尿路の再生・再建に関する研究第4報 : a.尿流遮断・再開の膀胱再生に及ぼす影響 b.テトロン結合繊膜による膀胱補填 c.膀胱粘膜再生に対する薬剤の影響

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a. Kassai reported that urinary diversion stepped up regeneration of ureopithelium but suppressed that of smooth muscle, in the experiments of bladder repair using fascia, peritoneum and OMS-membrane. The present writer made the following study. Repair of the upper half of dog bladder using autogenous facia was done at the same time with bilateral ureterocutaneostomy. Two weeks later, when complete epithelial regeneration was expected, ureter reanastomosis was carried out. 18 dogs were used but only 6 dogs survived for more than 4 weeks with adequate urinary flow into the bladder and they were sacrificed at the period of 4, 6, 9, 15, 18 and 25 weeks after the repair of gladder. Mild to moderate hydronephrosis was observed. Complete epithelial regeneration of the grafted portion was seen in every case. Inflammatory reaction of the new bladder wall was severe, especially under the regenerated mucosa. but decreased with the time. Replacement of degenerated fiber bundles by new connective tissue began at 6 weeks after the bladder repair and progressed thereafter. Fragmentation of muscles at the cut edges of the bladder, suggesting a state of preparation of muscle regeneration, was observed at the end of 4 weeks (2 weeks after ureter reanastomosis), and a new muscle layer appeared thereafter towards the center from the periphery. A muscle layer was seen in about one-third of the grafted portion at 6-9 weeks and about one half at 15 weeks, but only two-tirds of the new bladder wall shoined a muscle layer and the cantral one third potion did not contain muscle even at 2.5 weeks after. The reason why muscle regeneration was not complete even after several months might be as follows: Infected hydronephrosis induced by repeated operations on the ureter, should give rise to moderate infection of the new grafted portion and result in detrimental effects upon muscle regeneration. b. The present writer attempted to find an artificial graft material which would incorporate with the new bladder wall. Repair of the upper half of bladder was done with tetron membrane burried subcutaneously 4 weeks in advance. After 4 weeks, uroepithelium regenerated over the tetron membrane in the peripheral portion of the grafted part, but the central portion showed ulceration with necrotic tissue and naked tetron membrane (deprived of the connective tissue envelope) was exposed directly to the bladder cavity. After 6 months tetron membrane was dislodged into the bladder cavity from the central ulcer and urinary caleuli was formed around the detached tetron membrane. However, the same experiment under urinary diversion was successful; after 4 weeks the grafted part was completely covered with regenerated epithelium and the tetron membrane seemed to be incorporated with the new bladder wall. c. Bladder mucosa of 1.5-2.0 cm diameter was removed and the process of regeneration was followed. Epithelial regeneration began at the 5th day when submucous hemorrhage and inflammation decreased, and completed at the 10th day. Glucorticoids, androgen, estrogen and anabolic steroids had no effect while α-chymotrypsin suppressed the inflammatory reaction and stepped up the regeneration of uroepithelium.
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