STUDIES ON THE URODYNAMICS OF THE UPPER URINARY TRACT IN PATHOLOGIC CONDITION BY UROMETRY

Abstract

The pressure of upper urinary tract of 250 cases selected from outpatients and inpatients of the urological clinic of Shinshu University Hospital was measured by means of the strain gauge manometer. In the cases, pathologic changes or condition of the upper urinary tract were observed in excretory urography and other routine examinations. Response of the upper urinary tract to drugs was also observed in some cases.
1) In cases of ureteral calculi, the ureter below the calculus had a tendency to decrease the frequency and the amplitude of peristaltic contraction in comparison with the unaffected ureter. On the contrary, the ureter above the calculus, as far as hydronephrosis did not occur above it, increased contraction frequency and resting pressure in comparison with the ureter below the calculus or unaffected ureter. In some cases, peristalsis in the renal pelvis were seen. In the cases of renal calculi, the ureter did not have a constant tendency in contraction frequency, but a half of the cases decreased amplitude and resting pressure as compared with unaffected side.
2) In the cases of nephroptosis, uncommon contraction waves in the renal pelvis, multiphasic contraction waves of the ureter, and ureteral pressure curve characteristic of ureteral obstruction were observed. Some of their excretory urograms showed pyelo-renal backflow.
3) In the cases of inflammatory ureteral stenosis, no or poor contraction waves and high resting pressure were observed at the affected part. Waves derived from respiration and pulsation were also observed at the part.
4) Most of urometrograms that showed high renal pelvic and ureteral pressure were the same type that was observed at experimental ureteral obstruction, Clinically many of these cases had lumbar or flank pain and hematuria which were considered as the result of elevation of the renal pelvic or ureteral pressure. In some of those, cystoscopic finding showed edema, hyperemia and narrowing of the ureteral orifice, and elevation of the interureteric ridge In some excretory urograms of these patients, pyelo-renal backflow, only nephrogram due to contrast material, and narrowing of the renal pelvis and ureter were seen.
5) In the cases which had severe vesico-ureteral reflux, decrease in contraction frequency and contraction amplitude and low resting pressure were observed, In response of ureter to bladder filling and voiding, both urometrograms of ureter and bladder were exactly parallel in the cases which had severe VUR. As VUR was less serious, the response of ureter became nearly normal.
6) Urometrograms in each stadium of hydronephrosis were observed. In the initial stadium of hydronephrosis, pressure of ureter and renal pelvis above obstruction was normal or high, and contraction frequency was normal or increased. In some cases, urometrograms showed the same type that was observed at experimental ureteral obstruction, and contraction waves in the renal pelvis were seen. As hydronephrosis developed, lowering of ureteral activity and renal pelvic pressure were seen.
7) Effect of drug on the ureteral activity was studied with TTFD (Alinamin F) and Piribenzil methyl sulfate (Acabel). The former increased ureteral contraction frequency and the latter decreased it, but the causes of these effects were still unknown.