Koff S A, Hayden L J, Cirulli C, Shore R
J Urol. 1986 Jul;136(1 Pt 2):336-8. doi: 10.1016/s0022-5347(17)44859-2.
We compared experimental ligature-induced ureteropelvic junction obstruction in the dog with naturally occurring ureteropelvic junction obstruction in children to determine if clinical behavior and difficulties in diagnosis could be related to different types or components of obstruction at the ureteropelvic junction. Measurements of flow rate out of the ligature-obstructed canine renal pelvis demonstrated a pressure-dependent pattern in which flow increased linearly in response to increasing pressures. In 5 human kidneys with intrinsic ureteropelvic junction obstruction a similar pressure-dependent pattern was demonstrated. This was in contrast to 6 human kidneys with extrinsic mechanical ureteropelvic junction obstruction in which a volume-dependent pressure flow pattern occurred, such that urinary flow rate did not keep pace with increases in pelvic pressure. In some cases flow actually decreased at high pressures because the ureteropelvic junction became self-obstructing as the pelvis enlarged. These findings indicate that the precise pathological anatomy of the ureteropelvic junction defines the pattern of flow across the obstruction. The 2 different types of obstruction, pressure-dependent and volume-dependent flow restrictions, which exist are important determinants of the clinical behavior of the obstructed kidney insofar as its potential for progressive hydronephrosis. They also help to explain why diagnostic tests for assessing obstruction in hydronephrosis are inaccurate at times.
我们将犬类实验性结扎诱导的输尿管肾盂连接处梗阻与儿童自然发生的输尿管肾盂连接处梗阻进行比较，以确定临床行为和诊断困难是否与输尿管肾盂连接处梗阻的不同类型或组成部分有关。对结扎梗阻的犬肾盂流出流量的测量显示出一种压力依赖性模式，即流量随压力增加呈线性增加。在5例患有内在性输尿管肾盂连接处梗阻的人类肾脏中也显示出类似的压力依赖性模式。这与6例患有外在性机械性输尿管肾盂连接处梗阻的人类肾脏形成对比，在这些病例中出现了容量依赖性压力流量模式，即尿流率跟不上肾盂压力的增加。在某些情况下，在高压时流量实际上会下降，因为随着肾盂扩大，输尿管肾盂连接处会出现自我梗阻。这些发现表明，输尿管肾盂连接处的确切病理解剖结构决定了梗阻部位的流量模式。存在的两种不同类型的梗阻，即压力依赖性和容量依赖性流量限制，是梗阻性肾脏临床行为的重要决定因素，就其发生进行性肾积水的可能性而言。它们也有助于解释为什么评估肾积水梗阻的诊断测试有时不准确。
