Komine S, Yoshida K, Yamashita H, Masaki Z
Department of Surgery, Saga Medical School, Japan.
Paraplegia. 1989 Jun;27(3):217-21. doi: 10.1038/sc.1989.32.
Voiding dysfunction was evaluated in 16 of 17 patients with human T-lymphotropic virus type-1 associated myelopathy (HAM). Among 16 patients 11 had both frequency and difficulty in voiding and 12 had urge incontinence of urine. Sensation of vesical filling and voiding remained either intact or only slightly suppressed in all patients. Residual urine ranging from 50 to 320 ml was observed in 14 patients. Urodynamic studies showed in every patient an overactive bladder with involuntary detrusor contraction. Only 2 patients had detrusor sphincter synergia, 6 patients had complete detrusor sphincter dyssynergia and 8 patients had incomplete detrusor sphincter dyssynergia. An overactive bladder associated with detrusor sphincter dyssynergia and less affected vesical sensation seems to be a characteristic urodynamic finding in HAM. These results combined with other neurological findings suggest that in patients with HAM lateral columns of the spinal cord between sacral and ponsmesencephalic micturition centre are mainly affected and that the posterior columns of the spinal cord are relatively less affected.
对17例1型人类嗜T细胞病毒相关性脊髓病（HAM）患者中的16例进行了排尿功能障碍评估。16例患者中，11例有尿频和排尿困难，12例有急迫性尿失禁。所有患者膀胱充盈和排尿感觉均保持完整或仅略有减退。14例患者残余尿量为50至320毫升。尿动力学研究显示，每名患者均存在膀胱过度活动伴逼尿肌不自主收缩。仅2例患者逼尿肌括约肌协同，6例患者完全性逼尿肌括约肌协同失调，8例患者不完全性逼尿肌括约肌协同失调。膀胱过度活动伴逼尿肌括约肌协同失调以及膀胱感觉受影响较小似乎是HAM的特征性尿动力学表现。这些结果与其他神经学发现相结合表明，HAM患者中，骶部和脑桥中脑排尿中枢之间的脊髓侧柱主要受累，而脊髓后柱受累相对较轻。
