The burden of chronic ureteral stenting in cervical cancer survivors

ABSTRACT Purpose Ureteral obstruction in cervical cancer occurs in up to 11% of patients, many of whom undergo ureteral stenting. Our aim was to describe the patient burden of chronic ureteral stenting in a population-based cohort by detailing two objectives: (1) the frequency of repeat procedures for ureteral obstruction; and, (2) the frequency of urinary adverse effects (UAEs) (e.g., lower urinary tract symptoms, flank pain). Materials and Methods From SEER-Medicare, we identified 202 women who underwent ureteral stent placement prior to or following cervical cancer treatment. The frequency of repeat procedures and rate ratios were compared between treatment modalities. The rates and rate ratios of UAEs were compared between our primary cohort (stent + cervical cancer) and the following groups: no stent + cervical cancer, stent + no cancer, and no stent + no cancer. The “no cancer” group was drawn from the 5% Medicare sample. Results 117/202 women (58%) underwent >1 stent procedure. The frequency of additional procedures was significantly higher in patients who received radiation as part of their treatment. UAEs were very common in women with stent + cancer. The rate of UTI was 190 (per 100 person-years), 67 for LUTS, 42 for stones, and 6 for flank pain. These rates were 3-10 fold higher than in the no stent + no cancer control group; rates were also higher than in the no stent + cancer and the stent + no cancer women. Conclusions The burden of disease associated with ureteral stents is higher than expected and urologists should be actively involved in stent management, screening for associated symptoms and offering definitive reconstruction when appropriate.

Acute flank pain due to renal infarction: limitations of unenhanced CT

A fifty-two-year-old woman developed severe right flank pain; she had an initial non-contrast CT, which was inconclusive. Subsequently, contrast enhanced CT showed subtotal infarction of the right kidney and occlusion of the right main renal artery. The current trend is using unenhanced helical CT for the diagnosis of acute flank pain; therefore, the diagnosis of acute renovascular occlusion is delayed. Although unenhanced helical CT can show other abdominal conditions such as appendicitis, diverticulitis, adnexal disease and aortic rupture, it cannot show acute renal artery occlusion. Contrast-enhanced CT was done to arrive at the final diagnosis, as the laboratory results were not conclusive and the patient had continuous flank pain for 48 hours

Treatment of Fraley’s syndrome by upper-pole nephrectomy

CONTEXT: Fraley’s syndrome is characterized by vascular compression on the superior infundibulum with secondary dilatation of the upper pole calyx, mostly located on the right side. CASE REPORT: We present the case of a 22-year-old woman with vascular compression of the upper-pole infundibulocalyceal system (Fraley’s syndrome). The patient had a history of frequent hospitalizations for emergency care due to lumbar pain over the past twelve months. The diagnosis was obtained following renal arteriography. Since the surgical treatment by means of upper-pole nephrectomy, the patient has not had any further symptoms.

CONTEXTO: A síndrome de Fraley é caracterizada por impressão vascular do infundíbulo superior com dilatação secundária do pólo caliceal superior. É geralmente localizada no lado direito. RELATO DE CASO: Nós apresentamos o caso de uma mulher com 22 anos de idade com compressão vascular do sistema infundibulocaliceal do pólo superior (síndrome de Fraley). A paciente trazia história de hospitalizações freqüentes em emergências nos últimos 12 meses devido a cólicas renais. O diagnóstico foi obtido após arteriografia renal. Depois do tratamento cirúrgico por meio de nefrectomia polar superior, a paciente não apresentou mais sintomas.

Avaliação da concordância interobservador na análise da tomografia computadorizada sem contraste no diagnóstico da urolitíase em pacientes com cólica renal aguda / Interobserver agreement on non-contrast computed tomography interpretation for diagnosis of urolithiasis in patients with acute flank pain

OBJETIVO: Avaliar a reprodutibilidade da tomografia computadorizada sem contraste na avaliação da litíase ureteral e os sinais secundários de obstrução do sistema coletor em pacientes com cólica renal aguda. MATERIAIS E MÉTODOS: Estudo prospectivo de 52 pacientes com diagnóstico clínico de cólica renal aguda submetidos a exame de tomografia computadorizada de abdome sem contraste. Os exames foram realizados com técnica helicoidal e posteriormente analisados por três observadores independentes, com a concordância interobservador avaliada pelo método estatístico kappa (kapa). Foram analisados os parâmetros: a) presença, localização e mensuração dos cálculos ureterais; b) dilatação do sistema coletor intra-renal; c) heterogeneidade da gordura perirrenal; d) dilatação ureteral; e) edema da parede ureteral (sinal do halo). RESULTADOS: Foram encontrados 40 cálculos ureterais na tomografia computadorizada (77 por cento). A concordância interobservador para a identificação do cálculo ureteral e da dilatação ureteral foi quase perfeita (kapa = 0,89 e kapa = 0,87, respectivamente), substancial para dilatação do sistema coletor intra-renal (kapa = 0,77) e moderada para heterogeneidade da gordura perirrenal e para edema da parede ureteral (kapa = 0,55 e kapa = 0,56, respectivamente). CONCLUSÃO: A tomografia computadorizada de abdome sem contraste apresenta elevada reprodutibilidade na avaliação da litíase ureteral e dos sinais secundários de obstrução do sistema coletor.

