Extravesical correction of the ureterovesical junction

In correction of the ureterovesical junction, the pathology can be corrected using an extravesical or intravesical technique. We performed an extravesical antireflux procedure with the dismembered or non-dismembered technique in 117 ureters between March 1991 and March 1996 at our Department of Pediatric Urology. The success rate was 94.9 % (111 renal units). Postoperative morbidity and complications were minimal, hematuria and bladder spasms were not seen. Associated pathology like paraostial diverticula, megaureter with the necessity for modeling and ureter duplex do not compromise the success rate.     

Extravesical correction of the ureterovesical junction

In correction of the ureterovesical junction, the pathology can be corrected using an extravesical or intravesical technique. We performed an extravesical antireflux procedure with the dismembered or non-dismembered technique in 117 ureters between March 1991 and March 1996 at our Department of Pediatric Urology. The success rate was 94.9% (111 renal units). Postoperative morbidity and complications were minimal, hematuria and bladder spasms were not seen. Associated pathology like paraostial diverticula, megaureter with the necessity for modeling and ureter duplex do not compromise the success rate.     

输尿管镜技术治疗输尿管膀胱壁间段结石的疗效观察

目的 探讨输尿管镜技术治疗输尿管膀胱壁间段结石安全性和有效性.方法 回顾性分析我院近10年采取输尿管镜技术治疗的输尿管膀胱壁问段结石患者86例.结果 全部患者成功碎石并留置双J管,术后4周拔除.术后6个月复查超声与尿常规未见同侧肾积水、输尿管开口狭窄和尿路感染.结论 输尿管镜技术治疗输尿管壁间段结石安全有效,具有创伤小、安全性高、疗效确切等优点,具有很强的实用性及可操作性.     

Nitroxergic innervation of the human ureterovesical junction

Nitric oxide synthase (NOS) immunohistochemistry and nicotinamide adenine dinucleotide phosphate diaphorase (NADPH-d) histochemistry were used to investigate the distribution of nitroxergic, i.e., nitric oxide-synthesizing, neuronal perikarya and processes in the human ureterovesical junction (UVJ). Tissue specimens obtained from two cadaver kidney donors and two patients undergoing radical cystectomy for bladder cancer were examined. Clusters of NOS-immunoreactive neurons were localized in extramural ureterovesical ganglia. NOS-containing nerve fibers traveled within large extramural nerve trunks and marched among smooth muscle bundles. Extramural and intramural blood vessels were encircled by varicose NOS-positive axonal processes. The distribution of NOS immunoreactivity paralleled the staining pattern for NADPH-d activity. Urothelium stained strongly for NADPH-d activity but showed no NOS immunolabeling. Specimens from all four patients investigated showed similar staining patterns. Our results suggest that nitric oxide, a potent smooth-muscle-relaxing neurotransmitter in the autonomic nervous system, plays a physiologic role in opening the human UVJ.     

Dynamics of the ureterovesical junction: interaction between diuresis and detrusor instability at the ureterovesical junction in pigs

In pigs under general anesthesia, the mutual relation between ureterovesical flow and detrusor activity was evaluated with juxtavesical ureteral perfusion pressure measurements and cystometry. At constant bladder filling volume ureterovesical perfusion could provoke detrusor activity, which was positively related to the perfusion rate, and which disappeared after perfusion was stopped. During such involuntary detrusor activity ureterovesical perfusion pressure might increase significantly more than intravesical pressure. It is concluded that ureterovesical flow causes distension of detrusor muscle bundles around the ureteric hiatus, which may trigger local and general detrusor activity in an unstable bladder. During such detrusor activity, due to forces in the bladder wall, resistance to outflow from the upper urinary tract could be significantly more impaired than is reflected by the increase of intravesical pressure at cystometry. The clinical implications are discussed.     

One-stage operation of ureteropelvic junction and ureterovesical junction stricture

One-stage surgical management for ureteropelvic (UP) and ureterovesical (UV) strictures is reported. A 3-year-old boy with UP and UV strictures on left side, underwent nephrostomy at 4 months old. The plastic operations which were Anderson-Hynes method for UP stricture and submucosal tunnel method with tailoring of dilated ureter for UV stricture were performed at the same time. The post-operative intravesical pyelogram and renal scintigraphy showed the improvement of hydronephrosis. Many authors have described two-stage operations for such cases. Our findings revealed that one-stage operation, carefully preserving the blood supply to the ureter, would be an alternative surgical management for UP and UV strictures.     

输尿管膀胱连接处梗阻的诊断与治疗

目的 探讨输尿管膀胱连接处梗阻的诊治方法.方法 回顾性分析我院2006年1月至2011年12月,10例输尿管膀胱连接处梗阻(UVJO)接受手术治疗患者的临床资料.男6例,女4例.间断腹痛和反复泌尿系感染.B超、IVU及排泄性膀胱尿道造影(VCU)诊断为UVJO.行横向膀胱黏膜下隧道膀胱输尿管再吻合术(Cohen术式).结果 10例术后恢复顺利,10～14 d出院.10例获随访,随访时间平均2.5(0.5 ～3.5)年.IVU示肾输尿管积水明显减轻8例,好转2例.并发泌尿系感染1例,抗感染治疗后好转;症状完全消失9例.结论 腹痛、泌尿系感染等临床症状或肾输尿管积水进行性加重为UVJO手术指征,Cohen式术式效果满意.积水较轻或无临床症状患者可动态观察.     

