Excretory Urography Research Articles

Excretory urography can track down morphological changes in the urinary bladder associated with urachal anomalies in calves for early diagnosis.

To investigate radiographic detection by excretory urography of morphological changes in the urinary bladder associated with urachal anomalies in calves. Excretory urography was performed to detect morphological changes in the urinary bladder of 13 calves, of which 6 were nondysuric with swelling of umbilical region and 7 were dysuric without clinical umbilical swelling from November 2022 through April 2024. The urinary bladder was delineated in all 13 calves after excretory urography. The aspect ratios (length:height), which objectively evaluate the shape of the urinary bladder, ranged from 1.08 to 2.43 (1.90 in average) and 1.34 to 11.89 (4.75 in average) in nondysuric and dysuric calves, respectively. The ratios of calves with nondysuric were significantly lower than those of dysuric (P < .05). Excretory urography could play an important role in evaluating abnormal morphological changes due to urachus anomalies in the urinary bladder of calves. Among calves with dysuria, urachal anomaly should be included in the differential diagnosis. Excretory urography is proposed as an alternative option for early diagnosis among calves presenting with dysuria to improve livestock productivity.

(Uro)genital developmental disorders

Congenital anomalies of the urogenital tract are common, whereas isolated developmental disorders of the genital organs are rare and varied. The type and timing of imaging to characterize these developmental disorders and the planning of any treatment are the subject of discussion. The aim of this article is to provide a brief overview of embryology, diagnostic procedures, and examples of findings. The primary procedure for imaging the genitals is sonography, which must be performed with appropriate empathy. In addition to the genitals, the general situation of the kidneys and urinary tract should be examined, as urogenital malformations are often combined. Dedicated magnetic resonance imaging (MRI) is indicated as advanced imaging in interdisciplinary consultations. Invasive procedures, such as genitography combined with micturition cystourethrography (MCU) using X‑rays or contrast-enhanced sonography, are rarely required. Computed tomography (CT) or excretory urography play no role. Imaging plays an important role in the assessment of genital anomalies. Knowledge of embryology facilitates anatomical understanding and the assessment of pathologies.

Optimal intestinal graft selection for reconstruction of extended ureteral stricture: an animal model study

Introduction. The prevalence of patients with extended ureteral strictures has been steadily increasing over the past decades. When it is not possible to perform reconstruction with the tissues of the urinary system, the best solution is intestinal replacement plasty. However, despite the great world experience, the search for the optimal method of intestinal reconstruction does not stop, which determines the relevance of conducting an experimental prospective study.Objective. To evaluate morphological changes in renal parenchyma after ureteral replacement reconstruction by segments of small and large intestine.Materials &amp; methods. Fifteen white giant rabbits (6-months-old, weighing 5 kg) were divided into three groups. Group A (n = 5) underwent small intestine [ilealplasty] replacement plasty. Group B (n = 5) double-flap ileoplasty using the Yang-Monti technique. Group C (n = 5) – large intestine [coloplasy] ureteral reconstruction. Before the operation and before withdrawal from the experiment, the level of creatinine and electrolytes was assessed, kidney ultrasound was performed on days 2, 5, 10. Excretory urography was performed to assess the patency of the anastomoses. Animals were withdrawn from the experiment from day 10 to 30. The material used for morphological study included kidneys from the operated and intact sides, proximal and distal anastomoses.Results. No increase in creatinine level, metabolic disorders were detected in animals. According to ultrasound data, hydronephrosis developed in all animals on day 2 and remained unchanged during the entire follow-up. Group A: no complications were detected. Histologically, the renal parenchyma showed moderate signs of chronic inflammation, single foci of lymphoid infiltration, but there were no irreversible processes in the form of necrosis and sclerosis. Group B: complications — stricture in the anastomosis area of the detubularised fragments and necrosis of the small intestine due to compression of the mesentery by the graft vascular stem. Histologically there were marked dilatation of the tubules at all levels, enlargement of the Bowman-Shumlansky capsule, as well as signs of moderate inflammatory process, there were hydropic and hyaline-droplet dystrophy, tubular necrosis foci. Group C: complications — accumulation of a significant amount of grit, mucus, and fibrin in the colocystoanastomosis area. Histologically, the renal parenchyma showed a marked inflammatory process, in particular, purulent inflammation with demarcation zones, infiltration with polymorphonuclear leukocytes and bacterial cells, foci of necrosis and sclerosis of both stroma and tubules, dilatation of tubules and Bowman-Schumlansky capsules.Conclusion. The use of an unchanged ileal-graft reconstruction of an extended ureteral defect showed acceptable histological results in an animal model, which confirms the feasibility of its use in clinical practice. The absence of foci of necrosis and fibrosis in the renal parenchyma indicates the preserved functional potential, which suggests the stabilization of renal function in the long term.