OBJECTIVE: To evaluate the interobserver agreement on non-contrast computed tomography interpretation by a group of experienced abdominal radiologists, for the study of urolithiasis in patients presenting acute flank pain. MATERIALS AND METHODS: Prospective study of 52 patients submitted to non-contrast enhanced helical computed tomography. The images were subsequently analyzed by three independent observers, with the interobserver agreement assessed by means of the kappa (kappa) statistical method. The following parameters were analyzed: a) presence, localization and measurement of ureteral calculi; b) intrarenal calyceal system dilatation; c) perirenal fat heterogeneity; d) ureteral dilatation; e) ureteral wall edema (halo sign). RESULTS: Ureteral calculi were found in 40 of 52 patients (77 percent). The interobserver agreement was almost perfect as regards identification of ureteral calculi (kappa = 0.89) and ureteral dilatation (kappa = 0.87), substantial for calyceal system dilatation (kappa = 0.77), and moderate for perirenal fat heterogeneity (kappa = 0.55) and ureteral wall edema (kappa = 0.56). CONCLUSION: Non-contrast-enhanced abdominal computed tomography presents high reproducibility in the evaluation of urolithiasis and secondary signs of the calyceal system obstruction.

Non contrast helical CT scan for acute flank pain: non calculus urinary and extra urinary causes

To determine the value of non contrast helical CT in the diagnosis of non calculus renal and extraurinary causes of acute flank pain. A prospective descriptive study. Radiology Department, Aga Khan University Hospital Karachi from January 2005 to June 2005. 130 consecutive patients with acute flank pain underwent Noncontrast enhanced helical CT scan [NHCT]. 100[73%] were male and 30[23%] were female. Scans were observed for noncalculus renal and extraurinary causes of acute flank pain. Out of 130 patients, 30 patients were excluded. In 23[23%] patients non calculus causes of pain were diagnosed. In 5 [5%] patients incidental findings were recorded which were most likely not cause of pain. Three patients had non calculus renal abnormalities which included renal cell carcinoma, horseshoe kidney adult polycystic kidney disease. The accurate and timely diagnosis of an obstructing ureteral calculus, a non calculus urinary abnormality or an extra urinary tract pathology, establishes non contrast helical CT as the diagnostic study of choice for the evaluation of patients with flank pain

Ureteric pellet causing non-functioning kidney

This case report describes a young man with bilateral flank pain for one year following a gunshot trauma to abdomen. On ureteroscopy a pellet was found in the right ureter

Unenhanced ultrafast computerized tomography for the evaluation of patients with acute flank pain.

OBJECTIVE: To determine the value of unenhanced ultrafast computerized tomography (CT) in the diagnosis of acute flank pain in 43 patients evaluated for suspected stone disease. MATERIAL AND METHOD: Noncontrasted ultrafast CT was performed in 43 consecutive patients seen in the emergency department to evaluate acute flank pain. All CT studies were reviewed for the presence of ureteral and renal calculi, perinephric and periureteral stranding, presence and degree of pelvicalicectasis or other radiological findings. If necessary, an excretory urogram was performed to confirm the presence or absence of urinary stone. Patients were followed to determine clinical outcome including the need for urological intervention. RESULTS: Of the 28 patients determined to have stones 16 (57.14%) had spontaneous stone passage, 7 (25%) had improved symptoms without documented stone passage and 4 (14.29%) required surgical intervention. In 6 of 14 patients (42.86%) with negative CT readings for stone disease a diagnosis was established by other intra-abdominal findings. In 7 patients (50%) no clinical diagnosis could be established, and 1 scan in a patient with a ureteral calculus was interpreted as falsely negative. These findings yielded a sensitivity of 96.63 per cent, Specificity 92.85 per cent and overall accuracy 95.24 per cent for diagnosing ureteral stones. CONCLUSIONS: Unenhanced ultrafast CT is an accurate, safe and rapid imaging modality for the detection of urinary tract calculi and obstruction. The majority of patients required no further imaging to determine the need for urological intervention. Ultrafast CT could be used as the standard method to evaluate patients with acute flank pain.