Pathophysiology and Management of Sphincter Dyssynergia

(1)肌电图研究：同时记录73例患者的尿道外括约肌（EUS）和膀胱压力的肌电图。64例患者出现胫肌协同失调（SD）。通过检查整个排尿过程中SD的模式，可以将其分为三种不同的类型，如Blaivas所做的那样。1型7例，2型10例，3型47例。其余9例为尿道括约肌协同活动（0型）。通过残余尿率评估的排尿功能障碍随着类型从1恶化到3而趋于增加。对运动单位的分析揭示，在排尿尝试期间，在膀胱的控制阶段期间注意到的单位消失（AO）、减少（AI），并且在具有（BI）或没有（BO）新单位募集的情况下保留或更确切地说增加它们的活动（A2）。A0 B1 3例，A1 B1 7例，A2 B1 32例，A2 B 0 4例，A1 B 0 2例。再次有一种趋势， ...更多信息 由于电机装置子类型从A0变更为A1和A2，因此可能会恶化。对这些运动单位活动的分析表明，异常的反射（i。e.膀胱尿道和输尿管尿道松弛反射的失败和输尿管尿道收缩反射的增强）可能是SD的原因。根治性TUR-P后，SD类型或其亚型的改善与残余尿率的降低有关。EUS对α-肾上腺素能刺激的反应是既存运动单位频率的增加和新运动单位的募集。根治性TUR-P后，EUS同样被激活时，刺激与α-肾上腺素能。提示根治性TUR-P可通过抑制或消除异常的电刺激反射而有效缓解SD。此外，EUS的α-肾上腺素能激活似乎也表明了可能的交感神经在SD的发生中的作用，尽管其参与EUS的躯体运动神经支配的确切模式仍有待解决。(2)人前列腺中的α_1-肾上腺素能受体：使用配备有测微计的光学显微镜通过颗粒计数来定量α_1-肾上腺素能受体的放射自显影分布。特异性结合主要表现在外周带（PZ）、中央带（CZ）和前列腺前括约肌的纤维肌间质中。PZ腺上皮和尿道周围腺无特异性结合。CZ的腺上皮细胞呈少量特异性结合。在纤维肌部分，特异性结合在CZ和前列腺前括约肌显着高于PZ。CZ的腺上皮特异性结合显著低于PZ的纤维肌性间质。这些结果表明，人前列腺α_1-肾上腺素能受体的分布存在区域性差异，可能反映了这些区域的某些功能差异。少

(1) Electromyographic study :Simultaneous recordings of electromyography of the external urethral sphincter (EUS) and bladder pressure were performed in 73 patients. Shincter dyssynergia (SD) was noted in 64 patients. By examining the patterns of SD throughout the voiding, it was possible to calssify them into three distinct types as done by Blaivas. Type 1 was found in 7 patients, Type 2 in 10 patients, and Type 3 in 47 patients. Synergic urethral sphincter activity (Type 0) was found in other 9 patients. Voiding dysfunction as evaluable by residual urine rate tended to increase as the type deteriorated from 1 to 3. Analysis of motor units revealed that the units noted during continent phase of the bladder disappeared (AO), decreased (AI), and retained or rather increased their activity (A2) during voiding attempt with (Bl) or without (BO) recruitment of new units. A0B1 was found in 3 patients, A1B1 in 7, A2B1 in 32, A2B0 in 4, and A1B0 in 2. Again there was a tendency for voiding fun … More ction to deteriorate as motor units sub-type changed from A0 to A1 and A2. The analysis of these motor units activities suggested that abnormal continence reflex (i. e. failure of vesicourethral and urethrourethral relaxation reflex and exaggeration of urethrourethral contraction reflex) might be contributing to the genesis of SD. After radical TUR-P, there was an improvement in the type of SD or in its sub-types associated with decrease in residual urine rate. EUS responded to alpha-adrenergic stimulation with an increase in the frequency of pre-existing motor units and recruitment of new motor units. After radical TUR-P, EUS was similarly activated when stimulated with alpha-adrenergics. These data indicated that radical TUR-P was effective in relieving SD by suppressing or abolishing abnormal continence reflex. Moreover, alpha-adrenergic activation of EUS also seemed to suggest a possible sympathetic role in the genesis of SD, although exact mode of its involvement in the somatomotor innervation of the EUS remains to be settled.(2) alpha_1-adrenoceptors in human prostate :Autoradiographic distribution of alpha_1-adrenoceptor was quantitated by grain counting using a light microscope equipped with a micrometer. Specific binding was demonstrated predominantly in fibromuscular stroma of peripheral zone (PZ), fibromuscular stroma of central zone (CZ) and preprostatic sphincter. No specific binding was demonstrated in glandular epithelium of PZ and periurethral gland. Glandular epithelium of CZ showed a few specific bindings. Among fibromuscular portion, specific bindings in both CZ and preprostatic sphincter were significantly higher than in PZ. Specific binding in glandular epithelium of CZ was significantly less than in fibromuscular stroma of PZ. These results show that the human prostate has a zonal difference in the distribution of alpha_1-adrenoceptors, probably reflecting some functional difference in these regions. Less