Computed Tomography Urography: State of the Art and Beyond.

Computed Tomography Urography (CTU) is a multiphase CT examination optimized for imaging kidneys, ureters, and bladder, complemented by post-contrast excretory phase imaging. Different protocols are available for contrast administration and image acquisition and timing, with different strengths and limits, mainly related to kidney enhancement, ureters distension and opacification, and radiation exposure. The availability of new reconstruction algorithms, such as iterative and deep-learning-based reconstruction has dramatically improved the image quality and reducing radiation exposure at the same time. Dual-Energy Computed Tomography also has an important role in this type of examination, with the possibility of renal stone characterization, the availability of synthetic unenhanced phases to reduce radiation dose, and the availability of iodine maps for a better interpretation of renal masses. We also describe the new artificial intelligence applications for CTU, focusing on radiomics to predict tumor grading and patients' outcome for a personalized therapeutic approach. In this narrative review, we provide a comprehensive overview of CTU from the traditional to the newest acquisition techniques and reconstruction algorithms, and the possibility of advanced imaging interpretation to provide an up-to-date guide for radiologists who want to better comprehend this technique.

Changing Abdominal Imaging Utilization Patterns: Perspectives From Medicare Beneficiaries Over Two Decades.

PURPOSE: To assess changing utilization patterns of abdominal imaging in the Medicare fee-for-service population over the past two decades. METHODS: Medicare Physician Supplier Procedure Summary master files from 1994 through 2012 were used to study changes in the frequency and utilization rates (per 1,000 Medicare beneficiaries per year) of abdominal CT, MRI, ultrasound, and radiography. RESULTS: In Medicare beneficiaries, the most frequently performed abdominal imaging modality changed from radiography in 1994 (207.4 per 1,000 beneficiaries) to CT in 2012 (169.0 per 1,000). Utilization rates of abdominal MR (1037.5%), CT (197.0%), and ultrasound (38.0%) all increased from 1994-2012 (but declined briefly from 2007 to 2009). A dramatic 20-year utilization rate decline occurred for gastrointestinal fluoroscopic examinations (-91.9% barium enema, -80.0% upper gastrointestinal series) and urologic radiographic examinations (-95.3%). Radiologists were the dominant providers of all modalities, accounting for >90% of CT and MR studies, and >75% of most ultrasound examination types. CONCLUSIONS: Medicare utilization of abdominal imaging has markedly changed over the past two decades, with overall dramatic increases in CT and MRI and dramatic decreases in gastrointestinal fluoroscopic and urologic radiographic imaging. Despite these changes, radiologists remain the dominant providers in all abdominal imaging modalities.

Trends in the utilization of imaging for upper tract urothelial carcinoma.

OBJECTIVES: To evaluate the changes in use of the different imaging modalities for diagnosing upper tract urothelial carcinoma (UTUC) and assess how these changes have affected tumor stage at the time of surgery. MATERIALS AND METHODS: We assessed the Surveillance, Epidemiology, and End Results (SEER) cancer registry and linked Medicare claims data (1992-2009) for 5377 patients who underwent surgery for UTUC. We utilized International Classification of Disease-Oncology 3 codes to identify UTUC. International Classification of Disease, ninth Revision, Clinical Modification and Current Procedure Terminology codes identified surgical treatment and imaging modalities. We assessed for use of intravenous pyelography, retrograde pyelography (RGP), computed tomography urography (CTU), magnetic resonance urography (MRU), and endoscopy. For each modality, patients were categorized as having received the modality at least once or not at all. Patient characteristics were compared using chi-squared tests. Usage of imaging modalities and tumor stage was trended using Cochran-Armitage tests. We stratified our data into 2 multivariate logistic regression models to determine the effect of imaging modalities on tumor stage: 1992 to 1999 with all modalities except MRU, and 2000 to 2009 with all modalities. RESULTS: Our patient population was predominantly White males of more than 70 years old. Intravenous pyelography and RGP declined in use (62% and 72% in 1992 vs. 6% and 58% in 2009, respectively) while computed tomography urography, MRU, and endoscopy increased in use (2%, 0%, and 37% in 1992 vs. 44%, 6%, and 66% in 2009, respectively). In both regression analyses, endoscopy was associated with lower-stage tumors. In the 2000 to 2009 model, RGP was associated with lower-stage tumors, and MRU was associated with higher-stage tumors. Finally, our data showed an increasing number of modalities utilized for each patient (1% receiving 4 modalities in 1992 vs. 20% in 2009). CONCLUSIONS: We found trends toward the utilization of newer imaging modalities to diagnose UTUC and more modalities per patient. Endoscopy and RGP were associated with smaller tumors, whereas MRU was associated with larger tumors. Further studies are needed to evaluate the utility of the different modalities in diagnosing UTUC.

