This document provides an overview of the embryology, anatomy, and physiology of the ureter. It discusses the embryonic development of the ureter from the ureteric bud. Anatomically, it describes the course, relations, blood supply, innervation, and sites of narrowing of the ureter. Physiologically, it explains the electrical and contractile properties of ureteral smooth muscle cells, the generation and propagation of action potentials, the role of neurotransmitters and second messengers in contraction, and the mechanical properties and pressure-length relationships of the ureter. The nervous system is noted to have a modulatory rather than essential role in ureteral peristalsis.
location, length, and relation of right an left ureter, raletion of male an female ureter, n physiological site of ureteric constriction, bloo supply an inerve supply of ureter, clinical sinificance of ureter with hysteriectpomy
location, length, and relation of right an left ureter, raletion of male an female ureter, n physiological site of ureteric constriction, bloo supply an inerve supply of ureter, clinical sinificance of ureter with hysteriectpomy
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
URETER - ANATOMY, PHYSIOLOGY, EMBRYOLOGY
1. EMBRYOLOGY , ANATOMY
AND PHYSIOLOGY OF
URETER
Dept of Urology
Govt Royapettah Hospital and Kilpauk Medical College
Chennai
1
Dept of Urology, GRH and KMC, Chennai.
2. Moderators:
Professors:
• Prof. Dr. G. Sivasankar, M.S., M.Ch.,
• Prof. Dr. A. Senthilvel, M.S., M.Ch.,
Asst Professors:
• Dr. J. Sivabalan, M.S., M.Ch.,
• Dr. R. Bhargavi, M.S., M.Ch.,
• Dr. S. Raju, M.S., M.Ch.,
• Dr. K. Muthurathinam, M.S., M.Ch.,
• Dr. D. Tamilselvan, M.S., M.Ch.,
• Dr. K. Senthilkumar, M.S., M.Ch.
Dept of Urology, GRH and KMC, Chennai. 2
4. INTRODUCTION
• B/L muscular retroperitoneal tubes as extension of the renal
pelvis
• Length - 22-30 cm (Adults) ;
6.5-7.0 cm (Neonates)
• Diameter = 1.5- 6.0 mm.
• Lateral to tips of transverse processes of lumbar vertebra.
• LEFT ureter is slightly longer than the right. 4
Dept of Urology, GRH and KMC, Chennai.
5. URETERAL SEGMENTATION & NOMENCLATURE :
• Upper
Renal pelvis to upper border of sacrum
• Middle
Upper to lower border of sacrum
• Lower
Lower border of sacrum till bladder
5
Dept of Urology, GRH and KMC, Chennai.
10. only two muscular layers
in this segment
UPPER URETER LOWER URETER
increased thickness of the
urothelium and additional
muscular layer.
UPPER URETER - More prone to injuries
10
Dept of Urology, GRH and KMC, Chennai.
11. COURSE IN ABDOMINAL PART :
• Downward continuation of renal pelvis
• Descend anterior to psoas major
• Cross ventral surface of transverse
processes of L3-5
• Passes anterior to the genitofemoral
nerve, & at its midpoint passes under the
gonadal vessels
• Enter pelvis by crossing in front of the
bifurcation of the CIA at the pelvic brim in
front of the SI joint. 11
Dept of Urology, GRH and KMC, Chennai.
13. COURSE IN PELVIS :
MALE :
• Follows the course of the IIA
• Runs downward, backward,
& laterally along the greater
sciatic notch.
• Opposite to the ischial spine -
turns forward & medially to
reach the base of the UB
13
Dept of Urology, GRH and KMC, Chennai.
14. • The vas deferens relation
14
Dept of Urology, GRH and KMC, Chennai.
16. PELVIC RELATIONS OF THE URETER IN FEMALE :
• Forms the posterior limit of the
ovarian fossa.
• Entering the parametrium of the
broad ligament, crosses under the
uterine vessels “water under the
bridge” ,
• 1 -4 cm lateral to the cervix to reach
the anterior aspect of the vagina
before joining the bladder.
• Run anteromedially about 1 cm above
the lateral vaginal fornix
16
Dept of Urology, GRH and KMC, Chennai.
