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Biomedical subjects

M P Banner

Publications and source records attributed to M P Banner.

At least 37 records · Page 2Linked to original sources
PubMed1989

Anastomosed ureters: fluoroscopically guided transconduit retrograde catheterization.

Fluoroscopically guided, transconduit retrograde catheterization of ureters that have been diverted to a bowel conduit is often feasible in patients with patient ureteroenteral anastomoses who might otherwise require a percutaneous nephrostomy (PCN) for reasons other than high-grade anastomotic obstruction. This procedure was attempted on 14 occasions and successfully accomplished on 12. In 11 of these cases, retrograde catheterization obviated PCN to provide renal drainage for a partially obstructing ureteral stricture or obstructing renal calculi, to remove ureteral calculi, or to insert a new ureteral stent after an unsuccessful attempt to exchange an existing occluded retrograde ureteral stent. The procedure also obviated Whitaker testing. On one occasion the retrograde procedure greatly facilitated subsequent PCN in an obese patient with faintly opaque calyceal calculi. These procedures were accomplished with standard angiographic equipment and, in many instances, Teflon sheaths in the bowel conduit to stabilize catheters and guide wires. No complications were encountered. The two patients whose ureters could not be catheterized in retrograde fashion subsequently required PCN.

Fluoroscopy↗
PubMed1989

Fluoroscopically guided pyeloureteral interventions by using a perurethral transvesical approach.

Using a perurethral transvesical approach, we attempted a total of 180 varied pyeloureteral uroradiologic interventional procedures during a 20-month period; 168 were successfully accomplished (93% success rate). We used standard interventional equipment, fluoroscopy, and (for access to the upper urinary tract) ureteral catheters that had been partially or completely inserted at cystoscopy by urologists. The successful procedures included insertion of double-pigtail ureteral stents (42 procedures), insertion of single-pigtail ureteral stents (47), advancement of arrested or incompletely inserted retrograde ureteral catheters (42), urothelial biopsy (30), balloon dilatation of ureteral strictures (three), retrograde cannulation of ureteropelvic junction obstructions that could not be negotiated in a percutaneous antegrade fashion (three), and ureteral stone extraction (one). The method was unsuccessful in 12 patients. Failures were due to caudal migration of a ureteral catheter into the bladder in eight patients and to an inability to advance a guidewire beyond an area of ureteral obstruction or perforation in four. Although most commonly used as an adjunct to extracorporeal shock-wave lithotripsy of renal and proximal ureteral calculi, the perurethral approach was extremely valuable for a wide variety of other indications. Significant complications, encountered in 5% of the procedures, included urosepsis (two), ureteral perforations (five), and cannulation of a false ureteral lumen (two). These problems resolved without sequelae with conservative management. The perurethral transvesical approach represents a relatively simple, safe, and expeditious interventional uroradiologic method. It frequently obviated other more invasive interventions such as percutaneous nephrostomy, ureteroscopy, or surgery.

Adolescent↗
PubMed1989

Fluoroscopically guided retrograde brush biopsy in the diagnosis of transitional cell carcinoma of the upper urinary tract: results in 45 patients.

This is a retrospective review of 45 patients suspected of having transitional cell carcinoma of the upper urinary tract who underwent fluoroscopically guided retrograde brush biopsy at our institution during a recent 3-year period. All patients evaluated had an abnormal IV urogram or retrograde pyelogram in which the diagnosis of transitional cell carcinoma of the kidney or ureter was suspected or could not be excluded. The results of the brush biopsy were compared with the final diagnosis established at surgery or through clinical and surgical follow-up. Results of the biopsies were classified into five categories: (I) normal transitional epithelium (16 patients), (II) atypical cells (eight patients), (III) dysplastic cells (two patients), (IV) suspicious for malignancy (four patients), and (V) conclusive evidence of malignancy (eight patients). In four additional patients, other miscellaneous diagnoses were made, and in three others the procedure was nondiagnostic. Brush biopsies interpreted as Categories III, IV, and V had a positive predictive value of 100% (14/14) for the diagnosis of transitional cell carcinoma, and biopsies showing atypical cells (Category II) had a positive predictive value of 75% (6/8). Tabulating all diagnostic categories except for normal as a positive diagnosis, the procedure had a sensitivity of 91%, a specificity of 88%, and an accuracy of 89%. No significant complications were encountered. This experience suggests that brush biopsy is a valuable technique in patients suspected of having transitional cell carcinoma.

Adult↗
PubMed1988

Calcified transitional cell carcinoma of the renal pelvis.

