STUDIES ON THE FUNCTION OF THE UPPER URINARY TRACT

VIII. ON VARIOUS PROBLEMS TO UTILIZE ELECTRO-URETEROGRAPHY IN CLINICAL UROLOGY

Abstract

In 66 urologically normal adults and 73 cases with diseases of upper urinary tract, various examinations were made to clarify the fundamental problems on electro-ureterography-through-cystoscope.
The results obtained are as follows:
1. Wave pattern of the action potential
A standard wave pattern, which has all of the four deflections, i. e., positive before-potential, negative main potential, negative accessory potential and positive after-potential, was recorded both in the ureter of the normal persons and that of the patients with deseases of the upper urinary tract. In the normal ureter, the action potential was found to travel from the renal pelvis down to the urinary bladder.
2. Electro-ureterographic difference between the upper and the lower portions of the ureter
No remarkable difference in discharge interval, amplitude and duration of the action potential was observed between the upper and the lower portions of the ureter. But conduction velocity was found to be faster in the lower portion.
Similarity of the discharge interval recorded both in the upper and the lower portions of the ureter showed that all peristalsis was conducted from the upper portion down to the lower portion without fading away on the way.
3. Electro-ureterographic difference between the right and the left ureters
Discharges of the action potential of the both ureters were not synchronized. However, measured values of the action potential were almost similar in the both ureters.
4. Relation between urinary volume and ureteral peristalsis
i) Despite of urine volume, the discharge interval was found to be almost the same, when the secretion rate of urine was constant. Alteration of discharge interval was proved to occur, when the secretion rate of urine was changing: The discharge interval shortened when urinary output increased abruptly and the discharge interval prolonged when urinary output was reduced. When the urine volume resumed to be constant, the shortened or prolonged interval gradually returned to the values seen before the alteration of urine output.
ii) Showing no relation with secretion rate of urine, conduction velocity of the action potential altered parallel to the alteration of the discharge interval. The amplitude and duration remained almost constant, regardless of the change in urine volume or in the discharge interval.
5. Ureteral response to the intravesical infusion
When the bladder was infused to some degree with a physiologic saline solution, the discharge interval began to shorten. The time lapsed from the onset of the infusion till appearance of the phenomenon became shorter with larger urine output. Further, the phenomenon occurred with small intravesical content as the urine output became larger.
6. Normal values in electro-ureterogram
Taking 99.8% confidence limits of the values measured in 66 normal adults, the normal ranges of various measurements of the action potential were decided as follows discharge interval 6.0-33.7 sec.; amplitude 0.13-1.02mV; duration 0.2-1.1sec.; conduction velocity 2.0-66.6mm/sec.
7. On retrograde peristalsis
i) Genetic ways of retrograde peristalsis could be divided into five types: appearance of a retrograde peristalsis in group, appearence of a retrograde peristalsis between consecutive antegrade peristalses, appearance of an antegrade peristalsis between two consecutive retrograde peristalses, appearance of retrograde peristalses only, and alternative appearance of ante- and retrograde peristalses. The frequency of these five types was found to be in the abovementioned order.
ii) Transition from antegrade peristalsis to retrograde peristalsis occurred after abnormally longer discharge interval of the former. On the other hand, transition from retrograde peristalsis to antegrade peristalsis occurred after shorter discharge interval, compared to the preceded retrograde peristalsis. In rare occasions, above-mentioned relation became re