CONTRIBUTION OF SYMPATHETIC NERVOUS SYSTEM TO BENIGN PROSTATIC HYPERTROPHY : Neural Regulation versus Humoral Regulation

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  • 前大腺肥大症における交感経系の関与について-神経性調節と体液性調節

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Contribution of the sympathetic nervous system to obstructive and irritative symptoms in benign prostatic hypertrophy was studied with special reference to the problem of neural versus humoral regulation. Concentration of noradrenalin in tissue of the prostate was significantly low in patients with benign prostatic hypertrophy than in those with bladder neck dysfunciton or in normal subjects. This indicates that sympathetic innervation nerver increases proportionally to the growth of prostatic adenoma. On the other hand, prostatic urethal pressure was significantly increased by intravenous infusion of noradrenalin (5 μg/ml) in benign prostatic hypertrophy, and a per-cent increase of the pressure showed a linear correlation to the volume of the prostate. These results suggest that the number of alpha-receptors increases in proportion to the increase of smooth muscle cell component in benign prostatic hypertrophy. Since uroflow rates were exacerbated and residual urine volume incrased significantly after loading noradrenalin in benign prostatic hypertrophy, it is suggested that acute retention and deterioration of symptoms in benign prostatic hypertrophy may be caused by increase of intrinsic catecholamine level. Furthermore, the prostatic urethal pressure significantly increased after loading noradrenalin in patients with uninhibited detrusor contraction. This also indicates that detrusor instability in benign prostatic hypertrophy may be caused by urethal instability which is induced by an increase of intrinsic catecholamine level. Humoral sympathetic regulation plays an important role as a cause of obstrucitve and irritative symptoms in benign prostatic hypertrophy, and control of the humoral sympathetic mechanism in the prostatic urethra is an important clue for satisfactory treatment of these symptoms.

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