Tomography Urogram Research Articles

Primary hemangioblastoma of the kidney with molecular analyses by next generation sequencing: a case report and review of the literature

BackgroundHemangioblastoma is an indolent mesenchymal tumor most frequently occurring in the central nervous system (CNS), but can also arise extraneuraxially, as part of Von Hippel-Lindau (VHL) disease or in sporadic tumors. Extraneuraxial hemangioblastomas occur outside the central nervous system. It includes tumors arising from the nervous paraneuraxial structures and visceral organs. Sporadic hemangioblastoma of the kidney, a rare subset of extraneuraxial hemangioblastomas, is an under-recognized renal neoplasm. There have been only 25 cases described to date in the English language literature. We report herein one additional sporadic tumor in a patient without VHL disease.Case presentationA 61 year old male presenting with gross hematuria was found to have a 3.5 cm renal mass at the lateral mid to lower pole of the left kidney on computed tomography urogram. The patient underwent a partial nephrectomy for the mass. Pathological examination showed a well-circumscribed non-encapsulated tumor composed of sheets of large polygonal cells traversed by a rich vascular network. The tumor cells showed clear to eosinophilic cytoplasm and overall bland nuclei. The diagnosis of hemangioblastoma was confirmed by positive immunostaining for alpha-inhibin, S100, neuron-specific enolase, and PAX8. No significant gene mutations, including VHL gene and copy number changes were detected in the tumor using next generation sequencing supporting the diagnosis of sporadic renal hemangioblastoma.ConclusionSporadic renal hemangioblastoma is a rare subset of extraneuraxial hemangioblastomas. We report one such tumor in a patient without clinical or molecular evidence of VHL disease. The literature was reviewed to better understand the clinical, radiological, pathological, and molecular features of this neoplasm. The majority of renal hemangioblastomas showed positive immunostaining for PAX8, which supports the idea that the immunoprofiles of extraneuraxial hemangioblastomas can vary depending on sites of origin. Diagnosis of renal hemangioblastoma is challenging because of its rarity and overlapping microscopic and immunophenotypic features with other renal tumors, including clear cell renal cell carcinoma. In some cases, molecular or genetic studies may be necessary to obtain an accurate diagnosis. Since renal hemangioblastoma is clinically benign, recognition of this pathological entity is important to avoid unnecessary over-treatment.

Laparoscopic Nephroureterectomy for Dysplastic Kidneys with Ectopic Ureters Opening Inside the Vagina

Urinary incontinence in girls could be due to ectopic ureteral insertion inside the vagina, a condition that is difficult to diagnose. In these patients, the urinary tract may be duplicated or single and be associated with a dysplastic kidney. We report two girls with dribbling of urine due to single ectopic ureteral insertion into the vagina. Computerised tomography urogram, retrograde contrast study and isotope scan revealed poorly functioning ectopic kidney. Hence, both patients underwent laparoscopic nephroureterectomy which led to the resolution of symptoms.

47-Year-Old Woman With Bilateral Flank Pain

47-Year-Old Woman With Bilateral Flank Pain

PD47-01 DIAGNOSTIC AND COST IMPLICATIONS OF THE 2020 AMERICAN UROLOGICAL ASSOCIATION (AUA) MICROHEMATURIA (MH) GUIDELINES: MODELING IMPACT IN A LARGE PUBLIC HEALTHCARE SYSTEM

