Regional and age-dependent residual strains, curvature, and dimensions of the human ureter

Abstract

The ureters are retroperitoneal structures controlling urine transport from the kidneys to the bladder. Because of the relative scarcity of data on the biomechanical properties of human ureter and the established importance of knowing these properties for understanding its physiology, we initiated biomechanical studies in cadaveric tissue. Herein, we report definite zero-stress/no-load geometrical characterization at 15 regions along the ureter of human cadavers aged 23–82 years, estimating the opening angle, circumferential residual strains, axial curvature, and dimensional parameters. Opening angle decreased along the proximal 25% of ureter, increased and reached a maximum near the mid-ureter, and then gradually decreased toward the vesicoureteral junction (young: p < 0.05; middle-aged: p < 0.05; old: p > 0.05; males: p < 0.05; females: p < 0.05). Similar were the regional distributions of residual strain at the interface between epithelium–lamina propria and muscle and of internal but not external residual strain. Wall thickness increased steadily with aging ( p < 0.05 at few regions), while ureteral circumference did not ( p > 0.05 at most regions) and opening angle decreased ( p < 0.05 at several regions). Consistent with Fung’s stress-growth law, the muscle layer thickened with age unlike the epithelium–lamina propria that thinned ( p < 0.05 at most regions for both thicknesses). Moderate-to-strong direct correlations of residual strain difference (= external – internal) with opening angle, wall thickness, and curvature were found in most ureters. The presented data will provide insight into the biomechanical response of ureter under zero/low-stress conditions and the relationship between ureteral remodeling and aging. Importantly, they may also be used to inform finite element models and computational studies simulating the ureter.