Caliceal Dilatation Research Articles

Evaluation of Early and Late Clinical, Radiological and Scintigraphic Datas After Laparoscopic Pyeloplasty in Ureteropelvic Junction Obstruction

Ureteropelvic junction obstruction(UPJO) causes inadequate transport of urine from the renal pelvis to the ureter. Laparoscopic pyeloplasty(LP) is increasingly preferred in patients with UPJO. We aimed to compare the clinical, radiological and scintigraphic findings before the treatment and the early and late progress of the patients underwent LP for UPJO. Sixty-eight cases underwent LP for UPJO(January 2010-May 2016) were included. Demographic characteristics, clinical findings, intraoperative characteristics, data on preoperative and postoperative clinical, radiological and scintigraphic follow-ups of the cases were evaluated retrospectively. LP was performed in 68 patients(51 males, 17 females) for UPJO. Twenty-four patients with antenatal hydronephrosis, 46 patients with abdominal pain, hematuria and urinary tract infection(UTI) findings were diagnosed with UPJO. Patients were preoperatively followed up by USG and DTPA-MAG3 imaging. During surgery, aberrant vessel in 13(19.1%) patients, malrotation in 4(5.8%) and polyp in one(1.4%) patient were detected. Thirteen patients(19.1%) underwent surgery with the transmesoolic approach, 55 patients(80.8%) underwent retrocolic surgery, 33 patients underwent laparoscopy-assisted extracorporeal pyeloplasty. In postoperative period, patients were followed up at 1st, 3rd, 6th months and in the first year with USG and at 6th months with DTPA-MAG3 imaging. Postoperative USG follow up showed a decrease in hydronephrosis(p<0.001), an increase in parenchymal thickness(p<0.001), and a decrease in caliceal dilatation(p<0.001). In scintigraphic data, renal function was increased but it is not statistically significant(p>0.05) and activated half-time was decreased(p<0.05) in postoperative period. LP is a surgical treatment method with successful results when performed with appropriate indications in experienced clinics.

Comparison of the reliability of two hydronephrosis grading systems: The Society for Foetal Urology grading system vs. the Onen grading system

To compare the reliability of the conventional ultrasonography grading system for hydronephrosis as suggested by the Society for Fetal Urology (SFU) in 1993 and that developed by Onen in 2007. One hundred and eighty kidneys in 90 paediatric patients were assessed by four radiologists using each of the two grading systems twice. The SFU system was graded 0-4 (0=no hydronephrosis; 1=visualized only renal pelvis; 2=plus a few caliceal dilatation; 3=all calyceal dilatation; 4=plus parenchymal thinning). The Onen system was graded 0-4 (0=no hydronephrosis; 1=only renal pelvic dilatation; 2=plus caliceal dilatation; 3=plus <50% renal parenchymal loss; 4=plus >50% renal parenchymal loss). Cohen's kappa statistic was used to estimate intra- and interobserver agreement. The weighted least-squares approach was used to compare the intra-observer agreement, and bootstrapping was used to compare the interobserver agreement between the two systems. Intra-observer agreement was substantial to almost perfect in both the SFU (κ0.79-0.95) and the Onen (κ 0.66-0.97) grading system without difference. The overall interobserver agreement was substantial in both the SFU (κ 0.61-0.68) and the Onen (κ0.66-0.76) grading system. However, interobserver agreement was fair to moderate for SFU grades 1 and 2 and Onen grades 2 and 3. Both the SFU and Onen grading system are reliable with good intra- and interobserver agreement. However, decreased interobserver agreement was demonstrated for SFU grades 1 and 2 and Onen grades 2 and 3.

