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A 38-year-old woman with neurogenic bladder caused by myelomeningocele, who had been on clean intermittent self-catheterization for years, complained of gross hematuria. Computerized tomography, urinary cytology and cystoscopy failed to reveal causative lesions and the hematuria ceased spontaneously. Because gross hematuria recurred 2 years later, we examined the patient again and detected calcification of the urinary bladder. Mucosal lesions suspicious of bladder tumor were detected during the transurethral surgery for the calcified lesion, and we promptly performed biopsy. As a result, she was diagnosed with invasive bladder squamous cell carcinoma. Radical cystectomy and urinary diversion were performed and the histopathological diagnosis was pT3aN0. Adjuvant therapies were not performed. No recurrence has been observed for 36 months after the surgery.

We report a case of misdirection of a catheter for clean intermittent catheterization (CIC) into the ureter. A four-year-old girl with neurogenic bladder due to myelomeningocele had been managed with CIC by her parents for several years. From about a month before her visit, macroscopic hematuria appeared intermittently followed by abdominal pain and fever-up for a short time which ceased spontaneously. As cystography demonstrated bilateral vesicoureteral reflux, we performed endoscopic intraureteral injection of Deflux[TM] and during the operation we confirmed influx of bloody urine from the right ureteral orifice but not from the left one. As computed tomography revealed a tubular foreign body located in the upper portion of the right ureter, another endoscopic operation was performed and it was removed successfully. The removed foreign body was identified as a disposable catheter that was used for CIC.

We report a case of misdirection of an indwelling urethral catheter into the ureter. An 86-year-old women with neurogenic bladder had been undergoing chronic indwelling urethral catheter exchange for 1 year. She was referred to our hospital owing to lower abdominal pain and gross hematuria. A computed tomographic scan showed an indwelling urethral catheter in the right ureter. Retrograde ureterography showed that the ureter had no leakage and the catheter was removed under fluoroscopic guidance. Urethral catheterization is a common procedure. We reviewed 23 cases of an indwelling urethral catheter entering the ureter and we consider that this misdirection occurs particularly among female patients with neurogenic bladder.

抗コリン抵抗性の神経因性膀胱7例に対するミラベグロンの併用効果について、ビデオウロダイナミクス(video UDS)を用いて検討した。基礎疾患は脊髄損傷3例、二分脊椎2例、脊髄梗塞、子宮癌術後が各1例で、ミラベグロン投与後のvideo UDSによる再評価時期は平均7ヵ月であった。その結果、ミラベグロン投与前に排尿筋活動(DO)を認めていた5例中2例で投与後にDOが消失した。DOが残存した3例中2例では、DO発生時の膀胱容量が増加した。ミラベグロン投与後、低コンプライアンス膀胱の4例を含む全例で膀胱コンプライアンスの悪化を認めず、改善傾向を示した。今回の検討から、低コリン抵抗性の神経因性膀胱に対するミラベグロンの併用投与の有効性が示唆された。

Using a videourodynamic study, we examined the efficacy of combination therapy with mirabegron for anticholinergic-resistant neurogenic bladder. We retrospectively studied 7 patients with neurogenic bladder (5 males and 2 females) who had detrusor overactivity (DO) or low compliance bladder (＜10 ml/cmH2O) despite taking anticholinergic medication. Bladder deformity was categorized from G0 to G3 by Ogawa’s classification. Mean age of study patients was 51 years (25-76). Underlying diseases were spinal cord injury in 3 patients, spina bifida in 2, spinal cord infarction in 1, and post-radical hysterectomy in 1. Preceding anticholinergic medication was solifenacin 5 mg in 1 patient, solifenacin 10 mg in 5, and tolterodine 4 mg in 1. Before mirabegron, bladder deformity was G1 in 4 patients, G2 in 1 and G3 in 2, and vesicoureteral reflux (VUR) was detected in 3 patients. Five and 4 patients had detrusor overactivity and low compliance bladder, respectively. Videourodynamic study was reevaluated at a mean of 7 months (2- 12 months) after mirabegron. After mirabegron, urinary incontinence was improved in all patients. G3 bladder deformity was improved to G2 and G1 in one patient each, and VUR disappeared in all 3 patients. DO disappeared in 2 of the 5 patients, and bladder compliance was improved in all 4 patients with low compliance bladder. In conclusion, combination therapy of mirabegron is effective and beneficial for anticholinergic-resistant neurogenic bladder.

A 62-year-old male came to our clinic complaining of residual sensation of urine and urinary frequency. He was diagnosed with neurogenic bladder, and has been performing clean intermittent self catheterization once or twice a day. According to his urination record of voided volume (VV) and post-void residual urine volume (PVR) on every urination, we investigated the relationship between pre-void bladder capacity (BC) and PVR. BC was expressed as the sum of VV and PVR. The PVR of BC 300-400, 400-500, 500-600 and ≧600 ml was 141.1, 167.7, 186.8 and 193.3 ml, respectively. PVR significantly increased as BC increased (p＜0.01). Although there are few reports about the relationship between BC and PVR, the present results show that bladder over distension may reduce the contractility of the urinary bladder.

A 71-year-old man had been under treatment for nocturia with an anti-cholinergic agent at a urologic clinic for the last 2 years. Because the symptoms did not improve, he was referred to our hospital for treatment of urinary retention. Based on the findings of a neurological examination, we suspected the presence of a neurogenic bladder due to sacral lesions. Moreover, magnetic resonance imaging indicated tethered cord syndrome (TCS) due to spinal cord lipoma. He underwent surgical treatment for TCS, which improved storage function, but not voiding function. Generally speaking, we believe that early diagnosis of TCS facilitates early surgery that can prevent the development of neurogenic disorders. In the present case, if the neurological findings had been appropriately assessed and cystometry/urodynamic studies had been performed at an earlier stage, a prompt diagnosis could have been made and surgery could have been performed earlier as well. Although adult cases with TCS are rarely observed, TCS should be considered as one of the causes of intractable lower urinary tract symptoms.

Herpes zoster is caused by the infection of Varicella-Zoster virus. The anatomical distribution of herpes zoster in the sacral area is only6. 9%1). Moreover, the onset rate of herpes zoster with urinary dysfunction is 0.6%1). The lesion sites of herpes zoster which cause urinary dysfunction are almost lumber and sacral areas. We describe four cases of sacral herpes zoster with urinary dysfunction in this report. All patients were elderly people (66-84 years old), and all patients were administered anti-virus drugs and alpha 1-adrenergic receptor blockers. Because of urinary retention, three patients have performed clean intermittent self-catheterization (CIC) for several weeks. As the lesions of herpes zoster healed, each patient recovered from urinary dysfunction.

