Kidney ultrasound - what is important for a urologist?

Kidney ultrasound is one of the basic procedures in the practice of a urologist. Apart from the location and the size, description of renal morphology should contain the thickness of the anterior lip parenchyma in a transverse section and the location of possible narrowings. Uneven outline of the kidney is a sign of past inflammatory conditions. In the case of the pelvicalyceal system dilation, it is advised to specify the dimensions of the pelvis and calyces. Convex shape of the calyces proves elevated pressure within the pelvicalyceal system. Hydronephrosis is present when urinary retention has led to thinning the renal parenchyma. In each case, one should identify the reason for urinary retention in the upper urinary tract. Urinary retention on both sides requires one to exclude urinary bladder tumor, it may also be caused by a benign prostatic hyperplasia. Ultrasound examination is a sensitive method of renal stones detection, regardless of their chemical composition. Cyst description in an ultrasound image should cover its morphological features, differentiating between the so-called simple or complex cysts. In the case of a solid lesion, ultrasound makes it possible to detect parenchymal lesions usually starting with the size of 2-2.5 cm. It enables one to particularly diagnose angiomyolipomas. As regards the remaining parenchymal lesions, differentiation of the lesion nature is impossible. In some cases of angiomyolipoma, when it contains bleeding areas present and when it is deficient in adipose tissue, it resembles adenocarcinoma. It is necessary that the description includes the exact location, especially the dimensions and relation of the tumor to the renal sinus. In the case of larger lesions, respiratory motion of the kidney, the condition of the adrenal gland and the presence of enlarged lymph nodes should be controlled. Additionally, one should evaluate the renal vein and inferior vena cava in terms of a neoplastic plug presence.

Novel trends in transrectal ultrasound imaging of prostate gland carcinoma.

Carcinoma of the prostate gland is the most common neoplasm in men. Its treatment depends on multiple factors among which local staging plays a significant role. The basic method is transrectal ultrasound imaging. This examination enables imaging of the prostate gland and its abnormalities, but it also allows ultrasound-guided biopsies to be conducted. A conventional gray-scale ultrasound examination enables assessment of the size, echostructure and outlines of the anatomic capsule, but in many cases, neoplastic lesions cannot be observed. For this reason, new sonographic techniques are implemented in order to facilitate detectability of cancer. The usage of contrast agents during transrectal ultrasound examination must be emphasized since, in combination with color Doppler, it facilitates detection of cancerous lesions by visualizing flow which is not observable without contrast enhancement. Elastography, in turn, is a different solution. It uses the differences in tissue elasticity between a neoplastic region and normal prostatic parenchyma that surrounds it. This technique facilitates detection of lesions irrespective of their echogenicity and thereby supplements conventional transrectal examinations. However, the size of the prostate gland and its relatively far location from the transducer may constitute limitations to the effectiveness of elastography. Moreover, the manner of conducting such an examination depends on the examiner and his or her subjective assessment. Another method, which falls within the novel, popular trend of combining imaging methods, is fusion of magnetic resonance imaging and transrectal sonography. The application of multidimensional magnetic resonance imaging, which is currently believed to be the best method for prostate cancer staging, in combination with the availability of a TRUS examination and the possibility of monitoring biopsies in real-time sonography is a promising alternative, but it is associated with higher costs and longer duration of the examination. This paper presents the most important novel trends in transrectal imaging in prostate cancer diagnosis based on the review of the articles available in the PubMed base and published after 2010.

Benign fibroepithelial polyp of the ureter.

Benign tumors of the ureter are rare and most often appear in the form of fibroepithelial polyps [1]. Fibroepithelial polyps represent from 2 to 6% of all benign tumors of the urinary tract [2]. The Authors report on two cases of fibroepithelial polyps of the ureter, which they treated between 1993-2009. One case was presented by acute urinary retention and gross hematuria. In the second case, hematuria and flank pain were observed. The first case was treated with open surgery and partial resection of the ureter, the second was treated endoscopically when the base of the polyp was well identified.

Analysis of microcracks caused by drop shatter testing of porcine kidneys.

Although kidney trauma is a relatively common injury, its microscopic biomechanics are poorly understood. Experimental low-grade trauma in pig kidneys was studied using optical microscopy. We observed ruptures in the cortex as well as in the medulla. Both parts of the renal parenchyma were damaged, even in areas of the kidneys that were free of macroscopic cracks on the surface. To determine which constituents of the renal cortex and medulla, i.e. tubular parts of the nephron or the interstitial connective tissue, were less resistant to injury during the drop shatter test, we applied a simple stereological method to discriminate between random and tissue-specific rupture propagation. The ruptures propagated predominantly through the interstitial connective tissue of the renal cortex and medulla. The volume fraction of the tubules assessed by the Cavalieri principle was 90.4% within the renal cortex and 52.4% within the medulla. The most frequently affected blood vessels were the arcuate and interlobular veins, followed by the arcuate and interlobular arteries. No disruptions of the renal calyces were found.

Possibilities of experimental verification of the validity of urethral pressure profilometry.

OBJECTIVES: The aim is to define conditions for exact measurement of urethral pressure profile, to prepare an aparatus and fabricate an artificial urethra for testing measuring catethers. To examine it's qualities by experiment. METHODS: We designed a measuring appliance and a specialized software for measuring and evaluating. An experimental phantom of urethra, made from a part of bull's urethra, was used for testing of measurement's validity with use of different measuring catethers. Measurements were 10x repeated within the same position of the catether. Reproducibility of the measurement and stability of the experimental model was tested. RESULTS: Measuring urethra and experimental phantom of urethra succeeded, it was possible to make well reproducible measurements with different measuring catethers and to evaluate their metrologic abilities and limits. Results of our measurements confirmed appointed theoretical conditions of the measurement. CONCLUSION: Measurements proved that it is possible to simulate the conditions that are similar to physiological conditions and that it is possible to test metrological qualities of compressive profilometry of urethra.