Urography Research Articles

Radiolucent Calculi in Kidneys on Intravenous Urography: Red Color on Dual-Energy Computed Tomography Clinches the Final Diagnosis

Radiolucent Calculi in Kidneys on Intravenous Urography: Red Color on Dual-Energy Computed Tomography Clinches the Final Diagnosis

Clinical outcome of intravenous urography-assisted shockwave lithotripsy for radiolucent ureteral stones

ObjectiveWe aimed to compare the clinical outcome of intravenous urography-assisted fluoroscopy-guided shockwave lithotripsy for radiolucent ureteral stones and standard shockwave lithotripsy for radiopaque ureteral stones. MethodsWe retrospectively reviewed 734 patients with ureteral stones treated by fluoroscopy-guided shockwave lithotripsy between March 2014 and March 2021. The primary outcome was a stone-free rate with one session within 30 days, defined as no residual stones without auxiliary treatment. Multivariate analysis was used to examine whether intravenous urography use predicted treatment success. Furthermore, we compared the outcomes using propensity score matching. ResultsNinety-eight patients underwent intravenous urography use protocol (Group I), and the remaining 636patients underwent non-intravenous urography protocol (Group N). Stone-free rates with one session within 30 days were 37.8% and 31.7% in groups I and N, respectively (p=0.20). No statistical differences were observed in the conversion rate to ureteroscopy (p=0.26) and complication rate (p=0.70) between Group I and Group N. One patient who developed skin redness was considered a complication of the contrast medium. Propensity score matching examined 88 matched pairs. Treatment success was obtained in 31 (35.2%) patients in Group I and 33 (37.5%) patients in Group N (p=0.88) within 30 days with one session. ConclusionsRadiolucent stones can be safely and effectively treated by shockwave lithotripsy with intravenous urography.

Pattern of IVU among patients presenting with flank pain at a tertiary hospital in Rivers State

Background: Intravenous urography (IVU) is a contrast based radiological procedure for the investigation and imaging of the urinary system. It was the gold standard, not until the last two decades when CTU (computed tomography urography) took over. The latter is better because of its improved accuracy in the diagnosis of urinary tract pathologies. Flank pain is a sensation of discomfort or distress in the part of the body below the rib and above the ilium. The possible organs in the flank to be affected include kidney and ureter. Aim This study is aimed at finding out the IVU findings in patients presenting with flank pain in a tertiary hospital in the southern part of Nigeria. Study design and settings: A retrospective study was conducted in the Radiology Department of Rivers State University Teaching Hospital (RSUTH) from 1st February 2021 to 10th February 2023. Data Analysis: Data was analyzed using SPSS 20.1 version. The level of statistical significance was set at p<0.05. Results: A total of 100 data was analyzed. Patients between the age of 5 years and 76 years with a mean age of 39.72 + 14.33 years was used for this study. Majority of the age group was greater than 41years of age with an equal male to female distribution. That is the ratio of female to male in this study is 1:1. The study shows that more patients had abnormal IVU patterns than normal. More females had normal IVU patterns while abnormal IVU patterns were more common in males. The study also shows that the ureters were more affected than the kidneys because we had more abnormal IVU pattern in the ureter than the kidney. Conclusion: The age group with the highest abnormal IVU pattern is the greater than 41years group, probably because they were more in number in the study population and again may be, we can say the frequency of diseases increases with increasing age.

Urinary incontinence in a male dog with an ectopic ureterocoele remnant associated with ipsilateral renal agenesis and cryptorchidism

