Pelvocalyceal System Research Articles

Prevalence of urinary tract infection in children with cerebral palsy: Experience at tertiary care centre.

Objective: To determine the prevalence of urinary tract infections, causative organisms and culture sensitivity pattern in children with CP. Study Design: Cross Sectional Descriptive. Setting: The Children Hospital and The Institute of Child Health Multan. Period: September 2020 to September 2021. Material & Methods: After consent from parents and ethical approval, 52 children diagnosed case of CP, 2-12 years, of both gender were enrolled. Demographic data and socioecononomical status was noted. Type of CP was ascertained. Complete urine examination was sent for microscopy and culture sensitivity. Results: Out of 52 children male were prominent with age range of 2-7 years (mean age ± SD, 5.8 years ± 3.27). Mostly children were malnourished, belonged to low socioeconomic status {73.1% (n=38)} and spastic quadriplegic type, {53.8% (n=28)}. UTI was significantly found in 73.1% (n=38) of CP children (p-value=0.002), predominantly in male (76.5%), of 2-7 years of age (66.7%), malnourished (66.6%), with low socioeconomic status (73.7%) and Spastic quadriplegic type (85.7%). No organisms were detected in 52.7% (n=20) of UTI positive children with predominantly E-coli 26.4% (n=10), and was found most susceptible to amikacin, gentamicin, imipenum and meropenum, while least susceptible to Nalidixic acid, Amoxicillin-clavulanic acid, Piperacillin-Tazobactum, cefotaxime and ceftriaxone. Other organisms were, Klebseila pneumonia in 10.1% (n=4), Enterobacter and Pseudomonas Aurigenosa in 5.4% (n=2) children each. Abdominal USG showed positive findings in 63.1% (n=24) children. 16 children detected thick walled urinary bladder, 2 fullness of pelvocalyceal system, 2 echogenic urinary bladder walls, and in 2 echogenic kidneys. Conclusion: UTI is common complication which can lead to renal compromise. So all the CP children must be properly screened and managed for UTI to minimize the complications. Appropriate antibiotic must be used to avoid the antibiotic resistance.

Prevalence of intrarenal reflux in pediatric patients on contrast-enhanced voiding urosonography.

Intrarenal reflux may be seen with vesicoureteral reflux (VUR) when contrast from the pelvocalyceal system extends into tubules in the parenchyma. Because intrarenal reflux has been associated with scarring, detecting intrarenal reflux may influence management to avoid renal damage. Our objective was to evaluate the prevalence of intrarenal reflux identified on contrast-enhanced voiding urosonography (ceVUS) and its association with sex, age, grade of VUR, location in kidney and stage of bladder filling or voiding. CeVUS studies performed from August 2019 through July 2020 with VUR were retrospectively reviewed by two pediatric radiologists. They independently graded VUR and assessed for intrarenal reflux, noting its location and stage of bladder filling or voiding during which it occurred. The presence and location of scarring was also recorded. One hundred and six ceVUS exams were reviewed with 211 kidneys evaluated (one solitary kidney). Patients were ages 2weeks to 12years (mean: 1.8years) with 71 females (67%) and 35 males (33%). Grades 2 to 5 VUR were detected in 165 kidneys with intrarenal reflux seen in 42 (25.4%). Intrarenal reflux waspresent in 1 of 40 kidneys (2.5%) with grade 2, 10 of 67 (14.9%) with grade 3, 25 of 47 (53.2%) with grade 4 and 6 of 11 (54.5%) with grade 5 VUR. Intrarenal reflux occurred during voiding in 31 of 42 kidneys (73.8%) and was seen most often in the lower pole (71.4%) with significantassociation between intrarenal reflux and interpolar renal scarring (odds ration [OR] 3.92; 95% confidence interval [CI] 1.49, 10.32; P-value 0.01). Intrarenal reflux was often seen on ceVUS, with the highest frequency occurring in young patients with grades 4 and 5 VUR and during voiding. Radiologists should have a high index of suspicion for intrarenal reflux on ceVUS, especially in young children with high-grade VUR.

