Histopathological and urodynamical study for the urinary passage in pelvo-ureteral junction

1.本研究应用扫描电镜和免疫组化方法对先天性肾盂输尿管连接部（PUJ）进行了组织病理学观察。原发性狭窄的PUJ具有以下结构特征：1）肌束稀疏细; 2）平滑肌细胞胶原纤维密集呈毡状; 3）间质胶原成分致密坚硬; 4）周围神经分布减少.放射性核素恒压灌注研究（CPPS）是一种简便的方法，可用于肾积水患者经肾造瘘术后肾出口流量的临床评估。上尿路无梗阻时，肾出口流量随肾盂内压增加而线性增加。这项技术将提供生理测量尿流量在可变水平的恒定肾盂内压在积水患者。产前诊断肾积水的处理和结局<99m>对仅在产前超声检查中发现的可疑肾盂输尿管连接部（UPJ）梗阻的患者，采用14 Tc-DTPA和呋塞米进行利尿性肾造影（DR）。在分裂肾功能（SRF）和利尿剂排出半衰期（DT 1/2）在其正常范围内的肾脏（60%在初始DR）中，重复DR时无加重体征。DT 1/2延长和SRF正常的肾脏（28%）在重复DR时无恶化，利尿反应改善，但有一个肾脏除外。虽然目前还没有一种检查方法能明确诊断UPJ梗阻，但我们可以通过仔细的重复检查来确定是否有明显的UPJ梗阻。

1. Stractural changes of collagen components and diminution of peripheral nerves in intrinsic pelvi-ureteric junction stenosisPelviureteric junction (PUJ) of congenital hydronephrosis was histopathologically observed by a scanning electron microscopy and an immunohistochemical staining to PGP 9.5 as a general nerve marker. PUJ of in trinsic stenosis had structal feature with 1) sparse and thin muscle bundles, 2) a dense felt-like collagen fibrils of smooth muscle cells, 3) compact and rigid interstitial collagen components, and 4) diminished perpheral nerve distribution.2. Radionuclide constant pressure perfusion studyA simple method, radionuclide constant pressure perfusion study (CPPS), was applied for clinical estimation of exit flow in hydronephrotic patients via nephrostomy. Exit flow in the kidney with non-obstructed upper urinary tract demonstrated a linear incrcase with the increased intrapelvic pressure. This technique will provide physiological measurement of the urine flow at variable levels of constant intrapelvic pressure in hydronephrotic patients.3. Management and outcome of antenatally diagnosed hydronephrosisDiuretic renography (DR) by using ^<99m>Tc-DTPA and furosemide was performed in patients with a suspicious ureteropelvic junction (UPJ) obstruction detected only on prenatal ultrasound. In the kidneys which split renal function (SRF) and diuretic drainage half-time clearance (DT 1/2) of radioagent were within their normal ranges (60% in initial DR) there were no aggravated signs on repeated DR.The renal function with prolonged DT 1/2 and normal SRF (28%) did not deteriorate and the diuretic response improved on repeat DR except one kidney. Although there is still no examination which can detect a definite UPJ obstruction, we can identify one as significant by careful repeat examinations.