Inter-rater reliability of retrograde urethrograms.

PURPOSE: Reliability of pre-operative testing is important for adequate surgical planning. For urethral stricture disease, preoperative planning frequently includes retrograde urethrogram (RUG). The radiographic interpretation of RUGs is often done by urologists themselves. We aimed to evaluate the reliability of RUG interpretation by urologists at our institution. METHODS: We examined the RUGs of 193 patients. These were deidentified and interpreted by three urologists, two general urologists and one reconstructive urologist. These interpretations were compared in 2 ways. Each of the general urologists was compared to the "gold standard" reconstructive urologist interpretation, and the general urologists were additionally compared to each other. We used intraclass correlation coefficient (ICC) for numerical variables and Fleiss' Kappa or Cohen's Kappa statistic (κ) for categorical variables to rate inter-interpreter reliability and agreement among interpretations with regards to the quantitative variables of stricture length and caliber. RESULTS: Level of agreement ranged from poor to moderate across all variables interpreted. Comparing general urologists to the gold standard yielded no better than moderate agreement, with the majority being poor to fair. Similarly, agreement amongst the general urologists did not reach above moderate, with the majority being poor to slight. CONCLUSION: To our knowledge, this is the first analysis of inter-rater reliability of RUGs among practicing urologists. Our analysis showed clinically unacceptable reliability with regards to stricture length, location, caliber, and indicated procedures. This study suggests a need for standardized interpretation of RUGs and poses an opportunity for actionable improvement in management of strictures.

The Society of Abdominal Radiology at 10 years: Reflections, status report, and look to the future.

In 2012, the Society of Abdominal Radiology (SAR) was formed by the merger of the Society of Gastrointestinal Radiologists (SGR) and the Society of Uroradiology (SUR). On the occasion of SAR's ten year anniversary, this commentary describes important changes in society structure, the growth and diversity of society membership, new educational and research initiatives, intersociety and international outreach, and plans for the future.

Super-selective Gelfoam embolisation in high-flow priapism.

INTRODUCTION: High-flow priapism is a rare condition with limited data in the literature, particularly in Australia. There is therefore no clear consensus regarding treatment. We aim to present our institutional network experience in managing this condition over the last decade with super-selective gelatin sponge (Gelfoam) embolisation of the internal pudendal artery. METHODS: We retrospectively searched for and reviewed the patient records of all cases of priapism encountered within our multicentre institutional network over the last 10 years. Of these, the cases of high-flow priapism treated with embolisation were analysed in depth and compared with the current literature. RESULTS: Overall, 93 patients in our network were diagnosed with priapism from 1 January 2012 to 1 January 2022. And 89 of these patients (96%) had low-flow priapism and four patients (4%) had high-flow priapism. Of these four patients, two were treated within our network with super-selective Gelfoam embolisation of the internal pudendal artery. Following embolisation, both patients achieved rapid detumescence and returned to baseline premorbid erectile function. There was no report of recurrence or erectile dysfunction on follow-up. CONCLUSION: Super-selective embolisation of the internal pudendal artery should be considered as a treatment option for high-flow priapism, with Gelfoam as an appropriate temporary embolic agent of choice. We show that it was a safe and effective option for the patients treated in this series, enabling quick and long-term return to baseline erectile function. Our results support data provided by the limited number of cases in the literature.

Detection of High-Grade Prostate Cancer With a Super High B-value (4000 s/mm2) in Diffusion-Weighted Imaging Sequences by Magnetic Resonance Imaging.