症例は72歳，女性．糖尿病，慢性膵炎，胃潰瘍，C型肝炎などで通院中であった．2008年5月，尿路感染による発熱で入院した際に神経因性膀胱と診断され，臭化ジスチグミンの服用を開始した．同年7月より腹痛が反復するようになった．消化管内視鏡，CT等で著変なく，対症療法で改善していたが，高度の下痢，腹痛のため8月に入院した．欠食・輸液にて症状は改善し，便培養で病原性大腸菌が検出された．退院2日後より水様下痢・腹痛をきたし再入院．この時，発汗が著明で，CTにて肝表面に少量の腹水あり．一連の経過から臭化ジスチグミンによるコリン作動性症状の可能性を指摘された．確かに7月に増量後，腹部症状は出現しており，中止後に腹痛・下痢の再燃はない．本例は腹痛・下痢の寛解・再燃を繰り返し，糖尿病性神経障害，慢性膵炎などの合併もあって診断に難渋したが，臭化ジスチグミン服用中の腹部症状には注意して対応する必要がある

Physical examination for pediatric urological disease is different from that in adults in various ways. When we practice pediatric urology, we must pay attention to this difference. This paper describes the diagnosis and treatment of dysuria (neurogenic bladder) and development of voiding function during childhood.

39歳女.患者は17歳の時, 関節炎および蝶形紅斑, 発熱で発症し, 23歳時に全身性エリテマトーデス(SLE)と診断された.プレドニゾロンの内服治療を受けていたが, 発熱はじめ両下肢の脱力とともに排尿困難感を自覚した.更に呼吸困難, 全身の筋肉痛が出現, 3ヵ月後の退院時には排尿状態は自排尿可能であったが, 尿失禁を認めた.以後, 全身性浮腫が出現し, 腹部CTにて両側水腎症を認めた.腎盂腎炎を繰り返し, 膀胱尿管逆流, 膀胱憩室を認めた.膀胱憩室切除術, 回腸利用膀胱拡大術を施行した結果, 病理組織検査では, 高度の炎症細胞浸潤と肉芽組織の形成を認め, 膀胱憩室炎の診断であった.術後3ヵ月で水腎症, 尿失禁は完全に消失し, 膀胱容量は300mlまで増加した, A 39-year-old female with systemic lupus erythematosus (SLE) with a neurogenic bladder is described. She developed voiding disturbance with paraplegia and sensory disturbance on her inferior limb. Clinical findings suggested elevated activities of SLE with transverse myelitis. Although her symptoms were improved after one course of methylprednisolone pulse therapy, clean intermittent catheterization was required for urinary incontinence and residual urine. One year later, bilateral hydronephrosis and vesical diverticulitis developed, and thus augmentation ileocystoplasty was performed. After three months of the operation, hydronephrosis and urinary incontinence resolved with frequent clean intermittent catheterization. We should not overlook lower urinary tract symptoms in patients with SLE. We advocate performing a surgical procedure in cases in which conservative treatments are not effective.

手圧排尿を施行した1群56例と, 腹圧排尿を施行した2群22例に大別した.尿管理開始年齢は1群で0～31, 平均2.1歳, 2群で0～20, 平均4.5歳であった.1群の17例及び2群の13例は平均でそれぞれ14.6及び13.7年追跡した.1群の3例及び2群の1例は膀胱変形の進行を示した.2群の1例で膀胱尿管逆流が新しく現れた.2群の3例で水腎症, 3例で水尿管, 1例で膀胱変形, 及び1例で膀胱尿管逆流の消失・改善がそれぞれ認められた.1群では1例での膀胱尿管逆流の消失を除き, これらの病的状態の消失・改善は見られなかった.尿路の保存上腹圧排尿の方が優れていることが示唆されるが, 両群間の差異は推計学的に有意ではなかった, Retrospective analyses were performed to elucidate the clinical significance between Crede voiding (n = 56) and Valsalva voiding (n = 22) in the urological management of spina bifida patients who do not match the indication of clean intermittent catheterization. The age at initiating the urological management ranged from 0 to 31 years old (mean 2.1) in the Crede voiding and from 0 to 20 years old (mean 4.5) in the Valsalva voiding group. Seventeen patients in the Crede voiding group and 13 in the Valsalva voiding group were followed up for more than 10 years with a mean follow-up period of 14.6 and 13.7 years, respectively. Three patients in the Crede voiding group and one in the Valsalva voiding group showed progression of bladder deformity. In one patient in the latter group, vesicoureteral reflux newly appeared. In the Valsalva voiding group, disappearance or improvement of hydronephrosis was seen in three patients and that of hydroureter in three, bladder deformity in one, and vesicoureteral reflux in one. On the contrary, no patients in the Crede voiding group showed favorable changes in these pathological conditions except for disappearance of vesicoureteral reflux in one patient. Although these findings suggest possible superiority of Valsalva voiding over Crede voiding in the preservation of urinary tract, the differences between the two groups were not statistically significant. The clinical significance of Valsalva voiding remains to be elucidated through further study in neurogenic bladder patients.

パーキンソン病, 多発性硬化症, 脊髄小脳変性症の診察においては, 原疾患の重症度の軽い時期から排尿症状の出現することが多く, また, 原疾患の重症度が変化しなくても下部尿路機能の病態が変化する可能性があることを念頭におくことが必要である.また, 症例ごとに下部尿路機能障害の病態・ADLレベル及び介助者の有無等の背景因子を考慮することで, 腎機能保護ならびにQOLの向上を目指した排尿方法の選択が可能である, Clinical symptoms, urodynamic findings, and urological treatment of 35 patients with neurogenic bladder dysfunction caused by Parkinson's disease (11 patients), multiple sclerosis (10 patients), and spinocerebellar degeneration (14 patients) were reviewed retrospectively. Most of the patients had a relatively low stage of disease, when they were first seen by their urologists. Chief urological complaints were of irritation in 63.6% of Parkinson's disease and 64.3% of spinocerebellar degeneration cases, compared with obstruction in 80.0% of multiple sclerosis cases. Cystometry revealed underactive detrusor function in 69.2% of the patients with spinocerebellar degeneration but no abnormalities in the patients with Parkinson's disease or multiple sclerosis. Of 34 patients, excluding one patient lost to follow-up, the period of urological management ranged from one to 44 weeks with a mean of 11.0. The final methods of urinary drainage in 34 patients consisted of voluntary voiding in 20, clean intermittent catheterization in 11 including eight by self catheterization, incontinence into diaper in two, and indwelling catheter in one. Five patients were compelled to change urinary drainage method from voluntary voiding to clean intermittent catheterization because of increasing residual volume in four and progressing bladder deformity in one. However, none of them showed the clinical signs of primary disease progression. These findings indicate that in patients with Parkinson's disease, multiple sclerosis, and spinocerebellar degeneration, the urological symptoms can appear even in the early stage of disease. In addition, close follow-up is important in the urological management of neurogenic bladder patients with these diseases, because the disorders of the lower urinary tract may progress regardless of the status of the primary disease.

