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1.
Medicina (Kaunas) ; 57(1)2021 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-33435420

RESUMO

Background and Objectives: Vesicoureteral reflux (VUR) describes a common pediatric anomaly in pediatric urology with a prevalence of 1-2%. In diagnostics, in addition to the gold standard of voiding cystourethrography (VCUG), contrast-enhanced urosonography (ceVUS) offers a radiation-free procedure, which, despite its advantages, is not yet widely used. In the present single-center study, subsequent therapeutic procedures and outcomes after ceVUS of 49 patients were investigated. The aim of the study is to investigate the efficacy of ceVUS with the intention of broader clinical implementation. Materials and Methods: Between 2016 and 2020, 49 patients were retrospectively included and received a ceVUS to evaluate VUR. With a distribution of 47:2 (95.9%), a clear female predominance was present. The age of the patients varied between 5 months and 60 years at the time of ceVUS. All examinations were all performed and subsequently interpreted by a single experienced radiologist (EFSUMB level 3). Results: Compared to intraoperative findings, ceVUS shows a sensitivity of 95.7% with a specificity of 100%. Allergic reactions to the contrast medium could not be observed. Conclusion: With its high sensitivity and intraoperative validation, ceVUS offers an excellent alternative to VCUG, the gold standard in the diagnosis of VUR. In addition, ceVUS is a radiation-free examination method with a low risk profile that offers an exceptional diagnostic tool in the diagnostic clarification of recurrent urinary tract infections with the suspected diagnosis of VUR and should also be included in the consideration of a diagnosis next to the established VCUG, especially in younger children.


Assuntos
Meios de Contraste , Técnicas de Diagnóstico Urológico , Ultrassonografia/métodos , Refluxo Vesicoureteral/diagnóstico por imagem , Adolescente , Adulto , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Cistografia , Feminino , Humanos , Lactente , Injeções , Laparoscopia , Masculino , Pessoa de Meia-Idade , Fosfolipídeos , Politetrafluoretileno , Exposição à Radiação , Recidiva , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Hexafluoreto de Enxofre , Ureteroscopia , Uretra/diagnóstico por imagem , Bexiga Urinária/diagnóstico por imagem , Infecções Urinárias/etiologia , Infecções Urinárias/prevenção & controle , Urografia , Refluxo Vesicoureteral/classificação , Refluxo Vesicoureteral/complicações , Refluxo Vesicoureteral/terapia , Adulto Jovem
2.
Clin Nucl Med ; 46(1): 66-68, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33181753

RESUMO

A 60-year-old woman with recurrent urinary tract infection who had several operations for colorectal carcinoma underwent Tc-DMSA renal scintigraphy which showed an unexpected accumulation of radiotracer in the colon. When symptoms were reviewed, we noticed that she was suffering from pneumaturia and fecaluria which raised the suspicion of enterovesical fistula. Rectal contrast-enhanced computer tomography of pelvis demonstrated enterovesical and enterovaginal fistulas. Colonic radioactivity was considered to be related to retrograde peristalsis of Tc-DMSA from bladder activity via enterovesical fistula. In patients with pelvic surgeries and radiotherapy, radioactivity in the colon should raise the suspicion of enterovesical fistula.


Assuntos
Colo/diagnóstico por imagem , Fístula Intestinal/diagnóstico por imagem , Ácido Dimercaptossuccínico Tecnécio Tc 99m , Fístula da Bexiga Urinária/diagnóstico por imagem , Adulto , Colo/patologia , Cistografia , Feminino , Humanos , Fístula Intestinal/complicações , Tomografia Computadorizada por Raios X , Fístula da Bexiga Urinária/complicações , Infecções Urinárias/complicações
4.
Methodist Debakey Cardiovasc J ; 16(2): 170-174, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32670481

RESUMO

The column in this issue is supplied by Juan Jose Olivero, MD, who recently retired as a nephrologist at Houston Methodist Hospital and member of the hospital's Nephrology Training Program. Dr. Olivero obtained his medical degree from the University of San Carlos School of Medicine in Guatemala, Central America, and completed his residency and nephrology fellowship at Baylor College of Medicine in Houston, Texas.


