著者
福井 準之助
出版者
社団法人 日本泌尿器科学会
雑誌
日本泌尿器科學會雑誌 (ISSN:00215287)
巻号頁・発行日
vol.68, no.4, pp.337-362, 1977 (Released:2010-07-23)
参考文献数
48
被引用文献数
2

Using a 6-channel polygraph, the age- and sex-bound difference of the mechanism of urination in normal children was studied through simultaneous measurement of the intra-vesical pressure, intraurethral pressure, intra-abdominal pressure, tone of the anal sphincter, EMG recording of the anal sphincter, and urinary flow rate.As the results of examination on the apparatus and method of measurement (Fig. 1), instrument for measurement (Fig. 2-1, 2, Fig. 3-1, 2), errors in measurement and method of correction (Fig. 4, Fig. 5-1, 2, 3, 4, Fig. 6-1, 2), the author was convinced of the sufficient feasibility of measurement by this method.Based on the wave patterns on urination of 6 factors of urination obtained by the methods described above, 35 parameters of urination were determined. These consisted of 25 parameters directly obtained by the measurement and 14 complex parameters obtained by synthesis of the former parameters (Fig. 7-1, 2).In 98 normal children, 43 boys and 55 girls (Table 1), these parameters were measured and statistically analyzed by student's t-test (Table 2-3). The purpose of this treatment consists of (1) establishment of normal criteria in the hydrodynamic tests of urinary flow in obstructive diseases of the lower urinary tract and (2) evaluation of the degree of completion of the mechanism of urination with advancing age and the functional difference of the lower urinary tract between males and females.The following conclusions were drawn.1) Results of measurement of these parameters in normal children of various ages are shown in Tables 2 and 3.2) Pelvic floor (striated musculature) appears to develop regardless of the sex difference (Table 4).3) Contraction or process of contraction of the detrusor muscle appears to be constant since birth regardless of age and sex (Table 4).4) Regardless of the age, parameters with male to female difference appear to reflect the anatomical and functional differences of the lower urinary tract between males and females.The following results were obtained from the analysis of wave patterns on urination of 6 factors of urination (Fig. 7-Fig. 10).1) A mild rise is noted in the wave pattern of the intra-abdominal pressure during the period of urination in girls but none at all in boys.2) The wave pattern of the intra-urethral pressure suddenly rises after the urinary inflow into the urethra, followed by a monophasic or occasionally biphasic smooth parabolic pattern.3) After a mild rise 2-3 seconds prior to urination, the wave pattern of the intra-vesical pressure rapidly rises simultaneously with the opening of the bladder neck, with the height somewhat larger than the wave pattern of the intra-urethral pressure.4) The wave pattern of the tone of the anal sphincter starts to fall 3 seconds prior to the beginning of urination. The low value persisted throughout the period of urination, followed by a rise soon after the end of urination.5) The EMG of the anal sphincter is similar to the wave pattern of the tone of the anal sphincter. Electrically silent state is seen from before urination and persisted for some time after urination, followed by increases in amplitude and discharge frequency.6) The wave pattern of the urinary flow rate assumes a smooth bell-like shape.The following wave patterns were demonstrated under special conditions.1) Cases with pain in urination (Fig. 11-1, 2, 3).2) Cases with maximum restraint on urination (Fig. 12).3) Wave patterns on voluntary interruption of urination (Fig. 13).4) Wave patterns on efforts of urination with empty bladder (Fig. 14).5) EMG recorded separately from the right and left side in order to evaluate the attitude of contraction of the right and left anal sphincters (Fig. 15).Studies were also made on the difference of EMG wave patterns between the surface electrode and needle electrode method (Fig. 16), the role of the pelvic floor during the peri
著者
福井 準之助
出版者
社団法人 日本泌尿器科学会
雑誌
日本泌尿器科學會雑誌 (ISSN:00215287)
巻号頁・発行日
vol.68, no.11, pp.1046-1071, 1977-11-20 (Released:2010-07-23)
参考文献数
74