18. INTRAMURAL URETER :
•Length - 1.2 to 2.5 cm
•Terminal ureter is enveloped by a
muscular layer, the Waldeyer sheath
•The Waldeyer muscle bundles of the
ureter coalesce with those of the
detrusor muscle . 18
Dept of Urology, GRH and KMC, Chennai.
19. RADIOLOGIC ANATOMY OF URETER :
• Three segments
• Proximal - From origin, down to the upper border
of the sacroiliac joint,
• Middle - lying over the sacrum,
• Distal - from the lower border of SI joint to its
entry into the bladder,
• Entire length of the ureter - rarely seen in a single
film of CTU
19
Dept of Urology, GRH and KMC, Chennai.
20. ENDOSCOPIC ANATOMY OF URETER
❑Retrogradely
• Ureter courses anterolaterally as it goes along the lateral pelvic wall
• Angulates posteriorly (after crossing the pelvic brim)
• Once the cystoscope is inside the bladder neck, the trigone can be
seen as a raised, smooth triangle.
• The apex of that triangle is situated at the bladder neck, and its base
is formed by the interureteral ridge or Mercier’s bar, extending
between the two ureteric orifices. 20
Dept of Urology, GRH and KMC, Chennai.
21. • The interureteral ridge is more prominent in males than females.
• The ureteric orifices are symmetrically located along it, approximately
1 to 2 cm from the midline.
• The normal ureteric orifice may appear as a volcano or a cone shaped
• However, it might look like a slit that can be identified with only
meticulous examination
21
Dept of Urology, GRH and KMC, Chennai.
22. • ureteral narrowing areas at the pelvic brim and UPJ are identified
endoscopically by being stenotic and relatively nondistensible.
• The pulsating iliac vessels could be seen endoscopically as the ureters
cross the pelvic brim
• The UPJ could be identified endoscopically during its frequent
opening and closing.
• The UPJ merges into the wider and more dependent part of the renal
pelvis.
22
Dept of Urology, GRH and KMC, Chennai.
23. • during ureteroscopy, the tidal volume could be decreased to minimize
renal excursions during respiration
• In the renal pelvis, the flexible ureteroscope first faces the ostia of the
major calyces, which look like circular openings separated by carinae.
• Then the flexible ureteroscope enters a long tubular infundibulum
that branches into the minor calyces.
• These infundibula usually connect the ostia of major calyces with
their apex
23
Dept of Urology, GRH and KMC, Chennai.
24. • For a flexible ureteroscope to pass from the axis of the upper ureteral
segment to the axis of the lower infundibulum, it should deflected
140 (104 to 175) degrees at the ureteroinfundibular angle .
• A circular muscle layer extends around the base of the papilla to help
expel urine jets from papillary ducts.
• The renal papillae appear endoscopically as protruding discs
surrounded by calyceal fornices, paler in color than the pink friable
epithelium covering the papillae
24
Dept of Urology, GRH and KMC, Chennai.
25. Endoscopic anatomy:
• Ureteric orifices @ UVJ – 5cm apart(full
bladder) ; 2.5 cm apart (empty)
• Merciers bar- more prominent in males
• Configuration of ureteric orifice:
• Higher the grade
• More lateral location
Reflux
25
Dept of Urology, GRH and KMC, Chennai.
26. Blood supply of Ureter :
Travel longitudinally in the Peri-ureteral adventitia.
ARTERIAL SUPPLY
UPPER URETER RENAL
AORTA
GONADAL
MID URETER CIA
GONADAL
LOWER URETER CIA
IIA
SUPERIOR VESICAL
26
Dept of Urology, GRH and KMC, Chennai.
28. VENOUS DRAINAGE
• Venous drainage parallels arterial.
• abdominal part - renal and gonadal veins.
• mid- and distal ureters - common and internal iliac veins.
28
Dept of Urology, GRH and KMC, Chennai.
29. LYMPHATIC DRAINAGE
Lymphatic drainage:
• Lymphatic plexus within muscular &
adventitia
• LEFT RIGHT
• Para-aortic LNs Paracaval, Interaorto-caval
UPPER
• Common iliac LNs
MID
• Common iliac
• Internal iliac
• External iliac
LOWER
29
Dept of Urology, GRH and KMC, Chennai.
