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PubMed1986

[Sonographic diagnosis of kidney calculi--comparative study of ultrasound, excretory urography and computer tomography in 310 patients].

The authors compared the value of sonography with I.V. urography and CT in the diagnosis of nephrolithiasis, employing a retrospective study conducted on 310 patients. False positive and false negative sonographic findings were analysed in retrospect and the differential diagnosis discussed. Sonography proved of equal value to I.V. urography. 90% correct diagnoses were made via sonography; its sensitivity was 89%, its specificity 91%. 29% of the sonographically correctly diagnosed kidney stones had been detected by chance. The smallest sonographically identified stone was 3 mm, whereas the biggest stone that had been missed out was 7 mm. Sonography is definitely superior to I.V. urography in the detection of nephrocalcinosis and of roentgen-negative stones. Sonographically questionable parenchymal calcifications without shadowing should be investigated further by CT in case of clinical significance, even if the plain film is negative. The number of false positive findings in sonography can thus be reduced. Sonographic differentiation between central parenchymal calcification and stone formation is difficult in rare cases only. If required, additional information can be obtained via I.V. urography. The authors recommend sonography as the method of choice for suspected nephrolithiasis before I.V. urography is performed.

Humans↗
PubMedDate not supplied

[Fatal case of metformin-induced lactic acidosis after urography in a diabetic patient (author's transl)].

The authors report a new case of lactic-acidosis in a diabetic patient receiving metformin. This patient, after urography developed an acute renal failure and a fatal lactic acidosis. Risks of urography in diabetic patients and guidelines for use of metformin are recalled; careful assessment of risk versus benefit for every proposed urography in diabetic patients never use metformin if creatinin is over 140 micromoles/liter, if an urography must be undergone, metformin must be stopped 3 days before urography and resumed only 3 days after it, if renal function allows it.

Acidosis↗
PubMed1983

[Problems of intravenous urography in patients with plasmocytoma].

Numerous reports refer to the development of acute renal failure following intravenous urography in patients with multiple myeloma, while other authors consider the risk to be acceptable if abdominal compression and dehydration are avoided and alkalization of urine is carried out. The outcome of 34 intravenous urographies with Conray 70, Conray FL, and Conray 36 has been evaluated in 26 patients with multiple myeloma. No case of acute renal failure was observed. Two patients experienced a mild increase (greater than 0.3 mg/dl) in serum creatinine levels. Mean value of serum creatinine was 1.28 mg/dl prior to and 1.18 mg/dl after urography. In three of four patients with preexisting azotemia serum creatinine levels fell after urography, while in the fourth a mild increase from 2.0 mg/dl to 2.5 mg/dl five days after the examination was observed. Data from the literature in addition to own data are presented. From all the data taken together we conclude that intravenous urography may carry a moderately increased risk of acute renal failure in patients with multiple myeloma. It may be performed if the indication is well established.

Acute Kidney Injury↗
PubMed1991

RARE-MR-urography in the diagnosis of upper urinary tract abnormalities in children.

RARE-MR-urography (Rapid Acquisition with Relaxation Enhancement) is a fast MR imaging technique (6.4 s/acquisition) that selectively depicts fluid by heavy T2-weighting. From 9/1989 to 11/1990, RARE-MR urograms were prospectively evaluated in the diagnosis of upper urinary tract abnormalities in 55 children. The method is performed in several planes and combined with a coronal, T1-weighted spin-echo sequence. Forty out of 42 kidneys with dilated renal pelvis, and 21 out of 24 dilated ureters were identified, only the mildly dilated ones were missed. Even in non-functioning kidneys the urinary tract was clearly depicted by RARE-MR-urography. However, no differentiation could be made with this technique between vesicoureteral reflux and non-refluxing dilatation of ureter and/or renal pelvis. All 19 pelviureteric obstructions and all eight renal duplications with a dilated segment were identified. RARE-MR-urography is a new tool for diagnosing urinary tract abnormalities in children without having to employ ionizing radiation, contrast media, or general anesthesia. A dilated urinary tract can be shown in one image displaying the entire urinary system, similar to excretory urography. The technique is presently not able to provide the information of voiding cystourethrography or renal scintigraphy, nor is it as easy to perform as ultrasound. However, in certain cases it may replace excretory urography.

