Interureteric ridge edema: incidence and etiology

Background Interureteric ridge edema may be seen at intravenous urography (IVU) and is related to acute lower ureteral obstruction, trauma, or calculi. The purpose of this study was to explore the relationship between interureteric ridge edema and acute distal ureteral obstruction caused by ureteral calculi.Methods A total of 338 patients who had IVU for various indications during a 6-month period were reviewed for the presence of interureteric ridge edema.Results Interureteric ridge edema was seen in 12 (4%) of 338 patients, all with acute lower ureteral obstruction from stones. Interureteric ridge edema was best demonstrated with the partially filled bladder film or postvoid bladder film in all cases.Conclusion Interureteric ridge edema is most commonly caused by stone-induced distal ureteral obstruction and is less commonly seen with recent passage of a stone or other etiologies. Interureteric ridge edema was present in 26% of patients with acute lower ureteral obstruction.     

Can noncontrast helical computed tomography replace intravenous urography for evaluation of patients with acute urinary tract colic?

The objective of this study was to determine whether helical computed tomography (CT) performed without oral or intravenous contrast agents is accurate in the evaluation of patients with suspected acute renal colic. One hundred consecutive patients with suspected renal colic or ureteral colic were referred by our institution's emergency department for unenhanced helical CT scans. We reviewed the original radiographic report for each patient and recorded the size and location of ureteral calculi and other concurrent urinary tract calculi, if any. We also recorded the presence or absence of hydronephrosis, hydroureter, perinephric edema, and periureteral edema. A total of 49 patients had ureteral calculi, 17 patients had only renal calculi, and 34 patients had no stones. Forty-nine patients had ureteral calculi, and 40 (82%) of these 49 patients had associated CT signs including hydroureter and periureteral edema. Calculi were present in the proximal ureter in 11 patients, the midureter in seven patients, and the distal ureter including ureterovesical junction in 31 patients. Calculi were seen elsewhere in the urinary tract and renal pelvis in 44 patients. Other diagnostic tests and stone passage were used to confirm the CT diagnosis of ureteral stones. The sensitivity and specificity of helical CT in evaluating ureteral calculi were 100% and 94%, respectively. Sixteen extraurinary lesions were detected in 34 patients who had no urinary calculi. Most extraurinary lesions (81%) were deemed the cause of acute flank pain. The room time for CT averaged 26 min, compared to 69 min for intravenous urography (IVU). The charge for CT was $600 compared to $400 for IVU in our institution. Unenhanced helical CT was fast and accurate in determining the cause of colic and proved to be highly accurate for emergency situations.     

Urolithiasis/nephrolithiasis: what's it all about?

Urolithiasis (urinary tract calculi or stones) and nephrolithiasis (kidney calculi or stones) are well-documented common occurrences in the general population of the United States. The etiology of this disorder is multifactorial and is strongly related to dietary lifestyle habits or practices. Proper management of calculi that occur along the urinary tract includes investigation into causative factors in an effort to prevent recurrences. Urinary calculi or stones are the most common cause of acute ureteral obstruction. Approximately 1 in 1,000 adults in the United States are hospitalized annually for treatment of urinary tract stones, resulting in medical costs of approximately dollar 2 billion per year (Ramello, Vitale, & Marangella, 2000; Tanagho & McAninch, 2004).     

数字胃肠机下静脉尿路造影在输尿管结石治疗前的应用价值

目的:探讨数字胃肠机下静脉尿路造影在输尿管结石治疗前的应用价值。材料与方法:对我院2008年1月～2010年3月经超声、KUB或CT诊断为输尿管结石的42例患者治疗前在数字胃肠机下静脉尿路造影资料及所得结果进行分析。结果:42例患者中,18例在常规时间内显影,20例行延时摄影,梗阻部位明确显示,结石定位准确;2例排除输尿管结石;2例由于重度肾积水无法显示,手术证实为输尿管结石。结论:输尿管结石在治疗前行数字胃肠机下静脉尿路造影显著提高了输尿管结石定位诊断的准确率,尤其是延时立位摄影更加有利于输尿管梗阻性结石的定位,同时输尿管梗阻程度的判定、肾功能的评估对临床治疗方法的选择上起到了重要的指导作用。     