Imaging for urolithiasis: standards, trends, and radiation exposure.

PURPOSE OF REVIEW: To discuss current trends in imaging for urolithiasis and review the recent scientific literature surrounding this topic. Specifically, to address the efforts urologist should be making to reduce the use of ionizing radiation and to examine alternatives to computerized tomography (CT) scan in diagnosing and managing patients with stones. RECENT FINDINGS: Although CT remains the gold standard for diagnosing urolithiasis, low-dose and ultralow-dose CT scans should be utilized more frequently. Imaging with ultrasound and digital tomosynthesis, especially in follow-up for urolithiasis, offers the dual benefit of reduced patient radiation exposure and acceptable diagnostic ability. SUMMARY: Urolithiasis is a prevalent and recurrent condition and patient radiation exposure throughout diagnosis and management of this disease needs to be considered. Imaging modalities that limit radiation and preserve diagnostic accuracy must be utilized.

Síndrome de Herlyn-Werner-Wunderlich / Herlyn-Werner-Wunderlich syndrome

El síndrome de Herlyn-Werner-Wunderlich (HWW) es una anomalía congénita rara que consiste en una hemivagina obstruida en útero didelfo asociado, en numerosas ocasiones, a agénesis renal ipsolateral. Se presenta un caso de una paciente de 31 años, sin antecedentes médicos importantes, con metrorragia escasa, intermitente y maloliente de 2-3 meses de evolución. En la exploración vaginal intraoperatoria se visualizaron un cérvix hipotrófico y un orificio externo de un trayecto fistuloso que comunicaba con la cavidad uterina derecha y drenaba material hemático oscuro. La urografía intravenosa constató una agenesia renal derecha y confirmó el diagnóstico (AU)

Uterus didelphys with obstructed hemivagina frequently associated with ipsilateral renal agenesis is a rare congenital anomaly known as Herlyn-Werner-Wunderlich syndrome (HWW). We report the case of a 31-year-old woman with no relevant medical history, with scant, intermittent and ill-smelling metrorrhagia for the last 2-3 months. Intraoperative vaginal exploration revealed a hypotrophic cervix and the external orifice of a fistula communicating with the right uterine cavity and draining a dark hematic fluid. Intravenous urography showed right renal agenesis and confirmed the suspected diagnosis of HWW (AU)

Divertículo vesical de hutch: una entidad de infrecuente presentación en el adulto / Hutch bladder diverticula: a very uncommon entity in adults

OBJETIVO: Presentamos el caso de un paciente adulto al que se le diagnosticó tras estudio realizado de divertículo de Hutch. Señalar que se trata de un tipo de divertículo vesical congénito muy infrecuente en la infancia y excepcional en el adulto, siendo muy escasos los casos en adulto comunicados en la literatura. MÉTODOS: El paciente fue estudiado mediante Urografía Intravenosa y Cistouretrografia Miccional Seriada. Una vez evaluadas las pruebas complementarias y establecido un juicio diagnóstico, se revisa la literatura y las alternativas terapeuticas. RESULTADOS: La Urografía intravenosa demostró en la fase excretora una ureterohidronefrosis sin defectos de repleción sugestivos de litiasis a nivel ureteral distal. Por otro lado se observaba un afilamiento del uréter a su entrada en vejiga debido a la presencia de un divertículo vesical yuxta-meatal. Posteriormente se realizó una cistografía retrógrada que descartó reflujo vesicoureteral y mostró que el divertículo presentaba residuo elevado tras la micción. Dadas las características de nuestro paciente y la ausencia de reflujo vesicoureteral ipsilateral asociado; se decidió un tratamiento endoscópio con apertura de la boca del divertículo. La evolución fue satisfactoria. CONCLUSIONES: El divertículo paraureteral de Hutch es una entidad infrecuente, incluso en la infancia. Para el diagnóstico en estos pacientes resulta especialmente útil la cistouretrografía miccional seriada (CUMS). Los síntomas, complicaciones asociadas así como la presencia de reflujo determinaran el tipo de tratamiento a realizar(AU)

