Objective We aimed to compare the clinical outcomes of intravenous urography-assisted fluoroscopy-guided shockwave lithotripsy for radiolucent ureteral stones and standard shockwave lithotripsy for radiopaque ureteral...Objective We aimed to compare the clinical outcomes of intravenous urography-assisted fluoroscopy-guided shockwave lithotripsy for radiolucent ureteral stones and standard shockwave lithotripsy for radiopaque ureteral stones.Methods We retrospectively reviewed 734 patients with ureteral stones treated by fluoroscopy-guided shockwave lithotripsy between March 2014 and March 2021.The primary outcome was a stone-free rate with one session within 30 days,defined as no residual stones without auxiliary treatment.The multivariate analysis was used to examine whether the intravenous urography use predicted treatment success.Furthermore,we compared the outcomes using propensity score matching.Results Ninety-eight patients underwent the intravenous urography use protocol(Group I),and the remaining 636 patients underwent the non-intravenous urography protocol(Group N).Stone-free rates with one session within 30 days were 38%and 32%in groups I and N,respectively(p=0.3).No statistical differences were observed in the conversion rate to ureteroscopy(p=0.3)or complication rate(p=0.7)between Group I and Group N.One patient who developed skin redness was considered a complication of the contrast medium.Propensity score matching examined 88 matched pairs.Treatment success was obtained in 31(35%)patients in Group I and 33(38%)patients in Group N(p=0.9)within 30 days with one session.Conclusion Radiolucent stones can be safely and effectively treated by shockwave lithotripsy with intravenous urography.展开更多
Objective To retrospectively evaluate the effects of saline administration following contrast material injection, abdominal compression and two delay phase acquisition on image quality improvement of computed tomograp...Objective To retrospectively evaluate the effects of saline administration following contrast material injection, abdominal compression and two delay phase acquisition on image quality improvement of computed tomographic urography (CTU). Methods Medical records and informed consents of patients were obtained. In totally 122 patients (50 men, 72 women), two delay phase images with CTU were performed. Scans began simultaneously with a contrast bolus injection of 100 mL (300 mgI/mL) followed by a saline bolus injection of 100 mL at a rate of 5 mL/s. Two delay phase images were taken at 400 and 550 seconds for each patient. Examinations were taken by using abdominal compression or not. The distention and opacification of the urinary tract were evaluated by two interpreters together on transverse images and post-processing images. Effects of four techniques (saline administration and abdominal compression, saline administration only, compression only, and neither saline administration nor compression) and two delay phase acquisition on image quality improvement were analysed by using ANOVA and Chi-square test. Results Saline administration improved opacification (P<0.05) and increased overall image quality (P<0.01) of the intrarenal collecting system and proximal ureter. Abdominal compression (P<0.05) and delayed phase image acquisition of 550 seconds (P<0.01) all improved distention of the intrarenal collecting system and proximal ureter but did not improve opacification. No statistically significant effects on the distal ureter were found. However, there were more visualized distal ureteral segments with the longer imaging delay. Conclusion Saline administration, abdominal compression and longer imaging delays are all effective in improving image quality of 64-detector row CTU.展开更多
Objective To observe the imaging findings of congenital megaureter in order to enhance the understanding of this disease. Methods Image data of 5 patients with congenital megaureter and 2 misdiagnosed patients were a...Objective To observe the imaging findings of congenital megaureter in order to enhance the understanding of this disease. Methods Image data of 5 patients with congenital megaureter and 2 misdiagnosed patients were analyzed, and image findings of congenital megaureter were summarized. Elscint Prestig 2.0T superconductive magnetic resonance urography （MRLI） with conventional sequence （spin-echo, T 1W1560 ms/16 ms; fast spin-echo, T2WI 9600 ms/96 ms） was performed. Raw data were acquired with fast spin-echo sequence from heavy T2-weighted image （9600 ms/120 ms）. Post-processing method of MRH was the maximum in- tensity projection with three-dimensional reconstruction in the workstation. Intravenous pyelography （IVP） was conducted, in which X-ray films were taken 7 minutes, 15 minutes, and 30 minutes after injecting contrast agent, except