AbstractA 2‐year‐old, male, neutered labrador retriever with a previous diagnosis of left renal agenesis and left cryptorchidism presented for investigation of mild intermittent urinary incontinence. Abdominal ultrasound, intravenous urography and retrograde positive‐contrast urethrocystography were performed, identifying an unusual fluid‐filled structure, confluent with the left side of the prostate gland. Histopathological diagnosis, following surgical excision, was an ectopic ureterocoele remnant. Urinary incontinence temporarily improved following surgery, but subsequently recurred. A presumptive diagnosis of urethral sphincter mechanism incompetence, in addition to the ectopic ureterocoele remnant was given. Dogs with renal agenesis typically have an absent ipsilateral ureter; however, this report demonstrates an ipsilateral ectopic ureterocoele remnant, a condition rarely reported in veterinary medicine. Multiple ipsilateral genitourinary deformities should be suspected and investigated in animals presenting with any urogenital developmental abnormality. Clinical significance of ectopic ureterocoele remnant in male dogs with urinary incontinence should however be carefully evaluated, and other causes (e.g., urethral sphincter mechanism incompetence) should be considered.

Arterial Embolization: A Superior Treatment for Massive Urinary Tract Bleeding in Emergency Care

Objective: To analyze the effect of arterial embolism (AE) in patients with massive urinary system bleeding (MBUS). Methods: From September 2018 to September 2023, 175 cases of MBUS patients in the emergency department of the hospital were randomly selected and divided into groups according to the length of stay. Among them, 85 cases (September 2018 – September 2020) underwent bladder irrigation treatment with aluminum potassium sulfate solution through a catheter (Group A), and 90 cases (October 2020 – September 2023) underwent AE treatment (Group B). The treatment effects of the two groups were compared. Results: The treatment effectiveness of Group B is higher than that of Group A (P < 0.05). The urinary hemoglobin level of Group B is lower than that of Group A at 1, 6, 12, and 24 hours after treatment (P < 0.05). Among the 90 cases treated with AE, 7 cases had a fever, with body temperatures ranging from 37.3°C to 38.9℃, with a mean temperature of 38.2 ± 0.3℃. Four cases experienced local pain, nausea, and vomiting, while two cases of intra-iliac AE showed transient buttock pain. These patients with adverse reactions were treated symptomatically for 7 days. All patients recovered after treatment. Intravenous urography of 87 patients in June showed that the renal pelvis and calyces were in good condition, the renal function returned to normal, and the blood urea nitrogen and blood creatinine test results were within the normal range. After 1 year of follow-up, no hypertension occurred. Conclusion: AE treats MBUS patients in the emergency department with remarkable efficacy. It has the advantages of less damage to the body, rapid hemostasis, high safety, and maximum preservation of organ function.

Modified percutaneous nephropexy for nephroptosis: Technical description and short-term results

Abstract Objectives Percutaneous nephropexy (PCN) has been demonstrated as a feasible method for treating nephroptosis. This study describes an improved technique for PCN that better addresses the issue of nephroptosis. Materials and methods We reviewed 4 patients who underwent the improved PCN procedure between January 2021 and January 2023. These patients were diagnosed with nephroptosis, with 1 case having both a narrow ureteropelvic junction and nephroptosis due to a kidney stone, and 3 cases having simple nephroptosis. Patient characteristics, perioperative data, and follow-up results were collected. Surgical success was determined by symptom relief (subjective success) and the absence of kidney descent by intravenous pyelography (objective success). Results Preoperative computed tomography urography showed that all patients had hydronephrosis, with severe hydronephrosis in 75% (3/4) and moderate hydronephrosis in 25% (1/4) of cases. The mean operative time was 63.8 minutes (range, 45–95 minutes), and the mean blood loss was 5 mL (range, 5–50 mL). The mean length of hospital stay was 4.5 days (range, 3–6 days). The mean time to removal of the nephrostomy tube was 2 months (range, 1–4 months). No serious complications (Clavien-Dindo grade ≥3) occurred during or after the procedure. The mean postoperative serum creatinine level was 54.75 μmoI/L (range, 43–65 μmoI/L). The mean follow-up time was 6.25 months (range, 4–8 months). The objective and subjective success rates were both 100%. Conclusions The improved PCN procedure that was used in this study is feasible and provides a good option for treating nephroptosis.

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. 