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation II (PD47)1 Sep 2021PD47-01 DIAGNOSTIC AND COST IMPLICATIONS OF THE 2020 AMERICAN UROLOGICAL ASSOCIATION (AUA) MICROHEMATURIA (MH) GUIDELINES: MODELING IMPACT IN A LARGE PUBLIC HEALTHCARE SYSTEM Samuel Gold, Alexander Kenigsberg, Gianpaolo Carpinito, and Yair Lotan Samuel GoldSamuel Gold More articles by this author , Alexander KenigsbergAlexander Kenigsberg More articles by this author , Gianpaolo CarpinitoGianpaolo Carpinito More articles by this author , and Yair LotanYair Lotan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002069.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The AUA released new MH guidelines in which risk of bladder cancer (BC) or upper tract urothelial carcinoma (UTUC) dictates subsequent work-up with increasing levels of invasiveness and cost. We sought to assess practical and financial impacts of the Microhematuria: AUA/SUFU Guideline (2020) via retroactive application to patients in a large public healthcare system. By comparing to prior AUA MH guidelines (2012), we modeled differences in imaging and procedure utilization, as well as associated costs. METHODS: Patients (≥18 years old) with MH on urinalysis (UA) (≥3 red blood cells/high-powered field) or gross hematuria (GH) were identified on retrospective chart review—initial encounter data was collected from January 2017-May 2018 from a multi-site healthcare system. Those with alternative MH etiologies (i.e. urinary tract infection, benign urologic conditions, gynecologic pathology, etc.) were excluded. Patients were retroactively risk stratified, then hypothetical work-ups were compared based on 2020 vs 2012 guidelines. Cost data was sourced from CMS Medicare Physician Fee Schedule and Clinical Laboratory Fee Schedule for 2020 localized to study site. RESULTS: 3789 patients were included for analysis: 1382 (36.5%), 1026 (27.1%), and 1381 (36.4%) patients were retroactively stratified as low-(LoR), intermediate-(InR), and high-risk (HiR). In LoR patients, 956 repeat UAs were done that would have re-stratified 91 patients to InR and 95 to HiR. Accordingly, the 2020 guidelines would have recommended 1117 renal ultrasounds (RUS) for InR, 1476 computed tomography urograms (CTU) for HiR, and 2593 cystoscopies for InR and HiR (assuming 100% guideline adherence). This compares to 3189 CTU and cystoscopies (2012 guidelines). CTU-specific costs decreased to 44% (2020) from 64% (2012) of total costs. Total costs were $1,260,677 (2020) vs $1,905,236 (2012), a difference of $644,558 (Figure 1). Costs were $332 (2020) vs $597 (2012) per patient. CONCLUSIONS: In practice, the AUA 2020 MH guidelines would result in significant changes to volumes of diagnostic and procedural studies, while substantially reducing costs in total and on a per-patient basis. Changes in CTU volumes, in particular, represent a major driver of cost difference. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e832-e832 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samuel Gold More articles by this author Alexander Kenigsberg More articles by this author Gianpaolo Carpinito More articles by this author Yair Lotan More articles by this author Expand All Advertisement Loading ...

Case report of ureteric transection of lower moiety in high-speed road traffic collision

Ureteric injuries from blunt trauma are rare in adults requiring prompt diagnosis and management. To our knowledge this is the second case report of a complete transection of the ureter due to blunt injury at the pelvi-ureteric junction in an adult. Following a high-speed road traffic collision, a 26-year-old female with bilateral duplex kidneys was admitted with complete transection of the lower moiety of her right collecting system confirmed on computed tomography Urogram. This was repaired successfully with a minimally invasive laparoscopic technique in keeping with European Association of Urology guidelines. A 3-month follow-up MAG 3 renogram indicated adequate drainage from the right kidney with no evidence of obstruction. This successful outcome demonstrates a laparoscopic repair is achievable and favourable, improving post-operative recovery and reduction of inpatient length of stay. We recommend that a laparoscopic approach should be attempted unless laparotomy is indicated for other injuries.

Diagnostic and Cost Implications of the 2020 AUA Microhematuria Guidelines: Modeling Impact in a Large Public Health Care System.

We sought to model the diagnostic recommendations and associated costs of new hematuria guidelines regarding referral patterns, procedure utilization and urothelial cell carcinoma (UCC) detection. Patients with microhematuria were identified retrospectively. Initial encounter data were collected from January 2017 to May 2018 from a large public health care system; followup was continued to December 2020. Risk stratification was performed based on the American Urological Association 2020 microhematuria guidelines, and disease outcomes were analyzed within this framework. The guideline-recommended workups and costs were modeled; cost data were sourced from the Centers for Medicare & Medicaid Services Medicare Physician Fee Schedule and Clinical Laboratory Fee Schedule for 2020. Modeled diagnostic volumes and costs were assessed for 2020 and 2012 microhematuria guidelines, respectively. Of the 3,789 patients included for analysis, 1,382 (36.5%), 1,026 (27.1%) and 1,381 (36.4%) were retroactively stratified as low risk, intermediate risk (InR) and high risk (HiR), respectively. A total of 19 cases of UCC (17 bladder, 2 upper tract) were diagnosed, of which 84% were HiR. For high-grade UCC, 92% of cases were HiR. The 2020 guidelines recommended renal ultrasound for 1,117 InR cases, computerized tomography urogram (CTU) for 1,476 HiR cases, and cystoscopy for 2,593 InR and HiR cases combined. Total costs were $1,905,236 (2012) versus $1,260,677 (2020), driven mainly by CTU costs. Per-cancer detected costs were $100,276 (2012) versus $61,760 (2020). In retrospect, the 2020 guidelines would have effectively risk-stratified microhematuria cases for detection of malignancies. As compared to the 2012 guidelines, application of the 2020 guidelines would result in significant changes to diagnostic and procedural volumes, while substantially reducing total and per-patient costs.

