I have measured the intraluminal pressure by using the ordinary simple cystometer tinder following 4 different conditions: 1) the artificial ileum-bladder, 2) the artificial sigmoid bladder, 3) the normal rectum and 4) the normal urinary bladder. The results are as the following table.
Tab. 1.
The followings become clear from these data:
1. In the ileum-bladder, the pressure is considerably lower than in the sigmoid bladder or normal rectum. These results coincide strikingly to the fact that the blood electrolyte imbalance occurs far more frequently after ureterosigmoidostomy or sigmoid bladder formation than after ileum-bladder formation. And, I think that the renal damage which is caused by the deleterious effect of high intrarectal preseure, is the cause of blood electrolyte imbalance. As the intraluminal pressure of the ileum-bladder is very low, the effect of the pressure upon the renal pelvis which is transmitted from the ileal segment is negligible. The blood chemistry imbalance which may be caused by the renal damage, has never been observed in all our cases with ileum-bladder formation.
Therefore I believe that the pressure in the bowel in which the ureter is transplanted, will play the very important role for the occurrence of the blood electrolyte imbalance following the uretero-intestinal anastomosis, and the bacterial infections in the bowel are of less importance (while the isolated sigmoid bladder is as sterile as the ileum-bladder, the former is remarkably more balanced than the latter in blood chemistry).
2. The normal intravesical pressure and the normal intrarectal pressure shown on Tab. 1, are values at the volume of 300cc. The intravesical pressure is considerably lower than the latter in various condition. But the former rises as high as the latter on straining in the erect position, which makes us consider that the structure of the ureteral orifice is important to prevent the free transmission of intravesical pressure to the renal pelvis.
Accordingly, the low pressure is particulary significant in the artificial urinary bladders which have no such structures of their ureteral orifices as normal bladders.
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