Assuntos
Nefropatias/diagnóstico por imagem , Rim/diagnóstico por imagem , Urografia , Adulto , Cistografia , Taxa de Filtração Glomerular , Humanos , Rim/fisiopatologia , Nefropatias/fisiopatologia , Nefropatias/terapia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Adulto Jovem
5.
Cir. pediátr ; 33(3): 124-130, jul. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193554

RESUMO

OBJETIVO: Actualmente, los algoritmos para estudiar hidronefrosis en niños incluyen realizar cistografía miccional (CUMS) y renograma diurético (RD) a todos. Ambos son invasivos, molestos y con riesgo de radiación. Contrariamente, las pruebas básicas de función renal (PFRb) no están incluidas. Este estudio se realizó para saber si las PFRb pueden ayudarnos a evitar alguna CUMS y/o RD. MÉTODOS: Análisis retrospectivo de todas las historias de niños con hidronefrosis (pelvis renal ≥ 20 mm) atendidos durante un año (n = 38), [estenosis pieloureteral (EPU) n = 12; reflujo vesicoureteral (RVU) de alto grado n = 8; hidronefrosis no obstructiva (HNO) n = 18]. Analizamos las tres PFRb protocolizadas [osmolalidad urinaria máxima tras DDAVP (UOsm), albúmina/creatinina (Alb/Cr) y NAG/creatinina (NAG/Cr)], junto con CUMS y RD. RESULTADOS: UOsm estaba disminuida en 100% RVU, 75% EPU, 16,7% HNO. Alb/Cr estaba aumentado en 62,5% RVU, 8,3% EPU, 11,1% HNO. NAG/Cr estaba aumentado en 42,8% RVU, 25% EPU, 6,7% HNO. En relación a la necesidad de cirugía, UOsm estaba disminuida en la mayoría de pacientes intervenidos (100% con RVU y 74% con EPU), mientras solo en el 11% de pacientes sin cirugía (HNO). CONCLUSIÓN: Estos resultados sugieren que las PFRb pueden ser útiles para retrasar o evitar CUMS en algunos niños con hidronefrosis. La UOsm es la PFRb más sensible. Ningún niño con RVU (de alto grado) mostró una UOsm normal. Se podrían haber evitado CUMS en el 43% de nuestros pacientes, con UOsm normal, sin haber perdido ningún diagnóstico de VUR (de alto grado)


OBJECTIVE: Nowadays, the algorithms for the study of hydronephrosis in children include voiding cystourethrogram (VCUG) and diuretic renogram (DR) in all patients. Both are invasive, distressing, and associated with radiation risk. However, basic renal function tests (bRFTs) are not included. This study was designed to determine whether bRFTs may help avoid VCUG and/or DR in some children. METHODS: Retrospective review of hydronephrosis (≥ 20 mm renal pelvis) patient records over one year (n = 38) (pyeloureteral stenosis (PUS) n = 12; high-grade vesicoureteral reflux (VUR) n = 8; non-obstructive hydronephrosis (NOH) n = 18. Data from the three protocolized bRFTs (maximum urine osmolality after DDAVP (UOsm), albumin/creatinine ratio (Alb/Cr), and NAG/creatinine ratio (NAG/Cr), together with VCUG and DR, were analyzed. RESULTS: 38 hydronephrosis patients (pyeloureteral stenosis (PUS) n = 12; high grade vesicoureteral reflux (VUR) n = 8; non-obstructive hydronephrosis (NOH) n = 18. UOsm was decreased in 100% of VUR patients, 75% of PUS patients, and 16.7% of NOH patients. Alb/Cr ratio was increased in 62.5% of VUR patients, 8.3% of PUS patients, and 11.1% of NOH patients. NAG/Cr ratio was increased in 42.8% of VUR patients, 25% of PUS patients, and 6.7% of NOH patients. UOsm was decreased in most patients who required surgery (100% of VUR patients and 74% of PUS patients), but only in 11.1% of patients who did not (NOH group). CONCLUSIONS: These results suggest that bRFTs may be useful in delaying or avoiding VCUG in some hydronephrosis cases. UOsm is the most sensitive test. No child with (high grade) VUR had a normal UOsm. VCUG could have been avoided in 43% of our patients –with a normal UOsm-without missing any high grade VUR


