RELATIONSHIP BETWEEN BLADDER TRIGONE AND BLADDER NECK INDUCED BY TRACTION OF AN INDWELLING BALLOON CATHETER WITH A SPRING BALANCE AND PARAMETERS OF CYSTOMETROGRAM

Abstract

Sensation of the bladder trigone and bladder neck induced by traction of an indwelling balloon catheter with a spring balance and cystometry was evaluated in 393 males and 106 females.
Male patients with an average age of 56.9±15.9 (mean±standard deviation) years old (range 17 to 88 years) were divided into 7 groups as follows: 19 patients without any micturitional disturbance, uregency and chronic prostatitis (11 patients), benign prostate hypertrophy (BPH) (131 patients), cervical or thoracic cord compression disorders (67 patients), lumbar vertebral disorders (114 patients), other peripheral nerve disorders associated with diabetes mellitus, post operative status of rectum cancer and others (27 patients) and brain diseases (24 patients). Female patients with an average age of 55.2±15.5 years old (range 17 to 88 years) were divided into 6 groups as follows: 24 patients without any neurological problems, urgency (7 patients), cervical or thoracic cord compression disorders (11 patients), lumbar vertebral disorders (37 patients), other peripheral nerve disorders (18 patients) and brain diseases (9 patients).
The observed sensation, first desire to void (FDV) and maximum cystometric capacity (MCC) were evaluated statistically in relation to clinical factors (e. g. disease group, generation and patterns of cystometrogram). The correlation between the sensation and FDV or MCC in these patients were assessed by linear regression analysis.
Sensation of normal males was 334.2±159.7g on the average and correlated well with FDV (r=0.88, y=375x-189.4). Sensation of normal females was 373.3±199.5g on the average. However, there was no correlation (r=0.35) between sensation and FDV in females.
In males, the means of sensation obtained in patients with other peripheral nerve disorders (557.3±314.5g) was significantly larger than the means of normal subjects (p<0.001), and patients with uregency and chronic prostatitis (236.4±148.3g, p<0.01), BPH (424.1±215.6g, p<0.001), cervical or thoracic cord compression disorders (349.0±229.5g p<0.001), lumbar vertebral disorders (349.7±201.7g, p<0.001) or brain diseases (490.6±305.0g, p<0.05). Furthermore, the differences in the means of sensation between BPH and lumbar vertebral disorders (p<0.05) or brain diseases (p<0.05) were statistically significant. In females, the means of sensation in patients with other peripheral nerve disorder (571.7±279.7g) was significantly larger than the means of normal subjects or patients with lumbar vertebral disorders (377.5±221.6g).
All patients were divided into three groups according to the pattern of cystometrogram. Two hundred nineteen males and 62 females, 56 males and 10 females, 116 males and 34 females had the normal, overactive, and underactive pattern, respectively. The means of sensation of 116 male patients with underactive bladder (541.5±266.6g) was significantly larger than those with normal bladder (330.9±175.6g, p<0.001) or overactive bladder (325.0±222.9g, p<0.001). However there was a significant difference only between underactive and normal bladder (p<0.001) in females. There was a good correlation (r=0.68, y=2.42x-12.33) between FDV and sensation in males with normal bladder. But, there was a poor correlation between them in males with overactive bladder (r=0.50) or with underactive bladder (r=0.41). In females, there was a good correlation (r=0.63, y=821.9-0.47x) between FDV and sensation only in the cases of overactive bladder.
In male patients, in spite of patterns of cystometrogram, the older the age was, the larger the sensation became, therefore, the bladder sensation seem to have degeneration with age.
These results suggest that the measurement of trigonal sensitivity using a spring balance is clinically useful as a screening test of underactive neurogenic bladder