Adolescent↗
PubMed2006

Magnetic resonance urography in the evaluation of prenatally diagnosed hydronephrosis and renal dysgenesis.

PURPOSE: We present our experience with dynamic contrast enhanced magnetic resonance urography for evaluation and treatment in infants born with prenatally recognized hydronephrosis. We determined the characteristics of renal dysgenesis in this population. MATERIALS AND METHODS: We reviewed magnetic resonance urography images done within the first 6 months of life in 67 infants born with prenatally recognized hydronephrosis. High resolution imaging was used to establish a morphological diagnosis. Functional evaluation was used to assess obstruction and individual renal function. Voiding cystourethrography was performed in 62 patients. RESULTS: Our study included 67 infants (87 renal units). There were 54 boys and 13 girls with a mean age of 2.8 months (range 0.9 to 4.6). Of these 87 renal units 30 (35%) had ureteropelvic junction obstruction, 18 (21%) had primary megaureters, 10 (11%) had nondilating vesicoureteral reflux, 10 (11%) had fetal folds, 8 (9%) had posterior urethral valves, 6 (7%) had ectopic ureters, 4 (5%) had multicystic dysplastic kidneys and 1 (1%) had a normal study. Magnetic resonance urography revealed renal dysgenesis in 24 renal units (28%), consisting of loss of corticomedullary differentiation, renal cystic changes distinct from multicystic dysplastic kidneys, solid renal dysplasia, hypoplasia and dysmorphic calyces. CONCLUSIONS: Magnetic resonance urography is an excellent addition to our armamentarium for evaluating neonatal hydronephrosis and renal dysgenesis. Due to its comprehensiveness magnetic resonance urography has the potential to become the study of choice for evaluating infants with significant prenatally recognized hydronephrosis. However, further prospective, comparative studies in larger patient populations are needed to justify the cost and the need for sedation in infants.

Female↗
PubMedDate not supplied

Intramuscular urography in rats.

In addition to macroscopic studies, microscopic studies, and biologic tests, urography is a valuable method for investigating renal function in rats. Intravenous urography is complicated, however, by the difficulty of puncturing a tail vein or the femoral vein. Intramuscular urography, on the other hand, is a simple and reliable method for radiographic examination of the kidneys and ureters, and gives information on morphology as well as physiology. In this study in 40 rats, intramuscular urography was performed under general anesthesia, and the contrast medium was injected into the gluteal muscles. Dense nephrograms and optimum films of the calices and the ureters were obtained approximately 40 minutes after injection.

Animals↗
PubMed1977

The value of routein intravenous urography in acute epididymitis.

The urographies of 106 patients with acute epididymitis are reviewed. In 71 cases the urogrpahy was completely normal, while in the remaining 35 patients abnormalities were found. In 25 patients the findings were consistent with hypertrophy of the prostate. More than half of the patients had known urological diseases and had undergone cystoscopy and/or catheterization prior to the onset of acute epididymitis. All 35 patients had demonstrated symptoms that would otherwise have resulted in intravenous urography independent of the epididymitis. No cases of urogenital tuberculosis were found. The authors conclude that routine urography under the age of 50 is not recommended. Over the age of 50 concomitant urological diseases are so common that urography is often indicated, but acute epidiymitis in itself is only a relative indication.

Acute Disease↗
PubMed2002

[Modern diagnostic imaging: MR urography].

MR-urography presents a new diagnostic approach to the urinary system, resulting in images comparable to those known from i.v.-urography. T2-weighted MR-urograms demonstrate static fluid without ionizing radiation or nephrotoxic contrast media. The excretory renal function can be examined by the use of gadolinium-enhanced T1-urography. The degree and cause of ureteric obstruction can be diagnosed with high sensitivity and specificity. On the other hand, urolithiasis is frequently misdiagnosed by MR-urography and, in this case, spiral CT should be used. Pediatric or pregnant patients can be examined as well as donors before and patients after renal transplantation. Furthermore, in case of a tumor MR-imaging, including MR-angiography, is a potential diagnostic "all-in-one" approach.

