Yamada Toru, Ogura Takako, Masue Naruyasu, Nishino Yoshinori, Takahashi Yoshito, Ishihara Satoshi, Deguchi Takashi
Department of Urology, Gifu University School of Medicine.
Hinyokika Kiyo. 2003 Jul;49(7):393-6.
We report a case of urinary retention complicated with acute transverse myelitis caused by Mycoplasma pneumoniae. A 16-year-old man visited a clinic because of urinary retention, fever, muscle weakness and sensory disturbance of lower extremities. He was referred to our hospital for further examination. He was diagnosed with acute transverse myelitis due to M. pneumoniae infection based on cerebrospinal fluid examination, serum titer of antibody to M. pneumoniae and magnetic resonance imaging. He was treated with corticosteroids for acute myelitis. A urethral catheter was indwellt for urinary retention. His muscle strength and sensory of lower extremities improved after 2 months of treatment, and he was discharged from our hospital. However, since urinary frequency, urge incontinence and weak urinary stream persisted, he was referred to us for further examination. A pressure-flow study examination showed a decreased maximum urinary flow rate and the findings of detrusor sphincter dyssnergia. We diagnosed him with uninhibited bladder and detrusor sphincter dyssnergia. We administered propiverine hydrochloride and imipramine hydrochloride, and his symptoms subsided significantly. Now, (8 months) after this medication, he still has incontinence at night.
我们报告一例由肺炎支原体引起的尿潴留并发急性横贯性脊髓炎的病例。一名16岁男性因尿潴留、发热、下肢肌无力和感觉障碍前往诊所就诊。他被转诊至我院作进一步检查。根据脑脊液检查、肺炎支原体抗体血清滴度及磁共振成像,他被诊断为肺炎支原体感染所致的急性横贯性脊髓炎。针对急性脊髓炎,他接受了皮质类固醇治疗。因尿潴留留置了尿道导管。治疗2个月后,他下肢的肌力和感觉有所改善,并从我院出院。然而,由于尿频、急迫性尿失禁和尿流无力持续存在,他被转诊至我院作进一步检查。压力-流率研究检查显示最大尿流率降低及逼尿肌括约肌协同失调的表现。我们诊断他患有膀胱无抑制和逼尿肌括约肌协同失调。我们给予盐酸丙哌维林和盐酸丙咪嗪治疗,其症状明显缓解。目前,在用药(8个月)后,他夜间仍有尿失禁。