Urinary Tract Lesions Research Articles

Role of diffusion weighted MR imaging in characterization of focal kidney and upper urinary tract lesions

Previous studies suggested that the apparent diffusion coefficient (ADC) value could help in the differentiation and characterization of the benign and malignant renal masses.However, there is still wide overlap in the ADC values between the benign and malignant tumors.Objectives: To retrospectively assess the usefulness of the diffusion weighted imaging (DWI) for the characterization and differentiation between benign and malignant renal masses.Methods: A total of 87 renal and/or upper ureteric masses were included in our study. The signal intensity of the lesions was assessed on both the DWI and ADC map and the ADC value was calculated. t test, ANOVA test and Receiver operating characteristic (ROC) curve analysis were performed.Results: The ADC values of benign lesions were significantly higher than those of the malignant masses [3.2 versus 1.3×10−3mm2/s], Median, P<0.0001.The sensitivity and specificity of the DWI for the differentiation of benign and malignant masses were 98% and 73% using an ADC cutoffvalue of 2.2. Clear cell renal cell carcinoma demonstrates higher ADC value than non clear cell RCC.Conclusion: DWI-MRI has a role in differentiation of benign and malignant renal masses and the characterization of different malignant categories, subtypes and grades.

Loop-Mediated Isothermal Amplification ( Lamp ) : Sensitive and Rapid Detection of Schistosoma Haematobium DNA in Urine Samples of Egyptian Suspected Cases

Schistosomiasis haemalobium is a major endemic parasitic disease in many tropical regions including Egypt. Typical infection results in haematuria, dysuria, anaemia, genital as well as urinary tract lesions, with prospect of kidney damage in complicated cases. In addition, deposited eggs in the tissue, eventually leads to squamous cell carcinoma of urinary bladder in chronically infected individuals. Microscopic detection of excreted ova in urine samples remains the gold standard diagnostic method, in spite of its inherited low sensitivity, inconsistent egg excretion and unreliable results in chronic phase of the disease. Moreover due to pre-requisite for skilled personals and pricey equipment, PCR-based technologies are of limited use especially in low-income endemic countries. So emergence of loop-mediated isothermal DNA amplification (LAMP) seemed a promising technique. Our study evaluated application of LAMP technique in detection of S. haematobium DNA in 69 urine samples of suspected patients for urogenital schistosomiasis, versus conventional urine filtration followed by microscopy ova detection method. Specificity of LAMP was tested using other parasites DNA samples that showed no cross reactivity. Furthermore our results of the calculated diagnostic parameters for sensitivity and specificity for LAMP assay were 100%, with 95% CI (88.78%-100%), and 63.16%, with 95% CI (45.99%-78.19%) respectively, moreover Positive likelihood ratio (LR+) 2.7, and Negative likelihood ratio (LR-) 0.0, which display that LAMP technique is an up-to-date simple, sensitive, diagnostic important tool that could be employed in clinical diagnosis in poorly equipped facilities, as well as in surveillance of infectious diseases. As authors knowledge, this is the first national report evaluation of LAMP technique as a promising diagnostic tool for urogenital schistosomiasis.

LOOP-MEDIATED ISOTHERMAL AMPLIFICATION (LAMP): SENSITIVE AND RAPID DETECTION OF SCHISTOSOMA HAEMATOBIUM DNA IN URINE SAMPLES OF EGYPTIAN SUSPECTED CASES.