Adult↗
PubMed2000

MR urography findings of a duplicated ectopic ureter in an adult man.

In this report we present the imaging findings in an adult male with a duplicated ectopic ureter which inserted into the prostatic urethra. The appearances at excretory urography, US, CT, and MR urography are described together with the potential pitfalls of the imaging techniques. Both US and MR urography accurately image the collecting system from the kidney to the point of distal ureteral insertion, and in our patient, MR urography provided similar information to US.

Adult↗
PubMed2001

Diuretic-enhanced gadolinium excretory MR urography: comparison of conventional gradient-echo sequences and echo-planar imaging.

The aim of this study was to investigate the utility of different gadolinium-enhanced T1-weighted gradient-echo techniques in excretory MR urography. In 74 urologic patients, excretory MR urography was performed using various T1-weighted gradient-echo (GRE) sequences after injection of gadolinium-DTPA and low-dose furosemide. The examinations included conventional GRE sequences and echo-planar imaging (GRE EPI), both obtained with 3D data sets and 2D projection images. Breath-hold acquisition was used primarily. In 20 of 74 examinations, we compared breath-hold imaging with respiratory gating. Breath-hold imaging was significantly superior to respiratory gating for the visualization of pelvicaliceal systems, but not for the ureters. Complete MR urograms were obtained within 14-20 s using 3D GRE EPI sequences and in 20-30 s with conventional 3D GRE sequences. Ghost artefacts caused by ureteral peristalsis often occurred with conventional 3D GRE imaging and were almost completely suppressed in EPI sequences (p < 0.0001). Susceptibility effects were more pronounced on GRE EPI MR urograms and calculi measured 0.8-21.7% greater in diameter compared with conventional GRE sequences. Increased spatial resolution degraded the image quality only in GRE-EPI urograms. In projection MR urography, the entire pelvicaliceal system was imaged by acquisition of a fast single-slice sequence and the conventional 2D GRE technique provided superior morphological accuracy than 2D GRE EPI projection images (p < 0.0003). Fast 3D GRE EPI sequences improve the clinical practicability of excretory MR urography especially in old or critically ill patients unable to suspend breathing for more than 20 s. Conventional GRE sequences are superior to EPI in high-resolution detail MR urograms and in projection imaging.

Adult↗
PubMed1980

Screening excretory urography in patients with cryptorchidism or hypospadias: a survey and review of the literature.

Hypospadias and cryptorchidism constitute common problems in urology for which the use of routine screening urography has been challenged recently. To assess better current thinking 233 urologists who devote a significant part of their practice to children were surveyed as to the number of procedures performed as well as to the instances when excretory urography was obtained. Of 163 physicians who responded 70 per cent do not favor routine screening urography in cryptorchid patients, while approximately 50 per cent believe that it is worthwhile in hypospadias. In the cryptorchid responses there was a definite decrease in the percentage of physicians obtaining x-rays as the yearly volume of cases increased (50 per cent with less than 10 cases per year and 18 per cent with greater than 20 cases per year), while this relationship was not maintained for hypospadias. A review of the literature correlates well with this survey in that excretory urography is not necessary in cases of cryptorchidism but its value is still debated in cases of hypospadias.

Cryptorchidism↗
PubMed1989

The evaluation of suspected renal colic: ultrasound scan versus excretory urography.