503 The ultrasonographic evolution of the hydronephrosis and renal parenchyma thickness in patients with congenital ureteropelvic junction (UPJ) obstruction who underwent pyeloplasty

INTRODUCTION AND OBJECTIVES: Introduction: Pyeloplasty is an established treatment for pelviureteric junction (UPJ) obstruction. After pyeloplasty diuretic renograms are often obtained to document surgical success by demonstrating better urinary drainage. However, while diuretic renograms may be the most accurate way to evaluate surgical outcome in the early postoperative period, renal ultrasound is more commonly used for long-term followup because it is less invasive and more cost-effective. OBJECTIVE: The aim of this study was to determine the ultrasonographic evolution of the pelvic and caliceal dilatations and of the renal parenchyma thickness in patients with congenital hydronephrosis who underwent pyeloplasty. METHODS: Materials and Methods: From January 2006 to January 2010, 265 patients with prenatally diagnosed hydronephrosis underwent a protocol of antibiotic prophylaxis, ultrasound, diuretic renography(DTPA) and voiding cystourethrography. Of the 265 patients, 85 (32%) who showed a trend of progressive hydronephrosis underwent pyeloplasty and were included. All the patients were evaluated with DTPA scans on the sixth month after surgery. The ultrasound performed before the surgery as well as all performed in the first 3,6,12,24 and 36 months after the pyeloplasty were reviewed and compared. The trends in the changes in these studies were studied. Statistical analyses were performed with SPSS (Statistical Package for the Social Sciences) version 18.0. RESULTS: All patients significantly improved the renal washout time (T1⁄2) in DTPA scans at six months postoperatively. The rate of caliceal dilatation decrease in the first 3, 6 and 12 months after surgery were 60%, 91,7%, and 100%, respectively. In a follow-up period of at least 1 year, 43 (50,6%) renal units had complete resolution of the pelvic dilation and 72 (84.7%) of the caliceal dilatation. The renal parenchyma was normal or had increased in 76 (89,4 %) of cases. CONCLUSIONS: The decrease in pelvic and caliceal dilatations occurred in the majority of the patients, but its complete resolution is relatively slow. Serial ultrasound is noninvasive and could replace serial invasive renal scans decreasing costs, instrumentation, and radiation exposure.

An Unusual Cause of Haematuria: Renal Arteriovenous Malformation Mimicking Caliceal Dilatation at Ultrasonography

We report a 37‐year‐old woman admitted to the emergency service with macroscopic haematuria and flank pain due to renal arteriovenous malformation (AVM). Ultrasonography showed apparent dilatation of the left renal caliceal system, whereas intravenous pyelography (IVP) demonstrated multinodular pelvicaliceal impressions with no caliceal dilatation. The final diagnosis was established with conventional angiography. Renal AVM may mimic caliceal dilatation on ultrasonography. Demonstration of multinodular pelvicaliceal impressions at IVP and lack of caliceal dilatation are clues for the correct diagnosis in this particular situation.

Ultrasonography for ureteral stone detection in patients with or without caliceal dilatation

To evaluate the relationship between the degree of hydronephrosis and the detection rates of ureteral stones with ultrasonography (US). Of 250 consecutive patients with suspected ureterolithiasis, 214 who were diagnosed with ureterolithiasis were enrolled in this study. First, both kidneys were observed by US to evaluate the intrarenal collecting systems. Thereafter, the possible course of the ureters and the bladder were searched to find any stones. Stones were clearly observed in 80 (73%) of 109 patients with caliceal dilatation, whereas stones were clearly observed in 46 (44%) of 105 patients without dilatation (P<0.05). Of the former 80 patients, 31 (39%) had stones in the ureterovesical junction (UVJ), whereas 51 (64%) had stones in the more proximal ureter. Of the latter 46 patients, 37 (80%) had stones in the UVJ or the bladder, whereas 9 (20%) had stones in the more proximal ureter. The US detection rate of ureteral stones was high in patients with caliceal dilatation. The whole ureter should be scanned in patients with caliceal dilatation for detection of ureteral stones. Even when patients have no caliceal dilatation, it is still considered to be useful to scan the UVJ and the bladder.