OBJECTIVE: We present the case of an adult patient diagnosed with Hutch diverticula after examination. Indications were of a type of congenital bladder diverticula very rare in children and unusual in adults, as very few cases in adults are addressed in the literature. METHODS: Intravenous Urography and Voiding Cystourethrogram (VCUG) were realized. RESULTS: The intravenous urography revealed ureterohydronephrosis in the excretory phase that did not have repletion defects suggesting lithiasis at distal urethra. On the other hand, a narrowing of the urethra was observed at the point of bladder entry due to the presence of a juxtameatal bladder diverticulum. Next a retrograde cystography was performed which ruled out vesicourethral reflux and revealed that the diverticulum presented elevated residuals after urination. As a result of our patient’s clinical characteristics and the absence of vesico-urethral reflux, we decided to perform an endoscopic surgical opening of the diverticula’s neck. CONCLUSIONS Hutch paraurethral diverticula is an very uncommon entity, even in infancy. The Voiding Cystourethrogram (VCUG) is especially useful in diagnosing these patients. In symptomatic cases surgical correction of the diverticula is required(AU)

Ruptura espontánea de la pelvis renal secundaria a litiasis ureteral: reporte de un caso y revisión de la literatura / Renal pelvis spontaneous rupture secondary to ureteral lithiasis. Case report and bibliographic review

OBJETIVO: Presentar un caso clínico atendido por el servicio de urología y revisar brevemente algunos de los aspectos mas importantes en la literatura.MÉTODO: Presentamos el caso de un paciente masculino de 46 años quien presentó cuadro de cólico renoureteral izquierdo. Se realizó urograma excretor. El estudio demostró ruptura espontánea de la pelvis renal secundaria a obstrucción por un lito de 7 mm localizado en la unión ureterovesical. Las bases de datos utilizadas fueron Promedicum, Pub Med y Ovid. Las palabras clave fueron: rupture, renal pelvis, lithiasis y spontaneous combinadas con operadores booleanos.RESULTADO: Este caso fue manejado exitosamente con ureteroscopia, ureterolitotricia, ureterolitolapaxia y colocación de catéter JJ que se dejo durante 2 semanas.CONCLUSIONES: La extravasación o ruptura espontánea de la pelvis renal es un evento patológico poco frecuente. La mayor parte de los casos pueden estar asociados a uropatía obstructiva, infección y a la realización de estudios diagnósticos en la vía urinaria. El urograma excretor es una herramienta útil en el diagnóstico aunque la tomografía multicorte contrastada tiene una sensibilidad y especificidad mayor. El tratamiento puede depender de la gravedad de la lesión y el estado del paciente, pero la mayor parte de los casos pueden tratarse vía endoscópica(AU)

OBJECTIVE: To report a case seen at the Urology Department and comment on the literature.METHODS: We present the case of 46 year-old male who presented left flank pain. Intravenous pyelography was performed. The study showed evidence of contrast extravasation at the level of the left renal pelvis and a 7 mm stone located on the left ureterovesical junction. A literature search was performed using Promedicum, Pub Med and Ovid. The search words were: rupture, renal pelvis, lithiasis and spontaneous combined by boolean operators.RESULTS: The management was successful using endourology procedures and a double pigtail catheter for a two week period.CONCLUSIONS: Spontaneous rupture of the renal pelvis (SRRP) is an infrequent pathological event. Most of the cases are related to obstructive uropathy, infection and diagnostic procedures. Intravenous pyelography is a useful tool although intravenous contrast CT scan has higher sensibility. The treatment depends on patient state but most cases can be managed with minimally invasive procedures and double pigtail catheter placement(AU)