60歳女性.患者は慢性関節リウマチ, アミロイドーシス, ステロイド長期服用に伴う糖尿病の経過中, 肉眼的血尿, 下腹部痛が出現し, 著者らの施設へ紹介となった.尿細菌培養はEscherichia coli 2+, 尿細胞診は陰性で, KUBにて膀胱辺縁に沿ったガス像と膀胱部の透過性の亢進を認めた.経腹的膀胱部超音波検査ではガスによるアーチファクトのため内腔は不明で, 膀胱鏡では粘膜全体に発赤, 多数の気泡を認めた.以上より, 気腫性膀胱炎と診断し, 抗菌剤投与にて経過観察を行ったが, 1ヵ月後の超音波では両側水腎症, 膀胱内の尿貯留を認めた.神経因性膀胱による尿閉と判断し, 膀胱内留置カテーテルによる尿路管理を行った結果, 両側水腎症は消失した, A 60-year-old woman visited our clinic with a complaint of gross hematuria. She was under treatment for rheumatoid arthritis, amyloidosis and diabetes mellitus at the Departments of Orthopedic Surgery and Internal Medicine. The results of a urine analysis showed protein urine, glucose urine, hematopyuria and bacteriuria. The diagnosis of emphysematous cystitis was made from radiography, ultrasonogram and cystoscopic findings. Antibiotics were administered effectively. However, one month later, bilateral hydronephrosis was identified by a computed tomographic scan performed by the Department of Internal Medicine. The bilateral hydronephrosis was brought on by urinary retention caused by a neurogenic bladder disorder. Thus, an indwelling catheter followed by intermittent catheterization was performed and cholinergic medication prescribed successfully.

難治性の尿失禁を有する神経因性膀胱症例9例に対し塩酸オキシブチニンの膀胱内注入療法を施行した.注入1ヵ月後に最大膀胱容量は128mlから212mlへと増大したが, 有意差は認められなかった.過活動型膀胱には平均175%の膀胱容量の増加が認められたが, 低活動型では平均13%であった.又, 無効例では尿道閉鎖圧の低い症例が多かった.現在2例のみが膀胱内注入を継続している, Nine patients with persistent urinary incontinence due to neurogenic bladder and intolerable systemic side effects on oral anticholinergic agents were treated with intravesical instillation of oxybutynin hydrochloride. Two tablets (6 mg) dissolved in 10 ml of physiological saline or sterile water were instilled into the bladder two times daily via self intermittent catheterization. The mean bladder capacity increased from 128 to 212 ml 1 month after intravesical instillation of oxybutynin hydrochloride, although this difference was not significant. The bladder was augmented more efficaciously in patients with overactive detrusor than patients with an underactive detrusor. Subjective improvement was recognized in 4 patients. Among 5 patients who discontinued therapy due to ineffective results, maximum urethral closure pressure below 50 cmH2O was seen in 4. Intravesical instillation of oxybutynin hydrochloride was considered to be ineffective clinically in patients with underactive detrusor and low urethral closure pressure. Although no systemic side effects were observed, a decrease of bladder capacity was recognized in 2 patients.

A 24-year-old female with neurogenic bladder due to spina bifida consulted our department for further evaluation and treatment of a left renal stone. She innately voided urine by Crede's method. At the age of 15 years, intermittent self-catheterization was started because left severe hydronephrosis was found. At the age of 19 years, cystostomy was performed because of low compliance bladder and an aggravation of hydronephrosis in spite of intermittent catheterization. Thereafter, she was referred to our department for further evaluation and treatment of a left renal stone since the stone was increasing in size. First, left percutaneous nephrolithotomy was performed successfully. Secondly, clam ileocystoplasty using the ileum was carried out, followed by 1) increase of the bladder capacity, 2) improvement of the bladder compliance, 3) adequate intermittent self-catheterization, and 4) disappearance of urinous odor resulting from removal of the cystostomy catheter. Thus, the clinical effects were thought to be significant.

難治性排尿困難患者に対しCICを指導した120例について臨床的検討を行った。1)CIC経過中, 尿路感染を認めなかったのは早期治療例は65%, 陳旧例は20%であった。無症状の尿路感染症に対しては, 特に抗菌剤の投与は不要と考えられた。2)CIC前に水腎症を認めた20例うち, CICにより18例が改善し, 悪化した症例は認めなかった。3)骨盤内臓器摘出術後の神経因性膀胱のCICの離脱時期は, 早期治療例は3ヵ月以内が45%, 時期の差はあれ84%が離脱できた。陳旧例は, ほとんどの症例で継続中である。残尿が100ml以下であれば, 定期的観察を行うことによりCICは不要と考えられた, We evaluated 120 patients with neurogenic bladder treated by clean intermittent self catheterization (CIC) in our department. These cases were divided into 2 groups: early treatment cases in which CIC started within 1 year after onset of dysuria, and late treatment cases in which CIC started after more than 1 year. Urinary tract infections (UTI) were recognized in 35% of the early treatment cases and 80% of the late treatment cases in the subsequent period. Pyelonephritis was experienced in 4% of the early treatment cases and 12% of the late treatment cases. Antibiotics therapy was considered unnecessary for asymptomatic UTIs. After CIC treatment, hydronephrosis detected by intravenous pyelography (IVP) and ultrasonography was improved in 18 of the 20 cases, and no cases showed deteriorated renal function. In the cases with neurogenic bladder after radical operations of the uterus or rectum, 45% of the early treatment cases have become free from CIC within 3 months postoperatively, and 84% eventually became free. Most of the late treatment cases have been continuing CIC. We considered that CIC was unnecessary when the residual urine was less than 100ml based on the periodical urinalysis and observation of renal function.

二分脊椎患者32例に於いて, VUR(膀胱尿管逆流現象)を有する50尿管に対して逆流防止術を行った。1例を除き全例にCohen法の尿管膀胱新吻合術, 1例に両側Politano-Leadbetter法を行った。平均追跡期間42.5ヵ月に, 尿管の92.0%, 症例の87.5%で成功した。これらの成績は最近の文献のそれ等に匹敵した。3例ではVURが再発した。一側再植え込みを行った別の1例では対側尿管に新しく逆流が発生した。術後VURを防止する為には間欠導尿法を続ける事が重要である事を強調した, A series of 32 patients with spina bifida, representing 50 renal units with vesicoureteral reflux (VUR), was treated with antireflux operation. All but one patient underwent ureteral reimplantation with Cohen's technique. Another patient was treated with bilateral Politano-Leadbetter's technique. The overall success rates were 92.0% by renal unit and 87.5% by case, with a mean follow-up period of 42.5 months. These results were comparable to those in the recent literature. Failure included recurrence of VUR in 3 patients. Another patient who had undergone unilateral reimplantation developed new occurrence of reflux in the contralateral ureter. Possible masking of contralateral VUR should be taken into consideration in patients with unilateral high grade VUR. We also emphasize the importance of continuing clean intermittent catheterization in a proper manner to be free of VUR postoperatively.

