Cinefluorographic Studies of the Normal Upper Urinary Tract

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Abstract
The motor activity of the upper urinary tract—calyx, infundibulum, and pelvis—is virtually an unexplored area of radiological investigation, although a method of observation and recording, cinefluorography, has been a practical procedure for almost ten years. Most of the work in this field of investigation, interestingly enough, was carried out prior to the introduction of the image-amplification tube and cinefluorography. Initially, the renal pelvis was filled with contrast matrial injected through a ureteral catheter, and observations were made with a fluoroscope. Later, movie records of the standard fluoroscope were attempted, but the high roentgen dose level was prohibitive. Additional attempts were made at rapid serial filming with the Cinex serial filmer (6, 7), but this, too, was limited to a short record because of the high exposure dose to the patient. The reader is referred to the excellent historical review by Narath (9) for the work done before 1950. Sporadic reports of cinefluorographic studies of the upper urinary tract may be found in the English language literature (1, 2, 4, 5) after the advent of the amplification tube, but the majority of the recent work, by far, has been done in Europe and Japan.3 The opinions of the various investigators are in many instances quite conflicting. At the present time, no single investigator has reported sufficient material in the area of observation to reach definitive conclusions. The purpose of this communication is to present the authors' findings and interpretations in the hope of stimulating additional investigative work in this most interesting field. Material A consecutive, nonselected group of 50 patients was examined; their ages ranged from the third to the eighth decade, and they were of both sexes. The cine examination was performed after routine intravenous urography. The indications for the urographie studies included abdominal pain, back pain, fever of undetermined origin, evaluation prior to therapy for carcinoma of cervix, and, most frequently, hypertension. No known case of upper urinary tract disease was included in this series; consequently, the intravenous urograms were considered normal in all cases. It is not possible to generalize about those patients in whose pelvocalyceal systems sufficient contrast remained for an adequate cine examination; some were obese and some were thin, some were tall and some were short. Since nonopacified kidneys at the cine study could not be evaluated, it is impossible to say if the kidneys were more or less active than normal. In the majority of patients with inadequate cine studies, intravenous urography was also poor. The factors affecting urography are pertinent here, with good roentgen studies preceding good cine studies. The roentgenographic examination was performed as follows: The night before the examination castor oil was administered, and on the following morning a cleansing enema was given.

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