输尿管非结石性梗阻的病因及诊断(附146例报告)

目的：提高对输尿管非结石性梗阻的诊断水平。方法：回顾性分析近10年来收治的输尿管非结石性梗阻患者的病因及诊断方法。结果：损伤性输尿管狭窄72例，输尿管癌22例，输尿管囊肿18例，输尿管结核13例，先天性肾孟尿管连接处狭窄8例，非特羿性输尿管炎7例，输尿管息肉6例。结论：输尿管癌为中老年输尿管非结石性梗阻的首要病因，损伤性输尿管狭窄为青年的首要病因。通过病史和恰当的检测手段，可明确病因。     

输尿管体外碎石失败切开取石体会（附72例报告）

目的 探讨输尿管结石体外碎石失败病因、诊断和治疗。方法 72例输尿管结石行超声波体外碎石失败后行输尿管切开取石，其中2例急诊手术；术中均放置输尿管支架引流管。结果 切口感染5例；切口漏尿1例；余病例恢复良好。结论 B超及X线检查是诊断输尿管结石主要方法，在没有输尿管镜的医院输尿管切开取石术仍是解除输尿管梗阻的有效方法。     

多层螺旋CT对上尿路梗阻性疾病的诊断价值

目的:探讨多层螺旋CT在上尿路梗阻性疾病诊断中的应用价值。方法:对60例上尿路梗阻性疾病的患者行多层螺旋CT平扫加增强检查。结果:60例均获得明确诊断,其中输尿管结石12例,输尿管良性狭窄7例,肾盂输尿管连接部梗阻19例,肾结核9例,巨输尿管2例,输尿管癌5例,输尿管外压迫6例。病因诊断由输尿管镜或开放手术证实。结论:对上尿路梗阻患者,尤其当超声和IVU未能明确诊断梗阻原因时,可以行多层螺旋CT平扫加增强的检查以判断梗阻原因,有助于确诊。     

多层螺旋CT尿路造影与逆行肾盂造影在诊断输尿管梗阻性疾病中的价值对比

目的：探讨多层螺旋CT尿路造影（CTU）和逆行肾盂造影（RP）在诊断输尿管梗阻性疾病中的准确性和应用价值。方法：对40例输尿管梗阻性病变患者均先后行CTU和RP,以输尿管镜或开放手术或（和）病理检杏结果为标准,两者进行对照分析。结果：40例输尿管梗阻性疾病患者中。肿瘤6例,先天性狭窄9例,结石8例,良性狭窄17例。CTU和RP诊断准确率均为92．5％（37／40）（P〉0．05）,病因诊断符合率分别为90％（36／40）和57．5％（23／40）（P〈0．05）。结论：CTU对输尿管梗阻性病变诊断的准确率和病因符合率高,较RP有更好的病因诊断价值,可作为IVU显影不良者的首选补充检查方法,但仍存在一定局限性,需选择性应用。     

输尿管镜治疗急性输尿管梗阻

目的探讨输尿管镜在急性输尿管梗阻的诊断及处理中的优势。方法回顾分析54例急性输尿管梗阻经过输尿管镜技术治疗的临床资料。结果52例经过输尿管镜技术成功解除梗阻。结石性梗阻50例,其中双侧输尿管结石3例,孤肾1例;息肉及狭窄各1例。2例因置镜失败经过手术解除梗阻,术后证实为结石。结论输尿管镜技术对急性输尿管梗阻性疾病具有诊断及治疗双重作用,对于持续性肾绞痛及急性肾后性肾功能不全等需急诊处理者更为适宜。     

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。     

应用输尿管镜治疗输尿管梗阻124例

报告我院应用输尿管镜治疗输尿管梗阻性病变 1 2 4例。1　资料与方法1 .1　临床资料本组 1 2 4例 ,男 6 8例 ,女 5 6例 ;年龄 1 8～ 6 9岁 ,平均 3 5 .4岁。输尿管梗阻原因 :结石 1 0 9例 ,输尿管异物 3例 ,血凝块 4例 ,单纯炎症息肉 8例。结石 1 0 9例中 ,阳性结石 84例 ,阴性结石 2 5例 ,结石并发炎性息肉 1 2例 ,上段结石 1 5例 ,中段结石 3 8例 ,下段结石 5 6例 ;单枚结石 86例 ,多发结石 2 3例 ;其中 6例系体外冲击波碎石术 (ＥＳＷＬ)治疗后输尿管“石街” ,均位于输尿管中下段。结石大小(0 .2～ 1 .5 )ｃｍ× (0 .2～ 1 .8)ｃｍ。输…     

