前立腺手術後の排尿困難 : 会陰部の温水噴射により自己導入から解放された1例  [in Japanese] POSTPROSTATECTOMY DYSURIA : RESTRORED VOIDING FUNCTION BY PERINEAL HOT WATER SPRAY IN AN OLD MALE WITH ACONTRACTILE BLADDER  [in Japanese]

膀胱収縮能障害患者が会陰部の温水噴射により間欠導尿から解放された1例を経験した。症例は77歳男性,2年前から尿意の低下と排尿困難が徐々に進行し,TUR-P後も間欠導尿を要してし)た。肛門反射,球海綿体筋反射の低下,足底と会陰部知覚の鈍化以外に神経学的に異常なく,膀胱内圧測定で尿意の低下と排尿反射を欠く低活動膀胱を,骨盤底筋EMG検査で膀胱充満時と括約筋収縮時の活動低下を認めたが,脊椎X線検査と脳脊髄画像検査で神経病変を確定できなかった。Distigmine bromide Cernilton, Poazosinの内服で排尿は改善しなかった。偶然,陰嚢・会陰部の温水噴射で排尿が誘発されることを発見し,以来4年間毎日温水刺激を続けている。この間導尿は不要となったが,尿意は低下したままである。本症例の病態と排尿反射に影響を及ぼす因子につき考察した。

The hot water spary on perineum restored voiding function in a 77-year-old male patient with the poorly contractile bladder. He noticed the gradual decrease of bladder sensation and voiding stream, and needed clean intermittent catheterization to empty bladder even after TUR-P. Neurological examination revealed only weakened anal and bulbocavernosus reflex and impaired skin sensation of foot plate and perineum. Simple cystometry showed impaired perception of bladder filling and underactive bladder. Electromyography of the pelvic floor displayed decreased responses to bladder filling and voluntary sphincter contraction. Spine-X-ray examination and computed tomography of brain and spinal cord did not reveal any neurological lesions except for the silent small infarction of subcortex. Trial of drug therapy with Distigmine bromide, Cemilton and Prazosin did not restore voiding function. By accident, however, patient himself found spontaneous voiding could be induced by hot water spray on perineum and/or scrotum during bidet using. Since then, he has been continuing this stimulation daily for 4 years, with which almost complete voiding is possible without catheterization, though bladder sensation remains impaired. The pathophysiology and affecting factors on micturition reflex in this case were discussed.