Ureterorrenoscopia retrógrada flexible: remodelando la endourología del tracto urinario superior / Retrograde flexible ureteroscopy: Reshaping the upper urinary tract endourology

La introducción de la ureteroscopia retrógrada flexible representó un salto adelante en la endourología del tracto urinario superior. Hoy en día se puede acceder por vía retrógrada, utilizando las vías anatómicas, a áreas del sistema pielocalicial que de otra manera solo eran accesibles por vía percutánea o cirugía abierta. Los ureterorrenoscopios flexibles han evolucionado desde la primera generación con un grado de deflexión limitado hasta los modelos digitales de alta maniobrabilidad. Los instrumentos auxiliares y las fuentes de energía han seguido una evolución similar. La ureteroscopia flexible es un método diagnóstico muy útil, especialmente en pacientes con datos radiológicos equívocos. La introducción de este procedimiento ha disminuido significativamente el número de casos de “hematuria esencial”. El seguimiento de los tumores del tracto urinario superior tratados de forma conservadora puede también hacerse de una forma más eficiente, identificando las recidivas antes de hacerse radiológicamente detectables. Inicialmente reservada sólo para diagnóstico, la ureteropieloscopia flexible puede ser utilizada también en el tratamiento de varias condiciones patológicas del tracto urinario superior como litiasis, estenosis, tumores, anomalías pielocaliciales, etc. Sin embargo, las limitaciones técnicas respecto a la visibilidad y el acceso todavía influyen en los resultados de la técnica. Las características del ureteroscopio flexible disponible y cómo influyen en ellas las fuentes de energía utilizadas e instrumentos auxiliares son cruciales para conseguir el mejor rendimiento. También las particularidades de la lesión y de la anatomía del tracto urinario superior tienen un impacto significativo sobre el abordaje con ureteroscopia flexible. A pesar de la eficacia conseguida, el progreso tecnológico puede todavía permitir diversas mejoras del procedimiento, incluyendo la ureteroscopia flexible robótica(AU)

Introduction of retrograde flexible ureteroscopy represented a leap forward in upper urinary tract endourology. Nowadays, areas of the pyelocaliceal system accessible otherwise only by percutaneous or open surgery, can be approached in a retrograde fashion, using the anatomical pathways. The flexible ureteroscopes evolved from the limited deflectable first generation ones to the digital very maneuverable models. The ancillary instruments and the energy sources underwent a similar evolution. Flexible ureteroscopy is a very useful investigative method, especially in patients with equivocal data provided by the imaging. Introduction of this procedure decreased significantly the number of cases with so called “essential” hematuria. The conservatively treated upper urinary tract tumors can be also followed-up more efficiently, the recurrence being identified before becoming radiological obvious. Initially reserved only for diagnostic purposes, flexible uretero-pyeloscopy may be used also in the treatment of various pathological conditions of the upper urinary tract such as lithiasis, stenosis, tumors, pyelocaliceal abnormalities etc. However, technical limitations regarding the visibility and access are still influencing the outcome of the method. The characteristics of the available flexible endoscope, and how they are influenced by the energy sources and ancillary instruments used is crucial for achieving the best performances. Also the particularities of the lesion and upper urinary tract anatomy have a significant impact over the flexible ureteroscopic approach. Despite the efficacy already achieved, the technological progress may still allow various improvements of the method, including robotic flexible ureteroscopy(AU)

Uréter: hallazgos en Tomografía Computarizada Multidetector / Con la aparición de la tomografía computarizada multidetector (TCMD) y el perfeccionamiento en las técnicas de urotomografía (UT), la evaluación del tracto urinario ha adquirido otra dimensión, obteniendo cada vez una mejor representación del uréter. Cuando el uréter es evaluado podemos encontrar una gran variedad de entidades, que incluyen anomalías congénitas y variantes anatómicas (alteración en el origen, distribución e inserción distal del uréter), todas las causas benignas y malignas de engrosamiento focal y difuso de la pared ureteral, incluyendo procesos inflamatorios e infecciosos, neoplasias, iatrogenia y cambios posquirúrgicos. Otros procesos benignos, como el asa ureteral y la estenosis por compresión extrínseca de vasos iliacos, pueden ser bien caracterizados por TCMD. El objetivo de este artículo es mostrar el espectro de patología y variantes ureterales diferentes a las entidades comunes relacionadas con cálculos

