RESUMO
ABSTRACT Purpose Congenital and acquired pathologies of the seminal vesicles (SV) are rare diseases. The diagnosis of SV anomalies is frequently delayed or wrong due to the rarity of these diseases and the lack of adequate evaluation of SV pathology. For this reason, we aimed to comprehensively evaluate SV pathologies and accompanying genitourinary system abnormalities. Materials and Methods Between March 2012 and December 2015, 1455 male patients with different provisional diagnosis underwent MRI. Congenital and acquired pathology of the SV was identified in 42 of these patients. The patients were categorized according to their SV pathologies. The patients were analyzed in terms of genitourinary system findings associated with SV pathologies. Results SV pathologies were accompanied by other genitourinary system findings. Congenital SV pathologies were bilateral or predominantly in the left SV. Patients with bilateral SV hypoplasia were diagnosed at an earlier age compared to patients with unilateral SV agenesis. There was a significant association between abnormal signal intensity in the SV and benign prostate hypertrophy (BPH) and patient age. Conclusion SV pathologies are rare diseases of the genitourinary system. The association between seminal vesicle pathology and other genitourinary system diseases requires complete genitourinary system evaluation that includes the seminal vesicles.
Assuntos
Humanos , Masculino , Adulto , Idoso , Adulto Jovem , Glândulas Seminais/anormalidades , Glândulas Seminais/diagnóstico por imagem , Doenças Urológicas/diagnóstico por imagem , Glândulas Seminais/patologia , Doenças Urológicas/patologia , Anormalidades Congênitas/patologia , Anormalidades Congênitas/diagnóstico por imagem , Imageamento por Ressonância Magnética , Pessoa de Meia-IdadeRESUMO
PURPOSE: Congenital and acquired pathologies of the seminal vesicles (SV) are rare diseases. The diagnosis of SV anomalies is frequently delayed or wrong due to the rarity of these diseases and the lack of adequate evaluation of SV pathology. For this reason, we aimed to comprehensively evaluate SV pathologies and accompanying genitourinary system abnormalities. MATERIALS AND METHODS: Between March 2012 and December 2015, 1455 male patients with different provisional diagnosis underwent MRI. Congenital and acquired pathology of the SV was identified in 42 of these patients. The patients were categorized according to their SV pathologies. The patients were analyzed in terms of genitourinary system findings associated with SV pathologies. RESULTS: SV pathologies were accompanied by other genitourinary system findings. Congenital SV pathologies were bilateral or predominantly in the left SV. Patients with bilateral SV hypoplasia were diagnosed at an earlier age compared to patients with unilateral SV agenesis. There was a significant association between abnormal signal intensity in the SV and benign prostate hypertrophy (BPH) and patient age. CONCLUSION: SV pathologies are rare diseases of the genitourinary system. The association between seminal vesicle pathology and other genitourinary system diseases requires complete genitourinary system evaluation that includes the seminal vesicles.
Assuntos
Glândulas Seminais/anormalidades , Glândulas Seminais/diagnóstico por imagem , Doenças Urológicas/diagnóstico por imagem , Adulto , Idoso , Anormalidades Congênitas/diagnóstico por imagem , Anormalidades Congênitas/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Glândulas Seminais/patologia , Doenças Urológicas/patologia , Adulto JovemRESUMO
A obstrução do trato urinário baixo fetal (fetal lower urinary tract obstruction - LUTO) é uma patologia caracterizada por dilatação da bexiga e hidronefrose bilateral causada por obstrução do trato urinário inferior. Sua incidência é de 2,2 em cada 10.000 nascimentos. A etiologia da LUTO inclui a válvula da uretra posterior (VUP), atresia ou estenose uretral. O diagnóstico é feito por ultrassom, que mostra bexiga dilatada, com paredes espessas (megabexiga), e uretra posterior aumentada. O tratamento cirúrgico clássico (derivação vésico-amniótica guiada por ultrassom) estaria indicado quando o líquido amniótico normal começa a diminuir, com aumento da distensão vesical e da hidronefrose. O tratamento inclui a colocação de derivação vésico-amniótica guiado pelo ultrassom e fetoscópica com coagulação a laser. De acordo com a gravidade, a LUTO é classificada nos estágios 1,2 e 3.(AU)
