Urography Research Articles

Сравнительная оценка эффективности коррекции дилатации чашечно-лоханочной системы почек в условиях применения различных вариантов дренирования верхних мочевых путей

Introduction. Upper urinary tract (UUT) obstruction remains a socially significant problem due to its high frequency and serious pathogenetic consequences. Dilation of calyx-pelvic system (CPS) remains one of the pathognomonic manifestations of this condition, which should be immediately corrected. Percutaneous puncture nephrotostomy, internal stenting, and ureteral catheterization are the most commonly used methods for draining the upper urinary tract. However, the problem of choosing a drainage method in a specific clinical situation based on the criterion of the effectiveness of elimination of CPS dilatation has not yet been resolved. Purpose of the study. Comparative analysis of the efficiency of drainage of the upper urinary tract under the conditions of the use of three alternative methods –распредеpercutaneous puncture nephrostomy, internal stenting and ureteral catheterization – followed by substantiation of the choice in a specific clinical situation according to the criterion of the effectiveness of correction of the dilatation of the CPS. Materials and methods. We included in this study 300 patients with obstruction of the upper urinary tract due to urolithiasis, oncourological and oncogynecological pathology. The presence and resolution of dilatation of the CPS was determined using ultrasound diagnostics and intravenous urography. Results. Percutaneous puncture nephrostomy is the most effective in treating upper urinary tract obstruction in terms of eliminating CPS dilatation, ureteral catheterization is less effective, and internal ureteral stenting occupies an «intermediate position». Conclusion. When planning and implementing the treatment of upper urinary tract obstruction, one of the main criteria should be taken into account the effectiveness of correction of the dilatation of the CPS. In a specific clinical situation in which dilatation of the PCS will be of the greatest importance, percutaneous puncture nephrostomy will be the optimal method of drainage.

Application of Nonvascular Interventional Radiology Procedures in the Treatment of Iatrogenic Ureteral Injuries

Abstract Introduction. He most common ureteral injuries are iatrogenic injuries. Diagnosis of ureteral lesions includes ultrasound, computer tomography, intravenous urography, anterograde and retrograde ureterography. For a definitive diagnosis it is necessary to determine the existence of the extralumination of contrast media from the ureter. Minor ureteral injuries can be treated with nonvascular interventional radiology procedures. Case presentation. We have presented two patients with iatrogenic ureteral injuries. Injury in the first patient occurred at the sigmoid colon resection and partial resection of the bladder, whereas in the second patient the lesion was formed as a result of cesarean section. In both patients, there was a history of previously conducted interventions, clinical picture included fever and pain, a diagnosis was made by intravenous and anterograde urography. Patients were treated with interventional radiology procedures and they have been definitely cured. Conclusion. Methods of nonvascular interventional radiology can be successfully applied in the treatment of minor iatrogenic ureteral injuries.

Post- hysterectomy Transient Hydronephrosis: A Prospective Study

Objective: To determine the incidence and importance of transient asymptomatic hydronephrosis following total hysterectomy. Materials and methods: In a prospective study over 4 year, 368 women were studied who had undergone a total abdominal or vaginal hysterectomy. Totally, 95% of operations were done for benign diseases (abnormal uterine bleeding, chronic pelvic pain, uterine prolapse, etc.) and 5% were performed for uterine malignancy. Renal ultrasonography was performed before and 3, 7 and 28 days after the surgery for diagnosing hydronephrosis. Intravenous urography was performed in patients with either persistent/progressive or symptomatic hydronephrosis. Results: There was no intraoperative identifiable ureteral injury. Hydronephrosis was seen in 35 (9.5%), 21 (5.7%), and 1 (0.27%) patients at days 3, 7 and 28 after the operation, respectively. The degree of hydronephrosis was graded I, II or III. Considering the frequency and severity of hydronephrosis, the right kidney was affected more. Hydronephrosis correlated significantly with indication, duration and route of surgery as well as patient's age. All kidneys improved spontaneously, except one case which needed ureteral stenting with no surgical intervention (p=0.05). Conclusion: Transient hydronephrosis could occur after simple total hysterectomy despite the absence of any obvious intraoperative ureteral injury. It is noted in 9.5% of the patients within three days after the non-complicated surgery. The clinical course may be continued until one month.

