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PubMed1985

Antegrade pyelography, percutaneous nephrostomy and ureteral perfusion (Whitaker test) for the renal transplant recipient.

Ureteral obstruction is a serious complication in renal transplant recipients. The diagnosis may be difficult with standard methods of investigation, and definite treatment may, therefore, be delayed. This paper describes the indications, the technique, and the experience with antegrade pyelography, ureteral perfusion and percutaneous drainage in 18 patients with suspected urinary obstruction. Though invasive, these methods proved to be a safe, fast and accurate means for evaluating the location and significance of ureteral obstruction. For initial treatment in obstruction, percutaneous nephrostomy is the method of choice. Surgery should be delayed until recovery of renal function with decreasing serum creatinine is demonstrated. Patients with persistent or rising serum creatinine (greater than 250 mumol./l.) did not benefit from surgical relief of obstruction.

Adolescent↗
PubMed1983

[Ultrasonically guided antegrade pyelography in kidney transplantations].

The indications for, and technique of ultrasound-guided antegrade pyelography of renal transplants are illustrated by eight patients. Because of the detailed anatomical information which the antegrade method provides, it is superior to other diagnostic methods for the investigation of ureteric obstruction or fistulae. The severity of renal pelvis dilatation as shown by sonography must not be taken as a criterian for the grade of obstruction, since transplants may show dilated collecting systems, even in the absence of obstruction. In our view, real time sonography with a suitable probe provides the best means of achieving successful puncture of the renal pelvis. The combination of ultrasound-guided puncture and radiological contrast examination of the ureter is the best diagnostic method available and lead, in all eight cases, to immediate and definitive treatment.

Adolescent↗
PubMed1990

[A comparison of sonography and intravenous pyelography in diseases of the kidneys and urinary organs].

Ultrasonography and intravenous pyelography (IVP) were compared for their diagnostic value in 65 patients (29 women, 36 men; mean age 57 [19-85] years) thought to have disease of the kidneys or urinary tract (microhaematuria in 16, macrohaematuria in 5, urinary tract infection in 11, suspicion of renovascular hypertension in 6, suspected tumour in 5, suspected nephrolithiasis in 15, and flank pain of uncertain cause in 7). Ultrasound established an abnormal condition in 29, in five of which IVP gave false positive results, false-negative results in three. The false-negative results were an indirect sign of renal artery stenosis in one patient and in one patient each of duplex ureter and cystic ureteritis. Mild hydronephrosis (n = 3), stone in a kidney or the renal calyx system (n = 2) and tumour of the right kidney (n = 1), diagnosed by ultrasound, were not seen by IVP. Concordant results were thus obtained in 70% of cases. Ultrasound examination of the urinary tract gives such reliable results that in many cases an additional IVP is unnecessary.

Adult↗
PubMed2002

The accuracy of noncontrast helical computed tomography versus intravenous pyelography in the diagnosis of suspected acute urolithiasis: a meta-analysis.

STUDY OBJECTIVES: We determine the accuracy of noncontrast helical computed tomography (NHCT) compared with that of intravenous pyelography (IVP) in diagnosing acute urolithiasis. METHODS: Computerized searches of MEDLINE and EMBASE were combined with hand reviews of major journals and of articles from reference lists. Articles were assessed according to a priori criteria for inclusion. Study eligibility was independently assessed by 2 reviewers in a blinded fashion. Test results were combined and analysis of log-transformed data was conducted by using general linear models. RESULTS: No disagreement was found between the 2 investigators in terms of articles that met the inclusion criteria or between the results of the studies. Four studies involving a total of 296 patients met all of the a priori criteria. The pooled positive likelihood ratios (LR+) for NHCT and IVP are 23.15 (95% confidence interval [CI] 11.53 to 47.23) and 9.32 (95% CI 5.23 to 16.61), respectively. The pooled negative likelihood ratios (LR-) for NHCT and IVP are 0.05 (95% CI 0.02 to 0.15) and 0.33 (95% CI 0.23 to 0.48), respectively. The differences between NHCT and IVP were statistically significant for both LR+ (P =.046) and LR- (P =.013). Differences among trials were not statistically significant in either analysis (P =.125 for LR+; P =.114 for LR-). CONCLUSION: The studies analyzed consistently demonstrated NHCT to be superior to IVP in accurately diagnosing acute urolithiasis, and differences between the 2 tests for both LR+ and LR- were statistically significant.

Acute Disease↗
PubMedDate not supplied

Pyelovenous and pyelolymphatic backflow during retrograde pyelography in renal vein thrombosis.

Pyelovenous and pyelolymphatic backflow have been observed during retrograde pyelography in three patients with renal vein thrombosis. The radiographic patterns of backflow following experimental unilateral renal vein occlusion in rabbits were analyzed and correlated with the clinical findings. Capsular, perihilar, periureteric, and retroperitoneal collateral vein networks and lymphatic channels were demonstrated on the venous occluded side. The appearance shown in the experimental study correlate well with the clinical observations.

Adolescent↗
PubMed1978

Intravenous pyelography in abdominal trauma.