The effect of zinc on healing of renal damage in rats.

Background: Several studies have previously been performed to promote kidney healing after injuries. Objectives: The aim of this study was to investigate the effect of zinc on renal healing after traumatic injury in rats. Materials and Methods: Forty healthy female rats were selected and one of their kidneys was incised. Half of the incisions were limited only to the cortex (renal injury type I) and the other ones reached the pelvocalyceal system of the kidney (renal injury type II). All the rats in the zinc treated group (case group) received 36.3 mg zinc sulfate (contained 8.25 mg zinc) orally. After 28 days, the damaged kidneys were removed for histopathological studies. Results: In the rats with type I injury, kidney inflammation of the case group was significantly lower than that of the control group. However, the result was not significant in rats with type II injury. Tissue loss and granulation tissue formation were significantly lower in the case group than the control group in both type I and II kidney injuries. Conclusions: Overall, Zinc can contribute to better healing of the rat’s kidneys after a traumatic injury.

Sandra's Dyspnea

Abstract Introduction This case is a problem-based learning (PBL) tutorial intended for use in a first-year medical school human gross anatomy course during anatomical dissections and discussion se...

Imaging features of helical computed tomography suggesting advanced urothelial carcinoma arising from the pelvocalyceal system

Urothelial carcinoma is the most common malignant tumor arising from the pelvocalyceal system. Helical computed tomography (CT) is probably the best preoperative-stage modality for the determination of treatment plan and prognosis. To obtain helical CT imaging features suggesting advanced pelvocalyceal urothelial carcinoma. Preoperative CT images in 44 patients with pelvocalyceal urothelial carcinoma were retrospectively reviewed and correlated with the pathological examination to determine imaging features suggesting stage III or IV of the disease. Pathological stages revealed stage I in 16, stage II in three, stage III in 17, and stage IV in eight patients. Seven patients had metastatic lymph nodes. CT imaging showed that renal parenchymal invasion, sinus fat invasion, and lymph node metastasis were highly suggestive of advanced urothelial cell carcinoma (P<0.05). Helical CT sensitivity, specificity, and accuracy for advanced pelvocalyceal urothelial carcinoma were 76% (19/25), 84% (16/19), and 80% (35/44), respectively. Preoperative helical CT may suggest imaging features of advanced urothelial carcinoma, influencing treatment plan and patient prognosis, even though its accuracy is not so high.

The Effectiveness of Simultaneous Renal Artery-vein Clamping during Laparoscopic Partial Nephrectomy on the Surgical Outcome

Purpose: We wanted to compare the surgical outcomes of laparoscopic partial nephrectomy (LPN) performed with and without simultaneous artery-vein clamping. Materials and Methods: Between April 2005 and December 2006, elective LPN was performed for 56 patients with renal tumors with using hilar clamping by a Satinsky clamp in 42 (75%) patients, and with using artery-only or no clamping in the rest of the patients. The Satinsky and non-Satinsky groups were compared for their perioperative characteristics, the pathologic findings and the complication rate. The postoperative renal function was evaluated with measuring the serum creatinine and also by technetium labeled diethylenetetraminepentaacetic acid (DTPA) renal scanning. Results: Renal cell carcinoma was diagnosed in 43 (76.8%) patients and all had negative margins. There were no significant differences between the two groups for tumor size (2.1 vs. 2.0cm, respectively), the operative time (210.9 vs. 199.3 min, respectively) and the hospital stay (5.9 vs. 5.6 days, respectively). The mean warm ischemia time was longer when the Satinsky clamp was applied (38.5 vs. 21.9 min, respectively, p=0.03). The postoperative serum creatinine level and glomerular filtration rate (GFR) were 1.13mg/dl and 41.4ml/min/m, respectively, in the Satinsky group and 1.17mg/dl and 33.5ml/min/m, respectively, in the non-Satinsky group, without significant differences. The postoperative transfusion rate was lower in the Satinsky group (9.5 vs. 28.5%, respectively, p=0.28), although more pelvocalyceal system repair was done in the Satinsky group (47.6 vs. 7.7%, respectively, p=0.006). Conclusions: Simultaneous clamping of the renal artery and vein during LPN enables efficient removal of tumors that are deep in the renal sinus with a safe margin, it facilitates closure of the pelvocalyceal system and it reduces the need for transfusion without impairing renal function. (Korean J Urol 2007;48:897-902)

