MR尿路造影在泌尿外科疾病诊断中的应用

自１９９６年１１月～１９９７年５月采用ＭＲ尿路造影（ＭＲＵ）诊断泌尿外科疾病患者２２例，其中尿路无病变６例，上尿路梗阻６例，输尿管癌２例，肾输尿管结核１例，输尿管结石４例，神经性膀胱所致慢性肾功能衰竭１例，膀胱癌２例。结果：尿路无病变６例ＭＲＵ均能明确显示尿路无梗阻；６例上尿路梗阻可明确病变；４例尿路结石单纯ＭＲＵ无法诊断病变；２例输尿管癌ＭＲＵ不能显示输尿管下段与膀胱重叠部位病变；１例肾输尿管结核ＭＲＵ有典型征象；１例慢性肾功能衰竭，ＭＲＵ清晰显示尿路扩张、积水；２例膀胱癌ＭＲＵ清晰显示膀胱占位及膀胱壁浸润。结果认为：ＭＲＵ是一种新的、无创性、无需造影剂诊断尿路病变的方法     

磁共振尿路造影在上尿路梗阻诊断中的应用

目的　评估磁共振尿路造影技术在诊断上尿路梗阻性疾患中的价值。　方法　采用磁共振尿路造影术（ Ｍ Ｒ Ｕ） 诊断上尿路梗阻患者３５ 例。　结果　所有病例均清晰显示梗阻部位及尿路积水情况。　结论　 Ｍ Ｒ Ｕ 是一种无创性、无需造影剂的诊断上尿路梗阻的方法。     

磁共振尿路造影在上尿路梗阻诊断中的

目的 评估磁共振尿路造影技术在诊断上尿路梗阻性疾患中的价值。方法 采用磁共振尿中造影术（ＭＲＵ）诊断上尿路梗阻患者３５例。结果 所有病例均清晰显示梗阻部位及尿路积水情况。结论 ＭＲＵ是一种无创性、无需造影剂的诊断上尿路梗阻的方法。     

磁共振成像尿路造影在输尿管结石诊断中的价值

目的 探讨磁共振成像尿路造影（ＭＲＵ）在输尿管结石诊断中的价值。方法 采用ＭＲＵ诊断输尿管结石４７例,其中ＩＶＵ患侧输尿管不显影者１５例,孤立肾尿管结石者３例,双侧结石合并上尿路扩张、积水者６例,结石合并肾功能不全者５例,因逆行插管失败者３例,另外高龄者５例、碘过敏者２例,不通耐受腹部加压、拒绝行ＩＶＵ或逆行尿路造影者５例。结果 ４７例输尿管结石患者中３４例可清晰显示结石上下方的尿路情况（７２％）     

小儿输尿管纤维上皮息肉的诊断与治疗

报告４例小儿输尿管纤维上皮息肉，４例病变均起源于输尿管上段，３例呈单发，１例呈多发，患侧胁复中疼痛或血尿为其主要表现，静脉尿路造影及Ｂ超显示患侧输尿管或肾积水，１中行逆行肾盂造影显示输尿管腔内有一球茎形充盈缺损，３例行息肉主病变段输尿管切除，１例行病变段输尿管１部分肾盂切除及部分息肉电灼治疗，结果疗效满意，随访至今无复发，认为对输尿管上段梗阻或主度疑为此病者，采用大剂量静脉尿路造影或逆行肾盂造影可     

磁共振尿路成像在输尿管肿瘤诊断中的应用价值

磁共振尿路成像（ＭＲＵ）是检查上尿路的一种新方法,我们将此方法用于输尿管肿瘤诊断,报道如下。临床资料　本组１０例。男７例,女３例。年龄４３～６７岁。血尿,Ｂ超提示左肾盂输尿管积水３例,右肾盂输尿管积水７例,均高度怀疑输尿管肿瘤。拟行ＩＶＵ,３例碘过敏试验阳性,７例患者未显影或显影不满意。方法　使用美国ＧＥ公司１－５Ｔ高场强磁共振仪,检查前禁食５～６小时。不做腹部压迫,患者在不屏气、平静呼吸下扫描,检查前训练患者的呼吸度。先采用自旋回波技术（ＳＥ）为患者作ＭＲ常规扫描,采用快速自旋回波（ＦＳＥ）和…     