Association of neural tube defects with congenital abnormalities of the urogenital system in a Chinese cohort

BackgroundThis study aimed to retrospectively analyze the correlation between congenital abnormality of the urogenital system and various factors in children with neural tube defects (NTDs).MethodsA total of 190 children with congenital NTDs, who were admitted to a hospital from May 2013 to May 2018, were included into the present study. All admitted children with congenital NTDs were carried out routine abdominal B-ultrasound examinations to determine the malformations of the abdominal organs, including the urinary system. Children with a B-ultrasound result of suspected and unsure malformation underwent intravenous pyelography (IVP) and voiding cysto-urethrography (VCU), and this was further confirmed by the CT results.ResultsThe incidence of urogenital malformation was 12.1% (23/190) in children with congenital NTDs. For the 23 children with urogenital malformations, most of these children had no definite urinary system symptoms, while some of these children had multiple incidences of urinary system infections.ConclusionsCongenital NTDs are often combined with urogenital malformations, if not specifically searched these may be overlooked. The early detection of these malformations is beneficial to reduce the risk of operation and improve the prognosis.

Recurrent hydronephrosis and spontaneous renal rupture caused by lymphoplasmacytic inflammation in a cat

A seven-year-old male cat that was previously diagnosed with – and treated for – left hydronephrosis due to suspected idiopathic proteinaceous materials in the renal pelvis, presented with a short history of anorexia and vomiting. The abdominal ultrasound revealed bilateral hydronephrosis, and the intravenous pyelography showed a moderate amount of free fluid in the retroperitoneal space at 48 hours. After the nephrectomy, the gross examination of the right kidney revealed a very thin capsule with urine leakage, and the right renal pelvis showed small, black deposits. The histopathology of the right kidney revealed hydronephrosis with compression atrophy, necrosis of the renal cortex/medulla, and a moderate lymphoplasmacytic inflammation. The crystallographic analysis revealed that the black deposits were composed of 100% protein and no minerals. The cat was diagnosed with hydronephrosis and spontaneous renal rupture caused by proteinaceous pelvic materials, secondary to the idiopathic renal lymphoplasmacytic inflammation. In addition to revealing the possibility that immune-mediated renal disease can induce spontaneous renal rupture in cats, this case report demonstrates the utility of imaging for diagnosing and monitoring hydronephrosis, detecting urine leakage, and planning surgery.

The Outcome of Transurethral Electro-Endoscopic Resection of Orthotopic Single System Ureterocoeles in Adults Nigerians.

Endoscopic transurethral electro-incision and resection are minimally invasive options for treating adult single system ureterocoele. Vesicoureteral (VU) reflux is frequently associated with ureterocoeles and can complicate the treatment. The literature on endoscopic management isscanty from sub-Saharan Africa. This study aimed to describe the technique and outcome of adult patients who had transurethral incision and or deroofing of orthotopic single system ureterocoele. This was a prospective study on patients who presented with single system ureterocoeles. All were diagnosed either by computerized axial tomography urography or intravenous urography and were followed up and monitored for resolution of symptoms, development of urinary tract infection, and ureterovesical reflux. The patients' demographic information such as their age, sex, details of endoscopic treatments, complications on follow-up were entered into Excel and analyzed using SPSS version 21. There were eighteen ureteric units managed in 10 patients with single system ureterocoeles. The male: female ratio was 3:2. The 30-39-year age group (four; 40%) and 60-69year age groups (four; 40%) had the highest frequency. Six (33.33%) had calculi, and 83.30% presented with lower urinary tract symptoms (LUTS). Nine (50%) of the ureteric systems had transurethral deroofing of ureterocoele (TUDU), while eight (44.4%) had transurethral incision of ureterocoele (TUIU). Urinary tract infection was the commonest complication. Ureterovesical reflux was present in two and two developed refluxes after TUDU. The patients with refluxes had antibiotics with the resolution of the ipsilateral symptoms. All had preserved renal function. VU reflux inpatients that underwent endoscopic incision or deroofing for single system ureterocoele is infrequent and can be managed conservatively. It is an effective treatment for single system ureterocoeles and has minimal complications.

