中老年人输尿管梗阻导致肾积水的病因及诊断分析

目的　提高中老年人输尿管梗阻的病因诊断水平。　方法　回顾性分析了近 10年来收治的 141例中老年人肾积水的病因及诊断方法。　结果　在本组病例中 ,输尿管结石 5 9例 ,输尿管癌 5 1例 ;输尿管结核 11例 ;肾盂输尿管交界处狭窄 9例 ;输尿管囊肿 6例 ;输尿管息肉 5例。　结论　输尿管结石和肿瘤是导致中老年人输尿管梗阻的主要病因 ,对于这些病因的诊断 ,尤其伴有血尿的患者 ,B超应作为诊断及定期复查的首选检查手段。     

移植肾输尿管梗阻的诊断与治疗：（附13例报告）

为了提高对移植肾输尿管梗阻患者的诊断与治疗水平，对在５３６例次肾移患者中发现的１３你输尿管梗阻患者进行临床总结分析，其中输尿管狭窄性梗阻１０例，输尿管结石性梗阻３例。分析认为，肾移植术后早期排斥反应、伤口深部感染及漏尿可能与发生移植肾输尿管狭窄性梗阻有关，而肾移植术后高尿酸血站与输尿管结石形成有关。提出Ｂ超、肾图、经皮顺行造影和肾盂内压测定为诊断移植肾输尿管梗阻的手段；对于输尿管狭窄性梗阻患者，早     

输尿管镜在输尿管梗阻中的诊治价值

目的探讨输尿管镜在输尿管梗阻诊治中的价值.方法应用输尿管镜对52例非结石性输尿管梗阻进行诊治.结果输尿管狭窄35例(行输尿管镜硬性扩张19例,气囊扩张13例,腹腔镜下输尿管成形术3例),输尿管息肉13例行钬激光切除,输尿管癌3例改行开放手术,腔静脉后输尿管1例改行输尿管成形术.手术并发黏膜明显裂伤或黏膜下假道2例,输尿管穿孔1例,其它并发症.结论输尿管镜术能明确输尿管梗阻的病因,并能采取相应治疗.     

梗阻性非特异性输尿管炎四例报告

报告４例梗阻性非特异性输尿管炎，对其病因，病理及发病特点作一简要介绍，提出了与输尿癌，输尿管结核及输尿管阴性结石性梗阻之鉴别要点，并对本病的手术适应证及方法进行了讨论。     

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。     

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诊断IVU未充分显影的上尿路梗阻性病变

目的 探讨多层螺旋CT在IVU未充分显影的上尿路梗阻性疾病诊断中的应用价值.方法 应用多层螺旋CT对52例经超声检查提示但IVU检查未能充分显影且血肌酐正常的上尿路梗阻性病变患者行平扫加增强检查.结果 52例多层螺旋CT诊断为肾盂输尿管连接部梗阻16例、肾结核8例、输尿管结石10例、输尿管良性狭窄6例、输尿管癌4例、输尿管外压迫6例、巨输尿管2例.10例结石性上尿路梗阻中,输尿管镜证实8例,开放手术证实2例.42例非结石性上尿路梗阻中,2例诊断为腹膜后淋巴结转移癌压迫输尿管者,仅行输尿管内双J管植入术,未获得病理证实;2例诊断为前列腺癌侵及输尿管末段者,由前列腺穿刺活检证实;其余38例均行开放手术经病理证实.52例中有50例得到手术病理证实.结论 对IVU未能充分显影且血肌酐正常的上尿路梗阻患者,多层螺旋CT平扫加增强在判断梗阻原因方面有重要价值.     

多层螺旋CT泌尿系造影在输尿管梗阻性疾病诊断中的应用价值

目的:探讨多层螺旋CT泌尿系造影(MSCTU)在输尿管梗阻性疾病诊断中的应用.方法:取输尿管梗阻病例40例,行多层螺旋CT扫描,将原始数据三维重建后进行尿路成像,并与X线平片、B超、IVU检查结果进行对比分析.结果:MSCTU诊断输尿管结石1 7例、肾盂输尿管连接部狭窄8例、输尿管中段狭窄6例,输尿管末端囊肿4例、输尿管肿瘤1例、腔静脉后输尿管2例、输尿管迷走血管压迫狭窄1例,输尿管畸形1例.结论:MSCTU是一种无创伤且安全有效的非侵袭性影像学检查方法,对输尿管梗阻性疾病的诊断有着重要的临床应用价值.     