Voiding urodynamic studies (V. U. D.) were performed in a series of 75 children with infravesical obstruction other than neurogenic bladder by simultaneously recording the abdominal pressuer, urethral pressure, vesical pressure, anal sphincter tone, electromyograms (EMG) of the anal sphincter and urinary flow rate with a 6-channel polygraph. In addition, patients were tested for sacral nerve reflex wherever deemed necessary by means of urethral pressure profile (U. P. P.) and anal sphincter EMG. Through statistical analysis (by the student t-test) of data obtained for 35 voiding parameters in the V. U. D., attempts were made to clarify the voiding urodynamic characteristics in various disease states as well as to characterize the tracing patterns of individual voiding factors. The results obtained are as follows.1) Urethral hypertoniaUrethral hypertonia with spasms of the pelvic floor musculature: Both in males and females, urethral resistance was increased during micturition due to spastic pelvic floor musculature. In spite of consequent application of abdominal contraction in the facilitation of voiding, a lowered urinary flow rate and protracted urination were noted (Table 2-A). The voiding urodynamic pattern seen in this group of patients was characterized by elevation of urethral pressure and emergence of spikes in the tracing of anal sphincter tonus during urination with concomitant increments of spike discharge and increased amplitude in the anal sphincter EMG (Figs. 3-a and 3-b).Urethral hypertonia without spasms of the pelvic floor musculature: Voiding was apparently aided by the abdominal muscular contraction to overcome the increased posterior urethral resistance, yet, the urinary flow rate remained low. Vesical after-contraction was fairly frequent in this group of patients, and this finding is of particular note when viewed with respect to the detrusor-urethral smooth muscle organization. No significant difference could be observed for any voiding parameter between females in this group and a normal female control group (Table 2-A), and a greater pressure was noted to be required in males than in females for dilatation of the posterior urethra (Table 2-B). In the polygraphic tracing of voiding urodynamics, a normal relaxation of the pelvic floor muscles, increased vesical and urethral pressure and a lowered urinary flow rate were evident during urination (Figs. 4-a and 4-b-i, ii and iii).2) Congenital bladder neck obstructionCongenital bladder neck obstruction with spasms of the pelvic floor musculature: The condition in this group of patients was characterized by stenoses in the two areas of the urinary tract, i. e. the bladder neck and the posterior urethra (chiefly the membranous urethra), with a greater loss of energy at the former site in voiding. A high vesical pressure is eventually required to facilitate urination by overcoming augmented resistance at these sites (Table 2-A). The study has revealed a greater pressure was required to open the posterior urethra in males than in females (Table 2-B). There was evidence for elevation of vesical pressure and only a slight increase of urethral pressure; hence a noticeable difference between these pressures. The tracing of anal sphincter tonus showed spikes during voiding. Coinciding with them were interference waves in the EMG of anal sphincter. The urinary flow rate remained low (Fig. 6-i and 6-ii).Congenital bladder neck obstruction without spasms of the pelvic floor musculature: Energy loss associated with urination occurred primarily in the bladder neck, the condition requiring a high intra-abdominal pressure to open this region of the urinary tract. There was also a high vesical pressure required to facilitate completion of voiding by overcoming the increased resistance of bladder neck. Patients showed low urinary flow rates (Table 2-A). Polygraphic tracings showed a remarkably elevated vesical pressure with a peak in the initial cour
著者
福井 準之助
出版者
社団法人 日本泌尿器科学会
雑誌
日本泌尿器科學會雑誌 (ISSN:00215287)
巻号頁・発行日
vol.67, no.6, pp.417-438, 1976-06-20 (Released:2010-07-23)
参考文献数
64