Emphysematous pyelonephritis treated with percutaneous catheter drainage and antibiotics

A 58-year-old woman presented acutely with a 3-day history of general weakness, vomiting and fever. For 2 years she had had untreated diabetes mellitus. On examination she was ill, blood pressure was 64/47mmHg, heart rate: 111 beats/min, respiration rate: 28/min and body temperature was 37.28C. The right upper abdomen was tender. There was right loin tenderness. Investigations: white blood cell count 10 380/mm; haemoglobin 7.8 g/dl; haematocrit 23.1%; platelet count 36 000/mm; blood urea nitrogen 70mg/dl; serum creatinine 6.2mg/dl; glucose 302mg/dl; C-reactive protein 21.4mg/dl; sodium 129mEq/l; potassium 4.1mEq/l; chloride 98mEq/l; and total CO2 8.9mEq/l. An arterial blood gas pH 7.242, pO2 60mmHg, pCO2 22mmHg and bicarbonate 9.3mEq/l. A plain abdominal film showed air density in the right pelvocalyceal system and upper ureter (Figure 1). Computed tomography (CT) of the abdomen without contrast confirmed the presence of air in the pelvicalyceal system and upper ureter of the enlarged right kidney (Figure 2). Six hours after admission, she became hypotensive and unconscious. She was intubated and ventilated. She received fluid resuscitation, emergency haemodialysis, and intravenous piperacillin and tazobactam. A percutaneous catheter was inserted into the pelvicalyceal system of the right kidney and drained turbid fluid. Blood and urine cultures grew Escherichia coli. The catheter was removed on day 12 because of disappearance of air in right excretory system at follow-up CT. Antibiotic therapy was continued for 4 weeks. She survived but did not recover renal function.

Laparoscopic Partial Nephrectomy for the 4cm or Less Renal Tumors

Purpose: The popularity of a partial nephrectomy has grown as a consequence of the increased detection of small incidental renal masses. Herein, our experience of laparoscopic partial nephrectomies is reported. Materials and Methods: Between December 2003 and April 2006, 27 cases underwent a laparoscopic partial nephrectomy for renal tumors up to 4cm in diameter. The tumors, and an approximate 0.5cm margin around the tumors, were resected with cold scissors. Hemostasis was achieved with freehand suturing of the pelvocalyceal system and renal parenchyme, over the surgical bolster, using fibrin glue. Results: Transperitoneal and retroperitoneal approaches were chosen in 14 and 13 cases, respectively. Hilar clamping of small exophytic tumors was performed in all but 3 cases, with minimal parenchymal invasion. The mean renal tumor size was 2.5cm (ranging from 1 to 4cm). The mean operative and warm ischemia times, and blood loss were 193 minutes (ranging from 115 to 300) and 27.8 minutes (ranging from 15 to 43), and 493ml (ranging from 32 to 1,248), respectively. The mean hospitalization stay was 5.2 days (ranging from 3 to 8 days). Conversion to a laparoscopic radical nephrectomy was required in one case due to a positive frozen biopsy of the resection bed. There were no perioperative complications or open conversions. Histological examinations yielded a renal cell carcinoma in 20 cases, an angiomyolipoma or oncocytoma in 2 cases each, a lipoma in 1 and a leiomyosarcom in 2 cases, two of which had positive margins. One patient underwent selective angioembolization for an asymptomatic renal artery pseudoaneurysm three months postoperatively. All patients were alive, without any local recurrence or metastatic disease, at a mean follow up of 11.4 months (ranging from 3 to 24 months). Conclusions: A laparoscopic partial nephrectomy can be performed safely. However, long-term follow-up is required to compare its cancer control with that of an open partial nephrectomy. (Korean J Urol 2006;47:1256-1262) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

