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Urodynamics pp 168-190 | Cite as

Dynamics of the Ureterovesical Junction

  • C. Blok
  • G. E. P. M. van Venrooij
  • B. L. R. A. Coolsaet

Abstract

The ureterovesical pressure profile (UVPP) and the dynamics of the urterovesical junction (UVJ) were analysed with prevesical and intraluminal perfusion pressure measurements, and with an intraluminal micro-pressure sensor catheter.

The reliability of the measuring techniques was evaluated with different pressure measuring catheters under varying conditions.

Prevesical and intraluminal perfusion pressure measurements with F8 or F5 flexible catheters, at high perfusion rates, and intermittent or low withdrawal velocity of the catheter, produced the highest reproducibility.

The dynamical factors and anatomical structures, which possibly contribute to, or influence the pressure phenomena within the UVJ, were evaluated by the principle of addition and elimination.

Besides a baseline pressure, the UVPP showed fast and slow pressure waves. The UVJ develops peristaltic activity by which it discharges fluid boli into the bladder. This UVJ peristalsis is responsible for the fast pressure waves in the UVPP.

The slow pressure waves represent the influence of detrusor activity upon urine transport through the UVJ, and reflect detrusor irritability.

Besides activity arteficially induced by an intraluminal catheter, the baseline pressure represents the resistance to continuous flow through the UVJ. It is determined by:
  • The intravesical pressure in the bladder at bladder filling.

  • The detrusor activity in the unexpanded bladder.

  • The bladder wall stretch in the overdistended bladder.

  • The bladder wall stress and intravesical pressure in the small volume, low capacity bladder.

  • Similar pressure measurements in man seem to confirm these findings.

Keywords

Bladder Wall Detrusor Pressure Bladder Filling Intravesical Pressure Ureteral Orifice 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Bäcklund L, Reuterskiöld AG (1969) The abnormal ureter in children. Scand J Urol Nephrol 3:219–228CrossRefGoogle Scholar
  2. Blok C Venrooij GEPM van, Coolsaet BLRA (1982) Active urine transport through the ureterovesical junction. Abstract fourth meeting ISDU, Utrecht, The Netherlands, August 29-September 1Google Scholar
  3. Blok C, Riel MPJM van, Venrooij GEPM van, Coolsaet BLRA (1982) Artificial sphincter pressure versus bladder leaking pressure. Proceedings 2nd Joint Meeting ICS and UDS, Aachen, Federal Republic of Germany, August 3–September 31 pp 96–98Google Scholar
  4. Boyarski S, Labay P (1972) Ureteral dynamics. Williams & Wilkins, Baltimore LondonGoogle Scholar
  5. Brat CG (1977) Renal function in patients with hydronephrosis. Br J Urol 49:249–255CrossRefGoogle Scholar
  6. Bruijnes E (1978) The ureteral pressure profile. Urol Int 33:381–392PubMedCrossRefGoogle Scholar
  7. Coolsaet BLRA, Griffiths DJ, Mastrigt R van, Duyl WA van (1980) Urodynamic investigation of the wide ureter. J Urol 124:666–672PubMedGoogle Scholar
  8. Coolsaet BLRA, Venrooij GEPM van, Blok C (1982a) The ureterovesical pressure profile. Abstracts 77th Annual Meeting of the AUA, Kansas City, May 16–20, 1982, p 180Google Scholar
  9. Coolsaet BLRA, Venrooij GEPM van, Blok C (1982 b) Detrusor pressure versus wall stress in relation to ureterovesical resistance. Neurourol Urodyn 1:105–112CrossRefGoogle Scholar
  10. Elbadawi A (1972) Anatomy and function of the ureteral sheaths. J Urol 102:224–229Google Scholar
  11. Elbadawi A, Amaku EO, Frank IN (1969) Anatomy of the submucosal segment of the ureter. Read at the annual meeting of the Northeastern section of the AUA. Quebec City, Quebec, September 1969Google Scholar
  12. Hald T, Bradley WE (1982) The urinary bladder. Williams & Wilkins, Baltimore LondonGoogle Scholar
  13. Hanna MK, Edwards L (1972) Pressure perfusion studies of the abnormal ureterovesical junction. Br J Urol 44:331–335PubMedCrossRefGoogle Scholar
  14. Koff SA, Lapides J, Piazza DH (1979) The uninhibited bladder in children:a cause for urinary obstruction, infection and reflux. In:Hodson J, Kincaid-Smith P (eds) Reflux nephropathy. Masson, Paris New York Barcelona Milan, pp 161–170Google Scholar
  15. Leen GL, Fegetter JGW, Stobbart D (1982) The ureterovesical pressure profile: fact or fiction. Abstract fourth meeting ISDU, Utrecht, The Netherlands, August 29-September 1Google Scholar
  16. Mathisen W (1964) Vesicoureteral reflux and its surgical correction. Surg Gynecol Obstet 118:965–971PubMedGoogle Scholar
  17. McGuire EJ, Woodside JR, Borden ThA (1983) Upper urinary tract detoriation in patients with myelodysplasia and detrusor hypertonia:a follow-up study. J Urol 129:823–826PubMedGoogle Scholar
  18. Rose DL, Constantinou CE, Sands JP, Govan DE (1971) Dynamics of the upper urinary tract:effects of changes in bladder pressure on ureteral peristalsis. J Urol 106:209–213Google Scholar
  19. Shehata R (1977) A comparative study of the urinary bladder and the intramural portion of the ureter. Acta Anat 98:380–395PubMedCrossRefGoogle Scholar
  20. Tanagho EA, Meyers FH, Smith DR (1968) The trigone:anatomical and physiological considerations in relation to the ureterovesical junction. J Urol 100:623–632PubMedGoogle Scholar
  21. Tokunaka S, Koyanagi T (1982) Morphologic study of primary nonreflux megaureters with particular emphasis on the role of ureteral sheath and ureteral dysplasia. J Urol 128:399–402PubMedGoogle Scholar
  22. Tsuchida S, Kimura Y (1967) Vesicoureteral reflux. Tohoku J Exp Med 91:1–12PubMedCrossRefGoogle Scholar
  23. Weiss RM, Biancani P (1981) Characteristics of normal and refluxing ureterovesical junctions. Abstract third meeting ISDU, Aarhus, Denmark, August 31-September 1Google Scholar
  24. Whitaker RH (1973) Methods of assessing obstruction in dilated ureters. Br J Urol 45:15–22PubMedGoogle Scholar
  25. Williams DI, Johnston JH (1982) Pediatric urology. Butterworth Scientific, LondonGoogle Scholar
  26. Zimskind PD, Davis DM, Decaestecker JE (1969) Effects of bladder filling on ureteral dynamics. J Urol 102:693–696PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1985

Authors and Affiliations

  • C. Blok
    • 1
  • G. E. P. M. van Venrooij
    • 1
  • B. L. R. A. Coolsaet
    • 1
  1. 1.Department of UrologyState University Utrecht, Academic HospitalUtrechtThe Netherlands

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