The present report is a retrospective review of 23 patients admitted to the University of Kentucky Medical Center during 1975 and 1976, selected because they had sustained renal trauma as ascertained by hematuria, intravenous pyelography (IVP), or operative intervention. The value of IVP was determined by the patients' eventual hospital course. Of five patients with penetrating injuries, all had hematuria and an intravenous pyelogram on admission. One of these patients did not require an operation. Among the 18 patients with blunt abdominal trauma, six of the 14 patients who had hematuria and an IVP on admission were spared operation. Four patients did not have hematuria, but all four had a renal lesion. Two of these patients required an operation: one for inspection of a traumatic left nephrectomy; the other for bilateral renal artery occlusion, successfully repaired after 16 hours. Whenever feasible all patients sustaining abdominal trauma should have an IVP regardless of whether or not hematuria is present.

Abdominal Injuries↗
PubMed1986

Indications for emergency intravenous pyelography (IVP) in blunt abdominal trauma: a reappraisal.

Renal imaging in the diagnostic evaluation of blunt abdominal trauma is a valuable adjunct, but its indications remain controversial. Classic indications for the use of emergency intravenous pyelography (IVP) have been liberal, but more recently the medical need, cost effectiveness, and potential risks of this approach have been questioned in favor of a more selective approach. This retrospective study was undertaken to reassess the value of emergency IVP in blunt abdominal trauma and to test the hypothesis that post-traumatic microscopic hematuria, without other physical or laboratory findings, can safely be managed by observation alone. With the aid of the computerized Trauma Registry at the University of Virginia Medical Center, 50 consecutive patients undergoing emergency IVP for blunt abdominal trauma were identified over a 1-year period. A significantly abnormal IVP was found in six of seven patients with gross hematuria (86%). No patient of 43 with microscopic hematuria had a clinically significant abnormality (p less than 0.001, Chi-square). Three patients in the latter group (7%) had IVP findings which were anatomically abnormal but clinically insignificant, while an equal number (7%) had IVP's which were inadequate or misleading. Emergency IVP is useful in patients with specific indications and gross hematuria, but patients with post-traumatic microscopic hematuria alone may be safely followed by observation. Abdominal CT scanning is emerging as a more useful study than IVP for renal imaging in the stable patient with blunt abdominal trauma.

Abdominal Injuries↗
PubMed1984

Percutaneous antegrade pyelography in children.

We report our experience with 107 percutaneous antegrade pyelograms in 79 children aged between 3 days and 14 years. The main indications for the procedure are outlined, together with a note on the technique. Puncture of the pelvicaliceal system failed in 10% of cases. The procedure is simple to perform and is preferred to retrograde urography, which carries significant morbidity and is impracticable in the male infant. Antegrade pyelography provides the definitive anatomical diagnosis of obstruction of the upper urinary tract. It is particularly useful in megaureters after reimplantation and in grossly dilated and/or poorly functioning systems where diagnosis of obstruction by radionuclide renal scan could be difficult. The procedure has been found to be safe and complications are minimal.

Adolescent↗
PubMed1998

Bedside emergency department ultrasonography plus radiography of the kidneys, ureters, and bladder vs intravenous pyelography in the evaluation of suspected ureteral colic.

OBJECTIVE: To determine the role of bedside renal ultrasonography (US) and plain radiography of the kidneys, ureters, and bladder (KUB) as the initial investigative modality for those patients presenting to the ED with unilateral flank pain and hematuria. The hypothesis was that the renal US + KUB may obviate the need for emergent i.v. pyelography (i.v.P) in a majority of patients. METHODS: Prospective study over an 8-month period of all consecutive adult patients between the ages of 18 and 65 years presenting with unilateral flank pain and hematuria to the ED at LAC + USC Medical Center. Patients received KUB followed by a 500-mL bolus of normal saline. Bedside US was then performed by emergency physicians (EPs). Hydronephrosis of the kidney was graded as mild, moderate, or severe. All patients then underwent i.v.P. The results of the bedside US + KUB were then compared with those of i.v.P (the criterion standard). RESULTS: Of a total of 139 eligible patients, 108 were enrolled. The combination of US and KUB correctly identified pathology consistent with nephroureterolithiasis with a sensitivity of 97.1% (95% CI = 93.1-100%) when compared with i.v.P. The KUB + US results were falsely positive in 16 patients, resulting in a specificity of 58.9% (95% CI = 43.5-74.3%). The positive predictive value of the combined modality was 80.7%, the negative predictive value was 92.0%, and the overall accuracy was 83.3%. CONCLUSION: The bedside US + KUB has a high sensitivity and can be performed rapidly at the bedside by the EP when compared with i.v.P. This combined modality is an effective screening tool in the initial evaluation of ureteral colic.

Abdominal Pain↗
PubMed1979

Intravenous pyelography in nonuremic diabetic patients.

We studied the influence of intravenous pyelography (IVP) in 40 diabetic patients with a serum creatinine level of less than 2 mg/100 ml. None of the patients experienced irreversible renal function changes but 4 patients had an early significant rise in creatinine levels (greater than 0.2 mg/100 ml). In 3 of these it was only mild, but 1 patient sustained reversible serious damage with a creatinine rising from 1.6 to 3.8 mg/100 ml. 3 of these 4 patients had evidence of renal disease with mild creatinine elevations or proteinuria. Thus, IVP is a relatively safe procedure in nonuremic diabetic patients. This is different from IVP in diabetic patients who have creatinines over 2 mg/100 ml where 76% of the patients have serious acute renal failure and this is irreversible in one-third.