that in 2 patients the films were taken delayed at 60 and 90 minutes. X-ray retrograde pyelography was performed on 2 patients, successful in one but failed in the other. Results The dilated ureter showed hypointensity on T1-weighted images and hyperintensity on T2-weighted images in conventional MRI. The mass wall was intact, uniform in thickness, and showing hy- pointensity on Tl-weighted and T2-weighted images. The MRH images showed a retroperitoneal mass appearing as an elongated tubular cystic structure spreading from kidney to bladder. MRLI also revealed dilated calices and renal pelvis, pelviureteric obstruction, and renal duplication. The main signs of congenital megaureter in X-urography was significant dilatation of ureter, or normal renal pelvis with ureter dilatation, hydronephrosis, deformity, and displacement. Conclusions MRH with X-urography could visualize the characteristics of congenital megaureter, including the dilation of renal pelvis and ureter, calculi, urinary tract duplication, and stenosis location. The two techniques can complement each other in disease diagnosis and provide more detailed information for preoperative treatment.展开更多
Objective:Understanding the role of Multi-slice CT Urography(MSCTU)over Ultrasonography(US)in patients presenting with hematuria.Materials and Methods:Retrospective study enrolled 131 patients presenting with hematuri...Objective:Understanding the role of Multi-slice CT Urography(MSCTU)over Ultrasonography(US)in patients presenting with hematuria.Materials and Methods:Retrospective study enrolled 131 patients presenting with hematuria[microscopic hematuria(n=60)]and macroscopic hematuria(n=71)]who have undergone both MSCTU and US of urinary tract system simultaneously.Results of tests were compared with respective surgical and histopathological analysis of lesion.The cases obtained were bladder carcinoma,ureter carcinoma,renal carcinoma,urinary tract calculi and bladder inflammation.PASW-18thstatistical tool was used for obtaining statistical analysis and final interpretation of results.Results:The sensitivity and specificity of MSCTU and US for recognition of lesions presenting with macroscopic hematuria were 95.38%,83.33%and 81.54%,66.67%respectively and for those with microscopic hematuria were 96.08%,88.89%and 86.27%,77.8%respectively.The positive and negative likelihood ratios of MSCTU and US in macroscopic category were 5.73,0.055 and 2.46,0.277 respectively while for those in microscopic category were 8.65,0.044 and 3.88,0.176 respectively.In context to the sensitivity of MSCTU and US in patients presenting with macroscopic hematuriathedifferenceswere significant(McNemar's test,P=0.039)suggesting the tests are not similar whereas for those with microscopic hematuria the differences were not significant(Mc Nemar's test,P=2.68)indicatingsimilarity between these tests.Conclusion:Diagnostic efficacy of MSCTU is found to be far superior over US for patients presenting with macroscopic hematuria,thus current practice of using it as a first line modality seems to be justified.However,for those presenting with microscopic hematuria MSCTU and ultrasonography shows near to similar resultsin accordance to MSCTU,thus US alone seems sufficient to exclude significant urinary tract lesions.展开更多
Anatomical renal anomalies are one of the most commonly occurring renal anomalies. Most of these anomalies require series of investigations for the proper diagnosis. We tried to compare the results of conventional rad...Anatomical renal anomalies are one of the most commonly occurring renal anomalies. Most of these anomalies require series of investigations for the proper diagnosis. We tried to compare the results of conventional radiological investigations with magnetic resonance urography in the diagnosis of complex renal anomalies. Materials and methods: This was a prospective study done over a period of five years from 2006 to 2011. All the patients with suspected or diagnosed presence of renal anomalies were investigated by ultrasound (USG), Intravenous urography (IVU), micturating cystourethrogram (MCU), magnetic resonance urography (MRU), retrograde urethrography, cystogenitoscopy, renal scans as per the indication in the case. Results: Total sixty three patients were studied over the period. The most common complex renal anomaly diagnosed was duplex system and conventional radiological investigations were useful in the diagnosis of less than 50% patients. Female patients outnumbered male patients in having complex renal anomalies. MRU was diagnostic in most of the patients with such anomalies and excellent mode of investigation for functional and anatomical details. Conclusion: MRU is better than conventional radiological investigations in the diagnosis of complex renal anomalies.展开更多