Congenital Anomalies of the Upper Urinary Tract: A Comprehensive Review.

The upper urinary tract is the most common human system affected by congenital anomalies. Congenital anomalies of the kidneys and ureters comprise a wide spectrum of disorders ranging from simple variants with no clinical significance to complex anomalies that may lead to severe complications and end-stage renal disease. They may be classified as anomalies of renal form, which are subclassified as structural anomalies (eg, persistent fetal lobulation, hypertrophied column of Bertin, and dromedary hump) and fusion anomalies (eg, horseshoe kidney and pancake kidney); anomalies of renal position (eg, renal malrotation, simple renal ectopia, and crossed renal ectopia) and renal number (eg, renal agenesis and supernumerary kidney); and abnormalities in development of the urinary collecting system (eg, pyelocaliceal diverticulum, megacalycosis, ureteropelvic junction obstruction, duplex collecting system, megaureter, ectopic ureter, and ureterocele). US is usually the first imaging modality used because of its low cost, wide availability, and absence of ionizing radiation. Intravenous urography and voiding cystourethrography are also useful, mainly for characterization of the collecting system and vesicoureteral reflux. However, intravenous urography has been replaced by CT urography and MR urography. These imaging methods not only allow direct visualization of the collecting system but also demonstrate the function of the kidneys, the vascular anatomy, adjacent structures, and complications. Comprehension of congenital anomalies of the upper urinary tract is crucial for an accurate diagnosis and correct management. The authors discuss the spectrum of these anomalies, with emphasis on embryologic development, imaging findings, clinical manifestations, and complications. Online supplemental material is available for this article. ©RSNA, 2021.

Ureteric injuries during cancer surgery presentation and management over a 20-year

Background: Iatrogenic ureteral injury rare 0.3-1.5%. complication of abdominopelvic cancer surgery. We aimed to study the risk and management of ureteral injury among cancer patients. Methods: Diagnosis can be achieved retrograde pyelography, ureteroscopy, CT, or intravenous urography. Results: Years 2000 to 2020, 2904 patients in the Department of Surgical oncology, Assuit University, and 47 ureteral injury cases were identified. (1.62), 4/231 cervical cancer, 9/611 ovarian cancer and 7/462 endometrial cancer.,11/818 colon cancer,12/620 rectal cancer, 1/11 prostatic cancer, 3/151 retroperitoneal sarcoma. 34% (radical abdominal hysterectomy 8.5% Wertheim hysterectomies 4%), colorectal surgery colectomy 25.5%, low anterior resection2.1% in radical prostatectomy and 6.4% in retroperitoneal tumor, intraoperative diagnosis 48.9%, 8.5% in laparoscopic surgeries, the distal third (53.2%),23.4% catheterization, complete transection 31.9%; partial 14.9%, ligation 8.5%, laceration in 19.1%, resection. 8.5%; and devascularization in 17%. Fever in 14.9%, abdominal or flank pain in 38.5%. Oligura in 6.4%, ileus in 19.3%, urinary leakage (vaginally or via abdominal wound) in 10.6% rise creatinine in 10.6%, hydronephrosis in 6.4%, urinoma in 27.7%, extravasation in 8.5% asymptomatic in 4.3%, 40.4% percutaneous nephrostomy. 19.1%primary repair Ureteroneocystostomy in (17%) Boari flap in 12.7%, Psoas hitch in 23.4% stenting in 14.9%, 8.5% ileum interposition, anastomosis to contralateral ureter in 4.3%, ureteral stricture 6.4%, ureterovaginal fistulas in 10.6%, acute renal failure 2.1%, peritonitis 4.3, urinary tract infection in 14.9%.Conclusions: The recognition and immediate repair of ureteral injuries early during the same procedure was highly desirable and to avoid a second operation.

