Balloon compression in excretory urography.

Abstract

An attempt to achieve visualization of the upper urinary tract by displacing obscuring bowel shadows with balloons placed over the renal areas on either side was made by comparison of repeat urographic examinations. Asimilar pad compression for pediatric use has recently been described (1). Method In addition to the usual compression device, described recently by Daughtridge (2) as a modification of earlier types, balloons measuring 7 × 7 em were applied over the renal areas on each side. Careful positioning was adjudged by the bony landmarks in the preliminary film. Care was taken to place the balloon lateral to the main vascular structures in the median plane in order to avoid any extrinsic disturbances of blood flow in the main vessels. After the balloons had been set in position, the compression device was tightened laterally with a ratchet mechanism. At the same time, the balloons were carefully maintained in position by hand pressure. When the ratchet was tightened completely, the balloons were inflated equally on each side (Fig. 1). The upper compression needed application for only a short time, usually two or three minutes. The films of 21 patients were compared, in whom repeat urographic examinations had been performed both with and without this upper abdominal compression. All other variables, such as the application of lower ureteral compression, amount of contrast medium, bowel preparation, radiographic technics, etc., were not significantly changed. The films were masked, and calyceal detail was scored by two observers independently and graded as poor, fair, good, or excellent, scoring respectively 1, 2, 3, or 4 points for each calyx identified. With allowance of an average comparative score of 10.0 for the routine examination with lower compression only, the average calyceal score of 21 selected upper balloon compression films was 14.1. Tomographic studies that were coincidentally performed in some of these patients were also compared and scored an average of 11.O. Only two retrograde pyelographic studies were included, and they averaged 23.5 on the same scoring basis. It should be noted that in this patient group multiple examinations of this type were required. The urological assessment was difficult, and repetition of the examination was usually needed because of poor visualization on the first occasion. Patient acceptance is no more difficult to obtain than when lower ureteral compression alone is employed, and this was applied for so short a time that any added discomfort was negligible. Summary The method may find some use in the course of a difficult examination and help to salvage an otherwise inadequate study.