Assuntos
Humanos , Masculino , Feminino , Lactente , Hidronefrose/diagnóstico por imagem , Hidronefrose/cirurgia , Algoritmos , Cistografia , Renografia por Radioisótopo , Estudos Retrospectivos , Pelve Renal/diagnóstico por imagem , Pelve Renal/patologia , Albuminúria/diagnóstico , Refluxo Vesicoureteral/diagnóstico , Razão de Chances , Técnicas de Laboratório Clínico
6.
Clin Imaging ; 67: 37-48, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32516692

RESUMO

Urethral strictures are a relatively common affliction of men with the anterior urethra being most frequently affected. Anterior urethral strictures (AUS) typically present with obstructive voiding symptoms and appropriate management is often based on findings at cystourethroscopy and retrograde urethrography (RUG). In particular, determining the number, length, severity and location of urethral strictures is of pivotal importance. The accurate reporting of findings at RUG is dependent on a thorough knowledge of the urethral anatomy as well as recognizing periurethral structures that may opacify during the procedure. Obtaining a diagnostic, high-quality RUG study requires adherence to proper fluoroscopic technique as well as recognizing when to adjust or modify the technique to address pitfalls that may be encountered during the procedure. AUS may be treated by a variety of procedures including urinary diversion, transurethral procedures such as urethral dilation and internal urethrotomy and open surgical repair techniques termed urethroplasty. Some authors have recommended urethroplasty as first-line treatment given the high rate of stricture recurrence with other treatment options. Buccal mucosal grafts are a mainstay of modern urethroplasty. Familiarity with the commonly performed urethroplasty procedures allows radiologists to accurately assess the post-operative urethra thus guiding the management of these patients.


Assuntos
Estreitamento Uretral/diagnóstico por imagem , Adulto , Constrição Patológica , Cistografia , Cistoscopia , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Radiologistas , Recidiva , Resultado do Tratamento , Uretra/diagnóstico por imagem , Uretra/cirurgia , Estreitamento Uretral/cirurgia
7.
Clin Imaging ; 65: 33-36, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32353716

RESUMO

The incidence of bladder diverticula in the pediatric population is unknown as they are often asymptomatic. A minority of cases are a manifestation of a genetic syndrome. Primary diverticula have different features compared to secondary diverticula, which are generally caused by an obstructive or iatrogenic mechanism. This clinical case deals with a rare neonatal finding of bladder diverticulosis with alteration of the bladder, first detected with ultrasound. Voiding cystography and magnetic resonance allowed us to delineate their heterogeneity in size, their distribution in the bladder and to rule out other malformations of the urinary tract. The features of these diverticula focused the diagnosis of cutis laxa syndrome, a rare disease where bladder diverticulosis is only one sign of a more complex disease.


Assuntos
Divertículo/diagnóstico por imagem , Bexiga Urinária/anormalidades , Criança , Cistografia , Humanos , Masculino , Síndrome , Bexiga Urinária/diagnóstico por imagem , Doenças da Bexiga Urinária/complicações , Doenças da Bexiga Urinária/diagnóstico
8.
Clin Imaging ; 65: 133-137, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32470834

RESUMO

BACKGROUND: Thyroid Imaging Reporting Data System (TI-RADS) is used to characterize thyroid nodules while reducing unnecessary FNAC. Over the years, several versions of TI-RADS have been developed but there is no consensus on which TI-RADS is the best system. This study aimed to compare the diagnostic accuracy and ability of ACR TI-RADS, EU TI-RADS, K TI-RADS, AI TI-RADS to eliminate unnecessary FNAC. METHODS: In this prospective study, thyroid nodules were characterized by using the four TI-RADS systems and US-guided FNAC was done for nodule with the highest ACR TI-RADS score. Correlation between TI-RADS and FNAC results were analyzed. RESULTS: Out of 244 thyroid nodules, 100 nodules with either size <1 cm (43 nodules) non-diagnostic or inconclusive FNAC results (57 nodules) were excluded. Seven nodules (4.9%) were confirmed to be malignant on FNAC. K TI-RADS showed 100% sensitivity and NPV but the lowest specificity (40.2%). EU TI-RADS had the highest specificity (83.2%) but the lowest sensitivity (57.1%) and NPV (97.4%). ACR TI-RADS had an average sensitivity (85.7%) and NPV (98.6%). The specificity of ACR TI-RADS (51.1%) was lower than EU TI-RADS but higher than K TI-RADS. AI TI-RADS showed higher specificity (61.8% vs 51.1%, p < 0.05) but comparable NPV and sensitivity to ACR TI-RADS. AI TI-RADS was able to avoid the highest number of unnecessary FNAC (62.5%) followed by ACR TI-RADS(54.2%), EU TI-RADS(37.5%) and K TI-RADS(11.8%). CONCLUSION: AI TI-RADS is a more simple scoring system with better overall diagnostic performance and ability to exclude unnecessary FNAC with high NPV. ADVANCES IN KNOWLEDGE: Highest number of unnecessary FNAC thyroid could be prevented by applying AI TI-RADS.


