An evaluation of orthotopic ileal neobladders by dynamic digital urography

PURPOSE: To report on the diagnostic capabilities of dynamic digital urography in the evaluation of orthotopic ileal neobladders. MATERIAL AND METHODS: Ten male patients (aged 61.3 +/- 14.7 years) with orthotopic ileal neobladder (4 Studer, 4 Camey type II with spiralized ileal segment and 2 classic Camey type II) underwent dynamic digital urography using an angiographic unit (Philips DVI/ARC-A). Eight patients were asymptomatic and two presented mild nycturia. All patients should have undergone follow-up conventional urography, which was replaced, for the purposes of our study, by dynamic digital urography. The intestinal cleansing regimen usual for the double contrast barium enema was used in all the patients. Ninety mL of a nonionic iodinated contrast agent were administered i.v. with an automatic injector. After precontrast mask images, two postcontrast sequences were acquired 15 s and 30 min after the injection (each made of 20 images acquired every 10 seconds). Postprocessing consisted of digital image subtraction and videorecording. RESULTS: Renal pelvis and calyceal systems were well visualized in 18/20 excretory systems. Eighteen of 20 ureters were visualized completely up to the ureteral jet, and two were only partially visualized. Calyceal, pyelic and ureteral enlargement with ureteral kinking were observed in a patient with classic Camey type II. High motility was seen in 11 ureters, moderate in 5 and mild in 4. The orthotopic ileal neobladder was well opacified in 8/10 patients. Effective peristalsis of the afferent ileal segment was seen in all the Studer type neobladders. Ureteral reflux was not observed in any patient. DISCUSSION: After orthotopic ileal neobladder reconstruction, the most frequent complications include urinary leakage, intestinal obstruction, venous thrombosis, stenosis of the neobladder anastomoses, incontinence, cancer recurrence, stone formation. In the follow-up, many diagnostic tools are used: intravenous urography, retrograde cystography, urodynamic studies, transabdominal and transrectal ultrasonography. With dynamic digital urography the nephrographic evaluation was possible in all patients, as well as the evaluation of calyceal, pyelic and ureteral opacification and even ureteral peristalsis. Moreover, this diagnostic tool allows the morphofunctional dynamic study of the ureteral-neobladder anastomoses and of the orthotopic ileal neobladder, even evaluating the residual peristalsis of the detubularized ileal segment. A major drawback of the new method is the relatively high radiation dose given to the patient. A limitation of the study is the selection of a population of completely or nearly asymptomatic patients. CONCLUSIONS: Dynamic digital urography provides useful morphologic and functional information in the follow-up of patients with orthotopic ileal neobladder and could replace conventional urography in symptomatic patients.     

多层螺旋CT尿路成像对肾盂和输尿管疾病的诊断价值

目的探讨多层螺旋CT尿路成像技术(MSCTU)在肾盂和输尿管疾病诊断中的应用价值。方法搜集2年间临床资料完整的肾盂和输尿管疾病患者46例,均行MSCT增强扫描,排泄期图像进行容积重建(SVR)、最大密度投影(MIP)、多平面重组(MPR)及曲面重组(CPR),获得完整的尿路影像。结果46例中,肾盂和输尿管结石16例,先天畸形12例(包括重复肾盂输尿管、腔静脉后输尿管、肾盂输尿管交处狭窄、额外肾),输尿管炎性狭窄5例,肾盂、输尿管癌7例,膀胱癌累及输尿管4例,外压性病变2例。结论MSCTU对肾盂和输尿管疾病诊断具有优势。     

Significance of collateral arterial supply to Wilms' tumours

The presence of collateral arterial supply was examined by angiography in 19 children with Wilms' tumour. Collateral arterial supply was related to tumour size. Ten of 14 tumours displaying collateral circulation were entirely intrarenal at operation, confirmed by histopathology. Angiography in Wilms' tumour is indicated when the results of urography, ultrasonography or computed tomography are equivocal or extrarenal tumour growth is suggested.     

