RESUMO
Endoluminal sonography is a technique well suited to imaging structures beyond the lumen of the hollow viscus. The development of small-diameter (6.2F), catheter-enclosed ultrasound probes has made this technique available for use within the urinary tract. It is capable of defining adjacent vessels, calculi, and masses. Ureteropelvic junction (UPJ) obstruction has been increasingly treated by incisional techniques, either nephroscopic, ureteroscopic, or radiographically controlled, with each incision at risk for causing damage to any adjacent vessel. Endoluminal sonography of the obstructed UPJ was attempted in 46 patients and completed in 45 patients, 41 with primary and 4 with secondary obstruction. Adjacent vessels could be seen in 24 patients. Twelve were located anterior or medial to the UPJ or both. Nine patients had vessels at the UPJ located laterally or anterolaterally, posterolaterally, or medially and laterally. Sonographic localization guided the choice of incision site in all patients and changed therapy in five patients. This technique also allows recognition of high insertion of the ureter into the renal pelvis. Endoluminal sonography of the obstructed UPJ is a valuable technique to determine the location and nature of associated vessels and, therefore, to guide decisions in treatment.
Assuntos
Ultrassonografia/métodos , Obstrução Ureteral/diagnóstico por imagem , Adulto , Angiografia , Artérias/diagnóstico por imagem , Desenho de Equipamento , Fluoroscopia , Humanos , Masculino , Ultrassonografia/instrumentação , Ureter/irrigação sanguínea , UrografiaRESUMO
Ureteropyeloscopy has gained increasing acceptance as an initial method of diagnosis, treatment, and surveillance of upper tract hematuria and radiographically demonstrated filling defects. With its more frequent use, concern for the possibility of migration of malignant cells during endoscopy secondary to increased intrarenal pressure must be addressed. We report on 13 patients, all of whom underwent ureteropyeloscopy with biopsy and treatment one to four times prior to nephroureterectomy for transitional cell carcinoma of the renal pelvis. Only one patients had vascular/lymphatic extension, and because of the tumor growth characteristics, extension was suspected prior to endoscopy. This patient had no free cells or clumps noted. There have been no local recurrences in the follow-up of 3 months to 6 years. We believe uretero pyeloscopy to be safe and effective for endoscopic diagnosis and treatment of upper tract neoplasm.
Assuntos
Carcinoma de Células de Transição/cirurgia , Endoscopia/efeitos adversos , Neoplasias Renais/cirurgia , Recidiva Local de Neoplasia/etiologia , Ureter/patologia , Urografia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células de Transição/patologia , Feminino , Humanos , Neoplasias Renais/patologia , Pelve Renal , Masculino , Pessoa de Meia-Idade , Invasividade NeoplásicaRESUMO
Eighty-one consecutive flexible cystoscopic examinations were performed on 69 patients with spinal cord injury (SCI) at the time of their urodynamic study. The indications for cystoscopy included hematuria, recurrent urinary tract infections, symptoms of bladder outlet obstruction, the presence of an intraurethral sphincter stent requiring evaluation, neurogenic vesical dysfunction requiring endourodynamic study (cystometrogram through the working port of the flexible cystoscope), or bladder calculi. Flexible cystoscopy was accomplished in all patients, whether lying supine or seated in a wheelchair (N = 16). Only 6 of 39 patients with previous episodes of autonomic dysreflexia became hypertensive during cystoscopy. When a urodynamic catheter could not be inserted, the flexible cystoscope was particularly useful in defining the urethral anatomy or obstruction and in performing endourodynamic evaluation. The only complication was the development of febrile urinary tract infection in four patients. The flexible cystoscope is a valuable tool in the urodynamic laboratory caring for patients with SCI and is effective for use in endourodynamics, especially when patient positioning or catheter placement is difficult. The procedure is well tolerated, causes minimal stimulation leading to the development of autonomic dysreflexia, and provides accurate cystometric data.
Assuntos
Cistoscópios , Traumatismos da Medula Espinal/fisiopatologia , Urodinâmica , Adolescente , Adulto , Idoso , Pressão Sanguínea , Cistoscopia/efeitos adversos , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Urinárias/etiologiaRESUMO
In flexible ureteroscopy, active deflection of the tip of the endoscope is essential to reach the lateral and inferior infundibula. Two other features may affect endoscope function: one- or two-way deflection and the presence of a secondary, passively deflectable, segment. In our 7-year experience with five different endoscopes, attempts to examine the intrarenal collecting system were successful in 205 of 225 patients (92%). The success rate was lowest with a prototype endoscope, which did not have a secondary deflecting segment. There was no significant difference between those instruments with single- or two-way deflection that possessed secondary deflection. Endoscopes with secondary deflection were most successful in entering the lower pole, and this feature was necessary to reach the entire collecting system in 51% of the patients. Most of the failures of access were in attempts to reach the lower infundibulum. There was some trend toward greater success with the smaller instruments (8.5F).