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1.
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
2.
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
3.
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
4.
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
5.
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
6.
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
7.
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
8.
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
9.
Emerg Radiol ; 27(1): 87-95, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31729629

RESUMO

Although conventional radiographic cystography has been traditionally considered the reference standard in detecting bladder injuries, computed tomography (CT) cystography has become the initial imaging method of choice in the acute setting. CT cystography has been shown to provide comparable accuracy as conventional cystography, and can be easily performed in conjunction with trauma CT surveys in patients with suspected bladder injuries. Despite increasing enthusiasm toward CT cystography in dealing with patients with suspected bladder injuries, there is little information in this regard in the literature. This article aims to discuss the role of CT cystography in the evaluation of bladder injuries.


Assuntos
Cistografia/métodos , Tomografia Computadorizada por Raios X/métodos , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/lesões , Humanos
10.
J Am Coll Radiol ; 16(11S): S417-S427, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31685109

RESUMO

Urothelial cancer is the second most common cancer, and cause of cancer death, related to the genitourinary tract. The goals of surveillance imaging after the treatment of urothelial cancer of the urinary bladder are to detect new or previously undetected urothelial tumors, to identify metastatic disease, and to evaluate for complications of therapy. For surveillance, patients can be stratified into one of three groups: (1) nonmuscle invasive bladder cancer with no symptoms or additional risk factors; (2) nonmuscle invasive bladder cancer with symptoms or additional risk factors; and (3) muscle invasive bladder cancer. This article is a review of the current literature for urothelial cancer and resulting recommendations for surveillance imaging. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.


Assuntos
Carcinoma de Células de Transição/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Guias de Prática Clínica como Assunto , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/cirurgia , Cistectomia/métodos , Cistografia/métodos , Cistoscopia/métodos , Medicina Baseada em Evidências , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Monitorização Fisiológica , Gradação de Tumores , Invasividade Neoplásica/patologia , Prognóstico , Controle de Qualidade , Radiologia/normas , Sensibilidade e Especificidade , Sociedades Médicas/normas , Tomografia Computadorizada por Raios X/métodos , Estados Unidos , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/cirurgia
11.
J Am Coll Radiol ; 16(11S): S392-S398, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31685107

RESUMO

Lower urinary tract injury is most commonly the result of blunt trauma but can also result from penetrating or iatrogenic trauma. Clinical findings in patients with a mechanism of penetrating trauma to the lower urinary tract include lacerations or puncture wounds of the pelvis, perineum, buttocks, or genitalia, as well as gross hematuria or inability to void. CT cystography or fluoroscopy retrograde cystography are usually the most appropriate initial imaging procedures in patients with a mechanism of penetrating trauma to the lower urinary tract. CT of the pelvis with intravenous contrast, pelvic radiography, fluoroscopic retrograde urethrography, and CT of the pelvis without intravenous contrast may be appropriate in some cases. Arteriography, radiographic intravenous urography, CT of the pelvis without and with intravenous contrast, ultrasound, MRI, and nuclear scintigraphy are usually not appropriate. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.


Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Guias de Prática Clínica como Assunto , Bexiga Urinária/lesões , Sistema Urinário/lesões , Ferimentos Penetrantes/diagnóstico por imagem , Traumatismos Abdominais/cirurgia , Meios de Contraste , Cistografia/métodos , Medicina Baseada em Evidências , Feminino , Humanos , Escala de Gravidade do Ferimento , Imagem por Ressonância Magnética/métodos , Masculino , Tomografia por Emissão de Pósitrons/métodos , Controle de Qualidade , Radiologia/normas , Sensibilidade e Especificidade , Sociedades Médicas/normas , Tomografia Computadorizada por Raios X/métodos , Estados Unidos , Uretra/diagnóstico por imagem , Uretra/lesões , Bexiga Urinária/diagnóstico por imagem , Sistema Urinário/diagnóstico por imagem
12.
Pan Afr Med J ; 33: 328, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692786

