Development of endoscopical erectical stimulation for patients of neurogenie bladder dysfunction

本文首次用家兔膀胱作电刺激诱发排尿反射的实验。在全身麻醉下，将家兔下腹部正中切口。电刺激探头插入膀胱肌层，但膀胱壁易穿孔。因此，无法进行膀胱测压。第二，尝试用新型小直径柔性石英纤维镜进行经尿道电刺激，但该纤维镜插入家兔尿道非常困难。另外，由于兔子的尿液浑浊，很难确定视野。兔膀胱电刺激实验失败。接下来的实验是腹腔镜电刺激猪膀胱逼尿肌层。在全身麻醉下，通过下腹壁留置一些套管针，开始腹腔镜检查。将两个勃起刺激探针从套管针插入猪双侧膀胱壁的逼尿肌。将柔性石英纤维镜插入膀胱，在纤维镜下未发现电刺激探针插入膀胱粘膜穿孔。膀胱内滴入生理盐水100 ml后开始膀胱测压。本实验研究找到了诱导排尿反射的最佳条件。刺激频率为20 Hz，脉冲时间为2.5 msec，电流为70 mA，电刺激持续时间为15 sec。在此最佳电刺激条件下，膀胱测压显示逼尿肌收缩100 cm H2O。

Experimental electrical stimulation for induction of micturition reflex was tried using rabbit urinary bladder in the first place. median incision of lower abdomen of rabbit was performed under general anesthesia. The probe of electrical stimulation was put into the bladder muscle layer, but the bladder wall was easily perforated. Thus, cystometry could not performed. Secondly, transurethral electrical stimulation using novel small diameter flexible quartz fiberscope was tried, but he insertion of this fiberscope for the urethra of rabbit was very difficult. Also, it was difficult to make sure of the field of vision because of the muddy urine of rabbit. The experimental electrical stimulation using rabbit urinary bladder was failed unfortunately. The next experiment was laparoscopic electrical stimulation of detrusor muscle layer of pig urinary bladder. Under general anesthesia, some trocars were indwelled via lower abdominal wall and the laparoscpic view was started. Two probes of erectrical stimulation were inserted from the trocars into the pig detrusor muscle of bilateral urinary bladder wall. The flexible quartz fiberscope was inserted into the urinary bladder, and no perforation of bladder mucosa by insertion of the electrical stimulations probes was found with fiberscope view. After 100ml normal saline was dripped in the bladder, cystmetry was started. The optimal condition for induction of micturition reflex was found in this experimental study. Frequency of stimulation was 20 Hz, pulse time was 2.5msec, electric current was 70mA, and duration of electrical stimulation was 15 sec. The detrusor contraction of 100 cm H2O was expressed in the cystometry under these optimal condition of electrical stimulation.