INTRODUCTION: High-grade adenocarcinoma of the prostate tends to have denser glandular structures and a prominent desmoplastic reaction, which could be detected by magnetic resonance imaging (MRI) with a super-high b-value in diffusion-weighted imaging (DWI) sequence, to differentiate it from low-grade carcinomas. OBJECTIVE: To evaluate the diagnostic validity of the diffusion sequence with values ​​of b4000 s/mm2 for the diagnosis of high-grade prostate cancer (Gleason score ≥ 7). MATERIALS AND METHODS: It is a retrospective analytical study of male patients who have undergone a prostate biopsy and count with a prostate MRI with a DWI sequence of a super-high b-value (4000 s/mm2). RESULTS: The sensitivity of the diffusion sequence with b4000 s/mm2 values ​​to classify as positive for prostate cancer was 57.14% as compared to biopsy. The specificity of the diffusion sequence with b4000 s/mm2 values ​​classifying patients with prostate carcinoma as negative was 84.62%. The probability that the diffusion sequence with b4000 s/mm2 values ​​classifies patients with prostate cancer was 80%. The probability that the diffusion sequence with b4000 s/mm2 values ​​does not classify patients with prostate cancer was 64.71%. The proportion of patients adequately classified with prostate cancer using the diffusion sequence with b4000 s/mm2 values ​​was 70.37%. CONCLUSIONS: The study shows that using the diffusion sequence with values of b4000 s/mm2 is an optimal value that serves as a tool to be able to decant those high-risk carcinomas with those of low risk; however, it is not a definitive method of diagnosis that could replace the performance of a biopsy. Since the study sample was limited, these results cannot be interpreted as reliable for diagnosing high-grade prostate cancer and should encourage future studies on a larger scale population to obtain significant evidence for a non-invasive diagnostic tool with a better cost-benefit for the patient.

Combination of MRI prostate and 18F-DCFPyl PSMA PET/CT detects all clinically significant prostate cancers in treatment-naive patients: An international multicentre retrospective study.

INTRODUCTION: Clinical and biochemical assessment and biopsies can miss clinically significant prostate cancers (csPCa) in up to 20% of patients and diagnose clinically insignificant tumours leading to overtreatment. This retrospective study analyses the accuracy of 18 F-DCFPyL PET/CT in detecting csPCa as a primary diagnostic tool and directly compares it with mpMRI prostate in treatment-naive patients. The two modalities are then correlated to determine whether they are better in combination, than either alone. METHODS: This is a retrospective dual-institution study of patients who underwent contemporaneous MRI and PSMA-PET between January 2017 and March 2020 with histologic confirmation. The images were re-reviewed and concordance between modalities assessed. Results were compared with histopathology to determine the ability of MRI and PSMA-PET to detect csPCA. RESULTS: MRI and PSMA-PET detected the same index lesion in 90.8% of cases with a kappa of 0.82. PET detected an additional 6.2% of index lesions which were MRI occult. MRI detected an additional 3.1% which were PET occult. No additional csPCa was identified on pathology which was not seen on imaging. The sensitivity of PSMA-PET in detecting csPCa is 96.7% and that of MRI is 93.4% with no statistically significant difference between the two (P = 0.232). Both modalities detected all four cases of non-csPCa with these being considered false positives. CONCLUSION: Both mpMRI and 18F-DCFPyL-PSMA-PET/CT have high sensitivity for detecting csPCa with high agreement between modalities. There were no synchronous csPCa lesions detected on pathology that were not detected on imaging too.

Reducing the rate of negative ureteroscopy: predictive factors and the role of preoperative imaging.

INTRODUCTION: The aim of this study was to investigate factors that may predict a negative ureteroscopy (URS) performed for ureteric calculi in prestented patients and to assess preoperative imaging in reducing the rate of negative URS. METHODS: Data were collected on emergency stent placement for a ureteric calculus from April 2011 to February 2016 (Group A) and October 2016 to October 2019 (Group B). Data included patient demographics, indication for a stent, stone characteristics, baseline bloods, urine culture, readmission, negative URS rate and the use of pre-URS imaging. Multivariate logistic regression was used for statistical analysis. RESULTS: Of 257 patients who underwent emergency stent insertion, 251 underwent deferred URS for a ureteric calculus and 6 avoided URS due to pre-URS imaging. Indications for stent were pain (42%), sepsis (39%) and acute kidney injury (19%). Mean stone size was 7.8mm, mean stone density was 699 Hounsfield units (HU) and the stone locations were upper (62%), mid (13%) and lower ureter (25%). The overall negative URS rate was 12%. The negative URS rate was lower in patients with pre-URS imaging compared with those with none, 6% and 14%, respectively (OR=2.33, 95% CI: 0.69-7.56, p=0.2214). Logistic regression analysis indicated stone size as the only significant predictor of a negative URS, where the greater the size of the stone the less likely URS would be negative (ß=0.75, 95% CI: 0.60-0.94 p=0.011). CONCLUSIONS: Utilising pre-URS imaging can lead to a reduction in negative URS rate. Stone size <5mm appears to be the subgroup most likely to benefit from imaging.

Intracranial Metastasis from Prostate Cancer: Investigation, Incidence, and Imaging Findings in a Large Cohort of Australian Men.