Vesicoureteral reflux-stenosis: an approach to diagnosis and treatment

Vesicoureteral reflux-stenosis is a malformation of the urinary system in which reflux is combined with a narrowing of the distal ureter at the site of its confluence with the bladder. At the same time, the diameter of the lumen of the formed rigid section of the narrowed ureter is sufficient for the occurrence of reflux, but not enough for normal emptying of the upper urinary tract, which leads to the development of a reflux megaureter. Histologically, the wall of the narrowed ureter is characterized by the presence of fibrosis, atrophy of the submucosal layer and the absence of neuromuscular elements of the ureterovesical junction. Diagnosis of reflux stenosis should include mycological cystography and intravenous excretory urography, the results of which, in addition to reflux itself, often determine the “beak symptom” – narrowing in the distal ureter; cystoscopy, which reveals narrow ureteral mouths without peristalsis; computed tomography with contrast enhancement; ultrasound examination of the kidneys and ureters on a urethral catheter with a diuretic test – an increase in the volume of the upper urinary tract by more than 30% of the initial values indicates the presence of stenosis. To clarify kidney function, the study is supplemented with static nephroscintigraphy. The most preferable option is a staged surgical treatment – the narrowed distal ureter is bujured and a ureteral stent is installed for a period of 1 month. While maintaining reflux, according to the data of microvascular cystography, endoscopic plastic surgery of the ureteral mouth is performed. In case of ineffectiveness of minimally invasive interventions, they proceed to Cohen’s neoimplantation of the ureter with resection of the distal ureter and, if necessary, with straining of the enlarged ureter.

Receiver operating characteristics of computed tomography (CT) compared to cystoscopy in diagnosis of canine ectopic ureters: Thirty-five cases.

The aim of the study was to determine receiver operating characteristics (ROC) of computed tomographic excretory urography (CTEU) in predicting cystoscopic findings of ureteral anatomy. Retrospective cohort study. Thirty-five client-owned dogs. The medical records of dogs referred for suspected ectopic ureters were reviewed. Inclusion criteria included CTEU findings reported by board-certified radiologists, followed by rigid cystoscopy with or without ureteral cystoscopic laser ablation (CLA). Data included signalment, urinary incontinence degree, body condition score, weight, degree of colon distension, CTEU and cystoscopy findings. ROC analysis was used to compare CT-predicted ureteral orthotopia/ectopia to cystoscopy findings. Additionally, ROC of CT predicted ureteral orifice locations was analyzed. Regression covariate analysis was performed to identify factors that may have influenced accuracy of diagnosis. The ability of CT to identify a normal and intra-or extramural ectopic ureters conclusively and correctly was 13/26 (50%) and 32/41(78%), respectively. Sensitivity and specificity of identifying extramural versus intramural ureters was 2/7 versus 30/46 (29 vs. 65%) and 61/63 versus 17/24 (97 vs. 71%), respectively. Ectopic orifice determination sensitivity and specificity varied widely depending on location from 0% to 76% and 67% to 97%, respectively. Covariate analysis failed to identify interfering factors. CT did not accurately predict anatomy of ureters; CT findings may need confirmation by cystoscopy and possibly intraoperative fluoroscopy prior to determining if CLA is indicated or not. Our results may be of importance for surgeons interpreting the CTEU findings. CTEU prediction of the location of the ureteral orifice shows low sensitivity especially in or close to the urethral sphincter area.