Primary Renal Well-Differentiated Neuroendocrine Tumor (Carcinoid) in a Horseshoe Kidney

A female patient was found to have a horseshoe kidney on imaging studies when undergoing evaluation for recurrent urinary tract infections when she was in her 20s. Now in her late 40s, she presented with gross hematuria. A computed tomography urogram revealed the presence of a 14.9-cm mass arising from the isthmus of the horseshoe kidney (Figure 1). Also present was an enlarged retroperitoneal lymph node suspicious for metastatic disease.

Assessment of Xpert Bladder Cancer Monitor test performance for the detection of recurrence during non-muscle invasive bladder cancer follow-up

PurposeTo assess the performance of the Xpert Bladder Cancer (BC) Monitor during the follow-up of patients with non-muscle invasive bladder cancer (NMIBC).MethodsPatients with previously diagnosed NMIBC and followed up in clinical practice settings in two French urology departments between September 2017 and July 2019 were consecutively enrolled in this prospective observational study. Patients with a positive cystoscopy or computed tomography urogram underwent subsequent transurethral resection of the bladder, and/or biopsy, and the specimens were pathologically assessed. Cytology and Xpert BC Monitor tests were performed on urine samples. Xpert BC Monitor performance was assessed versus cystoscopy for disease-negative patients or versus histology for disease-positive patients, and was compared to that of cytology.ResultsOverall, 500 patients with a median age of 70.0 years were included. NMIBC recurrence was diagnosed in 44 cases (8.8%). Overall sensitivity, specificity, and negative predictive values (NPVs) were 72.7% (32/44), 73.7% (330/448) and 96.5% (330/342) for the Xpert BC Monitor, and 7.7% (2/26), 97.8% (310/317) and 92.8% (310/334) for cytology, respectively. The Xpert BC Monitor detected 92.3% (12/13) of the high-grade tumours and ruled out their presence in 99.7% (330/331) of cases. Analysis of the areas under the receiver operating characteristic curves demonstrated the superior performance of the Xpert BC Monitor over that of cytology.ConclusionXpert BC Monitor performance was superior to that of cytology in the follow-up of NMIBC. The exclusion of aggressive tumours with a very high NPV (99.7%) supports the use of this urinary test in daily practice.

Rare Surgical Complication of In Vitro Fertilisation Treatment: Bladder Injury During Oocyte Retrieval

Current literature suggests that surgical complications from oocyte retrievals (ORs) are uncommon. Here, we present a rare case of bladder injury during OR and its subsequent management. A 37-year-old nulliparous woman underwent assisted reproductive therapy (ART) for primary infertility secondary to anovulatory cycle. During OR, there was an inadvertent puncture of the bladder, with active intra-bladder bleeding seen on transvaginal ultrasound. Bladder washout followed by continuous drainage was instituted with antibiotic coverage over several days. Bladder integrity ascertained through computer tomography urogram and cystoscopy were unremarkable. She was discharged well and continued with her fertility treatment. Transvaginal OR is associated with few complications. Bladder injury, albeit rare, can present with massive hematuria and hemodynamic instability. Early identification of the injury is key to management with insertion of the indwelling urinary catheter, hemodynamic resuscitation and bladder irrigation. With a urological multi-disciplinary approach, most bladder injuries can be resolved non-invasively. J Med Cases. 2021;12(3):102-106 doi: https://doi.org/10.14740/jmc3632