Patients commonly present to the emergency department with a suspected diagnosis of renal colic. A prospective study of 98 patients presenting with acute flank or abdominal pain or both was conducted to determine the diagnostic accuracy of ultrasound scan compared with excretory urography for the diagnosis of urinary tract calculi. All patients underwent standardized ultrasound scan and excretory urography as independent procedures. Two staff radiologists who reported the procedures were blinded to the results of the other diagnostic test and ultimate clinical outcome. All patients discharged home from the ED were followed to the hospital urology clinic. The diagnosis of urinary calculus was made only by identification of calculus at surgery or by reported passage of a stone by the patient. Of 85 patients available for follow-up study (56 men, 29 women; mean age, 40.5 years; range 18 to 77 years), calculi were identified in 69 (81%). Ultrasound identified calculi in 44 patients (sensitivity, 64%; specificity, 100%). Excretory urography identified calculi in 44 patients (identical sensitivity and specificity). When the presence of obstructive hydronephrosis only was used to diagnose renal calculi, ultrasound scan identified 59 patients (sensitivity, 85%; specificity, 100%) and excretory urography identified 62 patients (sensitivity, 90%; specificity, 94%). When the results of both diagnostic modalities were combined, calculi were identified in 59 patients (sensitivity, 85%; specificity, 100%) and hydronephrosis was seen in 66 patients (sensitivity, 95%; specificity, 94%). Our study shows that the diagnostic abilities of these procedures are equal in the detection of renal calculi.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1999

[Virtual endoscopy of the upper urinary tract based on contrast-enhanced MR urography data sets].

PURPOSE: To investigate the feasibility of reconstructing a virtual endoscopy from MR imaging data sets of the upper urinary tract. METHOD: The data obtained from 28 contrast-enhanced MR urographic examinations (5 normal; 23 pathologic) were post-processed to reconstruct a virtual ureterorenoscopy (VURS) using a threshold image segmentation. The visualization of the upper urinary tract was based on the acquisition of T1-weighted 3D gradient-echo sequences after intravenous administration of gadolinium-DTPA and a prior injection of low-dose furosemide. RESULTS: The employed MR urography technique created in all 28 cases a complete and strong contrast enhancement of the urinary tract. These 3D sequence data allowed the reconstruction of a VURS, even when the collecting system was not dilated. The best accuracy was provided by the MR urography sequences with the smallest voxel size. Moreover, the data acquisition based on a breath-hold technique has proved superior to that using a respiratory gating. Inside the renal pelvis, all calices could be assessed by turning the virtual endoscope in the appropriate direction. The visualization of the ureteral orifices in the bladder was also possible. All filling defects that were diagnosed by MR urography could be evaluated from the endoluminal view using the VURS. The exact characterization of the lesions based only on the assessment of the surface structure was difficult. CONCLUSION: A virtual endoscopy of the upper urinary tract can be successfully reconstructed using the data sets of high-resolution 3D MR urography sequences.

Adult↗
PubMed2005

Routine postoperative urography after cystectomy and urinary diversion is not necessary.

OBJECTIVE: It is routine procedure to obtain a urogram or retrograde stentogram 1-2 weeks after urinary diversion. The purpose of this is to diagnose silent urinary leakage and obstruction of the anastomosis. We registered the frequency of significant findings at routine postoperative urography in patients with bladder cancer treated with radical cystectomy and urinary diversion. MATERIAL AND METHODS: We identified a total of 200 consecutive patients who were treated with radical cystectomy and urinary diversion between 1994 and 2002. Eight patients were never evaluated radiologically and another 14 were examined earlier than planned due to symptoms or signs from the urinary tract and abdomen. The remaining 178 patients underwent a routine radiological examination. The methods of deviation in these patients were Bricker conduit (n=119), continent abdominal reservoir (n=24) and orthotopic bladder reconstruction (n=35). A total of 170 patients underwent urography, seven underwent bilateral retrograde pyelographies and one was examined by means of antegrade pyelography. RESULTS: Not a single significant finding was identified with urography in 170 patients. Minimal leakage was identified at retrograde pyelography in one patient with a Bricker conduit, which resulted in treatment for 2 weeks with a pyelostomy catheter. CONCLUSION: Routine postoperative urography is not necessary in patients who have a normal postoperative course after cystectomy and urinary diversion.

Aged↗
PubMedDate not supplied

Metrizamide in urography. II. A comparison of 51Cr-EDTA clearance and metrizamide clearance in man.

