病的状態にある上部尿路のUrometryによるUrodynamicsの研究

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The pressure of upper urinary tract of 250 cases selected from outpatients and inpatients of the urological clinic of Shinshu University Hospital was measured by means of the strain gauge manometer. In the cases, pathologic changes or condition of the upper urinary tract were observed in excretory urography and other routine examinations. Response of the upper urinary tract to drugs was also observed in some cases. 1) In cases of ureteral calculi, the ureter below the calculus had a tendency to decrease the frequency and the amplitude of peristaltic contraction in comparison with the unaffected ureter. On the contrary, the ureter above the calculus, as far as hydronephrosis did not occur above it, increased contraction frequency and resting pressure in comparison with the ureter below the calculus or unaffected ureter. In some cases, peristalsis in the renal pelvis were seen. In the cases of renal calculi, the ureter did not have a constant tendency in contraction frequency, but a half of the cases decreased amplitude and resting pressure as compared with unaffected side. 2) In the cases of nephroptosis, uncommon contraction waves in the renal pelvis, multiphasic contraction waves of the ureter, and ureteral pressure curve characteristic of ureteral obstruction were observed. Some of their excretory urograms showed pyelo-renal backflow. 3) In the cases of inflammatory ureteral stenosis, no or poor contraction waves and high resting pressure were observed at the affected part. Waves derived from respiration and pulsation were also observed at the part. 4) Most of urometrograms that showed high renal pelvic and ureteral pressure were the same type that was observed at experimental ureteral obstruction. Clinically many of these cases had lumbar or flank pain and hematuria which were considered as the result of elevation of the renal pelvic or ureteral pressure. In some of those, cystoscopic finding showed edema, hyperemia and narrowing of the ureteral orifice, and elevation of the interureteric ridge. In some excretory urograms of these patients, pyelo-renal backflow, only nephrogram due to contrast material, and narrowing of the renal pelvis and ureter were seen. 5) In the cases which had severe vesico-ureteral reflux, decrease in contraction frequency and contraction amplitude and low resting pressure were observed. In response of ureter to bladder filling and voiding, both urometrograms of ureter and bladder were exactly parallel in the cases which had severe VUR. As VUR was less serious, the response of ureter became nearly normal.
社団法人日本泌尿器科学会の論文

病的状態にある上部尿路のUrometryによるUrodynamicsの研究

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