Six patients with calcified transitional cell carcinoma of the renal pelvis were encountered over a 10-year period, and the radiographic features in these cases are presented. Radiographically discernible calcification is one of the less common manifestations of this lesion, and the pattern of calcification may be variable. However, the combination of a coarse, punctate pattern with a mucosal lesion on excretory or retrograde urography should suggest the diagnosis and prompt further investigation.

Aged↗
PubMed1988

Renal and related retroperitoneal abscesses: percutaneous drainage.

Renal and related retroperitoneal abscesses cause significant morbidity and mortality and almost always require drainage. The authors report 18 cases of percutaneous drainage of renal and related retroperitoneal abscesses, all of which were successfully managed. In 11 of these cases (61%), percutaneous drainage constituted the only treatment required. In the remaining seven (39%), the patients' clinical status improved after percutaneous drainage, and they were able to undergo subsequent elective nephrectomy with fewer complications. These results are comparable to those achieved with percutaneous abdominal abscess drainage and justify the use of percutaneous drainage for renal and related retroperitoneal abscesses as the therapeutic procedure of choice.

Abscess↗
PubMed1988

Balloon catheter dilation of ureteroenteric strictures: long-term results.

Balloon catheter dilation of benign ureteroenteric anastomotic strictures has been proposed as an alternative to either surgical revision or chronic ureteral stenting, with moderately successful short-term results reported by several groups in a limited number of patients. However, the authors' experience with 29 patients exhibiting 37 benign ureteroenteric strictures treated over the past 7 years revealed that in the majority of cases (23 patients, 26 strictures [70%]), strictures recurred within 6 months of balloon catheter dilation/ureteral stent therapy. Furthermore, of the 11 strictures that appeared to have been successfully dilated at a follow-up interval of 6 months, five restenosed within 1 year. Therefore, only six of 37 (16%) ureteroenteric stricture dilations could be considered successful when viewed at least 1 year after interventional therapy. Furthermore, repeat dilations have often been required to maintain ureteral patency in these patients.

Adult↗
PubMed1988

The development of steinstrassen after ESWL: frequency, natural history, and radiologic management.

Stone fragments that develop after extracorporeal shock-wave lithotripsy (ESWL) may lodge within the ureter. This column of fragments is referred to as a "steinstrasse" (plural, steinstrassen). We evaluated the first 1000 patients treated with ESWL at our institution to determine the frequency of steinstrasse formation, the clinical course of patients with steinstrassen, and the types of intervention, if any, required. Steinstrassen were seen in 20% of 1000 patients treated with ESWL. In 65% of the patients studied, the steinstrassen passed spontaneously. Of the remaining patients, all but 3% required treatment for ureteral obstruction. Seventy-five percent were treated urologically (ureteroscopy, ureteral catheterization), but 25% required radiologically directed intervention, either percutaneous nephrostomy or fluoroscopically monitored retrograde ureteral catheter/stent placement. Twenty-seven percent of our patients with persistent steinstrassen had silent obstruction. In view of the insidious manner in which kidney function may be jeopardized by steinstrassen, they should be managed with great circumspection. Radiologists dealing with steinstrassen should be skillful in both antegrade and retrograde methods of urinary tract intervention.

Humans↗
PubMed1987

Kidney changes after extracorporeal shock wave lithotripsy: CT evaluation.

Computed tomography (CT) was performed in 50 patients before and after extracorporeal shock wave lithotripsy (ESWL) to determine the effects of ESWL on the kidney and perinephric tissues. Bilateral treatments were performed in three patients. Post-ESWL scans demonstrated subcapsular hematomas in eight (15%) patients (two large, six small, none symptomatic) and intrarenal hematomas in two (4%) patients. In three (6%) patients small subcapsular fluid collections of uncertain cause were seen. Treated kidneys showed a statistically significant mean increase in size (9%) after ESWL, as measured at the axial level of the major stone fragment. Perinephric soft-tissue stranding and fascial thickening were seen in 37 (70%) of 53 treated renal fossae, with the changes ranging from mild to severe. The authors conclude that while most patients undergoing ESWL will show some posttreatment abnormality on CT scans, the procedure appears to be associated with a low frequency of serious renal trauma.

Adult↗
PubMed1987

Interstitial emphysema associated with epidural anesthesia for extracorporeal shock-wave lithotripsy.

Interstitial emphysema was noted on abdominal radiographs in 38 (15%) of the first 150 patients treated by extracorporeal shock-wave lithotripsy at our hospital. All 38 patients had undergone successful or attempted epidural anesthesia for the lithotripsy. This finding was not seen in any patient who had not undergone epidural puncture. The emphysema is the result of the introduction of air into the paraspinal and back muscles or subcutaneous tissues during attempted or actual puncture of the epidural space. This air was apparent on abdominal radiographs taken after lumbar puncture in 38 (23%) of 167 patients who underwent attempted or actual puncture of the epidural space. The emphysema decreases over the ensuing days, is of no clinical significance, and bears no direct relationship to extracorporeal shock-wave lithotripsy. This finding should not be mistaken for emphysema caused by gas-producing or gas-containing retroperitoneal diseases.