Schistosomiasis haemalobium is a major endemic parasitic disease in many tropical regions including Egypt. Typical infection results in haematuria, dysuria, anaemia, genital as well as urinary tract lesions, with prospect of kidney damage in complicated cases. In addition, deposited eggs in the tissue, eventually leads to squamous cell carcinoma of urinary bladder in chronically infected individuals. Microscopic detection of excreted ova in urine samples remains the gold standard diagnostic method, in spite of its inherited low sensitivity, inconsistent egg excretion and unreliable results in chronic phase of the disease. Moreover due to pre-requisite for skilled personals and pricey equipment, PCR-based technologies are of limited use especially in low-income endemic countries. So emergence of loop-mediated isothermal DNA amplification (LAMP) seemed a promising technique. Our study evaluated application of LAMP technique in detection of S. haematobium DNA in 69 urine samples of suspected patients for urogenital schistosomiasis, versus conventional urine filtration followed by microscopy ova detection method. Specificity of LAMP was tested using other parasites DNA samples that showed no cross reactivity. Furthermore our results of the calculated diagnostic parameters for sensitivity and specificity for LAMP assay were 100%, with 95% CI (88.78%-100%), and 63.16%, with 95% CI (45.99%-78.19%) respectively, moreover Positive likelihood ratio (LR+) 2.7, and Negative likelihood ratio (LR-) 0.0, which display that LAMP technique is an up-to-date simple, sensitive, diagnostic important tool that could be employed in clinical diagnosis in poorly equipped facilities, as well as in surveillance of infectious diseases. As authors knowledge, this is the first national report evaluation of LAMP technique as a promising diagnostic tool for urogenital schistosomiasis.

CD138 Expression Is Observed in the Urothelial Epithelium and in Various Urothelial Carcinomas, and Cannot Be Evidence for Plasmacytoid Urothelial Carcinoma.

CD138 (syndecan-1) immunoexpression has been reported to be specific for the plasmacytoid variant of urothelial carcinomas (UCs). The aim of this study was to examine the utility of CD138 immunohistochemistry for diagnosing the plasmacytoid variant of UCs. The extent and intensity of CD138 immunostaining were evaluated in 22 infiltrating UCs, 2 other infiltrating carcinomas, 15 noninvasive urothelial lesions, 3 other benign lesions, and perilesional normal tissues. CD138 immunostaining of the normal urothelial epithelium was universally diffuse and strong. In addition, all 42 cases of urinary tract lesions exhibited positive CD138 immunostaining; however, 1 of 3 plasmacytoid variants exhibited focal CD138 expression. The frequency of CD138 positivity in plasmacytoid variants may be relatively low, compared with that observed in the conventional types and other variants; thus, it is not appropriate to assume that CD138 expression in UCs is specific for plasmacytoid variants.

Anatomo-pathological and epidemiological analysis of urinary tract lesions in dogs

ABSTRACT: In dogs, diseases of the urinary tract are common and can be caused by disorders of varied etiology. The objective of this study was to classify qualitatively and quantitatively urinary tract lesions of 363 dogs, which were classified according to its anatomical distribution and etiology. The data was obtained from the revision of 36 years of protocols from the Regional Laboratory of Diagnosis (LRD/UFPel) and it represents 4.0% of diagnoses from a total of 8980 for that period and species. Renal injury accounted for 93.1% of cases, with 309 being primary kidney lesions; from which the main lesions were the tubulointerstitial nephritis (142 cases) often associated with Leptospirosis (47). Injuries of lower urinary tract accounted for 6.9% of the cases where acute cystitis stands out (19). In this study, renal failure, acute or chronic, represented an important cause of death in dogs.

DWI in the Etiologic Diagnosis of Excretory Upper Urinary Tract Lesions: Can It Help in Differentiating Benign From Malignant Tumors? A Retrospective Study of 98 Patients.

The objective of this study was to evaluate the diagnostic performance of high-field DWI in distinguishing benign from malignant lesions of the upper urinary tract (UUT). Ninety-eight patients who underwent 3-T DWI (b = 1000 s/mm(2)) for assessment of a UUT lesion were retrospectively included in the study. Data on the size, location, and mean apparent diffusion coefficient (ADC) value of the lesions were collected and correlated with the final diagnosis. ROC curve analysis was used to determine the best threshold value of the mean ADC for characterization of the lesions. A total of 66 carcinomas and 33 benign lesions were identified. The mean (± SD) ADC value was statistically significantly lower for the malignant lesions than for the benign lesions (0.984 ± 0.048 vs 1.536 ± 0.067 × 10(-3) mm(2)/s; p = 0.000007). For characterization of malignant lesions, the best cutoff ADC value on the ROC curve was found to be less than or equal to 0.996 10(-3) mm(2)/s. On the basis of this value, the sensitivity and specificity of 3-T DWI for the identification of malignant UUT lesions were 78.3% and 95.5%, respectively, with a positive predictive value of 94.7% and a negative predictive value of 80.8% (p = 0.0001). The thickness of the smallest lesion was 3 mm. The mean ADC value of high-grade tumors was not statistically significantly lower than that of low-grade tumors. The best cutoff value for predicting benignancy was greater than or equal to 1.100 × 10(-3) mm(2)/s with sensitivity of 90.9%, specificity of 82.6%, positive predictive value of 83.3%, and negative predictive value of 90.5%. The ADC measurement is a useful additional parameter in the differentiation of benign from malignant UUT lesions.

