Surgical Implications of Ureteral Neurology

Abstract

Ureteral nerves have been dissected, described, photographed and successfully stimulated. Acceleration of peristalsis by sympathomimetic drugs has been easily demonstrated. Critical experiments have also demonstrated depression of peristalsis by β-adrenergic drugs.A paradox remains to be solved, in that the ureter is as richly innervated by cholinergic nerves as it is by adrenergic. Because of the greater complexity of cholinergic nerve distribution and interrelation with the adrenergic, and possibly because of the subtlety of their function, it is more difficult to demonstrate or to evoke a clear-cut parasympathetic response. We herein present a summary of the evidence which supports a functional role for ureteral nerves and proposes the establishment of a ureteral neurology.

The Effect of Glucagon and Diazoxide on the Normal and Obstructed Upper Urinary Tract

“…Therapeutically it has been used in many situations, chiefly as an inhibitor of smooth muscle activity in hypotonic duode nography [16], for the relief of esophageal food impaction [17,18], and there is a short report on its use in renal colic [5]. Boyarsky and Labay [4] showed that propranolol mod ified and prolonged the effect of glucagon, but that its action was probably not mediated by the (3-receptors. Our results showed that it also inhibited renal pelvic and ureteral activ ity for a short period in the unobstructed upper tract and that recovery was associated with retrograde activity.…”

“…Pharmacolog ical treatment of the ureter with adrenergic agents and their blockers have not been re warding because their actions are short-lived and are often associated with severe cardio vascular side effects. Other drugs have been shown to alter ureteral behavior and Boyarsky and Labay [4] were the first to show that glucagon and diazoxide inhibited ure teral peristalsis. Lowman et al [5] reported ten cases of ureteral colic relieved by intrave nous glucagon with rapid passage of the cal culus in three of these cases.…”

“…In previous experimental studies of these drugs, ureteral activity was measured with intraluminal catheters [4] and the ureter was perfused directly. Weinberg [6,7] and Dale el al.…”