Abstract
Corelation between cystoscopic examination and urine cultures and their relation to clinical symptoms were observed in 490 cases of patients with diseases of the urinary bladder seen at Urology department of Juntendo University Hospital in the last 5 years.
1. Incidence of bladder diseases was significantly higher in females with the ratio of 2.24 : 1 when compared with male patients. This fact is beliebed to be due to anatomic and physiologic differences in sexes. However in patients under 10 years of age, a higher rate was seen in males.
2. Seasons : There was little change in male cases outside of January but in female cases the months of June, July and August was especially high and showed a rate of 34.6 percent.
3. Age : The highest rate was seen between twenty to thirty years of age in females.
4. Bacteria : Coli group was highest followed by staphylococci.
5. No specific mucus membrane changes were seen in bladders infected by the coli group.
6. Cystitis from staphylococcus albus showed distnict characteristic membrane changes. The infection was generalized and the membrane showed distinctive hemorrhagic spots and reddening due to capillary dilatation and engorgement.
7. Fungus infections did not show specific membrane changes. Relatively higher age group (av. 39.75) was infected and was rarely seen in summer months but mostly between october and march.
8. Cystitis of the trigone was most frequency encountered and in 940 cases, 134 cases were seen. It was mostly seen in female cases with 115 cases seen compared to 18 male cases (1 : 6.4).Those in the marriaging age group and of sexually mature group of 20 age group and 30 age group showed highest incidence. Of 134 cases, 84 cases (62.69 percent) were seen.
This is an indication that in women retrograde infection is most frequent.
In trigonitis the subjective symptoms are more pronounced in relation to the light membrane changes seen. This shows the sensitivity of trigone and its influence on the internal sphincter.The bladder volume of inflamation in the trigone show relatively little change with the average being 304cc, this is believed to be due to the relative immobile characteristics of the trigone.
9. In hemorrhagic cystitis ecchymosis and petechia are seen. In staphylococcus albus infection petehia is most frequently present and in coli group infection ecchymosis is most common.Hematuria is present in most cases and of the total number of 123 cases, 63 cases of gross and 50 cases of microscopic hematuria was seen.
Only 10 cases did not show any hematuria. The petechia was frequently microscopic and ecchymosis presented gross hematuria.
The site of bleeding was found to be mostly in the lateral walls followed by anterior wall and then the trigone. The common site of lateral wall for bleeding is believed to be due the extensive and erratic movement of this region.
10. Leukoplakia was thought of as occurring mostly in males of over middle age and as a relatively rare disease state. Howerver Taguchi in 1941 indicated that this disease was not rare and was often seen in sexually mature age-group females. This difference in view point lies in fact whether Putschar's präleukoplakie is included in the leukoplakia or whether it is to be excluded. Clinically it is difficult to differentiate between the two forms. When careful cystoscopic examinations are made, with the so-called preleukoplakia included there are unexpectedly frequent cases of leukoplakia. In our own experiences female cases were significantly higher and the age group was between 20 and 30. The site mostly seen with these changes were the trigone the neck of the bladder. The duration necessary for the development of leukoplakia is contary to expectation short and can develop by 3 weeks. We have experienced two these cases and these cases agree with the animal experiments of Tsuji et al.
