Nofuji Seisuke, Kyoda Yuki, Fukuta Fumimasa, Kobayashi Ko, Wanifuchi Atsushi, Shinkai Nobuo, Ichihara Koji, Tanaka Toshiaki, Masumori Naoya
The Department of Urology, Sapporo Medical University School of Medicine.
Hinyokika Kiyo. 2021 Mar;67(3):109-112. doi: 10.14989/ActaUrolJap_67_3_109.
A 44-year-old man was carried to the hospital in an ambulance because of dyspnea, paralysis and dysuria after signs of the flu. Acute encephalomyelitis was diagnosed by examination of magnetic resonance imaging. Antimicrobial treatment and respirator management was carried out with indwelling of urethral catheter for urinary retention. After improvement of encephalitis, the urethral catheter was removed. However, he still needed medical care because of persistent lower urinary tract symptoms. He complained of urge incontinence and urination frequency. Decrease of functional bladder capacity was noticed in a frequency volume chart. After consulting with our neurologist, acute transverse myelitis was diagnosed from imaging and neurological findings. Pressure flow study (PFS)demonstrated detrusor overactive during the filling phase and insufficient contractility during the voiding phase. We reached the diagnosis of detrusor hyperactivity with impaired contractility (DHIC). We did not introduce clean intermittent catheterization but used the mirabegron instead. Although storage symptoms did not improve on the mirabegron monotherapy, the symptoms improved by solifenacin added. There is a possibility that combination therapy with mirabegron and solifenacin is effective for DHIC.
一名44岁男性因流感症状出现后出现呼吸困难、瘫痪和排尿困难，被救护车送往医院。通过磁共振成像检查诊断为急性脑脊髓炎。进行了抗菌治疗和呼吸管理，并因尿潴留留置了尿道导管。脑炎好转后，拔除了尿道导管。然而，由于持续的下尿路症状，他仍需要医疗护理。他主诉急迫性尿失禁和尿频。在频率-容量图中发现功能性膀胱容量减少。在咨询我们的神经科医生后，根据影像学和神经学检查结果诊断为急性横贯性脊髓炎。压力流研究（PFS）显示充盈期逼尿肌过度活跃，排尿期收缩力不足。我们诊断为逼尿肌收缩力受损的逼尿肌活动亢进（DHIC）。我们没有采用清洁间歇性导尿，而是使用了米拉贝隆。尽管米拉贝隆单药治疗时储尿症状没有改善，但加用索利那新后症状有所改善。米拉贝隆和索利那新联合治疗对DHIC可能有效。