Totally intracorporeal robotic ileal ureter replacement: focus on surgical technique and outcomes.

Background Aim of the study was to describe our totally intracorporeal robotic ileal ureter replacement technique, reporting perioperative and mid-term results and compare it with previous similar experiences, specifically focusing on technical considerations. Methods Three patients were submitted to robotic ileal ureter substitution for long ureteral defects in our institution during 2019. The procedures were carried out fully intracorporeally. Two patients received a complete replacement of the urinary tract using an ileal segment, while in one patient the lower ureteral stump was maintained, and an ileal-ureter anastomosis was performed distally. Patients' baseline characteristics, as well as, perioperative and mid-term results were collected. A detailed description of the technique is reported and compared with prior similar experiences. Results Median operative time was 270 (range 240-300) min. No Clavien-Dindo complications >2 were collected. All patients experienced a fast return to oral intake and canalization. Antegrade pyelography, performed a 1-month follow-up, revealed full passage of the medium contrast in those patients submitted to complete ileal ureter replacement while, in the third one, stenosis at the level of ileal-ureter anastomoses was found. Conclusions Robotic ileal ureter replacement can be performed completely intracorporeal with optimal results and limited complication rate, in selected cases. According to our considerations, specific surgical steps are needed to reduce the risks related to this procedure, including avoiding partial ileal substitution.

Nephrectomy in a Patient with Medullary Sponge Kidney Associated with Severe Nephrocalcinosis and Nephrolithiasis: A Rare Condition

Background: Medullary sponge kidney (MSK) is a disturbance of renal development characterized by cystic dilation and diffuse precalyceal duct ectasia. The disease affects both genders in equal proportions and is generally diagnosed in adulthood, as a result of recurrent calcium nephrolithiasis and nephrocalcinosis. The most frequently encountered manifestations being renal colic, microscopic or macroscopic hematuria, and fever. The intravenous pyelogram is standard for diagnosis and metabolic workup is required to identify the underlying cause. The main goal of treatment is to prevent recurrence and disease progression. Though considered a benign condition, a nephrectomy may often be required in patients presenting late with irreversible complications and end-stage renal disease. Aim: To highlight and discuss the presentation and management of a rare case of nephrocalcinosis and nephrolithiasis secondary to the medullary sponge kidney. Case presentation: We report herein the case of a 56-year-old male with long-standing hematuria in whom a diagnosis of medullary sponge kidney disease was made and he underwent a left total nephrectomy. The postoperative course was uneventful. Conclusion: Nephrocalcinosis and nephrolithiasis are complications of MSK and can result in irreversible renal damage. A high index of suspicion is necessary for patients presenting with renal colic, recurrent urinary tract infections, or hematuria for prompt diagnosis and management.

Design microstructure fibers as sensor for protection against x-ray abdominal region exposure

Abstract In this research, two crystalline optical fiber sensors were designed to detect an X-ray exposure dose for the abdominal cross-section imaging. Use solid crystal fibers in the design. A sensor is designed to detect abdominal X-ray radiation where the X-ray doses are high, (computerized tomography (CT), intravenous pyelography (IVP), barium enema (low X-ray GI), study of the upper digestive system with barium). Optical crystal fiber (PCF) was used to detect the intensity of X-rays, the first design was the diameter of the crystal fiber 127.5 μm, while the second design reduced the diameter to 60 μm. The results showed the photon crystal fiber fractionation increases the sensitivity of detecting all variable X-ray doses. We tested the first design by exposing a bundle of the abdominal X-ray to the abdominal segment and proven successful in sensitivity and sensitivity (3.04 nm/mSv). To improve the sensor's work, we developed a second design by reducing the diameter of the crystalline fibers (the waist) to fibers, which proved successful in the few ranges that we could not sense in The first design and we got a sensitivity (1.002 nm/mSv).

