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1.
Br J Radiol ; 94(1120): 20201291, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33571034

RESUMO

OBJECTIVES: To compare the image quality of low-dose CT urography (LD-CTU) using deep learning image reconstruction (DLIR) with conventional CTU (C-CTU) using adaptive statistical iterative reconstruction (ASIR-V). METHODS: This was a prospective, single-institutional study using the excretory phase CTU images for analysis. Patients were assigned to the LD-DLIR group (100kV and automatic mA modulation for noise index (NI) of 23) and C-ASIR-V group (100kV and NI of 10) according to the scan protocols in the excretory phase. Two radiologists independently assessed the overall image quality, artifacts, noise and sharpness of urinary tracts. Additionally, the mean CT attenuation, signal-to-noise ratio (SNR) and contrast-to-noise (CNR) in the urinary tracts were evaluated. RESULTS: 26 patients each were included in the LD-DLIR group (10 males and 16 females; mean age: 57.23 years, range: 33-76 years) and C-ASIR-V group (14 males and 12 females; mean age: 60 years, range: 33-77 years). LD-DLIR group used a significantly lower effective radiation dose compared with the C-ASIR-V group (2.01 ± 0.44 mSv vs 6.9 ± 1.46 mSv, p < 0.001). LD-DLIR group showed good overall image quality with average score >4 and was similar to that of the C-ASIR-V group. Both groups had adequate and similar attenuation value, SNR and CNR in most segments of urinary tracts. CONCLUSION: It is feasibility to provide comparable image quality while reducing 71% radiation dose in low-dose CTU with a deep learning image reconstruction algorithm compared to the conventional CTU with ASIR-V. ADVANCES IN KNOWLEDGE: (1) CT urography with deep learning reconstruction algorithm can reduce the radiation dose by 71% while still maintaining image quality.


Assuntos
Aprendizado Profundo , Interpretação de Imagem Assistida por Computador/métodos , Doses de Radiação , Tomografia Computadorizada por Raios X/métodos , Urografia/métodos , Doenças Urológicas/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema Urinário/diagnóstico por imagem
3.
Ann Vasc Surg ; 68: 570.e5-570.e8, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32339681

RESUMO

Pseudoaneurysm of the uterine artery is a rare condition, which usually occurs after a traumatic birth, cesarean section, dilatation and curettage, and hysterectomy. This case is a 28-year-old female patient that presented with the chief complaint of severe urinary tract bleeding and hypovolemic shock. This patient underwent cesarean section 2 months before the first presentation. After the primary examination, the patient was sent to the hybrid operation room with the primary diagnosis of uterine artery pseudoaneurysm and coil embolization was done for treating the pseudoaneurysm. Considering continued bleeding, open surgery was performed and the internal iliac artery was ligated.


Assuntos
Falso Aneurisma/etiologia , Aneurisma Roto/etiologia , Cesárea/efeitos adversos , Hemorragia/etiologia , Doenças Urológicas/etiologia , Artéria Uterina , Adulto , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/terapia , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/terapia , Embolização Terapêutica , Feminino , Hemorragia/diagnóstico por imagem , Hemorragia/terapia , Humanos , Gravidez , Choque/etiologia , Resultado do Tratamento , Doenças Urológicas/diagnóstico por imagem , Doenças Urológicas/terapia , Artéria Uterina/diagnóstico por imagem
4.
Prog Urol ; 30(3): 155-161, 2020 Mar.
Artigo em Francês | MEDLINE | ID: mdl-32122748

RESUMO

INTRODUCTION: Urinary complications after kidney transplantation are common and can compromise renal function. While they are mainly attributed to ischemic lesions of the ureter, there is no existing method to evaluate its vascularization during surgery. The aim of the study was to evaluate if indocyanine green, revealed by infra-red light andused to visualize tissue perfusion, could provide an appreciation of the ureter's vascularization during kidney transplantation. METHODS: This feasibility study was conducted over one month, on eleven consecutive kidney transplants. During transplantation, an injection of indocyanine green enabled the surgeon to visualize in real time with an infra-red camera the ureter fluorescence. Its intensity was reported on a qualitative and semi-quantitative scale. Occurrence of urinary complications such as stenosis or ureteral fistula were collected during 6 months. RESULTS: In all of the 11 cases (100%), the last centimeters of the ureters were not fluorescent. Three (27%) ureters were poorly or partiallly fluorescent. Out of these three cases, only one case of urinary fistula occurred, followed by ureteric stenosis. In the series, two fistulas (18%) and two ureteric stenoses (18%) occurred. No side effects were observed. The low number of events did not allow statistical analysis. CONCLUSION: Infra-red fluorescence of indocyanine green could be a simple and innovative way to appreciate the transplant's ureteric vascularization during kidney transplantation. It could help surgeons to identify the level of ureter section and to decide the anastomosis technique, in order to limit urinary complications. LEVEL OF EVIDENCE: 3.