Acute Kidney Injury↗
PubMed1978

Observations on the value and limitations of infusion pyelography in anuric patients.

Infusion pyelography was performed in 103 anuric patients with no attendant mortality. It was useful in 83 cases in distinguishing obstructive uropathy from renal parenchymal disease. However, in the remaining 20 cases when either renal parenchymal disease co-existed with obstructive uropathy or obstructive uropathy existed alone under certain circumstances, opacification of the collecting system did not occur. The clinicopathological setting of some of the latter group of cases is illustrated by examples.

Anuria↗
PubMed1989

Tumor volume, CT scan, lymphography, sonography, intravenous pyelography, and tumor markers in testis tumors.

Correlation of tumor volume to tumor stage in 134 patients with nonseminomatous testicular tumors, which were classified according to the TNM system, revealed similar tumor load for N0 and N1 patients. CT scans (n = 92), lymphangiography (n = 47), intravenous pyelography (IVP) (n = 134), sonography (n = 118) and serial tumor markers (n = 82) were evaluated for sensitivity, specificity and accuracy, both separately and in different combinations. The best individual results were obtained by lymphangiography (sensitivity 0.77, specificity 0.73, accuracy 0.75) and CT scan (sensitivity 0.52, specificity 0.91, accuracy 0.70). In combination CT scan and lymphangiography were the most valuable diagnostic tools (accuracy 0.79) with high sensitivity (0.88) and specificity (0.77). For patients with negative CT scans, subsequent lymphangiography is recommended for accurate staging, as seems mandatory in stage 1 patients entering surveillance programs.

Adult↗
PubMed1982

Pyelorenal backflow during retrograde pyelography in normal and ischemic porcine kidneys. A radiologic and pathoanatomic study.

Retrograde pyelography was performed in 14 kidneys of anesthetized baby pigs to study the phenomenon of pyelorenal backflow. In this model, a constant retrograde perfusion rate of 10 ml/min was used which resulted in a progressive increase in pelvic pressure. The experiments were done on normal and ischemic kidneys. Pyelosinous backflow developed in twelve kidneys at an average intrapelvic pressure of 197 mm Hg and was independent of renal ischemia. Intrarenal backflow was observed only in kidneys which had been ischemic for 60 min and after 2 h of hypotension, or in postmortem kidneys. Intrarenal backflow in one or two papillae occurred at an intrapelvic pressure of 125 mm Hg. At higher intrapelvic pressures there was more intense and widespread intrarenal backflow. Histologic examination revealed tears in the calyceal fornix in cases with pyelosinous backflow. If intrarenal backflow was present there was parenchymal necrosis, interstitial Ferritin (added to the contrast material) in the papilla and in the corticomedullary junction, and tears leading from the pelvic cavity into the renal parenchyma.

Animals↗
PubMed1985

Renal failure and upper urinary tract obstruction after retrograde pyelography with potassium bromide solution.

Two iodine-sensitive women in whom potassium bromide solution was used as a radiocontrast agent for retrograde pyelography developed similar clinical conditions culminating in renal failure. Renal failure was due to upper urinary tract obstruction from fibrosis and fat necrosis in each case. Similar histological findings have been described in rabbit bladder exposed to sodium bromide solution. Different patterns of exposure corresponded with different sites of major damage in the two cases. One patient, who had repeated studies of the pelvicalyceal system with potassium bromide developed papillary necrosis. Systemic exposure to bromide-releasing compounds (in animals) and to bromides (in humans) has also been associated with papillary necrosis.

Adult↗
PubMed1977

CT-guided antegrade pyelography and percutaneous nephrostomy.

Percutaneous antegrade pyelography and percutaneous nephrostomy can be easily performed using CT guidance. CT provides cross-sectional images which facilitate accurate needle placement into the renal pelvis. CT is capable of detecting subtle density differences within the tissues so that even renal pelvises which do not contain contrast material and are not dilated can be accurately punctured. In addition to these procedures, CT accurately displays the perinephric space so that assessment of complications is possible. Four of five attempted percutaneous nephrostomies and two antegrade pyelograms were successfully performed using CT gudance.

Aged↗
PubMed1977

Fungal infection of the urinary tract: demonstration by antegrade pyelography and drainage by percutaneous nephrostomy.

Most fungal infections of the urinary tract involve the drainage structures rather than the kidney parenchyma. They usually occur in patients with diabetes or other chronic debilitating diseases and in the presence of urinary stasis. Conglomeration of fibrillar hyphae results in fungal balls which produce nonopaque filling defects in the renal pelvis, ureter, or bladder. Such fungal ball colonies were demonstrated by percutaneous (antegrade) pyelography in the upper urinary tract in two cases. A percutaneous nephrostomy was performed in one patient to provide drainage of pus in the renal pelvis.

Aged↗