Further Experience With the Vascular Hitch (Laparoscopic Transposition of Lower Pole Crossing Vessels): An Alternate Treatment for Pediatric Ureterovascular Ureteropelvic Junction Obstruction

Standard treatment for ureterovascular ureteropelvic junction obstruction has been dismembered pyeloplasty. We previously reported the alternative technique of laparoscopic transposition of lower pole vessels (the vascular hitch) in pediatric patients. This report is an update of this select group of pediatric patients with intermediate followup. Patients underwent diagnostic renal sonography and (99m)technetium-mercaptoacetyltriglycine diuretic renography with additional magnetic resonance angiography in candidate patients. Radiographic criteria included moderate hydronephrosis with no caliceal dilatation and a well preserved cortex, poor renal drainage with preserved split function and lower pole crossing vessels. Intraoperative criteria included a normal ureter and ureteropelvic junction with peristalsis. Postoperatively patients were followed clinically, and with renal sonography and (99m)technetium-mercaptoacetyltriglycine renography at 1 and 2 months, respectively. Success was defined as symptom resolution with radiographic improvement in hydronephrosis and drainage with preserved renal function. Nine boys and 11 girls 7 to 16 years old (mean age 12.5) underwent laparoscopic transposition of crossing vessels, including 3 with da Vinci robot assistance. Mean operative time was 90 minutes (range 47 to 140). Median hospital stay was 24 hours. No ureteral stents or urethral catheters were placed intraoperatively. At a mean followup of 22 months (range 12 to 42) 19 of 20 patients (95%) had been successfully treated. One patient who had recurrent pain underwent successful laparoscopic pyeloplasty. At intermediate followup the laparoscopic vascular hitch procedure has been successful in treating patients with ureterovascular ureteropelvic junction obstruction. In these select patients this technique offers a feasible and durable alternative to standard dismembered pyeloplasty. Ongoing evaluation continues to ensure that the promising results endure.

An alternative grading system to refine the criteria for severity of hydronephrosis and optimal treatment guidelines in neonates with primary UPJ-type hydronephrosis

Objective We present our alternative hydronephrosis grading system (AGS) in an attempt to establish optimal treatment guidelines, and clarify and refine the criteria for severity of hydronephrosis in neonates. Patients and methods A total of 162 newborns (228 affected kidneys) with antenatally diagnosed primary ureteropelvic junction-type hydronephrosis were prospectively followed and treated by the same surgeon for a mean of 46 (6–65) months. Ultrasonography and diuretic renogram were used for diagnosis and follow up. Society for Fetal Urology (SFU) grading system, anteroposterior diameter of renal pelvis (APDRP) and our AGS were used to determine the degree of hydronephrosis. AGS: 0, no hydronephrosis; 1, dilatation of renal pelvis alone; 2, plus caliceal dilatation; 3, plus <1/2 (mild-to-moderate) renal parenchymal loss; 4, plus >1/2 (severe) renal parenchymal loss (cyst-like kidney with no visually significant renal parenchyma). Results On the first postnatal ultrasound, the severity of hydronephrosis was SFU ≤ 2 in 152 kidneys (surgery, 0%), SFU-3 in 41 kidneys (surgery, 19.5%) and SFU-4 in 35 kidneys (surgery, 68.6%). The follow up, treatment and outcome of SFU-1 and SFU-2 patients were similar; all resolved spontaneously without renal deterioration (renal function >40%). Renal function ranged between 7% and 39% in SFU-4 patients. Intrarenal pelvis was found in one patient with an APDRP of <15 mm, seven patients of 16–30 mm, and five patients of >30 mm. Overall, 201 hydronephrotic kidneys (88.2%) resolved spontaneously while 27 (11.8%) required pyeloplasty. Conclusion Neither an SFU grading system nor measurement of APDRP is the gold standard in determining the severity of hydronephrosis. Both methods may fail, particularly in children with intrarenal pelvis configuration or SFU-4 hydronephrosis. Our AGS promises easier follow up and more timely treatment.

