臨床泌尿器科71巻8号

2017年07月発行

綜説

小児尿失禁

著者： 野口満¹

所属機関： ¹佐賀大学医学部泌尿器科

ページ範囲：P.559 - P.566

文献概要

要旨

　小児の昼間尿失禁は，排尿障害，尿路感染症，腎機能障害の症状のほか，患児の精神的負担も夜尿症より大きい．治療介入は排尿が自立した5歳以降となる．病態把握と診断のためDVSS（dysfunctional voiding symptom score）などの問診票を利用し，排尿状況を聞き取るほか，排便状況や精神的・心因的問題も拾い上げる．初期評価は膀胱部エコー，尿流量検査，残尿測定など，侵襲性のない検査が行われる．治療は，尿失禁を来しうる併発疾患があればそれを加療し，なければurotherapyが第一選択となる．治療抵抗性であれば薬物療法を併用するが，器質的疾患の可能性も念頭に置かねばならない．

参考文献

1） Chen JJ, Mao W, Homayoon K, et al : A multivariate analysis of dysfunctional elimination syndrome, and its relationships with gender, urinary tract infection and vesicoureteral reflux in children. J Urol 171 : 1907─1910, 2004

2） Bulum B, Özçakar ZB, Kavaz A, et al : Lower urinary tract dysfunction is frequently seen in urinary tract infections in children and is often associated with reduced quality of life. Acta Paediatr 103 : e454─e458, 2014

3） Grzeda MT, Heron J, von Gontard A, et al : Effects of urinary incontinence on psychosocial outcomes in adolescence. Eur Child Adolesc Psychiatry 26 : 649─658, 2017

4） Bower WF : Self-reported effect of childhood incontinence on quality of life. J Wound Ostomy Continence Nurs 35 : 617─621, 2008

5） Chang SJ, Van Laecke E, Bauer SB, et al : Treatment of daytime urinary incontinence : A standardization document from the International Children's Continence Society. Neurourol Urodyn 36 : 43─50, 2017

6） Lebl A, Fagundes SN and Koch VH : Clinical course of a cohort of children with non-neurogenic daytime urinary incontinence symptoms followed at a tertiary center. J Pediatr （Rio J） 92 : 129─135, 2016

7） Sureshkumar P, Jones M, Cumming R, et al : A population based study of 2,856 school-age children with urinary incontinence. J Urol 181 : 808─815, discussion 815─816, 2009

8） Chung JM, Lee SD, Kang DI, et al : Prevalence and associated factors of overactive bladder in Korean children 5-13 years old : a nationwide multicenter study. Urology 73 : 63─67, discussion 68─69, 2009

9） Kajiwara M, Inoue K, Kato M, et al : Nocturnal enuresis and overactive bladder in children : an epidemiological study. Int J Urol 13 : 36─41, 2006

10） Farhat W, Bägli DJ, Capolicchio G, et al : The dysfunctional voiding scoring system : quantitative standardization of dysfunctional voiding symptoms in children. J Urol 164 : 1011─1015, 2000

11） 今村正明, 碓井智子, 上仁数義, 他 : 日本語版DVSS （Dysfunctional Voiding Symptom Score） の公式認証─小児質問票における言語学的問題を中心に. 日泌尿会誌105 : 112─121, 2014

12） Burgers RE, Mugie SM, Chase J, et al : Management of functional constipation in children with lower urinary tract symptoms : report from the Standardization Committee of the International Children's Continence Society. J Urol 190 : 29─36, 2013

13） Koppen IJ, von Gontard A, Chase J, et al : Management of functional nonretentive fecal incontinence in children : Recommendations from the International Children's Continence Society. J Pediatr Urol 12 : 56─64, 2016

14） van Engelenburg-van Lonkhuyzen ML, Bols EM, Benninga MA, et al : Bladder and bowel dysfunctions in 1748 children referred to pelvic physiotherapy : clinical characteristics and locomotor problems in primary, secondary, and tertiary healthcare settings. Eur J Pediatr 176 : 207─216, 2017

15） Heron J, Grzeda MT, von Gontard A, et al : Trajectories of urinary incontinence in childhood and bladder and bowel symptoms in adolescence : prospective cohort study. BMJ Open 7 : e014238, 2017

16） Chumpitazi BP, Lane MM, Czyzewski DI, et al : Creation and initial evaluation of a Stool Form Scale for children. J Pediatr 157 : 594─597, 2010

17） Joinson C, Heron J and von Gontard A : Psychological problems in children with daytime wetting. Pediatrics 118 : 1985─1993, 2006

18） von Gontard A, Baeyens D, Van Hoecke E, et al : Psychological and psychiatric issues in urinary and fecal incontinence. J Urol 185 : 1432─1436, 2011

19） Lopes I, Veiga ML, Braga AA, et al : A two-day bladder diary for children : Is it enough? J Pediatr Urol 11 : 348.e1─4, 2015

20） Deshpande AV, Craig JC, Smith GH, et al : Management of daytime urinary incontinence and lower urinary tract symptoms in children. J Paediatr Child Health 48 : E44─52, 2012

21） Nevéus T, von Gontard A, Hoebeke P, et al : The standardization of terminology of lower urinary tract function in children and adolescents : report from the Standardisation Committee of the International Children's Continence Society. J Urol 176 : 314─324, 2006

22） Leung VY, Chu WC, Yeung CK, et al : Nomograms of total renal volume, urinary bladder volume and bladder wall thickness index in 3,376 children with a normal urinary tract. Pediatr Radiol 37 : 181─188, 2007

23） Yeung CK, Sreedhar B, Leung VT, et al : Ultrasound bladder measurements in patients with primary nocturnal enuresis : a urodynamic and treatment outcome correlation. J Urol 171 : 2589─2594, 2004

24） Cvitković-Kuzmić A, Brkljacić B, Ivanković D, et al : Ultrasound assessment of detrusor muscle thickness in children with non-neuropathic bladder/sphincter dysfunction. Eur Urol 41 : 214─218 ; discussion 218─219, 2002

25） Kuhn S, Natale N, Siemer S, et al : Clinical differences in daytime wetting subtypes : urge incontinence and postponed voiding. J Urol 182 : 1967─1972, 2009

26） Loening-Baucke V : Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood. Pediatrics 100 : 228─232, 1997

27） Dohil R, Roberts E, Jones KV, et al : Constipation and reversible urinary tract abnormalities. Arch Dis Child 70 : 56─57, 1994

28） Bachmann CJ, Heilenkötter K, Janhsen E, et al : Long-term effects of a urotherapy training program in children with functional urinary incontinence : a 2-year follow-up. Scand J Urol Nephrol 42 : 337─343, 2008

29） Van den Broeck C, de Mettelinge TR, Deschepper E, et al : Prospective evaluation of the long-term effects of clinical voiding reeducation or voiding school for lower urinary tract conditions in children. J Pediatr Urol 12 : 37.e1─6, 2016

30） Van Laecke E, Raes A, Vande Walle J, et al : Adequate fluid intake, urinary incontinence, and physical and/or intellectual disability. J Urol 182 : 2079─2084, 2009

31） Arlen AM : Dysfunctional Voiders-Medication Versus Urotherapy? Curr Urolo Rep 18 : 14, 2017

32） Tugtepe H, Thomas DT, Ergun R, et al : Comparison of biofeedback therapy in children with treatment-refractory dysfunctional voiding and overactive bladder. Urology 85 : 900─904, 2015