Sonographic Evaluation of Hydronephrosis in Pediatric Patients and Correlation with Intravenous Urography

Introduction: This cross sectional study was carried out with an aim to evaluate the accuracy of ultrasonography (USG) in the evaluation of hydronephrosis (HDN) in pediatric age group. Methodology: The study was carried out from January 2017 to November 2017 in the Department of Radiology and Imaging, Sir Salimullah Medical Collage and Mitford Hospital, Dhaka. Eighty two patients aged from 1-18 years, admitted as suspected HDN were included as study subject. Result: In this study, the mean age of the patients was 6.31 (±3.34) years and 46.3% belonged to 5 years age group. Male and female ratio was approximately 2:1, 55 (67.1%) were male. Regarding the presenting complains, loin pain was most common (81.7%) feature. Recurrent urinary tract infection (URI) was observed in 52.4%, hematuria in 29.3%, flank mass in 18.3%, vomiting in 2.4% of the study patients. In every patient, with proper clinical evaluation, renal function test was done. After admission, in every patient USG and IVU was done in every patient. In IVU, it was found that 25.6% of cases had left sided HDN, 24.4% right sided HDN and 31.7% both sided HDN. In USG, out of 93 HDN cases in IVU, 85 were correctly diagnosed. The sensitivity was 91.4%. Out of 71 non-obstructed kidneys on USG, 68 were correctly assigned as non HDN, the specificity was 95.8%. Conclusion: This study findings showed USG to be a sensitive screening technique for excluding urinary tract obstruction.

Long-term results of augmentation ileocystoplasty in spinal cord injury patients.

IntroductionThe aim of this article was to report the long-term results of increased ileocystoplasty in 58 patients with spinal cord injury (SCI) with an impact on overall renal function and quality of life. In a representative number of patients, where we followed individual subjects for more than 20 years, we wanted to determine their quality of life and preservation of renal function after surgery.Material and methodsAfter unsuccessful conservative therapy of urinary incontinence, increased ileocystoplasty was performed. In addition to biochemical analysis, intravenous urography (IVU) was performed preoperatively (urography and/or ultrasound assessment of the upper urinary tract) and urodynamic tests were performed in all patients preoperatively.ResultsAfter a follow-up of patients within the group (>20 years), 2 patients reported being incontinent. The median elapsed time of action was 20 (13–24) years. Vesical capacity increased in all cases postoperatively when the median vesical capacity was 420.0 (387.5–460.0) ml (p <0.001). Long-term complications included use of bladder chambers, kidney stones and urosepsis. Creatinine clearance confirmed satisfactory renal function after the elapsed time period from surgery.ConclusionsThe results confirmed that augmentation ileocystoplasty had excellent long-term outcomes in the definitive therapy of refractory neurogenic detrusor overactivity in patients with SCI.

Indications and techniques of mr urography

Magnetic Resonance Urography (MRU) provides a comprehensive assessment of both morphology and function of the urinary system by using various sequences of T1W, T2W, 2D and 3D. T1W and T2W 2D images are optimal to evaluate the morphology of the kidneys and the urinary tract. Fast gradient echo 3D T1W sequence with the use of fat saturation technique (Fatsat or Dixon sequences), gadolinium administration, diuretic maneuver, and maximum intensity projection allows visualization of the urinary tract similar to that of conventional intravenous urography. MRU is also helpful in investigating renal function based on the hemodynamic study of contrast medium. Recent data prove that MRU, except for the study of renal calculi, is not inferior to computed tomographic urography (CTU) in evaluating diseases of the urinary system such as neoplasm, malformation and obstruction. MRU is an alternative to CTU when CTU is contraindicated. This article aims to review the techniques of MRU to optimize visualization of the urinary system and their indications in daily practice. Key words: MRU, MR hydrography, MR dynamic

