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At least 37 records · Page 2Linked to original sources
PubMed1994

Pediatric pyeloplasty: is routine retrograde pyelography necessary?

To evaluate the necessity for retrograde pyelography in the preoperative evaluation of children undergoing pyeloplasty, we reviewed the records of 108 consecutive patients (age range 5 days to 18 years, median 1 year) who underwent pyeloplasty at our institution during a 6-year period. The routine preoperative evaluation consisted of a renal/bladder sonogram, furosemide renal scan (99mtechnetium-diethylenetriaminepentaacetic acid or 99mtechnetium-mercaptoacetyltriglycine) and voiding cystogram. No other imaging studies were obtained in 95 patients (88%). Other upper tract studies usually performed before referral included excretory urography in 9 cases and computerized tomography in 5. Preoperative retrograde pyelography was only performed in 1 symptomatic patient before referral to our institution. Surgical findings confirmed obstruction at the ureteropelvic junction in all patients. Undetected ureteral dilatation, which might suggest undiagnosed distal obstruction, was not encountered. After pyeloplasty 2 patients were lost to followup, renal drainage improved in 104 (98%) and drainage failed to improve in 2 of whom 1 (0.9%) required reoperation. All patients who presented with symptomatic uretero-pelvic junction obstruction experienced postoperative resolution of the presenting complaints. Our series demonstrates that routine retrograde pyelography to define the level of obstruction is not necessary for successful primary pyeloplasty. In experienced hands and with careful attention to detail, the combination of renal/bladder sonography and diuretic renography can reliably exclude the possibility of distal obstruction in children with hydronephrosis before pyeloplasty.

Adolescent↗
PubMed1981

Fine needle antegrade pyelography in the renal transplant.

Antegrade pyelography by fine needle puncture provides superior anatomic detail of the transplant ureter. It is the most accurate and informative examination for ureteral stricture and perforation, providing information not usually obtainable by excretory urography, radionuclide scan, ultrasound or retrograde pyelography. We herein describe our technique of fine needles antegrade pyelography and its application in 11 patients. The method is remarkably safe, with no clinical significant complications in this series or in a literature survey of 734 other fine needle kidney punctures.

Humans↗
PubMed2004

Detection of crossing vessels as the cause of ureteropelvic junction obstruction: the role of antegrade pyelography prior to endopyelotomy.

PURPOSE: To review the utility of antegrade pyelography in detecting crossing vessels as the cause of uretero-pelvic junction (UPJ) obstruction prior to planned endopyelotomy. MATERIALS AND METHODS: A retrospective review of the medical records, surgical reports, and medical images was performed in 109 consecutive adult patients in our practice who underwent antegrade pyelography just prior to planned endopyelotomy for symptomatic UPJ obstruction between January 1996 and December 2002. RESULTS: Fourteen patients were identified in whom a specific antegrade pyelographic appearance was detected in the diagnosis UPJ obstruction caused by crossing vessels. Surgical plans were changed in all 14 patients from antegrade endopyelotomy to open surgical pyeloplasty, during which the anterior (ventral) crossing vessels causing obstruction were confirmed. An additional three patients in the reviewed endopyelotomy group clinically failed their initial endopyelotomy procedure and were shown at the time of subsequent open or laparoscopic reconstructive surgery to have UPJ obstruction caused by anterior crossing vessels, but that diagnosis was missed at the time of the initial antegrade pyelogram. CONCLUSION: A specific antegrade pyelographic appearance was identified to diagnose UPJ obstruction caused by anterior crossing vessels with a sensitivity of 82.4% and a specificity of 100%. The direct obstructing effect of the vessels on the ureter is defined with pyelography as an acute posteriorly angulated ureteral deformity just below a patent UPJ. Recognition of this specific antegrade pyelographic appearance permits use of an appropriate surgical technique for UPJ obstruction repair.

Adolescent↗
PubMed1982

Constant pressure flow-controlled antegrade pyelography.

Flow-controlled antegrade pyelography is performed by perfusion of contrast dye after transcutaneous puncture of the renal cavities. The procedure enables excellent visualization in cases of upper tract dilatation, when the result of high-dosis excretory urography is not satisfactory. Flow-controlled antegrade pyelography under constant pressure provides urodynamic support to pyelography because the flow rate is known during the procedure, facilitating the interpretation of the relation dilatation and flow in cases of upper tract equivocal obstruction. Perfusion under constant pressure enables the recognition of the resistance to flow of the pyeloureteral tract in a simple manner.