BACKGROUND Ureteropelvic junction obstruction(UPJO)is a common congenital urinary tract disorder in children.It can be diagnosed as early as in utero due to the presence of hydronephrosis or later in life due to sympt...BACKGROUND Ureteropelvic junction obstruction(UPJO)is a common congenital urinary tract disorder in children.It can be diagnosed as early as in utero due to the presence of hydronephrosis or later in life due to symptomatic occurrence.AIM To evaluate the discrepancy between dynamic contrast-enhanced magnetic resonance urography(dMRU)and scintigraphy 99m-technetium mercaptoacetyltriglycine(MAG-3)for the functional evaluation of UPJO.METHODS Between 2016 and 2020,126 patients with UPJO underwent surgery at Robert DebréHospital.Of these,83 received a prenatal diagnosis,and 43 were diagnosed during childhood.Four of the 126 patients underwent surgery based on the clinical situation and postnatal ultrasound findings without undergoing functional imaging evaluation.Split renal function was evaluated preoperatively using scintigraphy MAG-3(n=28),dMRU(n=53),or both(n=40).In this study,we included patients who underwent surgery for UPJO and scintigraphy MAG-3+dMRU but excluded those who underwent only scintigraphy MAG-3 or dMRU.The patients were divided into groups A(<10%discrepancy)and B(>10%discrepancy).We examined the discrepancy in split renal function between the two modalities and investigated the possible risk factors.RESULTS The split renal function between the two kidneys was compared in 40 patients(28 boys and 12 girls)using scintigraphy MAG-3 and dMRU.Differential renal function,as determined using both modalities,showed a difference of<10%in 31 children and>10%in 9 children.Calculation of the relative renal function using dMRU revealed an excellent correlation coefficient with renal scintigraphy MAG-3 for both kidneys.CONCLUSION Our findings demonstrated that dMRU is equivalent to scintigraphy MAG-3 for evaluating split renal function in patients with UPJO.展开更多
The objective of this study was to compare Magnetic Resonance Urography (MRU) with Intravenous Pyelography (IVP) in evaluation of patients with hydronephrosis on ultrasonography. 49 patients of hydronephrosis on USG w...The objective of this study was to compare Magnetic Resonance Urography (MRU) with Intravenous Pyelography (IVP) in evaluation of patients with hydronephrosis on ultrasonography. 49 patients of hydronephrosis on USG were enrolled for the study from Jan. 2011 to Dec. 2012. All patients under went Intravenous Urography (IVU). MRU was done to determine the anatomical details and function of each renal unit. MRU was performed on a 1.5 tesla unit (Magneton Avento;Siemens, Erlangen, Germany). Static T2-weighted Magnetic Resonance Urography (MRU) was performed by using a standard fast spin echo technique. Dynamic study was performed after injecting intravenous diuretic followed by Gadolinium contrast media. Morphological results of MRU were compared with IVU. The anatomical findings were compared with operative findings. Stastical analysis was performed and data expressed as mean ± SD. MRU showed PUJ obstruction in 41 out of 45 patients (91.1%). We concluded that MRU can provide complete diagnostic evaluation of entire urinary tract in a single session and has potential to replace IVP.展开更多
文摘Objective We aimed to compare the clinical outcomes of intravenous urography-assisted fluoroscopy-guided shockwave lithotripsy for radiolucent ureteral stones and standard shockwave lithotripsy for radiopaque ureteral stones.Methods We retrospectively reviewed 734 patients with ureteral stones treated by fluoroscopy-guided shockwave lithotripsy between March 2014 and March 2021.The primary outcome was a stone-free rate with one session within 30 days,defined as no residual stones without auxiliary treatment.The multivariate analysis was used to examine whether the intravenous urography use predicted treatment success.Furthermore,we compared the outcomes using propensity score matching.Results Ninety-eight patients underwent the intravenous urography use protocol(Group I),and the remaining 636 patients underwent the non-intravenous urography protocol(Group N).Stone-free rates with one session within 30 days were 38%and 32%in groups I and N,respectively(p=0.3).No statistical differences were observed in the conversion rate to ureteroscopy(p=0.3)or complication rate(p=0.7)between Group I and Group N.One patient who developed skin redness was considered a complication of the contrast medium.Propensity score matching examined 88 matched pairs.Treatment success was obtained in 31(35%)patients in Group I and 33(38%)patients in Group N(p=0.9)within 30 days with one session.Conclusion Radiolucent stones can be safely and effectively treated by shockwave lithotripsy with intravenous urography.
