输尿管占位性病变的多层螺旋CT鉴别诊断

目的 探讨多层螺旋CT在输尿管占位性病变鉴别诊断中的应用价值。资料 回顾性分析经病理证实的16例输尿管癌、4例输尿管子宫内膜异位和3例输尿管息肉的CT资料。结果 16例输尿管癌的CT表现为管壁增厚3例、腔内充盈缺损7例和腔外肿块6例,合并后腹膜淋巴结肿大5例。4例输尿管子宫内膜异位者CT表现为腔外软组织肿块3例、腔内充盈缺损1例,合并附件囊性灶2例。3例输尿管息肉均表现为腔内充盈缺损。结论 MSCT在鉴别输尿管占位性病变方面具有很高的临床应用价值。     

输尿管息肉九例报告

输尿管息肉罕见,我院自1991年以来共收治输尿管息肉9例,现报告如下.9例中男6例,女3例;年龄18～59岁;输尿管上段4例,中段1例,下段4例;右侧6例,左侧3例.病程5天～27年.7例以患侧腰痛为主诉,2例输尿管下段息肉脱入膀胱致排尿困难,均无血尿.8例术前行IVP检查,均显示患肾积水及梗阻段以上输尿管扩张,仅1例显示梗阻段以下充盈缺损.3例合并输尿管结石,     

输尿管息肉的诊断和治疗(附22例报告)

目的　探讨输尿管息肉的诊断与治疗体会。方法　回顾性分析 2 2例输尿管息肉患者的临床资料 ,结合文献进行讨论。结果　 2 2例共 2 4侧输尿管息肉患者中 ,2例行肾盂成形 ,7例行单纯息肉切除 ,7例行病变段输尿管切除加端端吻合 ,1例行输尿管下段及部分膀胱切除加输尿管膀胱重植 ,2例行病变段肾输尿管切除 ,3例行输尿管镜检加钬激光息肉电灼。全部病例均获治愈并经病理证实。结论　IVU (分泌性尿路造影 )加输尿管逆行造影检查可能对诊断输尿管息肉有帮助 ,其特征是边缘光滑锐利的充盈缺损。输尿管息肉的治疗以手术为主 ,应根据息肉的大小、数量、部位及肾脏受累程度选择单纯切除术、输尿管部分切除术和肾盂成形术等。输尿管镜检查与处理是诊断和治疗输尿管息肉的最好方法之一。     

小儿输尿管息肉6例报告

小儿输尿管息肉又称输尿管纤维性息肉或上皮息肉,系输尿管原发性良性病变,占输尿管肿瘤1%左右[1],我院自1995年1月共收治6例,现将诊断和治疗进行探讨,报告如下:1资料与方法1.1一般资料:本组6例,均为男性,年龄5~11岁,平均7.8岁,病程6个月~5年。左侧5例,右侧1例。2例表现间歇性血尿,活动后加重,3例以腹部肿块就诊,1例为间歇性肉眼血尿,镜下血尿3例。6例术前B超均有不同程度肾积水[肾盂造影(IVP)示轻至重度肾积水],其中2例报告术前定为肾盂输尿管部(UPJ)狭窄,2例输尿管上1/3有边缘光滑的条状充盈缺损,典型1例为蟠龙柱样改变,1例因IVP积水原…     

经尿道输尿管肾盂镜临床应用149例总结

我院1985年6月～1988年12月临床应用经尿道输尿管肾盂镜检查并诊治上尿路结石和其它疾病149例,镜检成功141例,占94.6%。取石和碎石126例,成功112例,占88.9%;失败14例,占11.1%。血尿待查4例,肿瘤3例,输尿管上段息肉及充盈缺损各1例,取异物(Double-J stent)5例,狭窄5例,炎症、积水4例,除1例无痛性血尿未找到原因外,其余均获得明确诊断,并作了处理。曾作输尿管扩张46例,未扩张103例。现将开展这一工作的经验总结如下。一、输尿管肾盂镜失败原因1.输尿管肾盂镜未能进入输尿管。由于解剖变异,管口畸形或麻醉不佳,管口发生痉挛、出血等。本组有8例未成功均与此有关,占5.4%。2.结石滑入肾下盏,硬性输尿管肾盂镜未能     