Assuntos
Biópsia por Agulha Fina , Sistemas de Dados , Nódulo da Glândula Tireoide/diagnóstico por imagem , Cistografia , Humanos , Estudos Prospectivos , Procedimentos Cirúrgicos Reconstrutivos , Estudos Retrospectivos , Sensibilidade e Especificidade , Nódulo da Glândula Tireoide/diagnóstico , Ultrassonografia/métodos
10.
Isr Med Assoc J ; 22(4): 241-243, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32286028

RESUMO

BACKGROUND: Transurethral prostatectomy is the gold standard surgical treatment of bladder outlet obstruction due to benign enlargement of the prostate, with more than 30,000 procedures performed annually in the United States alone. The success rate of this minimally invasive procedure is high and the results are durable. The development of urethral stricture is a long-term complication of the procedure and is noted in about 2% of patients. The stricture narrows the urethral lumen, leading to re-appearance of obstructive urinary symptoms. Traditionally, the evaluation of the stricture was performed by retrograde urethrography. Advancements in the fields of flexible endoscopy allowed rapid inspection of the urethra and immediate dilatation of the stricture in selected cases. OBJECTIVES: To compare the efficacy of urethrography versus cystoscopy in the evaluation of urethral strictures following transurethral prostatectomy. METHODS: A retrospective review was conducted of a series of 32 consecutive patients treated due to post-transurethral resection of prostate (TURP) urethral stricture. RESULTS: Twenty patients underwent both tests. In 16 there was concordance between the two tests. Four patients had no pathological findings in urethrography but had strictures in cystoscopy. All strictures were short (up to 10 mm) and were easily treated during cystoscopy, with no complaints or re-surgery needed in 24 months follow-up. CONCLUSIONS: Cystoscopy was superior to urethrography in the evaluation of post-TURP strictures. Strictures where often short and treated during the same procedure. We recommend that cystoscopy be the procedure of choice in evaluating obstructive urinary symptoms after TURP, and retrograde urethrography be preserved for selected cases.


Assuntos
Cistoscopia/métodos , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Uretra/diagnóstico por imagem , Estreitamento Uretral/diagnóstico , Urografia/métodos , Idoso , Estudos de Coortes , Cistografia/métodos , Seguimentos , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Ressecção Transuretral da Próstata/efeitos adversos , Resultado do Tratamento , Estreitamento Uretral/etiologia , Estreitamento Uretral/cirurgia , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/cirurgia
11.
Radiol Med ; 125(10): 907-917, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32274620

RESUMO

PURPOSE: To evaluate the diagnostic utility of bladder air distension (pneumo-CT-cystography) in the detection of bladder rupture in patients with blunt pelvic trauma. MATERIALS AND METHODS: 843 patients with blunt pelvic trauma were evaluated. Intravenous contrast-enhanced CT was performed for trauma staging. 97 of 843 patients had clinical and radiological signs of possible bladder injury and underwent retrograde air distension. RESULTS: Among 97 patients, 31/97 showed CT signs of bladder rupture, of which 5/31 (16%) intraperitoneal, 25/31 (81%) extraperitoneal and 1/31 (3%) combined. 23 of these patients underwent surgery, which confirmed bladder injury in 100% of cases. The other 8 patients were managed conservatively, and follow-up studies showed disappearance of free air. Among the 66/97 patients with no signs of bladder injury, 38/66 had surgery, which confirmed bladder integrity, while 28/66 were managed conservatively and showed no signs of bladder rupture at clinico-radiological follow-up examinations. CONCLUSIONS: CT evaluation of urinary bladder after retrograde air distension (pneumo-CT-cystography) may be a reliable diagnostic tool in the detection of bladder rupture in patients with blunt pelvic trauma. This technique is faster, cheaper and allows to overcome some of the limitations of conventional CT-cystography.


