Measurement of Peristalsis of the Ureter and its Relation to Drugs

Abstract

An electronic device, the electromanometer, was used to obtain a record of peristalsis of the normal human ureter before, during, and after the administration of morphine sulfate, atropine sulfate, propantheline, and atropine tannate in 31 patients. Because of its sensitivity the electromanometer can measure directly the absolute value of pressure in the ureter and the alterations that occur with peristalsis. It is used with a small-caliber catheter in order to avoid obstructive factors that were inherent in prior methods used to evaluate peristalsis of the ureter. The tracings obtained showed that these four drugs in the dosages used did not alter peristalsis of the ureter.The purpose of this study is twofold: (1) The peristalsis of the normal human ureter is investi¬ gated in an attempt to establish a standard pattern of activity comparable to that obtained from the heart by electrocardiogram. As yet a normal pat¬ tern has not been accepted for the human ureter.With these standards there would be a basis for comparison with pathological ureterometrograms.(2) The effect of narcotics and parasympathicolytic drugs thought capable of affecting ureteral peristal¬ sis, as recorded on the ureterometrogram, is de¬ termined.The current concept of activity of drugs on the ureter is based on Lapides' study of 1947.1 He studied the mechanical peristalsis of the human ureter using a T-pattern hydrophorograph, which records ureteral peristalsis by measuring variations of pressure as urine flows through a large-sized ureteral catheter. He concluded that no drug of the studied group affected resting pressure or peristal¬ sis of the ureter. However, since it is known that a large-sized catheter paralyzes ureteral activity, Lapides' work has been criticized on the basis that he was measuring merely the hydraulic pressure of a column of urine in which fluctuations may occur with the rate and quantity of urinary output. In order to avoid the errors inherent in this method, Draper and Zorgniotti2 have used more refined methods in studying the effect of various drugs on the action-potential pattern of the intact dog ureter. Action potentials are a measure in millivolts of the electrical activity of the ureter that immediately precedes peristalsis. Sleator and Butchers measured mechanical peristalsis of the dog ureter by using an intraluminal balloon.

Fluid mechanical modeling of the upper urinary tract

“…According to the measurement taken from 17 healthy adult females, the maximum pressure amplitude averages 17.5 cm H 2 O in the midureter, and 22 cm H 2 O in the lower ureter (Rattner William et al, 1957). From other studies (i.e., Weinberg & Maletta, 1961), this peak pressure value varies between 15 and 50 cm H 2 O in normal humans, and is generally larger toward the lower part of ureter.…”

“…These waves are mostly monophasic, traveling at speeds of approximately 2–3 cm/s, and are typically 6–10 cm in length (Griffiths, 1987, 1989). The peristaltic wave happens about 1–8 times per minute in normal human, and averages about three times per minute (Edmond et al, 1970; Weinberg & Maletta, 1961). According to the measurement taken from 17 healthy adult females, the maximum pressure amplitude averages 17.5 cm H 2 O in the midureter, and 22 cm H 2 O in the lower ureter (Rattner William et al, 1957).…”

The Effects of Some Anticholinergic Compounds on the Rabbit Ureter

“…Some authors concluded that the ureter was inert to cholinergic drugs (Agar, 1948;Butcher et al, 1957;Weinberg & Maletta, 1961;Ross, Edmond & Grif-Present address: Dept. of Pharmacology, Leo Research, Fack, S-25100 Helsingborg, Sweden.…”

The pharmacology of the rat ureter in vivo

“…There is so far no explanation of the fact that higher doses inhibit the frequency of peristalsis, particularly since there is no evidence of the presence of autonomic nerve plexuses or enteroargentaffine cells in the ureter. Nelse (1935) reported that morphine increased the amplitude of ureteral contraction in man, while other workers (Lapides, 1948;Kiil, 1957;Weinberg & Maletta, 1963) found that morphine did not have this effect. In our experiments, morphine reduced the rate of perfusion in the ureter by 5-10% over a wide range of doses, but reduced peristaltic frequency only at the highest dose level.…”