下腔静脉后输尿管综合影像特征分析

目的：探讨下腔静脉后输尿管的综合影像特点。材料与方法：经B超、静脉尿路造影、逆行性肾盂造影及CT扫描等综合影像检查,诊断下腔静脉后输尿管4例,并结合有关文献,对下腔静脉后输尿管的综合影像特点进行回顾性分析。结果：本组4例均为低襻型。B超检查提示右肾盂积水和上段输尿管扩张以及肾结石,静脉尿路造影呈典型的反“J”状,逆行性肾盂造影呈“S”形弯曲,CT扫描加二维重建显示肾盂积水呈囊状,下腔静脉压迫输尿管,受压段细小呈“蝌蚪”状。结论：影像学协同检查能准确显示下腔静脉后输尿管的异常走向、受压的具体位置、肾盂及输尿管扩张积水的程度,为临床治疗提供准确影像依据。     

下腔静脉后输尿管的临床诊治

目的：提高下腔静脉后输尿管的诊治效果。方法：联合应用静脉尿路造影(IVU) 逆行性尿路造影(RU)，Presman法、CT、磁振尿路造影(MRU)明确诊断。采用输尿管离断，切除或旷置病变段输尿管，于下腔静脉前外侧行输尿管对端吻合术，恢复输尿管正常解剖通道。结果：11例患者术前均明确诊断，手术矫正复位顺利。术后3--12个月复查症状消失，肾及输尿管上段积水扩张有不同程度减轻，输尿管通畅，无吻合口狭窄。结论：下腔静脉后输尿管的诊断需联合应用各种影像学检查。输尿管离断复位吻合术是治疗该病的主要术式。     

下腔静脉后输尿管的诊治

【目的】总结下腔静脉后输尿管的诊治经验。【方法】对6例下腔静脉后输尿管患者的症状,影像学检查和治疗进行回顾性分析。【结果】6例均有右腰胀痛,2例有发作性血尿,1例继发输尿管结石且伴肾绞痛发作。诊断主要依据IVU及逆行输尿管造影,表现为肾及输尿管上段积水,呈“S”形扩张。6例均行狭窄段切除,输尿管复位成形术。随访8个月至12年,所有患者症状消失,肾积水明显减轻。【结论】对不明原因的右肾及右输尿管上段积水者应考虑到本病可能,IVU及逆行输尿管造影是主要诊断方法,狭窄段切除,输尿管复位成形术效果良好。     

下腔静脉后输尿管的诊断与治疗

目的：提高腔静脉后输尿管的诊断与治疗水平。方法：对6例下腔静脉后输尿管患者的临床资料进行回顾性分析。结果：术后3～6个月复查，6例患者右侧腰胀、腰痛症状消失，肾积水不同程度减轻，吻合口无狭窄。结论：逆行肾盂输尿管造影是诊断下腔静脉后输尿管最可靠的方法，同时应结合其他影像学检查方法，治疗主要采用输尿管复位矫正术能取得良好疗效。     

下腔静脉后输尿管11例诊治体会

目的：总结下腔静脉后输尿管的诊治经验。方法：对11例下腔静脉后输尿管患的症状、影像学检查、治疗和随访的临床资料进行回顾性分析。结果：11你术前均明确诊断，均行输尿管复位矫形手术。术后随访6mo-3a，均症状消失，右肾积水改善，输尿管通畅，吻合口无狭窄。结论：下腔静脉后输尿管需联合多种影像学检查明确诊断，输尿管复位矫形手术可获得良好效果。     

下腔静脉后输尿管11例诊治分析

目的：提高对下腔静脉后输尿管的诊治水平。方法：对11例下腔静脉后输尿管临床资料进行回顾性分析。结果：11例均采用B超及静脉、逆行肾盂造影等检查而确诊，治疗采用输尿管复位矫正术，术后3个月复查临床症状基本消失，随访11月至15年，肾积水及输尿管扩张明显改善，症状消失。无吻合口狭窄等并发症。结论：静脉、逆行肾盂造影诊断下腔静脉后输尿管经济、实用、方法简便、准确率高；手术采用输尿管复位矫正术损伤小、并发症少、效果良好。     

下腔静脉后输尿管的诊断与治疗(附5例报告)

目的：探讨下腔静脉后输尿管的诊断和治疗。方法：回顾分析5例下腔静脉后输尿管患者的临床资料。结果：术前确诊，均进行手术治疗，术后痊愈出院。结论：下腔静脉后输尿管的诊断主要是静脉尿路造影（IVU）＋逆行造影（RU），如同时行CT检查，则更为明确。输尿管切断复位矫正术是治疗下腔静脉后输尿管的主要手术方式。     

下腔静脉后输尿管的诊断与治疗

目的提高下腔静脉后输尿管的诊治水平。方法对12例下腔静脉后输尿管的临床资料进行回顾性分析。结果8例患者行输尿管逆行造影联合CT检查确诊,2例行多层螺旋CT三维尿路重建成像确诊,2例行磁共振尿路造影确诊;治疗采用输尿管复位矫形术,术后3个月复查,患者临床症状消失,右肾积水明显减轻,吻合口无狭窄。结论下腔静脉后输尿管的诊断主要依靠影像学检查,多层螺旋CT三维尿路重建成像、磁共振尿路造影是确诊下腔静脉后输尿管无创检查方法,采用输尿管复位矫形术能取得良好疗效。     

