Two cases of adult tethered cord syndrome with surgical treatment
| Autor: | Takei, Kazushiro, Suzuki, Koichi, Kito, Hiroki, Naito, Hitoshi, Mochizuki, Makondo |
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| Jazyk: | japonština |
| Rok vydání: | 2006 |
| Předmět: | |
| Zdroj: | 泌尿器科紀要. 52(11):841-844 |
| ISSN: | 0018-1994 |
| Popis: | 症例1:35歳女。主訴は体動時の尿失禁で、DIPで肉柱膀胱および第5腰椎以下の脊椎披裂と仙骨の変形を認め、MRIで第2仙骨上線の低位脊髄円錐とそれに続く肥厚性終糸および脂肪腫を認めた。膀胱内圧測定では最大尿意355ml時の排尿筋圧58cmH2Oで、コンプライアンス3.6ml/cmH2Oであった。排尿は完全な腹圧排尿で残尿は185mlであり、低コンプライアンスをともなう排尿筋無収縮であった。以上より、脊椎披裂、仙骨硬膜内脂肪腫に伴う低位脊髄円錐および脊髄係留症候群(TCS)と診断した。係留解除術を施行し、術後28ヵ月で蓄尿機能の改善、排尿筋の収縮を認めた。症例2:27歳女。主訴は腹圧排尿で、画像検査所見にて肉柱膀胱および第2仙椎以下の脊椎披裂を認め、第5腰椎下端の低位脊髄円錐とそれに続く肥厚性終糸および脂肪腫を認めた。最大尿意255ml時の排尿禁圧50cmH2Oでコンプライアンス3.6ml/cmH2O、完全な腹圧排尿で残尿150mlで、低コンプライアンスを伴う排尿筋無収縮であった。脊椎披裂と仙骨硬膜内脂肪腫に伴う低位脊髄円錐およびTCSと診断し、係留解除術を施行した。術後24ヵ月で蓄尿機能は正常化したが、排尿筋収縮は改善しなかった。 We report two cases of adult tethered cord syndrome alleviated by untethering surgery. Case 1 was a 35 year-old female who complained of incontinence while exercising. Radiograph revealed spinal disraphism below the L5 level. In addition, magnetic resonance imaging (MRI) showed low placed conus medullaris at the levels of S2 and sacral intradural lipoma. Further urodynamic studies demonstrated normal sphincteric function and autonomous bladder. Diagnosis resulted in the decision to perform an untethering operation. The patient had increased bladder compliance after surgery for untethering and has continued to be continent 16 months post-operatively. Case 2 was a 27-year old female who complained of apprehension to void and straining during urination. Radiograph demonstrated spinal disraphism below the S2 level and MRI revealed low placed conus medullaris at the level of S5 and sacral intradural lipoma. Urodynamic examination verified normal sphincteric function and autonomous bladder. After complete diagnosis, an untethering operation was performed. Post-operatively, bladder compliance and urinary sensation normalized. Furthermore, the patient spontaneously delivered a baby 3 years after having the untethering operation. |
| Databáze: | OpenAIRE |
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