Further cinefluorographic observations on the upper urinary tract. II. The effects of diuresis and ureteral obstruction.

Abstract

Study of the physiology of the renal pelvis and the ureter has been hampered by the relative inaccessibility of these structures. Frequently examinations have been performed with instruments and equipment which, by the very nature of their construction or method of application, yielded results rendered invalid through artefact production. Although at present several methods for the study of renal pelvic and ureteral function yield acceptable and reproducible results, (3, 5, 9–11) only radiography permits direct observation of undisturbed structures under consideration. A previous publication has shown that cinefluorography is a satisfactory technic for visualizing the dynamic changes which occur in the normal upper urinary tract (1). At that time, it was pointed out that the activity of the upper urinary tract could be divided into two patterns: that of the bifid renal pelvis, in which the contractions originate in the upper infundibulum and that of the ampullary renal pelvis in which the contractions originate in the pelvis proper. The purpose of this paper is to extend these observations by studying the effects of both diuresis and ureteral obstruction on the motor function of the upper urinary tract. Method A total of 25 cinefluorographic studies were undertaken in 25 patients. Of these, 21 were suitable for analysis and inclusion in this study. The 21 patients were free from significant urinary tract disease, and intravenous urographic examinations were essentially normal. The patients were divided into two separate groups, a diuresis group numbering 12 and an obstruction group of 9. A. The Diuresis Group: All patients in the diuresis group received a preliminary intravenous injection of 25–30 cc of Renografin-60 or Renovist, after which cinefluorography of the upper urinary tract was carried out in a fashion previously described (1). The ciné runs were long enough to include several peristaltic complexes. At this point, an intravenous infusion of 150 cc of Renovist was instituted and the entire contents were infused in a period of ten to fifteen minutes, in an attempt to take advantage of the well known osmotic diuretic properties of concentrated urographic contrast media. At the end of the infusion, cinefluorography was once again performed. In some cases, hypertonic mannitol was infused, in addition to the urographic contrast medium, but this resulted in considerable dilution and impaired opacification of the renal collecting system. The use of mannitol was discontinued because its effects were simulated by the contrast medium alone. B. The Ureteral Obstruction Group: The patients in the ureteral obstruction group also received 25–30 cc of Renografin-60 or Renovist, following which cinefluorography was performed.