排尿期尿道测压的临床应用

目的：确定下尿路梗阻及其梗阻部位。方法：对４１例有下尿路梗阻症状患者进行了排尿期尿道测压（ＭＵＰＰ）,其中包括前列腺增生症（ＢＰＨ）２９例,男性尿道狭窄３例,逼尿肌－外括约肌协同失调３例,女性压力性尿失禁４例,女性尿道末端缩窄综合征１例,前例腺炎１例。结果：２９例ＢＰＨ患者中,２６例有梗阻,其中梗阻位于膀胱颈部２０例;３例逼尿肌－外括约肌协同失调患者表现为外括约肌部压力下降;４例女性压力性尿失禁患     

先天性血管压迫致输尿管梗阻的诊断与治疗

目的：探讨先天性血管压迫致输尿管梗阻的诊断与治疗方法。方法：术前采用Ｂ超、静脉层路造影（ＩＶＵ）、逆行尿路造影和磁共振水成像（ＭＲＵ）诊断先天性血管压迫致输尿管和肾积水患者１９例，均采用手术治疗，术中切断腔静脉后输尿管、切除异位血管和切除受压部分输尿管后作输尿管端端吻合或肾盂整形术。结果：手术证实下腔静脉压迫致输尿管梗阻８例，异位血管压迫致输尿管梗阻１０例，左侧髂总动脉压迫致输尿管梗阻１例。术后３     

磁共振尿路造影术在泌尿系疾病的应用

目的 评价磁共振尿路选影术（ＭＲＵ）在泌尿系统疾病的临床应用价值。方法 ４４例检查者,包括正常对照７例,尿路结石１５例,泌尿系统原发及继发肿瘤１１例,输尿管良性狭窄４例,泌尿系统先天畸形６例,尿路结核１例。采用ＧＥ１．５Ｔ超导型磁共振机,ＭＲＵ经冠位ＦＳＥ序列重Ｔ２加权成像所得。结果 ＭＲＵ能较好地显示尿路全程,对尿路梗阻能作出准确的定位及定性诊断,但对非梗阻性病须结合ＭＲＩ检查综合分析。结论 ＭＲＵ在泌尿系疾病有较大的应用价值,值得推广应用。     

磁共振水成像对上尿路梗阻的诊断价值

目的:评价磁共振水成像(MRU)对泌尿系梗阻性疾病的临床诊断价值。方法:采用快速自旋回波重T2加权序列和脂肪抑制技术,对56例经B超和IVP怀疑上尿路梗阻患者,进行泌尿系冠状位扫描,将图像按最大强度投影法重建出MRU图像。结果:其中32例MRU均能清晰显示尿路梗阻的部位和肾盂积水,解剖结构清楚,可对梗阻作出定性诊断,并经手术和病理证实为尿路梗阻者。其中尿路结石16例,尿路先天性梗阻4例,输尿管炎性狭窄2例,移植肾输尿管狭窄2例,其他8例。余26例排除上尿路梗阻。结论:MRU是无创伤的检查方法,不接触射线,不需碘对比剂,诊断尿路梗阻性疾病定位、定性准确,尤其适用于因严重梗阻IVP显影不良的病例。     

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。     

Use of urography by magnetic resonance for the study of the urinary apparatus versus conventional urography