输尿管息肉9例报告

报告１９８４－１９９７年收治的９例输尿管息肉，主要症状为腰痛和血尿，放射学检查是诊断输尿管息肉的主要方法，其特征表现为边缘光滑的充盈缺损，但应注意与输尿管癌、透Ｘ线结石及血凝块和相鉴别；治疗应根据息肉大小、数据、部位及肾脏受累程度选择局部切除术、输尿管部分切除术和肾盂成形术等，并结合有关文献，就其病因、诊断及治疗进行了讨论，认为输尿管肾镜检查和处理是诊断和治疗输尿管息肉的最好方法 。     

磁共振尿路成像在泌尿外科疾病诊断中的应用

目的：探讨磁共振尿路成像（MRU）对泌尿外科疾病的诊断价值。方法：总结58例泌尿外科患者接受MRU检查的临床资料。结果：肾结核6例,MRU有典型征象;各种先天畸形27例,MRU均清晰显示其尿路形态;肾盂癌2例,MRU不能明确诊断,确诊需结合临床资料综合判断;输尿管癌10例,9例MRU输尿管梗阻部位有截断影;输尿管息肉2例,MRU显示输尿管梗阻部位可见泡沫样充盈缺损,但其影像不如逆行造影清晰;输尿管结石8例,MRU5例可见结石影,3例结石被高信号尿液掩盖;医源性输尿管狭窄3例,MRU均可显示梗阻部位及尿路扩张的形态。MRU检查尿路梗阻部位准确率为100％。结论：MRU用于泌尿外科疾病诊断,有其优势,也有其缺点,应正确合理应用。     

小儿输尿管息肉的影像学特点

目的探讨小儿输尿管息肉引发肾积水的临床及影像学特点。方法总结我院近年来18例输尿管息肉引发肾积水的临床资料,所有患者均行腹部X线平片(KUB),排泄性尿路造影(IVP),泌尿系超声(US)检查,CT平扫或增强及三维重组检查。部分患儿行磁共振尿路造影检查。结果临床有腹痛,腰痛及消化道症状者14例,不同程度血尿者4例。影像学检查均可见不同程度肾积水表现,合并或可见充盈缺损,或可见软组织密度影,或可见输尿管内肿物等征象。结论小儿输尿管息肉的影像学特点结合临床,可提高诊断准确性。     

良性纤维性输尿管息肉的诊断与冶疗

本文对良性纤维性输尿管息肉的诊断与治疗作了讨论。术前诊断是根据一青年患者长期腰痛或:血尿史,成两者同时存在。并且放射学发现输尿管梗阻或充盈缺损。术中确诊是根据切开输尿管发现起始于同一基底部的特有的叶状息肉。正如以前所指出治疗应     

输尿管镜在早期泌尿系结核诊治中的应用

目的:探讨输尿管镜在早期泌尿系结核诊断和治疗的应用价值。方法:回顾性分析21例应用输尿管镜诊断和治疗早期泌尿系结核患者的临床资料。21例输尿管镜表现分别为输尿管狭窄14例、输尿管开口炎性水肿4例、输尿管下段息肉3例。18例通过输尿管镜收集肾盂尿作结核杆菌聚合酶链反应(MTb-PCR)、沉渣找抗酸杆菌(AFB)检查和结核杆菌培养诊断为泌尿系结核,其中16例(88.9%)尿MTb-PCR呈阳性,11例(61.1%)尿沉渣找AFB阳性,7例(38.9%)结核杆菌培养阳性。3例输尿管下段息肉,用输尿管镜摘除息肉作病理检查,2例病理诊断为输尿管结核,1例误诊为输尿管炎性息肉。11例输尿管下段狭窄予行输尿管镜狭窄内切开术,其余10例予行输尿管镜扩张置管术。除误诊为输尿管炎性息肉的1例患者外,20例术后均予抗结核治疗至少6个月。结果:21例平均随访18个月,12例(57.1%)一次手术治愈;8例出现狭窄复发,5例需再次行输尿管镜狭窄内切开术治愈,3例因狭窄多次复发致无功能肾行患肾切除术;误诊为输尿管炎性息肉1例,术后12个月复查发现患侧结核性脓肾及膀胱挛缩,予行患肾切除+乙状结肠膀胱扩大术。结论:早期泌尿系结核可表现为输尿管狭窄、输尿管开口炎性水肿或输尿管下段息肉。输尿管镜技术有助于早期诊断和治疗泌尿系结核。     

