尿路通過障害に関する臨床的研究 --膀胱内圧,排尿力,腎機能検査について--

Abstract

Cystometric and uroflometric studies were performed to evaluate the bladder function in the cases suffering from bladder outlet dysfunction. The recovery of renal function and the site of altered nephron function 1ll the cases of postrenal oliguria were also studied. The results obtained were as follows; 1. The normal cystometric curve showed a gradual increase in pressure at a constant rate to the point of sensation of the first de3ire to void with a fluid content of 140ml recording 9 mmHg resting pressure. The maximum desire to void was recorded with a fluid content of 265 ml as the filling continued. 2. The supranuclear lesions located anywhere above the sacral cord were characterized by the presence of hypertonic pattern, while the nuclear or infra nuclear lesions located in the sacral cord, cauda equina or pelvic nerves demonstrated hypotonic pattern. 3. The effect of the cholinergic and anticholinergic drugs on the normal urinary bladder is little but characteristic on the neurogenic bladder. Hypertonic neurogenic bladders tend to be hypotonic following the administration of anticholinergics, on the contrary, hypotonic neurogenic bladders are apt to be hypertonic by the administration of cholinergics. 4. Uroflometric studies on normal adults were carried out. Reliable recordings were required with voided volume of 100 to 300 ml. The maximum voiding rate (MVR) over 20 ml /sec with voiding time (VT) below 20 seconds was thought to be normal range. 5. Age-grouped studies of uroflometry showed the decrease of MVR and average voiding rate (AVR) as well as the prolongation of VT along with increasing age. The result implies the physiological decrease in the flow rate. 6. Decrease of MVR and A VR, and the prolongation of VT were prominent in the obstructive uropathy such as prostatic hypertrophy and urethral stricture. Uroflometry might be valuable as a diagnostic aid and as a means of evaluation of the effect following treatment. 7. A study on the recovery of the renal function based on observation in seven cases of postrenal oliguria was attempted by using author's criteria which consisted of routine renal function tests. 8. The correlation of recovery rate was studied with (3) duration of obstruction, (b) required days BUN and creatinine recovered to normal range after diuresis and (c) urine volume after diuresis. According as (a) and (b) decreased, the recovery rate became higher. However, no direct correlation with (c) was observed. 9. Renal function test herein adopte are divided into those which mainly concern cortical function and those which chiefly concern medullary function. The consequence of analytical studies of nephron function following diuresis on cases whose renal function was severely damaged, was uncertain and rather complicated. 10. Although the criteria to evaluate the renal function is not completed yet, the method would be useful to observe the degree of the renal lesion and the process of the recovery.