Conventional urography (IVU) is an essential examination for the assessment of urinary tract but it is not free of complications, such as adverse reactions to contrast agents used (vasovagal and anaphylactic reactions), neurotoxicity, nephrotoxicity, as well as the damage due to the ionizing irradiation applied to the patient. For this reason, alternative imaging techniques such as magnetic resonance (MR) urography or uro-resonance have been developed.Objective:We present a case study assessing the diagnostic accuracy, specificity and sensitivity of uro-resonance and IVU as a morphological and functional examination of the urinary tract; and a quality study of the urographic images obtained with MR versus IVU.Materials and methods:150 patients have submited to a MR study, 63 of them with an IVU study already performed, acquiring high-intensity signals at T2 corresponding to abdominal and retroperitoneal fluid, initially using furosemide at low doses and, in a final study, administering gadolinium at a rate of 0.1 mg/Kg. The test was indicated in patients with antecedents of adverse reactions to iodine contrast, acute or chronic kidney failure, functional cancellation of the kidneys, pregnant patients and those in paediatric age. The capacity of diagnosis of urinary obstruction and the aetiology of this obstruction of both tests was studied, as well as the quality of the images obtained by the urographic study using MR.Results:High resolution images were obtained of all the upper urinary tracts using MR, especially in the renal pelvis, without artefacts caused by peristalsis or intestinal fluid interposition. In 83.3% of cases, examinations revealed urological pathology. The diagnostic accuracy of the involvement cause of the urinary tract was 83.3%, with a sensitivity of 89.6%, a specificity of 69.2%, a positive predictive value of 86.6% and a negative predictive value of 75%.Conclusion:MR urography is a high sensitive technique for the study of urinary tract, used as an alternative to conventional urography particularly in cases of the contraindication of ionizing radiation or allergy to the contrast agent, as well as in patients with renal failure, and offers a wider morphological and functional study, with a high image quality, able to displace conventional examinations in the short or medium term.     

Ultrasonography for diagnosis of obstructing ureteral calculus

The reliability of ultrasonography in diagnosing ureteral obstruction caused by calculus was prospectively investigated. In 60 consecutive cases sonograms were compared with excretory urograms. The sonographic diagnosis was correct in 27 (79%) of the 34 cases shown by urography to have ureteral obstruction, and the sonograms showed the causal calculus in 17. The rate of false negative sonographic diagnosis was thus 21%. In two patients with no urographic abnormality, the sonograms indicated ureteral calculus without signs of obstruction. Ultrasonography may be used as an alternative to emergency urography for initial imaging in cases of suspected ureteral obstruction, but urography remains the standard method for evaluating the obstructed urinary tract, due to its greater accuracy and ability to assess renal function.     

MRU诊断上尿路梗阻性疾病的价值

目的 探讨磁共振尿路造影（MRU）诊断上尿路梗阻性疾病的意义。方法 59例上尿路梗阻性疾病患者接受检查，MRU为冠状位快速自旋回波T2加权像。结果 所有病例MRU尿路梗阻部位及扩张状况均显示良好，其中54例经手术或病理确诊，仅2例术前MRU误诊。结论 MRU作为一种非侵袭性、无辐射损伤和不需造影剂的新技术，对上尿路梗阻性疾病的定位及定性诊断具有特殊价值，是一种可供选择的有临床实用价值的尿路成像方法。     

Pre-prostatectomy excretory urography: does it merit the expense?

To evaluate the necessity of an excretory urogram before prostatectomy the records of 557 patients admitted to 3 community hospitals in 1977 and 1978 for urinary obstruction were reviewed. Of the entire series 27 per cent revealed urographic abnormalities and 72 significant lesions of the upper urinary tract were noted. An operation other than prostatectomy was necessary in 14 cases. Abnormalities involving the bladder were detected in 29 cases. We conclude that excretory urography remains a sound principle of proper urologic care.     

The continuing challenge of bilharzial ureteric stricture

The commonest urologic complication in 176 cases of chronic urinary bilharziasis was ureteric stricture (87 ureters in 55 patients), with the lower third of the ureter affected in 87% of the cases. Other complications included squamous-cell carcinoma of the bladder, urinary calculi and bladder calcification. Intravenous urography and cystoscopy were the most useful diagnostic methods in 76% of the cases. Post-micturition erect urography and frusemide intravenous urography gave great help in distinguishing between true mechanical and non-mechanical ureteric obstruction in patients with dilated pelvicalyceal system on conventional urograms. Only 17 of 68 dilated ureters were truly obstructed and required excision and ureteroneocystostomy. Postoperative vesicoureteric reflux developed in four of these cases. No deterioration of renal function occurred in the remaining, conservatively treated patients.     

