Pathophysiology and Management of Sphincter Dyssynergia
| Project/Area Number | 02454365 |
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| Research Category |
Grant-in-Aid for General Scientific Research (B)
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| Allocation Type | Single-year Grants |
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| Research Field |
Urology
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| Research Institution | Hokkaido University |
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Principal Investigator |
KOYANAGI Tomohiko Hokkaido Univ. School of Med., Professor, 医学部, 教授 (80001923)
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| Co-Investigator(Kenkyū-buntansha) |
KOBAYASHI Shinya Hokkaido Univ. Medical Hospital, Instructor, 医学部附属病院, 助手 (80221240)
SHINNO Yuichiro Hokkaido Univ. School of Med., Instructor, 医学部, 助手 (70216232)
DEMURA Takayoshi Hokkaido Univ. School of Med., Instructor, 医学部, 助手 (00133827)
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| Project Period (FY) |
1990 – 1991
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| Project Status |
Completed(Fiscal Year 1991)
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| Budget Amount *help |
¥7,000,000 (Direct Cost : ¥7,000,000)
Fiscal Year 1991 : ¥300,000 (Direct Cost : ¥300,000)
Fiscal Year 1990 : ¥6,700,000 (Direct Cost : ¥6,700,000)
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| Keywords | Sphincter dyssynergia / Motor unit / Subtype / Urethral reflex / alpha_1-adrenoceptors / Autoradiography / Prostate / Radical TURP / sphincter dyssynergia / subtype分類 |
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| Research Abstract |
(1) Electromyographic study :
Simultaneous recordings of electromyography of the external urethral sphincter (EUS) and bladder pressure were performed in 73 patients. Shincter dyssynergia (SD) was noted in 64 patients. By examining the patterns of SD throughout the voiding, it was possible to calssify them into three distinct types as done by Blaivas. Type 1 was found in 7 patients, Type 2 in 10 patients, and Type 3 in 47 patients. Synergic urethral sphincter activity (Type 0) was found in other 9 patients. Voiding dysfunction as evaluable by residual urine rate tended to increase as the type deteriorated from 1 to 3. Analysis of motor units revealed that the units noted during continent phase of the bladder disappeared (AO), decreased (AI), and retained or rather increased their activity (A2) during voiding attempt with (Bl) or without (BO) recruitment of new units. A0B1 was found in 3 patients, A1B1 in 7, A2B1 in 32, A2B0 in 4, and A1B0 in 2. Again there was a tendency for voiding fun
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ction to deteriorate as motor units sub-type changed from A0 to A1 and A2. The analysis of these motor units activities suggested that abnormal continence reflex (i. e. failure of vesicourethral and urethrourethral relaxation reflex and exaggeration of urethrourethral contraction reflex) might be contributing to the genesis of SD. After radical TUR-P, there was an improvement in the type of SD or in its sub-types associated with decrease in residual urine rate. EUS responded to alpha-adrenergic stimulation with an increase in the frequency of pre-existing motor units and recruitment of new motor units. After radical TUR-P, EUS was similarly activated when stimulated with alpha-adrenergics. These data indicated that radical TUR-P was effective in relieving SD by suppressing or abolishing abnormal continence reflex. Moreover, alpha-adrenergic activation of EUS also seemed to suggest a possible sympathetic role in the genesis of SD, although exact mode of its involvement in the somatomotor innervation of the EUS remains to be settled.
(2) alpha_1-adrenoceptors in human prostate :
Autoradiographic distribution of alpha_1-adrenoceptor was quantitated by grain counting using a light microscope equipped with a micrometer. Specific binding was demonstrated predominantly in fibromuscular stroma of peripheral zone (PZ), fibromuscular stroma of central zone (CZ) and preprostatic sphincter. No specific binding was demonstrated in glandular epithelium of PZ and periurethral gland. Glandular epithelium of CZ showed a few specific bindings. Among fibromuscular portion, specific bindings in both CZ and preprostatic sphincter were significantly higher than in PZ. Specific binding in glandular epithelium of CZ was significantly less than in fibromuscular stroma of PZ. These results show that the human prostate has a zonal difference in the distribution of alpha_1-adrenoceptors, probably reflecting some functional difference in these regions. Less
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Report
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Research Products
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