Urinary Tract Endoscopy Research Articles

Diagnostic Accuracy of Ureteroscopic Biopsy in Upper Tract Transitional Cell Carcinoma

Our aim was to determine the accuracy of ureteroscopic biopsies and cytological techniques compared to open surgical specimens of upper tract transitional cell carcinoma. From 1985 to 1995, 51 cases of upper tract transitional cell carcinoma were diagnosed ureteroscopically and distal ureterectomy or nephroureterectomy was performed. Each patient underwent direct ureteroscopic inspection and biopsy. Fresh samples were delivered to the cytopathology laboratory, where they were examined using cytospin and smear. A cell block was prepared when visible tissue was present. Grades of ureteroscopic biopsies were compared to grades and stages of surgical specimens in 42 cases. Cytological evaluation was positive for malignancy in 48 of the 51 cases (94.1%). Grading of ureteroscopic specimens was possible in 42 cases (82.4%). Transitional cell carcinoma grade on ureteroscopy accurately predicted tumor grade and stage in the surgical specimens. Of 30 low or moderate grade ureteroscopic specimens 27 (90%) proved to be low or moderate grade transitional cell carcinoma in the surgical specimens, while 11 of the 12 high grade ureteroscopic specimens (91.6%) proved to be high grade transitional cell carcinoma (p < 0.0001). Of 30 low or moderate grade ureteroscopic specimens 26 (86.6%) had a low stage (Ta or T1) tumor. In contrast, 8 of 12 high grade ureteroscopic specimens (66.7%) had invasive tumor (stage T2 or T3) in the surgical specimen (p = 0.0006). Ureteroscopic inspection and biopsy combined with cytological techniques provide accurate information regarding grade and stage of upper tract transitional cell carcinoma.

A REVIEW OF EQUINE RENAL IMAGING TECHNIQUES

Radiography has a limited role in the evaluation of the kidneys in foals and adult horses. Ultrasonography is the current method of choice for structural evaluation of the kidneys in horses as it provides additional information to standard serum chemistry and urinalysis evaluation. A variety of structural abnormalities have been identified in diseased equine kidneys with the use of ultrasound. Ultrasound guided renal biopsy is the preferred method for performing renal biopsy in the horse. The use of Duplex Doppler ultrasound may allow for the characterization of regional hemodynamics of the equine kidneys, but is currently an untapped method for evaluation of equine renal hemodynamics.Radionuclide methods including scintigraphy and quantitative renal function measurement can be used to provide further information about equine renal function. Scintigraphy can provide structural and possibly functional information. Quantitative methods using radiopharmaceuticals can provide precise measurement of glomerular filtration rate and effective renal blood flow. This method is especially helpful in identifying acute renal failure and in guiding response to treatment.All equine renal imaging techniques should be a supplement to the physical examination and standard laboratory tests. Additional diagnostic aids such as urinary tract endoscopy should also be considered in horses with hematuria, hydroureter, and suspected calculi. Taken together, all these modalities provide a through evaluation of the equine renal system and provide a basis for the clinician to select treatment options and provide prognostic information to the owner.

A 7.5/8.2 F actively deflectable, flexible ureteroscope: A new device for both diagnostic and therapeutic upper urinary tract endoscopy

Objective. To develop and employ in a prospective fashion a small-diameter, actively deflectable, flexible ureteroscope that could be easily placed into the upper urinary tract and would increase the overall therapeutic potential for this class of endoscope. Methods. A small-diameter, actively deflectable flexible ureteroscope was recently employed in clinical trials at two university centers. Improvements in fiberoptic engineering allowed endoscope miniaturization (7.5 F tip and 8.2 F shaft) while maintaining a relatively large (3.6 F) centrally located working channel. A variety of design modifications were employed through various prototype stages. Mechanical parameters included maximizing two-way active deflection, adequate secondary deflection allowing access to the lower pole caliceal system, and maintaining a sturdy (nonbuckling) durometer. Results. The 7.5 F flexible ureteroscope was employed in sixty-seven procedures (64 patients). Therapeutic rather than purely diagnostic maneuvers made up the majority of procedures. Thirty-one upper ureteral, renal pelvic, or caliceal calculi were treated with a variety of endoscopic lithotriptors placed through the ureteroscope. Six patients underwent both biopsy and endoscopic treatment of superficial papillary transitional cell malignancies. Retrograde endopyelotomy, incision or dilation of ureteral strictures, extraction of renal pelvic foreign bodies, and endoscopic access and treatment of obstructed caliceal diverticula were other applications. Endoscopic access to the upper urinary tract rarely required active intramural ureteral dilation (14%). Excluding patients with prior ureteral stents or those who underwent rigid distal third ureteral endoscopy prior to flexible proximal ureteroscopy, 31 patients (48%) required no intramural ureteral dilation prior to placing the endoscope. Conclusions. The increased therapeutic potential observed with the 7.5 F actively deflectable, flexible ureteroscope opens a variety of upper urinary tract pathologic states to minimally invasive (endoscopic) treatments.

Assessment of the Urinary System

History and physical examination alone will most often provide conclusive evidence of urinary tract disorders in ruminants. Detailed examination of the urinary system is described, and examples of disease are presented. Ancillary testing may be indicated to confirm the diagnosis, direct treatment, or clarify the prognosis. Serum chemistry interpretation, urinalysis, urinary tract endoscopy and radiography, ultrasonography, abdominocentesis, and renal biopsy are discussed.