Retroperitoneal Mullerian Cyst of Renal Origin in a Cat - A Case report

Extreme rarely reported mullerian cysts of the retroperitoneum are considered to be a subtype of urogenital cysts. Retroperitoneal cysts can be categorized into lymphatic cysts, mesothelial cysts, enteric cysts and urogenital cysts based on embryological origin and histogenesis. The present case is an rare encounter and the successful management of the same is herewith discussed. A twelve months old intact female domestic short hair cat was presented with a history of progressive abdominal distension, anorexia, lethargy and oliguria. On abdominal palpation, an extensive globular mass was palpable in the cranial abdomen a survey radiography of the abdomen and thorax revealed a soft tissue contour at the cranial abdomen at the left renal position, thoracic radiography revealed absence of any abnormalities.  Renal functional status was ascertained with intravenous pyelography which revealed unilateral cystic dysgenesis of left kidney and agenesis of left ureter. Hematobiochemical profiles and preoperative assessment were done to rule out general organ health. Following routine  and special diagnostic procedures, an exploratory laparotomy confirmed the cystic renal distension that was excised through an unilateral nephrectomy and the cat was observed on periodic reviews to confirm any abnormalities if any which was absent and the animal had an uneventful recovery,.

Coexistence of Ureterocele with a Solitary Kidney in a Nigerian Child: Case Report

Ureterocele is a cystic dilatation in the terminal section of the ureter that is located inside the bladder, the urethra, or both. Renal agenesis refers to a congenital absence of one or both kidneys. If bilateral is referred to as classic potter syndrome, the condition is fatal, whereas if unilateral, patients can have a normal life expectancy. Unilateral renal agenesis affects approximately 1 in 500 live births while bilateral agenesis is less common affecting approximately 1 in 4000 live births. There may be a slightly greater male predilection. Radiographic studies have been valuable in diagnosing and confirming diseases in the genitourinary system. Ultrasonography, intravenous urography (IVU) and computed tomography urography (CTU) has greatly helped in evaluation of patients presenting with renal symptoms/abdominal pains. Our case study is a 9 years old male child who presented to the Radiology department for abdominopelvic CT scan/computed urography (CTU) on account of recurrent abdominal pains of two years. Previous abdominopelvic ultrasound scan done reviewed a solitary kidney with left ureterocele not in our center. However, the CT scan done in our center showed the left kidney with left ureterocele.

Changing trends in the management of posttransplant ureteric stricture

Abstract Introduction: Chronic kidney disease (CKD) is a common disease now. Diabetes and hypertension are the main cause. Renal transplant is a gold standard treatment. Posttransplant stricture is also common, and changing trends in management are emerging. Materials and Methods: It is a retrospective observational study in a tertiary care hospital in East India. The study duration was from January 2019 to December 2021. In total, 140 patients were studied, including both live and cadaveric transplants. A patient who developed posttransplant hydronephrosis or presented with acute kidney injury was evaluated with ultrasonography, intravenous urography, contrast-enhanced computerized tomography, and magnetic resonance imaging. Management was done with double J (DJ) stenting, percutaneous nephrostomy (PCN) insertion, or surgical intervention. Results and Analysis: Twelve (8.6%) patients out of 140 developed posttransplant ureteric stricture. Five (41.7%) out of 12 patients were managed with long dura DJ stenting, and five (41.7%) were managed with PCN insertion and serial follow-up. Only two (16.7%) required ureteric reimplantation. Discussion: Posttransplant ureteric stricture is a common complication following renal transplantation. Common causes are increased cold ischemia time, ureteral edema, clots, tumors, calculi, lymphocele, abscess, and hematoma. Other causes include kinking of the ureter and previously unrecognized pelviureteric junction obstruction. In the literature, the incidence of posttransplant ureteric stricture ranges from 2% to 10% in one study; and in another study, it is 1% to 9%. In our study, it is 8.6%. Conclusion: Diagnosis of the posttransplant ureteric stricture should be prompt, and management should be given as early as possible for better graft survival.