1)PSPでは6例で蓄尿期の収縮筋反射亢進のために尿失禁を生じていたが, 4例では排尿期の括約筋の活動異常あるいは膀胱収縮の低下のために残尿が認められた。PAでは蓄尿期の収縮筋反射亢進が主体で切迫性尿失禁を呈し, 残尿を伴うような排尿障害は認めなかった。2)PSPではPAとは異なり, 尿意が低下し排尿障害を伴っていたことと, 高頻度に痴呆とADLの低下を伴っていたことが尿失禁の治療を困難にしていた。3)膀胱容量が低下して切迫性の尿失禁を示したPAでは抗コリン薬や三環系抗鬱薬が有効であったが, PSPでは排尿障害に対してαブロッカーが有効なものが2例あったが排尿症状の薬物治療は困難であり, 尿意の低下や痴呆による機能性の尿失禁の看護に対して排尿ベルが有用であった, We compared the vesicourethral function between progressive supranuclear palsy (7 cases) and Parkinson's disease (vesicourethral function study in 8 patients with dysuria and questionnaire study in 44 patients). The frequency of urinary incontinence in the 44 patients with Parkinson's disease was 38.7%. Vesicourethral function study showed hypersensitivity, low bladder capacity, detrusor hyperreflexia and normal sphincter EMG. The frequency of urinary incontinence in supranuclear palsy was 85.7%. Vesicourethral function study showed hyposensitivity and detrusor hyperreflexia in 6 cases, and 4 of these 6 cases had residual urine due to impaired detrusor contraction in micturition phase and/or abnormal sphincter EMG. Compliance was normal, but bladder capacity was decreased in progressive cases. Impaired contraction and hyposensitivity made it more difficult to control the urinary incontinence in supranuclear palsy than in Parkinson's disease. Dementia and lower ADL were frequently accompanied with supranuclear palsy (rare in Parkinson's disease). These were other factors that worsen the control of incontinence.

26歳男, 尿失禁を主訴とした仙骨形成不全に対して, S状結腸を用いて膀胱拡大術を施行し, 尿失禁の改善をみた, Sacral agenesis is an uncommon disease. About 50 cases have been reported in Japan since 1929. Neurogenic bladder is often accompanied with the disease. The patient was a 26-year-old man who had suffered from persistent urinary incontinence since his childhood. Kidney-ureter-bladder (KUB) revealed Type IV sacral agenesis according to the classification by Renshaw. The upper urinary tract remained normal. Urodynamics study showed a low compliance bladder with low urethral pressure. Pharmacotherapy failed to improve his continence. Augmentation sigmoid-cystoplasty was undertaken to enlarge vesical capacity and it has successfully overcome his urinary incontinence. Clinical aspects of sacral agenesis are discussed focusing on urological problems.

We report two cases of neurogenic bladder due to spina bifida which resulted in end-stage renal failure, and critically review their clinical courses. The following were concluded to be important for successful urological management of spina bifida patients. First, urological management should be initiated as soon after birth as possible ; this requires adequate recognition by the physician of the presence of the concomitant neurogenic bladder. Second, once renal parenchymal damage appears, not only management of the urinary tract, but also general management, i. e. diet therapy etc., should be initiated in order to prevent the progress of the renal dysfunction. We also emphasize the closer follow-up is necessary for patients in their adolescence when they are required to start self-management of their handicaps including neurogenic bladder.

1)ヒト膀胱はangiotensin 1, 2いずれに対しても強い収縮反応を示した.2) angiotensin 2に対する収縮反応はCa-free Krebs中ではほぼ完全に消失した.verapamilやindomethacinによる抑制効果は僅かであった.3) captoprilによりangiotensin 1の抑制作用は完全に抑制された.saralasinによりangiotensin 1, 2の収縮作用は完全に抑制された.4)神経因性膀胱のangiotensin 1, 2に対する収縮反応は, いずれもコントロールに比較して減弱していた.ただし, ED50値には差を認めなかった, The response of the human detrusor muscle to angiotensins and the difference in contractility between neurogenic and control bladders were examined. Both angiotensin I and II induced potent contraction of the human detrusor muscle. In Ca-free Krebs' solution the contractile response to angiotensin II was abolished. However, verapamil and indomethacin suppressed it only slightly. Captopril blocked completely the response to angiotensin I, and saralasin inhibited completely the response to both angiotensin I and II. The contraction strength in response to both angiotensin I and II was significantly weaker in the neurogenic bladder than in the control. However, there was no difference in the value of ED50 between the two groups. These findings suggest that angiotensin I is converted to angiotensin II by angiotensin converting enzyme at the detrusor, and that angiotensin II subsequently contracts the detrusor muscle through angiotensin II receptors. The contractility of the neurogenic bladder in response to angiotensin was significantly lower compared to that of the control.

A 23-year-old man consulted the urological department of our hospital with a complaint of urinary retention. He had consulted the department of ophthalmology for decreased vision and visual defect in both of his eyes of 1 year duration. Urodynamic study revealed detrussor hyporeflexia. Neurologically cerebellar signs were seen. Auditory brain stem response and visual evoked potential revealed damage of the pons. Magnetic resonance imaging revealed atrophy of the cerebrum and cerebellum, dilatation of the fourth ventricle and loss of gray/white differentiation of the brain stem on T2-weighted sequence. Urinary level of hippuric acid was markedly high and the neurogenic bladder was considered to have been induced by the demyelinization at the pons which was caused by chronic toluene abuse.

8例の直腸肛門奇形症例を対象とした.年齢は1歳～14歳に分布し, 全例男児であった.直腸肛門奇形の病型は, 低位型1例を除くすべての症例が高位型であった.これらの症例の泌尿器科的合併症は, 水腎症, VURなどの尿路異常から停留精巣, 陰茎前位陰嚢などの性器異常まで多岐にわたっており, しかもいくつかの異常が重なっている症例が多かった, Anorectal malformations involve genitourinary anomalies frequently. In this study, the treatment and prognosis for genitourinary anomalies in 8 patients with anorectal malformations were discussed. All patients were men (range 1 to 14 years). Seven of them showed high types of anorectal malformations and one low type. Five patients were managed surgically. Among them, 3 were treated successfully, but the outcome was not good for 2 patients. These 2 patients have been followed up under careful observation. The treatment could not be performed on one patient with poor bowel function. In this series, successful results were obtained on patients with a low degree of anomalies. However, there were hazard problems in patients with a high degree of anomalies. Neurogenic bladder was included among these problems. It is difficult to diagnose and treat genitourinary anomalies on a newborn baby with anorectal malformations, when these anomalies might be complicated with other severe anomalies such as congenital heart diseases. In such cases, genitourinary anomalies should be treated as conservatively as possible until the patient's condition has improved.