Con la aparición de la tomografía computarizada multidetector (TCMD) y el perfeccionamiento en las técnicas de urotomografía (UT), la evaluación del tracto urinario ha adquirido otra dimensión, obteniendo cada vez una mejor representación del uréter. Cuando el uréter es evaluado podemos encontrar una gran variedad de entidades, que incluyen anomalías congénitas y variantes anatómicas (alteración en el origen, distribución e inserción distal del uréter), todas las causas benignas y malignas de engrosamiento focal y difuso de la pared ureteral, incluyendo procesos inflamatorios e infecciosos, neoplasias, iatrogenia y cambios posquirúrgicos. Otros procesos benignos, como el asa ureteral y la estenosis por compresión extrínseca de vasos iliacos, pueden ser bien caracterizados por TCMD. El objetivo de este artículo es mostrar el espectro de patología y variantes ureterales diferentes a las entidades comunes relacionadas con cálculos (AU)

Multidetector computed tomography (MDCT) and advances in CT urography techniques have enabled vast improvements in the depiction of the ureter. Studies of the ureter can find a wide variety of conditions including congenital defects and anatomic variants (anomalies in the origin, distribution, and distal insertion of the ureter) as well as all benign and malignant causes of focal and diffuse wall thickening (inflammatory and infectious processes, and neoplasms, as well as iatrogenic thickening and postsurgical changes). Other benign processes like ureteral kinking and stenosis due to extrinsic compression of the iliac vessels are also well characterized by MDCT. The aim of this article is to show the spectrum of ureteral variants and disease apart from common entities related to stones (AU)

Genitourinary imaging: current and emerging applications.

This review discusses the current and emerging techniques in urinary tract imaging. Recent technical advances and novel discoveries make this an exciting but challenging time for urinary tract imaging. The first section describes the imaging of the adrenal gland which has made great strides in the last decade, the current major adrenal imaging modalities as well as new applications are discussed with particular attention to the role of imaging in the incidentally detected adrenal lesion. In the second section the role of ultrasound, computed tomography (CT) and magnetic resonance (MR) in evaluation of the renal tract are discussed with the new technical advances leading to earlier detection and characterization of renal lesions. Complementary to this is the emerging role of CT and MR urography in assessment of the urinary tract and bladder in contrast to the demise of plain film studies/intravenous urography. The role of CT angiography in assessment of the renal vasculature is also discussed. The third section discusses the role of prostate imaging in the diagnosis, staging and management of prostate cancer. Transrectal ultrasonography, can be used to guide biopsy, CT is frequently used in staging, with bone scintigraphy and positron emission tomography having roles in advanced disease. Currently, all imaging modalities, especially MR are evolving to improve disease detection and staging. The final section discusses the recently encountered adverse reaction of nephrogenic systemic fibrosis in patients post gadolinium-enhanced MRI and how to help prevent this adverse reaction.

Magnetic resonance urography update--are we there yet?

Magnetic resonance (MR) urography, in conjunction with traditional MR imaging sequences, offers the potential for a comprehensive evaluation of the entire urinary tract. In addition to defining anatomic form, MR imaging excels at tissue differentiation and can estimate renal function. Most importantly, this information can be obtained without ionizing radiation or iodinated contrast media. Therefore, MR urography has become of particular interest in certain populations, including children, pregnant women, and renal transplant donors and recipients. Despite the challenges inherent in imaging a dynamic system with often subtle abnormalities, recent advances in MR technology and field strength, coupled with expanding functional capabilities, promise a bright future for MR urography.

Radiological investigations following urinary tract infection: changes in Australian practice.