Duplicated Collecting System

Study Objective The objective of this video is to discuss the presentation, evaluation, and treatment of duplicated urinary collecting systems, and to present a case of duplicated ureters with ectopic ureteral implantation at the vaginal introitus. Design N/A Setting N/A Patients or Participants We present the case of a 56 year-old presenting with a history of recurrent urinary tract infections starting in adolescence. She reported symptoms of urinary urgency, frequency, and incontinence. She additionally reported an unclear history of an incidental diagnosis of ureteral anomaly in childhood. Interventions For evaluation of this patient, a computed tomography urogram was performed which revealed a right duplicated kidney with upper ureter inserting into the bladder neck, and lower ureter with unclear course. A voiding cystogram was performed to evaluate for ureteral reflux which was not demonstrated. A renal MAG3 scan was performed and demonstrated differential function between the two right renal moieties but no evidence of obstruction to the outflow tract to either renal moiety. Exam under anesthesia, cystoscopy, and right retrograde pyelogram revealed an ectopic ureteral orifice at the vaginal introitus and mild hydroureter leading to the upper renal moiety. Measurements and Main Results Complete mapping of this patient's right collecting system revealed complete ureteral duplication with the lower renal moiety drained by a normal ureter leading to an orthotopic ureteral orifice and the upper renal moiety draining into a mildly dilated ureter leading to an ectopic ureteral orifice at the vaginal introitus. The patient will subsequently undergo robotic-assisted right ureteroureterostomy and excision of distal ectopic ureter in a combined laparoscopic and vaginal approach. Conclusion Duplicated urinary collecting systems are the most common birth defect related to the urinary tract and can be frequently encountered by the pelvic surgeon. Knowledge of the presentation and workup of these anomalies is important in determining appropriate treatment.

Abstract 6366: Novel imidazolium compounds as intravesical therapeutic agents for non-muscle invasive bladder cancer

Abstract Introduction: Intravesical therapy has critical role in the treatment of high-risk non-muscle invasive bladder cancer. Due to ongoing shortage of BCG and lack of effective alternatives, there is an urgent need for novel intravesical chemotherapeutic agents. In this study, we investigated novel imidazolium compounds on bladder cancer cell lines to characterize activity and mechanism of action and in a mouse model to assess their efficacy and toxicity as intravesical agents. Methods: Three different imidazolium compounds (IS23, TPP1 and TCK1) were screened for their activity against six bladder cancer cell lines at various concentrations and different exposure time. The GI50s for each compound were then used to assess induction of apoptosis in vitro and to study mechanism of action. In vivo efficacy and toxicity of these compounds was studied in normal mice. The BBN mouse model was used to assess in vivo efficacy of these compounds, as it recapitulates the histological and genetic characteristics of human bladder tumors. The drinking water of 6 to 8 weeks old mice was supplemented with 0.05% BBN for 12 weeks, then switched to regular drinking water. Mice were randomly assigned into 5 intravesical treatment groups with 50:50 male:female make up in each group: 1) IS23; 2) TPP1; 3) TCK1; 4) Gemcitabine; 5) vehicle. Drugs and vehicle were instilled for four weeks. Each mouse was subjected to excretory computed tomography urogram to assess the filling defects in the bladder before treatment and every two weeks following the treatment. Mice were euthanized if size of filling defect in urograms exceeded 1/3 of the bladder, developed hydronephrosis, or 4 weeks after completion of intravesical treatment, whichever came first. Results: All imidazolium compounds showed toxicity to bladder cancer cells, TCK1 and TPP1 being the most and least potent respectively. They were also highly effective in killing bladder cancer cells with a 15-min GI90-dose. They briskly induced apoptosis by directly causing Cytochrome C expulsion from isolated mitochondria. Intravesical imidazolium compounds did not cause significant histopathological changes in normal bladder compared to vehicle group, but TPP1 was found to be tumor specific in vivo. TPP1 induced apoptosis in tumor without affecting normal bladder urothelium. In BBN-induced mice, 4/4 IS23-treated mice had filling defects while 8/15, 5/6, 10/11, and 7/8 TPP1-, TCK1-, vehicle-, and gemcitabine-treated mice had filling defects on urograms consistent with tumor. TPP1- and TCK1-treated mice had smaller filling defects compared to vehicle group mice, which was also confirmed histopathologically. Conclusions: TPP1 has a novel and potent mechanism and is worthy of further study as an intravesical agent for the treatment of high-grade superficial bladder cancer. It appears to work through a mitochondrial-centric mechanism and have cancer-specificity. Citation Format: Uttam Satyal, Abhishek Srivastava, David J. Weader, Michael L. Stromyer, Marie R. Southerland, Wiley J. Youngs, Philip H. Abbosh. Novel imidazolium compounds as intravesical therapeutic agents for non-muscle invasive bladder cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 6366.

