Long term outcome of Wilms' tumor in tertiary care hospital

Background: Nephroblastoma, or Wilms’ tumor, is an embryonal tumor that develops from remnants of the immature kidney. It is the most common renal tumor of childhood. The aim is to analyze the long term outcome in Wilms’ tumor in perplex situations as double moiety and to correlate with multiple organ defects.Methods: It is a combined perspective and retrospective study that pediatric urology outpatient department (OPD) at the Institute of Child Health and Hospital for Children, Madras Medical College, Chennai. The study included patients with Wilms, who attended the pediatric surgery during the ten years, from March 2008 to February 2011. The patients were subjected to detailed clinical examination and relevant investigations were performed.Results: Among patients with stage I–II fumarate hydratase (FH) tumors, the relative risk (RR) of relapse and death were increased for loss of heterozygosity (LOH) 1p only (RR=2.2 for relapse; RR=4.0 for death), for LOH 16q only (RR=1.9 and RR=1.4), and LOH for both regions (RR=2.9 and RR=4.3) in comparison with patients lacking LOH at either locus.Conclusions: Stage I and II have a good prognosis. Stage III and IV need close surveillance since they have a high rate of recurrence. Stage V has a bad prognosis. Stage IV Wilms need lung irradiation. Neoadjuvant chemotherapy reduces tumor spillage in stage III and IV.

Is a contrast study really necessary prior to ureteroscopy?

This study aimed to evaluate the effect of preoperative imaging techniques on the success and complication rates of ureteroscopy. We performed a retrospective analysis of 736 patients (455 males and 281 females), with a mean age of 45.5±15.2 years (range, 1-88 years), who underwent rigid ureteroscopic procedures for removal of ureteral stones. Patients were divided into 4 groups according to the type of imaging modality used: group I, intravenous urography (n=116); group II, computed tomography (n=381); group III, computed tomography and intravenous urography (n=91), and group IV, ultrasonography and abdominal plain film (n=148). Patients’ demographics, stone size and location, prior shock wave lithotripsy, lithotripsy technique, operation time, success rate, and rate of intraoperative complications were compared among the groups. There were no significant differences in success and complication rates among the groups. The stone-free rate after primary ureteroscopy was 87.1% in group I, 88.2% in group II, 96.7% in group III, and 89.9% in group IV (P=0.093). The overall incidence of intraoperative complications was 11.8%. According to the modified Satava classification system, 6.1% of patients had grade 1, 5.1% had grade 2, and 0.54% had grade 3 complications. Intraoperative complications developed in 12.1% of patients in group I, 12.6% of patients in group II, 7.7% of patients in group III, and 12.2% of patients in group IV (P=0.625). Our findings clearly demonstrate that ureteroscopic treatment of ureteral stones can be safely and effectively performed with no use of contrast study imaging, except in doubtful cases of anatomical abnormalities.

Radiation Dose Comparison between Intravenous Urography (IVU) and Unenhanced Helical Computed Tomography (UHCT) Urography / Jurnal Sains Kesihatan Malaysia

Intravenous urography (IVU) and unenhanced helical computed tomography (UHCT) urography are the two main procedures performed in the radiological investigation for urolithiasis (urinary stone). However, exposure to ionizing radiation is the main concern in both procedures. Therefore, a dose comparison study was conducted between IVU and UHCT urography procedures to determine the optimum exposure parameters in this study. An anthropomorphic whole body phantom was used following the exact procedure of UHCT urography and series of imaging for IVU with an administration of contrast media. Three different exposure parameters were used for IVU with 75 kVp, 80 kVp and 85 kVp while 100 kVp, 120 kVp and 140 kVp for UHCT urography respectively. As a result, the radiation doses for IVU were 1.40 mSv, 2.10 mSv and 2.79 mSv corresponding to 75 kVp, 80 kVp and 85 kVp. On the other hand, the radiation doses for UHCT urography were 0.76 mSv, 1.32 mSv and 1.82 mSv for 100 kVp, 120 kVp and 140 kVp, respectively. However the optimum image was obtained at 85 kVp for IVU and 120 kVp for UHCT urography. In conclusion, the doses obtained from IVU were consistently higher than UHCT urography but not signifi cantly different

Alterações do trato urinário em urografias excretoras realizadas no Hospital Nossa Senhora da Conceição, Tubarão- SC, de setembro de 2004 à dezembro de 2005 / Urinary tract changes found in intravenous urography examinations in the Hospital Nossa Senhora da Conceição, Tubarão- SC, from september 2004 to december 2005