OBJECTIVES: Prostate cancer metastasizing to the brain is remarkably uncommon, with the incidence never having been described in the modern setting. The objective of this study was to determine the incidence and imaging pattern of intracranial metastasis from prostate cancer in a large cohort of Australian men with prostate cancer. MATERIAL AND METHODS: Retrospective review was undertaken of imaging reports for all known prostate cancer patients, who underwent an imaging examination inclusive of the brain, between July 1, 2014, and July 1, 2020. Once an intracranial lesion was identified, all available imaging and clinical notes were reviewed. RESULTS: A total of 5644 imaging examinations which included the brain were identified in 4341 prostate cancer patients. The majority (92.1%) of examinations were 68-Gallium-labeled prostate-specific membrane antigen (68Ga-PSMA) positron emission tomography/computed tomography (PET/CT). Eight patients were identified as having an intracranial metastasis from prostate cancer, yielding an incidence of 0.18%. All patients had a Gleason score of 9 (where known), and the majority of patients (5/8) had a non-acinar variant of prostate cancer. At the time of diagnosis of intracranial metastasis, all patients had extensive metastatic disease. Imaging characteristics of the intracranial lesions were highly variable. CONCLUSION: The incidence of intracranial metastasis in prostate cancer patients has never been well-established. In this study, we determined the incidence as being 0.18%. Given the majority of metastasis constituted unexpected findings on routine restaging 68Ga-PSMA PET/CT, the incidence determined in our study is arguably the most accurate and clinically relevant described to date.

Diagnostic and Interventional Radiology Management of Ureteral Iatrogenic Leakage after Gynecologic Surgery.

OBJECTIVE: To report safety and efficacy of interventional radiology procedures in the treatment of gynecologic iatrogenic urinary leaks. METHODS: A retrospective analysis of iatrogenic ureteral lesions treated between November 2009 to April 2019 was performed. Under ultrasound (US) and fluoroscopy guidance, an attempt to place a ureteral stent and nephrostomy was carried out in the same session using an anterograde percutaneous approach. At the end of any procedure, a fluoroscopic control and a cone-beam CT scan (CBCT) were performed to check the correct placement and functioning of the nephrostomy and DJ stent. In cases of difficult ureteral stent placement via the single anterograde approach, the collaboration of urologists was requested to perform a rendezvous technique, combined with the retrograde approach. RESULTS: DJ stent placement was achieved using the anterograde approach in 12/15 (80.0%) patients and using the retrograde approach in 3/15 cases (20.0%). Moreover, in 3/15 (20.0%) patients, surgical treatment was needed: in one case because of the persistence of ureteral stenosis at 6 months, and in the other two cases due to ureter-vaginal fistula. No major complications were recorded; overall, minor complications occurred in 4/8 patients. CONCLUSION: Percutaneous minimally invasive treatment of iatrogenic ureteral lesions after gynecological surgery is a safe and effective option.

Prostate penile metastasis: Incidence and imaging pattern on 68 Ga-PSMA PET/CT.

BACKGROUND: Prostate cancer commonly metastasises to bone and regional lymphatics and more rarely to locations such as the brain, skin and penis. Gallium-68 prostate-specific membrane antigen (68 Ga-PSMA) positron emission tomography/computed tomography (PET/CT) has widely become the routine imaging modality for prostate cancer staging and re-staging in Australia. The aim of this study was to retrospectively review all 68 Ga-PSMA PET/CT examinations performed to date at our institution to determine the frequency of penile metastases. METHODS: A total of 4860 68 Ga-PSMA PET/CT examinations were performed between 16/07/2014 and 31/10/2019. Radiology reports for each examination were filtered to identify those with the words 'penis' or 'penile'. Once identified, relevant reports and images were individually reviewed to confirm the presence of a PSMA-avid penile lesion. RESULTS: The incidence of penile metastasis of prostate cancer observed in this study was 0.1% with six examinations identified as having PSMA-avid penile lesions in five prostate cancer patients (age range: 71-88 years). The patients had a 1-8 year history of prostate cancer with varying severity of disease. Appearance of PSMA-avidity varied between single focal lesion, multiple focal lesions and diffuse lesion. CONCLUSIONS: An incidence of 0.1% in our study confirms the rarity of penile metastases of prostate cancer. Although rare, identification of prostate cancer penile metastases is important for appropriate treatment management and symptom-relief.