Bladder dysfunction is one of the major symptomatologies characteristic to HAM (HTLV-I associated myelopathy). Four patients, 3 females and 1 male, were diagnosed by neurologists to have HAM with spastic gait disturbance and increased titer of antibody to HTLV-I. They complained of urge incontinence, bed wetting, difficulty in micturition and/or pollakisuria. Urodynamically, in 3 of them severe uninhibited detrusor contractions were observed. On the other hand, in one case detrusor contractility was lost completely at voiding. In all patients, bladder sensation was well preserved. Corticosteroids and interferon could not improve their urological symptoms. Clean intermittent catheterization (CIC) put on 3 patients who had a significant amount of residue relieved them of urinary incontinence. We believe that HAM in patients suffering from severe difficulty in micturition is a good indication for CIC.

1)自覚的症状としての頻尿, 尿意切迫感および尿失禁いずれに関しても, ほぼ満足すべき改善率が得られた.2)疾患別, 診断名別の全般改善度では, 脳性疾患や前立腺疾患などによる神経因性膀胱および不安定膀胱に対して, その有効性が認められた.3)他覚的所見では, 最小尿意および最大膀胱容量とも本剤投与後に有意の増加がみられた.4) 1日投与量別改善度は6 mgと9 mg投与群で有意差はなかった.5)総合全般改善度は改善以上が43/75例, やや改善以上が67/75例と良好な結果が得られた.6)概括安全度は安全性に問題なしが73/75例で安全性の高い薬剤と考えられた.7)有用度は有用以上が44/75例, やや有用以上が61/75例であり, 本剤の有用性が認められた.8)副作用は73例中5例に口渇, 3例に排尿困難がみられた.また6 mg投与群は9 mg投与群に比べ副作用発現率が低かった.9)よって高齢者に対しては1日6 mg (2 mg×3回)投与が適していると考えられた, Oxybutynin hydrochloride (Pollakisu tablets) was administered at a daily dose of 6 or 9 mg to 75 elderly patients with urinary tract disorders, including neurogenic bladder and unstable bladder, with chief complaints of pollakisuria, urgency on urination and urinary incontinence. A post-marketing follow-up survey (phase IV study) was then performed to evaluate the efficacy safety and usefulness of Pollakisu tablets in these patients. The administration of Pollakisu tablets produced good results in the comprehensive assessment of overall improvement, being rated as "improved" or better in 57.5% of the patients and "slightly improved" or better in 89.0%. The assessment of general safety revealed that the drug caused almost no problems, with "no problem in safety" accounting for 97.3% of the responses. The assessment of the usefulness indicated that Pollakisu tablets are highly useful, being rated as "useful" or better in 58.9% and as "slightly useful" or better in 82.2%. Evaluation of the results according to daily dose indicated that a dose of 6 mg per day was appropriate for elderly patients from the viewpoint of drug efficacy and safety. With respect to adverse reactions, thirst was found in 5 and dysuria in 3 of the 73 patients. The overall incidence of adverse reactions was 11.0%. The above results indicate the efficacy, safety and usefulness of Pollakisu tablets in treating elderly patients with pollakisuria, urgency on urination and urinary incontinence.

70歳男, 糖尿病の合併はなく, 膀胱アミロイド症の存在する患者に発生した気腫性膀胱炎, This is a report of the thirteenth known case in Japan of emphysematous cystitis. A 70-year-old man visited our hospital because of pollakisuria and macrohematuria on November 21, 1989. The patient had been known to have familiar amyloid polyneuropathy for the previous 3 years. Urinalysis showed marked hematopyuria. The residual urine was 216 cc, and urine cultures yielded 10, 000, 000 colonies of Escherichia coli per ml. Laboratory studies revealed systemic inflammatory findings, but no diabetic change. A plain X-ray film of the abdomen and an excretory urogram (DIP) showed small linear and round gas collections in the bladder shadow. A CT scan revealed multiple gas locules within the bladder wall. A diagnosis of emphysematous cystitis was established. The patient was given antibiotics, and there was striking clinical improvement. Histological examination of the endoscopically obtained biopsy specimen of the bladder revealed amyloidosis. We believe that this patient had a cystitis emphysematosa precipitated neurogenic bladder due to amyloid polyneuropathy and amyloidosis of the bladder.

We have previously reported about a surgical procedure, ileal flap fixation to the urinary bladder, to obtain a new voiding desire in children with congenital neurogenic bladder mainly due to spina bifida cystica, and have demonstrated satisfactory results by the procedure. The present study was conducted to physiologically elucidate the mechanism of development of the new voiding desire by the procedure by using adult female mongrel dogs. Histopathological examinations failed to reveal communication between nerves of the ileum and the urinary bladder or regeneration of nerves in the ileal flap. However, physiological examinations showed an increase in the electric activity of the mesenteric splanchnic nerve on full bladder at the portion close to the attached site of the ileal flap, and an electroneurogram of the nerve was successfully introduced. The data suggest that the extension of the ileum wall fixed to the bladder resulted in the substitute urinary sensation as the new voiding sensation which was transmitted via the vagus and splanchnic nerves of the large or small intestine.

1)対象症例は脳疾患27例, 脊髄疾患18例, 末梢神経疾患13例, 混合型3例, 不明8例であった.2)排尿動態はunderactive detrusor 42例, overactive detrusor 21例, normal detrusor 6例で, そのうち排尿筋括約筋協調不全(DSD)を示したものは29例であった.3) DSDの発生頻度は脳疾患40.7%, 脊髄疾患44.4%, 末梢神経疾患46.2%であった.4)治療はおもに内科的治療(清潔間欠導尿, ブジーを含む)で, 7例にのみ外科的治療を行った.5)治療による自覚症状の改善率はoveractive detrusor 85.7%, underactive detrusor 64.3%であった.6)尿路感染症の改善率は63%であった, Clinical evaluation was made in 69 cases of neurogenic bladder experienced during the past 3 years. Thirty seven of the patients were male and 32 female, and they ranged in age from 4 to 88 years with an average of 63.2 years, The basic diseases of neurogenic bladder were brain lesions in 27 cases, spinal cord lesions in 18 cases, and peripheral nerve lesions in 13 cases. Three cases were of the mixed type and the basic disease was unknown in 8 cases. Cerebrovascular diseases were the most frequent, followed by spinal cord injuries and intrapelvic operations. Duration from the onset of urological symptoms to the first visit to our clinic was less than 1 month in half of the patients. The chief complaints at the first visit were pollakisuria in 25 cases (25.8%), incontinence in 18 cases (18.6%), urinary difficulty in 25 cases (25.8%) and urinary retention in 13 cases (13.4%). Urological conditions at the first visit were spontaneous urination in 53 cases (76.8%), indwelling catheterization in 12 cases (17.4%) and clean intermittent catheterization in 4 cases (5.8%). Urological complications seen at the first examination were urinary tract infections (UTI) in 27 cases (39.1%) and chronic renal failure in 2 cases (2.9%). The patients were classified by cystometrography into 3 patterns: 42 cases (60.9%) with underactive detrusor, 21 cases (30.4%) with overactive detrusor and 6 cases (8.7%) with normal detrusor. Detrusor sphincter dyssynergia was observed in 29 cases (42.0%), 40.7% had brain lesions, 44.4% spinal cord lesions, and 46.2% peripheral nerve lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Cutaneous vesicostomy according to Paquin's modification was performed on 5 female patients with neurogenic bladder caused by cervical spinal cord injury and long-term follow-up is now available. All patients are free from risk of autonomic dysreflexia and catheter trouble. There was one significant complication, stomal stricture, but it did not result in severe urinary infections or secondary changes in the upper urinary tract. Cutaneous vesicostomy proved to be valuable to improve the quality of life in female patients with neurogenic bladder caused by cervical spinal cord injury.