肾盂移行细胞癌的影像诊断

目的比较静脉尿路造影（IVU）、逆行尿路造影（RU）、B超、CT检查对肾盂移行细胞癌的诊断敏感性。方法回顾性分析28例经手术病理证实的肾盂移行细胞癌的影像学资料，18例经IVU检查；14例经逆行。肾盂造影；28例均经CT检查，其中11例为平扫，17例为平扫加增强；20例经超声检查。结果对照手术病理结果，IVU的敏感性为55，6％（10／18）；逆行肾盂造影的敏感性为92．9％（13／14）；CT检查的敏感性为89．3％（25／28）；B超的敏感性为60％（12／20）。结论RU准确率最高，CT和B超其次，IVU最低，但因IVU是无创性检查，临床依然将其作为肾盂移行细胞癌常规的首选检查方法，RU，CT和B超作为IVU重要的补充。     

Urinary tract infection in infants and children evaluated by ultrasound

Fifty-nine pediatric patients with urinary tract infection (UTI) underwent renal ultrasonography, excretory urography, and voiding cystourethrography. The imaging procedures were analyzed retrospectively to determine their relative effectiveness in detecting abnormalities that might predispose the patient to UTI. Voiding cystourethrography provided valuable information, particularly the presence or absence of vesicoureteral reflux, that could not be obtained from the other procedures. Excretory urography was less specific than ultrasonography in the majority of patients, with the exception of those who had renal scarring. The authors recommended ultrasonography as the initial imaging procedure in the evaluation of children with UTI. When the sonogram is normal, excretory urography is not considered necessary, but voiding cystourethrography is thought to be essential. If sonography is abnormal, excretory urography and/or other follow-up studies are indicated.     

Diagnostic value of diuretic-enhanced excretory MR urography in patients with obstructive uropathy

PURPOSE: Ultrasonography and conventional intravenous urography are most common methods in diagnosis of obstructive uropathies. The disadvantage of ultrasonography is inability of visualizing middle and lower one thirds of ureter, while intravenous urography is using radiation, also functionally extra loading effect on kidneys. In this study, the diagnostic value of MR urography on obstructive uropathy were investigated. MATERIALS AND METHODS: Forty five patients who were suffered from obstructive uropathy examined by ultrasonography, intravenous urography and diuretic-enhanced excretory MR urography by using MR-contrast-agent. RESULTS: MR urography established accuracy rate of 92.8% for stone diseases which formed the largest group in this study, however, in other causes of obstructive uropathy, MR urography provide 100% correct diagnosis. CONCLUSION: MR urography provide high quality images for diagnosing and determining causes of urinary obstruction defining position and severity of dilatations as well as showing localization of the pathology. We think that MR urography should be a primary investigation in patients with obstructive uropathy who have contrast agent and X-ray contrindication.     

Reliability of the combination of ultrasonography-cystography in the study of urinary infection in children. Prospective study on 90 cases

The authors report a prospective study concerning 90 children with a urinary tract infection, investigated for the first time by radiological and ultrasonographic techniques. Amongst these 90 children, 50 (i.e. 55% of cases) had a normal retrograde cystography and ultrasonography. These children did not have any IVU and medical surveillance proved to be sufficient. Ten patients had a normal retrograde cystography and abnormal ultrasonography. Intravenous urography carried out in these 10 cases revealed in 8 instances an abnormality of the upper urinary tract. Finally 30 children had an abnormal retrograde cystography, with reflux in 29 cases, leading to intravenous urography which yielded a pathological result in only half of the cases studied. This series confirms the central role of retrograde cystography. When it is normal, intravenous urography may be legitimately substituted by ultrasonography.     

Multiple-section radionuclide tomography of the kidney: a clinical evaluation

The clinical utility of radionuclide emission tomography of the kidney in comparison with conventional gamma-camera imaging has been assessed from scans of 60 patients suspected of having space-occupying lesions of the kidney. Nineteen patients had renal tumour, 17 had cysts and seven had renal pseudotumours; the remainder had no lesion. Objective trials using four observers showed only a slight, statistically insignificant advantage from the addition of tomographic sections to conventional images. However, in several individual cases tomography had aided diagnosis, particularly in obese patients, when an alternative non-invasive investigation (ultrasonography) was inconclusive. In seven patients a positive diagnosis of renal pseudotumour was made possible by tomography; definite identification of ectopic functioning cortical tissue at the location of a mass suspected after urography was considered to be a distinct diagnostic advantage gained from emission tomography of the kidney.     

Imaging of children with urinary tract infection: a tailored approach

We reviewed the initial imaging studies of 283 children with urinary tract infection in order to decide on the most effective approach. A voiding cystogram was performed in all, complemented by either urography (147 patients), ultrasonography (65), or both (71 patients). In the latter group there was good correlation between sonographic and urographic findings, except for a more accurate delineation of renal scars and anomalies on urography, all in children with vesicoureteral reflux and/or abnormal sonograms. From these data we derived two imaging sequences tailored to the clinical circumstances: cystography as the initial study in ambulatory patients after infection has subsided, and sonography followed by cystography in children hospitalised with severe infection. The upper tracts are studied by ultrasonography and/or urography in patients with significant vesicoureteral reflex or an abnormal sonogram. Both these sequences reduce radiation by omitting the urogram in roughly half of the patients.     

