INVESTIGATION OF URETERIC FUNCTION BY ISOTOPE RENOGRAPHY: WITH PARTICULAR REFERENCE TO PATIENTS WITH " UNEXPLAINED " RENAL PAIN

Abstract

The isotope renogram offers a simple and safe method of studying the passage of urine from kidney to bladder. By this technique it can be shown that urine flow down the ureter is often irregular. Transient episodes of complete or partial interruption of ureteric urine flow on one or both sides are common in patients with anatomically normal urinary tracts. A study of 200 patients with otherwise normal renograms showed that such changes were detectable in 75% of cases. The duration of the longest observed period of urine hold-up was sometimes considerable, being over 150 seconds in 28 patients (14%). The majority of these 28 subjects had no pathological or radiological evidence of renal or urinary-tract disease. There was, however, a striking clinical similarity in 14 cases, all but 1 being women. There was a story of recurrent attacks of loin pain, urgency, and frequency, without any consistent laboratory evidence of urinary-tract infection. 4 patients had undergone repeatedly negative hospital investigations for suspected pyelonephritis or renal colic for over twenty years. The symptoms in these patients may be due to contractions of the ureters and trigone, associated with a temporary hold-up of ureteric urine flow—a functional condition analogous to spastic colon.