输尿管镜气压弹道碎石术治疗输尿管结石223例

目的探讨输尿管镜气压弹道碎石术治疗输尿管结石的疗效。方法将223例249侧输尿管结石患者分为3组,并对151侧下段输尿管结石,56侧中段结石,42侧上段结石临床治疗效果进行回顾总结。结果输尿管气压弹道碎石术治疗输尿管各段结石均可取得很好的治疗效果。下段结石清除率98.0%(148/151),中段结石清除率达94.6%(53/56),上段结石清除率达88.1%(37/42)。其中并发症的发生率为8.5%(19/223),包括结石移位、输尿管穿孔、改开放手术、发热等。结论输尿管镜气压弹道碎石术是一种安全有效的治疗输尿管结石的方式,尤其对中下段结石、体外冲击波碎石术处理失败的结石及伴肾绞痛者是一种很好的方法。     

磁共振尿路成像对尿路梗阻的诊断价值

目的：评价磁共振尿路成像（MRU）对尿路梗阻的诊断价值。材料与方法；在PHILIPSGYROSCANT10－NT1．0T超导型磁共振成像仪上用重度T2加权（TR／TE＝2000／700ms）涡流自旋回波（TSE）序列对13名病人的14例尿路梗阻病变（先天性肾盂输尿管交界处狭窄4例、输尿管炎性或手术后狭窄4例、输尿管结石3例、输尿管癌1例、腹腔肿瘤侵犯输尿管1例及先天性输尿管膀胱连接区梗阻1例）作MRU检查，同时采用呼吸触发和脂肪抑制技术。图像后处理以最大强度投射法（MIP）进行三维（3D）重建。结果：14例尿路梗阻病变的MRU检查成功率为100％，MRU对尿路积水程度的判断和尿路梗阻的定位诊断准确性为100％，MRU对尿路梗阻的定性诊断符合率为85．7％。结论：MRU检查具有无创伤性、不需造影剂和不受肾功能异常的影响等诸多优势，为泌尿系疾病的影像学诊断开辟了一条新的途径。MRU对尿路梗阻的定位和定性诊断准确性高，尤其是在静脉尿路造影（IVU）等其它检查有禁忌症或诊断不明确时，可以作为一种理想的替代检查方法。     

输尿管结石的急诊诊断

目的：提高输尿管结石的急诊诊断水平，方法：对310例输尿管结石伴腰得部疼痛患者的急诊诊断方法进行回顾性分析。结果：本组患者定位诊断准确率为92％，定量诊断的准确率是91％，临床症状与体检分析定性诊断的准确率是85．8％，B超检查的定位准确率是72．5％，KUB和IVU检查的定位准确率分别为69．1％和60．3％，CT检查的定性定位准确率是69．6％。，结论：输尿管结石诱发的肾绞痛是泌尿外科急诊的常见多发病，其急诊诊断需要主观症状结合多种辅助检查综合考虑。     

输尿管镜气压弹道碎石术治疗输尿管结石

目的探讨输尿管镜治疗输尿管结石的,临床效果。方法回顾性分析72例应用8／9．8F输尿镜配合气压弹道碎石治疗输尿管结石的患者资料,其中输尿管上段结石13例,中段结石18例,下段结石41例。结果72例输尿管结石,一次成功清除结石70例（97．2％）。2例输尿管上段结石倒回肾脏,留置双J管后进行体外震波碎石术,拔除双J管后结石自行排出。无发生输尿管穿孔和输尿管撕脱等严重并发症。结论输尿管镜气压弹道碎石术治疗榆尿管结石是安全而有效的,适合在基层医院推广。     

Intravenous urography in the emergency department: when do we need it?

