尿管膀胱移行部の筋構築について

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タイトル別名
  • MUSCULAR STRUCTURE OF THE URETEROVESICAL JUNCTION
  • ニョウカン ボウコウ イコウブ ノ キン コウチク ニ ツイテ

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In an attempt to elucidate the mechanism for the vesicoureteral reflux, anatomical studies were made on the ureterovesical junction of normal and affected cases. The results were as follows:<br>1) Macro- and micro-dissections and histological findings of autopsied normal ten cases of male adult respectively revealed that: Waldeyer's sheath rises around the ureter about 3cm above the bladder and ends at the intramural ureter; part of the terminus of the ureteral muscles joins the muscles of the other side to form Mercier's bar, and the rest, after forming the triangular part of the so-called Bell's muscle, terminates as a few muscular bundles at the vermontanum without intruding into the prostate.<br>2) From histological examination of the lower ureter of nine affected male cases consisting of congenital vesical sphincter sclerosis (1), neurogenic bladder (1), tumor at the lower end of the ureter (2), ureterocele (3), and hydroflux (2), it was demonstrated that: in the cases that showed vesicoureteral reflux, irregular arrangement and hypertrophy of the ureteral muscular bundles and a marked increase of the connective tissue, and in those without vesicoureteral reflux, the muscular bundles of the ureter showed no changes or hypertrophy of the muscular bundles and a slight increase of the connective tissue.<br>3) The ureter is fixed to the bladder by Waldeyer's sheath, Mercier's bar and so-called Bell's muscle and it is speculated that organic changes in any of these supporting parts may cause, vesicoureteral reflux.<br>4) In the pathogenesis of vesicoureteral reflux, Mercier's bar or so-called Bell's muscle plays more significant role than Waldeyer's sheath.

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