原发性输尿管癌的诊断

目的:提高原发性输尿管癌术前诊断水平。方法:对1973～1997年收治的50例原发性输尿管癌的诊断经验进行总结。结果:50例均作IVU检查,其中31例患侧肾脏不显影,仅有7例显示输尿管充盈缺损或狭窄。26例行逆行造影,有16例输尿管充盈缺损或狭窄。48例作B超检查,有43例显示肾积水,35例显示输尿管扩张积水,25例显示输尿管低回声或略强回声的实质性肿物。27例作CT检查,有17例显示输尿管软组织密度实质性肿物。44例作膀胱镜检查,有8例肿瘤自输尿管管口脱出,11例患侧输尿管管口喷血。47例作尿脱落细胞学检查,阳性率为40.4%。结论:术前联合应用IVU、B超、逆行造影、CT、膀胱镜和尿脱落细胞学等检查可提高原发性输尿管癌的正确诊断率。     

Ureteral polyp resected with a ureteroscope: report of two cases

Two cases of ureteral polyp resected by a transurethral approach are presented. Case 1: A 70-year-old woman was referred to our clinic because of hydronephrosis incidentally found. Excretory urography demonstrated a filling defect with a long and round smooth contour in the left lower ureter without hydroureter. Urine cytology was negative for malignant cells. Under the clinical diagnosis of left ureteral polyp, polyp was resected transurethrally. The pathological diagnosis was fibroepithelial polyp. Case 2: A 59-year-old woman was referred to our clinic with a chief complaint of macroscopic hematuria. Excretory urography revealed a filling defect with a long and round smooth contour in the left upper ureter. Because urine cytology was negative for malignant cells, left ureteral polyp was suspected. After the operation by tranthurethral approach, the pathological diagnosis was fibroepithelial polyp. No intraoperative complication was observed in either case. Ureteral polyps resected by a transurethral approach are relatively rare. We reviewed and discussed 46 cases of ureteral polyp resected transurethrally, reported in Japan including our two cases.     

Ureteral polyp in childhood: a case report

An 8-year-old boy was admitted because of left flank pain. The excretory urogram showed left hydronephrosis and a filling defect at the pelviureteric junction. Surgical exploration revealed a polypoid lesion on the mucous membrane of the pelviureteric junction and ureteric stenosis due to a periureteric fibrous band. Dis-membered pyeloplasty was performed. The pathological diagnosis was benign fibrous polyp of the ureter. Convalescence was uneventful and an intravenous pyelogram showed no evidence of recurrence one year after operation. We found 13 cases of ureteral polyps in children in the Japanese literature. The differences between ureteral polyps in childhood and those in adults are discussed.     

A case of ureteral polyp in a young man with renal autotransplantation

We report a case of fibroepithelial polyps of the ureter in a 18-year-old boy with the chief complaint of left flank pain. An excretory urogram and retrograde pyelogram revealed left hydronephrosis and a filling defect at the pelvic-ureteral junction. This ureteral disorder was corrected by the renal autotransplantation for conserving the renal function. The pathological diagnosis was fibroepithelial polyps of the ureter. Convalescence was uneventful and after 3 months of follow up, excretory urogram and 99mTc-DTPA renogram showed good renal function and improvement of hydronephrosis. Along with our case, we briefly reviewed 32 cases of ureteral polyp in men under 20 years old.     

Case of mid-ureteral fibroepithelial polyps in a child

A 11-year-old boy showed gross hematuria and left flank pain. Ultrasonography and CT revealed left hydroureteronephrosis, and he was referred to us for the further evaluation. MRI revealed left hydroureteronephrosis with filling defect at the distal end of the dilated ureter suggesting ureteral polyp. Open surgery was performed with the diagnosis of mid-ureteral obstruction. In the operative findings, multiple stalks of ureteral polyps arose from the entire ureteral wall over 5 cm in length at the site of ureteral obstruction. Mid-ureter with polyps was completely resected, and end-to-end anastomosis was performed. The pathological diagnosis was fibroepithelial polyp of the ureter.     

