Reflex anuria is a well known phenomenon in urology, observed after bilateral ureteral catheterization and retropubic prostatectomy. Aetiologically, it is badly demonstrated. On the basis of the rare literature and our own experiences, we try to explain the pathophysiologic pathway. The first question is, if there is a possible influence from the bladder and the distal ureter on kidney function: Electrostimulation of the kidney nerves results in a decrease of renal plasma flow, glomerular filtration rate and urine excretion. The former both return to normal in 1–2 h independently of persistent stimulation, while urine excretion remains decreased until the end of stimulation. The same phenomenon can be observed during electrostimulation of bladder neck and distal ureter. The pathophysiological answer is a continuous excretion of the antidiuretic hormone and a shifting of the intrarenal blood flow from the cortex to the medulla. Only urine excretion, and not the function of the kidney, is influenced. In addition, experiments on the dog demonstrate that mechanical irritation of the distal ureters results in reduced plasma flow and glomerular filtration rate in the ipsilateral kidney, whereas by superposition of a psychogenic stimulus both parameters decrease also in the contralateral kidney. Short obstruction of the renal pelvis has two consequences: first, pressure in the renal pelvis arises for a certain time and synchronously tubular function decreases, with a predominant decrease of urine osmolarity. An increase of the hydrostatic pressure in the renal pelvis results in a decrease of urine excretion of the contralateral kidney. Secondly, simultaneously with ureter obstruction renal plasma flow decreases by preglomerular vasoconstriction and results in a diminution of glomerular filtration. Our conclusion is, that there are two reasons for the origin of the reflex anuria: (1) an increase of the hydrostatic pressure in the renal pelvis which affects the tubular system, and (2) a reflexive preglomerular vasoconstriction which is followed by a decrease of the glomerular filtration rate and urine excretion. The second reflexive action has, in our opinion, three possible pathways: (a) a direct vasomotoric reflex via the nerves of the kidney; here, psychical stress is probably very important; (b) a viscero-visceral reflex via the distal part of the ureter, and (c) a cutaneo-visceral reflex: in this connexion pain may be in the foreground.

Keywords:
Reflex anuria, Pathophysiological possibilities, Hydrostatic pressure in renal pelvis, Reflexive preglomerular vasoconstriction, Direct vasomotoric reflex, Viscero-visceral reflex, Cutaneo-visceral reflex
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© 1983 S. Karger AG, Basel
1983
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