DETRUSOR HYPERACTIVITY WITH IMPAIRED CONTRACTILE FUNCTION に類似する排尿障害を呈した神経因性膀胱症例の検討

Abstract

Clinical features of 21 patients with neurogenic bladder dysfunction which meeting the criteria of "detrusor hyperactivity with impaired contractile function (DHIC)" as reported by Resnick NM in 1987, were reviewed in terms of clinical symptoms, urogra- phic findings, urodynamic findings, and treatment. Chief complaints of urination problems were of irritation in 14 patients (irritative group) and of obstruction in 7 patients (obstruc- tive group). Incidence of bladder deformity as a risk factor of upper urinary tract deterioration was 71.4% in the obstructive group and 21.4% in the irritative group. Urodynamic examination revealed no remarkable difference between the two groups regarding urine storage dysfunction, whereas the rate of residual urine as an indicator of deteriorated voiding function was significantly higher in the obstructive group (83.9%) than in the irritative group (70.2%, P＜0.05). Pharmacotherapy with various agents affecting lower urinary tract function was conducted in most of the patients. Two patients underwent transurethral resection of the bladder neck and prostate for maximal reduction of urethral resistance. Urological treatment achieved mitigation of the chief complaints in all the patients in the obstructive group in contrast to 64.3% of the irritative group. There is no clear difference in the objective findings, including urodynamics and urographics, between the obstructive and irritative groups, with the result that the treatment strategy against subjective symptoms is very difficult to plan.