English

BACKGROUND Urinary stone disease is major health problem affecting 2 – 3 % population worldwide, and is more commonly seen in the working age group (30 - 60 years) of society. X-ray, USG, CT, and IVU are diagnostic modalities available to us. IVU is still being requested by clinicians as diagnostic tool for urolithiasis but we need to reassess the importance of this modality as it seldom makes a difference in the management decision and outcome. METHODS Medical records of 184 patients who underwent ureteroscopic pneumatic lithotripsy from 2016 to 2019 for lower ureteric calculus were reviewed retrospectively. All patients of lower ureteric calculus (n = 184) were included in study; of which 130 patients had undergone USG and x-ray as pre-operative imaging; 54 underwent CT / IVU in pre-operative imaging along with USG and Xray. Stone free rate, complication, requirement of repeat procedure, and post op fever were compared and analysed. RESULTS Results were analysed in view of the need of second look surgery, post op fever, complication, and Stone Free Rate (SFR). The majority of patients who underwent URSL were with lower ureteric calculus 184 (43.8 %), upper ureteric 145 (34.5 %), middle ureteric 70 (16.7 %) and multiple 21 (5 %). The mean stone size of lower ureteric calculus was 10.4 ± 3.8 mm. Stone free rate for with URSL for lower ureteric calculus was 88 %, upper ureteric calculus 60 %, middle ureteric calculus 68 %. Overall SFR was 69.5 %. SFR in patients with imaging group was 61 % whereas in patients who didn’t undergo imaging was 77.83 %; this difference is statistically significant with a p-value 0.0003 (&lt; 0.05). The complication rates were group I 106 (50 %) and group II 95 (45.6 %) and the difference is not statistically significant. In patients with imaging study (CT and IVU) done in the pre-op period the average hospital stay is 3.89 ± 1.23 days. CONCLUSIONS IVU has a limited clinical role, and its use should be strictly limited to highly select cases and can be avoided in straight forward cases. Similarly, CT can also be avoided in straight forward cases of lower ureteric calculus as it doesn’t provide any added advantage in terms of decreasing intra-op complication and SFR. KEYWORDS Computed Tomography, Intravenous Urography, Stone Free Rate, Stone Migration, Re Procedure

Flexible Cystoscopy a Valuable Diagnostic Lool for Lower Urinary Tract Pathology

Objective: To assess the role of flexible cystoscopy in the diagnosis of lower urinary tract pathology and its suitability as a routine diagnostic protocol in outdoor patients. Methods: The cross sectional study was conducted at the advanced centre of kidney diseases and urology, Dhaka central international medical college, Dhaka from Jan 2016 to jan2019. All adult patients presenting with lower urinary symptoms to outdoor department were included. Flexible Cystoscopy was performed as a outdoor based procedure without sedation. Results: Of the 249 patients in the study,198(79%) were male and 51(21%) were female. Lower urinary tract pathologies were found in 192(72%) patients. The most common pathology among males was enlarged prostate 56(31%) patients. Urethral stricture, bladder neck high were found 23(11%),21(10%) respectively. Among females, urethral stenosis was the most common pathology in 23(32%)patients. Transitional cell carcinoma was seen in 11(4.4%) patients having hematuria with inconclusive ultrasound and intravenous urography. .All patients tolerated the procedure well with no procedure related complaints. Conclusion: Flexible cystoscopy is an effective, well tolerated and easy way of detecting lower urinary tract pathologies. It can alter the management as well as support the diagnosis and management. It is also helpful in routine surveillance of bladder tumours of low grade and low stage. Flexible cystoscopy should therefore be used as routine diagnostic protocol in outdoor practice. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.151-153

Combined Intravenous Urogram and 68Ga-PSMA PET/ CT for Improved Staging and Restaging of Prostate Cancer.

Staging/restaging of prostate cancer utilizing Gallium-68 (68Ga) prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) in combination with an intravenous urogram allows improved discrimination between radiotracer activity in the renal tract and small pelvic nodes or local recurrences. Within this pictorial essay, we describe the imaging protocol utilized at our institution and present cases which demonstrate the utility of this combined imaging approach.