Dilatation, Pathologic↗
PubMed1993

Does the Whitaker test add to antegrade pyelography in the investigation of collecting system dilatation in renal allografts?

Significant pelvicalyceal dilatation in renal allografts is currently investigated by antegrade pyelography. However, the clinical significance of a radiologically demonstrated narrowing of the ureter is unclear. Over a 21-month period 26 of 155 renal allografts with pelvicalyceal dilatation were investigated by antegrade pyelography. In eight allografts no ureteric stenosis could be identified. Two grafts were shown to have ureteric necrosis and required surgical intervention and 16 of the other grafts appeared to have a ureteric stenosis. 15 of the 16 allografts with radiological ureteric stenosis underwent a concurrent pressure flow study to assess the functional relevance of the ureteric narrowing. As shown by a pressure rise of > 7 mmHg at a perfusion rate of 10 ml min-1, 11 of the 15 grafts were functionally obstructed and were treated by a nephrostomy catheter followed by antegrade insertion of a ureteric stent. The four grafts with a negative pressure flow study were subsequently shown on biopsy to have rejection. The diagnosis of allograft rejection was also confirmed by biopsy in seven of the eight allografts without a radiological ureteric stenosis. The last of the eight allografts was found to be cyclosporin toxic. Pelvicalyceal dilatation of renal allografts is appropriately investigated by antegrade pyelography in combination with a pressure flow study which identifies those grafts with mechanical obstruction.

Adult↗
PubMed1988

Urine leaks after renal transplantation: value of percutaneous pyelography and drainage for diagnosis and treatment.

We reviewed our experience with 12 renal transplant patients who had urine leaks to compare the accuracies of sonography and nuclear renography with that of antegrade pyelography in establishing the diagnosis. The leak was proved by surgery in 11 of the 12 cases. We also determined the role of diverting percutaneous nephrostomy drainage in the treatment of such leaks. The diagnosis was established by sonography in eight (67%) of the 12 patients. Nuclear renography, performed in nine patients, showed decreased renal function but showed the leak in only three (33%) of the nine cases. Antegrade pyelography, performed in all 12 patients, showed leakage in 10 (83%). In the other two patients, follow-up nephrostograms done within 24 hr showed leaks near the ureterovesical anastomotic site. Seven of 11 patients who were managed with a combination of percutaneous nephrostomy drainage and surgical reconstruction were treated successfully (i.e., a functioning graft was retained); however, only one patient was managed successfully by percutaneous methods alone. Antegrade pyelography is more accurate than sonography and nuclear renography in the detection of urine leakage after renal transplantation. However, percutaneous nephrostomy drainage appears useful only as an adjunct to surgery for treatment of this complication.

Adolescent↗
PubMed1980

Intravenous pyelography versus radioisotope renography combined with plain roentgenography of the urinary tract in the follow-up of patients with ureteral calculi.

Isotope renography combined with plain roentgenography of the urinary tract was compared with intravenous pyelography in the follow-up of 50 patients with pyelographically confirmed, radiopaque ureteral stone. The combined method was as informative as intravenous pyelography regarding the site of the obstruction, and gave better information on the function of the renal parenchyma and the passage of urine. Since in the combined method the level of radiation to which the patient is exposed is much lower than in intravenous pyelography, and since no allergic reaction to the combined method has been reported, it would seem useful in the follow-up of patients with roentgenographically visualized ureteral stone.

Adolescent↗
PubMed1999

[A renocolic fistula diagnosed by retrograde pyelography].

OBJECTIVE: To describe a case of renocolic fistula diagnosed by retrograde pyelography. METHODS: A case of renocolic fistula associated with pyonephrosis and left pleural empyema in a 48-year-old female with a history of recurrent pyelonephritis is presented. RESULTS: The ultrasound findings were suggestive of pyonephrosis and an excretory urogram showed a non-functioning left kidney. Retrograde pyelography showed passage of contrast medium into the descending colon. Surgical treatment consisted of nephrectomy, exteriorization of the compromised colon and pleurotomy. The patient died from septic shock. CONCLUSIONS: The utility of retrograde pyelography in the diagnosis of renocolic fistula is demonstrated in the case described herein.

Colon↗
PubMed1975

Electrocardiographic changes following intravenous pyelography.