OBJECTIVE: To examine practice changes in the conduct of radiological investigations in Australia following urinary tract infection (UTI). DESIGN: Observational study using data from the national Medicare database over the 15-year period July 1993 to June 2008 for four investigations: renal ultrasound (renal US), micturating cystourethrography (MCU), intravenous pyelography (IVP) and nuclear medicine isotope scanning of the renal tract (NM). Rates per 100,000 children in the age groups 0-4 years and 5-14 years were calculated for each test. SETTING: Australian medical practice, including private and public medical settings. RESULTS: The rates of performance of renal US remained fairly constant throughout the study period in both age groups, while those for MCU, IVP and NM showed a strong falling trend over time for each test in both age groups. For the more invasive tests (MCU, IVP and NM) the total number performed per annum fell from 11,169 (costing 2,032,621 dollars) to 3361 (costing 689,742 dollars) in the last 10 years. CONCLUSION: There have been very marked practice changes over the last 10-15 years. This trend followed the publication of scientific evidence which has raised doubts about the benefit of performing these investigations.

Voiding cystography practices and preferences of North American pediatric urologists.

PURPOSE: Little consensus exists regarding the choice of a specific modality of voiding cystography in the evaluation and management of vesicoureteral reflux. We hypothesized that choices of pediatric urologists are based on technical factors of the studies themselves, as well as institutional factors unique to their hospital(s). Therefore, we surveyed pediatric urologists to determine their current practices and preferences of modalities of voiding cystography. MATERIALS AND METHODS: We mailed an anonymous survey of 40 questions to all fellows of the American Academy of Pediatrics Section on Urology. RESULTS: Surveys were returned from 186 of 301 fellows (62%). Of the respondents 57% were in academic, 30% in private and 13% in mixed practices. Given a choice of fluoroscopic voiding cystourethrography, radionuclide cystography and voiding ultrasonography, fluoroscopic voiding cystourethrography was preferred by 98% and 96% of respondents for initial evaluation of urinary tract infection in males and females, respectively, 96% for assessment of prenatal hydronephrosis, 54% for followup of vesicoureteral reflux, 59% for screening siblings, and 63% and 66%, respectively, after open and endoscopic correction of vesicoureteral reflux. Voiding ultrasonography was preferred by less than 10% of respondents in all groups, and radionuclide cystography was preferred by the remainder. Voiding images of the urethra, child-friendliness of staff, sensitivity and accuracy were factors most important in choosing a test. Of the respondents 83% reported full-time access to pediatric radiologists at their primary hospital, although a minority had full-time access to pediatric radiologists at additional institutions. Sedation was used in some or most cases by 29%, rarely by 56% and never by 15% of respondents. CONCLUSIONS: Pediatric urologists prefer fluoroscopic voiding cystography in all situations to evaluate vesicoureteral reflux but the proportion varies by indication. Diagnostic and patient issues are of greater concern than radiation dose. Variability in access to pediatric radiologists and ability to obtain the desired study may also alter ordering practices.

Current use of computed tomographic urography: survey of the society of uroradiology.

OBJECTIVE: To determine uroradiologists' opinions and practices regarding computed tomographic (CT) urography. METHODS: A Web-based survey was sent via e-mail to all 259 members of the Society of Uroradiology. Of the 229 successfully delivered e-mails, 90 (39%) members responded. RESULTS: Of 90 uroradiologists, 87% perform CT urography. Compared with intravenous (IV) urography, 69% of uroradiologists use CT urography more than 75% of the time urinary tract imaging is requested; 27% stated that CT urography has completely replaced IV urography. Most uroradiologists perform CT urography using multidetector-row CT alone (79%) and use a 3-phase technique (52%) using a single injection (76%) of contrast material at 3 mL/s (52%) without a compression device (81%) and with the patient in supine position (80%). CONCLUSIONS: Most uroradiologists use CT urography in their practice today; some no longer perform IV urography. Variability in multidetector-row CT technique suggests that more research is needed to determine the optimal protocol.