135 Benign lesions of upper urinary tract with nephroureterectomy: The preoperative characteristics

135 Benign lesions of upper urinary tract with nephroureterectomy: The preoperative characteristics

Diagnóstico, evaluación y seguimiento de la hematuria microscópica. Un enfoque al alcance de todos

Asymptomatic microscopic haematuria, defined as the presence of three or more red blood cells per high-power field on microscopic examination of the urinary sediment, with no of infection, is a warning sign of disease of the kidney disease or the urinary tract. Among the most common causes include, urinary tract infection, benign prostatic hyperplasia, and urolithiasis, but there is also a likelihood that a patient with microscopic haematuria may have a neoplasm. The risk of urological malignancy increases in men over 35 years, people with a history of smoking, and exposure to environmental or occupational dyes, glues, benzene, etc. Its evaluation includes the study of erythrocyte dysmorphia, proteinuria, serum creatinine, or hypertension. An assessment of the entire urinary tract is required, with CT being the best tool for identifying lesions of the upper urinary tract. The lower urinary tract is best explored with cystoscopy. Urine cytology is not recommended for routine study of asymptomatic microscopic haematuria. In this review, an approach is presented on the diagnosis, evaluation and follow-up of patients with asymptomatic microscopic haematuria that enables it to be within everyone's reach.

Correlation and comparison of CT Urography and non contrast MR Urography in evaluation of malignant urinary tract lesions- A study of 54 patients

Correlation and comparison of CT Urography and non contrast MR Urography in evaluation of malignant urinary tract lesions- A study of 54 patients

Correlation and comparison of CT Urography and non contrast MR urography in evaluation of non-neoplastic urinary tract lesions- A study of 32 patients

Correlation and comparison of CT Urography and non contrast MR urography in evaluation of non-neoplastic urinary tract lesions- A study of 32 patients

Schistosomiasis in the Democratic Republic of Congo: a literature review.

Schistosomiasis is a poverty-related parasitic infection, leading to chronic ill-health. For more than a century, schistosomiasis has been known to be endemic in certain provinces of the Democratic Republic of Congo (DRC). However, a clear overview on the status of the disease within the country is currently lacking, which is seriously hampering control. Here, we review the available information on schistosomiasis in DRC of the past 60 years. Findings and data gaps are discussed in the perspective of upcoming control activities.An electronic literature search via PubMed complemented by manual search of non-peer-reviewed articles was conducted up to January 2015. The search concerned all relevant records related to schistosomiasis in the DRC from January 1955 onwards. A total of 155 records were found, of which 30 met the inclusion criteria. Results were summarized by geographical region, mapped, and compared with those reported sixty years ago. The available data reported schistosomiasis in some areas located in 10 of the 11 provinces of DRC. Three species of Schistosoma were found: S. mansoni, S. haematobium and S. intercalatum. The prevalence of schistosomiasis varied greatly between regions and between villages, with high values of up to 95 % observed in some communities. The overall trend over 60 years points to the spread of schistosomiasis to formerly non-endemic areas. The prevalence of schistosomiasis has increased in rural endemic areas and decreased in urban/peri-urban endemic areas of Kinshasa. Hepatosplenomegaly, urinary tract lesions and anaemia were commonly reported in schistosomiasis endemic areas but not always associated with infection status.The present review confirms that schistosomiasis is still endemic in DRC. However, available data are scattered across time and space and studies lack methodological uniformity, hampering a reliable estimation of the current status of schistosomiasis in DRC. There is a clear need for updated prevalence data and well-designed studies on the epidemiology and transmission of schistosomiasis in DRC. This will aid the national control program to adequately design and implement strategies for sustainable and comprehensive control of schistosomiasis throughout the country.