30. URETERAL INNERVATION
• 1. Sympathetic - from T12–L1 spinal segments through
RENAL,
AORTIC, &
HYPOGASTRIC plexuses.
• 2. Parasympathetic - S2–S4 via
Pelvic Splanchnic nerves.
❑ PERISTALSIS – independent of nerve supply
30
Dept of Urology, GRH and KMC, Chennai.
31. SITES OF ANATOMICAL
NARROWINGS/CONSTRICTIONS :
• 1. At the PUJ - approx 5 cm away from the
renal hilum. (12 Fr)
• 2. At the pelvic brim where it crosses the
common iliac artery. (12 Fr)
• 3. At the UVJ (3-10 Fr)
• Intramural ureter – narrowest
• (3-4 mm)
31
Dept of Urology, GRH and KMC, Chennai.
34. CONTENT
• CELLULAR ANATOMY
• ELECTRICAL ACTIVITY
• CONTRACTILE ACTIVITY
• MECHANICAL PROPERTIES
• ROLE OF NERVOUS SYSTEM IN URETERAL FUNCTION
• URINE TRANSPORT 34
Dept of Urology, GRH and KMC, Chennai.
35. CELLULAR ANATOMY
❖Functional unit – smooth muscle cell
(L= 250- 400 um, D= 5-7 um)
❖DOUBLE LAYER CELL MEMBRANE
❖NUCLEUS
❖MITOCHONDRIA – POWER HOUSE
❖ENDOPLASMIC RETICULUM – Calcium STORAGE
❖Contractile proteins
35
Dept of Urology, GRH and KMC, Chennai.
36. ELECTRICAL PROPERTIES
❖RMP – ( -33 to -70 Mv ) Determinant - K ions
❖AP – primary event in the conductance of the peristalstic impulse >>>
ureteral contraction
CELL STIMULATION
DEPOLIRIZATION
TP
AP
36
Dept of Urology, GRH and KMC, Chennai.
38. CELL STIMULATION
LOSS OF PREFFERTIAL PERMEABILITY TO K
MORE PERMEABILITY TO CA
FAST L-type CA channels
ACTION POTENTIAL
Slow rate of upstroke of AP >> slow conduction velocity
38
Dept of Urology, GRH and KMC, Chennai.
40. ❖PACEMAKER POTENTIAL & ACTIVITY
• Electrical activity in cell – external stimulus / spontaneously >> pacemaker cells (
opening and slow closure of voltage activated L-type Ca. channels )
LOCATION
Multicalyceal system
Unicaleceal system
pelvicalyceal border to UPJ Near pelvicalyceal border
40
Dept of Urology, GRH and KMC, Chennai.
41. • LATENT PACEMAKER – THROUGHT URETER
• ICC LIKE CELLS
➢ Not a primary pacemaker cells
➢ Provide electrical conduction from pacemaler cells to typical smooth
muscle cells in renal pelvis and ureter
➢ Act as pacemaker cells & trigger contraction in absence of
pacemaker cells
41
Dept of Urology, GRH and KMC, Chennai.
42. ❖PROPAGATION OF ELECTRICAL ACTIVITY
➢Ureter acts as functional syncytium
➢Electrical activity arises proximally and conducted distally from cell to cell
through intermediate junctions
➢Gap junctions – electrical coupling and electrochemical coupling ( exchange
ions & small molecules)
➢Conduction velocity in ureter – 2- 6 cm / sec
42
Dept of Urology, GRH and KMC, Chennai.
47. ❖Second messengers
Mediate functional response to hormones, NT, other agents
c AMP
c GMP
Ca+
IP3
Diacylglycerol
47
Dept of Urology, GRH and KMC, Chennai.
50. • A-adrenergic & cholinergic agonist ----------increase ca-----increase contraction
Agonist –receptor complex ++++++++++ Phospholipase-C Protein kinase- C
Phosphatidylinositol 4,5 biphosphate
IP-3 & DAG
50
Dept of Urology, GRH and KMC, Chennai.