Laparoscopic intracorporeal ileal ureter replacement: multi-institutional data from 102 patients

Objective To present long-term results of our laparoscopic intracorporeal ileal ureter replacement (LIUR) cohort, including more complex cases of laparoscopic ileocalycostomy. Material and methods We collected records of patients undergoing LIUR. Follow-up included a chemical profile and urine cultures. Imaging consisted of renal ultrasonography, excretory urography, cystography, and computer tomographic or magnetic resonance urography. Results One hundred and two patients were included. Stricture location was left (46.1%), right (39.2%), or bilateral (14.7%). No open conversion was performed. Seventy-four patients (72.5%) underwent a total ureteral unit removal. The mean operative time was 289.4 (120 – 680) minutes. The estimated blood loss was 185.2 (10–400) mL. Three patients had intraoperative complications, and fifteen had early postoperative complications. The mean postoperative hospital stay was 12.2 (7–35) days. The mean follow-up duration period was 37.7 (12–162) months. Most patients’ follow-up was uneventful (88%), and seven patients presented with Grade 2 late complications. Conclusions Intracorporeal laparoscopic ileal ureteral replacement in cases of extensive ureteral lesions offers optimal long-term outcomes and a low complication rate. Ileocalycostomy constitutes a viable option in the small group of patients with long proximal ureteral strictures and intrarenal pelvis.

Imaging after kidney transplantation in childhood and adolescence

The ultrasound (US) examination is the most important imaging procedure in the clinical care of children with chronic kidney disease, the assessment before kidney transplantation and in the acute and chronic phase after successful kidney transplantation. In trained hands, particularly with experience in Doppler sonography, US ensures that vascular complications, such as occlusions, thrombosis, stenosis as well as non-vascular complications, e.g., urinary tract dilatation, abscesses, hematomas, urine leaks or lymphoceles, are cost-effectively and rapidly diagnosed at any time. For the diagnosis of acute rejection, the US signs in the intraindividual course are only suggestive, but not specific. The gold standard for the diagnosis of acute rejection is a kidney biopsy. In these cases, US serves to exclude other causes. The use of multimodal techniques, various Doppler techniques and microvascular procedures, such as superb microvascular imaging (SMI) or B‑flow and contrast-enhanced ultrasonography (CEUS), optimizes the imaging in the context of transplantations in children. Magnetic resonance imaging with diffusion-weighed imaging (DWI), magnetic resonance angiography (MRA) and magnetic resonance urography (MRU) as well as functional MRU (fMRU) performed with the administration of gadolinium-containing contrast agents, are part of the extended diagnostics and possibly necessary for surgical planning in the early phase after kidney transplantation and for long-term assessment after transplantation. Excretory urography is associated with ionizing radiation and intravenous administration of iodine-containing contrast medium and is obsolete in children. Computed tomography (CT) using age-adapted and weight-adapted dose protocols is an alternative in emergencies if MRI is not available.

Dual-energy computed tomography in reducing the effective radiation dose of computed tomography urography in patients with urinary calculi.

To evaluate the diagnostic performance of split-bolus single-phase dual-energy computed tomography (DECT) with virtual non-contrast computed tomography (VNCT) compared to three-phase computed tomography (CT) urography in patients with urinary calculi, and to examine the performance of split-bolus single-phase DECT when reducing the effective dose. A total of 48 patients with abdominal pain or hematuria suggestive of unilateral urinary calculi were enrolled and randomly divided into the experimental and control groups, with 24 cases in each group. Patients in the experimental group underwent split-bolus single-phase DECT to obtain a mixed nephrographic excretory phase. Patients in the control group accepted a single-bolus three-phase CT urography scan (non-contrast, nephrographic phase, and excretory phase). The CT values and the contrast-to-noise ratio (CNR) of 7 segments of the urinary tract were measured and compared between the two groups by using the Mann-Whitney U test. The dose-length product (DLP) and effective dose of each patient were compared between the two groups using an independent t-test. Among all 48 patients, 35 calculi were detected in the experimental group (n=24), and 47 calculi were detected in the control group (n=24). There was no significant difference between the two groups in both CT value measurements and the CNR. The mean DLP and mean effective dose of the experimental group were significantly lower than those of the control group, and the effective dose in the experimental group was decreased by 40% compared with the control group. The application of DECT combined with split-bolus nephrographic excretory phase CT urography can reveal the urinary calculi covered by a contrast medium and also reduce the effective dose exposure to patients.

