Table Of ContentContributors
RICHARD ABSHER FRANK HINMAN, JR.
KENJI ΑΙΤΟ TIN-KAN HUNG
GORDON F. ANDERSON M. Y. JAFFRIN
DONALD W. BAKER PEREGRINA C. LABAY
LLOYD BARR WYLAND F. LEADBETTER
WILLIAM F. BARRY, JR. PAUL S. LYKOUDIS
JOHN A. BENJAMIN JOSEPH M. MALIN, JR.
SAUL BOYARSKY RICHARD L. MALVIN
WILLIAM H. BOYCE W. F. MELICK
E. M. BRIGGS FREDERICK H. MEYERS
GEORGE BUGLIARELLO PABLO A. MORALES
C. E. CONSTANTINOU SIMON OSTRACH
R. L. DALE JAMES M. PIERCE, JR.
DAVID M. DAVIS A. H. SHAPIRO
O. DUARTE-ESCALANTE ARTHUR M. STERLING
CHRISTOPHER M. FREDERICKS EMIL A. TANAGHO
YUAN-CHENG B. FUNG ERIC E. THERKELSEN
J. F. GLENN S. L. WEINBERG
WILLARD E. GOODWIN ROBERT M. WEISS
CARL W. GOTTSCHALK J. J. WORTMAN
D. E. GOVAN PAUL D. ZIMSKIND
JAY H. HARRIS NORMAN R. ZINNER
URODYNAMICS
Hydrodynamics of the Ureter and Renal Pelvis
Saul Boyarsky Carl W. Gottschalk
Division of Genitourinary Surgery Department of Medicine and Physiology
Department of Surgery University of North Carolina
Washington University School of Medicine Chapel Hill, North Carolina
St. Louis, Missouri
Emil A. Tanagho Paul D. Zimskind
Division of Urology Department of Urology
University of California School of Medicine Jefferson Medical College
San Francisco, California Philadelphia, Pennsylvania
Planning and conduct of Workshop and preparation of the proceedings for publication
were supported by the Offices of the Surgeon General of the Department of the Army,
the Department of the Navy, and the Department of the Air Force, Contract DADA17-
69-C-9084; the Division of Research Grants, National Institutes of Health Contract
PH43-64-44, Task Order No. 3; and the National Institute of Arthritis and Metabolic
Diseases Contract NIH-69-797.
ACADEMIC PRESS New York and London 1971
COPYRIGHT © 1971, BY ACADEMIC PRESS, INC.
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List of Contributors
Numbers in parentheses indicate the pages on which the authors' contributions begin.
RICHARD ABSHER (233, 399, 473), Department of Electrical Engi-
neering, University of Vermont, Burlington, Vermont
KENJI AITO (497), Urological Department, Matsuyama Sekijuji Hos-
pital, Matsuyama, Ehenie-Ken, Skikoku, Japan
GORDON F. ANDERSON (283), Department of Physiology and Pharma-
cology and Department of Urology, Wayne State University School
of Medicine, Detroit, Michigan
DONALD W. BAKER (425), Bioengineering Program, University of
Washington, Seattle, Washington
LLOYD BARR (49), Department of Physiology and Biophysics, Woman's
Medical College of Pennsylvania, Philadelphia, Pennsylvania
WILLIAM F. BARRY, JR. (133, 399), Department of Radiology, Duke
University Medical Center, Durham, North Carolina
JOHN A. BENJAMIN (77), Division of Urology, Department of Surgery,
University of Rochester School of Medicine and Dentistry, Rochester,
New York
SAUL BOYARSKY (55, 99, 163, 317, 349, 399, 473, 497, 571), Division of
Genitourinary Surgery, Department of Surgery, Washington Uni-
versity School of Medicine, St. Louis, Missouri
WILLIAM H. BOYCE (513), Division of Urology, Department of Surgery,
The Bowman Gray School of Medicine of Wake Forest University,
Winston-Salem, North Carolina
xvii
xviii LIST OF CONTRIBUTORS
E. M. BRIGGS (143, 455), Division of Urology, Department of Surgery,
Stanford University School of Medicine, Stanford, California
GEORGE BUGLIARELLO (485), University of Illinois at Chicago Circle,
Chicago, Illinois
C. E. CONSTANTINOU (143, 455), Division of Urology, Department of
Surgery, Stanford University School of Medicine, Stanford, California
R. L. DALE (143, 455), Division of Urology, Department of Surgery,
Stanford University School of Medicine, Stanford, California
DAVID M. DAVIS (363), Department of Urology, Jefferson Medical
College, Philadelphia, Pennsylvania
0. DUARTE-ESCALANTE (29, 317), Division of Genitourinary Surgery,
Department of Surgery, Washington University School of Medicine,
St. Louis, Missouri
CHRISTOPHER M. FREDERICKS (283), Department of Physiology
