Status lacunaris （多発性小窩状態）における排尿障害の研究

DISTURBANCE OF MICTURITION IN STATUS LACUNARIS

　抄録　排尿症状を有するstatus lacunaris患者42名に対して，詳細な問診とurodynamic studyを行った。問診の結果，刺激症状が21名（50％），閉塞症状が7名（16.7％），両症状共存が14名（33.3％）にあった。Urodynamic studyの結果，尿流曲線は20名中6名で異常，残尿は40名中19名に30〜470ml，平均135mlあり，最高尿道閉鎖圧は42名中1名で高値，3名で低値を示し，膀胱容量は初発尿意時100ml以下は20名，300ml以上は4名，最大尿意時200ml以下は20名，600ml以上は2名であり，膀胱内圧曲線は無抑制収縮が34名，自律性収縮が1名，両者の合併が3名，正常曲線が4名にあり，排尿筋括約筋協調不全が42名中10名，無抑制括約筋弛緩が42名中4名，球海綿体筋反射亢進が42名中14名にみられた。問診とurodynamic studyの結果から排尿障害の頻度と平均的程度を判定すると，排出障害は42名中25名（59.5％）に中等度，蓄尿障害は42名中37名（88.1％）に高度であった。

Detailed micturitional history and urodynamic study were performed on 42 patients with status lacunaris who had urinary symptoms.

1) Micturitional history revealed 21 patients (50%) had irritative, 7 (16.7%) had obstructive and 13 had both symptoms.

2) Urodynamic study revealed the followig : Six among 40 had abnormal uroflowmetrogram. Nine-teen among 40 had residual urine of 30~470ml, on the average 135ml. Among 42 one had high and 3 had low maximal urethral closure pressures. Bladder capacity at maximal sensation was below 200ml in 20 and over 600ml in 2. Electromyo-graphy showed 10 had detrusor-sphincter dyssyn-ergia, 4 had uninhibited sphincter relaxation and 14 had brisk bulbocavernosus reflex.

3) Judging from the above results 25 over 42 patients (59.5%) had on the average a moderate degree of evacuation disturbance and 37 over 42 patients (88.1%) had on the average a severe degree of storage disturbance.