Marked Maternal Ureteropelvic Obstruction Mimicking a Large Ovarian Mass at 20 Weeks' Gestation

Physiologic dilatation of the maternal urinary collecting system occurs in more than 80% of gravidas by mid gestation. 1 Caliceal and ureteral dilation are more common on the right, and, similarly, the degree of caliceal dilatation is more pronounced on the right (15 versus 5 mm). 2 Although most women with hydronephrosis during pregnancy are asymptomatic, a few may have clinical signs and symptoms related to the upper urinary system. 3 When left-sided hydronephrosis is greater than the right, particularly if the patient is symptomatic, the likelihood of a pathologic condition, especially obstructive, should be considered. We present an unusual case in which a large left upper abdominal cystic structure depicted sonographically at mid gestation, initially considered consistent with an ovarian cyst, resulted from marked maternal ureteropelvic obstruction and required nephrostomy.

Megacalycosis: report of two cases

Congenital megacalycosis is a rare renal disorder consisting of caliceal dilatation without evidence of renal pelvic or ureteral obstruction. Since its first description in 1963, only a few cases have been reported. The defect is mostly unilateral, shows male predominance and does not disrupt the renal functions. We report on two male patients with bilateral megacalycosis and different clinical presentations. The first case was diagnosed in adolescence during examination for a urinary tract infection and was followed-up uneventfully for nearly ten years. The second case was found to have megacalycosis during the assessment of antenatal hydronephrosis. We aimed to emphasize the importance of considering megacalycosis in the differential diagnosis of both antenatal hydronephrosis and other causes of caliceal dilatation to prevent unnecessary diagnostic and therapeutic interventions.

Images in clinical medicine. Ureteral obstruction in pregnancy.

This 19-year-old primigravida presented with fever and right-flank pain at 22 weeks of gestation. Renal ultrasonography showed caliceal dilatation of 23 mm in the right kidney.

Malacoplakia of the Bladder in a 16-Year-Old Girl

Malacoplakia is a rare disease of the urinary tract, especially in children, with only 15 reported pediatric cases in the English literature. We report on a 16-year-old girl who presented with renal insufficiency and multiple bladder masses. CASE REPORT A 16-year-old girl was admitted to the hospital for a possible seizure. Evaluation revealed a creatinine of 3.0 mg/dl (normal 0.7 to 1.5) and an Escherichia coli urinary tract infection. The patient had developmental delay and was unable to give a reliable symptom history but the family denied any history of flank pain, urinary tract infection, dysuria, hematuria, frequency or incontinence. She was on no medications at home. Renal ultrasonography demonstrated echogenic kidneys bilaterally with caliceal dilatation and multiple polypoid solid bladder masses with blood flow by color Doppler (fig. 1). Diuretic renography showed minimal function of the left kidney but no obstruction. Voiding cystourethrography revealed multiple filling defects in the bladder and grade I vesicoureteral reflux bilaterally. Retrograde pyelograms demonstrated dilatation of the calices bilaterally, normal ureters and no filling defects in the upper tracts. Cystoscopy showed multiple yellow-tan polypoid smooth masses, which were biopsied. Histological changes were consistent with malacoplakia. The patient was never febrile while in the hospital and the seizure evaluation was negative. She was discharged home on oral fluoroquinolone and bethanechol therapy for 3 months. She remained asymptomatic. Followup ultrasonography revealed resolution of the bladder polyps and no change in the kidneys. Repeat bladder biopsy was negative for malacoplakia. Urine culture was negative off of antibiotic prophylaxis. DISCUSSION

