No abstract

Histological and chemical studies were carried out on the elastin and collagen content of the normal and the obstructed urinary bladder wall. The observations were made on 3 different age groups: (1) 3-month-old children with vesical outlet obstruction, (2) children aged between 4 and 8 years with partial vesical obstruction, and (3) adults with a chronically obstructed bladder. An increase in elastic tissue was shown only in the newborn and in the adults. The collagen did not vary in any of the cases studied. The elastin showed an increase in polar amino acids in the pathological organs compared with the normal. A similar increase in elastin was observed in normal individuals as a result of the ageing process.

The ultrastructure of the normal rat ureter has been studied in order to correlate the morphological findings with the function of the organ. Electron microscopy demonstrates that the ureteral musculature behaves as a functional syncytium which permits the spread of electrical excitation from cell to cell. A scanty number of nerve endings without evidence of autonomic ganglia was found throughout the ureteral layers. These morphological data support the hypothesis that ureteral peristalsis is an essentially myogenic phenomenon, the influence of the autonomic nerve supply being limited to modulating peristalsis and influencing ureteral tonus.

Using chemical and histochemical techniques, it has been possible to calculate the exact amount and distribution of the elastin in normal and abnormal ureters in children. From the quantitative analyses, it has been calculated that in the dilated ureters the elastin content represents the 3% to 5% of the organic material, while in the normal ureters it is less than 1%.

The clinical presentation and management of 57 primary obstructed megaureters in 46 patients, 35 of whom were children, are reported. Indications for operation include pain, infection, progressive pyelo-ureteric dilatation and reduction in the glomerular filtration rate. We have found that affected children cannot be managed successfully without operation. Conservative treatment may be employed effectively in adults in whom the condition is often stable and complications are less frequent. The preferred surgical technique is ureteric narrowing with reimplantation to the bladder by the Politano-Leadbetter method. The results of surgery are less satisfactory in adults than in children. This may be related to the reduced quantity of elastic tissue in the ureteric wall in adult cases.