逆行性尿道抵抗の臨床的研究

Abstract

In a series of normal male adults and patients with neurogenic bladder due to spinal cord injury, measurement of the intraurethral pressure by continuous retrograde infusion method (RUR). According to the observation of urethrography on X-ray TV and detection by retrograde urethral infusion with 131I-containing fluid, it was suggested that the minimum retrograde urethral resistance (Min -RUR) indicated resistance of the external urethral sphincter and the posterior urethra whereas the maximum retrograde urethral resistance (Max -RUR) represented reactive contracture of the posterior uretha by retrograde infusion of the fluid. The intraurethral pressure was found to be elevated in response to bulbocavernosus reflex test during the measurement of RUR. This reflexive rise presented on the intraurethral pressure curve was designated as BCR-RUR and it was ranged from 7 to 25 mmHg (median value 14 mmHg) in the normal subjects. The data obtained were analyzed to make comparison between the patients with neurogenic bladder and the normal subjects as well as to assess relations of RUR changes to dysuria, to the effect of transurethral resection (TUR) and to the intravesical pressure and the response to anticholinergic drugs. From the effect of TUR on Max-RUR observed, it was assumed that a smooth muscular system connected with the urinary bladder might possibly take part in the control of intraurethral pressure. The response to anticholinergic agents have suggested parasympathetic innervation. The Min-RUR was frequently lowered in neurogenic bladder whilst the Max-RUR was occasionally elevated. Therefore these parameters are of rather modest diagnostic significance for assessing the site or degree of cord injury. Dysuria was frequently of a mild degree in patients showing Max-RUR values below 10 mmHg and BCR-RUR below 5 mmHg. The results indicate that determination of BCR-RUR represents a simple technique for objective and quantitative expression of BCR. Therefore this method is useful for evaluating the degree and nature of dysuria as referred to the interrelation of Max-Min-RUR and dysuria, and also a useful clinical diagnostic procedure in selecting appropriate therapy for neurogenic bladders.