Renal Scintigraphy in Combination with Intravenous Pyelogram for the Diagnosis of Nephroptosis

Renal Scintigraphy in Combination with Intravenous Pyelogram for the Diagnosis of Nephroptosis

Radiological Anatomy Quiz: Reconstructed coronal image from a computed tomography (intravenous) urogram

Not abstract available

Combination of robot-assisted laparoscopy and ureteroscopy for the management of complex ureteral strictures

BackgroundTo summarize the efficacy of combined robot-assisted laparoscopy and ureteroscopy in treating complex ureteral strictures.MethodsEleven patients underwent combined robot-assisted laparoscopy and ureteroscopy for ureteral strictures between January 2020 and August 2022. Preoperative B-ultrasound, glomerular filtration rate measurement, and intravenous pyelography showed different degrees of hydronephrosis in the affected kidney and moderate to severe stenosis in the corresponding part of the ureter. During the operation, stricture segment resection and end-to-end anastomosis were performed using the da Vinci robot to find the stricture point under the guidance of a ureteroscopic light source in the lateral or supine lithotomy position.ResultsAll the patients underwent robot-assisted laparoscopy and ureteroscopy combined with end-to-end ureterostenosis. There were no conversions to open surgery or intraoperative complications. Significant ureteral stricture segments were found in all patients intraoperatively; however, stricture length was not significantly different from the imaging findings. Patients were followed up for 3–27 months. Two months postoperatively, the double-J stent was removed, a ureteroscopy was performed, the ureteral mucosa at the end-to-end anastomosis grew well, and the lumen was patent in all patients. Furthermore, imaging examination showed that hydronephrosis was significantly improved in all patients, with grade I hydronephrosis in three cases and grade 0 hydronephrosis in eight cases. No recurrence of ureteral stricture was observed in patients followed up for > 1 year.ConclusionRobot-assisted laparoscopy combined with ureteroscopy is an effective method for treating complex ureteral strictures and can achieve accurate localization of the structured segment.

A rare case report of multiple calculi in an adult female having cystic nephroma

A benign multilocular cyst is a benign, nondysplastic, neoplastic lesion that occurs most commonly either before the age of 4 years in males or after the age of 30 years in females. The only way to determine the diagnosis of a multilocular cystic lesion is by surgical excision. We report a case of 50 years old female with chronic left flank pain. After imaging like Ultrasonography, Intravenous pyelography, patient underwent nephrolithotomy with deroofing of the cyst under the impression of multiple renal calculi within a renal cyst. Histopathological examination showed that it was a multilocular cystic nephroma, a rare benign neoplasm of the kidney. This case report discusses the epidemiology, clinical presentation, radiological features, differential diagnosis and histopathology of this neoplasm.

Bilateral complete ureteropielocalicial duplicity associated with ectopic ureteral vaginal insertion in childhood: Case report

Ureteral duplication associated with ectopic ureteral insertion is a rare congenital anomaly clinically more common in females. Early urinary incontinence is the main symptom of ureteral ectopy in the first childhood of these patients. Contrast computed tomography and magnetic resonance imaging are the most effective imaging methods to rule out or confirm the diagnosis of ectopy associated with ureteral duplication. In cases where significant surgical functions are performed, the reconstructive surgical approach with reimplantation of the ureteral unit is the technique of choice. We present the case of a 6-year-old female patient who was diagnosed with bilateral complete ureteropielocalicial duplicity confirmed by intravenous pyelography. Confirmation of ureteral ectopy only occurred intraoperatively. The surgical correction consisted in reimplantation of the ectopic ureteral unit in the patient's bladder, since preserved renal functions evidenced in renal scintigraphy with DMSA. After performed the procedure, the patient remained asymptomatic and with normal urinary patterns. For the accomplishment of the present study, we used as data source the patient's medical records, useful for the realization of the clinical history from the diagnosis to the definitive surgical treatment that concluded the case. Ureteral duplication associated with ectopic ureteral insertion should be perfectly understood and had with a possible diagnosis for cases of urinary incontinence and recurrent urinary infections. Investigation through detailed physical examination and the use of appropriate imaging tests may help in the early detection of this rare anomaly of the genitourinary tract.

