儿童扩张的前列腺囊影像学诊断

目的：探讨儿童扩张的前列腺囊影像学特点。方法回顾性分析13例儿童临床诊断为扩张的前列腺囊病例,其中6例行排泄性膀胱尿道造影(VCUG)检查,5例行 MRI 检查,2例行 VCUG 及 MRI 检查。结果8例 VCUG 均在排尿时后尿道后方膀胱后下方见类圆形或长圆形囊腔影,3例囊腔可见管状影与后尿道相通,另5例囊腔影与尿道影重叠,囊腔与后尿道相通管道显示不清。7例 MRI 检查,均在膀胱后方中线区见上下走行长圆形囊状长 T1长 T2信号,穿过前列腺中心。5例囊腔可见条形高信号与后尿道高信号相通,5例发现睾丸炎、附睾炎、阴囊炎,1例发现右肾缺如。结论VCUG 和 MRI 检查是儿童扩张的前列腺囊重要检查方法,两者各有优缺点。     

小儿盆腔及泌尿生殖系横纹肌肉瘤的影像诊断

目的探讨儿童盆腔及泌尿生殖系横纹肌肉瘤(RMS)的尿路造影和CT表现及其诊断价值。资料与方法回顾性分析20例经手术及活检病理证实的原发于盆腔及泌尿生殖系RMS的影像学资料。其中10例经静脉肾盂造影(IVP)检查,3例经膀胱尿道造影(VCUG)检查,10例经CT检查,1例经MRI检查。结果8例膀胱RMS的IVP、CT表现为膀胱内葡萄状充盈缺损,膀胱颈部与耻骨联合间距增宽,VCUG可见肿物延伸至后尿道;4例前列腺RMS表现为后尿道肿物压迫膀胱颈部并使其抬高、环绕尿道的盆底部包块。6例盆腔RMS IVP及CT表现为盆腔包块,压迫膀胱移位、变形,膀胱壁轻度浸润不规则,输尿管下段浸润者可有轻度输尿管及肾盂积水。1例尿道RMS表现为尿道内充盈缺损,1例阴道RMS,IVP表现为膀胱颈部充盈缺损。结论IVP及VCUG能明确诊断原发于膀胱、前列腺、尿道的RMS及上尿路继发病变;CT及MR可进一步了解起自阴道、前列腺、盆腔的RMS及其与周围器官的关系。     

外科治疗腺性膀胱炎40例临床探讨

目的：探讨腺性膀胱炎的临床诊断与外科治疗。方法：回顾性分析2005—01～2008—12诊治的经病理检查证实为腺性膀胱炎40例患者的临床资料。结果：本组经尿道膀胱电切＋膀胱灌注化疗治疗,随访10～46个月,平均（16．8±3．8）个月,25例治愈,好转10例、无效2例、复发3例,再次经尿道电汽化切除后膀胱镜检查正常。结论：腺性膀胱炎病因尚不明确,临床表现缺乏特征,确诊主要靠膀胱镜检加病理检查。经尿道膀胱电切＋膀胱灌注化疗治疗为首选治疗方法,但是本病复发率高,定期复查膀胱镜和影像学长期随访有重要意义。     

经会阴部超声检查诊断前列腺部尿道结石16例

近几年我们对临床拟诊为尿道结石的患者作了经会阴部Ｂ超检查 ,诊断前列腺部尿道结石 16例 ,经膀胱镜检查及取石术证实有前列腺部尿道结石 13例 ,误诊 3例 ,现报告如下。1　资料和方法1 1　一般资料　 16例前列腺部尿道结石患者 ,年龄 2 2～ 4 3岁 ,平均 2 7岁 ,病程最长 0 5ａ,最短 2ｄ ;10例为初诊患者 ,3例复诊患者曾在外院作过检查治疗 ,均未发现尿道结石。所有患者临床表现有排尿困难、小便不畅、尿流变细、尿道疼痛 ,9例患者伴尿频、尿急及血尿 ;7例患者有肾结石史 ,3例患者有输尿管结石史。1 2　检查仪器和方法　使用日立ＥＵＢ - 4…     

经尿道汽化术治疗腺性膀胱炎17例

腺性膀胱炎为膀胱黏膜增生性病变。 2 0 0 0年 3月～ 2 0 0 1年 12月 ,我们应用尿道汽化术治疗经病理证实的腺性膀胱炎 17例 ,疗效满意。1　临床资料1 1　一般情况　经病理检查证实为腺性膀胱炎 17例 ,男 4例 ,女 13例 ;年龄 2 8～ 6 5岁 ,平均 4 9岁。临床症状为尿频、尿急、尿痛 13例 ,血尿 5例 (肉眼血尿 3例 ,镜下血尿 2例 ) ,排尿困难 7例 ,伴前列腺增生 2例 ,并发膀胱结石 1例。 17例均经Ｂ超检查 ,发现膀胱内占位性病变 5例 ,其中强回声结节 2例。经静脉尿路造影 (ＩＶＵ)检查 14例 ,发现右肾积水 1例 ,左肾积水 2例。经ＣＴ检查 4例…     

