組織像から見た女子膀胱頸部障碍の研究

Abstract

The purpose of my study was to reveal the causes of the bladder neck disorders in female, especially some relation of the “female prostate” with the trigonal cystitis.The materials of this histological study consist of 28 cases of the tissue of the bladder neck and the inner part of the urethra, containing deeply the muscle layers, which have been resected transurethrally from patients with the bladder neck lesion, 11 cases of the tissue resected in the same manner from patients with the urinary tuberculosis (the bladder neck itself is not affected by the tuberculosis) and 18 cases from those with non-tuberculous lesions of the urinary tract, and 63 cases of the tissue of the bladder neck and the entire urethra from autopsy cases.The conclusions obtained are as follows:1) Glandluar tissue was found in 22 cases (44.4%) out of the 66 autopsy cases. It was mostly located in superficial muscle layer at the portion adjacent to the urethral meatus and was found only in 2 cases (3.2%) adjacent to the bladder neck.These findings coincide with the Johnson's description, and I have been unable to reveal the female prostate brought foward by Folsom and a few other investigators.2) The mucosae in clinical cases, whatever were their disorders, showed various kinds of metaplasia much more frequently than in autopsy cases, probably because of mechanical irritation such as catheterisation prior to the resection in the former. The changes, however, were not found more frequently in the cases of the bladder neck lesion than in other clinical cases.3) Submucous edema and hyperemia were found, in the cases of the bladder neck lesion, rather more frequently and of somewhat higher degree than in other clinical cases.4) Thickening of the muscle layer was noticed in a quarter of the cases of the bladder neck lesion and in none of other clinical cases.5) Glandular tissue was found in none of the clinical cases, whatever were their diseases.6) The histological study as above-mentioned shows that somewhat characteristic change of the bladder neck lesion is slight degree of thickening and sclerosis of the deep layer and not a change of the mucosa. These findings are supported by the fact that the resection of the deep tissue has led to an improvement most cases of the bladder neck lesion which had not yielded to other sorts of treatment.7) The histological and clinical study (urinalysis and cystoscopy) has revealed only a slight degree of changes, contrary to complaints of the patients. And for the origin of the bladder neck lesion, that the thickening and sclerosis of the deep tissue of the bladder neck takes place in a nervous woman, or in other words, two factors, organic and functional, seem to be necessary, and inflammation in the mucosa and the “female prostate” are insignificant.