and Pharmacology and Department of Urology, Wayne State Uni-
versity School of Medicine, Detroit, Michigan
YUAN-CHENG B. FUNG (177), Department of Engineering Science
(Bioengineering), University of California at San Diego, La Jolla,
California
J. F. GLENN (497), Division of Urology, Duke University Medical
Center, Durham, North Carolina
WILLARD E. GOODWIN (507), Division of Urology, Department of
Surgery, University of California Medical School and Wadsworth
Veterans Administration Hospital Los Angeles, California, and Los
Angeles County Harbor General Hospital, Torrance, California
CARL W. GOTTSCHALK (299, 571), Department of Medicine and
Physiology, University of North Carolina, Chapel Hill, North Carolina
D. E. GO VAN (143, 455), Division of Urology, Department of Surgery,
Stanford University School of Medicine, Stanford, California
JAY H. HARRIS (465), Department of Electrical Engineering, and Uro-
dynamics Laboratory, Department of Urology, University of Wash-
ington, Seattle, Washington
FRANK HINMAN, JR. (353), Division of Urology, University of Cali-
fornia School of Medicine, San Francisco, California
LIST OF CONTRIBUTORS xix
TIN-KAN HUNG (485), Biotechnology Committee, Carnegie-Mellon
University, Pittsburgh, Pennsylvania
M. Y. JAFFRIN (217), Department of Mechanical Engineering, Massa-
chusetts Institute of Technology, Cambridge, Massachusetts
PEREGINA C. LABAY (55, 99, 163, 317, 349, 497), Division of Genito-
urinary Surgery, Department of Surgery, Washington University
School of Medicine, St. Louis, Missouri
WYLAND F. LEADBETTER (503), The Massachusetts General Hos-
pital, Harvard Medical School, Boston, Massachusetts
PAUL S. LYKOUDIS (199), School of Aeronautics, Astronautics, and
Engineering Sciences, Purdue University, West Lafayette, Indiana
JOSEPH M. MALIN, JR. (125), Department of Urology, Wayne State
University School of Medicine, Detroit, Michigan
RICHARD L. MALVIN (309), Department of Physiology, University of
Michigan, Ann Arbor, Michigan
W. F. MELICK (493), Division of Urology, Department of Surgery,
St. Louis University School of Medicine, St. Louis, Missouri
FREDERICK H. MEYERS (119, 255, 479), Department of Pharma-
cology, University of California School of Medicine, San Francisco,
California
PABLO A. MORALES (87), Department of Urology, New York Univer-
sity Medical Center, New York, New York
SIMON OSTRACH (167), Division of Fluid, Thermal, and Aerospace
Sciences, Case Western Reserve University, Cleveland, Ohio
JAMES M. PIERCE, JR. (283), Department of Physiology and Pharma-
cology and Department of Urology, Wayne State University School
of Medicine, Detroit, Michigan
A. H. SHAPIRO (217), Department of Mechanical Engineering, Massa-
chusetts Institute of Technology, Cambridge, Massachusetts
ARTHUR M. STERLING (411), Urodynamics Laboratory, Department
of Urology, University of Washington, Seattle, Washington
EMIL A. TANAGHO (3, 119, 255, 479, 571), Division of Urology, Uni-
versity of California School of Medicine, San Francisco, California
XX LIST OF CONTRIBUTORS
ERIC E. THERKELSEN (465), Department of Electrical Engineering,
and Urodynamics Laboratory, Department of Urology, University of
Washington, Seattle, Washington
S. L. WEINBERG* (217), Department of Mechanical Engineering,
Massachusetts Institute of Technology, Cambridge, Massachusetts
ROBERT M. WEISS (261), Section of Urology, Yale University
School of Medicine, New Haven, Connecticut, and Department of
Pharmacology, Columbia University, College of Physicians and Sur-
geons, New York, New York
J. J. WORTMAN (473), Research Triangle Institute, Research Triangle
Park, North Carolina
PAUL D. ZIMSKIND (61, 293, 339, 509, 571), Department of Urology,
Jefferson Medical College, Philadelphia, Pennsylvania
NORMAN R. ZINNER (411, 465), Urodynamics Laboratory, Depart-
ment of Urology, University of Washington, Seattle, Washington
♦Present address: Washington University, St. Louis, Missouri.
