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Upper Urinary Tract Function (Reflux, Obstruction, and Kidney Function)

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In this chapter, several (patho-)physiological and diagnostic aspects of the upper urinary tract are discussed. Under normal circumstances, ureteral peristalsis is initiated by so-called interstitial cells of Cajal (“pacemaker cells”), causing a urinary bolus to move through the urinary tract. The function of the urinary tract can be affected by both upper and lower motor neuron diseases, giving rise to different clinical entities. If obstruction of the urinary tract occurs due to neurological dysfunction, this can have various effects on renal blood flow and peristalsis. Nuclear agents with which upper urinary tract function can be assessed are technetium-99m diethylenetriamine pentaacetic acid (99mTc-DTPA), technetium-99m dimercaptosuccinic acid (99mTc-DSMA), and technetium-99m mercaptoacetyl triglycine (99mTc-MAG3) renal scans. The Whitaker test is of use when noninvasive tests such as these yield unequivocal results. In the case of neurogenic bladder disease, function of the lower urinary tract should also be taken into account, which can best be done using (video) urodynamics; usage of fluoroscopy during cystometry is very important to demonstrate or rule out vesicoureteric reflux. Global renal functioning is usually assessed using serum creatinine, but in those with neurogenic bladder disease, this may be unreliable and alternative methods (e.g., 24-h clearance, cystatin C) could be used.


  • Upper urinary tract
  • Neurogenic bladder disease
  • Ureteric peristalsis
  • Urodynamics
  • Whitaker test
  • Upper urinary tract obstruction
  • Ureteral obstruction
  • Vesicoureteral reflux

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Technetium-99m dimercaptosuccinic acid


Technetium-99m diethylenetriamine pentaacetic acid


Technetium-99m mercaptoacetyl triglycine


Bilateral ureteric obstruction


European Association of Urology


Estimated glomerular filtration rate


Glomerular filtration rate


Renal blood flow


Renal vascular resistance


Spinal cord injury


Half-life time


Ureteropelvic junction


Unilateral ureteric obstruction


Vesicoureteric junction


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Correspondence to J. L. H. Ruud Bosch .

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Veenboer, P.W., Bosch, J.L.H.R. (2018). Upper Urinary Tract Function (Reflux, Obstruction, and Kidney Function). In: Dmochowski, R., Heesakkers, J. (eds) Neuro-Urology. Springer, Cham.

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