Simultaneous measurements of the voiding factors: vesical pressure, urethral pressure, intraabdominal pressure, tone of anal sphincter, E. M. G. of anal sphincter including external urethral sphincter partially and flow rate or velocity were made by using a six channel polygraph. The values of measurement and patterns of voiding factors were analyzed and their correlation was studied to make clear characteristics of the voiding mechanism of normal status and obstructive diseases.This report centers about the urinary flow rate in many voiding factors. Ultrasonic Doppler flowmeter is used for the measurement of urinary flow rate. The principle, structure of the flowmeter (Fig. 2-1, 2-2), the conditions of measuring technique (Fig. 4), the method of calibration (Fig. 6, 7, 8, 10), the limit of this method due to the error of measurement (Fig. 11) and the parameters which could be determined by this method (Fig. 12) were discussed.It was concluded that this apparatus was probably useful to measure the urinary flow rate and velocity nonobstructively.Fourteen parameters were taken from the relation between the urinary flow rate and vesical pressure.Based on those, the correlation by T-test between normal boys and girls, high and low voiding voumes, normal and abnormal subjects with lower urinary tract obstructive disorder including neurogenic bladder were investigated.The result1) The correlation between normal boys and girls.It was found that the effect of vesical pressure was immediately refected on urinary flow rate in girls. It was suggested that it is due to the specific anatomical and functional characters of the urethra in girls.2) The correlation between normal and disordered subjects in lower urinary tract.It was known that the energy, which was lost at the lower urinary tract in the latter, was extremely large. The average energy loss was in the order of neurogenic bladder, congenital bladder neck obstruction and urethral hypertonia.When the paper speed was kept constant, the urinary flow rate curve appeared as below (Fig. 13, 14, 15, 16).Normal subject: bell type waveStenosis of external urethral meatus: spike waveUrethral hypertonia: Plateau wave or plateau and spike waveCongenital bladder neck obstruction: plateau wave or plateau and spike waveNeurogenic bladder:Brain bladder: bell or plateau waveCord bladder:Automatic type: hill type and spike waveAutonomous type: intermittent serrated waveThe waves are changeable under the influence of urine output and catheters for vesical and urehtral pressure measurements. The classification according to the patterns is also only a supplementary method.
著者
福井 準之助
出版者
社団法人 日本泌尿器科学会
雑誌
日本泌尿器科學會雑誌 (ISSN:00215287)
巻号頁・発行日
vol.77, no.5, pp.707-710, 1986-05-20 (Released:2010-07-23)
参考文献数
8
被引用文献数
1

18歳から88歳までの952名の健康女性に対し, 尿失禁についてのアンケートを配布した. 分析の結果, 32%の女性に尿失禁が認められ, 未産婦では19%, 経産婦では41%に尿失禁が存在した. 40歳以後の経産婦では, 尿失禁の発現頻度が40歳未満の女性より有意に高率であった. 閉経, 夜尿の既往, 尿路感染の既往, 排尿症状等の有無と尿失禁との関係を調べたが有意差がなかった. 尿失禁の発生機序はほとんどが腹圧性尿失禁と考えられた.
著者
福井 準之助 山口 建二 仲間 三雄 富田 康敬 原田 勝弘 小俣 和一郎
出版者
社団法人日本泌尿器科学会
雑誌
日本泌尿器科學會雜誌 (ISSN:00215287)
巻号頁・発行日
vol.76, no.10, pp.1561-1566, 1985-10-20

71歳,16歳,23歳女性に生じた3例の心因性尿閉を報告する.全症例共,神経学的検査で異常なく,器質的下部尿路閉塞も認められなかった.2症例で尿閉は"emotional stress"の後に生じた.症例1では両側VURと軽度の肉柱形成膀胱を認めたが,症例2と症例3では通常の泌尿器科検査では異常がなかった.全症例で膀胱容量は500ml以上で尿流動態検査にて排尿中の外括約筋のaction potentialの増大を認めた.精神科的考察では,症例1はdepressionの1つの型であり,抗うつ剤の投与で尿路症状の改善をみた.症例2はヒステリーであり,精神安定剤と自律神経訓練法により尿路症状の改善をみた.症例3は神経分裂病によるもので,種々の治療に対し抵抗性であった.結婚と共に症状の消失をみたが,その後離婚し,再び残尿の増大を認められた.心因性尿閉の治療は,泌尿器科医と精神科医との協力の下でなされるべきである.