One hundred consecutive patients who underwent i.v. pyelography had ECG performed before, immediately following and 5 min after the injection. ECG changes appeared in 15 patients and were considered to be major in five of them. The incidence of ECG changes was significantly higher in patients with abnormal ECG prior to pyelography. The average age of the patients who developed changes was higher than that of patients in whom no ECG changes were observed. There was no significant difference in the incidence of ECG changes after standard and infusion pyelography.

Clinical Trials as Topic↗
PubMed2001

Iohexol does not influence the levels of blood serum cation electrolytes during intravenous pyelography.

PURPOSE: The influence of the nonionic contrast agent iohexol on blood pH and the cation electrolytes Ca, Na, K and Mg was studied in vivo in humans during the intravenous pyelography. MATERIAL AND METHODS: A population of 28 patients without renal function impairment or electrolyte imbalance was divided into two equal groups. The first group received an intravenous injection of 0.6 mL Omnipaque per kg of body weight (0.388g iohexol/kg and 0.18 g iodine/kg). The second group received a double dose of Omnipaque (1.2 mL iohexol/kg; 0.776g iohexol/kg and 0.36g iodine/kg). Blood samples (5 mL) were taken before the injection of the contrast medium and 5, 10 and 20 minutes (marking the end of the examination) after the injection. Blood pH was also determined immediately after each sample collection, while electrolytes were measured in the laboratory. Systolic and diastolic blood pressure were also determined simultaneously with each sample collection using a mercury manometer. RESULTS: Iohexol in simple and double doses did not have any statistically significant effect either on blood pH or on blood serum electrolytes during intravenous pyelography. Blood pressure, both systolic and diastolic, remained stable in all the patients during the examination. CONCLUSIONS: Our results show that the nonionic contrast medium iohexol at the doses used in routine intravenous pyelography does not have any influence on blood pH and serum cardioactive cation electrolytes in humans. An electrolyte imbalance is always a risk factor that may contribute to the development of cardiovascular side effects. This factor is eliminated when iohexol is administered intravenously instead of an ionic agent.

Adult↗
PubMed2002

Does replacing intravenous pyelography with noncontrast helical computed tomography benefit patients with suspected acute urolithiasis?

OBJECTIVE: To determine if replacing intravenous pyelography with noncontrast helical computed tomography (NHCT) scanning of the abdomen for the investigation of suspected acute urolithiasis results in shorter stays in the Emergency Department, reduced hospital admissions or fewer interventions. METHODS: A retrospective review of the charts of all patients who were discharged from the Emergency Department with a diagnosis of acute urolithiasis or renal colic was conducted. Length of stay, hospital admissions and the number of therapeutic interventions were compared for the 5-month period before and the 5-month period after the implementation of NHCT scanning of the abdomen as the primary investigation of suspected acute urolithiasis. RESULTS: Of 230 cases reviewed, 119 met all of the inclusion criteria (61 in the intravenous pyelography group and 58 in the NHCT group). No significant differences were found between the 2 groups on median length of stay in the Emergency Department (7.6 h v. 6.2 h), hospital admission rates or post-test therapeutic interventions. CONCLUSIONS: Replacing intravenous pyelography with NHCT scanning for the investigation of suspected acute urolithiasis does not result in significantly shorter stays, reduced hospital admissions or fewer interventions for patients.

Acute Disease↗
PubMed1978

Ultrasonically guided antegrade pyelography.

Guided by ultrasound percutaneous antegrade pyelography can be accomplished with great ease in patients with obstructive hydronephrosis. The exact location and the depth of the dilated renal pelvis can be determined accurately with the use of ultrasound and the procedure is similar to that of a cyst puncture. Antegrade pyelography provides significant diagnostic information on the nature of the obstructive lesion and can be performed as an adjunct to a retrograde study or as an alternative to a retrograde pyelogram. Ultrasound is considered a most advantageous aid to the performance of antegrade pyelography.

Adult↗
PubMed1982

Diagnostic value of distended urinary bladder pyelography in adults.

Intravenous pyelography carried out with a previously distended bladder in order to produce partial urinary flow obstruction offers superior delineation of the pelvi-caliceal system and ureters. Often, these structures are visible in their entirety on a single film. In 100 adult patients of both sexes who had undergone conventional i.v. pyelography, a second examination was carried out without external compression, after preliminary distension of the urinary bladder (DUB). DUB was achieved by three different methods. In 25 patients the urinary bladder was distended by retrograde instillation of saline. Another 25 patients retained their overnight urine and 50 others retained their urine following a water load of 1,000 ml. Best results were obtained in patients examined by the retrograde and water-load methods. The vast majority of examinations in these groups were of superior quality compared with that obtained by the routine technique. Pyelography with a distended bladder proved to be a valuable diagnostic adjunct in all instances in which application of external compression is undesirable, particularly in cases of trauma.

