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

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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