Table Of ContentUrodynamics
Upper and Lower Urinary Tract
I I
Edited by
W. Lutzeyer . J. Hannappel
With 243 Figures and 22 Tables
Springer-Verlag
Berlin Heidelberg New York Tokyo
Professor Dr. WOLFGANG LUTZEYER
Privatdozent Dr. JOSEF HANNAPPEL
Abteilung Urologie der Medizinischen Fakultiit
der Rhein.-Westf. Techn. Hochschule Aachen
PauwelsstraBe, 0-5100 Aachen
ISBN-13: 978-3-642-70438-3 e-ISBN-13: 978-3-642-70436-9
DOl: 10.1007/978-3-642-70436-9
Library of Congress Cataloging in Publication Data. Urodynamics, upper and lower uri
nary tract II. Contributions resulting from a two-day workshop held in Aachen in 1983.
Bibliography: p. Includes index. I. Urodynamics-Congresses. I. Lutzeyer, W. (Wolf
gang), 1923- . II. Hannappel, J. (Josef), 1942- . RC90l.U747 1985 616.6 85-4765
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2122/3130-543210
List of Contributors
You will find the addresses at the beginning of the respective con
tribution
Anger, K. 154 Melchior, H. 317
Bisballe, S. 95 Meyhoff, H. H. 253
Blok, C. 168 Morita, T. 45
Bottaccini, M. R. 253 Mortensen, J. 95
Boyarsky, S. 333 Mtiller-Schauenburg, W. 154
Coolsaet, B. L. R. A. 168 Nawrath, H. 30, 51
Djurhuus, J. C. 95 Notley, R. G. 286
van Duyl, W. A. 20, 60 Ohlson, L. 69
Gleason, D. M. 253 Plevnik, S. 139
Gerlach, R. 102 Rakovec, S. 139
Griffiths, D. 120 Schmiedt, E. 203
Hannappel, J. 13 Schulman, C. C. 292
Hertie, L. 30, 51 Tanagho,E.A. 193
Hinman Jr., F. 241 Turner-Warwick, R. 212
Hock, F. 148 van Venrooij, G. E. P. M. 168
Laursen, H. 95 Vyska, K. 148
Laval, K. U. 148 Vrtacnik, P. 139
Marberger, H. 246 Wieland, W. 203
van Mastrigt, R. 3, 126 Zinner, N. R. 263
Preface
The preface to Urodynamics - Upper and Lower Urinary Tract edited
by LUTZEYER and MELCHIOR (Springer-Verlag 1973) mentions the
self-evidence of using functional examinations in other medical de
partments: "It is self-evident that the cardiologist uses the EeG not
just routinely, but continuously in an intensive-care unit, where it is
computerized and always on call. It is self-evident, too, in gastro
enterology and pulmology that a functional analysis is based on
readings of different electronic probes. In urology, however, we tend
to rely on optical control by cystoscopy, static data in order to reach
a functional interpretation that is based on this information alone."
Referring to the preface mentioned above, especially the upper uri
nary tract is said to be assessed mainly from an anatomic-morpho
logic point of view in the clinical routine, though in this case we are
also mainly concerned with an active transport system.
Twelve years after the urodynamic meeting in 1971, which the
above-mentioned volume was based on, a second urodynamic meet
ing took place in Aachen that was called and also dealt with "Re-:
viewing the Aachen 1971 Meeting." Its purpose was to review which
of the statements that had been made more than a decade before
were still valuable, what had to be added or revised, and which ex
perimental tests and results could be clinically applied. This was the
reason that invitations to speakers were confined to those who had
already displayed their results in 1971 and who in the past decade
had had a significant influence on the development of urodynamics,
based either on theoretical and experimental or on clinical and
practical research.
Thus, TANAGHO reports that new findings concerning the mor
phology and function of the sphincter externus vesicae were
achieved in the period between the two meetings in Aachen, and
that in spite of the close evolutionary, anatomical, and functional
interrelation between the floor of the pelvis and the external sphinc
ter, both structures differ immensely in the properties of their
smooth muscles. SCHMIEDT introduces an interesting new scrotal flap
technique as an operative. method for improving continence. An
alternative is the new AMS-800 sphincter, whose implantation was
demonstrated in a movie by GREGOIR. TuRNER-WARWICK empha
sizes the, meanwhile clinically accepted, necessity of differentiating
between organic infravesical obstruction (like BPH) and functional
obstruction caused by dyssynergic bladder neck obstruction. In this
VIII Preface
way uroflow measurement, a simple method of examination, has
gained great importance. Recurrent infection of the uroepithelium
is found in the borderland between urodynamics and immunology,
whereby HINMAN differentiates between extrinsic and intrinsic de
fenses. MARBERGER and BOTTACCINI examine the loss of energy that
occurs during bladder emptying in the region of the bladder neck
and urethra from a clinical and engineering scientific point of view.
ZINNER gives a summary of the development of our knowledge on
the hydrodynamic bladder and urethral function. He states that
"over the years the field has grown and now incorporates new com
ponents including neurophysiology, anatomy, pharmacology, and
the like."
Essential items of the morphology described in 1971 have be
come approved during the past years (NOTLEY, SCHULMAN). Though
the nexus have in the meantime changed their names and are now
called "close approaches," the distribution of the ganglion cells and
the existence of pacemaker cells are now no longer disputed.
MELcmOR describes the value of urorheomanometry introduced in
1971, comparing it with the recently developed noninvasive pan
urography. The last article of this collection, BOYARSKY'S lecture
"Ureteral Urodynamics, Past and Future," almost seems like an
epicrisis, a review and a challenge for the future.