The Fetal Lower Urinary Tract Obstruction (LUTO) is a spectrum of diseases characterized by bladder distension and bilateral hydronephrosis in consequence of the LUTO. The incidence is approximately 2.2 in 10,000 births and it is commonly diagnosed during the late first or early second trimester of pregnancy. The etiologies of LUTO include posterior urethral valves, urethral atresia and urethral stenosis. Complete bladder outlet obstruction (severe LUTO) is associated with high perinatal mortality due to pulmonary hypoplasia and severe renal impairment/damage. The prenatal intervention includes vesicoamniotic shunt placement guided by ultrasound and fetoscopic laser coagulation. It is suggested that LUTO patients could be categorized in three stages according to disease gravity: Stages 1, 2 and 3.(AU)
Assuntos
Humanos , Gravidez , Diagnóstico Pré-Natal , Obstrução Uretral/cirurgia , Obstrução Uretral/diagnóstico por imagem , Doenças Urológicas/diagnóstico por imagem , Doenças Fetais/fisiopatologia , Obstrução do Colo da Bexiga Urinária , Fotocoagulação a Laser , Dilatação Patológica , Mortalidade Perinatal , Sofrimento Fetal , Líquido Amniótico , HidronefroseRESUMO
Introduction The Spies™ system (Karl-Storz®) was introduced into digital ureteroscopy to improve endoscopic vision. To date, there is no data to either indicate which of the Spies modalities is better for improving diagnosis and treatment procedures, nor to compare the modalities in terms of image quality. The aim of this study was to evaluate and compare the image quality of five Spies™ modalities (SM) to the standard white light in an in-vitro model. Materials and Methods Two standardized grids and 3 stones of different composition were recorded in white light and the 5SM (Clara, Chroma, Clara+Chroma), Spectra A and B) using 4 standardized aqueous scenarios. Twelve templates were done in order to simultaneously compare the same objective in the different modalities. Six urologists, five medical students, five urology residents, and five persons not involved with urology evaluated each video on a scale of 1 (very bad) to 5 (very good). Results Comparing white light to SM, subjects scored better the quality of Clara and Clara+Chroma than white light (p=0.0139 and p<0.05) and scored worse Spectra A and B (p=0.0005 and p=0.0023)). When comparing Clara to the other SM, it was ranked equivalent to Clara+Chroma (p=0.67) and obtained a higher rank than Chroma, Spectra A and B (p<0.05, p=0.0001 and p=0.0001). In the multivariate analysis mean scores were higher among urologists. Conclusion In all analyzed scenarios, the subjects ranked Clara and Clara+Chroma as the modalities with better image quality compared to white light.
Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Doenças Urológicas/diagnóstico por imagem , Ureteroscopia/instrumentação , Neoplasias/diagnóstico por imagem , Litotripsia a Laser , Ureteroscopia/métodos , Ureteroscópios , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: The Spies™ system (Karl-Storz®) was introduced into digital ureteroscopy to improve endoscopic vision. To date, there is no data to either indicate which of the Spies modalities is better for improving diagnosis and treatment procedures, nor to compare the modalities in terms of image quality. The aim of this study was to evaluate and compare the image quality of five Spies™ modalities (SM) to the standard white light in an in-vitro model. MATERIALS AND METHODS: Two standardized grids and 3 stones of different composition were recorded in white light and the 5SM (Clara, Chroma, Clara+Chroma), Spectra A and B) using 4 standardized aqueous scenarios. Twelve templates were done in order to simultaneously compare the same objective in the different modalities. Six urologists, five medical students, five urology residents, and five persons not involved with urology evaluated each video on a scale of 1 (very bad) to 5 (very good). RESULTS: Comparing white light to SM, subjects scored better the quality of Clara and Clara+Chroma than white light (p=0.0139 and p<0.05) and scored worse Spectra A and B (p=0.0005 and p=0.0023). When comparing Clara to the other SM, it was ranked equivalent to Clara+Chroma (p=0.67) and obtained a higher rank than Chroma, Spectra A and B (p<0.05, p=0.0001 and p=0.0001). In the multivariate analysis mean scores were higher among urologists. CONCLUSION: In all analyzed scenarios, the subjects ranked Clara and Clara+Chroma as the modalities with better image quality compared to white light.