Objetivo: Avaliar 235 laudos de urografia excretora, descrevendo as principais alterações relacionadas com o trato urinário, testar a associação entre as alterações encontradas segundo sexo e faixa etária e discutir a utilidade do método radiológico de imagem. Métodos: Estudo transversal, descritivo realizado a partir de levantamento de 235 laudos de urografia excretora realizados no período de 14/09/2004 à 21/12/2005, no Serviço de Radiologia do Hospital Nossa Senhora da Conceição, Tubarão - SC. Resultados: Do total de 235 exames, 127 (54,04%) apresentaram alterações radiológicas, 93 (39,57%) foram normais e 15 (6,38%) foram excluídos por falha técnica, por serem inconclusivos, por ter idade inferior a 18 anos ou pelo exame não corresponder ao proposto pela avaliação do estudo. A alteração mais frequente foi a de litíase (76,3%), seguida da dilatação do sistema pielocalicial (26,8%). Observamos que 60 exames (47,24%) eram pacientes do sexo masculino e 67 (52,75%), do sexo feminino. A média de idade do estudo foi de 42,19 anos e a faixa etária que apresentou maior número de alterações foi a de idosos (70,58%), seguido do grupo de adultos (56,54%) e adultos jovens (44,44%). Conclusão: Com relação ao sexo, a única alteração com relevância estatística, foi a Estenose de JUP - presente, em sua totalidade, no sexo feminino - porém, com relação às faixas etárias estudadas, não foi observado nenhum achado radiológico com significância estatística. Apesar do advento de novas técnicas diagnósticas de imagem como o ultra-som, a tomografia computadorizada e a ressonância magnética, a urografia excretora continua tendo importante papel diagnóstico.

Background: To evaluate 235 reports of intravenous urography, analyzing the main alterations related with urinary tract, to test the association between the joined alterations according to sex and age, and to discuss the utility of the radiological method of image. Materials and Methods: Descriptive cross-sectional study based on data of 235 intravenous urography reports which was made between the period from September 2004 to December 2005, at the Radiological Service of Hospital Nossa Senhora da Conceição, Tubarão - SC. RESULTS: Of all the 235 exams, 127 (%) had presented radiologic alterations, 93 (%) were normal and 15(%) had been excluded by imperfection technique, for being inconclusive, being age lower than 18 years or for the exam not to correspond to the considered for evaluation of the study. The alteration most frequent was lithiasis (76,3%), followed by dilatation of the calyceal system (26,8%). It was observed that 60 exams (47,24%) were of the masculine sex e 67 (52,75%), of the feminine sex. The average age of the patients was 42,19 years and the age group which presented greater number of alterations was of aged (70,58%), followed by the group of adults (56,54%) and young adults (44,44%). Conclusions: With regard to the sex, the only alteration with relevance statistics, was stenosis of uretero-pelvic junction - present in its totality in the feminine sex - however, with regard to the studied ages, no radiological finding with statistic significance was found. Although the advent of new diagnostic techniques of image as the ultrasound, the computerized cat scan and the magnetic resonance, intravenous urography continues having important diagnostic paper.

Comparison between intravenous urography and computed tomography urography in diagnosing disease of urology / 中华泌尿外科杂志

Objective The purpose of this study was to evaluate computed tomography urography (CTU) and compared with conventional intravenous urography (IVU) in diagnosis of urological disease. Methods One hundred and sixty-five patients with 111 males and 54 females underwent CTU urography including 78 cases underwent IVU were reviewed in this study. There were 12 cases underwent retrograde pyelography. There were 75 cases of nephrolithiasis and ureterolithiasis, 30 cases of ureteropelvic junction obstruction (UPJO), 30 cases of bladder cancer, 15 cases of pyelogenic cyst and parapelvic cyst, 9 cases of megaloureter and 6 cases of cancer in pelvis and ureter. Results The accuracy of diagnosis was 94.5% (156/165) in CTU group and 46.7% (42/90) in IVU group.The accuracy of diagnosis was 100.0% (75/75)of nephrolithiasis and ureterolith in CTU group and 78. 6%(33/42)in IVU group, 90.0% (27/30) of UPJO in CTU group, 100.0% (30/30) of bladder cancer in CTU group and 75.0%(9/12)in IVU group, 80.0%(12/15)of pyelogenic cyst and parapelvic cyst in CTU group, 100.0% (9/9)of megaloureter in CTU group, 100.0% (6/6)of cancer in pelvis and ureter in CT group. The displayed rate of the distal end of stenosis and obstruction was 79.4%(81/102)in CTU group and 25.0%(15/60)in IVU group. The examination time was (18.9±8.4)min in CTU group and (67.1±26.7)min in IVU group. Conclusion The CTU can provide more information than conventional IVU and can replace the IVU as routine examination in most cases.