Effectiveness of Ureteric Reimplantation on Non-Refluxing Obstructive Congenital Megaureter

Background: One in ten thousand children born with megaureter. A significant portion of this groups are of obstructed variety and the rest are refluxing ureter. It can cause obstructions and back pressure renal damage. Early diagnosis and treatment can stop deterioration of renal function and prevent complications like renal failure. Definitive treatment is uretero-neocystostomy with or without tailoring the ureter. Objective: Objective of this study was to observe the effectiveness of ureteric reimplantation on non-refluxing obstructive congenital megaureter. To achieve this objective we had observed serum creatinine level pre and postoperatively and assessed structural changes in kidney by ultrasonogram, IVU, MCU and RGP pre and postoperatively. We also observed the split renal function and split GFR of the affected kidney both pre and post operatively. Methods: This was a cross-sectional observational study. This study comprise of 35 cases of congenital non-refluxing obstructed megaureter, who were admitted in BIRDEM General Hospital and multiple other hospitals in Dhaka city from July 2013 to December 2014. Diagnosis was made by intravenous urography (IVU) reveling a dilated lower third or entire ureter with narrow tapering lower end. Obstruction was also confirmed by diuretic Tc99m DTPA scan. A voiding cystourethrogram was obtained to exclude VUR. Those with poor renal function were evaluated by ultrasonography, DTPA scan and retrograde ureteropyelography. Results: Of 35 patients, 20 were male and 15 were female. Age range 2 to 19 years. All patients underwent ureteric reimplantation, with tailoring in 15 cases. Post-operative mean serum creatinine was 0.99±0.34 which showed improvement. Split function in DTPA renogram and split GFR of patient with POM in the affected right side also showed improvement (29.49±4.02 and 29.64±4.86) as well as affected in left side (27.77±4.18 and 28.02±5.31). Conclusion: Ureteral tailoring with an extravesical ureteral reimplantation can be performed safely and effectively for primary obstructive megaureter. It is found that, ureteroneocystostomy ensured free renal drainage and preserved renal function as well as prevented complications and further deterioration. Bangladesh Journal of Urology, Vol. 21, No. 1, January 2018 p 20-24

Ultrasound to address medullary sponge kidney: a retrospective study

BackgroundMedullary sponge kidney (MSK) is a rare disease characterized by cystic dilatation of papillary collecting ducts. Intravenous urography is still considered the gold standard for diagnosis. We identified a cohort of patients from our outpatient clinic with established diagnosis of MSK to outline some ultrasonographic characteristics that may help establish a diagnosis.MethodsWe conducted a retrospective study of patients seen between January 1st 2009 and January 1st 2019 in our clinic. Out of 4321 patients, 18 had a diagnosis of MSK. We reviewed their clinical and family history, laboratory data and imaging studies. Specifically, we focused on ultrasound imaging.ResultsPatients were referred to our outpatient clinic because of renal impairment (44%), family history of nephropathy (17%), nephrolithiasis or an established diagnosis of MSK (39%). Seventy-two percent of patients presented with chronic kidney disease, 22% required hemodialysis. Urinary tract infections (44%), nephrolithiasis (33%), microscopic hematuria (50%) and proteinuria (44%) were reported. Seven patients underwent computed tomography; all of them received ultrasound. Ultrasound examination showed bilateral renal cysts, usually small and located in the renal medulla, and microcalcifications located in the medulla or within the cysts.ConclusionWe identified a peculiar tetrad associated with MSK: 1) hypoechoic medullary areas, 2) hyperechoic spots, 3) microcystic dilatation of papillary zone, 4) multiple calcifications (linear, small stones or calcified intracystic sediment) in each papilla. The presence of this diagnostic tetrad, added to laboratory data and clinical history, could be helpful in the differential diagnosis to identify patients with MSK.

Obstipation leading to urethral obstruction and uroabdomen in a dog

An 11-month-old entire female bulldog mix was presented for stranguria and pollakiuria of several days duration which had progressed to anorexia and abdominal pain. A diagnosis of uroabdomen was made...