神経因性膀胱に関する実験的研究

第7報 膀胱レ線像

抄録

Many reports on cystometrogram obtained in the cases with experimental or clinical neruogenic bladder have been presented, but associated radiographic findings were not described clearly. Therefore, neurogenic vesical dysfunction was produced experimentally in adult dogs by uni- or bilateral section of the hypogastric, the pelvic, and the pudendal nerve, and moreover uni- or bilateral section of the ventral, the dorsal, the ventral and dorsal roots of sacral nerve, and uni- or bilateral resection of the spinal ganglion of that nerve, respectively. Cystogram was obtained pre- or post-operatively in these dogs, pouring 10cc/kg of NaI solution into the urinary bladder, and it was examined to clarify the pathological physiology of neurogenic bladder concerning to the various sections of nerves innervating the urinary bladder.
The results obtained were as follows:
1) Section of the pudendal nerve:
The shape of the urinary bladder in cystogram was scarecely changed after unilateral section of this nerve, but slight transformation in cystogram was found after bilateral section of that nerve. The area of the urinary bladder reduced, suggesting the elevation of intravesical pressure following to uni- or bilateral section of the pudendal nerve. But in either case, residual urine could not be proved.
2) Section of the hypogastric nerve:
The shape of the urinary bladder in cystogram revealed almost normal findings, but the area of it slightly reduced following to the bilateral section of this nerve, despite of its normal shape.
3) Section of the pelvic nerve:
The area of the urinary bladder increased remarkably soon after the uni- or bilateral section of this nerve, suggesting a hypotonic state of the bladder. But within 4-6 weeks after the operation, cystogram became to almost normal. On the other hand, in 8-10 weeks after the bilateral section of this nerve, the shadow of the urinary bladder changed into round and vesicoureteral reflux appeared. These changes could not be found in the case with the unilateral section of this nerve.
4) Section of the unilateral (the ventral, the dorsal, or the ventral and dorsal) sacral roots, 1, 2, and 3:
In the case in which the unilateral ventral or the dorsal roots of sacral nerve were resected, the area of the urinary bladder increased temporarily soon after the nerve section. But in the case with the unilateral section of the ventral and dorsal roots as well as in the case with the unilateral resection of the spinal ganglion of sacral nerve, enlargement of shadow of the urinary bladder could not be seen. The shape of the bladder was recovered in all cases close to pre-operative state in the course of time.
5) Bilateral section of the ventral root of sacral nerves, 1, 2, and 3:
The area of the urinary bladder in cystogram enlarged after the nerve section, but contour of the bladder had smooth lining. Small wavelike countour of the bladder near the bladder neck was seen, and this had not disappeared over 6 weeks after the operation.
6) Bilateral section of the dorsal root of sacral nerves, 1, 2, and 3:
Changes in cystogram soon after the operation were very distinct, such as marked enlargement of area of the urinary bladder, such as the residual urine constantly found, and such as the overflow incontinence arised. Many dogs died by urinary infection or other causes in this time. On the other hand, in the survival cases, the bladder function recovered gradually and the shape and the area of the urinary bladder became almost close to pre-operative state.
7) Bilateral section of the ventral and dorsal roots of sacral nerves, 1, 2, and 3:
The results obtained in this case was similar to that in the case in which the section of the pelvic nerve was performed, but reduction in area of roundy shadow of the urinary bladder and dilatation of the urethral shadow was slight, compared to the latter case.
8) Bilateral resection of the spinal ganglion of sacral ner