5例下腔静脉后输尿管的诊治体会

目的：探讨下腔静脉后输尿管的治疗体会.方法：运用B超、静脉尿路造影（IVU）、逆行肾盂输尿管造影（RU）或MRI等检查,明确诊断.治疗采用输尿管切断,于下腔静脉前外侧复位矫正术.结果：术前对5例患者的诊断明确,均采用矫正复位术治疗,手术后3～6个月进行复查,原先症状未见,肾积水及输尿管上段的扩张和积水均显著减弱,输尿管保持通畅,吻合口也未见狭窄.结论：下腔静脉后输尿管诊断主要依靠IVU和RU,输尿管切断复位矫正术是治疗的主要方法.     

腔静脉后输尿管5例临床诊断体会

腔静脉后输尿管是腔静脉发育异常引起的一种先天性畸形 ,本院自 1 993年以来收治 5例 ,现就其诊断与治疗探讨如下。1　临床资料本组 5例下腔静脉后输尿管 ,男 4例 ,女 1例 ,年龄 2 5～ 60岁。临床表现为右侧腰部胀痛伴血尿 2例 ,无症状体检时发现右肾积水 1例。 5例均常规行B超及静脉尿路造影 (RVU)检查 ,3例行逆行尿路造影 ,2例行MRU(磁共振尿路造影 ) ,经上述检查均能作明确诊断。Ⅰ型 (低襻型 )4例 ,Ⅱ型 (高襻型 ) 1例。 4例均作输尿管切断作端 端吻合术 ,并置入内支架双“J”管 ,4周后拔除。 6个月后复查作B超及IVU检查提示肾积水…     

高频超声显像诊断婴幼儿先天性输尿管畸形

目的 探讨高频超声显像诊断婴幼儿先天性输尿管畸形的应用价值.方法 应用高频超声探头对3460例年龄2个月～3岁,无明确排尿异常症状的婴幼儿泌尿系统进行普查.结果 共检出先天性输尿管畸形8例,其中输尿管狭窄4例,输尿管囊肿2例,重复输尿管合并输尿管开口异位2例,所有病例均经CT检查证实.结论 高频超声对于诊断婴幼儿先天性输尿管畸形具有较高的应用价值.     

原发性输尿管移形细胞癌的CT表现

目的：探讨原发性输尿管移形细胞癌的ＣＴ表现及ＣＴ检查对该病的诊断价值。材料与方法：８例患者均作了ＣＴ平扫与增强扫描，其中３例４～８小时后还作了延迟扫描。全部病例均经手术、病理证实为移行细胞癌。结果：原发性输尿管移形细胞癌直接ＣＴ征象为管壁的不规则增厚及管腔的不规则狭窄，部分表现局部软组织肿块，位于下端的可突入膀胱。间接征象为肾盂肾盏扩张、淋巴结转移及输尿管瘘。ＣＴ检查既可观察腔内病变又可显示腔外肿瘤情况及远处转移，且为无创性检查。结论：ＣＴ检查是诊断原发性输尿管癌的有效手段。     

Laparoscopic nephroureterectomy: Initial laboratory experience

Summary

Nephroureterectomy was performed using laparoscopic techniques in seven adultfemale pigs. In all cases, kidneys were dissected without significant bleeding. A cuff of bladder was excised along with the distal ureter in each case. The mean dissecting time of the kidney was 98 min while the dissection of the ureter required an additional 74 min. The bladder was closed using one of a variety of instruments: a GIA stapler, titanium clips, or an Endoloop.

Clinical application awaits improvement in instrumentation forclosure of the bladder and the development of an entrapment sack impermeable to cells.     

输尿管导管辅助软镜工作内鞘扩张输尿管在二期软镜碎石术中置鞘困难时的应用

目的探讨输尿管导管辅助软镜工作内鞘扩张输尿管在二期输尿管软镜碎石术中置鞘困难时的临床应用。方法对一期放置5F输尿管支架管、二期行输尿管软镜碎石术时置鞘困难的9例患者,采用5F输尿管导管辅助12F软镜工作内鞘扩张输尿管后置鞘并行输尿管软镜钬激光碎石术。结果经扩张后的9例患者,软镜工作鞘均置于满意位置并成功碎石,未出现严重并发症。术后随访6个月未发现输尿管狭窄。结论应用输尿管导管辅助软镜工作内鞘扩张输尿管对二期行输尿管软镜碎石术置鞘困难的患者有提高手术成功率、降低手术风险、减轻经济负担的作用,是二期行输尿管软镜碎石术出现置鞘困难时有效、便捷、安全的辅助手段。     

