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CINE‐RADIOLOGY OF CONGENITAL BLADDER‐NECK OBSTRUCTION and THE MEGAURETER 1
Author(s) -
Edwards David
Publication year - 1957
Publication title -
british journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 0007-1331
DOI - 10.1111/j.1464-410x.1957.tb09374.x
Subject(s) - megaureter , medicine , ureter , neck of urinary bladder , lumen (anatomy) , reflux , urethra , urinary system , urology , urination , urinary bladder , vesicoureteral reflux , peristalsis , hydronephrosis , anatomy , surgery , disease
SUMMARY Cine‐radiology with an image intensifier is a valuable aid to the study of the anatomy and physiology of the normal and abnormal urinary tract. The appearances of the normal bladder and urethra, and the physiology of normal micturition, are described. The normal bladder neck may produce a distinct impression on the lumen of the posterior urethra. The appearances of the megaureter‐megacystis are described. In the mild cases the bladder is smooth, increased in capacity, and contracts normally without vesical residue, and the bladder neck is normal. By means of double or triple micturition the urinary tract can be largely cleared of residual urine. Vesico‐ureteral reflux is the rule and the ureteric contractions are increased in frequency and amplitude, and reverse contractions are present. In the retention phase the bladder is trabeculated and ureteric contractions, although still present, are reduced in frequency and amplitude as compared with the mild cases. The simple megaureter also shows active contractions with reverse contractions. The bladder is normal. Where a narrow supravesical segment is present, reverse contractions are not seen and the movements of the lower ureter suggest that the narrowed segment produces partial obstruction of the lumen of the ureter. Vesico‐ureteral reflux was seen in only one case of simple megaureter. Congenital bladder‐neck obstruction shows a trabeculated bladder with vesical residue and ureteral reflux into atonic ureters. Diverticulum formation and hydro‐ureter do not necessarily indicate lower urinary tract obstruction. Cine‐radiography demonstrates the fallacy of attempting to assess the size of vesical diverticula on a single still radiograph. Double and triple micturition is a means of clearing the urinary tract of residual urine in cases of vesico‐ureteral reflux and vesical diverticula.