The X-ray Manifestation and Etiological Analysis of Pyeloureteric Junction Obstruction / 实用放射学杂志

Objective To improve the diagnosis to the cause of pyeloureteric junction(PUJ) obstruction.Methods We carried out intravenous urography(IVU) exam in 22 cases and pyelography exam through percutaneous trans-renal puncture in 6 cases.Among them,15 cases had also received retrograde urography(RGU)exam.Results Among the 23 cases,12 cases were of stenosis,4 cases were of vagrant vessel,3 cases were of fibrous band,2 cases were of high-positioned ureter,1 case was of ureteric valve and 1 case was of viviparous remains texture.The above results were attested by operation.Conclusion IVE,RGU and percutaneous trans-renal puncture pyelography are the most commonly used and most efficient ways to the diagnosis of PUJ obstruction.They can help diagnosis the causes of some PUJ obstruction.

The Position and Mobility of the Kidneys in Healthy Korean Men and Women / 대한비뇨기과학회지

A roentgenologic study of the position and mobility of the kidneys of 50 men and the same number of women at Kang Nam Sacred Heart Hospital were performed during the period from January 1980 through December 1981. The age of the subject were from 21 to 50. None of them had any pathologic conditions of urinary system. Followings are the results of this study: Subject erect 1. The cephalic pole of the right kidney of males is below L 1 more often than the cephalic polo of the left kidney. 2. The cephalic pole of the right kidney of females is below T 12 more often than the corresponding pole of the left kidney. 3. The cephalic pole of the right kidney is below T 12 more often in females than in males. 4. The caudal pole of the right kidney of females is below L 3 more often than the caudal pole of the left kidney. 5. The caudal pole of the right kidney of females is below L 3 more often than the corresponding pole of males. Subject Supine 6. The cephalic pole of the left kidney of females is more often above T 12 than that of the right. 7. The caudal pole of the right kidney of males is below L 3 more often than that of the left kidney. 8. The caudal pole of the right kidney of females is be1ow L 3 more often than that of the left. Relation to Interiliac Line 9. The caudal pole of the right kidney of males, erect, is below the interiliac line more often than the caudal pole of the left. 10. The caudal pole of the right kidney of males, erect, is below the interiliac line more often than the corresponding pole of the left kidney. Kidney Mobility 11. The excursion of the right kidney of females is longer than that of the right kidney of males. 12. The excursion of the right kidney of females is longer than that of the left kidney. 13. The excursion of the right kidney of males is longer than that of the left kidney.

A Clinical Observation on Non-visualizing Kidney / 대한비뇨기과학회지

A clinical observation was made on the non-visualizing kidneys of the inpatients and outpatients in the Department of Urology, Chosun University Hospital during the period from January 1979 to December 1981. The results were as follows. 1. IVP was performed on 849 cases. Among these 131 cases revealed non-visualizing kidney at the rate of 15.4%. 2. Male and female was in the ratio of 1.4:1 and the largest percentage (26%)of the patients was in the fourth decade. 3. Of the causes of non-visualizing kidney, the parenchymal origin was more common than obstructive origin and the renal tuberculosis was the most common disease (43 cases). 4. About a third of 131 non-visualizing kidneys showed abnormal renal function. 5. Operation was performed in 93 patients (71%).