16层螺旋CT诊断单侧上尿路多发癌

目的 探讨16层螺旋CT扫描对单侧上尿路多发癌的诊断价值.方法 回顾性分析10例经病理证实的单侧上尿路多发癌患者的16层螺旋CT影像表现.结果 单侧肾盂、输尿管多发癌同时累及膀胱6例,肾盂及输尿管同时受累3例,输尿管中下段癌累及膀胱1例.CT图像上表现为病变肾盂及输尿管管壁不规则增厚和(或)腔内软组织肿块,管腔变窄,累及膀胱者表现为膀胱壁不规则增厚或软组织肿块,大范围的曲面重建可全程清晰显示上尿路病变累及范围,直观显示上尿路腔内外改变.发现腹膜后淋巴结肿大3例,2例经病理证实为转移癌,影像所见与手术、病理完全符合.结论 16层螺旋CT容积扫描能清楚显示单侧上尿路多发癌发生的部位、累及范围.     

特发性乳糜尿患者直接淋巴管造影后CT表现

目的 采用直接淋巴管造影CT(PLCT)观察特发性乳糜尿患者泌尿系统及其他腹部区域淋巴管表现.方法 观察26例乳糜尿患者PLCT图像,分析泌尿系统及腹部其他区域对比剂异常分布部位及范围,进行影像学分型;并根据临床表现进行分型,以K ap p a检验评估2种分型结果的一致性.结果 26例中,25例(25/26,96.15...     

产前超声诊断重复肾畸形及误诊原因分析

目的 探讨胎儿重复肾畸形的产前超声声像图特征,分析误诊原因。 方法 对2007年1月—2010年6月经产前超声诊断的27胎重复肾胎儿的声像图特点与临床资料进行回顾性分析。 结果 产前超声诊断胎儿重复肾27胎,21胎为单侧重复肾,4胎为双侧重复肾,共29侧重复肾;其中12侧合并输尿管扩张,5侧合并输尿管囊肿。4胎合并其他系统器官畸形。产前超声误诊3胎,其中1胎产前诊断为左侧重复肾,出生后复查左肾未见明显异常;1胎产前诊断右侧重复肾,出生后复查为右侧肾上腺血肿;1胎产前诊断为左肾积水合并输尿管扩张,出生后复查为左侧重复肾。 结论 两个不相通的肾盂是胎儿重复肾的主要声像图特征;超声对于中、晚孕期诊断胎儿重复肾有重要的价值。     

Ureteroscopic Holmium:YAG laser lithotripsy is effective for ureteral steinstrasse post-SWL

Abstract

Objective: To evaluate the efficacy of Holmium: YAG laser lithotripsy for ureteral steinstrasse after extracorporeal shock lithotripsy (SWL). Material and methods: Holmium: YAG laser lithotripsy was performed on 21 patients who had developed ureteral steinstrasse post-SWL. Results: Nineteen cases had successful treatment. The ureteral steinstrasse was cleared within one month after the treatment (success rate of 90.48%). Upper ureteral steinstrasse shifted to the renal pelvis was noted in one patient, who underwent a second SWL treatment. Another patient had a severely kinking ureter and underwent open surgery after ureteroscopy failed. Conclusion: Holmium: YAG laser lithotripsy of ureteral steinstrasse post-SWL is an effective clinical modality due to its high success rate, short lithotripsy time, high safety and reliability, and easy feasibility.     

Duplicated or Ectopic Renal Collecting System in Two Adult Emergency Department Patients

BackgroundDuplicated renal collecting system is a urological anomaly often found in pediatric patients. It is less commonly diagnosed in adulthood, particularly in a pregnant patient. Many point-of-care ultrasonography users may not be aware of this diagnosis, particularly in patients in the emergency department. It is important to recognize the duplicated system because in general, patients will often have hydronephrosis in only one renal pole rather than the entire kidney, which corresponds to an unequal renal function as documented on renal nuclear medicine functional scans. As a consequence, if the sonographer only identifies one ureter and incompletely visualizes the kidney, obstruction of one of the duplicated structures may be missed.Case ReportWe report 2 cases of duplicated ureter in patients in the emergency department who present with flank pain and urinary symptoms. Both patients were adult females, one pregnant, with duplicated ureter and severe right upper pole hydroureteronephrosis. The first patient was admitted for intravenous antibiotic therapy for pyelonephritis in pregnancy. The second was discharged with oral antibiotics and urgent urologic follow-up.Why Should an Emergency Physician Be Aware of This?Duplicated ureter should be considered in patients with recurrent urinary tract infections or enuresis. Point-of-care ultrasonography users should note the differential hydronephrosis between upper and lower renal poles and may visualize duplicate or ectopic ureteronephrosis or ureterocele. Patients should be prescribed prophylactic antibiotics and have urgent urologic follow-up because the untreated condition can lead to irreversible renal damage.     

Retrograde nephrostomy and percutaneous resection of fibroepithelial polyps of the renal pelvis

Summary

Benign fibroepithelial polyps of the renal pelvis are extremely rare with only 20 cases reported in the literature. Fibroepithelial polyps of the ureter occur more frequently. We report a case of fibroepithelial polyps in the renal pelvis near the ureteropelvic junction successfully treated by retrograde nephrostomy and percutaneous resection.