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Pathophysiology and Management of Sphincter Dyssynergia

Research Project

Project/Area Number 02454365
Research Category

Grant-in-Aid for General Scientific Research (B)

Allocation TypeSingle-year Grants
Research Field Urology
Research InstitutionHokkaido University

Principal Investigator

KOYANAGI Tomohiko  Hokkaido Univ. School of Med., Professor, 医学部, 教授 (80001923)

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)
Project Period (FY) 1990 – 1991
Project Status Completed (Fiscal Year 1991)
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)
KeywordsSphincter dyssynergia / Motor unit / Subtype / Urethral reflex / alpha_1-adrenoceptors / Autoradiography / Prostate / Radical TURP / sphincter dyssynergia / subtype分類
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 … More 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

Report

(3 results)
  • 1991 Annual Research Report   Final Research Report Summary
  • 1990 Annual Research Report
  • Research Products

    (20 results)

All Other

All Publications (20 results)

  • [Publications] 信野 祐一郎: "低コンプライアンス膀胱に関する諸問題:脊髄損傷患者40例における経験" 脊椎脊髄ジャ-ナル. 3. 351-357 (1990)

    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      1991 Final Research Report Summary
  • [Publications] 小柳 知彦: "神経因性膀胱にともなう排尿障害に対する塩酸ブナゾシンの臨床効果" 泌尿器科紀要. 36. 1233-1252 (1990)

    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      1991 Final Research Report Summary
  • [Publications] 小柳 知彦: "宿題報告Sphincter dyssynergiaの診断と治療" 日本泌尿器科学会雑誌. 81. 1967-1976 (1990)

    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      1991 Final Research Report Summary
  • [Publications] Kobayashi,S.: "Autoradiographic localization of α_1- adrenoceptors in human prostate:Special reference to zonal difference." Journal of Urology. 146. 887-890 (1991)

    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      1991 Final Research Report Summary
  • [Publications] 信野 祐一郎: "低コンプライアンス膀胱に関する諸問題" 日本パラプレジア医学会雑誌. 3. 50-51 (1990)

    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      1991 Final Research Report Summary
  • [Publications] 柿崎 秀宏: "交感神経刺激に対するネコ尿道の反応" 日本泌尿器科学会雑誌. 82. 1664-1670 (1991)

    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      1991 Final Research Report Summary
  • [Publications] Shinno, Y.: "Compliance in the neurogenic bladder : An experience from 40 spinal subjects" Spine & Spinal Cord. 3. 351-357 (1990)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1991 Final Research Report Summary
  • [Publications] Koyanagi, T.: "Clinical evaluation of bunazosin hydrochloride for the treatment of voiding disturbances due to neurogenic bladder -A double-blind study-" Acta Urol. Jpn.36. 1233-1252 (1990)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1991 Final Research Report Summary
  • [Publications] Koyanagi, T.: "Diagnosis and treatment of sphincter dyssynergia" Jpn. J. Urol.81. 1967-1976 (1990)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1991 Final Research Report Summary
  • [Publications] Kobayashi, S.: "Autoradiographic localization of alpha_1-adrenoceptors in human prostate : Special reference to zonal difference" J. Urol. 146. 887-890 (1991)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1991 Final Research Report Summary
  • [Publications] Shinno, Y.: "Problems around the low compliance bladder" The Journal of the Japan Medical Society of Paraplegia. 3. 50-51 (1990)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1991 Final Research Report Summary
  • [Publications] Kakizaki, H.: "Urethral response to sympathetic nerve stimulation in the cat" Jpn. J. Urol. 82. 1664-1670 (1991)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1991 Final Research Report Summary
  • [Publications] Kobayashi,S.: "Autoradiographic localization of α_1ーadrenoceptors in human prostate:Special reference to zonal difference." Journal of Urology. 146. 887-890 (1991)

    • Related Report
      1991 Annual Research Report
  • [Publications] 柿崎 秀宏: "交感神経刺激に対するネコ尿道の反応" 日本泌尿器科学会雑誌. 82. 1664-1670 (1991)

    • Related Report
      1991 Annual Research Report
  • [Publications] 信野 祐一郎: "低コンプライアンス膀胱に関する諸問題:脊髄損傷患者40例における経験" 脊椎脊髄ジャ-ナル. 3. 351-357 (1990)

    • Related Report
      1990 Annual Research Report
  • [Publications] 小柳 知彦: "神経因性膀胱にともなう排尿障害に対する塩酸ブナゾシンの臨床効果" 泌尿器科紀要. 36. 1233-1252 (1990)

    • Related Report
      1990 Annual Research Report
  • [Publications] 小柳 知彦: "宿題報告Sphincter dyssynergiaの診断と治療" 日本泌尿器科学会雑誌. 81. (1990)

    • Related Report
      1990 Annual Research Report
  • [Publications] Kobayashi,S.: "Autoradiographic localization of α_1ーadrenoceptors in human prostate:Special reference to zonal difference." Journal of Urology.

    • Related Report
      1990 Annual Research Report
  • [Publications] 信野 祐一郎: "低コンプライアンス膀胱に関する諸問題" 日本パラプレジア医学会雑誌. 3. 50-51 (1990)

    • Related Report
      1990 Annual Research Report
  • [Publications] 小柳 知彦: "Sphincter dyssynergiaの診断と治療" 第78回日本泌尿器科学会総会特別プログラム. モノグラフ. (1991)

    • Related Report
      1990 Annual Research Report

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Published: 1990-04-01   Modified: 2016-04-21  

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