Effectiveness of urethral endosphincteroplasty in children with urinary incontinence, myelodysplasia, and epispadias

BACKGROUND: Periurethral injections of various materials in the treatment of stress urinary incontinence have been known since 1938. In the literature, we could not find reports of endosurgical correction of urinary incontinence as the main method of treatment in children with myelodysplasia and epispadias and a pathogenetically based examination algorithm to predict the result of the injection, taking into account the endoscopic technique and volume of the injected drug.&#x0D; AIM: To present an assessment of long-term results, i.e., correction of stress urinary incontinence in children with myelodysplasia and epispadias, after endoimplantation of a stable synthetic volume-forming polymer.&#x0D; MATERIALS AND METHODS: The study analyzed 38 patients (517 years old) with urinary incontinence with myelodysplasia and epispadias: boys and girls with epispadias (n = 9 and n = 3, respectively) and with myelodysplasia (n = 10 and n = 16), respectively. For diagnostic purposes, clinical and instrumental (excretory urography, cystography, cystoscopy, uroflowmetry, electrophysiological, and urodynamic) examination methods were used. To correct incontinence, intra- and paraurethral endoinjections of a stable polyacrylamide mesh polymer with silver ions were performed.&#x0D; RESULTS: According to the literature, the effectiveness of the intraurethral administration of stable implants with urinary incontinence in catamnesis for up to 12 months reached 50%; with longer follow-up, positive results did not exceed 40% of observations. In this study, complete retention of urine was achieved in 25 (66%) children. Satisfactory result (incontinence in the afternoon up to 40 mL) was observed in 8 (21%) children, and unsatisfactory in 5 (13%) children.&#x0D; DISCUSSION: Indications for endosphincteroplasty in children with stress incontinence having myelodysplasia and epispadias with a stable implant should be determined considering urodynamics, blood circulation, innervation, and functional (urethral profilometry) parameters in the detrusor-sphincters-pelvic floor system.&#x0D; CONCLUSIONS: In patients with myelodysplasia and epispadias with isolated insufficiency of urethral sphincters, surgical treatments can be performed independently, and their effectiveness can reach 70%.

Рентген-эндоскопическое лечение облитерации уретерорезервуароанастомоза после перенесенной ортотопической пластики мочевого пузыря

Strictures and obliterations of ureteral anastomosis after radical cystectomy with orthotopic neobladder reconstruction occur in 8-13% of cases, mainly in the first 2 years after surgery. According to the European Association of Urology guidelines, open reconstruction is considered the "gold standard" for the treatment of those patients. At the same time, according to various publications, X-ray endoscopic treatment of ureteral anastomotic strictures can be performed, especially in patients who have undergone orthotopic neobladder reconstruction.Three clinical cases of endoscopic treatment of ureteral anastomotic obliteration after orthotopic neobladder formation are presented. In all patients, nephrostomy tube was initially put due to acute pyelonephritis. Obliteration of the ureteral anastomosis was diagnosed by contrast-enhanced multispiral computed tomography and antegrade pyelography. The length of obliteration in all patients did not exceed 1.0 cm. The recurrence of the bladder cancer was excluded. After percutaneous opacification of the pelvicalyceal system and advancement of two guidewires ("working" and "safety") to the level of ureteral obliteration, a catheter with a built-in fiber optic light source was put in antegrade fashion along the "working" guidewire to the area of obliteration. During transurethral inspection of the reservoir, the distal end of the light source was visualized and the reservoir wall was cut "to the light" using electrosurgery (n=2) and a thulium fiber laser (one case). For adequate kidney drainage, two internal stents of 6 Fr were put for a period of 6 months in two patients and for 2 months in another case.All patients had an adequate diameter of the ureteral anastomosis after removal of the stents. In two cases, an adequate passage of the contrast agent through both ureters was maintained for 42 and 37 months after procedure (according to the follow-up computed tomography and excretory urography). One patient had an attack of acute pyelonephritis 2 months after the removal of internal stents due to recurrent stricture. After repeated endoscopic ureteral recanalization with putting of two internal stents for a period of 6 months, no recurrence of the stricture was observed during 28 months of follow-up.Endoscopic treatment of both primary and recurrent short ureteral anastomotic obliterations in patients with orthotopic neobladder allows for adequate ureteral patency, provided that two internal stents are left in place for 6 months.

