膀胱尿管逆流の研究 : 膀胱尿管逆流防止機構に関する臨床的,実験的観察

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Experimental observations. Adult dogs, anesthetized with sodium isomital, were used in all experiments. Experiment I. The partial resection of ureteral orifice was performed and immediately the cystogram were obtained at several pressure levels. Only one cystogram revealed a vesicoureteral reflux. (V. U. R.) Experiment II. Nylon ureteral catheter of about 1.5 cm lengths was inserted into the intravesical ureter to break down the physiological function of the ureterovesical junction. (U. V. J.) Then immediately a cystogram was obtained. No reflux was demonstrated. Experiment III. A Nylon ureteral catheter was inserted into the lower ureter. The contrast agent was gradually poured into the ureter through the catheter elevating slowly the other tip of the catheter connected with the small bottle containing the contrast agent. Then cystograms were obtained, and ureteral pressure (resistance against the reflux) was observed. Experiment IV. As Experiment III, the ureter was incised 5 cm above the tip of the inserted catheter. For the purpose of interrupting the urinary flows, the upper part of the ureter was ligated. Intraureteral pressure never showed the zero point. Experiment V. The partial cystectomies were performed as nearly as possible at the right ureteral orifices. In dogs that V. U. R. were demonstrated to be in good health 2, 3 and 6 months after operation, specimens of ureterovesical junction and bladder wall were removed and histologically studied. V. U. R. was seen at the ureter near the resected bladder wall without remarkable changes at V. U. J.. Experiment VI. The partial resection of ureteral orifice was performed and the ureter was incised 5 cm from ureteral orifice. The upper part of the ureter was ligated, then the bladder was closed and indigocarmine solution was poured into the bladder through an urethral catheter. The efflux of liquid (indigocarmine solution) from the incised orifice of the ureter was observed only after the death of the animal. Clinical observations V. U. R. after partial cystectomy was frequently observed without remarkable changes at U. V. J. and at the upper urinary tract. V. U. R. after ureterocystoneostomy was not observed in spite of the remarkable anatomical changes of the upper urinary tract having a low intraureteral pressure. V. U. R. following contracted bladder, neurogenic bladder, diverticulum of bladder, complete duplication of ureters, megacystis syndrom, cystitis and radiation therapy was discussed. V. U. R. after transurethral ureteral meatotomy or transvesical resection of the submucosal ureteral wall and V. U. R. of residualureter after nephrectomy and other operations were observed in a few cases having some special changes. From the results of the recordings of the intraureteral pressure by means of a strain gauge in 2 channels, it has been observed that the intraureteral pressure of the ureter showing a reflux is usually low. Based on these findings, the following conclusions. were drawn : It is believed that, the action of the bladder wall has been observed to play an important role in the mechanism of preventing the reflux, in addition to the action of U. V. J., the pressure of the intraureteral urinary flow and the action of the ureteral wall.
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膀胱尿管逆流の研究 : 膀胱尿管逆流防止機構に関する臨床的,実験的観察

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