膀胱頚部硬化症の臨床的研究

Abstract

I) The clinical features and results of various urological examinations of 22 patients with bladder neck sclerosis (BNS) and 43 patients with benign prostatic hypertrophy (BPH), who had been operated on during the past six years, were investigated in detail. II) The typical characteristics of voiding double contrast cystourethrography (VDCUG) were demonstrated in about 389 voiding double contrast cystourethrograms performed on 206 cases including the aforesaid cases, 141 outpatients diagnosed as having BNS and 28 control patients including 17 cases admitted because of other urological diseases without lower urinary tract obstruction, and 11 outpatients of infertility without lower urinary tract obstruction. III) The pathological investigation was performed on the aforesaid cases and 17 control cases consisting of 3 autopsy cases who had no urinary difficulties in their lifetime and 14 inpatients who had operations of the bladder for other urological deseases without lower urinary tract obstruction. Results were as follows : 1) The clinical features of BNS were similar to those of BPH as a cause of lower urinary tract obstruction. However, the influence on the upper urinary tract, urinary infection and trabeculation were observed less in BNS than in BPH. 2) In age distribution, BPH was found in the post 50-year-age group but BNS was found in all generations. There was an especially high incidence in the fourth decade group and also among those over 60 years old. 3) VDCUG demonstrated specific findings in BNS and in BPH respectively. 4) Cystometry showed hypotonic bladder in BNS and hypertonic bladder in BPH. 5) In both diseases, descending mobility of the bladder fundus increased with the advancement of the urinary obstruction. Hypertrophy of the middle lobe in BPH mainly hindered easy micturition. On the other hand, contracture of the bladder outlet and weakness of the vesical detrusor in BNS were the main factors in causing disturbance of urination. 6) In BNS, the forms of bladder neck in the voiding stage were classified into two types. One showed the contracture localized to the internal urethral orifice, the other showed the contracture mainly in the posterior urethra. 7) Pathologically, BNS was mainly characterized by an overgrowth of fibrous tissue in the so-called internal sphincter. Etiology of BNS may be a hormonal disorder which may result in weakness of the smooth muscle. The weakness of the internal sphincter may make it impossible to open the base plate, therefore elastic fibers may play a role for this purpose. But increasing fibers and disorders in both the structure and the arrangement of the internal sphincteric muscle bundles produce bladder neck contracture being followed by narrowness and rigidity. 8) BNS may be classified into INFANTILE TYPE and ADULT TYPE. The former may have severe symptoms with abnormalities and disorders of the upper urinary tract (congenital Marion's disease). The latter gradually advances with little influence on the excretory system.