1/89. Clinics in diagnostic imaging (38). Post-ESWL perinephric haematoma.A 57-year-old man presented with urosepsis related to urinary calculi. He underwent multiple sessions of ESWL and developed a perinephric haematoma that was treated conservatively and monitored by serial imaging. However, the haematoma became infected, necessitating percutaneous drainage 2 months after the initial ESWL. The risk factors and sequelae of post-ESWL perinephric haematoma, as well as its diagnosis and imaging, are discussed.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
2/89. Combined antegrade and retrograde endoscopic approach for the management of urinary diversion-associated pathology.BACKGROUND: Endourologic management of stones and strictures in patients with a urinary diversion is often cumbersome because of the absence of standard anatomic landmarks. We report on our technique of minimally invasive management of urinary diversion-associated pathology by means of a combined antegrade and retrograde approach. patients AND methods: Five patients with urinary diversion-associated pathology were treated at our institution between May 1997 and October 1998. Their problems were: an obstructing ureteral stone in a man with ureterosigmoidostomy performed for bladder extrophy; two men with a valve stricture in their hemiKock urinary diversions; an anastomotic stricture in a man with an ileal loop diversion; and a long left ureteroenteric stricture in a man with a right colon pouch diversion. After percutaneous placement of an guidewire across the area of interest, the targeted pathology was accessed via a retrograde approach using standard semirigid or flexible fiberoptic endoscopes. Postoperative follow-up with intravenous urography, differential renal scan, or both was performed at 3 to 24 months (mean 12 months). RESULTS: The combined antegrade and retrograde approach allowed successful access to pathologic areas in all patients. holmium laser/Acucise incision of stenotic segments or ballistic fragmentation of stones was achieved in all cases without perioperative complications. None of the strictures with an initially successful outcome has recurred; however, in one patient, the procedure failed as soon as the internal stent was removed. The patient with the ureteral calculus remains stone free, and his ureterosigmoidostomy is patent without evidence of obstruction on his last imaging study, 24 months postoperatively. CONCLUSIONS: Combined antegrade and retrograde endoscopic access to the area of interest is our preferred method of approaching pathologic problems in patients with a urinary diversion. An antegrade nephrostogram provides better delineation of anatomy, while through-and-through access enables rapid and easier identification of stenotic segments that may be hidden by mucosal folds. Furthermore, this approach allows the use of larger semirigid or flexible endoscopes in conjunction with more efficient fragmentation devices, resulting in enhanced vision from better irrigation. Finally, an initial endoscopic approach may be preferred because its failure does not compromise the success of future open surgery.- - - - - - - - - - ranking = 9keywords = urinary (Clic here for more details about this article) |
3/89. Matrix calculi.Matrix calculi are an uncommon form of urinary tract concretion. They must be considered in the differential diagnosis of a radiolucent mass within the renal collecting system or ureter. The clinical and radiographic features of three cases are presented and the literature of matrix calculi is reviewed.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
4/89. Silent hydronephrosis/pyonephrosis due to upper urinary tract calculi in spinal cord injury patients.STUDY DESIGN: A study of four patients with spinal cord injury (SCI) in whom a diagnosis of hydronephrosis or pyonephrosis was delayed since these patients did not manifest the traditional signs and symptoms. OBJECTIVES: To learn from these cases as to what steps should be taken to prevent any delay in the diagnosis and treatment of hydronephrosis/pyonephrosis in SCI patients. SETTING: Regional spinal injuries Centre, Southport, UK. methods: A retrospective review of cases of hydronephrosis or pyonephrosis due to renal/ ureteric calculus in SCI patients between 1994 and 1999, in whom there was a delay in diagnosis. RESULTS: A T-5 paraplegic patient had two episodes of urinary tract infection (UTI) which were successfully treated with antibiotics. When he developed UTI again, an intravenous urography (IVU) was performed. The IVU revealed a non-visualised kidney and a renal pelvic calculus. In a T-6 paraplegic patient, the classical symptom of flank pain was absent, and the symptoms of sweating and increased spasms were attributed to a syrinx. A routine IVU showed non-visualisation of the left kidney with a stone impacted in the pelviureteric junction. In two tetraplegic patients, an obstructed kidney became infected, and there was a delay in the diagnosis of pyonephrosis. The clinician's attention was focused on a co-existent, serious, infective pathology elsewhere. The primary focus of sepsis was chest infection in one patient and a deep pressure sore in the other. The former patient succumbed to chest infection and autopsy revealed pyonephrosis with an abscess between the left kidney and left hemidiaphragm and xanthogranulomatous inflammation of perinephric fatty tissue. In the latter patient, an abdominal X-ray did not reveal any calculus but computerised axial tomography showed the presence of renal and ureteric calculi. CONCLUSIONS: The symptoms of hydronephrosis may be bizarre and non-specific in SCI patients. The symptoms include feeling unwell, abdominal discomfort, increased spasms, and autonomic dysreflexia. physicians should be aware of the serious import of these symptoms in SCI patients.- - - - - - - - - - ranking = 5keywords = urinary (Clic here for more details about this article) |