术中腔内US对尿道憩室的估价

作者对8例术前诊断尿道总室的病人(男1例,女7例)术中用腔内US估价。术前7例做了排尿性膀胱尿道造影,3例经阴道US,2例用双囊导管作了尿道造影。在切除憩室时用小型号US换能器连续监测有助于憩室切除。先用21F硬性膀胱镜完成膀胱尿道检查,使膀胱部分扩张,将6.2F或9F带有12.SMHz或20MHz换能器的腔内导管置入尿道并     

小儿肾发育不良的超声诊断

目的：探讨超声诊断小儿先天性肾发育不良的临床应用价值,提高肾发育不良的超声诊断水平。方法：回厕性分析30例经手术病理证实的肾发育不良患者的影像学资料,所有患者均行超声检查,21例行静脉肾盂造影（IVP）描查,2例行排尿膀胱尿道造影（VCU）检查,4例行CT平扫,2例行CT平扫及增强扫描。分析小儿肾发育不良的超声稍点,并与其它影像学检查结果进行对照分析。结果：30例患者超声均诊断正确,诊断符合率为100％。30例中患肾异枉26例,患肾实质结构不良26例,实质内检出囊泡者28例。30例中合并输尿管远端开13异位20例,合并其它泌尿系畸呒7例。IVP检出患肾2例（2／21）,CT增强扫描栓出患肾1例,VCU提示膀胱输尿管返流1例。结论：超声诊断肾发育环良准确有效,是值得推荐的影像学检查方法。     

铥激光联合输尿管镜治疗合并尿道狭窄膀胱尿路上皮癌的疗效观察

目的:观察铥激光治疗合并尿道狭窄低级别膀胱尿路上皮癌的疗效。方法:回顾分析2015年3月至2016年12月,采用铥激光治疗伴有尿道狭窄的膀胱尿路上皮癌4例。年龄58～78岁。肿瘤直径1～2 cm。左侧壁2例,右侧壁1例,底部1例。初发2例,肾盂癌根治术后复发1例,膀胱尿路上皮癌术后复发1例。单发3例,多发1例。均病理证实为低级别尿路上皮癌。患者早期化疗药物尿道直接灌注致尿道长段狭窄1例,前列腺电切术后尿道狭窄1例,经尿道膀胱肿瘤电切术后尿道狭窄2例。4例患者16号膀胱镜均未能通过尿道,均以标准输尿管镜经尿道进入膀胱,探查发现膀胱内肿瘤后先取活检,再以铥激光将肿瘤灶予以烧灼汽化,范围超过肿瘤边界0.5 mm,直至深肌层。结果:4例患者术后每3月随访1次,共随访1～2年,未见肿瘤复发。结论:铥激光联合输尿管镜治疗合并尿道狭窄的低级别膀胱尿路上皮癌是一个有效方法。     

经直肠腔内超声检查在诊断前列腺疾病中的价值分析

目的：探讨经直肠腔内超声检查在诊断前列腺疾病中的价值。方法：选择临床拟诊的前列腺疾病61例,分别采用经直肠腔内超声及经腹超声对前列腺组织进行观察,并将其检查结果与穿刺活检或术后病理结果相比较。结果：穿刺活检或术后病理检查证实前列腺癌4例中,经直肠腔内超声诊断3例,经腹超声诊断0例;病理检查证实前列腺巨大囊肿16例中,经直肠腔内超声诊断16例,经腹超声诊断6例;病理检查证实前列腺重度增生伴钙化18例中,经直肠腔内超声诊断17例,经腹超声诊断9例;病理检查证实前列腺严重钙化23例中,经直肠腔内超声诊断23例,经腹超声诊断18例。经直肠腔内超声检查对前列腺癌、前列腺囊肿、前列腺增生合并钙化、前列腺钙化的诊断准确率均显著高于经腹部超声检查（P〈0.05）。结论：经直肠腔内超声检查对前列腺疾病的诊断价值优于经腹超声。     

光敏技术诊治膀胱癌13例

临床资料与方法 本组膀胱肿瘤13例,男12例,女1例。年龄46～78岁。除4例为初发患者外,其余均为膀胱移行细胞癌术后复发患者。所有病例均经膀胱镜检查及病理检查明确诊断。肿瘤均在2.0cm以下。13例中9例采取直接光敏技术治疗,4例采用经尿道将膀胱肿瘤电切或电疑术     

