低コンプライアンス膀胱に関する検討 : 膀胱血流測定の試み

Abstract

新しい組織内血流計測システムであるレーザードップラー血流計を用いて, 正常膀胱機能ボランティア, 神経因性膀胱患者および非神経因性の萎縮膀胱患者に対して膀胱伸展に伴う膀胱内圧と膀胱血流量の変化の測定を行った。1)膀胱血流量は正常膀胱であっても, 膀胱壁の伸展につれ, 膀胱内圧の増加以上にその減少が著しかった。2)神経因性膀胱患者でも膀胱コンプライアンスの良好な症例は正常膀胱と同等の膀胱血流量を示した。一方, 神経因性, 非神経因性を問わず, 低コンプライアンス膀胱症例では正常膀胱に比し, 著しい膀胱血流量の減少を示した

Laser-doppler blood flowmetry, a new instrument for measurement of tissue blood flow, was used to evaluate the changes occurring in the bladder blood flow and the intravesical pressure during bladder distension in 4 patients with normal detrusor function, 4 patients with neurogenic bladder dysfunction and one patient with non-neurogenic contracted bladder. In patients with normal detrusor function and normal compliance, the bladder blood flow relatively decreased, but the intravesical pressure was not affected by the bladder distension. On the other hand, the bladder distension in patients with low compliant bladder caused a significant decrease of the bladder blood flow and marked increase of the intravesical pressure. These observations suggest that the reduction of the bladder compliance is related to the decrease of the bladder blood flow. Furthermore, the bladder over distension and the high intravesical pressure in patients with low compliant bladder are thought to induce deterioration of bladder compliance and upper urinary tract.