Assuntos
Transplante de Rim , Ureter/diagnóstico por imagem , Fístula Urinária/diagnóstico por imagem , Doenças Urológicas/diagnóstico por imagem , Adulto , Idoso , Estudos de Viabilidade , Feminino , Fluorescência , Corantes Fluorescentes , Humanos , Verde de Indocianina , Masculino , Pessoa de Meia-Idade , Doenças Ureterais/diagnóstico por imagem , Doenças Ureterais/etiologia , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/etiologia , Fístula Urinária/etiologia , Doenças Urológicas/etiologia
5.
Neurourol Urodyn ; 39(2): 715-720, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31846117

RESUMO

AIMS: To evaluate the impact of a protocol for standardized image capture during video urodynamics (VUD) on radiation exposure. Secondly, to categorize radiation exposure by condition warranting VUD and to identify clinical variables that correlate with increased radiation exposure. METHODS: One hundred fifty patients underwent VUD using our standardized protocol. All images were taken using low dose and pulsed settings. Four images are captured: one scout image, one filling image, one voiding image, and one post-void image. If the patient is unable to void with the catheter in place, the catheter is removed and a second image is taken during an attempt at unintubated flow. If vesicoureteral reflux (VUR) is identified, an alternate protocol is entered to document parameters. The mean radiation exposure measured in dose area product (DAP), fluoroscopy time, and number of images were noted and compared with previously published fluoroscopy data collected at our institution before protocol implementation. RESULTS: The mean fluoroscopy exposure after the implementation of our protocol was 273.5 mGy/cm2 taking 5.2 images in 4.5 seconds. Protocol implementation leads to a 51.2% reduction in radiation exposure calculated by mean DAP (P < .0001) and a 96.5% reduction in fluoroscopy time (P < .0001). The presence of VUR, fluoroscopy time, and body mass index (BMI) > 25 were associated with higher radiation exposure (P < .0001). CONCLUSION: Implementation and adherence to a standardized protocol for fluoroscopy led to a reduction in radiation exposure fluoroscopy time. The presence of VUR, fluoroscopy time, and BMI > 25 were associated with higher radiation exposure.


Assuntos
Exame Físico/efeitos adversos , Doses de Radiação , Exposição à Radiação , Urodinâmica , Doenças Urológicas/diagnóstico por imagem , Idoso , Índice de Massa Corporal , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Cateterismo Urinário , Refluxo Vesicoureteral
6.
Clin Radiol ; 75(1): 78.e17-78.e24, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31590913

RESUMO

AIM: To examine the improvement in the visualisation of bladder and ureteric pathologies next to a hip prosthesis with metallic artefact reduction for orthopaedic implants (O-MAR). MATERIALS AND METHODS: Thirty-four patients who underwent pelvic computed tomography (CT) for non-prosthesis-related causes were enrolled retrospectively. Portal venous phase scans were reconstructed both with standard iterative reconstruction (ITR) and with O-MAR. The density of the ureters and the bladder was measured at both sides in the plane of the prosthesis. A semi-quantitative score was also used to assess visibility. The R (version 3.4.1) package was used for statistical analysis. RESULTS: The average (µ) density of the 41 prosthesis side ureters was significantly lower on ITR images (µ=-94.76±150.48 [±SD] HU) than on O-MAR images (µ=-13.40±36.37 HU; p<0.0004). The difference between the ITR and O-MAR (µ=-138.62±182.64 versus -35.55±40.21 HU; p<0.0003) was also significant at the prosthesis side of the bladder. The visibility of the prosthesis side ureters was improved: 53.7% was obscured on ITR series compared to 4.9% on O-MAR. The visibility score was also better across all levels (p<0.001) with O-MAR. In four cases (13%), the O-MAR images significantly changed the diagnosis: in two cases ureteric stones, in one case each a bladder stone and a bladder tumour were discovered. CONCLUSIONS: O-MAR reconstruction of CT images significantly improves the visibility of the urinary tract adjacent to metallic hip implants. Thus, O-MAR is essential for detecting ureteric and bladder pathologies in patients with a hip prosthesis.


