Mori Ken-ichi, Noguchi Mitsuru, Matsuo Manabu, Nomata Koichiro, Nakamura Tatsufumi, Kanetake Hiroshi
Department of Urology, Nagasaki University Graduate School of Medicine, Nagasaki City, Nagasaki 852-8501, Japan.
J Neurol Sci. 2004 Jan 15;217(1):3-6. doi: 10.1016/j.jns.2003.08.004.
Patients with human T-cell lymphotropic virus type I (HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) frequently experience voiding dysfunction. In patients with HAM/TSP, the major symptoms are gait disturbance and voiding dysfunction. However, the detailed natural course of voiding function and the management of their urination has not previously been investigated. We examined the correlation between voiding function and clinical features and evaluated the management of urination, in the patients with HAM/TSP.
The voiding function of 47 patients (7 males, 40 females, aged 29-89 years, mean: 60.9 years) with HAM/TSP was analyzed retrospectively. All HAM/TSP patients are positive for HTLV-1. Patients were referred to a neurologist for analysis of bladder function. In the present study, we analyzed their clinical details, age at disease onset, voiding function and alterations in the management of their urination. Furthermore, we investigated the relationship between urological management and the clinical features of HAM/TSP.
Of the 47 patients, 20 (42.5%) were able to void with or without drug therapy. Thirty-four (72.3%) experienced clean intermittent self-catheterization (CIC), with 25 of these 34 continuing CIC, 7 changing to voiding and 2 changing to management with the Foley catheter. No relationship was noted between disruption of voiding function and either age or gender. However, significant inverse correlation was observed between the age at disease onset and the time to CIC (r=-0.77, P=0.00001).
These data suggest that the younger a patients is at HAM/TSP onset, the longer voiding function will be maintained.
I型人类嗜T淋巴细胞病毒（HTLV-I）相关脊髓病/热带痉挛性截瘫（HAM/TSP）患者常出现排尿功能障碍。在HAM/TSP患者中，主要症状为步态障碍和排尿功能障碍。然而，排尿功能的详细自然病程及其排尿管理此前尚未得到研究。我们研究了HAM/TSP患者排尿功能与临床特征之间的相关性，并评估了排尿管理情况。
回顾性分析47例（男性7例，女性40例，年龄29 - 89岁，平均60.9岁）HAM/TSP患者的排尿功能。所有HAM/TSP患者HTLV-1均呈阳性。患者被转诊至神经科医生处进行膀胱功能分析。在本研究中，我们分析了他们的临床细节、发病年龄、排尿功能以及排尿管理的变化。此外，我们还研究了泌尿外科管理与HAM/TSP临床特征之间的关系。
47例患者中，20例（42.5%）在接受或未接受药物治疗的情况下能够自行排尿。34例（72.3%）患者进行了清洁间歇性自家导尿（CIC），其中34例中的25例继续进行CIC，7例改为自行排尿，2例改为使用Foley导尿管进行管理。排尿功能障碍与年龄或性别之间均未发现相关性。然而，观察到发病年龄与开始CIC的时间之间存在显著的负相关（r = -0.77，P = 0.00001）。
这些数据表明，HAM/TSP发病时患者年龄越小，排尿功能维持的时间越长。