Sonographic and CT appearance of exogastric leiomyoma

Conventional barium examinations and endoscopy are often inconclusive in patients with subserosal, exogastric leiomyoma. Ultrasonography and CT in a patient with a large exogastric leiomyoma revealed a rounded, well-encapsulated tumour with a necrotic cavity centrally. The origin of the tumour from the stomach was demonstrated on both ultrasonography and CT.     

Urinary tract infection in children. A reappraisal of its radiologic investigation

In a prospective study, 100 children with either an acute or a previous history of urinary tract infection were investigated by intravenous urography, micturition cystourethrography, and ultrasonography. The results from the three diagnostic modalities were compared: The urinary tracts in 59 patients were normal, and revealed some abnormality in 41. Ultrasonography proved to be superior to intravenous urography in outlining renal contours and in detecting subtle cortical changes secondary to urinary tract infection (such as slight increases in cortical thickness and edema or cortical scarring). The mucosa of the renal pelvis and bladder was more easily assessed by ultrasound than by intravenous urography. Both modalities were "equally" accurate in detecting important congenital malformations of the urinary tract. Ultrasound failed to detect 24 of 28 ureters demonstrating reflux on voiding cystourethrography. We propose that carefully performed abdominal ultrasonography can replace intravenous urography in the initial investigation of urinary tract infection in children. It should be done in association with a radiographic or radionuclide voiding cystogram. Intravenous urography would then become a complementary examination for abnormal or problematic patients.     

Present-day imaging of patients with renal colic

In the past decade alternatives to urography have been proposed for the study of patients with renal colic. In 1992 it was suggested to replace urography with KUB and ultrasonography. In 1993 the combination of KUB and ultrasonography followed by urography in unresolved cases was proposed and, in 1995, it was suggested to replace urography with unenhanced helical CT (UHCT). This article illustrates the contribution of UHCT to the study of patients with renal colic and analyses advantages and shortcomings of the technique compared with other diagnostic approaches. Diagnostics of the patient with renal colic is based on the detection of direct and indirect signs which allow identification of not only the calculus, with a sensitivity of 94–100 % and accuracy of 93–98 % according different authors, but also other signs that can serve to guide patient management and evaluate long-term prognosis. Unenhanced helical CT has the capability to detect extraurinary abnormalities which present with flank pain and mimic renal colic. The examination technique affects the quality of the images and therefore diagnostic accuracy as well as the dose to the patient. With regard to setting parameters, the choice of thickness and table feed should be guided by numerous factors. Multiplanar reconstruction is indicated in the study of the entire ureter course to identify the exact site of the calcification for the urologist to perform an evaluation similar to that obtained by urography. Many authors consider UHCT to be a valuable tool for suggesting the best therapeutic approach. Among these there are also urologists. The evaluation is based on the stone detection, its size and level in the urinary tract. Cost analysis shows that the cost of UHCT is equal to or inferior to the cost of urography. With regard to the dose, different data are reported in the literature. A high pitch (more than 1.5) and a thin collimation (3-mm thickness) are good compromise between quality and dose which can be compared to the dose of normal urography. What is to be done if helical CT is not available? If helical CT is not available, plain film plus ultrasonography should be considered. This approach does not solve all the cases; in unresolved cases urography is indicated. It should also be noted that US has a good sensitivity in detecting other conditions such as biliary lithiasis, acute pancreatitis, acute appendicitis and abdomino-pelvic masses which are responsible for pain that mimics renal colic. In conclusion, IVU should not have any more the priority in investigating the patients with renal colic. Helical CT should be the first choice in imaging a patient with renal colic. If this technique is not available, plain film and ultrasonography should be considered adding urography in unresolved cases.     

A comparison of real-time ultrasonography with intravenous urography in the follow-up of patients with spinal cord injury

Patients with spinal cord damage require an expert urological assessment at regular intervals. Seventy-five patients with neurogenic bladder dysfunction associated with spinal paralysis attending for routine assessment of the upper urinary tract had both intravenous urography (IVU) and renal ultrasonography. The combination of a plain radiography of the abdomen and an ultrasound scan of the kidneys was found to be a cheap, safe and reliable alternative to intravenous urography for the regular follow-up of these patients.     

