The value of doppler ureteral jets evaluation by Doppler ultrasonography in upper urinary lithiasis

Abstract

Introduction: The aim of our study was to asses the importance of ureteral flow analysis by Doppler ultrasonography in upper urinary tract lithiasis. We analyzed the particularities of the ureteral flow in order to find its place in the diagnostic algorithm of lithiasis. Method: Between January 2005 and January 2008, we examined 500 patients with upper urinary tract lithiasis and a number of 53 healthy volunteers. We used a General Electric 400MD device, with a 3.5MHz abdominal transducer and a 10MHz rectal transducer. Also, we used a Kretz Voluson 730 device, with 3D transducer. The ureteral flow recording was performed using the Doppler module, and the flow velocity was determined using the Pulse Doppler module. In all patients, we evaluated the renal vascularization and we calculated the resistive index (RI) as an intrarenal pressure indicator. Results: 365 patients (73%) presented hydronephrosis (stage I-III). In 63 of these cases, a weak flow was observed on the obstructed ureter, with a flow velocity 50% slower than on the opposite side. In 302 patients, a ureteral flow could not be observed. In 286 of these patients a normal contralateral flow was visible. 354 patients with hydronephrosis presented RI greater than 0.7. 135 patients had no hydronephrosis and RI was below 0.7. Conclusion: The ureteral flow analysis, both morphological (shape, dimensions) and dynamical, may be a useful addition to the diagnostic armamentarium of the upper urinary tract lithiasis. Doppler ultrasonography may offer useful information regarding the renal function and may also help establishing the surgical indication.