多层螺旋CT在输尿管结核性梗阻诊断中的应用

目的探讨多层螺旋CT(MSCT)在输尿管结核性梗阻诊断中的作用。方法对2例IVU检查发现肾积水输尿管不显影及RGP插管受阻的患者行MSCT扫描，并行3D重建，将诊断结果与手术结果对照。结果MSCT能明确输尿管梗阻的部位和性质。手术结果证实MSCT诊断正确。结论MSCT能对输尿管结核梗阻作出明确诊断，是一种有效的无创检查手段。     

磁共振尿路造影在上尿路梗阻中的诊断价值

目的　比较磁共振尿路造影(MRU)和静脉尿路造影(IVU)在上尿路梗阻中的诊断价值。方法　对100例上尿路梗阻患 者分别进行了MRU和IVU检查,并与术后结果比较。结果　MRU对输尿管狭窄、肾盂输尿管连接部梗阻、输尿管肿瘤和输尿 管结石的术前诊断率分别为93.75%、100%、87.5%、40%,而IVU术前诊断率则分别为82.5%、56.25%、27.5%、80%。结论　 IVU目前仍为诊断上尿路梗阻的常用方法,但MRU水成像对无分泌功能的肾积水、孕妇、儿童和碘过敏患者的诊断价值更大, 是对IVU的有益补充。     

Spontaneous urinary extravasation due to chronic ureteral obstruction

Spontaneous nontraumatic perirenal extravasation of urine is an unusual phenomenon, and the majority of the reported case were caused by acute obstruction with passage of a ureteric calculus. Extravasation due to obstruction of more gradual onset occurs less frequently. We report four cases, three caused by tumor obstruction of the ureter, and one thought to be obstructed by the stricture due to ureteral inflammation. We discuss the diagnosis and treatment of spontaneous urinary extravasation, especially due to chronic ureteral obstruction.     

An unusual case of bilateral primitive obstructed megaureters due to ureteral valves presenting with anuria at the age of 1 month

Ureteric valves represent a very rare etiology of ureteral obstruction. We experienced an unusual case of bilateral distal ureteric valves that presented as bilateral primitive obstructed megaureters with anuria at the age of 40 days. To our knowledge, this is the second case of bilateral involvement of distal ureteric valves reported in the literature. Bilateral ureteral valves should be included in the differential diagnosis of bladder outlet obstruction, as well as bilateral primitive obstructed megaureters in children. Excision and ureteral reimplantation is curative.     

输尿管镜在急性上尿路梗阻性肾功能衰竭中的临床应用

目的探讨急性上尿路梗阻性肾功能衰竭的治疗方法。方法采用输尿管镜检查,酌情气压弹道碎石,放置双J管内引流治疗76例急性上尿路梗阻性肾功能衰竭患者。结果术后患者血清BUN、SCr均明显下降,尿量不同程度恢复。结论输尿管镜诊治急性上尿路梗阻性肾功能衰竭,具有安全、疗效可靠、损伤小等优点,能同时处理双侧输尿管病变,可作为首选治疗方法。     