Combination of plastic surgery of the pyeloureteral junction with kidney transposition and nephropexy in hydronephrosis of a dystopic kidney

Introduction. Obstruction of the pyeloureteral junction is the most common anomaly of the upper urinary tract. Irrespective of the causes, narrowing of the ureteropelvic junction leads to abnormal urine outflux, increased intrarenal pressure, gradual sclerosis of renal parenchyma, loss of kidney function. In some cases, obstruction of the ureteropelvic junction can be accompanied by dystopic kidney, nephroptosis, abnormal location of the main and accessory renal vessels which requires correction of the standard surgical treatment.The study objective is to evaluate the effectiveness of combination of laparoscopic pyeloplasty with kidney transposition and nephropexy in obstruction of the pyeloureteral junction of a dystopic kidney.Materials and methods. Medical records of 8 patients who underwent surgery in the Kracnoyarsk Regional Clinical Hospital between 2017 and 2021 were analyzed. Obstruction of the pyeloureteral junction was confirmed clinically by ultrasound of the kidneys, excretory retrograde pyelography, contrast-enhanced spiral computed tomography.Results. In all of the 8 patients, lumbar dystopia of the affected kidney was diagnosed, in 25 % pathology was accompanied by nephroptosis, in 50 % of cases by abnormal location of the main and accessory renal vessels. All patients underwent laparoscopic plastic surgery of the pyeloureteral junction per Anderson–Hynes with antegrade ureter stenting, kidney transposition, nephropexy. Mean operative time was 190 ± 39 min, no intraoperative blood loss was observed. Ureteral catheter was removed at day (6.3 ± 2.2). Hospital length of stay was 9.3 ± 3.7 days. In 1 patient, postoperative period was complicated by suture breakage in the posterior wall of the pyeloureteral anastomosis which required repeat laparoscopy to correct suture defect. Time of ureteral stent implantation was 34.6 ± 8.5 days. Control examination showed full remission of pain syndrome. Excretory urography showed full outflow of the contrast agent after examination with furosemide in 100 % of cases.Conclusion. Combination of laparoscopic plastic surgery of the pyeloureteral segment with kidney transposition and nephropexy is an effective minimally invasive operation for treatment of ureteropelvic junction stricture of a dystopic kidney.

