脊髓損傷併發膀胱結石及膀胱輸尿管逆流：病例報告

A spinal cord injured patient complicated with huge bladder stones and vesico-ureteral reflux

陳律文(Lu-Wen Chen) ； 畢柳鶯(Liu-Ing Bih) ； 陳玲芳(Liang-Fang Chen) ； 丁化(Hwa Ting)

《中華民國復健醫學會雜誌》 23卷1期 (1995/06) Pp. 59-64

摘要

25歲男性病人，民國七十四年因第一腰椎骨折致雙下肢麻痺及神經性膀胱功能障礙。受傷後逐漸恢復到可持雙側腋下拐杖獨立行走，但逼尿肌反射一直沒有恢復，因此長期放置尿道內留置尿管。受傷七年來因反覆尿路感染，經常前往各醫院求診，從未做過泌尿系統影像檢查。來本院檢查時發現有五顆栗子大小膀胱結石及兩側膀胱輸尿管逆流。開刀取出五顆結石共重81克，分析其成分合磷酸氨鎂83%及草酸鈣17%。手術後尿路感染得到控制，然而病人逼尿肌無力，肌電圖顯示尿道外擴約肌收縮力強，且其膀胱輸尿管逆流在膀胱內壓不到20cmH2O即已發生，因此給予留置尿管處置。出院四個月後追蹤檢查仍有膀胱輸尿管逆流，故建議做尿道擴約肌切開手術。手術後六個月追蹤檢查，只發現有短暫性左側輸尿管逆流，解尿後殘尿量少於50ml，也沒有顯影液留在上尿路系統。近六個月來病人只發生過一次尿路感染，目前其健康情況及生活品質得到明顯改善，病人非常滿意。

關鍵字

脊髓損傷 ； 膀胱結石 ； 膀胱輸尿管逆流 ； 擴約肌切開手術

並列摘要

A 25 years old male patient suffered from L1 compression fracture with weakness of both lower extremities and neurogenic bladder dysfunction 7 years prior to admission. Motor recovery over both lower extremities developed gradually that he could walk with bilateral axillary crutches later. However, the detrusor reflex did not restore so that a transurethral catheter had been left ever since he was injured. Frequent urinary tract infection manifested with fever and cloudy urine occurred off and on in the past years. Neither regular follow up nor urinary tract imaging study had been performed. Upon admission to our hospital, 5 bladder stones measuring up to 3.5x2.5x1.5 Cm3 and bilateral vesico-ureteral reflux (GrIII/V) were revealed. Cystolithotomy was done, stones weighed 81 gms with 83% magnesium ammonium phosphate and 17% calcium phosphate in composition. The urinary tract infection was under control after surgery. Cystometry study showed detrusor areflexia with sustained urethral sphincter contraction, and the vesico-ureteral reflux (VUR) occurred in low intravesical pressure, an transurethral indwelling catheter was applied.
Four months after discharge, cystogram study revealed persistent bilateral low pressure VUR, and urethral sphincterotomy was therefore performed. After surgery, the post-voiding residuals was less than 50 ml. However, an external urinal was applied for stress incontinence. A cystogram study was followed 6 months later, and transient GrII VUR was found over the left ureter, radioisotope renogram study showed prompt excretion of the isotope. Six months after sphincterotomy, only one episode of urinary tract infection was noted. The patient is very satisfied with the significant improvement of life quality and health situation.
As what we try to emphasize, regular follow up of urinary tract function and imaging study are essential for early diagnosis of urological complications in spinal cord injured patients. Urethral sphincterotomy is one of the effective treatments for VUR even in the absence of detrusor contraction.

並列關鍵字

spinal cord injuryl ； vesical calculi ； vesico-ureteric reflux ； sphincterotomy