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

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Neuro-Urology

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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.

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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

T½:

Half-life time

UPJ:

Ureteropelvic junction

UUO:

Unilateral ureteric obstruction

VUJ:

Vesicoureteric junction

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Authors and Affiliations

  1. Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands

    Paul W. Veenboer & J. L. H. Ruud Bosch

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  1. Paul W. Veenboer
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  2. J. L. H. Ruud Bosch
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Correspondence to J. L. H. Ruud Bosch .

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Editors and Affiliations

  1. Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA

    Roger Dmochowski

  2. Department of Urology, Radboud University, Nijmegen, The Netherlands

    John Heesakkers

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Veenboer, P.W., Bosch, J.L.H.R. (2018). Upper Urinary Tract Function (Reflux, Obstruction, and Kidney Function). In: Dmochowski, R., Heesakkers, J. (eds) Neuro-Urology. Springer, Cham. https://doi.org/10.1007/978-3-319-90997-4_16

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  • DOI: https://doi.org/10.1007/978-3-319-90997-4_16

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-90997-4

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