成人男子における膀胱括約筋硬化症の研究
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概要
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Idlopathic solerosis of the internal urinary sphincter in the adult has long been discussed, but its real nature has not yet been clarified. The author has experienced 35 cases of this category 10-40 years of age in the past two years. This is to report his view on the subject to help understand its essential nature. 1) Clinical findings a) Clinical manifestations are almost same as those which have been considered to be since long. b) Urethrography revealed that narrowing or restriction of the internal meatus urinarius was seen in all the cases. c) In two cases ureterovesical reflex was disclosed in cystography based on 15 cm Gravity method. The phenomenon attests the existance of ureterocele which was found by cytoscopic exarnination. d) Edeiken's cystography was observed in 12 cases. e) Treatment, 20 cases were treated preservedly; 2 cases were by TUR. 15 cases were given surgical treatment: suprapubic cystostomy. That is, the internal urinary sphincter was so completely removed as to allow the operation to reach the depth where perforation appears at the vesicla neck, with part of the bladder muscle layer attached to it. And part of the prostate was removed. f) Among 20 cases of preserved treatment, 5 cases presented complete disappearance of manifestations, being mild cases originally. Surgically treated 17 cases showed broadening of the internal meatus urinrius, revealed by urethrographies which were taken 1-1.5 years after the operation, and complete improvement in clinical manifestations. III. Histological findings Observations were made on removed internal urinary sphincters, prostates, and bladder muscle layers of 15 operated cases, with strict distinction given on each of them. a) The internal urinary sphincter. In all the cases fibroelastosis was seen in severe state, and it ranged from the one in which the original structure was not entirely identifiable to the one in which the urinary sphincter was surrounded by connective tissues with increased thin muscular bundles. However, no findings were obtained which may suggest adenoma, infarct, supprative lesions, muscular hyperplasie, nor fibromyoma. No sclerotic findings in blood vessels was observed, but congestion was severe in all the cases. b) The Prostate. Although there were parts which indicated fibroelastosis in the connective tissues of the prostate near the sphincter, there was no marked demacation observable, and it was seen to have transformed into normal prostatic connective tissues. No abnormality was found around prostatic ducts. c) The bladder muscle layer. Muscular hyperplasie was striking at the bladder muscle layer adjacent to the sphincter, and increase of elastic components were observed in the connective tissues. Judging from those histological findings, it is conceivable that the primary cause of the subject matter is the transformation of sphincter and that the transformation brings about secondarily changes of the prostate and bladder muscle layer, and that the initial change of the sphincter is congestion. The author has thus been led to conclude, with the preceding findings, that, first, congestion occures at the sphincter, its continuation produces fibroelastosis, then the subject disease is complicated.
- 社団法人日本泌尿器科学会の論文