膀胱尿管逆流

Abstract

The conclusions on vesicoureteral r e flux from the study of consecutive cystograms of 76 males with injuries of spinal cord for three years may be expressed as follows. Vesicoureteral reflux in paraplegics may follow any of three courses. I t may disappear spontaneously, type 1; it may persist and be of no further consequence to the patient, type 2; or it may continue and result in progressive upper urinary tract damage, type 3. Type of reflux may be differentiated with some accuracy by "Diphemanil methy l sulfate test" and "Bethanechol chloride test" Method of the former : Bladder is filled with contrast medium 10-20 minutes after injection of dephemanil methylsulfate 25 mg. As contrast medium the authors have used Urographin 60%, a total of 40 ml. diluted with 100-120 ml. sterile water. Exposure is made 10-20 minutes after the filling. Method of the latter : Bladder is filled with contra s t medium 1-2 hours after oral administration of bethanechol chloride 200 mg and exposure is made as above described. Positive result, disappearance of reflux by autonomic drugs may suggest t he reflux to be type 1, and negative to be type 3. This classification is not always valid, and so it is expected to establish the more accurate method to differentiate them. The difference of type 2 and 3 become clear only by long te r m observations. The reflux in some cases disappear completely after the oral ad m inistration of bethanechol chloride for months. It is advisable to try such conservative therapy once at least before surgical treatment. According t o Hutch's theory the anatomical changes in the bladder wall which permit the intravesical ureter to become extravesical is assumed as the cause of reflux, and the treatment is reconstructive surgery on ureterovesical junction. This seems to be true in type 3. It is indispensable to exclude type 1 and 2 before such operation.