Shafik A, Al-Sherif A
Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, Cairo, Egypt.
Eur Urol. 1999 Aug;36(2):150-6; discussion 156-7. doi: 10.1159/000067987.
To study the anatomy of the normal ureteropelvic junction (UPJ) and investigate its pressure response to distension, aiming at elucidation of its function in the light of its anatomical structure.
The UPJ of 25 cadaveric specimens (15 male, 10 female; 15 adults, mean age 33.6 +/- 8.4 years; 10 fully mature neonatal deaths) was studied morphologically and microscopically after staining with hematoxylin and eosin and Masson's trichrome. Furthermore, the length of the UPJ as well as the UPJ pressure response to UPJ distension were assessed in 13 subjects (8 men, 5 women, age 48.8 +/- 10.3 years). The response of the anesthetized UPJ to distension was reported in 7/13 subjects and of the saline-injected UPJ in the remaining 6/13. The UPJ had been anesthetized by injecting 1% xylocaine into its wall.
Grossly, there were no features characteristic of the UPJ externally, although internally the mucosa was thrown into folds forming a 'mucosal rosette'. Microscopic examination showed the muscle fibers to be arranged in two well-formed layers: circular and longitudinal. Mucosal folding and structured muscle fiber arrangement were lacking in the adjacent renal pelvic and ureteral walls. The mean UPJ length in adults as measured manometrically by the pull-through technique was 6.9 +/- 1.5 mm. UPJ distension led to an elevated UPJ pressure; the latter increased with increase of the volume of distension. There was no UPJ pressure response to distension of the UPJ locally anesthetized by injecting xylocaine into its tissue, but there was response when saline was injected into the tissue of the UPJ.
The UPJ might be identifiable by the presence of the mucosal rosette. The reaction of the UPJ to distension probably indicates that the UPJ possesses a motile activity. This, as well as the presence of a structured muscle coat at the UPJ would suggest the presence of a 'sphincter' at the UPJ.
研究正常输尿管肾盂连接部（UPJ）的解剖结构，并探究其对扩张的压力反应，旨在根据其解剖结构阐明其功能。
对25个尸体标本（15例男性，10例女性；15例成年人，平均年龄33.6±8.4岁；10例完全成熟的新生儿死亡病例）的UPJ进行形态学和显微镜检查，标本经苏木精-伊红染色和马松三色染色。此外，对13名受试者（8名男性，5名女性，年龄48.8±10.3岁）的UPJ长度以及UPJ对扩张的压力反应进行评估。13名受试者中有7名报告了麻醉状态下UPJ对扩张的反应，其余6名报告了向UPJ组织内注射生理盐水后的反应。通过向UPJ壁内注射1%的利多卡因对其进行麻醉。
大体上，UPJ外部没有特征性表现，但其内部黏膜形成褶皱，构成“黏膜玫瑰花结”。显微镜检查显示肌纤维排列成两层结构良好的肌层：环形和纵形。相邻肾盂和输尿管壁缺乏黏膜褶皱和有结构的肌纤维排列。通过牵拉技术测量，成年人UPJ的平均长度为6.9±1.5毫米。UPJ扩张导致UPJ压力升高；后者随扩张体积的增加而增加。向UPJ组织内注射利多卡因进行局部麻醉后，UPJ对扩张无压力反应，但向UPJ组织内注射生理盐水时有反应。
UPJ可能可通过黏膜玫瑰花结的存在来识别。UPJ对扩张的反应可能表明UPJ具有运动活性。这一点以及UPJ处有结构的肌层的存在提示UPJ处存在“括约肌”。
