Value of cystography in urinary tract infections.
Fifty-one children with a bacteriologically proven urinary tract infection had both an intravenous urogram (IVU) and a micturating cystogram. The IVU was normal in 35. Only 6 of these children showed reflux in the cystogram, affecting 7 of the 70 ureters at risk. Since reflux on its own does not cause renal damage, which occurs only with super-added infection, detection of reflux is not important providing the urine is kept sterile. We suggest that cystography be deferred providing the IVU is normal until recurrent infections occur while under hospital care, and, with this policy this unpleasant and sometimes hazardous investigation could be avoided in many children with a single urinary tract infection. (+info)
Unilateral renal cystic disease in adults.
Unilateral renal cystic disease (URCD) is morphologically indistinguishable from autosomal dominant polycystic kidney disease (ADPKD) except for its unilaterality. Unlike ADPKD, URCD patients show neither a genetic background nor progressive deterioration in renal function; thus, the differential diagnosis of URCD from ADPKD is important. Only a few cases of URCD have been reported. This study reports two cases of URCD in adults together with a literature review. We identified these two cases using abdominal computerized tomography and family screening with renal ultrasonography. (+info)
Sonographic diagnosis of ureteral tumors.
We present our experience with transabdominal ultrasonographic diagnosis of ureteral tumors. During the years 1989 to 1998, 16 patients were diagnosed as having ureteral tumors. These patients were referred for sonographic examination for evaluation of hematuria (seven patients) or flank pain (four patients) or for follow-up screening in patients who were asymptomatic but at high risk for transitional cell carcinoma because of known past bladder tumor (five patients). Ten of these patients underwent intravenous urography examination, three patients had retrograde pyelography, and 11 patients underwent CT scanning. Ultrasonography revealed the ureteral tumors in all 16 patients, which appeared as hypoechoic intraluminal soft tissue. Three tumors were localized in the upper ureter, four in the middle ureter, and nine in the distal ureter. The degree of ureterohydronephrosis was minimal (two cases), mild (five cases), moderate (eight cases), or severe (one case). Eleven tumors caused local widening of the ureteral diameter. On intravenous urography, four patients had a nonfunctioning kidney, three patients had unexplained ureterohydronephrosis, and three patients showed ureteral filling defects, of which only two had irregular contours. On retrograde pyelography, two patients had filling defects (one of which with smooth margins), and one had a truncated ureter. On CT the tumor was clearly demonstrated in only seven patients. We found that ultrasonography can be a useful diagnostic tool in the workup of ureteral tumors. (+info)
Contrast material and gallbladder kinetics: implications for same day sonography after intravenous pyelography or CT scanning.
Sonographic examination of the gallbladder has allowed us to study the effects of various substances on this organ. A prospective study involving 77 patients was undertaken to evaluate the effects of intravenous or oral contrast agents on gallbladder volume changes in patients without known gallbladder disease. A mean volume after contraction of 24.8% was observed after administration of intravenous contrast agent (P < 0.01) and of 31.9% after oral administration (P < 0.01). This phenomenon of contraction of the gallbladder should therefore be recognized when sonographic or computed tomographic evaluation of the gallbladder is undertaken after imaging procedures that use radiographic contrast agents either intravenously or orally. (+info)
Sonographic features of horseshoe kidney: review of 34 patients.
Horseshoe kidney is a difficult sonographic diagnosis, especially if the isthmus is not seen. The purposes of this report are to review the sonographic images in 34 patients with proven horseshoe kidney, to discuss the limitations of ultrasonography in demonstrating the anomaly, and to identify features that would alert the examiner to the possibility of a horseshoe kidney. Among 34 patients, the isthmus was noted in 27. Of the 67 kidneys studied, 52 (78%) were judged to be low-lying, and in 24 (36%) the sonographic images suggested malrotation with anteriorly pointing pelvis. Additional sonographic features seen in the 67 kidneys included a bent or curved configuration of the kidney in the long axis (58%), tapering and elongation of the lower pole (60%), and a poorly defined inferior border of the kidney (84%). These features should suggest the presence of a horseshoe kidney and direct the examiner to search for the isthmus. (+info)
The diagnostic yield of intravenous urography.
BACKGROUND: Intravenous urography (IVU) is considered an integral imaging component of the nephro-urological work-up in a wide array of clinical settings. At our institution there is an open-access policy with regard to requesting IVU studies. METHODS: In a prospective, blinded observational study we undertook to assess the diagnostic yield of IVU with respect to the source of referral (i.e. Urology, Nephrology, GP, A & E, other speciality) and the presenting features, such as renal colic, haematuria, bladder outflow obstruction, recurrent urinary tract infection (UTI) etc. Two hundred consecutive patients were evaluated. RESULTS: Overall, 23% of tests were positive. There was a highly significant difference in diagnostic yield between the groups (P<0.001 for both referral source and test indication). A positive result was most likely after referral by a kidney specialist (37.1%) and when the test indication was renal colic (42%) or haematuria (32%). The yield was <15% in all other circumstances, with 94.9% and 92.1% of GP- and other hospital speciality-initiated IVUs being negative. When investigating recurrent UTI, 91.7% of tests were negative and 86.2% were negative when the indication was bladder outflow obstruction. CONCLUSIONS: It is suggested that an open access policy for IVU is not justified, especially when cost and the risk associated with contrast media and radiation exposure are taken into account. Our study supports the abandonment of routine IVU in the investigation of UTI and bladder outflow obstruction. (+info)
We report a case of circumcaval ureter diagnosed preoperatively by 'fish-hook' appearance on intravenous pyelogram. At surgery, patient was treated by 'Anderson Hones' pyeloplasty leaving the retrocaval segment in-situ. (+info)
Single unilateral ectopic bifid ureter with contralateral orthotopic quadrufid ureter--a rare combination.
This is a report a case with a unilateral single ectopic ureter associated with ipsilateral incomplete duplication of upper third of the ureter, contralateral quadrufid ureter and L3 hemivertebra. These findings provide further evidence of a generalised mesenchymal or epithelial defect, which would explain a defective ureteral bud and metanephric development, besides associated anomalies. (+info)