Intravenous urography (IVU) is a useful radiographic study in the detection of renal and ureteral calculi. However, it is time consuming, expensive, and exposes the patient to i.v. contrast and radiation. To determine the impact of utilizing IVU less for the detection of renal calculi, criteria for ordering IVU in the emergency department (ED) were evaluated, and patients with high probability of positive IVU were identified. Variables included presence of acute flank pain with haematuria, prior history of renal calculus, degree of haematuria, and uncontrolled pain. We reviewed patients presenting with acute flank and abdominal pain with haematuria from May 1995 to May 1996 at a large urban university hospital. Charts were abstracted for prior history, reason for ordering IVU, time in the ED, laboratory results, IVU result, final diagnosis, and disposition. Data was analysed with Student's t-test, Wilcoxon rank-sum and receiver operating characteristic (ROC) analysis. A total of 302 patients were identified, and 185 underwent IVU during the study period. For patients with prior history of renal calculi 82% had positive IVU (sensitivity 51%, specificity 87%). For patients with both acute flank pain and haematuria, 92% had a positive IVU (sensitivity 93%, specificity 43%), and 19% of patients with abdominal pain of unclear aetiology with haematuria had a positive IVU. All patients with uncontrolled pain had evidence of high-grade obstruction on IVU. Degree of haematuria was not predictive of a positive IVU from ROC curve derivation. IVU is a useful study in the ED but may be overutilized, leading to lengthy patient stays. The combined objective findings of acute flank pain and haematuria are sensitive, and prior history is specific in identifying patients with renal calculi. Degree of haematuria was not useful in predicting renal calculi. By utilizing the criteria of acute flank pain and haematuria as a decision aid, 66% of all IVUs ordered could have been avoided.     

Diagnostic imaging of calculi in the upper urinary tract--sonography vs. computerized tomography

The choice of the most suitable technique for radiologic evaluation of upper urinary tract stones depends on the precise clinical questions that have to be answered. Many of these questions can still be answered by plain films of the abdomen and excretory urography. This review addresses the value of ultrasonography and computed tomography (CT) with respect to the two most important clinical questions, i.e. 1) presence/extent of obstruction/hydronephrosis and perinephric abscess in patients with acute flank pain; and 2) precise location, number and size of calculi. Because its sensitivity is comparable with CT and it is widely available, ultrasonography in the hands of experienced clinicians/radiologists may be preferred for evaluation of patients with acute flank pain. However, it must be emphasized that ultrasonography may totally miss acute ureteral obstruction/hydronephrosis within the first 12-24 hours. In children as well as in pregnant women, ultrasonography is still the technique of choice, but it may be replaced by magnetic resonance urography in the future. For precise stone location or detection of calcifications, however, the speed, safety and accuracy of unenhanced helical CT make this the most sensitive method and therefore the technique of choice. It also detects urinary calculi more accurately and exposes patients to less radiation than the traditional combined plain abdominal film/intravenous urography. Furthermore, CT can most readily reveal alternative diagnoses in patients with acute flank pain and other intraabdominal pathologies than stones.     

Evaluation of Patients With Suspected Ureteral Calculi Using Sonography as an Initial Diagnostic Tool

Objective. The purpose of this study was to evaluate the usefulness of sonography as an initial diagnostic tool in patients with suspected ureterolithiasis. Methods. We performed a prospective study of 318 patients with suspected ureteral stones over a 14‐month period. All patients underwent sonography after fasting for 8 hours and bladder filling. If no cause of the flank pain was found by sonography, computed tomography or intravenous urography was performed immediately to confirm the absence of ureteral stones. Results. We found urolithiasis with sonography in 291 of 296 patients with confirmed urolithiasis. The 5 remaining cases were identified after non–contrast‐enhanced computed tomography (n = 3), intravenous urography (n = 1), or the passage of a stone (n = 1, pregnant patient). We detected 313 calculi in the 291 patients with sonography as follows: 307 ureteral calculi in 285 patients, 5 urinary bladder calculi that were probably passed from the ureter in 5 patients, and 1 urethral calculus. The locations of the 313 calculi in the 291 patients with a sonographic diagnosis were as follows: 21 were in the ureteropelvic junction, 96 in the proximal half of the ureter, 69 in the distal half of the ureter, 121 in the ureterovesical junction, 5 in the urinary bladder, and 1 in the urethra. Hydronephrosis was seen in 200 of the 291 patients with calculi identified by sonography (68.7%). Twinkling artifacts helped confirm the presence of tiny calculi in 184 of the 214 calculi (86%). Conclusions. Sonography can be used as an initial diagnostic tool in patients with suspected ureterolithiasis.     