钬激光输尿管软硬镜结合治疗结石梗阻性急性肾功能衰竭39例分析

目的探讨钬激光输尿管软硬镜治疗输尿管结石致急性梗阻性肾衰竭的应用价值。方法回顾性分析2006年7月～2010年12月39例输尿管嵌顿性结石梗阻致肾后性急性肾衰竭患者的资料,其中36例患者入院后24h急诊手术行输尿管镜检查及钬激光碎石取石术（其中5例接受急诊血液透析）,术毕安置双＂J＂管内引流,2例输尿管中段结石因输尿管迂曲、狭窄进镜失败留置输尿管导管后行二次手术成功,1例因输尿管膀胱开口异常而中转开放手术。术后随访泌尿系彩超、腹部X线片（KUB）4～6周。结果 5例患者由于严重水钠潴留、高血钾接受急诊血液透析。38例患者输尿管镜下钬激光碎石获得成功,平均手术时间45.3（20～125）min,碎石成功率97.2%（70/72）,患者术后结石清除率100%（38/38）。术后36例患者（92.3%）于术后10d肾功能恢复正常,3例患者（7.6%）肾功能显著恢复,但随访12周仍未恢复至正常范围内。无术中并发症及术后输尿管狭窄等发生。结论钬激光输尿管软硬镜结合治疗输尿管结石梗阻性急性肾衰竭安全、有效,可同期处理双侧输尿管结石及肾结石,并且可一次性将结石完全清除。     

Examining the obstructed ureter with intraluminal sonography.

PURPOSE: Intraluminal sonography was used to define, differentiate and direct better treatment of obstructing ureteral lesions. MATERIALS AND METHODS: A total of 63 patients with a history of ureteral obstruction and suspected stricture were accrued for evaluation. All patients underwent retrograde contrast imaging, ureteroscopy and intraluminal sonography as part of a diagnostic algorithm. Specific sonographic criteria to differentiate lesions and stricture types were developed. Associated complicating variables defined on sonography included foreign bodies, submucosal stone fragments, ureteral wall fibrosis, mass lesions and adjacent vasculature. Endoscopic treatment was then performed with ultrasound guidance if technically feasible. RESULTS: A total of 63 ureters were evaluated with the preoperative diagnosis of ureteral stricture disease. All ureters were narrowed on contrast imaging in the segment where a stricture was suspected. On sonography 24 ureters (36%) had wall fibrosis with normal periureteral tissues. In general these strictures did well with endoscopic incision. Of the 67 ureters 13 (19%) were thickened or had edematous walls with normal architecture and without fibrosis. These patients all did well with expectant therapy. In contrast, 7 ureters (10%) were obstructed by segmental retroperitoneal fibrosis which did not respond to minimally invasive therapies. In addition, 8 ureters (12%) were obstructed by ureteral wall scarring and periureteral fibrosis, and required open surgical intervention. Ten ureteral strictures had adjacent vasculature, and endoscopic incisions under ultrasound guidance were directed safely away from these structures without associated morbidity. Calculi, stone fragments and foreign bodies embedded in the ureteral wall with associated inflammation were defined with sonography and responded to endoscopic therapies. The intraluminal sonographic diagnosis of ureteral endometriosis was made in 6 patients with a range of lesions from bright, hyperechoic blood filled cysts to an inhomogeneous fluid filled scar involving the wall and periureteral tissues. Primary ureteral carcinoma was also demonstrated in 2 patients after other diagnostic techniques failed. In 1 of these patients intraluminal sonography directed biopsies diagnosed submucosal tumor. Finally, 1 patient had a small periureteral urinoma on intraluminal sonography which was missed on other imaging studies. CONCLUSIONS: Intraluminal sonography is useful in patients with ureteral obstruction of unclear etiology as well as for selecting patients who may benefit from minimally invasive therapies and safely directing these treatments.     

Laparoscopic ureteral reimplantation using the dome advancement technique: A case series and review of the literature

Aim: Ureteral resection and reimplantation is one of the treatment options for pathology in the middle and distal ureter. Laparoscopic ureteral reimplantation has been shown to be a feasible alternative to the open approach. Among the various techniques of laparoscopic reimplantation, the dome advancement technique has been reported as a simple and effective method. Patients and Methods: Five patients were found to have distal ureteric stricture necessitating partial ureterectomy and ureteral reimplantation. Their results are reviewed and compared to published results. Results: Laparoscopic distal ureterectomy and ureteral reimplantation was successfully performed in all five patients using the dome advancement technique. All patients made good postoperative recovery without evidence of obstruction on follow‐up imaging. Conclusion: Laparoscopic ureteral reimplantation is a feasible minimally‐invasive option for patients requiring ureteral reconstruction. The dome advancement technique is simple and reproducible, with a good functional outcome.