PROGRESS IN URODYNAMIC RESEARCH ON THE UPPER URINARY-TRACT - IMPLICATIONS FOR PRACTICAL UROLOGY

The development of new surgical techniques for bladder substitution an d continent urinary diversion has extended interest in urodynamics of the upper urinary tract. From a subdiscipline attracting mainly scient ists and bioengineers, renal pelvic kinetics and ureteral peristalsis have evolved as important factors in routine clinical urology. The obs erved changes in peristaltic pattern during high diuresis, obstruction and urinary reflux have influenced management of stone disease and ne urogenic bladder. The demonstration that high intravesical pressure is reflected to the kidney not only when the ureteric orifice is incompe tent, but also during high diuresis, established the necessity for low pressures in neobladders. Much further clarification of urinary trans port from the renal tubules to the bladder should be achievable by ref ined techniques of fluoroscopy, isotopic renography and manometry.