Pediatric Renal Pelvic Fullness: An Ultrasonographic Dilemma

We conducted a prospective study to define normal renal pelvic size in children. Institutional Review Board approved consent was obtained to perform renal ultrasound during excretory urography (IVP) scheduled for medical management. Mean patient age (17 females, 11 males) was 5.2 years. Renal ultrasound was conducted concurrent with 10-minute IVP. Fifty kidneys were imaged with 51 collecting systems. IVP defined 44 collecting systems as normal. Mean anteroposterior pelvic diameter on sonography for these 44 systems was 3.3 mm. One normal collecting system on IVP had a diameter greater than 10 mm on ultrasound (14 mm). No sonographic caliceal dilatation was seen in any kidney appearing normal on IVP. The 7 dilated systems on IVP had a mean ultrasound diameter of 17.1 mm. Two dilated collecting systems smaller than 10 mm in diameter on sonography had caliceal distention on ultrasound. Normal renal pelvis threshold diameter was 10 mm in asymptomatic children. We recommend further evaluation in children with caliceal dilatation and/or dilatation of the anteroposterior renal pelvis greater than 10 mm. Using these criteria, no system appearing abnormal on IVP would have been missed.

Management of Staghorn Calculus: Analysis of Combination Therapy and Open Surgery

Objective: To assess the role of primary open surgery versus the recommended combination approach (percutaneous and lithotripsy) to treat staghorn calculi in a developing country. Patients and Methods: Available records (n = 91) of patients with staghorn managed during the last 4 years were retrieved. Patients were placed in two groups, open surgery and combination group, according to the primary procedure chosen by the patient. Demographic data in two groups was comparable in most of the respects except that renal failure patients were more in the combination group. Stone clearance, major residue, auxiliary procedures, morbidity, hospital stay and the cost were studied in the two groups for comparison. Results: Complete clearance could be obtained in 66 and 59% with open and combination method respectively. Major residue (>16 mm²) was present in 21% of open and 38% of the combination group. In patients with primary stone burden <900 mm², the total clearance rates were 66 and 60% in open and combination group, respectively. Total clearance was not affected by caliceal dilatation, total stone burden, pelvic and caliceal bulk separately or their ratio, as arrived by logistic regression analysis. The incidence of haematuria in the combination group was marginally higher, probably due to more renal failure patients in this group. Hospital stay in the two groups was comparable (13.0 days in combination vs. 12.1 days for open). The cost of treatment with combination group was significantly higher. Conclusion: Open surgery for staghorn is still an economically viable option for difficult stone disease, specially in a developing country, with comparable efficacy, favourable morbidity and hospital stay.

Stratégie diagnostique postnatale des uropathies malformatives dépistées avant la naissance

Background. — The increasing experience with prenatal ultrasonographic diagnosis allows detection of more and more mild urinary tract anomalies. Thus, the clinical significance of many pyelectasis detected before birth is not known. Patients and methods. — From a retrospective study of 78 patients, we determined the positive predictive value (PPV) of prenatal ultrasound findings for urinary tract malformations. Results. — This PPV was 27.3% when the prenatal pelvic dilatation was isolated, but grew up to 100% if a caliceal dilatation was associated. Renal pelvic diameter in the third trimester of pregnancy could predict the degree of post-natal renal impairment, as pelvic size was 6.7 ± 2.15 mm for the post-natal pyelectasis group, significatively smaller than 13.4 ± 3 mm in the ureteropelvic junction obstruction group (grade I) and than 17 ± 9 mm in other pathological renal units. On the other hand, antenatal ultrasound had a bad sensibility for vesico-ureteral reflux detection, four primary reflux among 14 being detected without homolateral antenatal ultrasound anomaly. Conclusion. — According these results, we propose a post-natal diagnostic strategy. Urological explorations are performed when the prenatal renal pelvic diameter is larger than 10 mm. If the postnatal ultrasound shows an isolated pyelectasis below this level, a clinical follow-up is advised, the parents being informed of the possibility of vesico-ureteral reflux and of the necessity to perform a cytobacteriological exam of urines in case of unexplained fever.

ABC of urology. Urinary stone disease.