Assuntos
Traumatismos Abdominais/complicações , Cistografia/métodos , Pneumorradiografia/métodos , Tomografia Computadorizada por Raios X/métodos , Bexiga Urinária/lesões , Ferimentos não Penetrantes/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pelve/lesões , Ruptura/diagnóstico por imagem , Ruptura/etiologia , Bexiga Urinária/diagnóstico por imagem , Adulto Jovem
12.
Cir. pediátr ; 33(2): 71-74, abr. 2020.
Artigo em Espanhol | IBECS | ID: ibc-190844

RESUMO

Introducción: La concomitancia entre la estenosis de la unión pieloureteral (EPU) y el reflujo vesicoureteral (RVU) se sitúa entre el 5,2 y el 18%. Actualmente, no existe consenso sobre la realización de screening rutinario para descartar dicho reflujo, pudiendo limitarlo a pacientes seleccionados. Objetivos: Estudiar la prevalencia del RVU en los pacientes diagnosticados de EPU. Estimar el grado de reflujo en aquellos pacientes con estudio positivo. Limitar la realización de cistouretrografía miccional seriada CUMS o de ecocistografía a pacientes seleccionados (uréter dilatado visible en ecografía, ITU previa). Material y métodos: Estudio observacional y retrospectivo sobre 74 pacientes intervenidos de EPU. Se ha recogido información acerca del sexo, realización de despistaje preoperatorio de RVU, los resultados (positivo o negativo para RVU) y grado de reflujo. Resultados: 53 casos fueron masculinos (71,6%) y 21 (28,4%) femeninos. El despistaje de reflujo fue realizado en 55 pacientes (74,3%) frente a 18 (24,3%) en los que no se realizó ningún estudio. El 16,2% de los casos en los que se realizó el estudio preoperatorio de RVU fueron abordados mediante ecocistografía, siendo el estudio preoperatorio positivo en 6 pacientes del total de 73 estudiados (un paciente fue excluido por ser diagnosticado de válvulas de uretra posterior), lo que sitúa la prevalencia de RVU en pacientes ya diagnosticados de EPU en un 10,7%. De estos, un caso fue de grado I, dos grado II y un caso grado III, IV y V, respectivamente. Conclusiones: El RVU en pacientes diagnosticados de estenosis de la unión pieloureteral presenta una incidencia ligeramente mayor que en la población general. El screening rutinario del reflujo vesicoureteral es innecesario, debiendo realizarse en casos que presenten infecciones urinarias previas, visualización del uréter dilatado en la ecografía o sospecha de causa secundaria


Introduction: The prevalence of vesicoureteral reflux (VUR) con-comitant with pyeloureteral junction obstruction (PUJO) ranges from 5.2% to 18%. Today, there is no consensus on whether routine screening should be performed or not to rule out reflux, and it can be limited to selected patients. Objectives: To study VUR prevalence in patients diagnosed with PUJO, estimate reflux levels in patients with positive study, and limit serial voiding cystourethrogram (SVCU) or ultrasound cystography to selected patients (dilated ureter at ultrasound imaging and previous UTI). Materials and methods: Observational, retrospective study carried out in 74 patients undergoing surgery for PUJO. Information on sex, preoperative VUR screening, results (positive or negative for VUR), and reflux levels was collected. Results: 53 cases (71.6%) were male and 21 (28.4%) were female. Reflux screening was performed in 55 patients (74.3%), vs. 18 (24.3%) where no study was carried out. 16.2% of cases with VUR preoperative study were managed using ultrasound cystography. The preoperative study was positive in 6 out of the 73 patients (1 patient was excluded after being diagnosed with posterior urethral valves), which means VUR prevalence in patients already diagnosed with PUJO was 10.7%. Of the six cases, one case was grade I, two cases were grade II, one case was grade III, one case was grade IV, and one case was grade V. Conclusions: VUR has a slightly higher incidence in patients diagnosed with pyeloureteral junction obstruction than in the general population. Routine screening of vesicoureteral reflux is unnecessary, unless in case of previous urinary infection, dilated ureter at ultrasound imaging, or suspected secondary cause