Assuntos
Algoritmos , Artefatos , Prótese de Quadril , Tomografia Computadorizada por Raios X , Doenças Urológicas/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Metais , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Estudos Retrospectivos
7.
Vet Clin North Am Exot Anim Pract ; 23(1): 131-149, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31759444

RESUMO

Reptiles can develop various diseases of the urinary tract, including, but not exclusively, urolithiasis, gout, acute and chronic kidney injury, and secondary renal hyperparathyroidism. Diagnostic imaging is instrumental in differentiating and diagnosing these ailments. This article describes the current diagnostic imaging approaches used in reptile medicine for evaluation of urinary tract disease. The use of radiographs, ultrasonography, computed tomography, MRI, and endoscopy is discussed and compared for the evaluation of urinary tract disease in reptiles.


Assuntos
Répteis , Doenças Urológicas/veterinária , Animais , Endoscopia/veterinária , Imagem por Ressonância Magnética/veterinária , Tomografia Computadorizada por Raios X/veterinária , Ultrassonografia/veterinária , Doenças Urológicas/diagnóstico por imagem
8.
Radiat Prot Dosimetry ; 186(2-3): 391-396, 2019 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-31832648

RESUMO

The pilot dose survey on paediatric general radiography, fluoroscopy and CT procedures was performed in four university hospitals. The analysis of data was focused on the radiography and CT imaging of head, chest, abdomen, pelvis and spine and fluoroscopic procedures of gastrointestinal and urinary tracts. The survey was conducted by the National Radiation Protection Institute. Two hospitals exported data from the patient dose management system, while the others collected the data manually. The methodology of diagnostic reference levels assessment was proposed and tested. Local diagnostic reference levels were calculated in terms of air kerma-area product $P_{KA}$, CT air kerma-length product $P_{KL,CT}$ and volumetric CT air kerma index $C_{VOL}$. The lack of procedure standardisation, e.g. in tube voltage setting irrespective of patient's weight, was revealed at one hospital. Dose and exposure parameters distributions with respect to patient's anatomical constitution are presented in this article. In future, this pilot study will be a base for national survey of paediatric diagnostic reference levels.


Assuntos
Fluoroscopia/métodos , Gastroenteropatias/diagnóstico por imagem , Órgãos em Risco/efeitos da radiação , Exposição à Radiação/análise , Radiografia Intervencionista/métodos , Tomografia Computadorizada por Raios X/métodos , Doenças Urológicas/diagnóstico por imagem , Criança , República Tcheca , Humanos , Processamento de Imagem Assistida por Computador/métodos , Projetos Piloto , Doses de Radiação , Proteção Radiológica
9.
J Xray Sci Technol ; 27(6): 995-1006, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31594279

RESUMO

BACKGROUND: Optical coherence tomography (OCT) is a non-invasive diagnosing tool used in clinics. Due to its high resolution (<10um), it is appropriate for the early detection of tiny infections. It has been widely used in diagnosis and treatment of diseases, evaluation of therapeutic efficacy, and monitoring of various physiological and pathological processes. OBJECTIVE: To systemically review literature to summarize the clinic application of OCT in recent years. METHODS: For clinic applications that OCT has been applied, we selected studies that describe the most relevant works. The discussion included: 1) which tissue could be used in the OCT detection, 2) which character of different tissue could be used as diagnosing criteria, 3) which diseases and pathological process have been diagnosed or monitored using OCT imaging, and 4) the recent development of clinic OCT diagnosing. RESULTS: The literature showed that the OCT had been listed as a routine test choice for ophthalmic diseases, while the first commercial product for cardiovascular OCT detection had gotten clearance. Meanwhile, as the development of commercial benchtop OCT equipment and tiny fiber probe, the commercial application of OCT in dermatology, dentistry, gastroenterology and urology also had great potential in the near future. CONCLUSIONS: The analysis and discussions showed that OCT, as an optical diagnosing method, has been used successfully in many clinical fields, and has the potential to be a standard inspection method in several clinic fields, such as dermatology, dentistry and cardiovascular.


