Study of ureteral reflux in neurogenic dysfunction of the bladder: the concept of a neurogenic ureter and the role of the periureteral sheath in the genesis of reflux and supersensitive response to autonomic drugs.

Ureteral pressure and its response to autonomic stimulations were investigated in paraplegics with ureteral reflux and compared to the response in patients with primary reflux, paraplegics without reflux, normal individuals and a patient who had undergone lumbar sympathectomy. Only the paraplegics with ureteral reflux responded supersensitively to the administration of an alpha-adrenergic drug. The demonstration of the specificity of this response to the lower end of the ureter suggested that although it is caused by the changes in the bladder it is dependent on the connection between the bladder and the distal ureter through the periureteral sheath. The ureteral ends in paraplegics with reflux that respond supersensitively to autonomic stimulations were proposed as possibly true cases of a neurogenic ureter in that it is believed to be a consequence of concomitant injury to the ipsilateral parasympathetic motor neuron to the periureteral sheath at the sacral spinal cord level. In the discussion on the mechanism of denervation supersensitivity reference is made to the modern concept of dual neuroanatomy of the ureteral sheath.