Assuntos
Humanos , Masculino , Feminino , Estenose Pilórica/complicações , Estreitamento Uretral/complicações , Refluxo Vesicoureteral/etiologia , Refluxo Vesicoureteral/diagnóstico por imagem , Índice de Gravidade de Doença , Estudos Retrospectivos , Cistografia/métodos
13.
Chin J Traumatol ; 23(3): 181-184, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32001130

RESUMO

PURPOSE: Pelvic fracture evaluation with abdominopelvic computed tomography (CT) and formal CT cystography for rule out of urine bladder injury have been commonly employed in pediatric trauma patients. The additional delayed imaging required to obtain optimal CT cystography is, however, associated with increased doses of ionizing radiation to pelvic organs and represent a significant risk in the pediatric population for future carcinogenic risk. We hypothesized that avoidance of routine CT cystography among pediatric pelvic fracture victims would not result in an appreciable rate of missed bladder injuries and would aid in mitigating the radiation exposure risk associated with these additional images. METHODS: A retrospective cohort study involving blunt trauma pelvic fractures among pediatric trauma patients (age<14) between the years 1997 and 2016 was conducted utilizing the Israeli National Trauma Registry. Statistical analysis was performed using SAS statistical software version 9.4 via the tests of Chi-square test and two-sided Fisher's exact test. A p value of less than 0.05 was considered statistically significant. RESULTS: A total of 1072 children were identified from the registry for inclusion. Mean age of patients was 7.7 years (range 0-14) and 713 (66.5%) were male. Overall mortality in this population was 4.1% (44/1072). Only 2.1% (23) of pediatric patients with pelvic fractures had bladder injury identified, with just 9 children having intraperitoneal bladder rupture (0.8% of all the patients). CONCLUSION: The vast majority of blunt pediatric trauma victims with pelvic fractures do not have urine bladder injuries. Based on our study results we do not recommend the routine utilization of CT cystography in this unique population.


Assuntos
Cistografia/métodos , Fraturas Ósseas/diagnóstico por imagem , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/lesões , Tomografia Computadorizada por Raios X/métodos , Procedimentos Desnecessários , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/lesões , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Risco
14.
Vet Radiol Ultrasound ; 61(3): 302-311, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32100910

RESUMO

Quantitative analysis of the normal retrograde urethrogram is well reported in radiography, but studies on CT urethrography are lacking. Recently, a method of retrograde CT urethrography using a power injector was described. The purpose of the current, prospective, analytical study was to quantify the urethral size of five, healthy, intact, male Beagle dogs using retrograde CT urethrography and a power injector. With the injection rate of the power injector set at 0.3 mL/s, 1 mL/kg of diluted contrast medium (15 mg I/mL) was injected, and a CT examination was performed. The state of the initial urethrogram taken was defined as "empty bladder." The same procedures were repeated with the injection of an additional 1 mL/kg of diluted contrast medium until the ureteral reflux was seen (distended bladder). There was a significant difference in volumes between the empty and distended bladder, but the membranous urethra showed the least difference (P = .0044) among the three regions (P < .0001 for the prostatic and penile urethra). Urethral diameters at six sites were measured from sagittal images, and the sites of measurements were adopted from the earlier radiographic studies. The most significant difference in the urethral diameters between the empty and distended bladder occurred at the cranial and middle prostatic urethra (P < .0001). The results of this study can be useful for interpreting the results of retrograde CT urethrography. Care must be taken when narrowing is suspected at the prostatic urethra, and if necessary, further distension of the urinary bladder should be tried.


Assuntos
Cistografia/veterinária , Cães/anatomia & histologia , Tomografia Computadorizada por Raios X/veterinária , Uretra/diagnóstico por imagem , Bexiga Urinária/diagnóstico por imagem , Animais , Cistografia/métodos , Cães/fisiologia , Masculino , Estudos Prospectivos , Próstata , Tomografia Computadorizada por Raios X/métodos , Uretra/anatomia & histologia , Uretra/fisiologia , Bexiga Urinária/anatomia & histologia , Bexiga Urinária/fisiologia
15.
Clin Imaging ; 60(2): 222-227, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31927498