Assuntos
Tomografia de Coerência Óptica , Doenças Cardiovasculares/diagnóstico por imagem , Oftalmopatias/diagnóstico por imagem , Gastroenteropatias/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador , Dermatopatias/diagnóstico por imagem , Tomografia de Coerência Óptica/instrumentação , Tomografia de Coerência Óptica/métodos , Doenças Dentárias/diagnóstico por imagem , Doenças Urológicas/diagnóstico por imagem
10.
Emerg Med Clin North Am ; 37(4): 785-809, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31563208

RESUMO

Emergency physicians rely on a multitude of different imaging modalities in the diagnosis of genitourinary emergencies. There are many considerations to be taken into account when deciding which imaging modality should be used first, as oftentimes several diagnostic tools can be used for the same pathologic condition. These factors include radiation exposure, sensitivity, specificity, age of patient, availability of resources, cost, and timeliness of completion. In this review, the strengths and weaknesses of different imaging tools in the evaluation of genitourinary emergencies are discussed.


Assuntos
Serviço Hospitalar de Emergência , Doenças dos Genitais Femininos/diagnóstico por imagem , Doenças dos Genitais Masculinos/diagnóstico por imagem , Doenças Urológicas/diagnóstico por imagem , Emergências , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Radiografia , Tomografia Computadorizada por Raios X , Ultrassonografia
12.
Urologiia ; (4 ()): 25-27, 2019 Sep.
Artigo em Russo | MEDLINE | ID: mdl-31535794

RESUMO

Imaging studies play a crucial role in the diagnosis of urologic diseases. X-ray and ultrasound studies are used as first-line diagnostic methods. Computed tomography and magnetic resonance imaging (MD-CT and MRI), radionuclide and hybrid methods allow to clarify diagnosis. Currently, the trend "from simple to complex" contributes to obtaining maximum information in the shortest possible time with a minimum cost.


Assuntos
Técnicas de Diagnóstico Urológico/tendências , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X , Doenças Urológicas/diagnóstico por imagem , Urologia/tendências , Alemanha , Humanos , Imagem por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/tendências , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/tendências , Ultrassonografia/métodos , Ultrassonografia/tendências , Urografia
13.
Abdom Radiol (NY) ; 44(12): 3786-3799, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31317210

RESUMO

PURPOSE: Computed tomography urography (CTU) has emerged as the modality of choice for imaging the urinary tract within the past few decades. It is a powerful tool that enables detailed anatomic evaluation of the urinary tract in order to identify primary urothelial malignancies, benign urinary tract conditions, and associated abdominopelvic pathologies. As such, there have been extensive efforts to optimize CTU protocol. METHODS: This article reviews the published literature on CTU protocol optimization, including contrast bolus timing, dose reduction, reconstruction algorithms, and ancillary practices. CONCLUSION: There have been many advances in CTU techniques, which allow for imaging diagnosis of a wide spectrum of diseases while minimizing radiation dose and maximizing urinary tract distension and opacification.


Assuntos
Tomografia Computadorizada por Raios X/normas , Urografia/métodos , Doenças Urológicas/diagnóstico por imagem , Meios de Contraste , Humanos , Interpretação de Imagem Radiográfica Assistida por Computador
14.
Abdom Radiol (NY) ; 44(12): 3919-3934, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31214728

