膀胱拡大術を施行したループス膀胱炎

A case of lupus cystitis in a patient who underwent bladder augmentation

　症例は28歳女性，全身性エリテマトーデス発症3年後より頻尿，尿意切迫感が出現した。抗コリン剤を投与されたが症状は改善せず，両側水腎症を呈し当科を受診した。著明な膀胱容量の低下と両側Ⅳ度のVURを認め，ステロイドパルス療法・DMSO膀胱内注入療法も効果なく，膀胱拡大術を施行した。内科的治療に抵抗するループス膀胱炎に対しては，膀胱拡大術も治療法の一つであると考えられた。

A 28-year-old female with a history of systemic lupus erythematosus visited our hospital with complains of pollakisuria and urinary urgency.An anticholinergic agent was not effective for these symptoms.Radiography demonstrated a contracted bladder and bilateral hydronephrosis.Based on these findings,the diagnosis was lupus cystitis.Although she was treated with both steroid pulse therapy and intravesical instillation of dimethyl sulfoxide（DMSO）,her bladder capacity did not change.Subsequently gradeⅣof bilateral vesico-ureteral reflux（VUR）developed.For relief of her symptoms and improvement of quality of life,bladder augmentation in accordance with Hautmann's procedure was performed.Radiographic evaluations revealed remaining hydronephrosis,however,VUR disappeared and her bladder capacity was increased to 300ml.For lupus cystitis,non-surgical treatment such as steroid and DMSO should be primarily considered.However,if these treatments are not effective,bladder augmentation or urinary diversion could be chosen for one of the option to treat.