排尿障害の臨床的研究

Abstract

In order to investigate vesical function and analyse nature of voiding in adults both normal and with impaired micturition, the following studies were made. Measurement of the urethral resistance in a simplified voiding method and uroflometric studies were carried out on 80 healthy male adults, 64 benign prostatic hyperplasia and 10 urethral strictures before and after treatments. Continuous retrograde cystometry was also performed on 30 healthy adults, 10 cerebral bladder, 20 spinal bladder, and 5 peripheral bladder under the loading of autonomic nerve drugs. A. Results 1. Urethral resistance of healthy male adults was 0.60 cmH[2]O/m1[2]2/sec[2] in average according to the simplified voiding method. In prostatic hypertrophy, it was much greater than normal but decreased to almost normal value after surgery. 2. Uroflometric examinations on healthy adult males showed the lowest urethral resistance 0.24 mmHg/ml[2]/sec[2], initial intravesical pressure 54.9 mmHg, maximum voiding pressure 58.8 mmHg, and maximum flow rate 16.4 ml/sec in average. In prostatic hypertrophy and urethral stricture, the minimum urethral resistance and intravesical pressure were higher and the maximum flow rate was lower than normal, and these values returned about normal after treatment. In urethral stricture, however, the intravesical pressure generally remained higher than that in prostatic hypertrophy even after urethral dilatation. 3. Continuous retrograde cystometry under administration of autonomic nerve drugs showed that normal or cerebral bladder scarecely responded to these drugs. In cerebral bladder, vesical capacity was greater and the maximum voluntary pressure was strikingly lower than values observed in normal bladder. On the other hand, spinal or peripheral bladder responded to these drugs. Injection of Buscopan® produced a low and that of bethanechol chloride a high cystometric curve. These responses seemed to be most striking at the time of maximum vesical capacity in spinal bladder and at the beginning of intravesical infusion in peripheral bladder. Vesical capacity was also affected by these drugs in spinal bladder and much less in peripheral bladder. B. Clinical significance of the urodynamic examinations. 1. The simplified measurement of urethral resistance is clinically useful as a screening method to evaluate the lower urinary tract obstruction. 2. Urofiometric examinations enable us to know grade and nature of the obstruction more accurately and concretely than the above, and they give us clinically useful informations as to treatment and its evaluation. 3. Continuous retrograde cystometry under administration of autonomic nerve drugs is also helpful in diagnosis and clinical judgment of neurogenic bladder.