EXPERIMENTAL STUDIES ON THE NEUROGENIC BLADDER (1967)

Neurogenic bladder is definited as one of the micturition dysorders due to some organic disturbances of the nerve innervating the urinary bladder, and many clinical and experimental observations were presented by today. However, the pathological physiology of this disease is so much complicated and it is not clear enough yet, so that we could not find out any reasonable planning of the therapies for this disease.Since the obstructions for this is that it is very difficult to find out the natures of the nerve injuries so exact by the neurological examinations, we are in unavoidable situation to know clinically not only the characters of nerve injury but also the micturition condition only throughout the cystometrogram.On the other hand, it was believed that storing of urine in the urinary bladder should be depend upon the stretch reflex of the vesical wall through the sacral micturition reflex arc, and voiding of urine from the urinary bladder should be depend upon the nervous control of higher center to the sacral cord. However, we can sometimes find out some reports that such bladder function is some part depend on the purely physical nature of the vesical wall itself, such as elasticity and so on, and some biophysical factors such as mural tension is also very important factors affecting the cystometrogram.Here, the author had assumed that the cystometrogram should be depend upon at least two factors, namely, the effect of the innervating nervous system coming from outside of the urinary bladder, and some biophysical properties of the vesical wall itself including the activities of the intramural nervous elements and also physiological characters of the other constituents of the vesical wall, mainly the smooth muscle. Therefore, to make the relationship between these two factors and the effects of them upon the cystometrogram so clear, several experimental observations were made as follows.At first, various experimental neurogenic bladders were produced on adult dogs, and its cystometrogram and cystoadaptometrogram were examined. The latter is recently developed procedure as one of in vitro examination of bladder function relating to the cystometrogram.Next, using normal adult dogs, the effect of some drug administration or electrical stimulation to the spinal cord were examined by the cystometrogram and cystoadaptometrogram.Furthermore, the adapting pressure curve, which was new concept developed from the results of cystodaptometrogram was analysed each other regarding to the experimental conditions such as the kind of drug administration or the kind of nerve resected. And following results were obtained.First in normal animals, the micturition contraction curve, which appears in the last part of the cystometrogram, reveals the existence of the innervation of the sacral cord activity coming from outside of the urinary bladder, especially the centrifugal fibers relating to the ventral root of the sacral nerves.Next, with the results of pharmacological experiments on normal animals, it was clarified that the most part of the cystometrogram, except the last one as described above, should be depend upon the biophysical properties of the vesical wall, including xylocainsensitive intramural nervous plexuses and other nervous elements as well as the other constituents of the vesical wall. And it was assumed that the cystometrogramm obtained would reveal the over-all characters of these factors of the vesical wall.And furthermore, with the analysis of the cystometrogram as well as the cystoadaptometrogram obtained from the animals in which various nerves innervating the urinary bladder were resecged, it was clarified that various alterations in cystometrogram should be depend upon almostly the changes of such a biophysical property of the vesical wall after the nerve section. And at the same time, some physiological activity of the sacral spinal ganglions on such alteration was assumed.