STUDIES ON THE FUNCTION OF THE UPPER URINARY TRACT

XII. CONCERNING THE URETER FUNCTIONS OF PATIENTS WITH TRAUMATIC SPINAL CORD LESIONS

Abstract

In patients with traumatic spinal cord lesion the disturbances of urinary tract functions cause various complications which have great effect upon such patient's prognosis. However, few studies have been reported on changes of ureter functions in such cases.
The author has performed a uretero-electro myographic study using a “U-schlinge” type lead on 89 ureters of 53 patients of traumatic spinal cord lesions and the following results have been obtained:
1) The patients in the study showed the uretero-electro-myographic abnormalities such as marked prolongation and shortening of discharge interval which were not seen in normal individuals. Furthermore, abnormalities in amplitude, duration time and conduction velocity were occasionaly observed, and even retrograde peristalsis was seen rarely.
2) Concerning the relationship of the utetero-electro-myogram and the position of the lesion no definite pattern was demonstrated, although the prolongation of discharge interval was relatively frequent in case of thoracic spinal lesions.
3) The more prolonged were the posttraumatic intervals, the more frequently the abnormal action potentials seemed to occur.
4) No direct relationship existed between the uretero-electromyogram and the bladder functions. No remarkable change in the urtero-electro myogram was seen in normotonic, hypertonic, and hypotonic bladders although relatively frequent abnormal discharges were observed in cases with absent automatic contraction wave or micturition contraction curve.
5) The abnormalities in renal functions were very frequently seen in cases with abnormal action potentials of ureter especially in cases in which long time passed after trauma.
This tendency was observed also in cases which showed retrograde ureter peristalsis. Therefore, this was considered to be the change of ureter function secondary to the spinal lesions.
6) In cases which showed retrograde ureter peristalsis, no specific abnormality in action potential was seen when the bladder was empty.
When the bladder was filled, its function was decreased compared to normal.
This decreased function at the time of bladder filling was observed also in cases without retrograde peristalsis and cases whose anterior and posterior sacral roots were severed.
However, the ureters responded to the pressure in bladder and it was presumed that no basic change occurred in ureter functions.
7) The retrograde peristalsis was seen in a small portion of cases under study. In such cases the renal functions were severely disturbed, and many had complications. There were two ways in occurrence of retrograde peristalsis.
One way was multiple occurrences as a group and the other was one occurrence innormal peristalsis.