臨床神経学

第48回日本神経学会総会

<教育講演1>
神経因性膀胱の診断と治療

服部 孝道

千葉大学医学研究院神経内科〔〒260-8670 千葉市中央区亥鼻1-8-1〕

Bladder function has two phases, urine storage and urine evacuation which are based on the complex neurological controls including central as well as peripheral nervous system. Therefore, various neurological lesions can cause bladder dysfunctions such as disturbed storage or disturbed urine evacuation. Micturitional symptoms can be divided into storage symptoms and voiding symptoms. Storage symptoms include urgency, frequency of micturition and urinary incontinence, on the other hand voiding symptoms include difficulty in starting micturition, prolonged or intermittent micturition and urinary retention. The pathophysiology of bladder dysfunction is known by performing urodynamic studies such as uroflowmetry, residual urine measurement, cystometry, external urethral sphincter electromyography, pressure-flow study and voiding urethrocystography. The most common cause of storage symptom is detrusor overactivity, which can occurs in the central nervous system disorders. Disturbed voiding can be due to poor relaxation of urethral sphincter or detrusor weekness. The treatment of neurogenic bladder usually can be done by the combination of bladder training, intermittent catheterization and pharmacotherapy. It is very important to try to avoid the bladder overdistension which can cause weak detrusor and poor recovery.

(臨床神経, 47:766−768, 2007)
key words:神経因性膀胱, 排尿障害, 排尿筋過活動, 尿流動態検査

(受付日:2007年5月16日)