Assuntos
Neoplasias/diagnóstico por imagem , Ureteroscopia/instrumentação , Doenças Urológicas/diagnóstico por imagem , Adulto , Feminino , Humanos , Litotripsia a Laser , Masculino , Pessoa de Meia-Idade , Ureteroscópios , Ureteroscopia/métodos , Adulto JovemRESUMO
En esta parte se describen distintas anomalías del tracto urinario: malformaciones congénitas, enfermedad renal poliquística autosómica recesiva, enfermedad renal poliquística autosómica dominante, displasia renal multiquística, displasia renal quística obstructiva, y quiste renal simple; así como la evaluación ecográfica postnatal de la patología fetal renal
Assuntos
Humanos , Gravidez , Feminino , Diagnóstico Pré-Natal , Ultrassonografia Pré-Natal/instrumentação , Doenças Urológicas/diagnóstico , Doenças Urológicas/diagnóstico por imagem , Anormalidades Congênitas/diagnóstico , Anormalidades Congênitas/diagnóstico por imagemRESUMO
Principales características del diagnóstico ecográfico prenatal del aparato urinario. En esta entrega se detallan tanto aspectos normales como anomalías del trato urinario como agenesia renal, ectopia renal, riñón pelviano, riñón en herradura, o riñón torácico.(AU)
Assuntos
Humanos , Gravidez , Feminino , Diagnóstico Pré-Natal , Ultrassonografia Pré-Natal/instrumentação , Doenças Urológicas/diagnóstico , Doenças Urológicas/diagnóstico por imagem , Anormalidades Congênitas/diagnóstico , Anormalidades Congênitas/diagnóstico por imagemRESUMO
Risk factors for renal scarring in children with lower urinary tract dysfunction (LUTD) were evaluated. The medical records of 120 patients were assessed concerning gender, presence of vesicoureteric reflux (VUR), bladder capacity, detrusor overactivity, residual urine, febrile urinary tract infection (UTI), bacteriuria, constipation, detrusor sphincter incoordination (DSI), high detrusor pressure at maximal cystometric capacity (PMCC), low compliance, and thickness and trabeculation of the bladder wall. Renal scarring was diagnosed by (99m)technetium-dimercaptosuccinic acid renal scan (DMSA). Renal scarring was detected in 38 patients (31%). VUR, UTI, decreased bladder capacity, urinary residue, and trabeculated and thick bladder wall were associated with scarring at univariate analysis. Multivariate analysis showed VUR (P < 0.0001) as the independent risk factor for renal scarring. Thickness of the bladder wall was a marginal risk factor (P = 0.07). Although UTI was not a risk factor, it was associated with VUR (P = 0.03). In our analysis, VUR was the main risk factor; however, renal scarring was probably due to multifactorial causes, as VUR was associated with UTI.
Assuntos
Cicatriz/diagnóstico por imagem , Cicatriz/epidemiologia , Doenças Urológicas/diagnóstico por imagem , Doenças Urológicas/epidemiologia , Criança , Pré-Escolar , Complacência (Medida de Distensibilidade) , Feminino , Humanos , Masculino , Análise Multivariada , Cintilografia , Estudos Retrospectivos , Fatores de Risco , Ácido Dimercaptossuccínico Tecnécio Tc 99m , Ultrassonografia , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinaria Neurogênica/diagnóstico por imagem , Bexiga Urinaria Neurogênica/epidemiologia , Bexiga Urinária Hiperativa/diagnóstico por imagem , Bexiga Urinária Hiperativa/epidemiologia , Infecções Urinárias/diagnóstico por imagem , Infecções Urinárias/epidemiologia , Urodinâmica , Refluxo Vesicoureteral/diagnóstico por imagem , Refluxo Vesicoureteral/epidemiologiaRESUMO
OBJECTIVES: To evaluate whether fetal urinary sodium and chloride provide clinically useful information in addition to ultrasound in bilateral obstructive uropathy. METHODS: Sonographic features and urinary concentrations of sodium and chloride were evaluated in fetuses with bilateral obstructive uropathy. After a minimum of 12 months of postnatal follow-up, cases that developed increased serum creatinine (greater than 50 micromol/L) were compared with those that did not. RESULTS: Of the cases studied, 16/35 died perinatally, all showing anamnios and markedly elevated urinary electrolytes. Of the survivors, ten maintained normal postnatal serum creatinine, whereas nine did not. The frequency of reduced amniotic fluid/olygohydramnios was higher in cases that developed increased serum creatinine (four out of nine) than in those that did not (nil). Sodium above the 95th percentile was 100% specific and 44% sensitive to predict an increased serum creatinine during early infancy, while chloride above the 95th percentile was 70% specific and 56% sensitive. All seven cases in which urinary sodium was elevated and/or amniotic fluid volume was reduced developed renal failure. CONCLUSION: Urine sampling slightly improved renal function prediction, but this must be balanced against its fetal risks.