51. MECHANICAL PROPERTIES
❖FORCE LENGTH RELATION
• Express the relation between the force developed by muscle
when it is stimulated under isometric condition & resting length
of muscle at the time of stimulation
• Ureter is viscoelastic structure
• The resting/contractile force developed at any given length
depends on the direction in which the change in length is
occuring & on the rate of length change ( HYSTERESIS) 51
Dept of Urology, GRH and KMC, Chennai.
52. • URETER SHORTENS– CONTARCTION FORCE GREATER THAN
RESTING FORCE
• URETER STRETCH – RESTING FORCE INCREASES
If the length is kept constant at its new longer length after a
stretch, changes occur that result in a decrease in the resting
force (stress relaxation )
52
Dept of Urology, GRH and KMC, Chennai.
53. ❖PRESSURE-LENGTH-DIAMETER RELATION
• Ureteral muscle fibres are arranged in longitudinal, circumferential
and spiral configuration
• Longitudianal & Diametral Deformation Of Ureter Are Interrelated
• CREEP – After the application of intaluminal pressure, the ureter
increase in both length and diameter.
53
Dept of Urology, GRH and KMC, Chennai.
54. ROLE OF NERVOUS SYSTEM IN URETERAL FUNCTION
• URETER – Syncytial type of smooth muscle without descrete NMJ.
• Ureteral peristalsis can occur without innervation proof –
1) persistence of peristalsis after transplantation or denervation
2) spontaneous activity in isolated in-vitro ureter
3) Normal antegrade peristalsis continues after reversal of segment
of ureter in-situ
so, nervous system has only modulatory role in ureteral peristalsis
54
Dept of Urology, GRH and KMC, Chennai.
55. PNS
• M2/3 muscarinic receptor – distal & intravesical portion
❖Cholinergic agonists ( Ach/mecholyl/ carbachol/bethanecol ) >> M3
- Increased frequency and force of contraction
❖Anti-Cholinesterases ( neostigmin /physostigmin)
❖Parasympathetic blocking agents (Atropin/ propantheline/
methanthelin)>> inhibition of ureteral activity ( effects are frequently
minimal and inconsistent )
55
Dept of Urology, GRH and KMC, Chennai.
57. ❖ADRENERGIC ANTAGONIST
1. A-adrenergic antagonist (tamsulosin) -inhibits contarctility of ureter
>> relaxation
2. B- adrenergic antagonist ( propranolol) – block or attenuate the
inhibitory effect of b-adnergic agonists ( isoproterenol ) >>
contraction of ureter
57
Dept of Urology, GRH and KMC, Chennai.
58. URINE TRANSPORT
❖PHYSIOLOGY OF UPJ AND PROPULSION OF URINARY BOLUS
Frequency of calyceal & renal pelvis contraction >>> upper ureter (
relative block of electrical activity at PUJ.
IN RENAL PELVIS PRESSURE EXTRUSION OF URINE IN URETER
URETERAL CONTRACTION PRESSURE >>>> RENAL PELVIS PRESSURE
58
Dept of Urology, GRH and KMC, Chennai.
59. • Resting pressure ------- 0-5 cm H20
• Superimposed ureteral contractions ------20-80 cm H20
• Ureter as tubular structure
• LAPLACE EQUATION
• pressure = TENSION X WALL THICKNESS
RADIUS
59
Dept of Urology, GRH and KMC, Chennai.
60. URINE TRANSPORT
❖EFFECT OF DIURESIS ON URETERAL FUNCTION
• Increased flow rate
INITIALLY – INCREASED PERISTALTIC FREQUENCY
INCREASE IN BOLUS VOLUME
MAX. FREQUENCY
60
Dept of Urology, GRH and KMC, Chennai.
61. URINE TRANSPORT
❖ EFFECT OF BLADDER FILLING & NEUROGENIC VESICAL
DYSFUNCTION ON URETERAL FUNCTION
PRESSURE WITHIN BLADDER DURING STORAGE PHASE IS OF
PARAMOUNT IMPORTANCE IN DETERMINING EFFICACY OF URINE
TRANSPORT ACROSS VUJ
INTRAVESICAL PRESSURE > 40 CM H20---------URETER DECOMPENSATE
61
Dept of Urology, GRH and KMC, Chennai.