Most patients with urinary stones have microscopic haematuria detected by routine urine analysis. An absence of red cells in the urine suggests an alternative diagnosis. #### Presenting features of urinary stone disease An x ray film of the kidneys, ureters, and bladder shows the position and size of the kidneys as well as the presence of any calculi, which usually obstruct at the pelviureteric junction, the point where the ureter crosses the iliac arteries at the pelvic brim, or the vesicoureteric junction. All patients suspected of having a urinary stone should then have intravenous urography, although renal ultrasonography is acceptable in patients who are either allergic to contrast medium or pregnant. Obstruction may be detected by the delayed appearance or persistence of the nephrogram phase on the intravenous urogram or by the finding of caliceal dilatation in an ultrasound scan. #### Differential diagnosis of renal colic Renography after injection of technetium-99m mercapto acetyltriglycine is not routinely used and …

ABC of Urology: UROLOGICAL EMERGENCIES IN GENERAL PRACTICE

Some urological conditions that are seen in general practice should be considered to be emergencies. Conditions that may need urgent treatment Although some stones remain asymptomatic, most will give rise to pain at some time. However, despite their size, staghorn calculi are often painless because of their inability to move within the renal collecting system. Narrow points in upper urinary tract The symptoms resulting from renal and ureteric stones can be predicted from a knowledge of the likely site of obstruction. Renal colic usually starts abruptly with flank pain, which then radiates around the abdomen as the stone progresses down the ureter. Typically pain is felt in the testes in male patients and the labia majora in female patients. Physical signs of renal colic In male patients the external genitalia and testes must be examined so that testicular torsion can be excluded, and a rectal examination may be necessary to rule out other diagnoses. The investigation of a patient with suspected renal colic should begin with routine urine analysis. Some patients have frank haematuria, but the rest have microscopic haematuria. If the results of urine analysis are normal then an alternative diagnosis should be considered. Patients suspected of having a stone should have intravenous urography unless they have a history of allergy to contrast media or are pregnant (renal ultrasonography is useful in these circumstances to show caliceal dilatation on the affected side). Differential diagnosis of renal colic Initial management is directed towards controlling the …

Insulin-Like Growth Factor Improves Renal Architecture of Fetal Kidneys with Complete Ureteral Obstruction

Others have previously demonstrated that the administration of insulin-like growth factor-I accelerates recovery from ischemic acute tubular necrosis in the rat kidney. We investigated the effect of insulin-like growth factor-I on the histology of unilaterally obstructed kidneys in the pouch young of the North American opossum, Didelphis virginiana. In this model complete unilateral ureteral obstruction reliably induces statistically significant degrees of caliceal dilatation, tubular cystic change, and cortical and medullary fibrosis in kidneys examined 1 week after the creation of complete obstruction. Cortical and medullary inflammation is also increased after 1 week of obstruction in this model but not to a degree that is statistically different than control (sham operated) animals. We administered insulin-like growth factor-I to opossum pups with complete unilateral obstruction created at a length of 5 cm. (age 25 days, human equivalent 18 to 20 weeks). Insulin-like growth factor-I (400 mcg./kg.) was injected subcutaneously on the day of operation and again on days 2 and 4 postoperatively. The animals were sacrificed 1 week after obstruction and the formalin fixed, paraffin embedded kidneys were assessed histologically. In the obstructed kidney insulin-like growth factor-I ameliorated the development of fibrosis (cortical and medullary) and caliceal dilatation such that these characteristics did not differ significantly from those of sham operated animals. Tubular cystic change in the obstructed kidneys was also decreased by insulin-like growth factor-I administration but not to significant levels. Insulin-like growth factor-I treatment in obstructed animals resulted in significantly more inflammation (cortical and medullary) than in the sham operated animals. We also administered insulin-like growth factor-I to normal pups with no other intervention. These insulin-like growth factor-I treated pups did not differ from sham pups for any characteristic studied. Our study suggests that there is a protective effect of insulin-like growth factor-I on renal architecture when administered in the setting of experimental fetal ureteral obstruction.