Utility of Ga68 prostate-specific membrane antigen positron-emission tomography for pre-operative staging of high-risk prostate cancer in a prospective cohort.

INTRODUCTION: To assess the yield of Ga68 PSMA PET/CT added to the conventional staging of high-risk prostate cancer in terms of altered staging and changes to management. METHODS: Patients with high-risk prostate cancer without metastatic disease on conventional staging referred for Ga68 PSMA PET/CT at Mercy Radiology, Auckland, New Zealand, were prospectively recruited. Conventional staging was double read in a blinded fashion by oncology fellowship-trained radiologists, who were also experienced in PET/CT, followed by interpretation of the PSMA PET/CT by the same radiologists. Confirmation of changes in management decision was obtained from the treating surgeon and multidisciplinary team meeting records. Ethical approval was obtained from the Health and Disability Ethics Committee. All patients gave written informed consent. RESULTS: A total of 49 patients were scanned. Three who were otherwise eligible for radical prostatectomy elected alternative treatments, leaving 46 patients included for analysis in the study. The addition of PSMA PET/CT was associated with highly statistically significant changes in both staging and management. The stage was changed in 32.6% (95% CI 20.8-47.1%, P < 0.001) patients upstaging in 60% and downstaging in 40%; clinical management in 34.8% (95% CI 22.6-49.3%; P < 0.001), with intramodality change in 25% and intermodality change in 75%. Factors predictive of a change in management with PSMA PET/CT included higher Gleason score and a greater proportion of prostatic cores positive for tumour. CONCLUSION: The addition of Ga68 PSMA PET/CT to conventional staging in high-risk prostate cancer frequently leads to changes in staging and management.

Adrenal collision tumour comprised of adrenocortical carcinoma and myelolipoma in a patient with congenital adrenal hyperplasia.

Adrenal myelolipoma is a benign tumour characterized by the presence of macroscopic fat. Further workup is not necessary if a diagnosis of adrenal myelolipoma is obtained via imaging. We report the first case of adrenal collision tumour comprised of adrenocortical carcinoma and myelolipoma in a patient with bilateral myelolipomas and congenital adrenal hyperplasia. Computed tomography showed a large right adrenal mass consisting of two different components: soft tissue with peripheral heterogeneous enhancement and macroscopic fat. Imaging findings reflected features of both adrenocortical carcinoma and myelolipoma. Although this entity is rare, collision tumour containing an adrenocortical carcinoma component should be suspected if portions of an adrenal mass partially consist of peripheral heterogeneous enhancement.

Five-year trends of bone scan and prostate-specific membrane antigen positron emission tomography utilization in prostate cancer: A retrospective review in a private centre.

INTRODUCTION: In the last 5 years, there has been a significant focus on the use of positron emission tomography (PET) for primary and secondary staging of prostate cancer. In this study, we aim to describe the trends of use between Gallium-68 prostate-specific membrane antigen ligand (Ga-68 PSMA) PET/computed tomography (PSMA PET/CT) and nuclear medicine bone scan (NMBS) for prostate cancer staging in the first institution in Australia to offer both modalities. METHODS: We evaluated trends in prostate cancer staging/restaging imaging modalities at our facility between the time period January 2013-April 2018. Imaging logs were filtered to identify NMBS and PSMA PET/CT scans done within the time period for prostate cancer. Sub-analysis was undertaken (i) to investigate the number of patients who were imaged using both modalities, (ii) to compare the age of the patients in the NMBS group and the PSMA PET/CT group and (iii) to compare the use of PSMA PET/CT for pre-treatment staging compared to the detection of recurrence or metastatic disease (secondary staging). RESULTS: A total of 3144 examinations were performed in the time period reviewed, with 546 NMBS and 2598 PSMA PET/CT scans performed. In the 6 months after PSMA PET/CT was introduced, there was a 45.7% decrease in the number of NMBS performed and 95.3% decrease across the duration of the study. In the PSMA PET/CT cohort, 1569 examinations were performed for pre-treatment staging and 1029 performed for secondary staging. There was a significant difference in the proportion of PSMA PET/CT conducted for pre-treatment staging compared with secondary staging when comparing the first and final 500 examinations (P < 0.05). CONCLUSION: After the introduction of PSMA PET/CT there was a marked decline in the use of NMBS for prostate cancer staging. This finding is of note as it occurred before there was clinical data or guidelines supporting the use of PSMA PET/CT for prostate cancer imaging.

