A radiological study of the effect of elevated intravesical pressures on ureteral calibre and peristalsis in patients with neurogenic bladder dysfunction

Abstract

Simultaneous radiographic studies of ureteral calibre, ureteral peristaltic activity and intravesical pressures were obtained in 9 patients with neurogenic bladder dysfunction. In all patients, as the intravesical pressure was increased and the bladder filled, the ureters became dilated and ureteral peristalsis diminished. Peristalsis ceased in those patients with an upper motor neurone lesion in whom the maximal intravesical pressures exceeded 37 mm./Hg. Ureteral peristalsis also ceased in patients with a lower motor neurone lesion when intravesical pressures above 37 mm/Hg. were induced by the Credé manoeuvre (manual expression). Clinical observations at Stanford Medical Center have shown that paraplegic patients treated by continuous catheter drainage have fared better than those on catheter-free therapy. The present investigation reinforces the concept that continuous bladder drainage is the management of choice in patients with neurogenic bladder dysfunction.