Insulin-like growth factor improves renal architecture of fetal kidneys with complete ureteral obstruction.

Others have previously demonstrated that the administration of insulin-like growth factor-I accelerates recovery from ischemic acute tubular necrosis in the rat kidney. We investigated the effect of insulin-like growth factor-I on the histology of unilaterally obstructed kidneys in the pouch young of the North American opossum, Didelphis virginiana. In this model complete unilateral ureteral obstruction reliably induces statistically significant degrees of caliceal dilatation, tubular cystic change, and cortical and medullary fibrosis in kidneys examined 1 week after the creation of complete obstruction. Cortical and medullary inflammation is also increased after 1 week of obstruction in this model but not to a degree that is statistically different than control (sham operated) animals. We administered insulin-like growth factor-I to opossum pups with complete unilateral obstruction created at a length of 5 cm. (age 25 days, human equivalent 18 to 20 weeks). Insulin-like growth factor-I (400 mcg/kg.) was injected subcutaneously on the day of operation and again on days 2 and 4 postoperatively. The animals were sacrificed 1 week after obstruction and the formalin fixed, paraffin embedded kidneys were assessed histologically. In the obstructed kidney insulin-like growth factor-I ameliorated the development of fibrosis (cortical and medullary) and caliceal dilatation such that these characteristics did not differ significantly from those of sham operated animals. Tubular cystic change in the obstructed kidneys was also decreased by insulin-like growth factor-I administration but not to significant levels. Insulin-like growth factor-I treatment in obstructed animals resulted in significantly more inflammation (cortical and medullary) than in the sham operated animals. We also administered insulin-like growth factor-I to normal pups with no other intervention. These insulin-like growth factor-I treated pups did not differ from sham pups for any characteristic studied. Our study suggests that there is protective effect of insulin-like growth factor-I on renal architecture when administered in the setting of experimental fetal ureteral obstruction.

Fate of Clinically Insignificant Residual Fragments after Extracorporeal Shock Wave Lithotripsy with EDAP LT-01 Lithotripter

The stone-free rate of 248 cases of clinically insignificant residual fragments (CIRF) was 32.7% by 1 month, 73.0% by 3 months, and 92.7% by 6 months of follow-up. The stone-free rate decreased but not remarkably in accordance with the increment of the caliceal dilatation (92.9%, 94.9%, 85.7%, and 83.3% for no, mild, moderate, and severe dilatation, respectively) by 6 months of follow-up. The clearance of the CIRF was not influenced by their location, the pelviocaliceal angle, the infundibular length, or the number of the lower calices. Of 16 patients who had residual stone fragments at 6 months and underwent an additional session of extracorporeal shock wave lithotripsy (SWL), 12 became stone free by another 6 months of follow-up. Therefore, it is desirable to wait for clearance of CIRF for at least 6 months before offering further treatment, regardless of their location and anatomic variation of the calices containing CIRF. Repeated SWL, even for stone fragments of 3 to 4 mm in diameter found initially 1 month after the last session of SWL, might promote clearance of the CIRF, and additional SWL for persistent CIRF could be an appropriate adjunctive measure.

Intravenous Urography versus Ultrasonography in Evaluation of Women with recurrent Urinary Tract Infection

Intravenous urography and ultrasonography were compared prospectively in 120 women with recurrent urinary tract infection. The median age was 44 years (range 15-85). There was good correlation between the two methods in detecting hydronephrosis, calculi greater than or equal to 5 mm, and major post-pyelonephritic scarring. Urography was superior in detecting small cortical scars, slight caliceal dilatation, and less than or equal to 4 mm calculi. Based on the good results, low cost, and absence of radiation hazards or contrast media reactions, we conclude that ultrasonography may replace urography when a radiological screening of the upper urinary tract is deemed necessary in women with recurrent urinary tract infection.