RESUMO

PURPOSE: The aim of this pictorial essay is to demonstrate several cases where the diagnosis would have been difficult or impossible without the excretory phase image of CT urography. METHODS: A brief discussion of CT urography technique and dose reduction is followed by several cases illustrating the utility of CT urography. RESULTS: CT urography has become the primary imaging modality for evaluation of hematuria, as well as in the staging and surveillance of urinary tract malignancies. CT urography includes a non-contrast phase and contrast-enhanced nephrographic and excretory (delayed) phases. While the three phases add to the diagnostic ability of CT urography, it also adds potential patient radiation dose. Several techniques including automatic exposure control, iterative reconstruction algorithms, higher noise tolerance, and split-bolus have been successfully used to mitigate dose. The excretory phase is timed such that the excreted contrast opacifies the urinary collecting system and allows for greater detection of filling defects or other abnormalities. Sixteen cases illustrating the utility of excretory phase imaging are reviewed. CONCLUSIONS: Excretory phase imaging of CT urography can be an essential tool for detecting and appropriately characterizing urinary tract malignancies, renal papillary and medullary abnormalities, CT radiolucent stones, congenital abnormalities, certain chronic inflammatory conditions, and perinephric collections.


Assuntos
Tomografia Computadorizada por Raios X/métodos , Urografia/métodos , Doenças Urológicas/diagnóstico por imagem , Algoritmos , Meios de Contraste , Diagnóstico Diferencial , Humanos , Doses de Radiação , Interpretação de Imagem Radiográfica Assistida por Computador
15.
PLoS One ; 14(6): e0217610, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31220089

RESUMO

Pain is a highly complex and individualized experience with biopsychosocial components. Neuroimaging research has shown evidence of the involvement of the central nervous system in the development and maintenance of chronic pain conditions, including urological chronic pelvic pain syndrome (UCPPS). Furthermore, a history of early adverse life events (EALs) has been shown to adversely impact symptoms throughout childhood and into adulthood. However, to date, the role of EAL's in the central processes of chronic pain have not been adequately investigated. We studied 85 patients (56 females) with UCPPS along with 86 healthy controls (HCs) who had resting-state magnetic resonance imaging scans (59 females), and data on EALs as a part of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network Study. We used graph theory methods in order to investigate the impact of EALs on measures of centrality, which characterize information flow, communication, influence, and integration in a priori selected regions of interest. Patients with UCPPS exhibited lower centrality in the right anterior insula compared to HCs, a key node in the salience network. Males with UCPPS exhibited lower centrality in the right anterior insula compared the HC males. Females with UCPPS exhibited greater centrality in the right caudate nucleus and left angular gyrus compared to HC females. Males with UCPPS exhibited lower centrality in the left posterior cingulate, angular gyrus, middle temporal gyrus, and superior temporal sulcus, but greater centrality in the precuneus and anterior mid-cingulate cortex (aMCC) compared to females with UCPPS. Higher reports of EALs was associated with greater centrality in the left precuneus and left aMCC in females with UCPPS. This study provides evidence for disease and sex-related alterations in the default mode, salience, and basal ganglia networks in patients with UCPPS, which are moderated by EALs, and associated with clinical symptoms and quality of life (QoL).


Assuntos
Dor Crônica/fisiopatologia , Dor Pélvica/fisiopatologia , Estresse Fisiológico , Doenças Urológicas/fisiopatologia , Adulto , Encéfalo/diagnóstico por imagem , Criança , Dor Crônica/complicações , Dor Crônica/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Dor Pélvica/complicações , Dor Pélvica/diagnóstico por imagem , Qualidade de Vida , Índice de Gravidade de Doença , Síndrome , Doenças Urológicas/complicações , Doenças Urológicas/diagnóstico por imagem
16.
J Pediatr Urol ; 15(4): 341.e1-341.e6, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31164273