Transection of Duplex Ureter During Vaginal Hysterectomy

Duplex ureter, an embryological developmental anomaly, can lead to intra-operative injuries, even by surgeons with a stronghold on normal ureteric anatomy. We describe the first case of an ectopic ureter transected during vaginal hysterectomy performed for pelvic organ proplase, due to its abnormally low implantation into the bladder, worsened by cystocoele. The injury was recognised, and the duplex ureter was diagnosed with cystoscopy and retrograde pyelography. A post-operative computed tomography urogram allowed us to map the exact course. In this case, there was injury to the ectopic, non-functional ureter, thus averting any further intervention. However, lower urinary tract injuries are serious complications with high morbidity, especially during delayed diagnosis. Knowledge of the ureter variants, meticulous tracing of the course, and use of post-operative cystoscopy could reduce these complications, particularly in face of increasing minimally invasive approaches.

Renal cell carcinoma of horseshoe kidney

Introduction. Horseshoe kidney is the most common developmental disorder of the urinary system, which involves an anomaly of kidney fusion, and occurs in 3% of the population. Kidneys are most often connected at the lower poles by fibrous or parenchymal isthmus. Renal cell carcinoma (RCC) is the most common tumor of the horseshoe kidney. Treatment involves surgical treatment that includes heminephrectomy or partial nephrectomy with different approaches. We report a case of RCC of a horseshoe kidney, located on the lower pole and the isthmus. Case outline. A 68-year-old patient reported to the urologist due to intermittent painless macroscopic hematuria. Computed tomography urogram revealed the presence of a tumor on the right kidney, measuring 85 ? 90 ? 60 mm, with radiological characteristics of RCC, which covered the entire lower pole of the kidney towards the isthmus. Angiography finding indicated a thickened isthmus with pronounced malformation of vascular structures. The right heminephrectomy was performed with resection of the isthmus from 15 mm to the healthy tissue. The isthmus was sutured in two layers with a catgut suture. Subsequently, hilar, paracaval, and interaortocaval lymphadenectomies were performed. The pathohistological finding indicated a tumor of renal cell origin, while the resection line was free of the tumor tissue, as were the lymph nodes. Conclusion. RCC is the most common neoplasm of the horseshoe kidney. Treatment is surgical and involves open or laparoscopic heminephrectomy or partial nephrectomy with a transperitoneal or extraperitoneal approach.

Traumatismes du rein

Renal traumas are common, observed in 10% of patients with abdominal trauma. Most renal traumas are blunt, resulting from a direct hit or from an abrupt deceleration. We realized a synthesis of renal trauma management for nurses. Clinical presentation often encompasses gross hematuria and lumbar pain. The best diagnostic tool is computed tomography (CT) urogram. Based on CT urogram images, renal traumas are classified according to the American Association for the Surgery of Trauma (AAST) classification in five grades of increasing severity. The management is conservative in the vast majority of cases and has been largely simplified over the past few years, being now mostly based on observation. Radiological interventional and endoscopic procedures are used only in very selected cases and surgical exploration has become extremely rare. The prognosis has also considerably improved and renal trauma rarely result in death or loss of the kidney nowadays.

Detection rate of crossing vessels in pediatric hydronephrosis: Transperitoneal laparoscopy versus open lumbotomy.

A bundle of crossing vessels (CV) supplying the lower pole of the kidney and causing mechanical obstruction of the ureteropelvic junction (UPJ) has been the subject of many discussions. During pyeloplasty, it is possible to overlook the CV. This may result in recurrent dilatation of the kidney and the need for re-surgery. To compare the detection rate of CV in UPJ obstruction (UPJO) depending on the operational access applied (transperitoneal laparoscopy (LAP) vs open lumbotomy (OPEN)). Assessment of features that could indicate the presence of CV. Two hundred and forty-six pediatric pyeloplasties were performed between January 2006 and July 2017 in the Department of Pediatric Surgery and Urology at the Wroclaw Medical University, Poland - 111 out of them by LAP and 135 by OPEN, on 98 girls and 148 boys. A retrospective analysis of the patient records for the detection of CV and characteristics of the CV before surgery was performed. Intraoperative CV causing obstruction of the UPJ in the LAP group were recognized in 34.2% (n = 38) of the patients, and within the OPEN group in 12.5% (n = 17) (p < 0.0001); 90% (n = 27) of patients with the diagnosed CV did not show congenital hydronephrosis. In 68% (n = 21) of the patients there were cases of recurrent renal colic. The presence of CV was suspected in 7.2% of kidney ultrasounds and in 12.5% in computed tomography (CT) urograms. The detection rate of CV in UPJO is statistically higher in LAP access than in open retroperitoneal lumbotomy. The distinguishing features of patients with CV are the lack of prenatal diagnosis for hydronephrosis and the presence of pain in the lumbar region.