儿童先天性前尿道憩室的X线诊断

目的 探讨儿童先天性前尿道憩室的X线检查方法及诊断。方法 回顾性分析5例经手术证实的先天性前尿道憩室的排泄性膀胱尿道造影检查及2例同时进行的逆行尿道造影检查的X线表现。结果 5例患儿均表现为与前尿道相通的憩室，3例位于尿道球部，2例位于阴茎部；球形憩室见于1例，囊状憩室见于4例。2例有左侧膀胱输尿管返流(Ⅳ级)。结论 排泄性膀胱尿道造影是本病首选的检查方法。     

Cystic lesions of the prostate.

As the use of ultrasound (US) for evaluating the prostate gland has grown, so has the variety of cystic prostatic lesions that can be identified with US. We review many of these cystic lesions seen in our department over the past several years. Lesions discussed include müllerian duct cyst, prostatic utricle cyst, ejaculatory duct cyst, cystic degeneration in benign prostatic hyperplasia, prostatic retention cyst, cavitary prostatitis, and prostatic abscess. The defect from transurethral resection of the prostate gland, which may have a sonographic appearance similar to that of a cystic prostatic mass, is also discussed. A diagnostic algorithm based on a combination of sonographic findings and the results of transperineal needle aspiration is presented.     

MR imaging of the male and female urethra.

Conventional radiographic contrast material-enhanced studies (eg, retrograde urethrography [RUG], voiding cystourethrography [VCUG], double-balloon catheter urethrography) and ultrasonography are useful in evaluating the anatomy of the urethra but are limited in demonstrating anatomic derangement of adjacent structures. Since the anatomic details of both the urethra and periurethral tissues can be evaluated noninvasively with magnetic resonance (MR) imaging, this modality can be used as an adjunctive tool for evaluation of urethral abnormalities. In patients with congenital anomalies, MR imaging is reserved for cases of intersex anomalies or complex genitourinary anomalies, in which evaluation of internal organs is essential. MR imaging may demonstrate diverticula that are not seen on radiographic contrast-enhanced studies, including VCUG, RUG, or double-balloon catheter study. In cases of inflammation, MR imaging can demonstrate not only inflammatory infiltration around the urethra but also the presence of a periurethral abscess or sinus tract. In cases of trauma, MR imaging is helpful in assessing the presence and extent of anterior or posterior urethral injury and predicting the occurrence of complications. At MR imaging, a fistula can be seen as a direct communicating channel with an adjacent organ. In patients with urethral tumors, the major role of MR imaging is in local staging.     

Evaluation of the Effects of Temporary Covered Nitinol Stent Placement in the Prostatic Urethra: Short-Term Study in the Canine Model

Purpose To evaluate the effect of temporary stent placement on the canine prostatic urethra. Methods Retrievable PTFE-covered nitinol stents were placed in the prostatic urethras of 8 beagle dogs under fluoroscopic guidance. Retrograde urethrography was obtained before and after stenting. Retrograde urethrography and endoscopy were performed 1 and 2 months after deployment. The endoscopic degree of hyperplasia was rated on a scale of 0 to 4 (0 = absence, 4 = occlusion). On day 60, stents were removed and urethrography was performed immediately before euthanasia. Pathologic analysis was performed to determine the degree of glandular atrophy, periurethral fibrosis, and urethral dilation. Results Stent deployment was technically successful in 7 animals, and failed in 1 dog due to a narrow urethral lumen. Complete migration was seen in 2 animals at 1 month, and an additional stent was deployed. On day 30, endoscopy showed slight hyperplasia (grade 1) in 3 animals. On day 60, moderate hyperplasia (grade 2) was evidenced in 4 cases. No impairment of urinary flow was seen during follow-up. Retrieval was technically easy to perform, and was successful in all dogs. The major histologic findings were chronic inflammatory cell infiltrates; prostate glandular atrophy, with a mean value of 1.86 (SD 0.90); periurethral fibrosis, with a mean ratio of 29.37 (SD 10.41); and dilatation of the prostatic urethra, with a mean ratio of 6.75 (SD 3.22). Conclusion Temporary prostatic stent placement in dogs is safe and feasible, causing marked enlargement of the prostatic urethral lumen. Retrievable covered stents may therefore be an option for bladder outlet obstruction management in men.     

Enhanced detection of vesicoureteral reflux in infants and children with use of cyclic voiding cystourethrography.