15例原发性输尿管息肉的诊治

目的 探讨原发性输尿管息肉的诊断与治疗方法,为该疾病的诊治提出方向性指导.方法 回顾性分析2009年5月至2014年6月收治的15例原发性输尿管息肉患者的临床资料.其中6例单发的输尿管息肉采取开放手术行输尿管病变切除肾盂成形术,3例行输尿管病变切除输尿管对端吻合术,3例行输尿管镜下息肉钬激光切除术,3例行腹腔镜下输尿管病变切除输尿管对端吻合术.结果 全部病例术后均获病理证实为输尿管息肉.术后随访6～12个月,未发现病变复发与恶变.结论 术前行逆行造影及输尿管镜检查是较为可靠的诊断方式.而近年来采取磁共振检查敏感性较高.开放手术处理输尿管息肉效果确切.输尿管镜下钬激光治疗输尿管息肉具有损伤小,恢复快等优势,但其远期效果则仍待观察.     

原发性输尿管癌诊治24例报告

目的提高输尿管癌的诊治水平。方法回顾性总结1990年1月至2005年3月收治的24例原发性输尿管癌患者的临床资料。男19例，女5例。年龄38～72岁，平均年龄59岁。左侧16例，右侧8例。肉眼血尿17例（71％），镜下血尿7例（29％）。尿细胞学检查16例，阳性1例。B超提示肾盂积水19例（79％），提示中下段输尿管低回声占位3例（12％）。IVU提示肾盂积水20例（83％），患侧输尿管充盈缺损3例（12％）。逆行肾盂造影检查21例，插管不成功5例，输尿管充盈缺损16例（76％）。CT检查20例，提示输尿管内软组织肿块14例（70％）。螺旋cT薄层扫描3例均确诊。MRU3例，确诊1例。结果24例均进行手术治疗，18例行肾、输尿管全长加膀胱袖状或膀胱部分切除，6例行肾切除加输尿管部分切除。术后病理报告移行细胞癌23例，腺癌1例。1990—1999年的14例中存活1、2、3、4、5、6年者分别为1、5、3、2、2、1例。2000—2005年的10例中，失访3例，术后存活1、3年者各2例，3例存活未满5年者仍在随访中。结论IVU、逆行肾盂造影检查仍是原发性输尿管癌最常用的基本诊断方法，联合其他影像学检查可减少漏诊。本组病例由于手术时病理分期偏晚，5年生存率较低。     

原发性输尿管息肉17例诊疗分析

目的探讨原发性输尿管息肉的诊断与治疗方法。方法回顾性分析1995~2007年收治的17例原发性输尿管息肉患者的临床资料,并结合文献讨论其诊断与治疗方法。结果17例患者中,肾及输尿管大部切除术2例,输尿管病变段切除肾盂成形术3例,病变段切除输尿管再吻合术9例,3例行输尿管镜下息肉切除。全部病例均获病理证实。术后随访6～24月,未发现息肉复发与恶变。结论静脉肾盂造影和逆行造影是诊断输尿管息肉常用的方法,术前确诊需输尿管镜活检。手术治疗以病灶局部切除为主。根据病变数量、累及输尿管范围及患者肾功能确定手术方案。     

Ureteral polyp occurring as renal dysfunction with contralateral ureteral calculi: a case report

A 46-year-old man was admitted to our hospital complaining of macroscopic hematuria with dull pain in the right flank. Laboratory finding showed renal dysfunction and abdominal ultrasound sonograph revealed bilateral hydronephrosis (right > left). Retrograde pyelography showed left ureteral calculi and a filling defect in the middle portion of the right ureter. Renal function improved after bilateral single-J ureteral stent placement. Selective wash cytology of right renal pelvis was class II. Ureteroscopy demonstrated right ureteral obstruction with smooth-surfaced protruded tumor and cold cup biopsy was performed. Histopathological diagnosis was a fibroepithelial polyp but with no malignancy. In addition, left transurethral lithotripsy was performed under ureteroscopy. After the endoscopic examination, a double pigtail stent inserted into the right ureter. We performed conservative management by repeat urine cytologies and retrograde pyelography due to thrombocytopenia. The urine cytologies all proved negative and retrograde pyelography showed no abnormal changes. A ureteroscopic procedure is considered to be useful for the diagnosis of ureteral polyps. Transurethral resection of ureteral polyps with a ureteroscope is recommended for treatment.