磁共振水成像与逆行肾盂造影检查对输尿管梗阻性病变的诊断价值

目的:比较磁共振输尿管水成像(MRU)和逆行肾盂造影(RP)检查对输尿管梗阻性疾病的诊断价值。方法:回顾分析20例输尿管梗阻性病变患者进行MRU和RP检查,并经病理证实,对两者进行对照分析。结果:20例输尿管梗阻中输尿管结石9例,先天性狭窄5例,输尿管炎性狭窄3例,输尿管肿瘤2例,输尿管内血凝块1例,MRU与RP均能清晰显示输尿管的梗阻部位,定位诊断准确率相似,定性诊断MRU明显高于RP。结论:MRU对输尿管梗阻性病变的定位、定性诊断准确率高,且具有无创伤、无痛苦、无辐射、不需造影剂及三维成像等特点,可以替代大多数RP检查,尤其是对儿童及不能耐受RP检查患者应为首选的检查方法。     

超声诊断输尿管结石合并输尿管不全梗阻的临床价值

目的评价超声诊断输尿管结石合并输尿管不全梗阻的价值。方法输尿管结石419例．对其中合并输尿管不全梗阻的67例进行回顾性分析。结果超声检出输尿管结石的总敏感性为91．17％(382／419);超声检出合并输尿管不全梗阻的42例，敏感性为62．69％(42／67)。结论超声是诊断输尿管结石并输尿管不全梗阻的快速、有效方法。     

输尿管梗阻致肾包膜下积液8例报告

目的:探讨输尿管梗阻致肾包膜下积液的原因与处理办法。方法:报告8例此种患者的临床资料。8例患者均经影像学检查确诊;输尿管结石所致者5例,外来肿瘤压迫输尿管、良性疾病手术后输尿管受压和放疗所致输尿管梗阻者各1例。针对梗阻原因分别行输尿管逆行插管、碎石、手术探查及肾包膜下穿剌等治疗。结果:8例患者输尿管梗阻解除后肾包被膜下积液均消失,肾功能恢复正常。结论:肾包膜下积液大多由泌尿系结石致梗阻而引起,也可由输尿管附近病变压迫输尿管致管腔梗阻所致。影像学检查对本病的诊断具有重要作用,解除梗阻后肾功能常恢复良好。     

The management of hydronephrosis in patients undergoing TURBT

Objective: Previous studies have shown the negative prognostic correlation of hydronephrosis in bladder cancer; however, practical uncertainties remain regarding the management of these patients. Methods: We retrospectively reviewed the notes of patients undergoing TURBT over a three year period and recorded the management and outcome of patients with hydronephrosis. Results: Six percent with bladder cancer had hydronephrosis. Nearly all the cases had muscle invasive disease. At TURBT, the ureteric orifice was seen in 41%; in the remaining 59% of patients, the ureteric orifice was involved and resected. This resolved the hydronephrosis in only one patient (who had superficial disease). Conclusions: Hydronephrosis in bladder cancer is associated with a poor prognosis. The hydronephrosis does not resolve with resection alone. As awaiting it’s resolution may delay definitive treatment, we suggest aggressive management of hydronephrosis from the time of initial diagnosis with ureteric stenting in order to protect renal units and optimize renal function prior to further definitive treatment of bladder cancer.     

Clinical experience with subcutaneous urinary diversion: new approach using a double pigtail stent.

Short-term results in 8 patients with ureteric obstruction and hydronephrosis who underwent subcutaneous urinary diversion show this procedure to be a simple and useful method of urinary diversion for uraemic cancer patients. This method has the additional advantage of avoiding the complications and social implications of other methods of palliative treatment.     

Extra-anatomic stents in ureteric obstruction: experience and complications.

OBJECTIVE: To assess the role of extra-anatomic stents (EAS) as a means of urinary diversion in patients with ureteric obstruction secondary to malignancy. PATIENTS AND METHODS: The technique for inserting EAS in patients with ureteric obstruction was described previously; to date, 13 patients (seven women and six men, mean age 45.3 years, range 22-78) have been treated. All patients had ultrasonographic evidence of hydronephrosis and/or significant biochemical evidence of renal impairment. Patients had advanced malignancy and one patient an abdominal aortic aneurysm. RESULTS: Urinary diversion was successful in all patients; two survived for more than 1 year, with stent changes at 6-monthly intervals. In three patients the stents were replaced by percutaneous nephrostomies because of problems with leakage or infection. The remaining patients died with functioning EAS in situ. CONCLUSIONS: In patients with ureteric obstruction secondary to malignancy or medical conditions excluding them from more invasive surgery, EAS provide a further therapeutic option instead of a permanent nephrostomy, which has associated inherent problems. This technique is not without potential problems and careful selection of patients remains vital in this difficult area.     

