Functional abnormalities of ureteric motility with a leaky urothelial barrier

ABSTRACT

A leaky urothelial barrier is a characteristic feature of bilharzial uropathy and renal calculi impaction. The structural evidence of bilharzial uropathy was demonstrated in this study together with its functional consequences. In vitro, the study was conducted on ten lower ureteric rings from patients with bilharzial stricture of lower ureter and ten normal lower ureteric rings from patients treated by cystectomy. It was found that the bilharzial rings display irregular phasic contractions with intermittent bursts of activity while the normal rings display regular rhythmic contractions. On addition of freshly voided human urine [2 ml] to the organ bath, the frequency of contractions and basal tone were significantly increased while the amplitude of contractions was significantly decreased in bilharzial ureters more than in normal ones. The urine induced changes in motility were reversed by H-blocker [Pheneramine maleate] and prostaglandin synthetase inhibitor [Diclofenac sodium]. Histamine [5 micro g / ml] was found to have similar effects to that induced by addition of urine, while prostaglandin F[2] alpha [5 micro g / ml] was found to increase the frequency of ureteric contractions. In conclusion, histamine and prostaglandin F[2] alpha play an important role in mediating the response of human ureter with a leaky urothelium to urine