Transuretero-ureterostomía espontánea después de estenosis completa de un conducto ileal, con cuatro años de seguimiento conservador / Spontaneous transuretero-ureterostomy after complete stenosis of an ileal conduit, with four years of conservative follow-up

Introducción: La estenosis del conducto ileal es una complicación infrecuente de esta derivación urinaria. En el caso que describimos pasó durante un tiempo inadvertida y llevó al paciente a una situación de riesgo. Después de implantar una nefrostomía bilateral, se encontró una transuretero-ureterostomia espontánea. Caso Clínico: Un varón de 70 años con un conducto ileal realizado 15 años antes por tener tumor vesical, ingresó con signos de infección intraabdominal grave y oliguria. Los estudios radiológicos mostraron absceso intraabdominal, y se encontró estenosis casi completa del conducto ileal, que se trató conservadoramente mediante una nefrostomia bilateral. Después de ser dado de alta ocurrió la caída accidental de la nefrostomía derecha, recogiendo cantidades normales de orina por la única nefrostomía izquierda. Se comprobó la existencia de una transuretero-ureterostomía espontánea, con estenosis de la porción distal del conducto ileal. Desde entonces permanece con la nefrostomía, que se cambia periódicamente y en cuatro años de seguimiento no ha tenido deterioro renal significativo. Comentario: El origen de esta estenosis se atribuye a los cambios inflamatorios o inmunológicos en la pared del segmento intestinal, inducidos por la presencia crónica de la orina. Nuestro caso es singular por el curioso resultado de una transuretero- ureterostomía in situ y por el largo seguimiento conservador que se hizo, en un paciente que mantiene una calidad de vida buena (AU)

Introduction: Stenosis of an ileal conduit is a rare complication of this urinary diversion. In the case here described, such a complication was neglected for some weeks and left the patient in a high risk situation. After implantation of a bilateral nephrostomy, a spontaneous transuretero-ureterostomy was found. Clinical case: A 70-year-old man with an ileal conduit performed 15 years before because of bladder tumour, was admitted with signs of severe intraabdominal infection and oliguria. The image studies shown intraabdominal abscess, and an almost complete stenosis of the ileal conduit, that was conservatively treated with a bilateral percutaneous nephostomy. After discharged, he reported an accidental falling-out of the right nephrostomy, collecting normal diuresis from the only left nephrostomy. The spontaneous appearance of a transuretero-ureterostomy was demonstrated. The patient refused surgery and remained with a nephrostomy that is periodically changed, and after four years of follow-up he has neither significant kidney dysfunction nor other incidences. Comment: The origin of this ileal conduit stenosis is related to the inflammatory or immunologic changes induced by the chronic presence of the urine on the wall of the intestinal segment. This case is singular because of the curious result of an in situ transuretero-ureterostomy, and because of the long conservative follow-up, without significant complications, in a patient that keeps a good quality of life (AU)

Quiste de Tarlov y disfunción vesical sintomática / Tarlov cyst and symptomatic bladder disfunction

El quiste de Tarlov o quiste perineural son lesiones de las raíces nerviosas localizadas a nivel de la región sacra y de etiología incierta. La mayoría de estos quistes permanecen asintomáticos y carecen de relevancia clínica. Los quistes sintomáticos son infrecuentes y los síntomas más habituales son el dolor y las radiculopatías. Nosotros presentamos el caso de una mujer de 53 años con un quiste de Tarlov sintomático ( síndrome de frecuencia y urgencia miccional) que tras el tratamiento quirúrgico presenta una mejoría clínica importante (AU)

Tarlov cysts or perineural cyst are lesions of the nerve roots located at the sacral level and uncertain etiology. Most of these cysts remain asymptomatic with no clinical relevance. The symptomatic cysts are uncommon and the usual symptoms are pain or radiculopathy. We report the case of a 53 year old woman with a symptomatic cyst (with a history of frequency and urgency syndrom), that disappears after surgery (AU)

