脊髄損傷患者における排尿機能の研究
1970 年 61 巻 3 号 p. 243-253
詳細
1970 年 61 巻 3 号 p. 243-253
During a five year period since 1963 to 1968, two hundred paraplegics due to cord injury had been examined for their bladder function by the hydrodynamic studies, including suprapubic and retrograde cystometry and sphinctermetry.
Two types of pathological bladder function derived from upper motor neuron lesion (UMNL) and from lower motor neuron lesion (LMNL) were differentiated by conal activity test, which was chiefly examined by the bulbocavernosus reflex.
1) Reserved power of voiding was estimated by retrograde cystometry and was expressed as maximum retaining pressure (MRP). No significant difference of average MRP values between two groups of LMNL and UMNL was noted. However, there was a significant difference between the catheter-free paraplegia and catheter-life paraplegia.
2) Maximum voiding pressure (MVP) recorded by means of suprapubic cystometry was almost in normal range and there was no difference between UMNL and LMNL, although MVP was lower than MRP in those paraplegics who were able to void without catheterization. It is thought that patients with paraplegia also can void with some reserved power even though their flow rates are limited.
3) Retrograde resistance (RR) was directly examined by sphincterometry and voiding resistance (VR) was calculated from the values of MVP and MFR recorded by combined method. VR value was higher than in normal subject because of lower flow rate in paraplegics. But VR was correlative with RR in the LMNL group but not in the UMNL group.
4) A ratio of difference between MRP and MVP to MRP (%) was calculated. This was considered as the spare ability of micturition and one of the practical parameter of “efficiency of micturition”. Relation to other parameters of bladder dysfunction, such as a ratio of residual-capacity (%), excretory urography, and urinary infections were also studied and was found that the grade of bladder dysfunction was chracteristically proportional to “efficiency of micturition”.
5) Transurethral resection of bladder outlets was carried out in 33 cases. The patients whose value of efficiency of micturition were low, were well corrected for their bladder function by transurethral resection. Efficiency of micturition was considered of more effective and convenient parameter to decide the indication of TUR in paraplegia.
