除脳犬を用いた骨盤および下腹神経切断時の排尿動態に関する研究
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除脳犬を対象として排尿動態における骨盤神経および下腹神経の役割について検討した.1)骨盤神経の片側切断により排尿時の排尿動態パラメータ6項目の内,残尿量と残尿率が上昇し,最大収縮圧,最大尿流量が低下を示した.また,蓄尿時の排尿動態パラメータ4項目の内,膀胱容量,膀胱収縮誘発閾値圧および膀胱コンプライアンスが有意に上昇した.2)骨盤神経の両側切断により膀胱収縮は消失し,溢流性尿失禁が認められた.3)下腹神経の片側神経の片側切断により蓄尿時の排尿動態パラメータの内,膀胱容量,膀胱収縮誘発閾値圧および開口時内圧が低下した.排尿時の排尿動態のパラメータでは最大収縮圧が有意に低下した.4)下腹神経の両側切断により蓄尿時の排尿動態パラメータのすべてに有意の変化がみられ,膀胱容量,膀胱収縮誘発閾値圧および開口時内圧が低下し,膀胱コンプライアンスが上昇した.排尿時の排尿動態パラメータの内,排尿量と最大収縮圧に軽度ではあるが有意の低下が観察されたThe effect of the transection of the pelvic and hypogastric nerves on the whole micturition cycle including the collecting and emptying phases was evaluated on the decerebrate dogs which exhibit highly consistent urodynamic parameters during a series of micturition cycles. Urodynamic parameters of each phase before and after each nerve transection were measured by pressure flow electromyographic studies and compared using the paired t test. Urodynamic parameters in the collecting phase consisted of threshold volume, threshold pressure, opening pressure and bladder compliance. Urodynamic parameters in the emptying phase consisted of voided volume, residual volume, residual ratio, contraction pressure, maximum flow rate and voiding time. Unilateral pelvic nerve transection produced a significant increase in threshold volume and bladder compliance and a significant decrease in threshold pressure during the collecting phase. There was a significant increase in residual volume and residual ratio and a significant decrease in contraction pressure and maximum flow rate during the emptying phase. After bilateral pelvic nerves transection, bladder did not contract and overflow incontinence occurred. Therefore, the pelvic nerves are considered to play an important role in both the collecting and emptying phases. Unilateral hypogastric nerve transection produced a significant decrease in threshold volume, threshold pressure and opening pressure during the collecting phase. There was a significant decrease in contraction pressure during the emptying phase. Bilateral pelvic nerve transection produced a significant decrease in threshold volume, threshold pressure and opening pressure, and a significant increase in bladder compliance during the collecting phase. There was a significant decrease in voided volume and contraction pressure during the emptying phase. Therefore, the hypogastric nerves are considered to play a certain role in the collecting phase.
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