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.

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.

Intravenous urography in dogs and cats / Urografia excretora de cães e gatos

The intravenous urography was studied in dogs and cats with the purpose of establishing the ideal dosage of the contrast media (Sodium diatrizoate) as well as the ideal times, after the drug administration, the kidneys, ureters, bladder, liver and spleen were better visualized. The ideal dose of the contrast obtained was 2 ml/kg of weight and the higher percentage of radiographies with the best view of the kidneys, ureters, bladder, liver and spleen were obtained fifteen minutes after the intravenous injection of the drug. It was also observed that the urographies performed with sedation or anesthetized animals (deep anesthesia) did not alter the radiographies images of those structures when in comparison with those urographies performed without these procedures.

A urografia excretora foi estudada em cães e gatos, com o objetivo da estabelecer-se a dose adequada do contraste à base de diatrizoato de sódio, e em quais tempos decorridos da injeção desta droga, ocorriam as melhores visualizações de rins, ureteres, bexiga, fígado e baço. A dose adequada de contraste foi de 2 ml/kg de peso e as maiores porcentagens de melhores visibilizações dos órgãos pesquisados ocorreriam após 15 minutos da sua injeção intravenosa . Ainda, verificou-se que as urografias realizadas com o animal em sedação ou mesmo em anestesia geral não mostraram alterações nas imagens radiográficas dos referidos órgãos, quando comparadas com exames efetuados sem estes recursos.

Intravenous urography in dogs and cats / Urografia excretora de cães e gatos

The intravenous urography was studied in dogs and cats with the purpose of establishing the ideal dosage of the contrast media (Sodium diatrizoate) as well as the ideal times, after the drug administration, the kidneys, ureters, bladder, liver and spleen were better visualized. The ideal dose of the contrast obtained was 2 ml/kg of weight and the higher percentage of radiographies with the best view of the kidneys, ureters, bladder, liver and spleen were obtained fifteen minutes after the intravenous injection of the drug. It was also observed that the urographies performed with sedation or anesthetized animals (deep anesthesia) did not alter the radiographies images of those structures when in comparison with those urographies performed without these procedures.

A urografia excretora foi estudada em cães e gatos, com o objetivo da estabelecer-se a dose adequada do contraste à base de diatrizoato de sódio, e em quais tempos decorridos da injeção desta droga, ocorriam as melhores visualizações de rins, ureteres, bexiga, fígado e baço. A dose adequada de contraste foi de 2 ml/kg de peso e as maiores porcentagens de melhores visibilizações dos órgãos pesquisados ocorreriam após 15 minutos da sua injeção intravenosa . Ainda, verificou-se que as urografias realizadas com o animal em sedação ou mesmo em anestesia geral não mostraram alterações nas imagens radiográficas dos referidos órgãos, quando comparadas com exames efetuados sem estes recursos.