Boy Sönke, Reitz André, Curt Armin, Schurch Brigitte
Balgrist University Hospital, Swiss Paraplegic Center, Zürich, Switzerland.
Nat Clin Pract Urol. 2005 Apr;2(4):199-204; quiz 1 p following 204. doi: 10.1038/ncpuro0140.
A 68-year-old man presented with a history of significant urinary urge incontinence, pollakiuria, and weak bladder sensation. He also reported mild fecal incontinence and a hypotrophic and slightly weaker left leg. At 63 years of age he had presented to a urologist for treatment of irritative lower urinary tract symptoms and incontinence. A transurethral resection of the prostate had been performed. After the operation, the symptoms had persisted and the incontinence seriously worsened.
Clinical neurologic examination, videourodynamic examination, neurophysiologic examination, and MRI of the spinal cord.
Neurogenic bladder dysfunction caused by adult tethered cord syndrome with myelon up to S2 level, spina bifida occulta, and lipoma infiltrating the conus medullaris.
Conservative anticholinergic treatment failed, and injection of botulinum-A toxin is planned.
一名68岁男性，有明显的尿急失禁、尿频及膀胱感觉减弱病史。他还报告有轻度大便失禁以及左腿萎缩且稍显无力。63岁时，他曾因刺激性下尿路症状及失禁就诊于泌尿科医生。当时进行了经尿道前列腺切除术。术后，症状持续存在，且失禁情况严重恶化。
临床神经学检查、影像尿动力学检查、神经生理学检查以及脊髓磁共振成像。
成人脊髓栓系综合征导致的神经源性膀胱功能障碍，脊髓病变达S2水平，隐性脊柱裂，脂肪瘤浸润圆锥。
保守抗胆碱能治疗失败，计划注射A型肉毒毒素。