Urolithiasis: Modern Approaches to Classification, Diagnosis and Treatment

Urinary stone disease (USD) is the most common and progressive disease of the urinary system, which is characterized by frequent exacerbations and a severe course. This is a complex disease caused by various causes, in which several biochemical processes are involved, occurring not only in the urinary system, but also in the whole organism. USD depends on geographical, climatic, ethnic, dietary and genetic factors. Over the past 20 years there has been an increase prevalence of this disease. The course of USD is characterized by the acute and chronic pyelonephritis and frequent recurrence, which leads to the development of renal failure, disability and fatal consequences. Calculus can form de novo anywhere in the urinary tract. The pathophysiology of USD differs depending on the place of stone formation and depends on endogenous and exogenous factors. Urinary tract stones are classified depending on etiology, location, size, number, frequency of occurrence, and radiopacity. The main symptoms of USD are pain of various nature; microscopic hematuria; dysuria, which most often indicates the presence of a stone in the urinary bladder or a low location in the ureters; discharge of crystals of urinary salts or concretions; increased body temperature. The diagnosis of USD is based on a carefully history taking and physical examination, which allows to determine the correct direction of diagnostic approach, which include laboratory and instrumental methods of diagnosis. Ultrasound diagnosis is used as the main method for visualization of calculi, but recently non contrast-enhanced computed tomography has become the standard for the diagnosis of acute low back pain, replacing intravenous urography. The choice of treatment is based on many parameters, such as the number, size, morphology, shape, volume, mobility, hardness and location of the stones and is individualized for each patient. There are two main approaches: conservative treatment and surgic al one. Medicinal treatment of USD is used primarily to prevent the repeated formation of new stones or to increase those inclusions that are already present in the organs. Drug therapy is carried out with the aim of normalizing processes in the body, the failure of which leads to the development of pathology. However, conservative treatment has its limitations and is most often used as a symptomatic treatment. Open laparoscopic interventions are rarely used recently, minimally invasive methods are more popular: extracorporeal shock-wave lithotripsy; ureterorenoscopy; percutaneous nephrolithotomy. Taking into account the increase in the prevalence of USD in Ukraine and disability (the third place among the general spectrum of causes of disability in urological practice), the article analyzes and reviews modern approaches to classification, early and accurate diagnosis, and choosing a timely and correct method of treatment.

ASSESSMENT OF OUTCOME OF THE REPAIR OF VESICO VAGINAL FISTULA

The retrospective study was conducted in the Urology & Gynecology Department from January 2022 to January 2023 to ascertain the outcomes of VVF repair in the local population. The study was conducted on a total of 20 patients. Reno ureteric configuration in all patients was documented using intravenous urogram (IUV) renal ultrasonography. A cystogram with lateral and anteroposterior views was taken. Perioperative details were recorded, including approach (vaginal or abdominal) and interposition flap (martius flap /omentum/ local peritoneum). The procedure was successful if the patient reported continence. 6 (30%) patients had complex fistulas, and 14 (70%) had simple fistulas. In the Open technique, 13/16 (81.25%) patients had successful VVF repair, while in the laparoscopic group, 4/4 (100%) had the successful group. The average blood loss during the laparoscopic technique was 100 ml, and for open repair, 600 ml. The operative time for the laparoscopic technique was 205 minutes, and for the open technique, it was 150 minutes. The follow-up period ranged from 2 to 25 months. 3 of the 16 patients undergoing open repair had fistula recurrence; the laparoscopic group did not report any recurrence. The mean duration of hospital stay for open and laparoscopic techniques was 24 days and 10 days, respectively. Surgical VVF repair provides a definitive cure. Complex fistulas are at an increased risk of failed repair. Primary repair has the highest success rate. The outcome depends upon case selection and principles of repair.