输尿管结石螺旋CT与静脉尿路造影检查结果比较

目的比较急性肾绞痛患者螺旋CT和静脉尿路造影检查诊断泌尿系结石的检出率，花费等。材料和方法对50例临床所见急性肾绞痛伴有镜下血尿患者，均行B超、螺旋CT、静脉尿路造影等检查的患者；对所有患者的检查结果进行回顾分析，包括有无结石，结石大小和位置，输尿管扩张以及输尿管梗阻继发症状。结果所有患者中16例无结石，余患者经自行排石，输尿管镜气压弹道碎石或手术均证实有结石。螺旋CT显示了34例结石，静脉尿路造影仅显示22例结石。而结石所致输尿管梗阻螺旋CT和静脉尿路造影有同样的临床意义。结论螺旋CT平扫是急诊诊断输尿管结石准确，安全快捷的方法，明显优于静脉尿路造影检查。可将其作为急诊情况下诊断输尿管结石的首选检查方法之一。     

Hematuria as an indicator for the presence or absence of urinary calculi

The purpose of this study was to determine whether the presence of hematuria or its absence can predict the presence or absence of urinary calculi as determined by computed tomography (CT) scan in patients presenting to the ED with acute abdominal colic. We reviewed the urine analysis and CT scans of all patients presenting to the ED over a 12-month period with acute colic and a clinical suspicion of urinary calculi. Urine samples were drawn on arrival in the ED before CT scanning. Two hundred seventy-seven patients were included in the study. The prevalence of urinary stones as detected by CT was 57.4%. The positive predictive value, negative predictive value, and accuracy for hematuria as a marker for stone disease was 60.9%, 72.4%, and 62.1%, respectively. A total of 3.24% of patients had some degree of obstruction, all of whom had hematuria. The absence of hematuria is not a reliable exclusion criterion for urinary calculi. The detection of urinary stones without hematuria does not imply obstruction.     

CT diagnosis of acute flank pain from urolithiasis

The use of noncontrast helical CT (NHCT) to assess patients with acute flank pain and hematuria for potential urinary tract stone disease was first reported in 1995. After several years of experience with the technique, sensitivity and specificity of NHCT has proven to be better than intravenous urography for evaluating ureteral stones. NHCT imaging findings for urinary calculi and the differential diagnosis are discussed in this article. Various extraurinary diseases found while using NHCT in searching for stone disease are addressed and illustrated. As experience with the use of NHCT has increased, clinicians have broadened the indications for this technique, which has a lower charge than standard CT, beyond the specific evaluation of urinary colic. This indication creep has increased the number of NHCT examinations ordered. It has also reduced the rate of stone positivity and increased the diagnostic yield for extraurinary disease.     

经皮输尿管镜肾穿刺治疗输尿管上段嵌顿性结石127例临床分析

目的总结输尿管上段嵌顿性结石的镜下特点并评价微创经皮肾镜技术治疗的疗效。方法微创经皮肾（MPCNL）输尿管镜观察127例输尿管上段嵌顿性结石的特点并用气压弹道碎石或钬激光治疗。结果结石大且形状不规则，并发输尿管息肉或肉芽组织49例，并发输尿管狭窄26例；均同期处理，113例为一期取石，结石清除率100％，平均手术时间60min，术中平均出血25ml，平均住院时间7d，未发生肾动静脉瘘及输尿管穿孔、断裂等严重并发症。随访3～12个月，未见结石及狭窄复发。结论造成大多数输尿管上段结石长期嵌顿的原因为输尿管息肉或肉芽、狭窄；结石大形状不规则。采用微创经皮肾镜技术治疗输尿管上段嵌顿性结石创伤小、结石清除率高、恢复快．效果满意。     

尿路小结石:MR和CT仿真内镜对比的实验研究

目的　探讨MR、CT仿真输尿管肾镜技术及其诊断尿路小结石的价值。方法　将 9枚直径 1～ 5mm的结石置入离体输尿管肾盂内 ,分别以生理盐水、3 %马根维显溶液或 3 %泛影葡胺完全充盈后行CT和MR容积扫描。源影像在工作站用Navigator软件做内镜重建。结果　VE对结石的敏感性源于CT技术者为 11.1%、源于多层薄层SS FSE序列者为44 .4%、源于HT2 FSE序列者 5 5 .6%、源于MR IVU序列者为 44 .4% ,检出的结石最小直径为 2mm。VE图像质量CT技术优于MR技术 (P <0 .0 1) ,MRH技术优于MR IVU技术 (P <0 .0 5 )。结论　磁共振仿真输尿管肾镜能够检出直径 2mm以上尿路结石 ,以HT2 FSE技术为佳 ;阳性造影剂法CT仿真内镜对尿路结石诊断价值有限     

Transvaginal sonography in the assessment of distal ureteral calculi.