RESUMO

OBJECTIVES: Thyroid imaging reporting and data system (TIRADS) is a combination of ultrasonographic features developed to help physicians in predicting the malignancy risk of thyroid nodules based on sonographic characteristics. Thyroid nodule size is another factor in determining whether a nodule is malignant. The aim of this study was detecting the predictive value of TIRADS and nodule size based on Bethesda classification in prognostication of malignancy. METHODS: This was a cross-sectional study of 239 patients with thyroid nodules. The patients underwent ultrasonography using TIRADS classification and FNA biopsy based on Bethesda categorization. The results were analyzed using SPSS with the cut off points and predictive values measured. RESULTS: TIRADS ≥4 could detect malignant nodules with a sensitivity of 91.67% and specificity of 52.8%. An inverse relationship was observed between nodule size and malignancy risk and cutoff point of 12 mm was found for detecting malignant nodules. CONCLUSIONS: Thyroid nodules with TIRADS 4 and 5 and diameter lower than 12 mm, are highly suspicious for malignancy and should be considered as indications for fine needle aspiration biopsy. ADVANCES IN KNOWLEDGE: The study suggests TIRADS and thyroid nodule size as sensitive predictors of malignancy.


Assuntos
Neoplasias da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Adulto , Biópsia por Agulha Fina/métodos , Estudos Transversais , Cistografia , Coleta de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Sensibilidade e Especificidade , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/patologia , Ultrassonografia/métodos
16.
Pediatrics ; 145(2)2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31915193

RESUMO

Imaging modalities for diagnosing kidney and urinary tract disorders in children have developed rapidly over the last decade largely because of advancement of modern technology. General pediatricians and neonatologists are often the front line in detecting renal anomalies. There is a lack of knowledge of the applicability, indications, and nephrotoxic risks of novel renal imaging modalities. Here we describe the clinical impact of congenital anomalies of the kidneys and urinary tract and describe pediatric-specific renal imaging techniques by providing a practical guideline for the diagnosis of kidney and urinary tract disorders.


Assuntos
Nefropatias/diagnóstico por imagem , Rim/anormalidades , Rim/diagnóstico por imagem , Criança , Meios de Contraste , Cistografia/métodos , Imagem de Difusão por Ressonância Magnética , Ecocardiografia Tridimensional , Técnicas de Imagem por Elasticidade , Humanos , Nefropatias/congênito , Impressão Tridimensional , Tomografia Computadorizada por Raios X , Ultrassonografia/métodos , Ultrassonografia/tendências , Uretra/diagnóstico por imagem , Bexiga Urinária/diagnóstico por imagem , Sistema Urinário/anormalidades , Sistema Urinário/diagnóstico por imagem
17.
Cir. pediátr ; 33(1): 36-42, ene. 2020. graf, ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-186136

RESUMO

Objetivos: Comunicar nuestra experiencia con la utilización de la urosonografía miccional seriada (UMS) para el diagnóstico y manejo de pacientes con válvulas de uretra posterior (VUP). Material y método: Estudio retrospectivo descriptivo en pacientes entre 0 a 14 años con sospecha de VUP en UMS realizada como primera prueba contrastada de la vía urinaria y con estudio cistoscópico posterior. Las variables se analizaron utilizando SPSSv22. Resultados: Fueron estudiados 18 pacientes (edad mediana de 6 meses). La mayoría de los pacientes (15) presentaban dilatación de la uretra posterior (diámetro medio de 9,56 mm) y diferencia entre uretra proximal y distal mayor de 2 mm. Trece casos tenían engrosamiento vesical y 9 RVU. Se diagnosticaron 15 casos de VUP, 1 caso de mucocele de uretra distal y 1 divertículo vesical que obstruía uretra. Se consiguió resección completa de las VUP en 10 pacientes (66,6%) en la primera cistoscopia. La UMS de control detectó un caso de resección incompleta por persistencia de dilatación de uretra posterior. Este caso y los 5 conocidos con resección incompleta se sometieron a una segunda cistoscopia y resección. El menor de los pacientes requirió una tercera resección y dilatación con balón de corte por estenosis residual. La creatinina media al diagnóstico fue 0,28 mg/dl. Conclusiones: La urosonografía miccional seriada (UMS) es una prueba complementaria útil en pacientes pediátricos con válvulas de uretra posterior. Su carácter dinámico y ventajas: ausencia de irradiación, seguridad y alta sensibilidad; la convierten en una prueba de imagen ideal para el diagnóstico y seguimiento de VUP


