在置入尿道导管和抗菌化疗后,患者的急性肾盂肾炎痊愈。他接受了索利那新治疗,并开始了清洁的自我间歇导尿(CIC)。CIC 开始后不久,急性肾盂肾炎再次复发,他接受了重新插入尿道导管的治疗,直到进行解拴手术。术前视频尿动力学检查显示,膀胱形态为小川分级 III 级,膀胱输尿管反流(VUR),输液量为 92 毫升。结合解系手术和额外的米贝格龙,膀胱功能容量增加到了 353 毫升,VUR 也得到了改善,从而可以安全地对 CIC 进行排尿管理。TCS 可在任何年龄段确诊,确诊后需要尽早进行适当的排尿管理和治疗干预。
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[A Case of Neuropathic Lower Urinary Tract Dysfunction Due to Spina Bifida Occulta Discovered at the Age of 19 Years and Successfully Treated with Multidisciplinary Therapy].

A 19-year-old man had been aware of dysuria and urinary incontinence since childhood but did not seek medical attention. He was diagnosed with acute pyelonephritis due to lower urinary tract dysfunction associated with spina bifida occulta and tethered cord syndrome (TCS) due to spinal cord lipoma. After placement of a urethral catheter and antibacterial chemotherapy, the patient was cured of acute pyelonephritis. He was treated with solifenacin and started clean self-intermittent catheterization (CIC). Shortly after the start of CIC, the acute pyelonephritis flared up again, and he was managed with a reinserted urethral catheter until an untethering operation. Preoperative video urodynamics showed that the bladder morphology was Ogawa classification grade III with vesicoureteral reflux (VUR) at 92 ml infusion. With the combination of an untethering operation and additional mirabegron, the functional bladder capacity was increased to 353 ml and VUR improved, allowing for safe urinary management of the CIC. TCS can be diagnosed at any age and requires appropriate urinary management and therapeutic intervention as early as possible after diagnosis.

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来源期刊
Acta Urologica Japonica
Acta Urologica Japonica Medicine-Medicine (all)
CiteScore
0.20
自引率
0.00%
发文量
74
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