The Usefulness of T2-weighted MR Urography and Contrast Enhanced MR Urography in the Evaluation of Obstructive Uropathy: Comparisonal Study with Antegrade Pyelography1

Purpose: To compare the efficacy of contrast-enhanced and T2-weighted magnetic resonance urography (MRU) for the depiction of obstruction and evaluation of the causes of obstructive uropathy with that of antegrade pyelography. Materials and Methods: Twenty-five patients with obstructive uropathy who underwent percutaneous nephrostomy (PCN) and antegrade pyelography (AGP) were included in the study. We performed MR urography, comprising half-Fourier acquisition single-shot turbo spin-echo (HASTE) T2-weighted imaging and 3-D fast imaging with steady state precession (3-D FISP) T1-weighted imaging after gadolinium enhancement and compared the quality of the images of both the HASTE and 3-D FISP MRU techniques in terms of their depiction of the dilated pelvocalyceal system, and the level, type, and causes of obstruction. Results: In terms of anatomical depiction of the pelvocalyceal system (p=0.002) and the causes of obstruction (p=0.003), T1-weighted MRU using 3D-FISP was significantly better than T2-weighted MRU using the HASTE sequence. Regarding level of obstruction, T2-weighted MRU using the HASTE sequence and contrastenhanced T1-weighted MRU using 3D-FISP showed an accuracy of 76% (19/25) and 84% (21/25), respectively. In terms of type of obstruction, the accuracy of T2-weighted MRU and T1-weighted CEMRU was 72%(18/25) and 88% (22/25), respectively. Conclusion: T2-weighted MRU and T1-weighted CEMRU provided both anatomical information and that relating to impaired renal function. The two modelities played a complementary role and their use could decrease the unnecessary use of invasive diagnostic examination for the evaluation of obstructive uropathy.

Vesicoureteral Reflux in Children: Comparison of Contrast - Enhanced Voiding Ultrasonography with Radiographic Voiding Cystourethrography: Preliminary Report

Purpose: To compare the usefulness of contrast-enhanced voiding ultrasonography(US) with that of radi-ographic voiding cystourethrography(VCUG) for the diagnosis of vesicoureteral reflux(VUR) in children.Materials and Methods: Ninety-five kidney-ureter units of 47 patients referred for investigation of VUR under-went contrast-enhanced voiding US followed by radiographic VCUG. After baseline US examination of the urinary tract, residual urine in the bladder was drained through an inserted Foley catheter and the bladder was gravity filled at a height of 1 m with normal saline. A galactose-based, microbubble-containing echo-en-hancing agent (Levovist; Schering, Berlin, Germany) was then administered. The amount of this was approxi-mately 10% of bladder capacity, and VUR was diagnosed when microbubbles appeared in the ureter or pelvo-calyceal system. Using radiographic VCUG as a reference point, the accuracy with which contrast-enhanced voiding US detected VUR was calculated.Results: In 87 of 95 kidney-ureter units (91.6%), the two methods showed similar results regarding the diagno-sis or exclusion of VUR, which was detected by both in 12 units, but by neither in 75. VUR was shown to oc-cur in a total of 20 units, but in eight of these by one method only. In two units, VUR detected by contrast-en-hanced voiding US was not demonstrated by radiographic VCUG; in six units, the reverse was true. In the de-tection of VUR, contrast-enhanced voiding US showed a sensitivity of 66.7%, a specificity of 97.4%, a positive predictive value of 85.7%, and a negative predictive value of 92.6%.Conclusion: Contrast-enhanced voiding US is highly specific and has high positive and negative predictive val-ues; its sensitivity, however, is not sufficiently high. The modality appears to be a useful diagnostic tool for the detection of VUR without exposure to ionizing radiation, though to be certain of its value, more experience of its use is first required.