The efficacy of tin-filtration for computed tomography in diagnosing urolithiasis

IntroductionThe purpose of this study was to evaluate the radiation dose and image quality of computed tomography urograms (CTU) using tin-filtration compared to conventional CTU (without tin-filtration) examinations in patients with suspected urolithiasis. MethodsGroup 1 consisted of 100 patients who were examined using the tin-filtered CTU protocols (Sn100kVp or Sn150kVp); Group 2 consisted of 100 patients who were examined using the same protocols but without tin-filtration (GE-NI41 or GE-NI43). The scanning protocol was based on the patients' body weight (<80 kg and ≥80 kg). The effective doses of all scans were compared between the two groups. Subjective image quality was evaluated by two blinded radiologists. The objective image quality was assessed for noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and figure-of-merit (FOM) using the CTU scans acquired from both the tin-filtered and non-tin-filtered protocols. ResultsTin-filtration resulted in the reduction of effective radiation dose ranging between 72% to 88% for the ≥80 kg and <80 kg patient groups respectively. For both groups, tin-filtration resulted in no significant differences in SNR and a significant increase in FOM. For the <80 kg group, tin-filtration resulted in significantly noisier images but with no significant difference in CNR. For the ≥80 kg group, tin-filtration resulted in significantly higher CNR. There was no significant difference in subjective image quality when assessed by the radiologists in terms of diagnostic confidence for urolithiasis. ConclusionTin-filtration significantly reduces patient dose while maintaining diagnostic image quality of CTUs for patients with suspected urolithiasis.

The effects of rectal cancer surgery on the anatomical localisation of ureters - a prospective observational study.

IntroductionAnatomical changes after surgery and fibrotic adhesions increase the organ laceration risk, including that of the ureter, in recurrent cases and secondary operations. The aim of this study was to investigate the changes in the anatomical localisations of the ureters via computed tomography urography in patients undergoing rectal cancer surgery.Material and methodsThe study involved prospectively collected data on the changes of ureteral location preoperatively and postoperatively in patients with operated rectal cancer. Distances (mm) of ureters determined midline in the computed tomography urogram phase.ResultsA total of 18 patients were included. The mean distances between the right (R1) and left (L1) ureters and the mid-vertebral line before the surgery were 30.9 ±5.4 mm and 34.5 ±9.9 mm, respectively. The postoperative distances between them (R2 and L2) were 26.4 ±9.1 mm and 29.5 ±9.9 mm, respectively. The R2 measurement showed that 83.3% (15/18) of the right ureters had deviated medially, whereas 16.7% (3/18) of them had deviated laterally. The L2 measurements showed that 88.8% (16/18) of the left ureters had deviated medially, whereas 11.2% (2/18) of them had deviated laterally. The differences between the preoperative and postoperative measurements of the right and left ureter positions were 4.5 ±9.2 mm and 4.9 ±4.6 mm, respectively, with the displacement in the left ureter being statistically significant (p ≤ 0.001).ConclusionsRectal cancer surgery causes medially deviated changes in the positions of the ureters.

Upper Tract Imaging in Patients with Initial or Terminal Hematuria Suggestive of Bleeding from the Lower Urinary Tract: How Often is the Upper Urinary Tract Responsible for the Hematuria?