Cervical Fibroids: A Surgical Challenge

ABSTRACT Leiomyomas are the most common benign tumors affecting the female reproductive tract and constitute around 18–20% of all the uterine pathologies that are seen in women of reproductive age group. Based on their location in the uterus, fibroids can be uterine, cervical, and ligamentary, of which the cervical fibroids are the rarest and make up only around 2–2.5% of the total incidence of fibroids. Large cervical fibroids generally give a typical appearance of “Lantern on St. Paul’s dome,” where the small size uterus sits on top of the cervical fibroid mimicking the lantern on the dome of the famous St. Paul’s Cathedral of Russia. We report here a case series of cervical fibroids who reported to the gynecology OPD of our institute. The first patient was a 41-year-old lady who presented with complaints of heavy menstrual bleeding for the last 2 years. Clinical findings as well as imaging confirmed a 24-week size large cervical fibroid along with surprise element in form of double ureters on right side on intravenous urogram(IVU). Our second patient was a peri-menopausal lady with heavy menstrual bleeding(HMB)for 2 months and cervical fibroid of 16-week size gravid uterus on examination. The third patient was a 37-year-old lady with heavy menstrual bleeding with pressure symptoms in the form of retention of urine. Clinically, a 16-week size cervical fibroid was present which after surgery revealed STUMP on histopathology. All patients were managed surgically with uneventful postoperative recovery.

Comparison between the Outcomes of Standard Percutaneous Nephrolithotomy (S-PCNL) and Mini-Percutaneous Nephrolithotomy (M-PCNL) while Treating Renal Calculi

Background: In urology, the most common disorder is represented as renal stones. Renal stones have 10% of humans reporting complaints. Their recurrence rate is very high, exhibiting approximately 70 percent recurrence rate. There have been significant advancements made in the treatment of renal stones. PCNL can be used in situations where renal stones are between 10-20 millimeters in the lower pole of a kidney and larger than 20 millimeters. Objective: This study was performed to compare the outcomes of S-PCNL and M-PCNL while treating renal calculi. Study design: A randomized control trial Place and Duration This study was conducted in Karachi Institute of Kidney Diseases Karachi from February 2022 to February 2023 Methodology: There were a total of 50 people included in this research who were equally divided into 2 groups. All of the participants were having a single unilateral renal stone which was <3cm in size. All of the included people were aged 18 years or older. Each patient underwent a physical examination as well as laboratory investigations which included urine culture, CBC, liver function, urinalysis, coagulation profile, and kidney function. There were certain imaging studies that included pelvic and abdominal ultrasonography, kidney–urinary bladder X-ray (KUB), and either intravenous pyelography (IVP) or computed tomography urinary tract (CTUT).

Demographic, Clinical and Radiological Findings among Patients with CTU Detected Urolithiasis in a Tertiary Hospital

Background: Computed tomography urography (CTU) is the current radiological imaging modality for the evaluation of the kidneys, ureters and urinary bladder pathologies. CTU has largely replaced intravenous urography in centers that has computed tomogram machines.
 Objectives: The aim of this study is to identify the common location of urolithiasis in the urinary tract and correlate it with age, sex, stone size and Hounsfield unit (HU) using CT scan in the Radiology department of Rivers State University Teaching Hospital.
 Methods: A retrospective study with descriptive study design was employed. A total of 140 patient’s data were used. A P-value below 0.05 was considered statistically significant.
 Results: One-hundred and forty patients were studied over a 24 months period. The median age was 43.50 years. The prevalence of stones (n=47, 33.6%) and age range with the highest prevalence is 41-50 years. The male: female was 1.8:1. Renal stones are commonly found in the inferior pole. Vesicoureteric junction stones were more prevalent in females. There was significant association between age and sex. (P=0.005).
 Conclusion: Urolithiasis is commonly seen in males. The location of calculi in the urinary tract is in the kidney, pelviureteric junction (PUJ), vesicoureteric junction (VUJ), ureters and the urinary bladder in a downhill order correspondingly. The inferior pole is the most prevalent site for renal stones and VUJ stones are more frequent in females while other locations are seen more in males. Interestingly, age and sex showed significant association.