A two-day workshop on the upper urinary tract preceded the re
view meeting. On the first day the urodynamic laboratories of
Aachen were open to the guests for in vivo and in vitro studies on
experimental animals and of course for any kind of information. The
second day offered a series of lectures concerning "Myogenic Con
trol for the Upper Tract" and "Hydrodynamics and Mechanics of
the Upper Tract." These lectures, which presented for many points
new approaches, examination techniques, and results, precede the
articles from the "Reviewing the Aachen 1971 Meeting." Thus, we
hope to be able to offer the readers both a survey of 12 years of
urodynamic research and clinical practice as well as new scientific
findings on this research field which is expanding faster and faster.
Aachen W. LUTZEYER
Contents
Workshop on Upper Urinary Tract Urodynamics
I. Myogenic Control for the Upper Tract
Passive Properties of the Smooth Muscle of the Pig Ureter
R. VAN MASTRIGT. With 6 Figures and 9 Tables. . . . 3
Myogenic Function of Normal and Chronically Dilated
Pyeloureters
J. HANNAPPEL. With 7 Figures . . . . . . . . . . 13
Modelling of the Propagation of an Action Potential
Along the Ureter
W. A. VAN DuYL. With 9 Figures . . . . . . . . . 20
Voltage-and Agonist-Induced Activation of Smooth Muscle
of the Human Upper Urinary Tract: Different Mechanisms
L. HERTLE and H. NA WRATH. With 11 Figures and I Table 30
Effects of ,8-Adrenergic Agonists on the Action Potentials
of Canine Pyeloureter
T. MORITA. With 4 Figures ..... . . . . . . . . 45
Effects of Some Directly-Acting Smooth Muscle Relaxant
Drugs on Isolated Human Preparations of the Upper
Urinary Tract
L. HERTLE and H. NAWRATH. With 7 Figures and I Table 51
Search for Anisotropy in Specific Electrical Conductance
of Ureteral TIssue as a Measure of Muscle-Fiber Structure
W. A. VAN DuYL. With 5 Figures and 2 Tables . . . . . 60
II. Hydrodynamics and Mechanics of the Upper Tract
Kinetic Urography
L. OHLSON. With 6 Figures 69
x Contents
The Reproducibility of the Pressure-Flow Relationship
in the Normal Upper Urinary Tract of the Pig
J. MORTENSEN, J. C. DJURHUus, S. BISBALLE, and H. LAURSEN
With 6 Figures . . . . . . . . . . . . . . . . . . 95
The TIme-Distance Diagram of the Ureteral Transport
R. GERLACH. With 14 Figures and 1 Table . . . . . . 102
Mechanics of the Upper Tract
D. GRIFFITHS. With 4 Figures 120
The Propagation Velocity of Contractions of the Pig Ureter
in Vitro
R. VAN MASTRIGT. With 11 Figures and 2 Tables . . . . 126
Assessment of Ureteric Dynamics by Simultaneous Electric
Conductance Measurements at Two Sites
S. PLEVNIK, S. RAKOVEC, and P. VRTACNIK
With 10 Figures and 1 Table . . . . . . . . . . . . . 139
Imaging of Peristaltic Urine Transport in the Ureter Using
123Jodine Hippurate
K. U. LAVAL, K. VYSKA, and F. HocK. With 4 Figures 148
The Nuclear Medical Space Time Matrix Approach
to Ureteral Motility
W. MOLLER-SCHAUENBURG and K. ANGER. With 5 Figures 154
Dynamics of the Ureterovesical Junction
C. BLOK, G. E. P. M. VAN VENROOIJ, and B. L. R. A. COOLSAET
With 23 Figures . . . . . . . . . . . . . . . . . . . . 168
Upper and Lower Urinary Tract Urodynamics -
Reviewing the Aachen 1971 Meeting
I. Lower Tract Urodynamics
Innervation and Histologic Characteristics of the Urinary
External Sphincter
E. A. TANAGHO. With 10 Figures . . . . . . . . . . . 193
The Scrotal Flap Technique as an Operative Method for the
Treatment of Iatrogenic and Posttraumatic Male Incontinence
E. SCHMIEDT and W. WIELAND. With 7 Figures and 2 Tables 203
Contents XI
A Urodynamic Review of Bladder Outlet "Obstruction"
in the Male and Its Treatment
R. TuRNER-WARWICK. With 9 Figures. . . . . . . . . . . 212
Surface Factors in Recurrent Infection
F. HINMAN Jr. With 5 Figures . . . . ... 241
Causes and Consequences of Bladder Neck Obstruction
H. MARBERGER. With 9 Figures . . . . . . . . . . . 246
Urinary Velocity: Twelve Years Later
M. R. BOTTACCINI, D. M. GLEASON, and H. H. MEYHOFF
With 4 Figures and 2 Tables . . . . . . . . . . . . 253
Review of Techniques to Evaluate Micturitional Performance.
Promises of 1971 Revisited
N. R. ZINNER. With 23 Figures and 1 Table .. . . . . . . 263
II. Upper Tract Urodynamics
Ureteric Ultrastructure - 12 Years on
R. G. NOTLEY. With 3 Figures . . . . ..... 286
Innervation of the Ureter: A Histochemical and
Ultrastructural Study
C. C. SCHULMAN. With 26 Figures . . . .. ...... 292
Progress in Diagnosis of Ureteral Urodynamics
H. MELcmOR. With 11 Figures . . . . . . . . . . . 317
Ureteral Urodynamics: Past and Future
S. BOYARSKY. With 4 Figures . . . . . . . . . . 333
Subject Index . . . . . . . . . . . . . . . . . . . . . 341
Workshop on Upper Urinary Tract
Urodynamics