RESUMO

BACKGROUND: There are limited data on the predictive value of the consensus urinary tract dilation (UTD) score with respect to subsequent clinical diagnoses. We sought to define the relationship between postnatal UTD risk score and clinical outcomes during childhood. METHODS: Complete ultrasound image sets from a random selection of infants aged 0-90 days undergoing initial ultrasound at a single institution for prenatal hydronephrosis between 2012 and 2014 were assigned a UTD score by 1 pediatric urologist and 1 pediatric radiologist. Urinary tract dilation risk score was analyzed for association with a composite outcome comprising urinary tract infection, vesicoureteral reflux (VUR), ureteropelvic junction obstruction, non-refluxing megaureter (NRM), ureterocele, bladder outlet obstruction (BOO), and chronic kidney disease. Surgical intervention and resolution of UTD were evaluated separately. Descriptive and survival analyses were performed. RESULTS: Urinary tract dilation scores for 494 subjects were P0 in 23.5%, P1 in 26.5%, P2 in 23.5%, and P3 in 26.5%. Seventy-four percent were male. Median age at initial imaging was 28 days; median follow-up was 19.8 months. The composite outcome occurred in 138 of 494 patients (27.9%) and varied significantly (p < 0.001) by UTD score: 11.2% for P0, 10.7% for P1, 29.3% for P2, and 58.8% for P3. On survival analysis (Summary Figure), higher UTD grade was significantly associated with the composite outcome (hazard ratio for P3 vs. P0 was 7.4 [95% CI: 3.44-15.92, p < 0.001]). Urinary tract infection and VUR diagnosis varied by UTD score (p = 0.03 and p < 0.001, respectively). Ureteropelvic junction obstruction was diagnosed (based on MAG3 results) in 6.3% of patients, 84% of whom were P3. Non-refluxing megaureter was diagnosed in 7.7%. Ureterocele and BOO were uncommon (1.4%, and 0.6%, respectively). Surgical intervention was also associated with UTD risk, with 46% of P3 undergoing surgery vs. 1% of P0, 1% of P1, and 6% of P2 (p < 0.001). Resolution of UTD occurred in 41% (median 10.1 months) and varied significantly by UTD risk (p < 0.001). DISCUSSION: Urinary tract dilation risk score is associated with clinical events, although ascertainment bias may influence some of the differences in outcomes, particularly for VUR, because VCUG utilization varied by the UTD group. The lack of any significant difference in outcomes between patients with UTD P0 versus P1 suggests that the P1 category could be eliminated as it does not meaningfully distinguish between outcome risk. CONCLUSIONS: Higher UTD risk scores are strongly associated with genitourinary diagnoses during the first two years of life.


Assuntos
Dilatação Patológica/epidemiologia , Hidronefrose/diagnóstico por imagem , Diagnóstico Pré-Natal , Ultrassonografia Doppler , Doenças Urológicas/epidemiologia , Fatores Etários , Estudos de Coortes , Dilatação Patológica/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Hidronefrose/patologia , Incidência , Recém-Nascido , Masculino , Cuidado Pós-Natal , Gravidez , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Doenças Urológicas/diagnóstico por imagem , Doenças Urológicas/fisiopatologia
17.
Abdom Radiol (NY) ; 44(12): 3800-3810, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31154484

RESUMO

Magnetic resonance imaging of the upper tract (pyelocalyces and ureters) or MR Urography (MRU) is technically possible and when performed correctly offers similar visualization of the upper tracts and for detection of non-calculous diseases of the collecting system similar specificity but with lower sensitivity compared to CTU. MRU provides the ability to simultaneously image the kidneys and urinary bladder with improved soft tissue resolution, better tissue characterization and when combined with assessment of the upper tract, a comprehensive examination of the urinary system. MRU requires meticulous attention to technical details and is a longer more demanding examination compared to CTU. Advances in MR imaging techniques including: parallel imaging, free-breathing motion compensation techniques and compressed sensing can dramatically shorten examination times and improve image quality and patient tolerance for the exam. This review article discusses updates in the MRU technique, summarizes clinical indications and opportunities for MRU in clinical practice and reviews advantages and disadvantages of MRU compared to CTU.


Assuntos
Imagem por Ressonância Magnética/métodos , Doenças Urológicas/diagnóstico por imagem , Humanos , Aumento da Imagem/métodos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X
19.
Ultrasound Obstet Gynecol ; 54(4): 500-505, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30977189