OBJECTIVES: To explore the morphological and functional findings of transvaginal sonography (TVS) in the diagnosis and management of distal ureteral calculi. METHODS: We retrospectively reviewed the imaging studies in seven cases of distal ureteral calculi (study group) and 20 cases of female volunteers without urinary tract infection (control group). All 27 patients had undergone TVS for assessment of the lower urinary tract. The variables measured on ultrasound included the presence or absence of distal ureteral calculi, the size and location of a calculus if present, the presence or absence of the ureter jet phenomenon, morphological changes of the ureteral papilla and adjoining tissue, and the height of the ureteral papilla, as well as vascular changes seen on Doppler imaging. RESULTS: In the controls, 80% of the ureteral papillae were triangular and 20% trapezoidal. The average (+/-SD) height of the ureteral papillae was 3.5 +/- 0.7 mm on the right and 3.6 +/- 0.9 mm on the left. There was no statistically significant difference between the heights of the right and left papillae (P = 0.619). In the study group, echogenic stones were identified in all seven patients and a hypoechogenic tubular structure connected to the involved papilla was identified in 6/7 patients. The average height of the involved papilla was 6.7 +/- 1.6 mm. Ureteric jets were visible in all patients in both the study and control groups. CONCLUSION: In patients with distal ureteral calculi, TVS provides a rapid, non-invasive and repeatable means of assessing the morphology and function of the distal ureter.     

彩超引导下微创经皮肾镜碎石取石术治疗复杂性上尿路结石的临床应用

目的探讨彩色多普勒超声（彩超）引导下微创经皮肾镜技术（MPCNL）取石治疗复杂性上尿路结石的疗效。方法于彩超引导下采用MPCNL治疗106例复杂性上尿路结石患者,评价手术疗效。结果106例均手术成功,一期手术时间（50±20）min,二期手术时间（30±10）min;一期结石清除率75．5％（80／106）,总结石清除率86．8％（92／106）,所有患者术中均无需输血及无出现严重并发症。有残余肾结石的14例采用体外冲击波碎石或口服排石药排出残余结石。1例出现术后大量出血,经介入科行超选择性肾动脉栓塞术后治愈。术后平均随访12个月,2例出现术后残余结石排至输尿管上段,经体外冲击波碎石治疗后结石自行排出,其余患者无明显并发症。结论彩超引导下MPCNL治疗复杂性上尿路结石疗效较好。     

膀胱癌患者常规行IVU检查的临床意义评估

目的对膀胱癌（bladdercellcarcinoma,BCC）患者是否应常规行IVU检查的临床意义进行评估。方法回顾分析我院1995年至2008年诊治的1053例BCC患者的临床资料,包括膀胱肿瘤的位置、临床分期、病理分级、上尿路影像学检查结果。结果1053例BCC患者中有28例伴发上尿路肿瘤,发生率为2．66％。其中20例为肾盂癌,IVU检查发现肾盂内充盈缺损,CT检查发现病变。另输尿管癌8例,IVU检查发现患侧上尿路不显影7例,输尿管下段充盈缺损1例;前者有6例经输尿管镜检查发现,1例经CTU检查示左输尿管下段占位病变。合并上尿路肿瘤患者的膀胱肿瘤位置均局限在患者上尿路肿瘤同侧输尿管口附近及三角区。结论本组BCC患者伴发上尿路肿瘤的几率低。采用无创超声检查有阳性上尿路发现及肿瘤位于输尿管口周围及三角区时应进一步行上尿路影像学检查,无需所有BCC患者均行IVU检查。     

Ultrasound diagnostics of upper urinary tract calculi

The review is dedicated to ultrasonography of the upper urinary tract in patients with nephrolithiasis. Ultrasonographic semiotics of urolithiasis, the ability of unlrasonography to detect nephrolithiasis, and methods of the optimization of these diagnostic techniques in patients with upper urinary tract calculi are covered. The author discusses difficulties that may be faced while differentiating between nephrolithiasis and such conditions as spongious kidney, nephrocalcinosis, calcification of renal papillae, cysts, tumors, and vascular walls, as well as other kinds of renal calcification, associated with ultrasonographic acoustic path phenomenon. The advantages and disadvantages of ultrasonography in cases of X-ray urolithiasis are evaluated in the paper. The article describes hardships in ultrasound visualization of ureteral calculi causing acute upper urinary tract obstruction, and the ways of getting over them.