A STUDY OF FUNCTIONAL ENURESIS IN CHILDREN : VOIDING CYSTOURETHROGRAPHIC AND CYSTOMETRIC STUDY Kiyotaka Kitagawa Department of Urology, School of Medicine, Kanazawa University. (Director : Prof. K. Kuroda) Functional enuretics were studied by voiding cystourethrography (VCUG) and cystometry. VCUG was done on 106 cases, and cystometry on 48 cases. Both were performed on 35 cases. 1) All cases had smooth vesical outline at rest. Abnormal base plate at rest was recognized in 14 of 26 cases (53. 8%). This finding was often appeared in older children and the prognosis of enuresis was poor. 2) On voiding, the form of the bladder was various. Mural irregularity was recognized in 42 of 106 cases (40. 6%), and it was more often in younger children. 3) The constricted bladder neck was recognized in 58 of 106 cases (54. 7%). This finding was more often recognized in boys (67. 1%) than in girls (23. 3%). The diameter of the bladder neck in mid voiding varies from 5 mm to 20 mm. Girls usually had a wider diameter. 4) The diameter of the prostatic urethra in mid voiding was under 13 mm except one case. The diameter of the mid urethra was relatively large, and the functional distal urethral stenosis was considered. The ring-like filling defect was observed in five cases. 5) The author classified voiding cystourethrogram from type I to type IV. Type I had smooth bladder neck. Type II had anterior defect of the bladder neck. Type III had posterior defect of the bladder neck. Type IV had anterior and posterior defects of the bladder neck. In boys type III and type IV were often seen, and in girls type I was usually seen. 6) On cystometry uninhibited contraction was observed in 45. 8% of 48 cases, and more in boys. It was considered that girls with uninhibited contraction had high possibility of urinary tract infection. 7) Mural irregularity and constricted bladder neck on VCUG were correlated with abnormal cystometric findings.

Table 1 Voiding cystourethrography in enuresis Table 2 Base plate at rest Table 3 Mural irregularity on VCUG

Table 5 Diameter of the bladder ueck on vcug Table 4 Bladder neck on VCUG

Table 6 Diameter of the prostatic (or mid) urethra on vcug Table 7 Diameter of the membranous (or distal) urethra on VCUG Table 8 Type of the Bladder neck on vcug

Table 9 Cystometric findings in enuresis

676 Fig. Fig. 5前 3 Urethral fold 像 立 腺 部 尿 道 の 拡張 と リン グ 状 陰影 欠 損)器 質 的 通過 障 害 を 認 めず) Fig. Tg+6 4女 児 に お け る 広 いmid Suspensory 異 常 所 見 あ り(器 ligalnentに uretllra よ る 影i響. 質 的 通 過 障 害 な し) 頚 部}こ も

677 Fig7外 尿 道 口狭 窄 に よる前 部 尿 道 の 円筒 状 像 Fig8(b)H型 のVCUG Fig.8(a)1型 のVCUG Fig8(c)1型 のVCUG

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