RESUMO

Urethral stricture is a disease whose cause and management vary according to the context. This study aims to analyze the epidemiological etiological and therapeutic features of urethral stricture in our department. We conducted a longitudinal cross-sectional study of patients with acquired urethral stricture admitted to our department between March 2014 and February 2016. The average age of our patients was 24.5 years (10 and 81years). The diagnosis was confirmed by retrograde and voiding Urethro-Cystography (UCG). The average stricture length was 2.28cm (0.5-5cm). The therapeutic approaches included: resection with termino-terminal anastomosis; retrograde dilatation etc. Outcome assessment performed 6-15 months after surgery was satisfactory with absence of recidivism, PMR ≤30cc and strong urine flow and weak in the case of recurrence of dysuria or PMR ≥100cc. Urethral stricture accounted for 7.14% of our urologic treatments. Most of our patients were farmers from the rural area. A history of recurrent urethritis was most often reported by our patients and 78,57% of them were married men, among whom 91% were polygamous). The main reason for consultation was dysuria (50% of the study population) and 50.01% of our patients had secondary urinary tract infection, most commonly caused by Escherichia coli. The main cause of urethral stricture was an infection (56.52%). The most affected area was the bulbar urethra (45.60% of cases). UCG was the most used technique (39.13%). Overall outcomes were good (85,65%) and failure rate reached 13.04%; the highest success rate was achieved with resection with anastomosis (94.44% respectively). Urethral stricture is common among young people. Infection is the main cause in our department. Prevention is essential as well as an efficient and effective management of sexually transmitted infections.


Assuntos
Anastomose Cirúrgica/métodos , Disuria/etiologia , Estreitamento Uretral/cirurgia , Uretrite/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Estudos Transversais , Cistografia/métodos , Disuria/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estreitamento Uretral/diagnóstico , Uretrite/epidemiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Adulto Jovem
13.
J Pediatr Urol ; 15(5): 514.e1-514.e6, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31285138

RESUMO

BACKGROUND: Primary vesicoureteral reflux (VUR) is the most common urological anomaly in children. Voiding cystourethrography (VCUG) is considered the reference standard for the diagnosis of VUR. Even if it is a secure and standardized technique, it is still an invasive method, hence, the effort to find an alternative method to diagnose VUR. The aim of the study is to evaluate the diagnostic accuracy of 99mTC-MAG3 scintigraphy with indirect cystography in detecting VUR and to estimate any interobserver variability in 99mTC-MAG3 scintigraphy interpretation. METHODS: The authors retrospectively reviewed all the pediatric patients who underwent both a VCUG and a 99mTC-MAG3 renal scintigraphy at the study institution between 2012 and 2016. RESULTS: A total of 86 children (and 168 renal units) were included. MAG3 scan revealed a sensitivity of 54% and a specificity of 90% with positive predictive value of 79% and negative predictive value of 73%. Each MAG3 scintigraphy was then independently and blindly evaluated by a pediatric urologist and two nuclear physicians. After revision, the concordance between VCUG and MAG3 in reflux cases dropped from 54% to 27% (on average), and the reviewers reclassified most examinations as non-conclusive. CONCLUSIONS: 99mTC-MAG3 renal scintigraphy with indirect cystography showed low sensitivity in detecting VUR of any grade and cannot, therefore, be proposed as completely alternative to VCUG in the diagnosis of VUR. Moreover, MAG3 scintigraphy interpretation for the diagnosis of VUR has a very high interobserver variability, mostly because of the lack of a correct and complete voiding phase.


Assuntos
Cistografia/métodos , Cintilografia/métodos , Ácido Dimercaptossuccínico Tecnécio Tc 99m/farmacologia , Bexiga Urinária/diagnóstico por imagem , Refluxo Vesicoureteral/diagnóstico , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Curva ROC , Compostos Radiofarmacêuticos/farmacologia , Estudos Retrospectivos , Micção , Urodinâmica/fisiologia , Refluxo Vesicoureteral/fisiopatologia
15.
J Pediatr Urol ; 15(4): 385.e1-385.e6, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31133505