Is Ureteroscopy Needed Prior to Nephroureterectomy? An Evidence-Based Algorithmic Approach

To develop an evidence-based approach to the diagnostic workup of suspicious upper urinary tract lesions. The PubMed database was searched using the following terms with a filter for English language: "upper tract urothelial carcinoma" and "upper tract transitional cell carcinoma," along with the following corresponding terms: "cost," "epidemiology," "diagnosis," "ureteroscopy," and "workup." A total of 404 articles were returned, and 33 were reviewed in full based on relevance. Computed tomography urogram is both sensitive and specific (96% and 99%). Cytology is utilized for its specificity (89%-100%). Ureteroscopy and biopsy of an upper tract lesion can be helpful in equivocal cases but can pose challenges in terms of yield and eventual pathologic upstaging. Due to the high sensitivity and specificity of other noninvasive tests, ureteroscopy can be obviated in select cases. We assess the available evidence and devise an algorithm for the evaluation of an upper tract urothelial carcinoma lesion. Ureteroscopy can be omitted as part of the diagnostic workup in appropriately selected cases of upper tract urothelial carcinoma.

Cytology in uropathological diagnostics

Cytology in uropathological diagnostics is mainly performed for oncological purposes. The assessment of malignancy by urothelial cell morphology is therefore decisive; however, cytology is only sensitive enough to detect high-grade tumor cells and the different low-grade tumors cannot be reliably diagnosed. Thus, the four-tier classification system of cytological findings (i.e. negative, atypical cells but significance uncertain, suspicious and positive) refers to high-grade tumor cells only. Furthermore, for valid cytological diagnostics not only the cytological specimen but also clinical information on cystoscopy findings and, if applicable, a biopsy should be evaluated together. In difficult differential diagnostic settings, e.g. differentiation between reactive versus neoplastic atypia or difficult to access lesions in the upper urinary tract, additional fluorescence in situ hybridization of cytological preparations might be helpful. At the moment there are no indications for further immunocytology or additional biomarker tests.

Tumor Mimicking Bladder Endometriosis

Endometriosis is described as the presence of endometrial tissue outside the uterine corpus. Though urinary tract endometriosis is uncommon, the bladder is the most common localization amongst them. Here we present three cases admitted to our hospital with similar complaints such as dysuria and abdominal pain. All of the patients had previous cesarean section history. And radiological examination of the bladder revealed solid masses located on the bladder wall. One of the case additionally had a protruding, polipoid luminal mass. Two of the cases were treated with transurethral resection and one with partial cystectomy. We noted similar histological findings such as endometrial stroma and glands within the smooth muscle fibers. The stromal components were positive with CD10, epithelial components were positive with both estrogen and progesterone receptor immunohistochemically. As a result bladder endometriosis should be kept in mind in the differential diagnosis of mass forming urinary tract lesions.

Adenocarcinoma at Anastomotic Site of Ureterosigmoidostomy Potentially of Urothelial Origin Spreading to the Upper Urinary Tract.

Ureterosigmoidostomy is associated with the risk of several late complications including cancer development at anastomotic sites. We present an unusual case with adenocarcinoma of the anastomotic site associated with multiple adenocarcinoma lesions in the upper urinary tract. A 69-year-old man complained of persistent melena and hematuria. He had undergone radical cystectomy for high-grade bladder cancer and ureterosigmoidostomy 30 years before. Colonoscopy showed a tumor at the right ureterocolonic anastomosis, which was endoscopically resected and histologically diagnosed as adenocarcinoma. Seven years later, a tumor of the left ureterocolonic anastomosis associated with hydronephrosis was found. He underwent temporal percutaneous nephrostomy followed by sigmoidectomy and left ureterocutaneostomy. Eighteen months after the operation, computed tomography (CT) detected left renal pelvic tumor with a mass along the former nephrostomy tract. Left nephroureterectomy and resection of the nephrostomy tract tumor revealed adenocarcinoma with multiple lesions of adenocarcinoma in the ureter. These tumors showed atypical immunohistochemistry as a colonic adenocarcinoma: positive for cytokeratin 7, negative for cytokeratin 20, and negative for β-catenin nuclear accumulation. Anastomotic site adenocarcinoma of the present case is potentially of urothelial origin because of unusual clinical manifestation and immunohistochemistry as a colon cancer.