文摘Objective To retrospectively evaluate the effects of saline administration following contrast material injection, abdominal compression and two delay phase acquisition on image quality improvement of computed tomographic urography (CTU). Methods Medical records and informed consents of patients were obtained. In totally 122 patients (50 men, 72 women), two delay phase images with CTU were performed. Scans began simultaneously with a contrast bolus injection of 100 mL (300 mgI/mL) followed by a saline bolus injection of 100 mL at a rate of 5 mL/s. Two delay phase images were taken at 400 and 550 seconds for each patient. Examinations were taken by using abdominal compression or not. The distention and opacification of the urinary tract were evaluated by two interpreters together on transverse images and post-processing images. Effects of four techniques (saline administration and abdominal compression, saline administration only, compression only, and neither saline administration nor compression) and two delay phase acquisition on image quality improvement were analysed by using ANOVA and Chi-square test. Results Saline administration improved opacification (P<0.05) and increased overall image quality (P<0.01) of the intrarenal collecting system and proximal ureter. Abdominal compression (P<0.05) and delayed phase image acquisition of 550 seconds (P<0.01) all improved distention of the intrarenal collecting system and proximal ureter but did not improve opacification. No statistically significant effects on the distal ureter were found. However, there were more visualized distal ureteral segments with the longer imaging delay. Conclusion Saline administration, abdominal compression and longer imaging delays are all effective in improving image quality of 64-detector row CTU.
文摘Objective To observe the imaging findings of congenital megaureter in order to enhance the understanding of this disease. Methods Image data of 5 patients with congenital megaureter and 2 misdiagnosed patients were analyzed, and image findings of congenital megaureter were summarized. Elscint Prestig 2.0T superconductive magnetic resonance urography （MRLI） with conventional sequence （spin-echo, T 1W1560 ms/16 ms; fast spin-echo, T2WI 9600 ms/96 ms） was performed. Raw data were acquired with fast spin-echo sequence from heavy T2-weighted image （9600 ms/120 ms）. Post-processing method of MRH was the maximum in- tensity projection with three-dimensional reconstruction in the workstation. Intravenous pyelography （IVP） was conducted, in which X-ray films were taken 7 minutes, 15 minutes, and 30 minutes after injecting contrast agent, except that in 2 patients the films were taken delayed at 60 and 90 minutes. X-ray retrograde pyelography was performed on 2 patients, successful in one but failed in the other. Results The dilated ureter showed hypointensity on T1-weighted images and hyperintensity on T2-weighted images in conventional MRI. The mass wall was intact, uniform in thickness, and showing hy- pointensity on Tl-weighted and T2-weighted images. The MRH images showed a retroperitoneal mass appearing as an elongated tubular cystic structure spreading from kidney to bladder. MRLI also revealed dilated calices and renal pelvis, pelviureteric obstruction, and renal duplication. The main signs of congenital megaureter in X-urography was significant dilatation of ureter, or normal renal pelvis with ureter dilatation, hydronephrosis, deformity, and displacement. Conclusions MRH with X-urography could visualize the characteristics of congenital megaureter, including the dilation of renal pelvis and ureter, calculi, urinary tract duplication, and stenosis location. The two techniques can complement each other in disease diagnosis and provide more detailed information for preoperative treatment.
文摘Objective:Understanding the role of Multi-slice CT Urography(MSCTU)over Ultrasonography(US)in patients presenting with hematuria.Materials and Methods:Retrospective study enrolled 131 patients presenting with hematuria[microscopic hematuria(n=60)]and macroscopic hematuria(n=71)]who have undergone both MSCTU and US of urinary tract system simultaneously.Results of tests were compared with respective surgical and histopathological analysis of lesion.The cases obtained were bladder carcinoma,ureter carcinoma,renal carcinoma,urinary tract calculi and bladder inflammation.PASW-18thstatistical tool was used for obtaining statistical analysis and final interpretation of results.Results:The sensitivity and specificity of MSCTU and US for recognition of lesions presenting with macroscopic hematuria were 95.38%,83.33%and 81.54%,66.67%respectively and for those with microscopic hematuria were 96.08%,88.89%and 86.27%,77.8%respectively.The positive and negative likelihood ratios of MSCTU and US in macroscopic category were 5.73,0.055 and 2.46,0.277 respectively while for those in microscopic category were 8.65,0.044 and 3.88,0.176 respectively.In context to the sensitivity of MSCTU and US in patients presenting with macroscopic hematuriathedifferenceswere significant(McNemar's test,P=0.039)suggesting the tests are not similar whereas for those with microscopic hematuria the differences were not significant(Mc Nemar's test,P=2.68)indicatingsimilarity between these tests.Conclusion:Diagnostic efficacy of MSCTU is found to be far superior over US for patients presenting with macroscopic hematuria,thus current practice of using it as a first line modality seems to be justified.However,for those presenting with microscopic hematuria MSCTU and ultrasonography shows near to similar resultsin accordance to MSCTU,thus US alone seems sufficient to exclude significant urinary tract lesions.