Cyclic voiding cystourethrography (VCUG) was prospectively evaluated to determine its ability to demonstrate vesicoureteral reflux (VUR) in children whose VCUG results were initially negative. The authors also assessed the effect of change in the patient's position on the detection of VUR. Seventy-seven children younger than 3 years of age, with negative results from a VCUG study performed while they were supine, underwent a second cycle of bladder filling after they were placed prone (group 1). Sixty-five children who were also younger than 3 years of age and had negative results from an initial VCUG examination performed in the usual supine position underwent a second cycle of bladder filling, which was also performed with the patient supine (group 2). VUR occurred in three children (4%) in group 1 and in eight (12%) in group 2. Most children (68.8%) in the two groups combined had grade II reflux. Cyclic VCUG increased detection of VUR, which led to a change in clinical treatment. Prone positioning did not enhance detection of VUR to the same degree as did multiple studies performed with the patient supine.     

Simultaneous voiding cystourethrography and voiding urosonography: an in vitro and in vivo study

AIM: To compare the diagnostic accuracy of fluoroscopic voiding cystourethrography (VCUG) and voiding urosonography (VUS) under identical conditions. We performed VUS and VCUG simultaneously with the total time for both examinations taking no longer than the time required for either examination individually. MATERIALS AND METHODS: X-ray contrast medium and echo-contrast agent were mixed together in vitro, and echogenicity of the mixture was confirmed. A clinical study was then performed on 33 children who had a history of urinary tract infection. The bladder was filled using simultaneous administration of X-ray contrast medium and echo-contrast agent. VCUG and VUS were then performed simultaneously and evaluated separately by two specialists. RESULTS: Equivalent results were obtained for the two examinations in 61 of 66 renal tracts. Sensitivities of VUS and VCUG for the detection of VUR were 86% and 79%, respectively. The average time from catheterization to the completion of the study was 9.1 minutes - approximately as long as performing VCUG alone. CONCLUSIONS: First, the present simultaneous study is superior to previous comparisons, because the two examinations were performed under identical physiologic conditions. Second, our results suggest that the two techniques demonstrate similar sensitivity in the detection of reflux.     

多层螺旋CT在儿童颈部囊状淋巴管瘤的应用

目的:探讨MSCT对儿童颈部囊状淋巴管瘤的诊断价值.方法:回顾性分析15例经病理证实的儿童颈部囊状淋巴管瘤MSCT表现并与手术病理所见对照.结果:儿童颈部囊状淋巴管瘤MSCT的特点:①多囊性;②可出现"液-液平面"征象;③沿疏松结缔组织生长;④增强扫描囊壁不强化或轻度强化,囊内容物不强化;⑤肿瘤包绕血管、神经及脂肪;⑥MSCT可以水平横断面、冠状面、矢状面结合显示病灶.结论:MSCT检查对儿童颈部囊状淋巴管瘤的诊断具有重要价值,有利于手术方案的制订,在评价肿瘤侵犯方面优于超声和普通CT.     

Role of MDCT in evaluation of urethral lesions

Objectives

To evaluate the role of multidetector computed tomography (MDCT) in the diagnosis of urethral lesions.

Methods

Thirteen CT urethrography examinations on 13 male patients were performed with 4-MDCT, over a 15 month duration. These patients were clinically examined and a urethral lesion was suspected. The study included recently traumatized patients and patients with suspected urethral lesions. The study was performed by retrograde urethral injection or during micturition after IV contrast injection. 3D-volume rendering (VR) images and VR-multiplanar reconstruction (MPR) sagittal images and virtual images were done.

Results

Out of the 13 patients, two patients were diagnosed having avulsed prostatic urethra.Nine patients were diagnosed having urethral strictures: two at the bulbous urethra (one of them associated with fistulous stricture), five at the membranous urethra (one of them having associated hypospadias) and two at the prostatic urethra. Two postoperative patients with hypospadias were evaluated, one with glans collection and the other with urethral stricture. One patient was diagnosed having urethral neoplasm.

Conclusion

MDCT urethrography is an accurate method in delineating small lesions, site, length, degree of strictures and extraluminal structures.     

小儿消化道重复畸形的临床及影像学特征分析

目的探讨小儿消化道重复畸形的临床及影像学特征。方法回顾性分析28例经手术病理证实的小儿消化道重复畸形的临床及影像学资料,术前20例行CT检查,27例行超声检查,7例行X线检查,3例行MRI检查。结果28例消化道重复畸形患儿中,位于食管3例,十二指肠2例,空肠2例,回肠14例,回盲部5例,空回肠交界处2例。术后分型为肠外型21例,肠内型4例,胸内型3例,影像学表现为多囊型3例,单囊型25例。与病理对照,CT及超声检查的诊断符合率分别为65%(13/20)和70%(19/27)。结论小儿消化道重复畸形临床及影像学特征有一定特异性,综合应用各种影像检查对提高本病的术前诊断率具有重要价值。