Lower pole pelvi-ureteric junction obstruction in duplicated collecting systems

OBJECTIVE: To determine the incidence and efficacy of treatment for pelvi-ureteric junction obstruction (PUJO, the most common cause of hydronephrosis in the fetal kidney) in duplicated systems. PATIENTS AND METHODS: We retrospectively assessed patients with PUJO in a duplex collecting system, reviewing each case for age, sex, anatomy, presenting symptoms and type of management. RESULTS: From 1994 to 2004, 1413 patients were identified to have hydronephrosis; 243 of them had pyeloplasty for PUJO, and five (2%) involved the lower pole of a duplicated collecting system. In two of the patients the presentation was prenatal hydronephrosis (mean age at diagnosis 6 weeks) and the remainder presented with flank pain and pyelonephritis (mean age 5 years); all were boys. There was only one incomplete duplication (Y type). Four patients had a dismembered pyeloplasty and one a ureteric calycostomy. Vesico-ureteric reflux was present in three patients and two required common sheath reimplantation. On a radioisotope scan during the follow-up (mean 12 months) the five patients showed an improvement and no evidence of functional obstruction. CONCLUSION: The incidence of PUJO in duplicated systems was 2%; treatment should be individualized and requires a careful preoperative evaluation. This anomaly appears to be more common in boys and in completely duplicated systems.     

The indwelling ureteric stent: a 'friendly' procedure with unfriendly high morbidity

OBJECTIVE: To review the morbidity and complications of ureteric stent insertion and to evaluate specifically the effect of an indwelling ureteric stent on the changes in hydronephrosis after stenting. PATIENTS AND METHODS: In a prospective study, 110 renal units with a stent in place were evaluated in 90 patients. Of the 110 stents, 52 were left in place for 3 months, 23 for 6, 11 for 9, 19 for 12 and five (forgotten stents) for 13-30 months. The patients were followed using plain abdominal X-ray at 1 and 30 days after stenting. They were further followed using ultrasonography and plain films every 3 months until the scheduled date for stent removal or the appearance of complications. RESULTS: Thirty-four patients had fever and bacteriuria after stent insertion. Of the 110 stents, 11 (10%) fragmented and nine (8%) migrated. Seventeen patients complained of flank pain on voiding. In 21 renal units (19%) there was no change in the severity of hydronephrosis, whereas in six (5.5%) hydronephrosis developed or worsened after stenting. CONCLUSION: Although ureteric stenting is undoubtedly an important procedure to relieve ureteric obstruction, the indications for stent insertion should be considered carefully in every patient. The close follow-up of stented patients is valuable for the early detection of morbidity or complications and in such cases the stent should be removed or exchanged as soon as possible.     

A comparison of non-contrast CT and intravenous urography in the diagnosis of urolithiasis and obstruction

ObjectivesTo compare the diagnostic accuracy of non-contrast-enhanced computed tomography (NCCT) and intravenous urography (IVU) performed in the same patient in the diagnosis of urolithiasis and ureteric obstruction.Subjects and methodsThis is a retrospective review of radiological and clinical data of patients with suspected urolithiasis or ureteric obstruction who had both NCCT and IVU performed within 30 days of each other. The data were analyzed using the statistical packages Epidata? and SPSS?. The number of calculi, presence of hydronephrosis and hydroureter, cysts and ureteric wall thickening were evaluated in both NCCT and IVU. Additionally, perinephric stranding in NCCT and delayed excretion in IVU were also evaluated.ResultsOf the 139 patients (87 male and 52 female), 102 patients (73.4%) had positive findings on NCCT and 71 (51.1%) on IVU. On NCCT 133 stones were detected in 80 patients (57.6%), 67 (48.2%) in the kidney, 63 (45.2%) in the ureter and 3 (2.2%) in the bladder. The findings on NCCT were hydronephrosis in 43 (31%), hydroureter in 34 (24.5%), perinephric stranding in 7 (5%), ureteric wall thickening in 4 (2.8%), renal mass and renal cyst in 1 (0.7%) each. On IVU 86 stones were detected in 46 patients (33.1%), 53 (38.1%) in the kidney, 31 (22.3%) in the ureter and 1 (1.4%) in the bladder. The findings on IVU were hydronephrosis in 31 (22.3%), hydroureter in 18 (13%), delayed excretion in 5 (3.6%), renal cyst and ureteric wall thickening in 1 (0.7%) each. Incidental findings were more common on NCCT (23/139, 16.6%) than IVU (2/139, 1.4%).ConclusionsNCCT compared with IVU had a higher detection rate for ureterolithiasis, especially for stones in the distal ureter. An added benefit of NCCT was the detection of significant additional findings.     

