Urometryによる上部尿路機能の研究

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The mechanism of urine transport in the upper urinary tract has not been well elucidated yet. The author reviewing the previous literatures pertaining to it studied the pressure in the renal pelvis and ureter on 200 patients (246 ureters) using the strain gauge electromanometer. The cases of various urinary tract diseases were included. First, the normal values were settled, and then alterations of the pressure under the various physiologic conditions and influences of a few drugs on the ureteral function were evaluated. The results obtained may be summarized as follows. (1) Normal pressure in the renal pelvis: The intrapelvic pressure fluctuates from 0 to 13 mmHg being 4.5 mmHg in average. The amplitude of it is much lower than that of the ureter. (2) Normal pressure of the ureter: The resting pressure is 0-17 mmHg (3.1-4.9 mmHg in average). The amplitude of the contraction is 5-58 mmHg (21.4-25.6 mmHg in average). The frequency is 1-7 times per minute (3.4-4.0 times in average). The duration of the contraction is 1.0-10.0 seconds (2.5-5.7 seconds in average). The travel rate is 4-6 cm. per second. The resting pressure and contraction amplitude is generally increased at the lower part of the ureter. The contraction complexes are also prolonged and are furnished with more pressure spikes. (3) Anesthesia of various types does not produce any specific changes of the intraureteral pressure. (4) Changing the position from the supine to the semi-sitting causes a slight raise in resting pressure, an increase in contraction frequency and a prolongation of contraction complexes. (5) If the intravesical pressure exceeds beyond a certain level, the resting pressure in the ureter begins to rise. Further increase leads to slow increase of the frequency of the ureteral contraction, prolongation of the contractile waves, decrease of the amplitude and occurrence of more complicated contraction complexes. If the bladder volume becomes more than 200 ml., the travel rate of ureteral contraction tends to decrease. (6) General response of the ureter to increase in urine flow is increase in contraction frequency, elevation in resting pressure, prolongation of contractile waves and decrease in amplitude. The rate of changes in urine flow, however, plays an important role in this subject, further studies are indicated. In experiments on dogs, the author designed an entirely new method to regulate the urine flow in the ureter by shutting off it from the kidney according to circumstances. This has been found to be useful for observation of influence of urine flow upon ureteral functions. (7) The ureteral response at the time of its obstruction is found to be much the same when the intravesical pressure is raised. (8) While the intrapelvic pressure of the well-established case of hydronephrosis is low (2-5 mmHg), in the progressing one, the resting pressure of the ureter is generally elevated. (9) In two cases of megaloureter, the urometrogram showed impaired ureteral functions. (10) At the time of vesico-ureteral reflux, the changes of the pressure in the ureter and bladder are synchronous, but retrograde contractions are not constant observation. (11) The change of the ureteral pressure in the woman late in pregnancy is that of obstructive type. (12) While a parasympatholytic drug and smooth muscle relaxants tend to decrease the frequency of ureteral contraction, both a parasympathomimetic drug and a smooth muscle stimulant do not exert an effect on the ureteral function. Activated vitamin B_1 drugs (Thiamine derivatives) accelerate generally the ureteral function although they shows minor deviations as to their effect.
社団法人日本泌尿器科学会の論文

Urometryによる上部尿路機能の研究

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