Three patients with contracted bladder caused by neurogenic bladder underwent ileocystoplasty. The primary diagnosis was meningomyelocele for all of them. The operative procedure adopted was Goodwin's Cup-patch method. All cases have obtained increased bladder capacity with improvement of bladder compliance and have been free from urinary incontinence. They were followed up by using clean intermittent self catheterization. Ileocystoplasty combined with clean intermittent self catheterization offers a successful method in patients with contracted bladder caused by neurogenic bladder.

The effect of thyrotropin-releasing hormone (TRH) on vesicourethral dysfunction in two patients with olivo-ponto-cerebellar atrophy was studied by urodynamic examination. The two patients had difficulty of urination with 200 ml of residual urine. Cystometrogram and electromyogram showed autonomous contraction without detrusor-sphincter dyssynergia. After administration of TRH, the symptom and volume of residual urine was not improved, autonomous contraction was not changed, while prostatic urethral pressure in urethral pressure profile was significantly increased in both patients.

A case of secondary VUR in neurogenic bladder with meningomyelocele treated successfully with urethral catheterization is reported. A 4-month-old girl was introduced to our clinic for the management of incontinence following the closure of the meningomyelocele (below S1 level). Anal sphincter and bulbocavernous reflex was almost normal. Since the IVP revealed right hydronephrosis, an urethral catheter was indwelt immediately in order to decompress the vesical pressure. Three weeks later, the right hydronephrosis improved, but the cystogram revealed right vesicoureteral reflux. The urethral catheter was left for the conservative management for 20 weeks. VUR had disappeared on the cystogram and right hydronephrosis returned to normal. Thereafter, the treatment was changed from indwelling catheter to clean intermittent catheterization by her mother. No urinary tract infection has occurred. The necessity of early management, especially decompression of the vesical pressure, for patients with neurogenic bladder associated with meningomyelocele is discussed.

Two cases of neurogenic bladder dysfunction due to tethered spinal cord syndrome in adults were experienced. They visited our hospital with the complaint of dysuria. The excretory urogram were almost normal. Urodynamic examinations revealed normoactive detrusor-overactive sphincter in case 1, and overactive detrusor-overactive sphincter in case 2. Cystometry-electromyogram demonstrated detrusor-external urethral sphincter dyssynergia in either cases. They were diagnosed as neurogenic bladder due to intraspinal tumor with spina bifida by myelography, computed tomography, and urodynamic examination. Laminectomy, subtotal extirpation of tumor and neurectomy of filum terminale were performed by orthopedists in both cases. The tumor was pathologically diagnosed as lipomas. Postoperatively they showed satisfactory recovery in micturition.

A 43-year-old woman with anterior spinal artery syndrome was admitted with complaints of tetraplegia and urinary retention. Her bladder had capacity of more than 500 ml and was inactive, with low voltage of external urethral sphincter. She was treated with distigmine bromide and intermittent catheterization. 50 days later, urodynamic study showed normal bladder and incomplete coordination of external sphincter. A 78-year-old man had chief complaints of urinary retention and paraplegia. A catheter was left indwell for 6 months. Then he was treated with intermittent catheterization, but urgency incontinence was still observed. We discussed the therapy of neurogenic bladder due to the anterior spinal artery syndrome.

1980年1月からの5年間に星ヶ丘厚生年金病院泌尿器科で尿路管理を行った女性脊髄損傷症例28症例について検討した.1)退院時排尿方法は, catheter free 11例(39.3%), 間欠的自己導尿法3例(10.7%), 介助者による間欠的導尿法1例(3.6%), 膀胱留置カテーテル13例(46.4%)であった.2)女性用の有効な集尿器や尿失禁防止器具のないことおよび下位胸髄損傷や腰髄損傷であってもADLレベルの低い症例が少なからず存在した.3)対麻痺患者においては, toilet activitiesが可能な症例に対して, 今後間欠的自己導尿法の適用が増加していくと思われる.4)頸髄損傷症例においては80%がやむなく膀胱留置カテーテルとなっていた, Most of the literature about the urological management of spinal cord injury patients is on male patients, and the method of the urological treatment for male spinal cord injury patients is often not useful for female patients. A clinical survey was done on 28 female neurogenic bladder patients after spinal cord injury treated at our Hospital between January, 1980 and January, 1985. At discharge, 11 patients (39.3%) were catheter free, 3 (10.7%) were managed by clean intermittent self catheterization, 1 (3.6%) was managed by clean intermittent catheterization by a helper, and 13 (46.4%) were on indwelling catheters. One of the main reasons that prevents female spinal cord injury patients from becoming catheter free is that there are no effective external collecting devices or devices to prevent urinary incontinence for female neurogenic bladder patients. Another reason is that some female patients can not obtain a high enough ADL level for toilet activities by rehabilitation in spite of lower thoracic or lumbar lesions.