Visible hematuria (VH) is a common urological complaint. A history of initial or terminal VH in men is indicative of a lower urinary tract (LUT) source. A careful clinical history could limit unnecessary extensive upper tract imaging in this group of patients with VH. We conducted a single-center prospective study to examine the usefulness of investigating the upper tract in patients with a history of VH likely from a LUT source (initial and/or terminal VH) with specific reference to the incidence of demonstrable significant upper tract abnormalities. We conducted a single-center prospective study of consecutive male patients presenting with VH over eight months. All patients underwent standard investigations including physical examination, flexible cystoscopy (FC), and radiological imaging (ultrasound scan (USS) and/or computed tomography urogram (CTU)). Those with a clear history of initial or terminal VH were identified for further scrutiny with regards to detectable upper tracts abnormalities. In total, 57 patients (aged 23-95 years) with initial or terminal VH were identified. Of these, 56 had FC and nine patients were subsequently diagnosed with a LUT malignancy. With regards to upper urinary tract (UUT), 35 patients (61.4%) had an USS, 46 (80.7%) underwent a CTU, and 25 (43.9%) patients had both. In this group, no UUT malignancy was identified on upper tract imaging. Initial or terminal VH patients may not need extensive upper tract imaging. FC is recommended, but a non-invasive USS can be a safe initial investigation for the UUT, with a CTU subsequently considered in those with abnormalities on USS and those with ongoing bleeding. Further combined multicenter analysis will help corroborate these findings and could have several beneficial outcomes including a reduction in investigations cost, patient inconvenience, and ionizing radiation.

This Month in Adult Urology

No AccessJournal of UrologyThis Month in Adult Urology1 Nov 2018This Month in Adult Urology Joseph A. Smith Joseph A. SmithJoseph A. Smith More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.07.052AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "This Month in Adult Urology." The Journal of Urology, 200(5), pp. 915–916 References 1 : Effectiveness of transurethral resection plus systemic chemotherapy as definitive treatment for muscle invasive bladder cancer in population level data. J Urol2018; 200: 996. Link, Google Scholar 2 : Conservative management following complete clinical response to neoadjuvant chemotherapy of muscle invasive bladder cancer: contemporary outcomes of a multi-institutional cohort study. J Urol2018; 200: 1005. Link, Google Scholar 3 : Can renal and bladder ultrasound replace computerized tomography urogram in patients investigated for microscopic hematuria?. J Urol2018; 200: 973. Link, Google Scholar 4 : Outcomes and prognostic factors in men receiving androgen deprivation therapy for prostate cancer recurrence after radical prostatectomy. J Urol2018; 200: 1075. Abstract, Google Scholar 5 : Complications and interventions in patients with an artificial urinary sphincter: long-term results. J Urol2018; 200: 1093. Abstract, Google Scholar 6 : Multiparametric magnetic resonance imaging/ultrasound fusion prostate biopsy—are 2 biopsy cores per magnetic resonance imaging lesion required?. J Urol2018; 200: 1030. Link, Google Scholar 7 : Evaluation of an aggressive prostate biopsy strategy in men younger than 50 years. J Urol2018; 200: 1056. Abstract, Google Scholar 8 : The temporal association of robotic surgical diffusion with overtreatment of the small renal mass. J Urol2018; 200: 981. Link, Google Scholar 9 : Can lumbosacral magnetic resonance imaging be performed safely in patients with a sacral neuromodulation device? An in vivo prospective study. J Urol2018; 200: 1088. Abstract, Google Scholar © 2018 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 200Issue 5November 2018Page: 915-916 Advertisement Copyright & Permissions© 2018 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph A. Smith More articles by this author Expand All Advertisement PDF downloadLoading ...

Effect of Prone and Supine Positioning on Computed Tomography Urography Examination

Objectives: The aim of this study is to evaluate the effects of performing computed tomography (CT) urogram in the prone position in terms of diagnosis. Methods: CT urograms of 208 patients imaged randomly in the prone and supine positions were included in this study. A total of 199 patients and 370 collecting systems were examined in total. Axial raw data and reconstructed coronal thin and thick MIP images with a slice thickness of 5 mm were evaluated by 2 independent radiologists blinded to the initial diagnosis. Renal collecting system, ureters, and bladder were included in radiological evaluation. Anatomically, the renal collecting system was separated into 7 regions. Filling and dilatation of collecting systems were evaluated via images at urogram phase by scoring. Results: Filling in lower pole infundibulum (p = 0.006), distal ureter (p = 0.006); and highly dilated lower pole calyx (p = 0.020), pelvis (p = 0.006), and bladder (p < 0.001) were determined to be better in images in the prone position compared to the supine position. There were no statistical differences in other regions. Conclusion: Better contrast material filling is achieved in dilated or non-dilated lower pole collecting system, dilated renal pelvis, non-dilated distal ureter of kidney, and in the bladder only by imaging the urogram phase in the prone position compared to the supine position. Additionally, presence of dilatation is a factor that could adversely affect filling. Studies in the future may investigate the contribution of prone positioning to CT urogram with larger series comparing it with other methods and modalities.