A Radiographic Observation of the Kidney in the Normal Korean Adult / 대한비뇨기과학회지

The place of excretory urography in the diagnosis of both renal and extrarenal lesions has been firmly established. Radiographic findings of the kidney by means of excretory urogram is no less important than any other functional study in the evaluation of clinicalconditions, such as atrophic kidney, hydronephrosis, renal tumor, renal hypertension and polycystic kidney. The present investigation was undertaken to establish the morphological features of the normal kidney in Korean adults of both sexes, such as size (length and width), renovertebral angle and distance, number of calices and position in the renal pelvis. 200 cases of normal intravenous pyelography were subjected to the present investigation. These materials were randomly selected from the X-ray file of St. Vincent's Hospital covering the period from Jan. 1979 to Dec. l980. There were 96 males and 104 females of normal health, and the age ranged from 20 to 54 years old, showing comparatively even distribution. The results were as follows: 1. Length: The mean values in males were 12.50 cm for the right side and 12.95 cm for the left side and those in females were 11.99 cm for the right side and 12.43 cm for the left side. The figures for both sides were about 0.5 cm larger in males than in females and the left side was about 0.5 cm larger in both sexes than the right side. 2. Width: The mean values in males were 6.24 cm for the right side and 6.60 cm, for the left side and those in females were 6.07 cm for the right side and 6.38 cm for the left side. The figure for the left side were wider than the right side about 0.4 cm in males and 0.3 cm in females, but there were no significant differences between the left side and the right side in both sexes. 3. Renovertebral angle: The mean values in males were 15.39 degrees for the right side and 15.40 degrees for the left side and in females the figures were 13.34 degrees for the right side and 13.47 degrees for the left side. There were no significant differences between the right and the left side in both sexes, but the angle in both sides were about 2 larger in the male than in the females. 4. Renovertebral distance: The mean values in males were 5.9 cm for the right side and 6.01 cm for the left side and in females the figures were 5.05 cm for the right side and 5.09 cm for the left side. There were no significant differences between the right and left and left side in both sexes, but the distance in both sides were about 0.9 cm larger in the males than in the females. 5. Number of the calices: The number of major calices was 2 to 4 and that of minor calices 5 to 13. The number of minor calices was 7 to 10 in 357 kidneys (89.3%). 6. Position in renal pelvis: An intrarenal pelvis was found in 263 cases (65.8%)and an extrarenal pelvis was seen in 137 cases (34.2%).

Clinical Observation on Non-visualizing Kidney / 대한비뇨기과학회지

We reviewed 67 cases of non-visualizing from September, 1979 to August, 1981. Among these, renal tuberculosis was the most common cause of non-visualizing kidney and renal or ureteral stone was thenext in number.

Clinical Study to the Problem of Intestinal Gas for Intravenous Urography / 대한비뇨기과학회지

Intravenous urography is very important in the detection of pathological conditions of the urinary tract, but the presence of intestinal gas shadows may be very confusing in the interpretation of urograms. There is considerable difference of opinion regarding the desirability of preparing patients for excretory urography. we obtained clinical impression and statistical results that intestinal gas was increased with prolonged duration after last diarrhea, also with sleeping after last diarrhea. So we attempted one new method of preparation in which employed 30cc, of castor oil for catharsis two times at night before examination and next morning 6:00 a. m. and result was compared with other methods. A total of 300 cases, for the most in-patients, consisted of 6 groups, were studied in this report. All patients had nothing by mouth after midnight until the X-rays were completed and pyelograms usually were taken in the morning. Following methods of preparation were studied. Group 1 : 60 cc. castor oil at bed time. Group 2 : 60 cc. castor oil at 4:00 a. m. Group 3 : 30 cc. castor oil at bed time and 30 cc. at 6:00 a. m. Group 4 : 60 cc. castor oil at bed time and enema in the morning. Group 5 : No cathartics and enema. Group 6 : Dulcolax 2 tablets at bed time. The X-ray films were graded as A) excellent B) good C) fair D) poor by three or more examiners. Group 3. afforded best result. We believed that result was due to prevention of intestinal fermentation by ingestion of castor oil at bed time and passage of swallowed air before X-ray examination by repeated ingestion at 6:00 a. m. A larger series of cases over a longer period of time, for more accurate statistical study, is warranted.

Nonvisuallzing Kidney on Radiography / 대한비뇨기과학회지

Although recently, there have been introduced many new diagnostic tools such as renal scanning and renogram, intravenous urogram remains to be one of the most useful method of urological diagnosis. Therefore it seems warranted to review 363 cases of intravenous urograms performed in the department of urology, St. Mary's hospital, Catholic Medical College during the period of January, 1962 to June, 1964. Among others, especial attention was paid to 60 cases of nonvisualizing kidneys. Of 60 nonvisualizing kidneys, renal tuberculosis occupied 27 cases(45%); ureteral and renal stones 13(21.6%); hydronephrosis 9(15%) (metastatic carcinoma 6(10%)and surgical manipulation 3(5%); Wilms' tumor 5 (8.3%) chronic atrophic pyelonephritis 3(5%) ; One case each of renal cell carcinoma, cystic kidney and thrombosis of the renal artery. Inasmuch as the present study revealed renal tuberculosis to be the most common cause of nonvisualizing kidneys, it is felt that one should always consider the possibility of tuberculosis in the diagnosis of nonvisualizing kidneys in Korea. This fact should be stressed because nontuberculous pathology such as chronic pyelonephritis has been implicated to be the most frequent cause of nonvisualizing kidneys by American authors.