Objectives: Report our experience with the use of contrast-enhanced serial voiding urosonography (SVU) for posterior urethral valve (PUV) patient diagnosis and management. Materials and Methods: Descriptive retrospective study in 0- to 14-year-old patients with suspected PUV at SVU performed as a first contrast-enhanced urinary tract test with subsequent cystoscopic study. Variables were analyzed using SPSSv22. Results: 18 patients were studied (median age: 6 months). Most patients (15) presented posterior urethral dilatation (mean diameter: 9.56 mm) and a >2 mm gap between proximal and distal urethra. 13 cases had bladder thickening and 9 had VUR. 15 PUV cases, 1 case of distal urethral mucocele, and 1 case of bladder diverticulum obstructing the urethra were diagnosed. Complete PUV resection was performed in 10 patients (66.6%) at the first cystoscopy. The control SVU detected one case of recurrence due to persistence of posterior urethral dilatation. The recurrence case and the 5 incomplete resection cases were treated with a second cystoscopy and resection. The youngest patients required a third resection and cutting balloon dilatation due to residual stenosis. Mean creatinine levels at diagnosis were 0.28 mg/dl. Conclusions: Serial voiding urosonography (SVU) is a useful complementary test in pediatric patients with posterior urethral valve. Its dynamic nature and its advantages - absence of irradiation, safety, and high sens efitivity - make it an ideal imaging test for PUV diagnosis and follow-up


Assuntos
Humanos , Recém-Nascido , Lactente , Criança , Adolescente , Uretra/anormalidades , Uretra/cirurgia , Obstrução Uretral/diagnóstico por imagem , Uretra/diagnóstico por imagem , Estudos Retrospectivos , Cistografia/métodos , Transtornos Urinários/complicações , 25783
18.
Arch Dis Child ; 105(3): 264-269, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31466991

RESUMO

BACKGROUND: Despite a trend towards early voiding cystourethrography (VCUG) after febrile urinary tract infection (fUTI) in children, clinical guidelines do not comment on the optimal timing and current practice varies considerably. OBJECTIVE: To assess whether the detection rate of vesicoureteric reflux (VUR) in children depends on the time period of VCUG procedure after onset of antibiotic therapy. METHODS: MEDLINE, EMBASE and Cochrane Controlled Trials Register electronic databases were searched for eligible studies without language or time restriction (19 November 2018). Inclusion criteria were (1) patients <18 years of age; (2) VCUG performed in patients with fUTI after onset of antibiotic therapy either in the same patient population or in two or more different patient populations within one study at different time periods; and (3) with reported detection rate of VUR. The systematic review was carried out following the recommendations of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS: Of 4175 records, nine studies were included (number of patients, n=1745) for the main outcome prevalence of VUR by VCUG <8 days compared with VCUG ≥8 days after onset of antibiotic therapy. Pooled overall prevalence of VUR was not significantly different between the early and the late VCUG groups (risk ratio 0.98, 95% CI 0.81 to 1.19). Prevalence of VUR stratified by grade was not significantly different between the two groups. CONCLUSION: Early VCUG within 8 days after onset of antibiotic therapy does not affect the prevalence of VUR. TRIAL REGISTRATION NUMBER: CRD42018117545.


Assuntos
Cistografia/métodos , Infecções Urinárias/diagnóstico por imagem , Adolescente , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Ensaios Clínicos Controlados como Assunto , Feminino , Febre/complicações , Humanos , Lactente , Recém-Nascido , Masculino , Prevalência , Encaminhamento e Consulta/estatística & dados numéricos , Fatores de Tempo , Infecções Urinárias/complicações , Infecções Urinárias/tratamento farmacológico
19.
Urology ; 136: e5-e6, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31726183

RESUMO

As gender-affirming genital surgery for transgender men becomes more common, general urologists may be confronted with unfamiliar anatomy and complications. We describe the use of voiding cystourethrogram and retrograde urethrogram in a transgender man in demonstrating the anatomy of the urethra, urethrocutaneous fistula, and a vaginal remnant after phalloplasty.


Assuntos
Fístula Cutânea/diagnóstico por imagem , Cistografia , Pênis/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Cirurgia de Readequação Sexual/métodos , Doenças Uretrais/diagnóstico por imagem , Fístula Urinária/diagnóstico por imagem , Vagina/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
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