Fischer W, Selig V, Lamm D
Zentralbl Gynakol. 1978;100(20):1320-31.
By means of 386 comparative cystometries hypertensive reactions were recorded from the urinary bladder both following total and radical vaginal hysterectomy. Hypertension was most strongly pronounced over the first two weeks after operation and receded spontaneously during the third and fourth weeks. That increased intravesical pressure, therefore, was attributed primarily to the surgical trauma and its inevitably accompanying irritation of the bladder. Predominant parasympathetic denervation of the bladder by radical surgery was found to be relevant, first of all, during micturation. Reduced sense of emptying the bladder and sympathetically induced disturbances in the correlations between detrusor and the urethrovesical region favoured the formation of residual urine. Its early therapy, using cholinergics, is becoming increasingly problematic. Intensive control of infections and persistent continuation of catheterisation, until the autonomously functioning bladder has got adjusted to its changed conditions, so far remain to be the most dependable approaches to prophylaxis and therapy of micturation disorders following radical surgery. In severe cases more recent pharmacological and neurohistochemical findings regarding selective effectiveness of alpha-receptor blockers and beta-stimulators in neurogenic bladder may open new therapeutic ways.
通过386例膀胱测压比较,记录了全子宫阴道切除术和根治性阴道子宫切除术后膀胱的高血压反应。高血压在术后头两周最为明显,并在第三和第四周自发消退。因此,膀胱内压升高主要归因于手术创伤及其不可避免地伴随的膀胱刺激。根治性手术导致膀胱主要的副交感神经去神经支配,首先在排尿过程中被发现是相关的。膀胱排空感觉降低以及交感神经引起的逼尿肌与尿道膀胱区域相关性紊乱有利于残余尿的形成。使用胆碱能药物对其进行早期治疗正变得越来越成问题。强化控制感染以及持续进行导尿,直到自主功能的膀胱适应其变化的状况,迄今为止仍然是根治性手术后排尿障碍预防和治疗最可靠的方法。在严重病例中,关于α受体阻滞剂和β刺激剂在神经源性膀胱中的选择性有效性的最新药理学和神经组织化学研究结果可能会开辟新的治疗途径。