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Upper Urinary Tract Urodynamics In Patients Before And After Percutaneous Nephrolitholapaxy | 25235
ISSN: 2161-069X
Journal of Gastrointestinal & Digestive System
Open Access
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Introduction: The disorders in upper urinary tract urodynamic caused by ureter impaired contractile function may be
supplementary to obstruction in patients with renal stones. Currently, clinical data on ureter function is limited to small
number of clinical observations.
Aim: The aim of this study is to evaluate the features of ureteral peristalsis and renal pelvis pressure in patients before and after
percutaneous nephrolitholapaxy.
Materials and methods: The study involved 20 patients with kidney stones 4.3�0.2 cm in size, which were removed by
percutaneous nephrolitholapaxy. It was assessed the state of peristalsis in the upper, middle and lower ureter segments
immediately prior to percutaneous nephrolitholapaxy by multichannel impedance ureterography in 12 patients. Pressure in
the renal pelvis was measured by electric pressure gauge Capto SP 844 coupled to a nephrostomy in 18 patients 2-3 days after
stones removal and nephrostomy drainage setting. Data was registered on a personal computer.
Results: Ureteral peristalsis in patients with renal stones is characterized by strong contractions (amplitude 1,61�0.16 and
1.78�0.21 ohms) of the upper and middle thirds, having mostly (60 %) retrograde (anastaltic) direction, and less pronounced
(amplitude of 0.70�0.13 ohm) and mostly (78%) simultaneous contractile waves in the lower part. At the same time the
tone of ureteral wall in the lower cystoid was higher (8.06�0.69 relative units) than in the upper and middle ureter segments
(3.66�0.37 and 3.53�0.48 relative units). In patients with newly diagnosed kidney stones the ureter contractions amplitude
proved almost twice as big as in patients who had undergone surgery due to urolithiasis. Among patients with remaining in the
cups post percutaneous nephrolitholapaxy residual stones, a trend towards higher values of the ureter contractions amplitude
was detected as compared to patients without residual fragments. Upper urinary tract urodynamic disorders after percutaneous
nephrolitholapaxy were manifested by a high pressure in the renal pelvis (20.1�0.7, range 9.5 - 31.3 cm water column) on the
next day after stone removal with daily diuresis per nephrostomy tube 0.81�0.03 liters. In addition, the higher by 45, 32 and
95% ureter contractions were observed in the patients (n=12) with higher pressure (23.8�0.8 cm H2O) in comparison to the
group of patients (n=6) whose pressure averaged at 12.8�0.6 cm H2O. Thus, surgical trauma of kidney parenchyma could be
the reason of the elevated intrapelvic pressure, and the ureteral peristaltic function could exert influence on the value of renal
pelvis pressure.
Conclusion: These studies have demonstrated significant violation of ureteral peristalsis in patients with kidney stones and
high pelvis pressure on the next to percutaneous nephrolitholapaxy day, thus indicating an urodynamics functional disorder. It
is assumed that the nature of these disorders is stipulated by the upper urinary tract smooth muscle reflex reactions in response
to stone irritation of a kidney, which is an important reflexogenic area.
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