Objective:The aim of our study was to examine results of pyeloplasty using the new methoddsubadventitial resection of the ureter with preservation of the ureteral artery proposed by us and the possibility of using thi...Objective:The aim of our study was to examine results of pyeloplasty using the new methoddsubadventitial resection of the ureter with preservation of the ureteral artery proposed by us and the possibility of using this method in one-stage surgery with ureteropelvic junction(UPJ)and ureterovesical junction(UVJ)obstructions or vesicoureteral reflux.Methods:A retrospective analysis of 108 patients with hydronephrosis(including two patients with hydroureteronephrosis)who received treatment from March 1998 to March 2020 was carried out,with an average follow-up period of 36 months.Dismembered pyeloplasty using a subadventitial technique with preservation of ureteral blood supply was performed in 108 patients(including bilateral in two cases).In one patient with UPJ and UVJ obstructions and in one patient with UPJ obstruction and vesicoureteral reflux subadventitial resection of the ureter were performed in both segments.Results:All patients managed to preserve the integrity of the ureteral artery during dismembered pyeloplasty,and two patients simultaneously underwent ureterocystostomy by subadventitial resection of the ureter.The method of pyeloureteroplasty with subadventitial resection of the ureter makes it possible to improve long-term results in patients with hydronephrosis,including those with lesions of the UPJ and UVJ segments.In all cases,it was feasible to achieve a decrease in the degree of hydronephrosis.Postoperative complications were observed in five cases(4.6%),in none of which there were complications associated with the surgical technique,and were eliminated without loss of renal function.Conclusion:Our 22 years of experience shows that the technique of subadventitial resection of the ureter allows us to preserve the ureteral blood circulation during dismembered pyeloplasty and thus creates conditions for prevention of restenosis of UPJ and for single-stage ureteroplasty on the upper and lower ureteral segments.展开更多
AIM To assess potential benefits of an additional unenhanced acquisition in computed tomography angiography(CTA)in patients with suspected acute aortic syndrome(AAS).METHODS A total of 103 aortic CTA(non-electrocardio...AIM To assess potential benefits of an additional unenhanced acquisition in computed tomography angiography(CTA)in patients with suspected acute aortic syndrome(AAS).METHODS A total of 103 aortic CTA(non-electrocardiography-gated,128 slices)performed due to suspected AAS were retrospectively evaluated for acute aortic dissection(AAD),intramural hematoma(IMH),or penetrating aortic ulcer(PAU).Spiral CTA protocol consisted of an unenhanced acquisition and an arterial phase.If AAS was detected,a venous phase(delay,90 s)was added.Images were evaluated for the presence and extent of AAD,IMH,PAU,and related complications.The diagnostic benefit of the unenhanced acquisition was evaluated concerning detection of IMH.RESULTS Fifty-six(30%women;mean age,67 years;median,68 years)of the screened individuals had AAD or IMH.A triphasic CT scan was conducted in 76.8%(n=43).56%of the detected AAD were classified as Stanford type A,44%as Stanford type B.53.8%of the detected IMH were classified as Stanford type A,46.2%as Stanford type B.There was no significant difference in the involvement of the ascending aorta between AAD and IMH(P=1.0)or in the average age between AAD and IMH(P=0.548),between Stanford type A and Stanford type B in general(P=0.650)and between Stanford type A and Stanford type B within the entities of AAD and IMH(AAD:P=0.785;IMH:P=0.146).Only the unenhanced acquisitions showed a significant density difference between the adjacent lumen and the IMH(P=0.035).Subadventitial hematoma involving the pulmonary trunk was present in 5 patients(16%)with Stanford A AAD.The difference between the median radiation exposure of a triphasic(2737 mGy*cm)compared to a biphasic CT scan(2135 mGy*cm)was not significant(P=0.135).CONCLUSION IMH is a common and difficult to detect entity of AAS.An additional unenhanced acquisition within an aortic CTA protocol facilitates the detection of IMH.展开更多
文摘Objective:The aim of our study was to examine results of pyeloplasty using the new methoddsubadventitial resection of the ureter with preservation of the ureteral artery proposed by us and the possibility of using this method in one-stage surgery with ureteropelvic junction(UPJ)and ureterovesical junction(UVJ)obstructions or vesicoureteral reflux.Methods:A retrospective analysis of 108 patients with hydronephrosis(including two patients with hydroureteronephrosis)who received treatment from March 1998 to March 2020 was carried out,with an average follow-up period of 36 months.Dismembered pyeloplasty using a subadventitial technique with preservation of ureteral blood supply was performed in 108 patients(including bilateral in two cases).In one patient with UPJ and UVJ obstructions and in one patient with UPJ obstruction and vesicoureteral reflux subadventitial resection of the ureter were performed in both segments.Results:All patients managed to preserve the integrity of the ureteral artery during dismembered pyeloplasty,and two patients simultaneously underwent ureterocystostomy by subadventitial resection of the ureter.The method of pyeloureteroplasty with subadventitial resection of the ureter makes it possible to improve long-term results in patients with hydronephrosis,including those with lesions of the UPJ and UVJ segments.In all cases,it was feasible to achieve a decrease in the degree of hydronephrosis.Postoperative complications were observed in five cases(4.6%),in none of which there were complications associated with the surgical technique,and were eliminated without loss of renal function.Conclusion:Our 22 years of experience shows that the technique of subadventitial resection of the ureter allows us to preserve the ureteral blood circulation during dismembered pyeloplasty and thus creates conditions for prevention of restenosis of UPJ and for single-stage ureteroplasty on the upper and lower ureteral segments.
文摘AIM To assess potential benefits of an additional unenhanced acquisition in computed tomography angiography(CTA)in patients with suspected acute aortic syndrome(AAS).METHODS A total of 103 aortic CTA(non-electrocardiography-gated,128 slices)performed due to suspected AAS were retrospectively evaluated for acute aortic dissection(AAD),intramural hematoma(IMH),or penetrating aortic ulcer(PAU).Spiral CTA protocol consisted of an unenhanced acquisition and an arterial phase.If AAS was detected,a venous phase(delay,90 s)was added.Images were evaluated for the presence and extent of AAD,IMH,PAU,and related complications.The diagnostic benefit of the unenhanced acquisition was evaluated concerning detection of IMH.RESULTS Fifty-six(30%women;mean age,67 years;median,68 years)of the screened individuals had AAD or IMH.A triphasic CT scan was conducted in 76.8%(n=43).56%of the detected AAD were classified as Stanford type A,44%as Stanford type B.53.8%of the detected IMH were classified as Stanford type A,46.2%as Stanford type B.There was no significant difference in the involvement of the ascending aorta between AAD and IMH(P=1.0)or in the average age between AAD and IMH(P=0.548),between Stanford type A and Stanford type B in general(P=0.650)and between Stanford type A and Stanford type B within the entities of AAD and IMH(AAD:P=0.785;IMH:P=0.146).Only the unenhanced acquisitions showed a significant density difference between the adjacent lumen and the IMH(P=0.035).Subadventitial hematoma involving the pulmonary trunk was present in 5 patients(16%)with Stanford A AAD.The difference between the median radiation exposure of a triphasic(2737 mGy*cm)compared to a biphasic CT scan(2135 mGy*cm)was not significant(P=0.135).CONCLUSION IMH is a common and difficult to detect entity of AAS.An additional unenhanced acquisition within an aortic CTA protocol facilitates the detection of IMH.