Prenatal and postnatal neuromuscular development of the ureterovesical junction

PURPOSE: The mechanisms underlying functional maturation of the ureterovesical junction during infancy are still not fully understood. We analyzed the development of smooth muscle components of the ureterovesical junction and their nerve supply in the fetal, newborn and adolescent pig. MATERIALS AND METHODS: Bladder specimens were obtained from porcine fetuses at gestational ages 60 days (5) and 90 days (5), newborn piglets (5) and 6-month-old pigs (4). Serial sections of the ureterovesical junction were investigated by Masson's trichrome, and hematoxylin and eosin histological staining, enzyme immunohistochemistry for alpha-smooth muscle actin and desmin, as well as double immunofluorescence staining using the neuronal marker peripherin and smooth muscle actin. RESULTS: At day 60 the detrusor muscle already consisted of distinctive muscle bundles with rich innervation, while the smooth muscle coat of the extravesical ureter and subsequently the intravesical ureter had only started to differentiate. At day 60 innervation of the extravesical ureteral smooth muscle was well developed, while the innervation of the intramural part did not mature until birth. Muscle fibers of the periureteral sheath were well distinguishable at day 60 but innervation of these fibers was sparse during fetal life and showed a remarkable increase during the postnatal period. All smooth muscle components showed a striking increase in muscle bulk between the neonatal and adolescent stages. CONCLUSIONS: Our findings show that the smooth muscle components and innervation of the ureterovesical junction continue to mature during the postnatal period. This may have implications for managing ureterovesical junction disorders.     

Dynamics of the ureterovesical junction; a qualitative analysis of the ureterovesical pressure profile in the pig

In pigs, ureterovesical pressure profiles were analyzed by combined prevesical perfusion pressure measurement and microsensor pressure profilometry of the ureterovesical junction, which showed comparable and reproducible fast and slow pressure waves. Cystoscopy revealed that the fast pressure waves were associated with fluid spurts from the ureteral orifice and wrinkling of bladder mucosa over the ureterovesical junction. During slow pressure waves only initial decreases in outflow from the orifice may occur. After dissection of the detrusor muscle at the UVJ only fast pressure waves were recorded. At similar pressure measurements on an inactivated ureter segment which was obliquely passed through the bladder wall only slow pressure waves could be detected. It is concluded that the fast pressure waves of the ureterovesical pressure profile represent peristaltic activity which is generated at the ureterovesical junction and by which fluid may be discharged into the bladder. The slow pressure waves of the pressure profile reflect impairment of flow through the ureterovesical junction by detrusor activity.     

A case of proliferative cystitis forming ureterovesical junction obstruction

We report a case of proliferative cystitis forming ureterovesical junction obstruction. A 28-year-old man presented with a complaint of gross hematuria. Abdominal ultrasonography revealed left hydronephrosis and bladder tumor. Drip infusion pyelography (DIP) demonstrated left ureterovesical junction obstruction and cystoscopic findings appeared papillary sessile tumor around the bladder neck, trigone, and bilateral ureteral orifice. Transurethral resection of the bladder tumor (TURBT) was performed. The pathological diagnosis of the tumor was proliferative cystitis and confirmed that left ureterovesical junction obstruction was derived from proliferative cystitis. The tumor was not responsive to medical treatment. After the 4th TURBT, the tumor was completely resected, and left hydronephrosis and ureterovesical junction obstruction were improved. One year after the last operation, there is no evidence of recurrence of the tumor. Tumor formation arising from proliferative cystitis is relatively rare. Pathogenesis and management of this rare condition are discussed.     

Horseshoe kidney in an infant associated with ureteropelvic junction and ureterovesical junction obstructions

A 4-month old baby was seen in August, 1982 because of abdominal distension. The findings of the physical examination were normal except for a man's fist sized mass in the left upper abdomen. IVP revealed left nonvisualizing kidney. CT scans revealed a large mass in the left abdomen with low density contents and renal scintigraphy revealed a horseshoe kidney. The tentative diagnosis was horseshoe kidney associated with hydronephrosis due to ureteropelvic junction obstruction. Left pyeloplasty was performed in September 1982 and postoperative X-ray examinations revealed left ureterovesical junction obstruction. Left ureteroneocystostomy was performed in October, 1982 and postoperative course was uneventful. Horseshoe kidney in infants is rare in the Japanese literature and our case is quite unique in that horseshoe kidney is associated with ureteropelvic junction and ureterovesical junction obstruction.     

Dynamics of the ureterovesical junction: its fluid transport mechanism in the pig

The peristaltic fluid transport mechanism of the ureterovesical junction was investigated with distal and juxtavesical ureteral perfusion pressure measurements. Elimination of the activity of the juxtavesical ureteral segment, juxtavesical or intravesical partial resection of the ureteral sheaths, and impediment of shortening of the muscular layers of the ureterovesical junction ureter segment, all reduced the effectiveness of ureterovesical junction peristalsis. From these findings and from the anatomy of the ureterovesical junction we concluded that peristaltic urine transport through the ureterovesical junction is effectuated by shortening and telescoping of the muscular layers of the ureterovesical junction ureter segment and its sheaths into each other and into the ureteric hiatus.     

The effect of acute chemical sympathectomy on the competence of the canine ureterovesical junction

Selective chemical destruction of the adrenergic nerve terminals in the dog bladder with 6-hydroxydopamine does not result in vesicoureteral reflux. The sympathetic nerve supply of the bladder does not appear to play a role in maintaining the normal competence of the ureterovesical junction.