RESUMO

OBJECTIVE: Congenital lower urinary tract obstruction (LUTO) is a rare condition with high perinatal mortality and morbidity when associated with severe oligohydramnios or anhydramnios in the second trimester of pregnancy. Severe pulmonary hypoplasia and end-stage renal disease are the underlying causes of poor neonatal outcome in these cases. However, little is known about the subset of fetal LUTO that is associated with a normal volume of amniotic fluid at midgestation. The objective of the current study was to describe the natural history, underlying causes, survival and postnatal renal function outcomes in pregnancies with fetal LUTO and normal amniotic fluid volume during the second trimester of pregnancy. METHODS: This was a retrospective study of all pregnancies with fetal LUTO and normal amniotic fluid volume in the second trimester that received prenatal and postnatal care at our quaternary care institution between 2013 and 2017. Data on demographic characteristics, fetal interventions, perinatal survival, need for neonatal respiratory support, postnatal renal function and need for dialysis at the age of 1 and 24 months were analyzed. RESULTS: Of the 18 fetuses that met the study criteria, 17 (94.4%) survived the perinatal period. Eleven (61.1%) pregnancies developed oligohydramnios in the third trimester, six of which were eligible for and underwent fetal intervention with vesicoamniotic shunt placement, which was performed successfully in all six cases. Two (11.1%) neonates required respiratory support owing to pulmonary hypoplasia. At the age of 2 years, 14 children had follow-up information available, two (14.3%) of whom had normal renal function, eight (57.1%) had developed some degree of chronic kidney disease (Stage 1-4) and four (28.6%) had developed end-stage renal disease (ESRD), including two who had already manifested ESRD in the neonatal period. CONCLUSIONS: Most fetuses diagnosed prenatally with LUTO that is associated with a normal volume of amniotic fluid at midgestation will have a favorable outcome in terms of perinatal survival and few will need long-term respiratory support. However, these children are still at increased risk for chronic renal disease, ESRD and need for renal replacement therapy. Larger multicenter studies are needed to characterize the prenatal factors associated with postnatal renal function, and to investigate the role of fetal intervention in the group of fetuses that present with late-onset oligohydramnios and evidence of preserved fetal renal function. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
Doenças Fetais/diagnóstico por imagem , Obstrução Uretral/diagnóstico por imagem , Doenças Urológicas/diagnóstico por imagem , Adulto , Líquido Amniótico/diagnóstico por imagem , Pré-Escolar , Feminino , Doenças Fetais/patologia , Doenças Fetais/cirurgia , Humanos , Lactente , Recém-Nascido , Oligo-Hidrâmnio/diagnóstico por imagem , Oligo-Hidrâmnio/cirurgia , Mortalidade Perinatal , Gravidez , Segundo Trimestre da Gravidez , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/terapia , Estudos Retrospectivos , Medição de Risco , Ultrassonografia/métodos , Obstrução Uretral/congênito , Obstrução Uretral/mortalidade , Doenças Urológicas/congênito
20.
Int Urol Nephrol ; 51(5): 765-771, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30903392

RESUMO

PURPOSE: With the availability of near-infrared fluorescence (NIRF) imaging using indocyanine green dye (ICG) to the robotic platform, utility of this imaging technology has evolved significantly across the board for ablative and reconstructive procedures. Herein, we describe the potential indications of indocyanine green for both oncologic and non-oncologic applications in robot-assisted laparoscopic urologic surgery. METHODS: A narrative mini-review was performed in November 2018 using PubMed, Scopus, EMBASE, and Web of Science databases utilizing the following search phrase: "indocyanine green fluorescence robotic surgery" resulting in 104 articles of which 30 articles had urologic-pertinent applications. All 30 articles, and the references within, were reviewed and judged for scientific integrity and merit. Articles with non-novel findings or similar conclusions to original papers were omitted. RESULTS: ICG does not have a urologic FDA indication, though it has been used off-label for urologic surgery since 2006. Fluorescence-augmented surgery with ICG can facilitate oncologic surgery in the adrenal gland, kidney, bladder, prostate, and retroperitoneum, in addition to lymph node dissection for various malignant pathologies. ICG-NIRF can enhance non-oncologic surgery including ureterolysis, ureteroureterostomy, ureteral re-implantation, pyeloplasty, and urinary diversion in both the adult and pediatric populations. CONCLUSIONS: Although it is not necessary to utilize fluorescence-enhanced surgery in all cases, the authors find the utilization of ICG-NIRF in complex and highly technical surgeries useful.


Assuntos
Corantes , Verde de Indocianina , Monitorização Intraoperatória/métodos , Procedimentos Cirúrgicos Robóticos , Doenças Urológicas/diagnóstico por imagem , Doenças Urológicas/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Humanos , Imagem Óptica , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias Urológicas/diagnóstico por imagem , Neoplasias Urológicas/cirurgia
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