Abstract
In pelviocalyceal systems of the ampullary type contraction starts near the ureteropelvic junction rather than at the calyces, in exceptional cases it may start at an uncommonly long upper calyceal neck. On the other hand, in bifid systems the systole begins at the upper calyceal neck and spreads to the lower part of the renal pelvis and to the ureter. In individual cases, the contractions arise at alternating sites, that is in certain phases of the study they are initiated in the upper, in some others in the lower calyx.
In 75% of intact pelviocalyceal systems urine is not only forwarded into the ureters but also refluxed into the calyces by each pelvic contraction. Pelviocalyceal backlow of this kind is thus regarded by the author as a physiological activity, as a whirling motion, which serves the purpose of flushing the cavities. It is rarely encountered in abnormal kidneys, muscle function being generally impaired, with the exception of urinary obstruction, where in case of still unaffected motor function the contractions result in a substantial backflow to the calyces.
With the exception of the described case where systole begins at some of the calyces, no calyceal contractions of their own are noted. On the other hand, pelvic contraction may extend to the calyces at the end of systole and the calyces also may contract in response to distension, as they do in case of retrograde pyelography. Contraction of the calyces occurs in the patient's upright position too. A further function of the calyceal muscle apparatus, in which the Disse-muscle is instrumental, consists in restraining the distending effect of calyceal backflow. Otherwise the calyces reveal no sphincter function or protective block.
No actual sphincter is involved in ureteropelvic closure either. Here this function is provided by contractions of alternating portions of the ureter, depending on the extent of diuresis.
With the exception of obstructions, all abnormalities of the pelviocalyceal system are associated with an impairment of tone and of motor function.
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Hajós, E. Recent views on pelviocalyceal motor function based on direct visualization by means of the TV-image-amplification system. International Urology and Nephrology 4, 121–142 (1972). https://doi.org/10.1007/BF02081834
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DOI: https://doi.org/10.1007/BF02081834