Adolescent↗
PubMed1994

[MR pyelography using fast spin echo technique in hydronephrosis].

MR pyelography using the fast spin echo technique and and a body coil were performed in ten patients with hydronephrosis. In all cases, pyelograms of the dilated urinary tract were obtained by this method, although they were obtained in only two cases by drip infusion pyelography. MR pyelography is an effective method with which to obtain images of dilated urinary tract non-invasively, and in a relatively short time. This method was also useful to evaluate intraureteral structure.

Adolescent↗
PubMedDate not supplied

Renocolic fistulas: complementary roles of computed tomography and direct pyelography.

Three patients with renocolic fistulas are presented. Antegrade or retrograde pyelography showed the fistula in one patient but was unsuccessful in two others. CT demonstrated perinephric inflammation extending to the colon, complex air-fluid collections within the kidney, or extension of renal contrast into the colon. CT and direct pyelography complement each other for the diagnosis of renocolic fistulas.

Aged↗
PubMedDate not supplied

Correlation between urinalysis and intravenous pyelography in pediatric abdominal trauma.

Controversy exists surrounding the appropriate indications for intravenous pyelography (IVP) in assessing blunt renal injuries in children. Forty-one consecutive cases of suspected blunt renal injuries, who had an IVP performed between January 1988 and December 1990 at The Children's Hospital of Eastern Ontario, were examined by a retrospective chart review. Eighty percent of the IVPs were normal. Of the eight abnormal IVPs, four were contusions, two lacerations, and two nontraumatic abnormalities. There was no hemodynamic compromise, no requirement for surgical intervention, and no deaths in the study population. In the absence of significant hematuria (> or = 100 rbc/hpf), the probability of detecting a traumatic abnormality on IVP is low (4%). There was no correlation between the mechanism of injury and the IVP findings. We conclude that intravenous pyelography has a low yield in the absence of significant hematuria (> or = 100 rbc/hpf).

Abdominal Injuries↗
PubMed2005

Anaphylactoid reaction after retrograde pyelography despite preoperative steroid preparation.

A 19-year-old woman with a known allergy to iodinated contrast presented with intermittent, gross hematuria of 2 years' duration. The patient was scheduled to undergo cystoscopy with bilateral retrograde pyelography, because this is considered a safe alternative to intravenous pyelography or computed tomography. Because of her contrast allergy, the patient completed a 13-hour steroid preparation before the procedure. However, within minutes of extubation, she developed an anaphylactoid reaction and, despite appropriate management, required reintubation and subsequent transfer to the intensive care unit. The patient was subsequently extubated 8 hours later and recovered completely.

Adult↗
PubMed1991

Radionuclide diuresis pyelography.

Radionuclide diuresis renography continues to be relied upon as a major diagnostic tool to differentiate obstructive and nonobstructive hydronephrosis. Controversy continues to exist with respect to methodology and interpretation of intermediate obstructive patterns. In this study radionuclide diuresis pyelography was performed in 11 renal units with hydronephrosis and a pre-existing percutaneous nephrostomy tube in place. The procedure consisted of the introduction per kidney of 20 muc./kg. 99mtechnetium-diethylenetriaminepentaacetic acid and sterile saline as a bolus into the renal pelvis via a percutaneous nephrostomy tube to produce a volume equal to the capacity of the hydronephrotic system. The kidney was monitored with a gamma camera and computer system. Furosemide (0.3 mg./kg.) was injected intravenously halfway into a 40-minute study. The time/activity curves thus generated were relatively independent of the cortical transport phase. The 2 types of curves were accelerated and constant. Analysis of these pyelogram curves revealed a strong correlation between the presence of an accelerated clearance rate response to furosemide and hydronephrosis without obstruction in 5 of 6 renal units. A constant clearance rate response to furosemide correlated with the presence of obstruction in 4 of 5 units. These observations may indicate that diuretic pyelogram curve dynamics may reflect not only the presence or absence of obstruction but also the ability of the hydronephrotic kidney to respond to the diuretic. More experience must be accumulated to determine the conditions under which diuresis pyelography may become useful clinically.

Child↗