X線映画による膀胱疾患の排尿運動

Abstract

The x-ray cinematography with Cinelix was applied to examine the miction motion in various urinary bladder diseases. Results summarized a s follows. 1) Normal urinary blad d er : In the cases where the inner urethral orifice is opened at the resting state and the repressing level of contrast media is located at the portion of the external sphincter muscle, no abnormality is found on shortening of the transverse diameter and prolongation of the longitudinal diameter of the bladder at miction motion, but no descent of the bladder basis is demonstrated. Many of these cases also show clear figure of the colliculus. 2) Urinary bladder diverticulum : The miction motion of the essential part of the bladder is same as the case of normal bladder but mode of miction motion of the diverticulum is altered. Namely such cases *are observed as showing absence of enlargement or reduction of the size of diverticulum during micturition or showing enlargement of the diverticulum as soon as micturition is ordered, with subsequent appearance of urinary stream at the definite enlargement of the diverticulum. The former mode is seen in cases where the diverticulum is excessively extended with absence of muscular layer, while the latter mode is seen in cases where the diverticulum has complete muscular layer of which contraction is adequately reserved. In both cases, however, the diverticulum never becomes empty so that the diverticular content flow slowly into the essential part of the bladder which is already empty after completion of micturition. 3) Urinary bladder tuberculosis : The characteris t ics of miction motion in urinary bladder tuberculosis is seen in change of the bladder neck. Namely, contractive function of the internal sphincter muscle is decreased which is resulted in opening of the inner urethral orifice. No descent of the bladder basis is also demonstrated on miction motion. Contractive function of the bladder is inadequate with occurrence of residual urine and ureteral reflux is acceralated due to increased inner pressure of the bladder. 4) Urinary bladder tumors : Motion of the bladder wall, which is no t observed with the ordinal cystography, is able to be easily demonstrated so that grade and extent of tumor infiltration are successfully estimated at miction motion. In our experiences, functional disturbance of the internal sphincter muscle and restrictive movements of the bladder basis indicate extension of infiltration over the bladder neck. 5) Neurogenic bladder : The miction motion of this disease having large hypotonic bladder, relaxed external sphincter, funnel urethra and vesico-ureteral reflux on cystographical picture (according to Ney and Duff), demonstrates inconsiderable contraction of the bladder and absence of descent of the bladder base. Despite atonic state of the bladder neck, the contrast media is refluented into the ureter due to increased bladder content which results in further manifestation of ureteral reflux.