Unilateral Renal Agenesis in Kitten

Background: The kidneys are a pair of organs that maintain homeostasis, and perform hormonal and excretory functions; the functional unit of the kidney is the nephron. Approximately 2% of cats are born with some structural or functional anomaly, which occurs during fetal development. Unilateral renal agenesis is a rare congenital anomaly in felines, where the cat has only one kidney. This can lead to a series of dysfunctions, with clinical signs, especially when the contralateralorgan does not adequately compensate, since there is more than one concomitant congenital disease like kidney dysplasia, which is the abnormal formation of the kidney structures. This study aimed to report the case of a kitten diagnosed with unilateral renal agenesis; the clinical signs, diagnosis, and treatment.Case: A 2-month-old mixed breed female kitten, weighing 0.5 kg, was attended in a veterinary clinic with emesis, hyporexia, hypodipsia, normuria, and diarrhea. Upon physical examination, dehydration, hyperthermia, and renomegaly by abdominal palpation were observed. Complementary examinations such as serum urea and creatinine estimation, abdominal ultrasound,and excretory urography, were requested, and the results include hemoglobin (9 g/dL), mean corpuscular volume (26%), normocytic normochromic anemia, urea (312 mg/dL), and creatinine (3.5 mg/dL). The abdominal ultrasound showed renomegaly on the left kidney and the absence of the right kidney. The above results and excretory urography help to confirm the diagnosis of unilateral renal agenesis and suggested renal dysplasia. The patient was hospitalized to stabilize her condition. The treatment is symptomatic and supportive and aims to increase the patient’s quality of life. Treatment with metoclopramide, erythropoietin, fluid therapy with ringer’s lactate solution, and renal therapeutic feed was prescribed. After 4 days of hospitalization and treatment, the serum creatinine was within normal parameters for the species and the animal showed no more clinical signs. She was discharged and was treatment continued at home. After 36 days, the patient returned for reevaluation: the tutor reported that the patient did not present with episodes of emesis, was active, with normodipsa and normuria, and via abdominal palpation, therewas no renomegaly of the left kidney; serum creatinine and urea levels were below and within the reference values, respectively.Discussion: Unilateral renal agenesis is a rare congenital anomaly in small animals and is characterized by the absence of one of the kidneys; in felines, its etiopathogenesis remains unclear. When the clinical signs are present, these are similar to those of chronic kidney disease. The most frequent signs are weight loss, polyuria and polydipsia, hyporexia or anorexia, emesis, halitosis, gastroenteritis, and gastric ulcers; some of them were presented by the patient in this study. Serum urea and creatinine levels are important to evaluate if there are alterations in the remaining kidney, which was detected in the initial examination. The diagnosis is made through imaging tests such as ultrasonography and excretory urography, used in this case for diagnosis. The treatment is symptomatic and supportive and aims to increase the quality of life of the patient. An antiemetic should be prescribed for patients with emesis, and the most used are maropitant, metoclopramide, and ondansetron. The diet must be changed; to reduce azotemia, therapeutic meals that aid renal functions are recommended. Unilateral renal agenesis is a rare anomaly in small animals, which can cause damage to the animal. Understanding this damage is essential in determining of the conduct by the veterinarian. Keywords: kidneys, azotemia, congenital, anomaly, feline. Título:Agenesia renal unilateral em gatinha Descritores: rins, azotemia, congênita, anomalia, felino.

Comparison of static-fluid or excretory magnetic resonance urography with computed tomography urography for visualization of nondilated renal pelvises and ureters in healthy Beagles.

To assess the usefulness of magnetic resonance urography (MRU) for the visualization of nondilated renal pelvises and ureters in dogs and to compare our findings for MRU versus CT urography (CTU). 9 healthy Beagles. Dogs underwent CTU, static-fluid MRU, and excretory MRU, with ≥ 7 days between procedures. Contrast medium was administered IV during CTU and excretory MRU, whereas urine in the urinary tract was an intrinsic contrast medium for static-fluid MRU. For each procedure, furosemide (1 mg/kg, IV) was administered, and reconstructed dorsal plane images were acquired 3 minutes (n = 2) and 7 minutes (2) later. Images were scored for visualization of those structures and for image quality, diameters of renal pelvises and ureters were measured, and results were compared across imaging techniques. Excretory MRU and CTU allowed good visualization of the renal pelvises and ureters, whereas static-fluid MRU provided lower visualization of the ureters. Distention of the renal pelvises and ureters was good in excretory MRU and CTU. Distention of the ureters in static-fluid MRU was insufficient compared with that in CTU and excretory MRU. Distinct artifacts were not observed in CTU and excretory MRU images. Static-fluid MRU images had several mild motion artifacts. Our findings indicated that excretory MRU with furosemide administration was useful for visualizing nondilated renal pelvises and ureters of dogs in the present study. When performing MRU for the evaluation of dogs without urinary tract dilation, excretory MRU may be more suitable than static-fluid MRU.

