X線映画による前立腺肥大症の排尿運動

Abstract

X-ray cineradiography by cinelix method was applied to observe morphological and functional changes of miction movement in patients with prostatic hypertrophy before and after operation. Miction mechanism in prostatic hypertrophy was compared to that in normal subjects. 1. Normal urinary bladder At an order of m i ction, contraction of urinary bladder with shortening of the cross diameter and elongation of the length diameter occur, followed by lowering of the base and apperance of the internal urethral orifice. Then the internal orifice gradually dilates and elongates downward with subsequent formation of urinary stream. The bladder with oval and slack shape becomes gradually strained to round shape at an order of miction and the lower triangular line is disappeared with appearance of urinary stream. Then the bladder reducts diffusely. The lowering of the base and the dilatation of the internal orifice continue until prior to the middle phase of miction and then defines at same situation. During the terminal phase of miction the base is slightly elevated. 2. Cases of prostatic hypertrophy a) Before operation : Compared to normal subjects, movements of the base is insufficient. The less or absence of the lowering of the base is observed in cases with the much residual urine. Restricted lowering and deteriorated dilatation of the internal orifice are also noted in such cases. In the experimental cases of III and IV where residual urine volume exceedes 400cc, the bladder is delayed and atonic due to insufficiency of bladder muscles, so that no change of shape is observed even with forced trial of miction. The interrupted location of contrast media is the internal orifice in all instances. b) After operation : Compare to that of before operation, the bladder reduces the size diffusely at miction without strong contraction such as shortening of the cross diameter and elongation of the length diameter. In the experimental cases III and IV where delayed and atonic bladder was noted before operation, contraction of bladder muscles became evident. In all cases, the internal orifice markedly dilates after removal of adenoma and motility of the bladder base increases, although grade of such recovery is not uniform. The internal orifice is frequently settled with opening situation so that the prostatic fossa and the connecting canal to the base are visuable even at rest and the interrupted area of contrast media locates at the site of external sphincter muscle. However as seen in the experimental case III, the site of interruption is also the internal orifice in some cases. The prostatic fossa shows slight dilatation due to filling of contrast media during most active phase of miction and slight contraction during terminal phase although such changes are minimally demonstrated. In all instances, residue of contrast media in the prostatic fossa was recognized after termination of miction.