急性梗阻性自发性尿外渗的临床诊治

目的：提高急性梗阻性自发性尿外渗的诊断和治疗水平。方法：回顾性分析9例急性梗阻性自发性尿外渗患者的临床资料,并结合文献探讨其诊断和治疗方法。结果：患者多以肾绞痛发病,逐渐发展成持续或不典型疼痛,并向腹部蔓延,患侧肾区有明显叩击痛。B超、尿路造影及CT检查对诊断有肯定价值。结论：本病为尿路梗阻后继发的临床综合症,早期诊断较为困难,确诊主要依靠影像学检查。尽早解除尿路梗阻是本病治疗的原则。     

THE LAPAROSCOPIC BOARI FLAP

PURPOSE: Laparoscopic management of ureteral pathologies, such as ureteropelvic junction obstruction, ureteral calculi and retroperitoneal fibrosis, has proved to be highly effective. We present our initial experience with the laparoscopic Boari flap in regard to feasibility, safety and short-term results. MATERIALS AND METHODS: Three patients who presented with distal ureteral obstruction underwent preoperative radiographic evaluation, including excretory urography, computerized tomography and retrograde pyelography, that showed upper urinary tract dilatation at the site of obstruction. The contralateral upper urinary tract was normal in all cases. Ureteroureterostomy and ureteroneocystostomy was not feasible because of stricture length and a laparoscopic Boari flap procedure was performed. Renal function, symptom improvement and radiological studies, including excretory urography and cystography, were assessed 3 and 6 months postoperatively. RESULTS: All procedures were successfully performed without any intraoperative complications or need for open conversion. Excretory urography showed good drainage with no obstruction of urine flow and all patients had grade I vesicoureteral reflux on cystography. CONCLUSIONS: The laparoscopic Boari flap is feasible using currently available laparoscopic suturing techniques. Longer followup and larger series of patients are necessary to provide data comparable to that of the open approach.     

多层螺旋CT泌尿系成像在上尿路梗阻诊断中的应用

目的 探讨多层螺旋CT泌尿系成像（MSCTU）在上尿路梗阻性疾病中的诊断价值。方法 对17例经B超或IVU检查显示上尿路梗阻患者行螺旋CT扫描，并行3D重建，将诊断结果与手术结果进行对照。结果 MSCTU诊断输尿管结核4例，肾盂输尿管连接部狭窄6例。输尿管末端狭窄2例，输尿管阴性结石3例。输尿管肿瘤1例，腔静脉后输尿管1例，均显示出梗阻部位及尿路扩张的形态。手术结果与MSCTU诊断相符。结论 SCTU是一种安全有效的非侵袭性的影像学检查方法，特别对患肾功能严重受损的上尿路梗阻性疾病患者具有特殊诊断价值。     

Duplex Doppler sonography in patients with acute renal colic: Prospective study and literature review

PURPOSE: To determine the value of duplex Doppler sonography in the diagnosis of acute urinary obstruction. MATERIALS AND METHODS: In 46 healthy individuals and 42 patients with urinary obstruction confirmed by intravenous urography, 176 kidneys were examined with duplex Doppler sonography. The mean intra-arterial resistive index value and the difference of mean resistive index values between both kidneys were determined for each person. Resistive index and delta resistive index values were compared with urographic findings in the 42 patients. RESULTS: In the 46 healthy individuals, the mean resistive index and delta resistive index values were 0.59 +/- 0.05 and 0.03 +/- 0.01. In the 14 patients with complete urinary obstruction, these values were 0.70 +/- 0.06 and 0.09 +/- 0.02, whereas in the 28 patients with partial urinary obstruction, these values were 0.64 +/- 0.06 and 0.03 +/- 0.05. Urographic findings and duplex Doppler sonography were correlated in the 42 patients, with a resistive index = 0.65 and delta resistive index = 0.05 as discriminatory thresholds for obstruction. In patients with complete obstruction, the diagnostic sensitivity of these values was 64% and 100% with a specificity of 82% and 89%, respectively. In patients with partial obstruction, the sensitivity of these values was 54% and 46% with a specificity of 82% and 89%, with respect to the control group of healthy individuals. CONCLUSION: Delta resistive index is a very sensitive and specific parameter in the sonographic diagnosis of complete urinary obstruction but insensitive in partial urinary obstruction. Duplex Doppler sonography is recommended in cases where intravenous urography is contraindicated.