水腎水尿管症における尿管運動のレ線キモグラフィーによる研究 殊に手術後の尿管運動の恢復について

Abstract

In hydronephrosis and hydroureter, the movement of t he renal pelvis and the ureter (especially the latter) was investigated by X-ray kymography before and after surgery to eliminate urinary obstruction. For the kymography , retrograde pyelography as adopted in most cases and intravenous pyelography in some cases. With Raster movable instrument, X-ray exposure was made every 6", 12" or 23" according to the condition of each case. The results were as follows : 1) In normal upper urinary tract, period of contraction (p), velocity of peristalsis (v), ratio of contraction (r), and phase of contraction (c) were as described in Tab. 2. 2) In the slightly dilated renal pelvis and ureter due to ureteral calculus, slight or no movement was recognized in most cases. No hyperkynesia was seen at least. Two weeks to one month after ureterolithotomy, their movement generally returned normal (Fig. 2). 3) The patients with ureteral calculus, whom 20 mg of Buscopan was given subcutaneously, showed that the ureter became most hypotonic with abated movement ten minutes after administration. (Fig. 3.) This effect produced by Buscopan was especially remarkable on the affected side. 4) In hydroureter and h ydronephrosis of moderate to comparatively severe grade, the movement of the renal pelvis was slight or unrecognized. In case of acquired hydroureter, velocity of the wave returned nearly normal 2 months after ureteral obstruction was eliminated by plastic surgery or by ureterolithotomy (Fig. 6, 7). In cases of congenital type of hydroureter, on the other hand, the moveme n t showed no remarkable improvement even 8 months after the operation. 5) In five cases out of eight hydronephrosis and h ydroureter, the movement of the renal pelvis and the ureter was slight or quite absent. In these cases, the shape and movement of the renal pelvis and ureter were restored in accordance with improvement of the ureteral passage following operations. Both contraction ratio and speed of peristaltic movemet, however, took a pretty long time before they returned to nearly normal value. In cases in which the contraction was recognized by kymography before the operation, sufficient result was obtained, showing recovery 2-5 weeks after the operation. 6) In cases with nephrostomy, hydronephrosis and hydroureter soon improved, the pelvic and ureteric movement showed quick recovery. There were no cases in which inactive atrophy of the ureter occurred. 7) In cases with intubated ureterostomy for 2-3 months, hyperkinesis of the renal pelvis and hypokinesia of the ureter resulted.