文摘Anatomical renal anomalies are one of the most commonly occurring renal anomalies. Most of these anomalies require series of investigations for the proper diagnosis. We tried to compare the results of conventional radiological investigations with magnetic resonance urography in the diagnosis of complex renal anomalies. Materials and methods: This was a prospective study done over a period of five years from 2006 to 2011. All the patients with suspected or diagnosed presence of renal anomalies were investigated by ultrasound (USG), Intravenous urography (IVU), micturating cystourethrogram (MCU), magnetic resonance urography (MRU), retrograde urethrography, cystogenitoscopy, renal scans as per the indication in the case. Results: Total sixty three patients were studied over the period. The most common complex renal anomaly diagnosed was duplex system and conventional radiological investigations were useful in the diagnosis of less than 50% patients. Female patients outnumbered male patients in having complex renal anomalies. MRU was diagnostic in most of the patients with such anomalies and excellent mode of investigation for functional and anatomical details. Conclusion: MRU is better than conventional radiological investigations in the diagnosis of complex renal anomalies.
文摘BACKGROUND Ureteropelvic junction obstruction(UPJO)is a common congenital urinary tract disorder in children.It can be diagnosed as early as in utero due to the presence of hydronephrosis or later in life due to symptomatic occurrence.AIM To evaluate the discrepancy between dynamic contrast-enhanced magnetic resonance urography(dMRU)and scintigraphy 99m-technetium mercaptoacetyltriglycine(MAG-3)for the functional evaluation of UPJO.METHODS Between 2016 and 2020,126 patients with UPJO underwent surgery at Robert DebréHospital.Of these,83 received a prenatal diagnosis,and 43 were diagnosed during childhood.Four of the 126 patients underwent surgery based on the clinical situation and postnatal ultrasound findings without undergoing functional imaging evaluation.Split renal function was evaluated preoperatively using scintigraphy MAG-3(n=28),dMRU(n=53),or both(n=40).In this study,we included patients who underwent surgery for UPJO and scintigraphy MAG-3+dMRU but excluded those who underwent only scintigraphy MAG-3 or dMRU.The patients were divided into groups A(<10%discrepancy)and B(>10%discrepancy).We examined the discrepancy in split renal function between the two modalities and investigated the possible risk factors.RESULTS The split renal function between the two kidneys was compared in 40 patients(28 boys and 12 girls)using scintigraphy MAG-3 and dMRU.Differential renal function,as determined using both modalities,showed a difference of<10%in 31 children and>10%in 9 children.Calculation of the relative renal function using dMRU revealed an excellent correlation coefficient with renal scintigraphy MAG-3 for both kidneys.CONCLUSION Our findings demonstrated that dMRU is equivalent to scintigraphy MAG-3 for evaluating split renal function in patients with UPJO.
文摘The objective of this study was to compare Magnetic Resonance Urography (MRU) with Intravenous Pyelography (IVP) in evaluation of patients with hydronephrosis on ultrasonography. 49 patients of hydronephrosis on USG were enrolled for the study from Jan. 2011 to Dec. 2012. All patients under went Intravenous Urography (IVU). MRU was done to determine the anatomical details and function of each renal unit. MRU was performed on a 1.5 tesla unit (Magneton Avento;Siemens, Erlangen, Germany). Static T2-weighted Magnetic Resonance Urography (MRU) was performed by using a standard fast spin echo technique. Dynamic study was performed after injecting intravenous diuretic followed by Gadolinium contrast media. Morphological results of MRU were compared with IVU. The anatomical findings were compared with operative findings. Stastical analysis was performed and data expressed as mean ± SD. MRU showed PUJ obstruction in 41 out of 45 patients (91.1%). We concluded that MRU can provide complete diagnostic evaluation of entire urinary tract in a single session and has potential to replace IVP.