Effectiveness of MR Urography in the Evaluation of Kidney which Failed to Opacify during Excretory Urography: Comparison with Ultrasonography

ObjectiveThe purpose of this study was to compare the effectiveness of MR urography (MRU) with that of ultrasonography (US) in the evaluation of urinary tract when this failed to opacify during excretory urography (EXU).Materials and MethodsTwelve urinary tracts in 11 patients were studied. In each case, during EXU, the urinary system failed to opacify within one hour of the injection of contrast media, and US revealed dilatation of the pelvocalyceal system. Patients underwent MRU, using a HASTE sequence with the breath-hold technique; multi-slice acquisition was then performed, and the images were reconstructed using maximal intensity projection. Each set of images was evaluated by three radiologists to determine the presence, level, and cause of urinary tract obstruction.ResultsObstruction was present in all twelve cases, and in all of these, MRU accurately demonstrated its level. In this respect, however, US was successful in only ten. The cause of obstruction was determined by MRU in eight cases, but by US in only six. In all of these six, MRU also successfully demonstrated the cause.ConclusionMRU is an effective modality for evaluation of the urinary tract when this fails to opacify during EXU, and appears to be superior to US in demonstrating the level and cause of obstruction.

Medullary CT Enhancement in Acute Renal Artery Occlusion

The diagnosis of traumatic renal artery occlusion by CT is based on finding the cortical rim sign, nonopacification of the pelvocalyceal system, and occasionally direct visualization of the thrombosed renal artery. We present four patients with renal artery occlusion who have an unusual pattern of medullary enhancement that has a vermiform and spoke-wheel appearance. It is important to realize that this enhancement does not represent functional renal tissue with a partially occluded renal artery. Instead, it is part of the spectrum of findings seen with complete occlusion of the renal artery.

Benign non-parenchymal renal tumors: Radiologic appearances

Two non-parenchymal renal tumors, capsular leiomyoblastoma and schwannoma in renal sinus, are reported with respect to radiographic appearance, reviewing the literature. Computerized tomography (CT) scan and pyelography define the localization of the renal tumor substantiated by angiography identifying the feeding arteries. Precise investigation of neovascularity is necessary to exclude malignant potency. A tumor in the renal sinus without destruction of pelvo-calyceal system should include schwannoma in the differential diagnosis.

Evaluation of intermittent drainage of the renal pelvis as seen in the isotope renogram.

Intermittent drainage (ID) of the renal pelvis is probably due to episodes of aperistalsis in the pelvo-calyceal system. The incidence of ID in adult patients referred for renography for various nephro-urological conditions was found to be 4.5%. Presence of ID was not related to sex or age but more common at a low urine flow. It was then usually bilateral and interpreted as a normal phenomenon. If the urine flow at the renographic examination exceeded 2 ml min-1, ID was typically unilateral and there was often a history of obstructive uropathy and dilatation of the renal pelvis. However, there were no signs of obstruction or flank pains in connection with the recording of ID and follow-up studies did not disclose any deterioration of renal function. It is concluded that ID seen at renography during diuresis should not be regarded as evidence of obstruction of pelvic outflow but merely as an indication of a dilated upper urinary tract.

Replacement of a dislodged nephrostomy catheter

A common complication of percutaneous nephrostomy is accidental withdrawal of the catheter. Opacification of the nephrostomy tract demonstrates an intact passage to the collecting system. First one should try to negotiate the tract with a probe under fluoroscopy. If the pelvocalyceal system cannot be entered by probing alone, a puncture is done next. The Seldinger-needle together with a 22-gauge needle and a mandrin allows to combine probing, puncture and fluoroscopy of the nephrostomy tract.