肾盂输尿管连接部梗阻的影像学分析(附18例报告)

目的 评价影像检查对肾盂输尿管连接部梗阻的诊断价值。方法 本组18例均经静脉尿路造影，其中10例又经逆行尿路造影，12例经B型超声检查。结果 肾盂输尿管连接部狭窄13例，输尿管高位附着3例，输尿管瓣膜1例，迷走血管压迫1例。全部病例均由手术证实。结论 静脉尿路造影和B超检查为最常用诊断方法。对部分病人能作出病因诊断。     

64层螺旋CT尿路成像与静脉尿路造影对照分析

目的探讨64层螺旋CT尿路成像(CTU)与静脉尿路造影(IVU)对泌尿系病变的应用价值。方法 130例临床疑诊泌尿系病变的患者,先进行IVU,再行64层螺旋CT尿路成像检查,通过工作站进行多种后处理,比较两者结果。结果 IVU诊断正常3例,诊断泌尿系结石95例,其中肾结石50例,输尿管结石44例,膀胱结石1例,输尿管外压病变2例,泌尿系畸形6例,肿瘤7例,感染性病变1例。CTU诊断正常2例,诊断泌尿系结石106例,其中肾结石60例,输尿管结石45例,膀胱结石1例,外压病变4例,泌尿系畸形9例,肿瘤20例,感染性病变17例。对于泌尿系结石、畸形的诊断两种方法无统计学差异(P>0.05),对于泌尿系肿瘤、感染的诊断两者有统计学差异(P<0.05)。结论 64层螺旋CT通过多种后处理方法,既可全景显示泌尿系的形态结构,也可观察局部病变细节,对泌尿系各种疾病的诊断有重要的临床价值;而对于泌尿系单纯结石性梗阻亦可采用IVU。     

Ultrasonography in the diagnosis of hydronephrosis in patients with normal renal function

In order to define the sensitivity and specificity of ultrasonography (US) in the diagnosis of hydronephrosis, 125 patients with normal renal function were examined after urography using high-resolution real-time scanning. The overall diagnostic accuracy of US in detecting hydronephrosis was 85.2%, with a specificity of 84.4% and a sensitivity of 89.9%. It is concluded that US may be considered the screening test of choice for the diagnosis of hydronephrosis. However, urography is still required for the evaluation of renal function, site, and nature of the obstruction when US shows a dilated collecting system and in the patient with a normal US but renal colic.     

Ultrasonic evaluation of the urinary tract in patients with spinal cord injuries. Systematic comparison with intravenous urography in 50 cases

Intravenous urography and ultrasonography were performed routinely, and at the same time, in 50 patients with spinal cord injuries, to compare diagnostic efficacy. Ultrasound was found to be as reliable as intravenous urography in 92% of renal and bladder explorations and to supply additional data on these regions in 6% of cases. It was also found to be equally effective for ureteral dilatation cases, although the site and nature of the obstacle could not be established except in 66% of patients. Ultrasound imaging should therefore play an important role in the urologic surveillance of these patients.     

Ultrasonography versus excretory urography: value in urological disease

Considerable savings in cost and some reduction in gonad dose and contrast medium allergy can be expected if excretory urography can be replaced by real-time ultrasonography as the first examination in upper urinary tract disease. For one year, all patients referred for excretory urography (UG) are first examined with real-time ultrasonography (US) to establish whether UG can be completely replaced by US, or the indications for which US should be the first examination of choice. The results in 200 consecutive patients indicate that both methods sometimes fail, but not in the same patients. A combination of the two may be unbeatable, but uneconomical. The results obtained over one year may give the answer. Hopefully studies at other centres will be initiated to increase the size of the case material.     

Stages in the growth of uroradiology

For much of its history, uroradiology was dominated by the urologists. At the birth of the Radiological Society of North America, retrograde pyelography was well established. The major actors in the discovery of intravenous urography were urologists. Despite the availability of urography, the preeminence of retrograde pyelography was initially maintained because of its superior demonstration of the pelvicalyceal system. Selective renal angiography, high-dose intravenous urography, and nephrotomography provided excellent radiologic means for study of the renal parenchyma and put radiologists firmly in charge of uroradiology, a position further strengthened by the advent of ultrasonography and computed tomography.     

Imaging and the first urinary infection in children. Respective role of each test during the initial evaluation apropos of 122 cases

122 pediatric patients with a first urinary tract infection underwent renal ultrasonography (US) and voiding cystourethrography (VCUG) to evaluate the usefulness of this association. The US was always the first examination undertaken, its sensitivity seems to be very good in detecting renal abnormalities. The major finding on the VCUG was the vesico-ureteral reflux: 25% of cases. When the sonogram and the VCUG are normal, 60% of cases, excretory urography is not considered necessary.