Photodynamic Diagnostic Ureterorenoscopy with Orally Administered 5-Aminolaevulinic Acid as Photosensitiser: How I Do It

Objective: To explain our use of photodynamic diagnostic ureterorenoscopy, we provide a detailed description of the choice of photosensitiser, equipment needed, a safety profile, and pointers on our technique. Technique: Patients are given oral 5-aminolaevulinic acid (5-ALA) as a photosensitiser 3-4 h pre-operatively, and by using a Xenon blue light source, an eyepiece which blocks light below 450 nm which is fitted onto the ureterorenoscope, we are able to conduct a thorough photodiagnosis of the upper urinary tract. Conclusion: Our technique of photodynamic diagnostic ureterorenoscopy has shown that the sensitivity, specificity and detection rates of upper urinary tract lesions can be significantly increased with the use of oral 5-ALA. Therefore, we provide a detailed explanation of the use of oral 5-ALA photosensitiser, indications and contraindications of the technique in addition to equipment used and potential complications of the procedures.

Upper urinary tract tumors: how does the contrast enhancement measured in a split-bolus CTU correlate to histological staging?

Computed tomography urography (CTU) is used widely in the work-up of patients with symptoms of urinary tract lesions. Preoperative knowledge of whether a tumor is invasive or non-invasive is important for the choice of surgery. So far there are no studies about the distinction of invasive and non-invasive tumors in ureter and renal pelvis based on the enhancement measured with Hounsfield Units. To examine the value of CTU using split-bolus technique to distinguish non-invasive from invasive urothelial carcinomas in the upper urinary tract. Patients who underwent nephroureterectomy between 2006 and 2011 and who had split-bolus CTU prior to surgery were included. The images were available electronically. The attenuation values before and after administration of iodine-based contrast media were measured. The radiology, patient, and pathology records were reviewed. Of the 158 patients who underwent unilateral nephroureterectomy 69 fulfilled the inclusion criteria. Histopathological examination revealed 31 patients with non-invasive and 38 with invasive urothelial carcinoma. Neither absolute attenuation nor change in attenuation values obtained at CTU could distinguish between invasive and non-invasive lesions. No patients had a CTU within the last year before the examination that resulted in surgery. A split-bolus CTU cannot distinguish between invasive and non-invasive urothelial tumors in the upper urinary tract, but the examination is useful to diagnose a tumor in the renal pelvis and the ureter.

Characterization of upper urinary tract urothelial lesions in patients with gross hematuria using diffusion-weighted MRI: A prospective study

ObjectiveOur objective was to evaluate the utility of diffusion-weighted MRI (DWI) and apparent diffusion coefficient (ADC) values in differentiation between malignant and non malignant lesions of the upper urinary tract in patients with gross hematuria. MethodsWe prospectively evaluated 51 patients with gross hematuria. The MRI sequences included T1, T2 weighted spin echo imaging and DWI with calculating ADC values of each detected lesion. Two radiologists independently reviewed the imaging sequences. The reference standard was established on the basis of histopathology. The agreement between two reviewers was tested by K statistics. Group comparison was completed with the Kruskal–Wallis test for ADC values and the Mann–Whitney U test. Furthermore, the diagnostic performance was evaluated by using the area under the curve (AUC) of receiver operating characteristic (ROC) curve analysis. ResultsDWI had higher sensitivity and specificity for both reviewers reviewer 1 [94%, 77%] and reviewer 2 [89% and 77%] over conventional sequences [T1 and T2] reviewer 1 [86%, 77%] and reviewer 2 [84% and 69%], respectively. Interobserver agreement was good (K=0.79) using DWI.AUC was 89% and ROC curve revealed that a value of 1.5×10−3mm2/s is the most significant cut off value with highest sensitivity and specificity 79% and 82% respectively in differentiation between malignant and non malignant lesions. ConclusionDWI had high sensitivity and accuracy in detection of upper urinary tract urothelial lesions and could also be used in differentiation between malignant and non malignant lesions of upper urinary tract lesions in patients with gross hematuria. Advances in knowledgeTo our knowledge this is the first prospective study that included benign lesions and tried to differentiate between malignant and non malignant lesions of the upper urinary tract.

