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Neuro-Urology pp 233-248 | Cite as

Upper Urinary Tract Function (Reflux, Obstruction, and Kidney Function)

  • Paul W. Veenboer
  • J. L. H. Ruud Bosch
Chapter

Abstract

In this chapter, several (patho-)physiological and diagnostic aspects of the upper urinary tract are discussed. Under normal circumstances, ureteral peristalsis is initiated by so-called interstitial cells of Cajal (“pacemaker cells”), causing a urinary bolus to move through the urinary tract. The function of the urinary tract can be affected by both upper and lower motor neuron diseases, giving rise to different clinical entities. If obstruction of the urinary tract occurs due to neurological dysfunction, this can have various effects on renal blood flow and peristalsis. Nuclear agents with which upper urinary tract function can be assessed are technetium-99m diethylenetriamine pentaacetic acid (99mTc-DTPA), technetium-99m dimercaptosuccinic acid (99mTc-DSMA), and technetium-99m mercaptoacetyl triglycine (99mTc-MAG3) renal scans. The Whitaker test is of use when noninvasive tests such as these yield unequivocal results. In the case of neurogenic bladder disease, function of the lower urinary tract should also be taken into account, which can best be done using (video) urodynamics; usage of fluoroscopy during cystometry is very important to demonstrate or rule out vesicoureteric reflux. Global renal functioning is usually assessed using serum creatinine, but in those with neurogenic bladder disease, this may be unreliable and alternative methods (e.g., 24-h clearance, cystatin C) could be used.

Keywords

Upper urinary tract Neurogenic bladder disease Ureteric peristalsis Urodynamics Whitaker test Upper urinary tract obstruction Ureteral obstruction Vesicoureteral reflux 

Abbreviations

99mTc-DSMA

Technetium-99m dimercaptosuccinic acid

99mTc-DTPA

Technetium-99m diethylenetriamine pentaacetic acid

99mTc-MAG3

Technetium-99m mercaptoacetyl triglycine

BUO

Bilateral ureteric obstruction

EAU

European Association of Urology

eGFR

Estimated glomerular filtration rate

GFR

Glomerular filtration rate

RBF

Renal blood flow

RVR

Renal vascular resistance

SCI

Spinal cord injury

Half-life time

UPJ

Ureteropelvic junction

UUO

Unilateral ureteric obstruction

VUJ

Vesicoureteric junction

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of UrologyUniversity Medical Center UtrechtUtrechtThe Netherlands

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