Preface
This volume summarizes the present status of urodynamics in pro-
gression from the known, to the untried, to the seemingly impossible. Too
many precedents exist, notably in the cardiovascular system, for us to
doubt that a bioengineering analysis of urinary physiology can be equally
productive. This volume spans nearly five decades in the development
of urodynamics, and includes as contributors such pioneers in ureteral
physiology as Davis, Lapides, Benjamin, and Morales with the more
advanced urodynamicists from the engineering community.
This book is an outgrowth of the proceedings and conclusions of an
interdisciplinary workshop devoted to the hydrodynamics of the ureter
and renal pelvis, a companion second workshop to one which dealt with
the hydrodynamics of micturition, both sponsored by The National Re-
search Council and National Academy of Sciences, Division of Medical
Sciences, Committee on The Genitourinary System. Such workshops have
introduced new concepts, new methodologies, and insights, and have dis-
solved language barriers in a very successful manner.
The workshop made it possible for representatives of some 30 active
laboratories to meet. A continuum of discussion developed between the
theoretical bioengineer, the research bioengineer, the research physiologist,
the research surgeon, and the clinical urologist.
Acknowledgments are due to the members of the Committee of the
Genitourinary System of the National Research Council, particularly to
the Chairman and guiding light, Dr. William Boyce; also to Drs. Flocks,
Glenn, Goodwin, Hinman, Kass, Lattimer, Leadbetter, Schlegel, Merrill,
Del Regato, and Colonel Derby, Captain Hubbard, Colonel Lewis, Dr.
Edwin Coyl and his staff, including Mrs. Jean Perrin, and to Mr. Harry
Weil of the Center for Continuing Education of the University of Chicago.
Saul Boyarsky
Carl W. Gottschalk
Emil A. Tanagho
Paul D. Zimskind
xxi
1
Ureteral Embryology, Developmental Anatomy, and
Myology
EMIL A. TANAGHO
DIVISION OF UROLOGY
UNIVERSITY OF CALIFORNIA SCHOOL OF MEDICINE
SAN FRANCISCO, CALIFORNIA
The ureter starts its development as an outgrowth of the mesonephric
duct at the end of the fourth week (5 mm stage) of embryonic life (Fig. 1).
Close to its caudal end, where it bends before opening into the cloaca, the
mesonephric duct develops a localized thickening with cell proliferation
around its circumference. An outpouching on the dorsomedial aspect of
this cellular proliferation indicates the first appearance of the ureteral bud.
The outpouching then grows cranially to meet and unite with the
metanephric cap (Fig. 2). The time of this meeting and union is important,
as it determines future nephric development and ascent.
Changes occur simultaneously at both ends of the ureteral bud. As a
result of the progressive shortening of the common nephric duct due to its
absorption into the ventral segment of the cloaca, the caudal end of the
ureteral bud gradually approaches the urogenital sinus (the urethrovesical
anläge differentiating from the cloaca). Finally (seventh week, 14 mm
stage), the ureteral bud achieves an independent opening into the uro-
genital sinus (Fig. 2). The accumulated absorbed tissue of the mesonephric
duct expands and forms the trigone, maintaining direct continuity with the
ureter exactly as the common nephric duct is continuous with the ureteral
bud originally.
If more than one ureteral bud develops, the accessory is higher on the
nephric duct and meets the urogenital sinus later than the original bud.
It drains the upper pole, and its vesical opening is always lower than and
medial to the original one. If the original and the accessory ureteral buds
3
4
EMIL A. TANAGHO
Fig. 1. Ureteral development from the mesonephric duct, demonstrating caudal and
cranial migration and its relation to the pronephros and mesonephros.
Fig. 2. Division of the cloaca and the progressive absorption of the mesonephric duct
into the urogenital sinus. This absorbed mesodermal tissue will form the trigone, and
the ureteral bud and mesonephric duct will have separate orifices.