Analysis of Intravenous Urography Findings in a Tertiary Reference Center.

OBJECTIVE: To analyze intravenous urography (IVU) findings in a tertiary reference center. MATERIALS AND METHODS: A retrospective, observational study was conducted in a tertiary reference center. The radiology reports of 1,470 patients subjected to IVU in the period from January 2008 to December 2012 were retrieved from the tertiary reference center databases. Patients' demographic characteristics, type of care (inpatient or outpatient), and IVU radiologic findings were reviewed and analyzed. RESULTS: Of 1470 patients, approximately two-thirds were males. The mean age of the patients was 39.12±14.80 years (range: 2-95). Most of them were inpatients (92.9%; 1365/1470). The IVU findings were abnormal in 68.8% (1012/1470) of patients. Urinary tract calculi were the most frequent type of calculi observed among patients (36.8%; 541/1470), and the kidney was the most frequently affected organ by calculi (66.5%; 541/814). Hydronephrosis was the second most frequent finding, being observed in 29.7% (436/1470) of patients. CONCLUSION: The presence urinary tract calculi was the most frequent IVU finding, revealing that urolithiasis could be the main indication for IVU.

The duplicated collecting system of the urinary tract: embryology, imaging appearances and clinical considerations.

Duplication anomalies of the urinary collecting system are common and can be discovered and characterized with multiple imaging modalities. The embryology, imaging manifestations and clinical ramifications of duplicated ureters and renal collecting systems vary from a normal anatomical variant to urological pathology and are discussed and illustrated in this review.

Interventional radiology in iatrogenic ureteral leaks: case series and literature review.

Iatrogenic ureteral injuries are a dramatic complication in medical practice. Nowadays there are no universal guidelines for their management. The aim of our study was to evaluate the feasibility of the percutaneous treatment in restoring ureteral integrity in 19 patients that came to our attention. In each case retrograde stenting failed and patients were candidates for re-surgery. Our strategy consists of two phases. The first step is the nephrostomy that allows an external urinary diversion putting dry the damaged ureteral segment. The second step is the anterograde ureteral double-J stenting that keeps near the two stumps promoting the healing of the injured tract. In complete sections, when both retrograde and anterograde stenting singularly failed, we performed a rendez-vous technique with a combined radiological trans-nephrostomic access and urological cystoscopic approach to realign and catheterize the ureteral stumps. In patients with Bricker urinary diversion, peri-anastomotic leaks were treated by positioning a multi-hole pig-tail catheter with the inner end in the renal pelvis and the distal portion outgoing from the cutaneous stoma. Subsequent pyelographic controls demonstrated the resolution of the ureteral leak in all patients and none required a surgical re-intervention. Nephrostomies were removed and ureteral stents were regularly changed. We conclude that interventional uro-radiology may offer a valid conservative option in iatrogenic urinary injuries.

Systematic review and meta-analysis of the diagnostic accuracy of low-dose computed tomography of the kidneys, ureters and bladder for urolithiasis.

Renal colic is a common clinical condition which is often investigated with a CT of the kidneys, ureters and bladder (CTKUB). Recent technological improvements have allowed a reduction in dose with the emergence of low-dose CTKUB (LD-CTKUB) techniques. The present meta-analysis aims to determine the diagnostic accuracy of LD-CTKUB in the diagnosis of clinically significant uroliths. A systematic review was performed using nine electronic databases from their dates of inception to May 2016. Inclusion criteria included studies reporting comparative outcomes using LD-CTKUB with a dose less than 3 millisieverts compared to an imaging gold standard or clinical and surgical evaluation. The primary endpoint was detection of a urolith ≥3 mm where specified and any urolith when size was unspecified. Twelve studies were identified according to selection criteria, involving 1250 patients. LD-CTKUB demonstrated a pooled sensitivity of 93.1% (95%CI 91.5-94.4), specificity of 96.6% (95%CI 95.1-97.7%), positive likelihood ratio of 19.9 (95%CI 12.7-31.2), negative likelihood ratio of 0.05 (95%CI 0.02-0.10) and AUC of 0.9877 in the detection of clinically significant uroliths. Although 86 alternative diagnoses were noted across seven studies, none assessed the accuracy of LD-CTKUB in their detection. The majority of newer studies report an average radiation dose from 1 to 1.5 millisieverts. This study demonstrates a high sensitivity, specificity and positive predictive value in the detection of uroliths, however, its accuracy in the detection of alternative diagnoses is unknown. Therefore, we recommend using LD-CTKUB when the pre-test probability of stone disease is significantly higher than the pre-test probability of alternative diagnoses, such as follow-up of known calculi. We suggest caution when the pre-test probability of alternative diagnoses is high, such as the initial presentation of renal colic.

