The Ureteric Jet Doppler Waveform As an Indicator of Vesicoureteric Sphincter Function in Adults and Children. An Observational Study

The nature of the action of the vesicoureteric junction (VUJ) in humans is still controversial. We were interested in the reasons why the jet consists of several peaks. We hypothesised that the modification of the jet into a variable number of peaks is the result of an active sphincter mechanism at the VUJ. A total of 1,010 subjects of all ages and both genders were recruited into this study. The Doppler waveform of the jet was recorded bilaterally. We could identify six basic patterns of ureteric jet according to the number of peaks: monophasic, biphasic, triphasic, polyphasic (four or more peaks), square and continuous. By analysing the duration, maximum peak velocity and initial slope of the first four patterns, a mechanism of action of an active VUJ sphincter could be postulated. Furthermore, the basic patterns could be assigned to three modes of ureteric actions: the square and continuous are only seen during diuretic stress; the biphasic, triphasic and polyphasic patterns are variations of the adult physiological steady-state mode, and the monophasic is distinctly different and represents the immature mode.