The natural history of hydronephrosis after radical hysterectomy with no intraoperatively recognisable injury to the ureter: a prospective study

OBJECTIVE: To investigate, in a prospective study, the natural history of hydronephrosis of the urinary tract after radical hysterectomy. PATIENTS AND METHODS: From December 1997 to March 2001, 34 patients with localized cervical cancer underwent radical hysterectomy by one gynaecologist, with no intraoperatively identifiable injury to the ureter. Intravenous urography was used routinely before and at 2 and 4 weeks after surgery. The degree of hydronephrosis was graded I-IV. RESULTS: Urography before surgery showed no abnormal finding in any of the patients, except in one with a unilateral duplex kidney. Hydronephrosis was found in 10 units in the upper tract (grade II in eight, III in one and IV in one) in seven patients (21%) 2 weeks after surgery (one right, three left and three bilateral). All the ureteric narrowing was in the distal ureter. The hydronephrosis disappeared in four units in three patients, but became worse in two units in two patients with bilateral pathology in the fourth week. At 3 months after surgery no hydronephrosis had deteriorated and the hydronephrosis in all units had disappeared by 6 months. The presence of hydronephrosis was significantly correlated with pathological stage and age (P < 0.05). CONCLUSION: Hydronephrosis was detected after radical hysterectomy even with no intraoperatively recognisable injury to the ureter, but in most the hydronephrosis improved spontaneously and needed no ureteric stenting or surgical intervention.     

The serous-lined tunnel principle for urinary reconstruction: a more rational method.

OBJECTIVE: To examine the feasibility of using the serous-lined-tunnel principle for orthotopic neobladder, continent cutaneous diversion and ureteric replacement by an intestinal segment. Patients and methods We created: (i) an orthotopic ileal neobladder using the serous-lined technique for antirefluxing ureteric implantation in 16 patients; (ii) a continent ileal pouch, adopting the principle for continent-valve construction and for ureteric implantation, in 10 patients (another patient with a failed continent valve underwent revision using an adaptation of this principle; and (iii) by applying the same principle an ileal ureter with a proximal antirefluxing mechanism was constructed in two patients (with lower ureteric cancer), and total replacement of the ureter by a tubular segment of the colon in association with a continent transverse colon pouch in one irradiated patient. RESULTS: In all, 52 ureters implanted into ileal neobladders or continent pouches functioned well, with neither obstruction nor reflux; 11 continent valves functioned well with no incontinence. Two patients with ileal ureters showed no ileo-ureteric reflux and had less hydronephrosis than before surgery. The tubularized ureter provided a unidirectional flow into the pouch. Conclusion Ureteric reimplantation and continent valve formation achieved by adopting the serous-lined tunnel principle provided satisfactory results. The versatility of the principle is apparent in the present experience and the creative application of the serous-lined tunnel principle should be possible in urinary reconstruction.     

Reversible bilateral hydronephrosis without obstruction in hepatitis B–associated polyarteritis nodosa

The manifestations of polyarteritis nodosa (PAN) are varied, but urological abnormalities other than ureteric stenosis and orchitis have not been described. We report a case of hepatitis B–associated PAN with bilateral hydronephrosis without obstruction. Retrograde urography conclusively demonstrated the absence of obstruction. Vasculitis-related myopathy, or neuropathy of the ureter, is the most likely cause of this finding. The patient was treated with high-dose steroids, cyclophosphamide, and plasmapheresis with resolution of hydronephrosis. Although the patient required dialysis at initiation of therapy, she went on to recover sufficient renal function to discontinue dialysis. We review the literature on the treatment of hepatitis B–associated PAN and discuss the pitfalls in diagnosis of this condition.