V10-03 USEFULNESS OF ENDOUROLOGY IN DIAGNOSIS AND TREATMENT OF URETEROINTESTINAL DIVERSION DISEASES

INTRODUCTION AND OBJECTIVES: Patients with ureterointestinal diversion after radical cystectomy are susceptible of developing different diseases in that location. Endourological techniques permit diagnosis and treatment of ureterointestinal diversion diseases as lithiasis, tumors and ureterointestinal anastomotic strictures. In these patients, we can also explore and treat upper urinary tract lesions. METHODS: In the context of ureterointestinal diversion lithiasis formation is unusual, but it is favored when urine drainage is slowed. Endoscopic examination permits direct visualization of the stones to complement imaging, evaluation of association with other lesions, intracorporeal lithotripsy if necessary and extraction for compositional analysis. In our experience we have noticed that lithiasis formation is more frequent specially around a foreign body such as metal suture used in elaboration of urinary diversion. Ureterointestinal nonmalignant anastomotic stricture is a late complication of difficult solution with conventional endourological techniques. In this cases we can perform endoureterotomy by intraluminal invagination adopting a combined percutaneous antegrade and endoscopic retrograde approach. Endoscopic approach also allows direct visualization and biopsy of suspicious lesions in the ureterointestinal diversion. Tumor recurrence in the urinary diversion is rare, it is more frequent in the anastomotic area and requires an individualized treatment. Endoscopical resection of de lesions is feasible, with the aim of establishing histological diagnosis prior to definitive treatment. In the same procedure we can also access the upper urinary tract in order to search for tumor or suspicious associated urothelial lessions, and it also permits the treatment of nonmalignant diseases such as lithiasis or ureteral strictures. RESULTS: Endourology permits the diagnosis and tratment of several diseases of ureteroileal diversion with good results and minimal invasion. CONCLUSIONS: In selected patients and with adequate training, endourology may offer a great spectrum of possibilities in diagnosis and treatment of patients with urinary diversion diseases.

Can We Improve the Biopsy Quality of Upper Urinary Tract Urothelial Tumors? Single-Center Preliminary Results of a New Biopsy Forceps

Objective: Our aim was to evaluate the biopsy quality of upper urinary tract urothelial transitional cell carcinoma with a new biopsy forceps (BIGopsy®, Cook Medical) compared to a classic biopsy forceps (Piranha®, Boston Scientific). Patients and Methods: From December 2009 to December 2011, 20 patients with upper urinary tract urothelial transitional cell carcinoma underwent conservative treatment endoscopically. All lesions were evaluated and biopsied with 3 Fr cup forceps using both types of forceps (BIGopsy and Piranha). A single pathologist blindly analyzed the specimens in order to determine the optimal biopsy for each patient. Specimen histopathology results were graded; however, they were staged if the lamina propria was not invaded (T1) or if the tumor was detected at the lamina propria (T1+). Results: Of the 20 upper urinary tract lesions, 12 (60%) were in the renal pelvis, 3 (15%) in the upper calyx, 1 (5%) in the middle calyx, 1 (5%) in the lower calyx, 1 (5%) in the upper third of the ureter and 2 (10%) in the middle third of the ureter. We did not detect T1 in all biopsies. One patient had no valid biopsies by both forceps. A diagnosis of urothelial carcinoma was made in 17 BIGopsy biopsies compared to 7 Piranha biopsies. Conclusion: Despite the limited number of cases, our study demonstrated the advantage of the new forceps (BIGopsy) in obtaining a valid biopsy of upper urinary tract urothelial tumors. Therefore, we recommend it in evaluating this pathology for optimal treatment.