RESUMO

INTRODUCTION: Vesicoureteral reflux (VUR) is a common pediatric urologic condition associated with urinary tract infection and pyelonephritis. It can be diagnosed via fluoroscopic voiding cystourethrogram (VCUG) and, more recently, contrast-enhanced voiding ultrasonography (ceVUS), which does not expose the patient to ionizing radiation. Voiding urosonography contrast agents used for the diagnosis of VUR have been widely available in Europe but were approved by the Food and Drug Administration for use in the United States only in 2016. OBJECTIVE: The objective was to optimize a protocol and compare the diagnostic performance of ceVUS to fluoroscopic VCUG in an academic medical center naïve to previous use of contrast-enhanced voiding urosonography. STUDY DESIGN: Thirty-nine patients referred for clinically indicated evaluation of VUR were enrolled between September 2016 and March 2017. Patients underwent contrast-enhanced ultrasonography with prediluted Lumason and under the same catheterization underwent fluoroscopic VCUG. Comparative grading was performed by pediatric radiologists on-site at the time of examination. RESULTS: Reflux was observed in 16 of 39 patients (20 of 64 renal units) ranging from grades 1 through 5. VCUG and ceVUS were concordant for detecting reflux in 10 of 39 patients (14 of 84 renal units) and excluding reflux in 23 of 39 patients (64 of 84 renal units) (Fig. 1). Using contrast enhanced voiding urosonography, 1 of 20 renal units had high-grade and 2 of 20 renal units had low-grade reflux that was not found on fluoroscopy. Using fluoroscopy, 1 of 20 renal units had high-grade and 2 of 20 renal units had low-grade reflux that had not been found on ceVUS. Two of 20 renal units were upgraded from low-grade on ceVUS to high-grade on fluoroscopy. This corresponds to a Cohen's kappa of 0.72 (confidence interval [CI] 0.54-0.91) or 'moderate.' DISCUSSION: During our investigation, we noted that there was a technical learning curve related to poor contrast mixing and the need to titrate the concentration of Lumason. However, over the course of the study, we were able to correct the technical aspects. Ultimately, our results showed good correlation between VCUG and Lumason ceVUS and only slightly less correlation than published studies by experienced centers. Future studies with voiding should allow for improved urethral visualization. CONCLUSION: While there is a considerable learning curve to the implementation of ceVUS for the diagnosis of pediatric VUR, these technical aspects can be corrected. Even a center previously naïve to contrast-enhanced ultrasound technology can, over a short period of time, demonstrate good correlation between VCUG and ceVUS in the diagnosis of VUR. Translation of ceVUS into clinical practice is an alternative to VCUG for diagnosis of reflux, is feasible, and can eliminate the radiation exposure associated with a VCUG.


Assuntos
Meios de Contraste , Cistografia/métodos , Fluoroscopia/métodos , Ultrassonografia/métodos , Refluxo Vesicoureteral/diagnóstico por imagem , Refluxo Vesicoureteral/epidemiologia , Centros Médicos Acadêmicos , Adolescente , Distribuição por Idade , Criança , Pré-Escolar , Feminino , Fluoroscopia/efeitos adversos , Seguimentos , Humanos , Incidência , Lactente , Curva de Aprendizado , Masculino , Pielonefrite/etiologia , Pielonefrite/prevenção & controle , Exposição à Radiação/prevenção & controle , Radiografia , Medição de Risco , Distribuição por Sexo , Estados Unidos , Micção/fisiologia , Urodinâmica/fisiologia , Refluxo Vesicoureteral/terapia
16.
Radiol Med ; 124(9): 812-818, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31087214

RESUMO

PURPOSE: We performed this prospective cohort study to compare the accuracy and technical characteristics of ultra-low-dose CT cystography with those of conventional retrograde cystography. MATERIALS AND METHODS: A cohort of 31 patients referred for cystography after bladder repair were enrolled. To detect urine leakage, we initially performed conventional cystography after retrograde distention of the bladder with dilute iodinated contrast material, followed by ultra-low-dose CT cystography. The diagnostic accuracy of these two modalities was compared, and the technical characteristics of ultra-low-dose CT cystography were examined. RESULTS: All 31 referred patients were included in this study. Of the 31 patients, 27 (87.1%) underwent bladder repair after radical prostatectomy, 3 (9.7%) after radical cystectomy, and 1 (3.2%) after bladder diverticulectomy. Four of the 31 patients were diagnosed with urine leakage by conventional cystography. These four patients were confirmed to have urine leakage by ultra-low-dose CT cystography. Another five patients who did not have urine leakage according to conventional cystography were diagnosed with urine leakage by ultra-low-dose CT cystography. Moreover, performing ultra-low-dose CT cystography enabled us to identify the precise location and amount of urine leakage in all nine patients. Based on these findings, we were able to establish a proper treatment plan. CONCLUSIONS: Ultra-low-dose CT cystography is an accurate method for evaluating urine leakage after bladder repair, and this technique may help determine the most appropriate treatment strategy for patients with urine leakage after bladder repair.