1978年1月から1982年10月までの間に, 直腸癌, 子宮癌根治手術後に排尿障害を認めた35例につき検討した.これらの症例を, 手術直後より自己導尿法を開始した新鮮例(27例)と, 手術後3ヵ月以降に薬物療法が無効などの理由により自己導尿法を開始した陳旧例(8例)に分類した.35例中16例は, 自己導尿法期間中の膿尿発生率が, 20%以下であった.新鮮例のうち6例は, 自己導尿法開始後1週から7ヵ月の間に残尿率が20%以下となり, 自己導尿法より離脱でき, 10例は自力排尿を認めるも, 残尿率20%以上であり自己導尿法を続けている.さらに11例は, 自己導尿法開始後もまったく自力排尿ができない状態であった.新鮮例中の9症例にUP maxを, 自己導尿法開始前と開始後3ヵ月以降の時点で比較したところ, 正常値以下ながら8例に上昇が認められた.新鮮例11例について, 膀胱内圧所見の変化を検討したが, とくに有意な所見は認められなかった, To determine the effectiveness of non-sterile intermittent self-catheterization, a study was made of 35 patients who had radical surgery of the carcinoma of the uterus or rectum between January, 1978 and October, 1982. These cases were divided into 2 groups; (1) early instituted group of 27 patients who used self-catheterization within 3 months following surgical intervention; (2) late instituted group of 8 patients who received drug treatment for more than 3 months after surgical treatments and then used self-catheterization. After the introduction of self-catheterization, urinary tract infection was evaluated on the basis of the incidence of pyuria defined as more than 5 white blood cells per high magnification field. In 16 of the 35 patients, the incidence of pyuria ranged from 0 to 20 per cent. Regarding prognostic results in the first group the application of self-catheterization, 6 patients had a residual urine ratio ranging from 0 to 20 per cent and were able to void at will. Uroflometry was performed in 9 patients in the first group. In 8 of these patients, UP max values increased 3 months after self-catheterization as compared with those before self-catheterization although their values were still lower than normal. Non-sterile intermittent self-catheterization can shorten the stay in hospital and enable the patient to live a catheter-free life.

Terodiline HCl was administered in a long-term study to 20 patients with neurogenic bladder and pollakisuria. Its efficacy on urinary frequency and urinary incontinence was studied together with its safety and changes in blood concentration. The dosing period extended from 2 through 53 weeks (21 weeks on the average). The drug was found effective in 62% of diurnal urinary frequency patients, 71% of nocturnal urinary frequency, 73% of urinary incontinence, and 69% of nocturnal enuresis. Side effects of dizziness and nasal obstruction were seen in only one case. The drug was judged to be useful in 75% of the patients studied. Terodiline HCl showed no further increase in plasma concentration due to the long-term administration, and it disappeared from plasma within one to two months after the last dosing.

The present report is Werner's-syndrome associated with a neurogenic bladder. The patient visited our clinic with the chief complaint of retention of urine and urinary tract infections. The diagnosis of Werner's syndrome was made because the patient had such clinical features as bird-like or "masked" face, short stature, graying of the hair in youth, cataracts in youth, skin changes like scleroderma principally on limbs, early menopause. After trans-urethral-resection of bladder neck and administration of distigmine bromide, her bladder function was improved, she could urinate by herself and she was free from urinary tract infections.

神経因性膀胱患者10症例に塩酸オキシブチニン1回2 mg 1日3回, 1日量6 mgを投与し, 臨床症状とともに下部尿路機能に及ぼす影響を膀胱内圧測定, 残尿量測定を施行して検討した.1)膀胱内圧測定では本剤投与により初発尿意量は約34%増加し有意差を認めたが, 最大膀胱容量, 最高内圧に関しては明確な変動は認められなかった.残尿量においても, 投与前後における変動は認められなかった.2)自覚症状に対しては頻尿, 尿失禁, 尿意切迫感に対して満足すべき有効率を示した.総合効果においては, 有効以上の有効率で50.0%を得た.3)副作用は10例中4例に認められ, 口渇3例, 下痢1例であった.いずれも一過性, 軽度なもので重篤な副作用は認められなかった, Clinical effects of oxybutynin hydrochloride on lower urinary tract function at a dosage of 2 mg given orally three times daily (6 mg/day), were studied on 10 patients with neurogenic bladder by cystometry and measurement of residual urine. There was a significant increase, of about 34% in FDV, but no significant changes in MBV, or maximum voiding pressure of residual urine after administration. Urinary frequency, incontinence and urgency in subjective symptoms were decreased in patients given this drug. The effective rate (excellent and good) was 50% in global evaluation. Side effects were observed in 4 out of 10 patients; 3 had dry mouth and 1 had diarrhea. There were no serious side effects. These findings suggested that oxybutynin hydrochloride may be a useful drug for neurogenic bladder.

Examination including residual urine measurement, cystometry and urethral pressure profile was performed before and 8 weeks, 3 months and 6 months after the operation in 17 patients with rectal cancer who were divided into mecobalamin administered group (8 patients) and non-administered group (9 patients) at random. Administration of mecobalamin (500 gamma i.m., 3 times a week for 4 weeks) was started within 3 weeks after the operation. In the 17 patients, the rate of patients with residual urine over 51 ml was 65% at 8 weeks, 24% at 3 months and 24% at 6 months. The mean value of bladder pressure at maximum capacity after the operation in the 17 patients showed a significant increase compared to that before the operation, while the mean value of maximum urethral pressure after the operation showed a significant decrease compared to that before the operation. The bladder pressure in patients with residual urine less than 50 ml was significantly lower than that in patients with residual urine over than 5 ml. The bladder pressure in patients with residual urine reduced to less than 50 ml at 3 months showed a tendency to decline. The rate of patients with residual urine of less than 50 ml at 8 weeks was 50% in the mecobalamin administered group and 22% in the non-administered group. There was no significant difference in bladder pressure between the two groups, or before and after the administration of mecobalamin.

Long-term therapeutic effect of Robaveron tablet (KN-7) was studied on 10 female patients of middle and old age with ptosis of urinary bladder and 9 patients with neurogenic bladder. The patients had mainly complained of such subjective symptoms as pollakisuria, difficulty of urination, sense of residual urine, lower abdominal discomfort and urinary incontinence. Robaveron tablet was administered at 2 tablets t.i.d. for 3-26 months. And the drug efficacy was evaluated by residual urine, cystometric findings and subjective symptoms. A significant decrease in the residual urine rate and a significant increase of pressure amplitude were obtained, and improvement of subjective symptoms was seen with an effective rate of about 70%. Overall effectiveness, rated slightly improved or better was 89.5%. No cases of side effects or abnormalities in laboratory tests were observed. Robaveron tablet is safe and effective for patients with urinary disturbance accompanied by ptosis of urinary bladder, as a myogenic disorder, as well as neurogenic bladder in the long-term therapy.

Two cases of neurogenic bladder with pituitary adenoma are reported. The pituitary adenomas produced excessive GH (growth hormone). The etiology of the neurogenic bladder was not identified by X-ray examination or any other tests. Urodynamic study, however, indicated a functional cause of neurogenic bladder. Case 1 was a 55-year-old male, who had a relatively small pituitary adenoma with mild symptoms. Urologically, there was complete urinary retention. Cystometrogram showed a flaccid pattern, detrusor-sphincter dyssynergia in sphincter-EMG and ice water test was negative. Case 2 was a 67-year-old female, who had a large pituitary adenoma and severe symptoms. Cystometrogram showed an almost normal pattern, however, there was detrusor-sphincter dyssynergia and ice water test was negative. We suggested that the neuropeptide takes some part in the pathophysiologic cause of neurogenic bladder.

