低コンプライアンス膀胱に関する検討 : 低コンプライアンス膀胱の形態学的検討

Abstract

低コンプライアンス膀胱症例を対象に, 膀胱拡大術を施行した膀胱組織を用いて神経因性膀胱, 非神経因性膀胱症例につき比較, 検討を行った。1)その結果, 非神経因性膀胱症例ではコントロール群に比べ著明な結合織成分この増加と平滑筋成分の減少を示したが, 神経因性膀胱症例では軽度の結合織成分の増加を示したが, 平滑筋成分には著片を認めなかった。2)以上の結果より, 非神経因性膀胱症例の膀胱コンプライアンスの低下は線維化といった膀胱壁の器質的変化に伴うものであるのに対し, 神経因性膀胱症例の膀胱コンプライアンスの低下は主として膀胱壁の機能的変化に基づくものである

Low compliant bladder is an important cause of detrusor dysfunction, although its cause is unknown. Two groups of patients who developed low compliant bladder have been studied by the morphometric technique. One group consisted of patients with neurogenic low compliant bladder, and the other group consisted of patients with non-neurogenic low compliant bladder. Control materials were obtained from postmortal samples offered from the department of anatomy. Bladder wall samples were obtained during bladder augmentation surgery. Morphometric computer analysis was used to measure the proportions of connective tissue and muscle layer in the bladder wall samples. In the non-neurogenic group, there was a significant increase in connective tissue and a marked decrease in muscle layer proportion than the control group. On the other hand, there was a mild increase in connective tissue, but no decrease in muscle layer proportion was observed in patients with neurogenic low compliant bladder. Comparison of the results obtained from the two groups suggested that low bladder compliance in neurogenic patients is mainly caused by functional alteration of the bladder wall, whereas that in non-neurogenic patients is caused by an organic change of the bladder wall.