Assuntos
Fístula Anastomótica/diagnóstico por imagem , Cistectomia , Cistografia/métodos , Tomografia Computadorizada por Raios X/métodos , Uretra/diagnóstico por imagem , Uretra/cirurgia , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/cirurgia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doses de Radiação , Urina
19.
Int J Urol ; 26(4): 440-445, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30762254

RESUMO

Vesicoureteral reflux, retrograde flow of urine from the bladder into the upper urinary tract, is one of the most common urological diagnoses in the pediatric population. Diagnosis and subsequent management of urinary reflux have become increasingly debated in the past decade, with divergent opinions over which patients should be evaluated for reflux, and when detected, which children should receive intervention. Although some argue that vesicoureteral reflux is a "phenotype" that often resolves without intervention, others contest that untreated reflux has the potential to cause irreversible renal damage over time. Voiding cystourethrogram images the urethra and bladder during both bladder filling and emptying, as well as the ureters and kidneys when reflux is present, and is considered the gold standard for diagnosing vesicoureteral reflux. Once detected, therapeutic options for urinary reflux are diverse, ranging from observation with or without low-dose antibiotic prophylaxis to a variety of operative interventions. Management should be based on a multitude of factors including patient age, risk of subsequent urinary tract infections, risk of renal parenchymal injury, a given child's projected clinical course and parental preference. Over the past two decades, investigators have elucidated many crucial voiding cystourethrogram findings in addition to grade that provide significant prognostic information and are useful in determining the best course of action for a child on a more individualized basis.


Assuntos
Cistografia/tendências , Guias de Prática Clínica como Assunto , Infecções Urinárias/prevenção & controle , Micção/fisiologia , Refluxo Vesicoureteral/diagnóstico , Fatores Etários , Criança , Cistografia/métodos , Cistografia/normas , Humanos , Seleção de Pacientes , Prognóstico , Ureter/diagnóstico por imagem , Ureter/fisiopatologia , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/fisiopatologia , Infecções Urinárias/etiologia , Refluxo Vesicoureteral/complicações , Refluxo Vesicoureteral/fisiopatologia , Refluxo Vesicoureteral/terapia
20.
Urology ; 126: 180-186, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30735743

RESUMO

OBJECTIVE: To evaluate rates of guideline adherence and associations with voiding cystourethrogram result. The American Academy of Pediatrics guidelines recommend voiding cystourethrogram after abnormal renal ultrasound or 2 febrile urinary tract infections. It is unclear whether guideline adherence increases vesicoureteral reflux detection. Additionally, guidelines targeting children 2-24 months are often applied to other ages. METHODS: Children undergoing voiding cystourethrogram from January 2012 to December 2013 at 1 institution were retrospectively reviewed. Children with known genitourinary abnormalities were excluded. The primary outcome was guideline adherence. Univariate and multivariate analyses were performed. Subgroup analysis of children 2-24 months was completed. RESULTS: Voiding cystourethrograms from 365 children were included in the primary analysis, including 187 (51.2%) aged 2-24 months. Overall, 60.3% of voiding cystourethrograms were ordered in accordance with the guidelines. Urologists/nephrologists were more likely to adhere to ordering guidelines than pediatricians/others (76.4% vs 51.7%, odds ratio 3.0 [1.9-4.9], P <.001). Subgroup analysis in children 2-24 months revealed similar findings (76.4% vs 51.5%, odds ratio 3.0 [1.5-6.2], P = .002). Voiding cystourethrograms were abnormal in 31.8% overall and 26.2% aged 2-24 months. Guideline adherence was associated with increased likelihood of abnormal voiding cystourethrogram among all children (P = .02), but not among children 2-24 months (P = .95). Older age, white race, and guideline adherence remained significantly associated with abnormal voiding cystourethrogram in a multiple logistic regression model. CONCLUSIONS: Guideline adherence was more likely among urologists/nephrologists than pediatricians/others and was not associated with abnormal voiding cystourethrogram among children 2-24 months. Multicenter evaluation is necessary to determine if ordering recommendations should be revised.


Assuntos
Cistografia/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Pediatria , Padrões de Prática Médica , Infecções Urinárias/diagnóstico por imagem , Urologia , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Cistografia/métodos , Feminino , Humanos , Lactente , Masculino , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Estados Unidos , Uretra/diagnóstico por imagem , Micção
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