La uroresonancia. Una alternativa diagnóstica / UroMRI, a diagnostic alternative

Objetivos: Este trabajo pretende evaluar la utilidad clínica y diagnóstica de la Uroresonancia (URM), mostrar la técnica del estudio y correlacionar algunos de sus resultados con el Urograma Excretor Convencional (UEC). Se evaluó la frecuencia de las patologías encontradas y su prevalencia por edad y sexo. Métodos: Se estudiaron un total de 58 pacientes, 31 mujeres y 27 hombres; con un rango de edad entre 22 a 92 años, a los cuales se les realizó la URM desde Abril de 2003 a Enero de 2005. Se hizo un estudio doble ciego con aquellos pacientes en los cuales se habían realizado el UEC previo a la URM. Resultado: El total de los pacientes evaluados fueron 58, de los cuales 35 presentaron mas de una patología coexistente. Se obtuvieron 17,2% (n: 10) de estudios normales, 5 hombres y 5 mujeres, con un rango de edad entre: 22 a 83 años, siendo la edad promedio de 46,1 años. Para la litiasis renal el UEC fue diagnostico del 100% y el 83,3%; y para la URM el 50% y el 0% en los observadores A y B respectivamente. La litiasis ureteral en el UEC mostró un resultado del 50% y el 100%; y con la URM el 75% para ambos observadores. En los casos de doble sistema pielocalicial ambos métodos tienen el 100% de acuerdo entre ambos observadores. En el cáncer de vejiga la URM, con el 100% y el UEC con el 0% para ambos observadores. Conclusiones: La patología coexistente más frecuente fue la enfermedad quística renal y en segundo término la urolitiasis con dilatación del sistema excretor. La URM resultó ser superior para la visualización de las patologías vesicales y pieloureterales, pero en los casos de litiasis renal y en las calcificaciones del aparato urinario el UEC sigue siendo el método de elección (AU)

Objectives: This paper aims to evaluate the clinical and diagnostic usefulness of uro MRI, to show the study technique and to establish correlations of some of its results with conventional intravenous urography (IVU). Frequency and prevalence by age and gender of pathologies were evaluated. Methods: We studied a total of 58 patients, 31 females and 27 males, with an age range between 22-92 years. All patients underwent uro MRI between April 2003 and January 2005. We perform a double-blind study with those patients undergoing conventional IVU before uro MRI. Results: The total number of patients evaluated was 58, 35 of which present more than 1 concurrent pathology. 17.2% (n = 10) of the studies were normal, five males and five females, with an age range between 22 and 83 years, and a mean age of 46.1 years. IVU was diagnostic for 100% and 83.3% of A and B observers respectively; uro MRI was diagnostic for 50% and 0% respectively. Ureteral lithiasis showed a result of 50% and 100% for IVU; uro MRI had a 75% for both observers. In cases of double pyelocalyceal system both methods have a 100% accordance between both observers. In bladder cancer, uro MRI was diagnostic in 100% and IVU in 0% for both observers. Conclusions: The most frequent concurrent pathology was cystic renal disease, and the second was urolithiasis with urinary tract dilation. Uro MRI was superior to see bladder and pyeloureteral pathologies, but in cases of renal lithiasis and urinary tract calcifications IVU is the test of choice yet (AU)

Prolapso uretral encarcerado. A propósito de un caso clínico / Strangulated urethral prolapse. Case report

Objetivo: Presentar un caso clínico de prolapso de la mucosa uretral encarcerado. Métodos/Resultados: Paciente del sexo femenino de 62 años de edad. Acude al Servicio de urgencias por masa vaginal sangrante acompañada de dolor, localizada en el introioto vaginal y disuria. Después del diagnóstico de prolapso de la mucosa uretral encarcerado, se sometió a exéresis quirúrgica del mismo. El examen histológico reveló uretra con proliferación vascular de tipo angiomatoso con trombosis y recanalización focal (Masson) e inclusión de raros fascículos de fibras musculares. El postoperatorio recorre sin incidencias, no recurrencias o problemas miccionales. Conclusión: Para el tratamiento del prolapso uretral encarcerado, la exéresis quirúrgica es el «gold stardard» (AU)

Objective: We report a case of strangulated urethral prolapse. Method/Results: A 62 year old female patient presents to the emergency department with complaints of a bleeding vaginal mass, pain referred to the vaginal introitus and dysuria. After being diagnosed with a strangulated urethral prolapse, surgical excision of the prolapsed urethra was performed. Pathologically, vascular proliferation of the angiomatous type with thrombosis and focal recanalization (Masson) and inclusion of rare muscular fibers were recognized. Her postoperative course was uneventful, without any recurrence or abnormal micturition. Conclusion: For the treatment of strangulated urethral prolapse, surgical excision has been widely applied with successful results (AU)