Assuntos
Diagnóstico Pré-Natal , Urinálise/normas , Doenças Urológicas/diagnóstico , Brasil , Creatinina/sangue , Dilatação Patológica/diagnóstico , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/embriologia , Dilatação Patológica/mortalidade , Dilatação Patológica/urina , Feminino , Idade Gestacional , Humanos , Mortalidade Infantil , Recém-Nascido , Valor Preditivo dos Testes , Gravidez , Sensibilidade e Especificidade , Cloreto de Sódio/urina , Ultrassonografia Pré-Natal , Doenças Urológicas/diagnóstico por imagem , Doenças Urológicas/embriologia , Doenças Urológicas/mortalidade , Doenças Urológicas/urinaRESUMO
OBJECTIVE: To assess the long-term outcome of infants with mild and moderate fetal pyelectasis and to determine the predictive value of neonatal ultrasound imaging in identifying significant nephrouropathies. STUDY DESIGN: This prospective study included 213 infants with antenatal mild to moderate pyelectasis who were followed for up to 2 years. Postnatal renal ultrasound examinations were performed at day 5 and months 1, 3, 6, 12 and 24 after birth. Voiding cystourethrography was performed in all infants. RESULTS: Normal or nonsignificant findings were diagnosed in 130 of 213 (61%) infants. Significant nephrouropathies were diagnosed in 83 of 213 (39%) infants. The sensitivity, specificity, positive predictive value, and negative predictive value of two successive neonatal renal ultrasound examinations performed at day 5 and 1 month to predict significant nephrouropathies were 96%, 76%, 72%, and 97%, respectively. In 102 of 213 (48%) infants with normal neonatal renal ultrasound scans, we later found only three of 102 (3%) cases with significant nephrouropathies. CONCLUSIONS: We found in a population of infants with mild to moderate fetal pyelectasis a 39% incidence of significant nephrouropathies. Ultrasound is an excellent screening tool with high sensitivity and negative predictive value that allows avoidance of unjustified medical follow-up in patients with two normal neonatal ultrasound scans.
Assuntos
Nefropatias/diagnóstico por imagem , Pelve Renal , Ultrassonografia Pré-Natal , Doenças Urológicas/prevenção & controle , Algoritmos , Bélgica/epidemiologia , Dilatação Patológica , Feminino , Humanos , Recém-Nascido , Masculino , Valor Preditivo dos Testes , Gravidez , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Doenças Urológicas/diagnóstico por imagem , Doenças Urológicas/epidemiologiaRESUMO
OBJECTIVE: To determine the significance of gray scale ultrasound as a tool for diagnosis, follow-up and treatment of urological complications of renal transplantation based on the experience of our institution. METHODS: A retrospective, longitudinal and observational study was carried out. We reviewed the patients' perioperative ultrasound scans and their respective urological complications from January 1, 1982 to January 1, 2000. The patients were consecutively taken from the kidney transplant registry of the Urology and Nephrology and Transplant Departments. We describe the ultrasound findings of normal functioning grafts as well as those with urological complications, such as fluid collections (lymphocele, hematoma, urinoma and abscess), uronephrosis and its possible causes, and symptomatic vesicourethral reflux. RESULTS/CONCLUSIONS: Diagnostic and therapeutic algorithms in kidney transplant patients have been changed since the advent of ultrasound in our country in 1981. Rapid diagnosis and better therapeutic options have been the hallmarks of ultrasound. Added advantages are: it is low-cost, non-invasive, not time consuming. It can be performed regardless of kidney function, can be repeated as many times as required, subsequent scans can be compared. It can be carried out in special care units. The superficial location of the graft makes it highly sensitive. Its disadvantages are low specificity to identify either the nature of the fluid collections or the precise site of urinary tract obstruction, apart from depending on the skill of the operator. Specialists should be familiar with the surgical anatomy of the kidney graft and its variations in order to utilize completely its diagnostic and therapeutic potentials.