Complex beam diagnostics of nephroptosis in adults

The informativity of the ultrasonic examination, intravenous excretory urography, radioisotopic renography in the diagnosis of nephroptosis is studied. It is shown that the combined use of radiation methods makes it possible to establish the nephroptosis degree, to reveal the disorders of uro- and hemodynamics and to determine the choice of treatment tactics.

Conventional uroradiology with excretory urography: a forgotten art?

Excretory urography (EU) had been the most frequently performed imaging modality for uroradiology in the past. With the advances in ultrasonography, and development of cross-sectional urography with CT and MRI, EU is now seldom performed. Consequently, there has been a decline of expertise in this technique. However, EU has multiple advantages such as dynamic nature, easy availability, low cost and radiation burden. These render it potentially very valuable in specific indications like congenital anomalies, urothelial lesions and urinary leaks. This review intends to emphasize the current day relevance of excretory urography, outline the key points of the technique, and describe the pearls and pitfalls of interpretation.

Magnetic resonance imaging in diagnosis of complications of kidney and ureteral injury in different periods of traumatic disease

To assess the possibility of magnetic resonance imaging in diagnosis of complications of kidney and ureteral injury in different periods of traumatic disease. There were 139 patients with kidney and ureteral injuries between 2015 and 2019. We clarified the MR-signs of renal complications in different periods of traumatic disease. We analyzed the effectiveness of MRI in identification of renal complications compared to ultrasound, excretory urography, computed tomography, intraoperative and follow-up data. High diagnostic accuracy of MRI for early and late manifestations of traumatic disease was demonstrated.

CHARACTERISTICS OF CERTAIN INDICES OF MINERAL METABOLISM IN CHILDREN WITH KIDNEY CALCULI

The aim: To study the violations of bone density indices in patients with kidney calculi. Materials and methods: 175 children with different types of kidney calculi were examined and treated in Ivano-Frankivsk Regional Children’s Consultative Polyclinics and Hospital, from 2016 to 2019 inclusively. Comprehensive metabolic panel involved by means of generally accepted biochemical methods. Sonography of the urinary tract was carried out. Voiding cystourethrography and excretory urography were performed. Bone mineral density was evaluated by means of ultrasonic densitometry. Statistical processing of the obtained data was carried out according to standard methods of variation statistics. Results: In patients with kidney calculi, oxaluria and oxalate-calcium nephropathy (60.0% and 30.0%, p &lt;0.05) occurred most frequently. Signs of syndrome of undifferentiated connective tissue dysplasia - postural malformation (50.0%), thoracic kyphosis (25.0%), and stigmas of dysembryogenesis (25.0%) were noticed. In the majority of children with oxalate-calcium nephropathy, levels of the bone alkaline and acid phosphatase isoenzymes in a blood serum were significantly high, indicating severity of the resorption and disorders in development of the bone tissue. In these children, decreased fraction of ionized calcium, hypomagniemia and hypophosphatemia were observed. Conclusions: Children with oxalate-calcium nephropathy are in group of risk for osteopenic syndrome.

Twinkle artifact in renal ultrasound, is it a solid point for the diagnosis of renal stone in children?

