Clinical and Experimental Studies on Functional and Morphological Changes of Urinary Bladder After Pelvic Autonomic Nerve Preserving Operation

Abstract

Three types of operative procedures on pelvic autonomic nerves, i. e., bilateral-preserving, unilateral-preserving and bilateral-cutting, were applied to 26 patients with rectal cancer and 58 adult mongrel dogs. The postoperative bladder function was assessed by the degree of dysfunction determined by the results of urodynamic study. The morphological changes of urinary bladder in rectal cancer patients were studied on the findings of retrograde cystogram taken 6 months after operation. Those in dogs were done on the resected specimens.
The changes in postoperative vesical function occurred very similarly in patients and dogs. The function was well preserved, and no significant changes occurred after bilateralpreserving operation. The function was disturbed in early postoperative period, but recovered thereafter following unilateral-preserving operation. On the contrary, significant changes occurred and lasted to the end of observation period after bilateral-cutting operation. The postoperative cystogram showed the findings of widening of internal orifice and irregularity of vesical wall most remarkably in patidnts after bilateral- cutting operation. The findings were less remarkable after unilateral-preserving operation. These morphological changes were related to the occurrence of functional disorders. After bilateral-cutting operation, thickening and inflammatory changes in vesical wall of dogs were also observed most remarkably, and became prominent with the lapse of time. The morphological changes occurred probably following denervation of urinary bladder and subsequent functional disorders.
The unilateral-preserving operation was considered to be worthy of clinical application from the viewpoint of postoperative preservation of urinary bladder function.