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- 저자 : Akira Furuta (검색결과 2 건)
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Akira Furuta,Yasuyuki Suzuki,Taro Igarashi,Takahiro Kimura,Shin Egawa,Naoki Yoshimura 대한배뇨장애요실금학회 2022 International Neurourology Journal Vol.26 No.1
Purpose: To investigate the influence of multiple recurrences and repeated surgeries of Hunner lesions on bladder capacity under general anesthesia in patients with interstitial cystitis (IC). Methods: We retrospectively reviewed the clinical records of Hunner-type IC (HIC) patients who underwent transurethral fulguration or resection of Hunner lesions combined with hydrodistension by a single surgeon between 2011 and 2020. Recurrence was defined as reappearance of uncontrolled urinary symptoms in association with new Hunner lesions identified by cystoscopy. Recurrent Hunner lesions were then treated by transurethral surgeries. The recurrence-free rate, potential predictive factors of recurrence, and changes in bladder capacity under anesthesia were examined at each surgical procedure. Results: A total of 92 surgeries were performed in 47 HIC patients, 23 (49%) of whom required multiple procedures (range, 1–5 times). The mean recurrence-free time after the first surgery was 21.7 months. The recurrence-free rate was 53% at 24 months, and decreased to 32% at 48 months. There were no significant differences in age, sex, bladder capacity under anesthesia at the first surgery, duration from symptom onset to the first surgery, O’Leary-Sant questionnaire including symptom and problem indexes, visual analogue scale pain score, and the number of comorbidities between the cases with or without recurrence. Bladder capacity under anesthesia was gradually decreased as the number of surgeries was increased, and bladder capacity at the fourth procedure was significantly decreased to 80% of the capacity at the first surgery. Conclusions: These results suggest that multiple recurrences and repeated surgeries of Hunner lesions result in a reduction of bladder capacity under anesthesia in HIC patients although no predictive factors for recurrence of Hunner lesions were detected
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Neural Mechanisms Underlying Lower Urinary Tract Dysfunction
Naoki Yoshimura,Teruyuki Ogawa,Minoru Miyazato,Takeya Kitta,Akira Furuta,Michael B. Chancellor,Pradeep Tyagi 대한비뇨의학회 2014 Investigative and Clinical Urology Vol.55 No.2
This article summarizes anatomical, neurophysiological, and pharmacological studiesin humans and animals to provide insights into the neural circuitry and neurotransmittermechanisms controlling the lower urinary tract and alterations in thesemechanisms in lower urinary tract dysfunction. The functions of the lower urinarytract, to store and periodically release urine, are dependent on the activity of smoothand striated muscles in the bladder, urethra, and external urethral sphincter. Duringurine storage, the outlet is closed and the bladder smooth muscle is quiescent. Whenbladder volume reaches the micturition threshold, activation of a micturition centerin the dorsolateral pons (the pontine micturition center) induces a bladder contractionand a reciprocal relaxation of the urethra, leading to bladder emptying. During voiding,sacral parasympathetic (pelvic) nerves provide an excitatory input (cholinergic and purinergic)to the bladder and inhibitory input (nitrergic) to the urethra. These peripheralsystems are integrated by excitatory and inhibitory regulation at the levels of the spinalcord and the brain. Therefore, injury or diseases of the nervous system, as well as disordersof the peripheral organs, can produce lower urinary tract dysfunction, leadingto lower urinary tract symptoms, including both storage and voiding symptoms, andpelvic pain. Neuroplasticity underlying pathological changes in lower urinary tractfunction is discussed.
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