Background: Twinkle artifact, also known as color Doppler comet-tail artifact, occurs behind very strong, granular, and irregular reflecting interfaces such as crystals, stones, or calcification. This is visualized as a random mixture of red and blue pixels in the high-frequency shift spectrum located deep to the interface. Study results have suggested that the sonographic twinkling artifact may aid in the detection of renal stones with a variety of reference standard imaging modalities, including abdominal radiography, excretory urography, gray-scale sonography, and CT. Material and methods: Our retrospective observational study included children who had undergone abdomen/renal ultrasound for kidneys stones in our radiology department between 2013 and 2019. Presence of the twinkle artifact, and stone numbers and sizes were documented. CT examinations done <3 months prior to or after US were retrospectively assessed to confirm the presence of kidney stones as a reference standard. Results: Thirty-three abdominal renal US scans of 33 patients (21 males, 12 females) fulfilled the entry criteria. The interval between the US and CT was <3 months for all patients. The median overall age of the patients was 4 years (IQR: 3.125, range: 1– 165 months), The median number of days between the US and CT was 13 (IQR: 26, range: 0–81 days). US detected 33 hyperechoic foci suspected to be stones; 26 were confirmed as true positive (i.e. showed the twinkle artifact and were seen in CT), 4 were false positive (showed the twinkle artifact but were not seen in CT), and 3 were false negative (did not show the twinkle artifact but were seen in CT). The overall median stone size was 2 mm in the right kidney, and 5 mm in the left kidney (IQR: 6,11 mm), respectively. Twinkle artifact sensitivity was found to be 89.7% (95% CI 39.574%–90%). The twinkle artifact was assessed in all true-positive stones, determining a relatively high PPV of 26/29 (86.7%) for the twinkle artifact. The twinkle artifact was not dependent on stone size. Specificity for the twinkle artifact could not be calculated due to a lack of true negatives. Conclusion: The twinkle artifact is a sensitive US tool for detecting pediatric kidney and ureter stones, but with a small risk of false positive findings.

Bilateral ectopic ureteroceles complicated by a large calculus within the left ureterocele in a dog

AbstractA 4‐year‐old, entire female Siberian husky was presented with a history of urinary incontinence since she was a puppy and intermittent haematuria. A diagnosis of bilateral ectopic ureteroceles, calculus in the left ureterocele and bilateral pyelectasia was made by ultrasonography and CT excretory urography. The ureters were visualized communicating with opacified oblong structures, both located in the bladder neck, and the left one extended into the urethra. Resection of ureteroceles, neoureterostomy and calculus removal was performed. The dog made an uneventful recovery and was discharged from the hospital after 36 hours. A 2‐week course of antibiotic treatment was followed (marbofloxacin). Chemical analysis of the calculus revealed that it was composed of struvite. Treatment is mandatory at the time of diagnosis to prevent chronic kidney injury and urolithiasis secondary to obstructive uropathy. To the best of our knowledge, this is the first description of bilateral ectopic ureteroceles associated with calculus in a dog.

Laparoscopic pyeloplasty of the pyeloureteral segment: our experience

The OBJECTIVE of the study was to analyze the results and to introduce our experience of the laparoscopic pyeloplasty regarding the stricture of the pyeloureteral segment.METHODS and MATERIALS. Our study represents results of treatment of 114 patients who had surgical treatment during the years 2013–2018. In that period, we made 114 primaries and 9 secondaries laparoscopic pyeloplasties with transperitoneal access. In this account, there were 43 men aged from 19 to 64 years, average age was (34.9±3.7), and 71 women aged from 19 to 77 years, average age was (39.2±4.2). All patients underwent ultrasound examination of the kidneys on the day of discharge and 3-5 days after stent extraction. Control examination, which included history taking, examination, clinical and biochemical blood analyses, clinical urine analysis and ultrasound of the kidneys were performed after 3 months. Plain and excretory urography were performed 6 and 18 months after surgical intervention. RESULTS. Operative removal of the stricture of the pyeloureteral segment was successful in 105 (92.2 %) out of 114 cases. 9 patients (7.8 % of the total number of operated patients) underwent repeated laparoscopic pyeloplasty. Duration stay after primary laparoscopic pyeloplasty was from 3 to 5 days, on average (3.9±0.7) days. Postoperative period after secondary pyeloplasty was without complications, the bed-day was from 3 to 6 days, on average (4.3±0.6) days.CONCLUSION. Our opinion is that the optimal method for surgical treatment of patients with primary and secondary strictures of the pyeloureteral segment is laparoscopic pyeloplasty. This kind of surgery has a favorable security profile and optimal postoperative results. Considering the possible causes of relapse of the stricture of the pyeloureteral segment, we came to the conclusion that the frequency of relapse is mainly connected with selected suture material, which determines the severity of scar changes.