Color Doppler sonography of ureteral jets in normal volunteers: importance of the relative specific gravity of urine in the ureter and bladder.

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Abstract
Sonographic visualization of ureteral jets is a well-recognized phenomenon. In vitro studies have indicated that detection of fluid flow similar to ureteral jets depends on differences in density between the moving and the stationary fluid. This study was undertaken to determine if differences in density between ureteral urine and urine in the bladder could make a significant impact on the sonographic detectability of ureteral jets in vivo. Ten healthy volunteers were vigorously hydrated after an overnight fast. An initial color Doppler sonographic examination of ureteral jets was performed before voiding (while concentrated urine that had accumulated overnight was still in the bladder). A second examination was performed after two cycles of voiding and refilling the bladder (to ensure that dilute urine produced by the hydration was in the bladder). In all subjects, normal ureteral jets were readily identified on the initial examination. The difference in the estimated specific gravity between bladder urine and ureteral urine during the initial examination ranged from 0.002 to 0.016 (mean, 0.008). This was a statistically significant difference (p less than .05). On the second examination, ureteral jets were not detected from either ureter in any subject. The difference in the estimated specific gravity of bladder urine and ureteral urine during the second examination ranged from 0.000 to 0.002 (mean, 0.001). This was not a statistically significant difference (p greater than .05). There was no statistically significant difference in the diuresis rates throughout the course of the examinations. These ranged from 300 to 1218 ml/hr. These in vivo results support the hypothesis that detection of ureteral jets depends on density differences between ureteral and bladder urine. This is important clinically, because normal ureteral jets may be undetectable, despite adequate hydration and high rates of diuresis, if the patient is allowed to completely void and refill the bladder before the examination.

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