神経因性膀胱に合併した尿道腟瘻

A CASE REPORT: TREATMENT OF INCONTINENCE IN A FEMALE NEUROGENIC BLADDER WITH URETHROVAGINAL FISTULA

　不完全核下型神経因性膀胱と性的虐待により形成された尿道腟瘻，そして膀胱下垂を合併した女性尿失禁例の治療経過を報告する。経腟的に尿道瘻を閉鎖し，腟前壁縫縮術を行ったが，37日後に尿失禁が再発した。症状再発の原因は，尿道括約筋の機能不全が存在し，さらに骨盤底筋群の弛緩状態が高度なためと推測した。あらためて，膀胱頸部を腹側へ挙上するStamey法を行い，尿禁制が獲得できた核下型神経因性膀胱に伴う女性尿失禁症例の治療法について考察した。

A female neurogenic bladder with cystocele, caused by the lumbar vertebral fracture and urethro-vaginal fistula, which was formed by sexual abuse, was treated. Firstly she was operated with trans-vaginal closure of the fistula together with the anterior colporrhaphy, which resulted in recurrence of incontinence 37 days after operation. The etiology of failure is probably due to the urethral sphincter incompetence and the pelvic floor relaxation of a severe degree. Stamey's bladder neck suspension procedure eventually resolved her symptom, where the bladder neck was elevated with a tension of 1000 g in each nylon thread.