Ureteric jets: evaluation of normal flow dynamics with color Doppler sonography

This study was designed to investigate a variety of sonographic features of ureteric jets in order to define patterns of flow and ranges of flow values in an asymptomatic population. The following features of ureteric jets were measured during a period of up to 30 min in a group of 15 asymptomatic volunteers after oral hydration (the mean value was calculated on each side): peak velocity (mean, 57 cm/sec); jet duration (mean, 4.6 sec); and number of peaks and subpeaks (mean, 2.2). Several flow patterns were observed, including discrete jets, ureteric streaming, and rest periods. For each patient the ratios of values obtained on the left and right sides were calculated for peak velocity (1.00-1.74; mean, 1.26); jet duration (1.00-4.69; mean, 1.83); and jet frequency (1.00-1.21; mean, 1.11). The interjet interval (period between jets) ranged from 2 to 150 sec. Bolus volume and jet frequency showed simultaneous moment-to-moment variation. The frequency and velocity rather than the duration ratios may be of greatest value in identifying patients with normal ureterodynamics. Our findings challenge two current concepts of renal pelvic and ureteral response to changes in urine output: (1) ureters have a fixed maximal discharge rate and (2) bolus volumes do not change until this rate is achieved. Asymmetric moment-to-moment fluctuations observed in jet frequency suggest that prolonged examination may be necessary to confirm normal symmetry of jet frequency in some patients with suspected ureteric obstruction.