Anesthesia, Epidural↗
PubMed1987

Genitourinary complications of inflammatory bowel disease.

Inflammatory bowel disease affects the genitourinary tract not infrequently, either by way of direct extension of the gastrointestinal inflammatory process or through metabolic interrelationships between the two organ systems. The abnormalities that most frequently result include retroperitoneal abscess, ureteral obstruction, cystitis, enterovesical fistula, and urolithiasis. Some of these may be sufficiently symptomatic to draw attention to their presence, even, on occasion, overshadowing or preceding gastrointestinal disease symptoms. Other urinary lesions are clinically silent and require periodic uroradiologic evaluation for purposes of discovery.

Abscess↗
PubMed1986

Magnetic resonance imaging of the adrenal glands.

Applications of nuclear magnetic resonance (NMR) to the adrenal gland have received considerable attention in recent years. Using high field strength magnets and surface coil technology, images of normal and abnormal adrenal glands have been obtained that compare favorably, and in some instances excel, computed tomography (CT) with respect to both image quality and, to a greater degree, differentiation of pathology. This article reviews the current state of magnetic resonance (MR) imaging of normal and abnormal adrenal glands, compares MR with CT imaging, and indicates where NMR spectroscopy has been of greatest value to date in the study of adrenal gland disease.

Adenoma↗
PubMed1986

Upper urinary tract calculi: extrusion into perinephric and periureteric tissues during percutaneous management.

While the goal of percutaneous management of renal and ureteral calculi is stone extraction or disintegration, perforation of the renal pelvis or ureter may allow stones or stone fragments to become extruded during endourologic manipulations. The authors have encountered six such patients: two with renal and four with ureteral calculi. Three stones were extruded into the perinephric or periureteric tissues during nephroscopy, two during attempted dislodgement with a balloon catheter, and one during antegrade passage of a ureteral catheter. All patients were managed conservatively by means of nephrostomy drainage and, in the four cases of ureteral laceration, ureteral stenting. Follow-up study, ranging from 12 to 24 months, has documented a benign clinical and radiological course. No ureteral strictures have ensued. In the absence of infected urine, urothelial laceration with calculus extrusion appears to be a benign occurrence and may be managed conservatively.

Adult↗
PubMed1986

Extracorporeal shock wave lithotripsy and the radiologist.

When a hospital acquires a lithotripter it is unlikely that the volume of interventional radiology performed by personnel in that institution will be reduced. On the contrary, a significant increase in workload will probably occur. This will encompass not only interventional procedures on the urinary tract, but will also involve abdominal radiographs, excretory urograms, and so forth. Additional demands on the radiology department in the form of space, equipment, and possibly technical personnel will go hand in hand with an increase in the professional responsibilities of the attending radiologists. Radiologists must prepare themselves and their departments to meet these new responsibilities so that high standards of patient care can be maintained.

Humans↗
PubMed1986

Selected endourologic techniques.

Specialized interventional radiologic techniques of use in the kidney and ureter are described in this article. Access via an antegrade percutaneous nephrostomy or in the retrograde direction via the urethra is considered. The use of sheaths and other specialized instruments is explained, as are ureteral manipulations as an adjunct to extracorporeal shock-wave lithotripsy. Interventional techniques used in the urethra and bladder are described.

Dilatation↗
PubMed1985

Bullet colic.

Ureteral obstruction by intramural bullet, buckshot, or related missle following penetrating abdominal trauma is rare; a search of the literature revealed only 4 previously described cases [1-4]. A fifth case of a bullet migrating from the renal pelvis to the ureter has been reported at autopsy [5]. We present 2 new cases of delayed symptomatic ureteral obstruction ("bullet colic") after abdominal gunshot wounds.

Abdominal Injuries↗
PubMed1985

Self-limiting extravasation in the unused urinary bladder.

Patients being evaluated as potential renal transplant recipients routinely undergo voiding cystourethrography. Eight patients were encountered in whom extraperitoneal extravasation was noted from the region of the ureterovesical junction during voiding (seven patients) or during filling (one patient). Extravasation was bilateral in six patients and unilateral in two. The patients neither experienced symptoms related to the extravasation, required treatment, nor had sequelae. Five of the eight patients have subsequently received renal transplants and their bladders were observed to be normal at surgery. Cystoscopy was also performed in two of these five patients and was unremarkable. After transplantation, these patients' bladders functioned normally and gave rise to no symptoms.

Adult↗