In nine subjects undergoing urography with metrizamide measurements of total serum clearance of 51Cr-EDTA have been made before, during, and after the urography. During the urography both total serum clearances and renal clearances were determined for 51Cr-EDTA and metrizamide. The present study in man confirms the previous results from investigations in rabbits, that most of the intravenously injected metrizamide is excreted through the kidneys, that tubular reabsorption of metrizamide occurs and suggests that metrizamide might be used with advantage for urography.

Chromium Radioisotopes↗
PubMed1994

Induction of micronuclei in lymphocytes of patients undergoing excretory urography with ioversol.

RATIONALE AND OBJECTIVES: The hypothesis that nonionic contrast medium administered during excretory urography may cause cytogenetic damage was tested. METHODS: Micronuclei were scored in peripheral blood lymphocytes obtained from 33 patients before and after excretory urography with ioversol, a nonionic contrast medium. RESULTS: The examination resulted in a highly significant (sign test, P = .005) increase in the median (range) counts of micronuclei per 1,000 binucleate from 18 (0 to 31) before to 24 (5 to 40) after excretory urography. CONCLUSIONS: Nonionic ioversol produces a statistically significant increase in the chromosome damage of lymphocytes from patients undergoing excretory urography. This increase is similar to that reported for the ionic contrast media, ioxaglate and iothalamate, and equal to that produced by 6 to 7 cGy of 100-kilovolt x-rays.

Adult↗
PubMedDate not supplied

Compression CT urography: a comparison with IVU in the opacification of the collecting system and ureters.

OBJECTIVE: The purpose of this study was to evaluate opacification of the collecting system and ureters using compression computed tomography (CT) urography compared with conventional intravenous urography (IVU). MATERIALS AND METHODS: Fifty consecutive patients underwent compression CT urography as part of a dedicated renal CT. A compression belt was applied prior to nephrographic phase imaging. Excretory phase scans were acquired through the kidneys 3 minutes post injection with the compression belt in place. The compression belt was then released, and scans were obtained through the ureters. Three independent readers then scored opacification of the collecting system and ureters on a scale of 0-2 (0 = no opacification, 1 = partial opacification, 2 = full opacification and distension). Fifty consecutive nonmatched IVUs were scored by segment by the same readers. Comparison of the two modalities was made using the Mann-Whitney U test. Interobserver agreement was assessed by the Kappa coefficient. RESULTS: CT demonstrated significantly better opacification (p < or = 0.02) of the upper and lower pole pelvicalyceal systems and midureters bilaterally. There was no difference in opacification of the proximal and distal ureters by CT compared with IVU. The Kappa coefficient was 0.53. CONCLUSIONS: Compression CT urography yields equal or better opacification of the collecting system and ureters when compared with IVU, and shows promise for the routine evaluation of the renal excretory system.

Adult↗
PubMedDate not supplied

Multidetector CT urography: comparison of two different scanning protocols for improved visualization of the urinary tract.

The goal of this study was to evaluate different CT scanning protocols on the depiction of the urinary tract by multidetector CT. The authors retrospectively reviewed 55 consecutive patients who underwent CT scanograms. Two groups of patients were included: renal donors (n=29) and hematuria patients (n=26). For the renal donor protocol, 120 mL of iodinated contrast was injected and a CT scanogram was obtained after a 5-minute delay. For the hematuria CT urography protocol, 100 mL of contrast was followed by a 250 mL normal saline drip and CT scanograms acquired after an 8-minute delay. Urinary tracts from both imaging protocols were then divided into four segments and evaluated by consensus reading of two experienced radiologists rated on a scale of 0 to 2. Complete visualization of the renal pelvis and the proximal, middle, and distal ureter for the renal donor protocol was noted to be 86%, 57%, 45%, and 52% and for that of the CT urography protocol to be 75%, 65%, 40%, and 44%, respectively. Comparing scanograms of the renal donor protocol and the CT urography protocol, there was no statistically significant difference in the depiction of renal pelvis or the proximal, middle or distal ureteral region (P=0.1625, 0.3226, 0.8636, and 0.6145, respectively). The study demonstrates that there is no significant difference between the CT urography protocol and the renal donor protocol in the depiction of the urinary tract.

Contrast Media↗