Contrast enhanced ultrasound in urothelial carcinoma of urinary bladder: An underutilized staging and grading modality.

INTRODUCTION: To evaluate contrast enhanced ultrasound (CEUS) as a modality to predict T stage of cancer of urinary bladder (CAUB) and to predict the grade of the tumor preoperatively. MATERIAL AND METHODS: 110 patients with CAUB presenting to the Department of Urology at our institution between July 2014 and December 2015 underwent CEUS prior to endoscopic resection and the CEUS findings were compared with histopathology results. RESULTS: CEUS had a sensitivity of 75, 65 and 90% and specificity of 95, 85 and 92% in detecting Ta, T1 and muscle invasion respectively. CEUS had a sensitivity of 78% and specificity of 85% in detecting the grade of the lesion. CONCLUSIONS: CEUS is a good alternative for T staging and grading of CAUB preoperatively. It is uniquely advantageous in detecting clots or necrosis and in patients with low eGFR where other imaging modalities are contraindicated.

Prostatosymphyseal fistula and osteomyelitis pubis following transurethral resection of the prostate: CT and MRI findings.

We present a very rare case of osteomyelitis pubis in a 75-year-old male patient due to a prostatosymphyseal fistula, which constituted a few weeks after trans-urethral resection of the prostate. The patient had a previous history of prostatic carcinoma treated by radiotherapy, which may have played a role in the development of the fistula. Computed tomography with excretory phase and magnetic resonance imaging were performed and enabled to make the final diagnosis.

Recent advances in pediatric uroradiology.

Pediatric Urology is a surgical subspecialty that is very dependent upon radiographic imaging as the majority of the genitourinary (GU) tract is internally located. Technological advances in various imaging modalities (e.g. ultrasonography, nuclear medicine, CT and MRI) have aided in our ability to visualize and evaluate the functionality of the GU tract, enabling the diagnosis of various disease processes that affect the genitourinary system. Collectively the advances in uro-radiology have improved our understanding of the natural history of many conditions that involve the GU tract. As a result of these newer imaging modalities, some of the more traditional techniques have assumed a limited role in the diagnostic evaluation of the pediatric GU patient (e.g. intravenous urography).The purpose of this article is to review the advances in radiographic imaging, in particular the cross-sectional imaging modalities and discuss their utility (appropriate indications and application) in Pediatric Urology, so that the reader can maximize the diagnostic yield of these studies. For a thorough review of any of the imaging modalities discussed in this article and their utility in the practice of pediatric urology, I would direct the readers to articles in the radiological literature that are specific to that technology. Besides the obvious technological advances in imaging modalities, this review also discusses the attention to radiation safety for the pediatric patient that every physician who orders a diagnostic imaging study in a child should be aware of.

Interventional uroradiologic procedures / 대한비뇨기과학회지

Between January l986 and June l990. 86 cases with interventional uroradiologic procedure entered into the study. Of 86 cases, 54 procedures were performed via percutaneous route and 32 procedures via intravascular. 54 percutaneous procedures included 24 of puncture and aspiration (13 for renal abcess and 11 for renal cyst). 2 of uric acid stone dissolution and 20 of UPJ and ureteral management (11 for UPJ stricture. 8 for ureteral stricture and 1 for ureteral fistula). 32 intravascular procedures included 24 of transcatheter embolization (10 for kidney. 3 for bladder and 11 for internal spermatic vein) and 8 of transluminal angioplasty (6 for renovascular hypertension and 2 for renal artery stenosis after renal tansplantation). Complications occurred in 10 cases which consisted of severe bleeding in 3, sepsis in 3, chronic urinary tract infection in 2. high fever with flank pain in 1 and paresthesia of gluteal muscle in 1. These complications were managed by conservative treatments with no sequalae. The results of interventional uroradiologic procedures for the 86 cases revealed good in 52. fair in 19 and fail in 15.