Assuntos
Transplante de Rim/efeitos adversos , Doenças Urológicas/diagnóstico por imagem , Doenças Urológicas/etiologia , Cor , Humanos , Estudos Longitudinais , Estudos Retrospectivos , Fatores de Tempo , UltrassonografiaRESUMO
The usefulness of pulsatility index determinations for the diagnosis of obstructive collecting system dilatation was investigated in 10 renal transplant patients whose grafts developed urinary obstruction from different causes. For this purpose we compared pulsatility index values obtained (1) before the ultrasonographic detection of obstruction or baseline study, (2) 1 day before surgical repair, and (3) within 2 weeks after surgery. In 7 of 10 obstructed grafts, the pulsatility index values were increased only mildly to moderately preoperatively. In the remaining three grafts, a mild decrease in pulsatility index was observed in spite of severe collecting system dilatation. Changes in pulsatility index were not statistically significant. Impedance measurements appeared not to be useful for diagnosing obstructive collecting system dilatation.
Assuntos
Transplante de Rim/fisiologia , Fluxo Pulsátil/fisiologia , Ultrassonografia Doppler , Doenças Urológicas/diagnóstico por imagem , Adolescente , Adulto , Dilatação Patológica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Ultrassonografia Doppler Dupla , Doenças Urológicas/fisiopatologiaRESUMO
OBJECTIVE: Dilatation of the urinary tract is common during pregnancy, but the limits between physiologic and pathologic dilatation are unknown. Our purpose was to establish the pattern of physiologic urinary tract dilatation during pregnancy. STUDY DESIGN: This was a cross-sectional study. The maximal caliceal diameter was measured by ultrasonography at different weeks' gestational age in 1506 pregnant and 181 postpartum women. A curve with the 90th, 75th, and 50th percentiles was drawn for each kidney. RESULTS: Fifty-three (6%) pregnant and postpartum women had some degree of dilatation. The right kidney was more frequently and severely affected, as were nulliparous women. The 90th percentile of maximal caliceal diameter of the right kidney increased about 0.5 mm/wk up to 24 to 26 weeks, about 0.3 mm/wk up to 31 to 32 weeks, and remained stable until term. The left maximal caliceal diameter attained 8 mm around week 20 to 24 and remained stable until term. Only 6% had dilatation in the postpartum period. CONCLUSION: A normal curve of dilatation of the urinary tract is proposed.
Assuntos
Complicações na Gravidez , Doenças Urológicas/patologia , Adulto , Dilatação Patológica , Feminino , Idade Gestacional , Humanos , Rim/diagnóstico por imagem , Rim/patologia , Gravidez , Valores de Referência , Ultrassonografia , Doenças Urológicas/diagnóstico por imagemRESUMO
Endoluminal sonography of the urinary tract was performed by using endoluminal ultrasound transducers contained within 2-mm-diameter catheters. The catheters were inserted into the urinary bladder via the urethra and advanced into the ureters and renal pelvis under cystoscopic control; then, cross-sectional images of the bladder, ureters, and renal pelvis were obtained. Two dogs and seven human patients were studied. In one dog, a 4.5-mm pseudopolyp, which was surgically created in the bladder wall, was successfully imaged; in the other, stones 2 mm or larger inserted into the bladder were identified. Of the seven patients, sonography showed stones embedded in the renal parenchyma (one patient) and the mucosa of the distal ureter (one patient). These were ultimately confirmed by their eventual removal. In a third, sonography showed a tumor of the distal ureter and identified the depth of the tumor. This was confirmed by biopsy. In a fourth, sonography clearly showed a crossing vessel as the cause for narrowing of the proximal ureter. In a fifth, sonography showed that the cause of a ureteral stricture was idiopathic. In the last two cases, sonography did not reveal a cause for hematuria. In these last three cases, negative sonographic results were confirmed by direct ureteroscopic examinations and follow-up studies. Our observations based on this limited study suggest that endoluminal sonography is a useful procedure for diagnosing diseases of the urinary tract. Further study is warranted.