1980年1月より3年6ヵ月間に, 入院した完全脊損患者180例に対して, catheter freeを目的として, 薬物療法, 手術療法および神経ブロック療法を施行し, 排尿訓練を指導した結果157例(87.2%)に対して, catheter freeとすることができた.1)神経因性膀胱の尿路管理に関して, 腎機能を保護し, 排尿効率のよい排尿方法を確立させることが最も大切であるが, 脊損患者の場合, 損傷レベル, 合併症の有無, ADLの状況, 介助者の有無などの社会的背景を考慮して, 排尿手段を考えていく必要がある.2)できるだけcatheter freeとすることが望ましいが, その目的のためには, TUR, 仙骨神経ブロック, 陰部神経ブロック, 閉鎖神経ブロック, 腰神経根ブロックなどを施行し, 緻密な排尿訓練を指導することが有用である, One hundred eighty patients with spinal cord injury were admitted to our hospital between January, 1980 and June, 1983. Eighty-five of them had cervical lesions, 54 had thoracic lesions and 41 had lumbar lesions. Most of the neurogenic bladders due to spinal cord injury treated in our clinic, could be classified into 3 major patterns: hypoactive detrusor-hypoactive sphincter, hypoactive detrusor-active sphincter, and hyperactive detrusor-hyperactive sphincter. To control the hyperactivity of the detrusor and the sphincter, we employed pharmacotherapy first and then we performed transurethral resection of the bladder neck and prostatectomy (TUR-Bn.P) and nerve block (sacral nerve block, pudendal nerve block, obturator nerve block and lumbar nerve block). In the case of a hypoactive detrusor, we employed TUR-Bn.P, open ileal flap fixation to the bladder and voiding training. Using these procedures, we could make 157 patients catheter-free.

Eperisone hydrochloride, a striated muscle relaxant, was tried on 20 patients suffering from neurogenic bladder due to various reasons. Clinical effectiveness was evaluated by subjective symptoms, residual urine, cystometry and electromyography of the external urethral sphincter. Difficulty of urination was improved in 9 of the 20 patients. Decrease of residual urine by more than 40% was seen in 10% of the 20 patients. No significant changes were observed in the cystometrograms. On the electromyograph, external sphincter spasms were seen in 6 of the 8 patients, and partially improved in 2 patients. No marked side effects were observed.

37施設で, 神経因性膀胱233例を対象に, ロバベロン注射剤を標準薬とし, KN-7錠剤の経口投与による排尿障害に対する有用性を, 二重盲検群間比較試験で比較検討した.解析対象例はKN-7群108例, ロバベロン群107例である.KN-7群は1日6錠投与した.改善度の効果判定では改善以上K群40.7%, R群38.7%, やゝ改善以上それぞれ76.9%, 72.6%と有意差はなかった.臨床所見中改善の良かった項目は, 尿意, 残尿感, 尿失禁, 排尿までの時間, 排尿時間, 尿勢-排尿力と尿線中断の改善などで, これらの改善以上はK群35.8%, R群30.8%で, 有意差はなかった.副作用はK群0.9%, R群6.8%, K群が有意に少なかった.両剤とも主として下痢で, R群ではその他頭痛, 頻脈, 肝機能障害, 発熱感などを少数例認めた.臨床検査値ではGOT, GPTの上昇が2例あった.有用度有用以上はK群46.3%, R群45.8%で有意差はなかった.疾患別では, 末梢神経疾患, 膀胱の性状では弛緩性, 時期では12ヵ月以内の例で特に改善率が高かった.以上から, KN-7錠剤は, ロバベロン注射剤に比べ, 同等の効果が期待でき, 安全性も高く, 長期投与あるいは外来患者の治療にも適する, The clinical effectiveness, safety and usefulness of KN-7 tablet as a new oral application of the prostatic extract, on urinary dysfunction of neurogenic bladder were compared with those of Robaveron injection by the double-blind test method. In the study, 2 tablets t.i.d. and a shot of intramuscular injection 1 ml a day were given successively for 3 weeks. A total of 233 cases were reported from 37 facilities belonging to the KN-7 Clinical Research Group. Some of them were excluded or dropped out. The number of cases used for analysing the effectiveness, safety and usefulness were 214, 232 and 215, respectively. There was no bias between the two groups with a significant homogeneity in the background. In the overall clinical effectiveness, the effective rate including excellent, moderate and slightly effective was 76.9% with KN-7 and 77.4% with Robaveron. In the clinical usefulness, the rate of usefulness of slightly useful or above was 75.0% with KN-7 and 75.7% with Robaveron. There was no significant difference between the two groups in the clinical effective and useful rates at a significant level of 5%. Side effects were observed in 1 of the 114 (0.9%) patients given KN-7 and 8 of the 118 (6.8%) patients given Robaveron. The incidence of adverse reactions with KN-7 was significantly lower than that with Robaveron. Based on the results, it was concluded that KN-7 tablets, 2 tablets t.i.d., would be as effective and useful as a Robaveron injection 1 ml daily and safer than the latter in the treatment of neurogenic bladder.

We report two cases of perivesical abscess associated with neurogenic bladders. One patient suffered from diabetic neurogenic bladder, and the other spinal cord injury. Both patients had an uninhibited contraction at the low capacity on cystometry. They complained of difficulty in micturition and presented with large lower abdominal tumors. Although the extravasation of contrast medium was not confirmed on cystography, we believe that the perivesical abscess was the consequence of urinary leakage out of the bladder. The abscesses disappeared after drainage. We have discussed the possible mechanism involved in the abscess formation which occurred in the neurogenic bladders.

Between 1978 and 1985, 72 patients with urinary and defecatory dysfunction due to neurogenic bladder associated with myelodysplasia (57), spinal cord injury (11), and other causes (4) were treated with modified sero-muscular ileal flap fixation to the bladder (modified IFFB). They were followed from 1 to 88 months (mean: 36.3 months). This operative procedure was attempted to recover urinary and defecatory function. Sixty-four patients underwent urodynamic studies before and after the modified IFFB. On urodynamic evaluation, bladder capacity was not decreased, voiding time was diminished, and average urine flow rate was significantly improved after the modified IFFB. Patients who were followed at least 6 months after the modified IFFB showed the following results. Urinary substitute sensation appeared in 57 out of 59 patients (96.6%) and fecal substitute sensation in 34 (57.6%). Urinary incontinence improved in 38 out of 42 patients (90.5%), disappearing completely in 19 (45.2%). Constipation improved in 26 of 59 patients (44.1%). The upper urinary tract improved in 22 renal units, remained unchanged in 90 renal units, and deteriorated in 6 of the 118 renal units. Operative complications were encountered in 6 out of 72 patients (8.3%). The modified IFFB procedure does not appear to be suitable for the low compliance bladders with high grade VUR or for young women who desire pregnancy in the future.