回腸導管における新しいAntireflux Ureteroileal Anastomosisについて

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Since Bricker popularized the use of an isolated ileal segment as a bladder substitute, the ileal conduit is the most widely accepted mode of supravesical urinary diversion. The most techniques of this satisfactory procedure today create free ileoureteral reflux which has been viewed with less concern than vesicoureteral or coloureteral reflux, for the ileal conduit has been considered as a low pressure and none reservoir system. However, in recent years serious long term problems such as pyelonephritis, calculous formation, and the renal deterioration without apparent urinary obstruction have been reported. Clinical and experimental considerations indicate the reflux of infected urine to the kidney as the etiology of these late complications. Therefore, the ureteroileal anastomosis preventing reflux without causing obstruction will give great contribution to reduce long term renal complications. From this point of view, as an ideal model to prevent the ureteral reflux, the ureterovesical junction was studied in the fetuses and the post-reimplanted intravesical ureter during micturition to search for the primary factor to prevent the vesicoureteral reflux. The results were as follows. 1) The ureterovesical junctions in human fetuses from 11 to 27 weeks of age were studied histologically. Anatomical relationships and origins of the periureteral sheaths, intravesical ureteral muscles, and trigonal muscles were shown. The superficial periureteral sheath arising from the vesical wali was not the source of the trigonal muscles; the deep periureteral sheath arising from the intravesical ureteral wall formed the deep trigonal muscles. The muscles of the intravesical ureter were differentiated longitudinaly and formed the superficial trigonal muscles. The development of the two trigonal muscles -superficial and deep- depends on the development of the deep periureteral sheath and the intravesical ureteral muscles. From the findings that both trigonal muscles are present in fetuses compared with both periureteral sheaths or intravessical ureteral muscles in the latest stage, the ability to maintain the valve mechanism in the ureterovesical junction in the human fetus is based on the periureteral sheaths and intravesical ureter -not on the trigone.
社団法人日本泌尿器科学会の論文
1978-07-15

回腸導管における新しいAntireflux Ureteroileal Anastomosisについて

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