Abnormal Left Kidney in a Patient With Acute Flank Pain

History A 40-year-old man had crampy pain in the left flank. This pain had an acute onset the previous evening, and the patient was afebrile. The left side of the abdomen was tender to deep palpation, but there was no rebound tenderness or palpable mass. Urinalysis demonstrated proteinuria without hematuria, bacteriuria, or pyuria. Figure 1 shows a 30-minute delayed roentgenogram from the excretory urogram. There were no abnormal calcifications on the scout roentgenogram. The left kidney now measures 1 cm longer than on a previous urogram four months earlier. The size of the right kidney is unchanged. Diagnosis Left renal vein thrombosis. Comment This urogram demonstrates extremely poor visualization of the left pelvocalyceal system and left ureter, indicating diminished function. This, combined with the fact that the left kidney has enlarged since the earlier examination, should strongly suggest renal vein thrombosis. The definitive study is selective renal phlebography (Fig 2,

New Fine Needle for Cholangiography with Optional Sheath for Decompression

A 45-cm Chiba needle with a 20-cm sheath at the hub end has been used successfully for percutaneous transhepatic cholangiography in 10 patients, including chronic decompression in one patient. This method permits localization of the biliary tree, vascular structures, cysts, cavities, pelvocalyceal system, and tumors with a 22 gauge needle and allows placement of a larger catheter for drainage or a larger needle for biopsy if required. No complications were observed.

Peripelvic renal pseudocyst due to obstruction

A 70-year-old male was seen with a 5 week history of recurrent left flank pain. Excretory urography confirmed the presence of a nadiopaque left uneteral calculus about 5 mm in diameter bocated at the bevel of L5 causing mild obstruction. In addition a 5 cm mass in the left kidney distorted the pelvocalyceal system (fig. 1A). This mass was radiolucent on nephrotomography. The right kidney appeared normal at this time, except for a 2 mm calculus in the lower pole calyx (fig. 1D). Microhematunia and left costovertebral angle tenderness was present. Ultrasound evaluation of the mass performed 6 days later was ‘ ‘suggestive of a cyst.” The patient remained free of symptoms for 10 days; he then experienced sudden onset of right flank discomfort. Repeat excretory urography revealed that he had passed the left unetenal calculus and that the previously noted penipelvic mass was moderately smaller (fig. 1B). However, the right pelvocalyceab system now appeared similar to that seen on the left side, with a definite mass lesion distorting the night renal pelvis and infundibubum (fig. 1E). The rightureter was dilatedto the ureterovesical junction suggesting obstruction. The radiopaque calculus previously seen in the right kidney was no longer present. It was suspected that the calculus had recently passed and that there was residual edema at the night uretenovesical junction. The patient remained free of symptoms, and a follow-up excretory unogram 10 weeks later appeared honmal (figs. 1C and iF). There was no residual distortion of the pelvocalyceal system and no evidence of obstruction.

Before and after dialysis urography.

Twelve patients receiving chronic dialysis treatment were studied to determine the effect of dialysis on visualization of the pelvocalyceal system. Patients received injections of contrast material before and after dialysis. It was found that dialysis enhanced visualization in one case; however, no patient showing nonvisualization of the pelvocalyceal system prior to dialysis showed visualization afterward.

Primary amyloidosis of the renal pelvis.

AMYLOID deposits restricted in distribution to the renal pelves have seldom been described in the literature.1 2 3 4 Recently, we encountered a patient with this unusual condition. The case is presented here to call attention to a distinctive and perhaps unique radiographic finding in primary amyloidosis of the renal pelvis: linear submucosal calcification outlining the pelvocalyceal system of the kidney.Case ReportA 39-year-old man was admitted to the hospital in March, 1969, for evaluation of progressive and undiagnosed renal disease of 2 years' duration. Complete physical examination and urinalysis had been within normal limits 4 years previously.In February, 1967, he . . .