The Uretero-Vesical Valve and Experimental Production of Hydroureter Without Obstruction.

Abstract

Many observations, both experimental and clinical, have been made to support or disprove the theory that the urine flows back into the ureter from the bladder. All early writers and many of the present time maintain the “vesical-ureteral sphincter” competent to withstand any pressure. Many men have alluded to the valve mechanism as preventing reflux yet most refer again to it as a “sphincter”. The oblique passage of the ureter through the bladder wall has been regarded as a sphincter in preventing reflux of urine.

Without experimental evidence, Sampson 1 in 1903, was the first to attribute to the intra-vesical ureter the function of a valve. He placed little value on his findings since his oblique transplants of the ureter without the valve also showed no reflux. Delbet 2 denies valve action to the intravesical ureter. Satani 3 believed that normally there is no reflux into the ureter although he found no special structures of a nature of a sphincter in the bladder. After destroying all the muscles of the bladder wall which cover the intra-parietal part of the ureter he found the ureter still fairly tight against reflux under intravesical pressure.

Excised bladders with ureters attached were used in this work in most experiments. These were obtained from human, monkey, baboon, dog, cat, rabbit and pig. Cannulae were tied in the ureters and these were attached to mercury manometers. A large brass tube, with a window at one end, into which ran inlet and outlet tubes, was fixed in the dome of the bladder, the urethra being tied off. A pressure bottle containing either normal salt solution or Ringer's solution was fastened with a long rubber tube to the inlet tube and a mercury manometer to the outlet tubes.