5/89. Pyeloureteritis cystica: case report.Pyeloureteritis cystica, characterized by multiple bubbly filling defects on urography and caused by inflammatory stimuli, is a rare disorder of the ureter. It commonly affects older people. diagnosis is established by radiological studies. Antibiotics should be given if urinary tract infection is present. Up to now, no other specific treatment can be used to cure this disorder. We report a case of pyeloureteritis cystica associated with urinary tract infection and a ureteral stone in a young woman who presented with hematuria and bilateral flank pain. The pyeloureteritis cystica had a bead-like appearance on intravenous pyelogram and retrograde pyelogram as well as in magnetic resonance urography. The diagnosis and treatment of this disorder are discussed. Magnetic resonance urography can provide high-resolution of coronal images of the entire urinary tract without the use of contrast agents or ionizing radiation. However, the cost of the procedure is a major concern.- - - - - - - - - - ranking = 3keywords = urinary (Clic here for more details about this article) |
6/89. Percutaneous transpouch management of a ureteral stone and ureteral-pouch stricture in a pelvic kidney.Stones in pelvic kidney collecting systems have not been routinely managed percutaneously in most urologic practices. Especially challenging is the management of stones in a pelvic kidney collecting system positioned posteriorly to a urinary diversion. In the present case, a 32-year-old man with a pelvic kidney and continent urinary diversion presented with fever and hydronephrosis. drainage of the kidney was obtained percutaneously by way of an anterior approach through-and-through the urinary diversion. The patient was found to have both a ureteral stone and a ureteral-pouch anastomotic stricture on subsequent imaging. We were able to successfully treat both these problems endoscopically through a solitary percutaneous access.- - - - - - - - - - ranking = 3keywords = urinary (Clic here for more details about this article) |
7/89. Endoluminal sonographic imaging of upper urinary tract: three-dimensional reconstruction.Two-dimensional endoluminal sonographic imaging of the ureter demonstrates the periureteral anatomy, as well as define lesions within the ureteral wall. It has been used for evaluation of a wide range of abnormalities, including ureteropelvic junction (UPJ) obstructions, crossing vasculature at an obstructed UPJ, ureteral and renal pelvic neoplasms, and the obstructed ureter. Three-dimensional (3D) reconstruction of two-dimensional (2D) sonographic imaging is a new technique applicable to intraluminal imaging. It offers advantages over 2D imaging by demonstrating the spatial relation of anatomic structures that cannot be appreciated using conventional imaging. We have evaluated a number of ureters with various pathology using 2D endouminal sonography. In this paper, we present three cases in which we have used 3D reconstruction to gain a clearer understanding of the pathology. Although still early in its application, 3D endoluminal reconstruction has potential to be a clinically useful aid to surgical decision-making.- - - - - - - - - - ranking = 4keywords = urinary (Clic here for more details about this article) |
8/89. Ureteral pressure flow studies in difficult diagnostic problems.Before a ureteral operation is undertaken for dilated, non-refluxing ureters it is essential to determine whether obstruction is present, since an operation is unnecessary and can be hazardous if there is no obstruction or infection. Obstruction is most accurately diagnosed by perfusing the upper tract at a known flow rate and measuring the resulting pressure. This test was performed on 5 patients in whom there was doubt as to the presence of obstruction from the radiographic evidence. In 4 of the 5 patients low pressure was found, the obstruction was excluded and an operation was avoided. In the fifth patient the obstruction was confirmed and relieved. The pressure flow test is useful in the diagnosis or exclusion of obstruction in the upper urinary tract.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
9/89. A stone developed within the dilated intravesical ureter following ureteroscopy.A 58-year-old man presented with a stone within the dilated intravesical ureter, which was probably attributable to a previous ureteroscopy. Transurethral incision of the right intravesical ureter and lithotripsy were carried out without subsequent urinary tract impairment. Although some complications resulting from ureteroscopy, such as ureteral stricture, ureteral perforation and vesicoureteral reflux, have been reported, this complication is considered to be very rare.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
10/89. Arterioureteral fistula--a rare complication of ureterolithotomy: treatment with embolization.fistula formation between a ureteral branch of a renal artery and the ipsilateral ureter is rare. We describe a case that followed ureterolithotomy of an impacted stone. Selective angiography with embolization of the bleeding branch was curative.- - - - - - - - - - ranking = 0.101488914601keywords = fistula (Clic here for more details about this article) |
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