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Query: UMLS:C0403608 (ureter)
 9,655 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The advantages of nonenhanced helical CT for the diagnosis of ureteral calculi include rapid scan time and patient throughput, safety (no contrast, less radiation), cost-effectiveness, high accuracy, minimal invasiveness, and ability to suggest of alternative diagnoses for flank pain--urologic and otherwise. Size measurement and location in the ureter, the two most important determinants of therapy, are precise with CT. It is particularly good for imaging small or radiolucent calculi, and calculi located at the ureterovesical. Secondary signs of obstruction and the soft-tissue rim sign are additional aids to the routine diagnosis of ureteral calculi. CT numbers indicate the fragility and therefore the likelihood of successful treatment of a calculus. Postprocessing options may help guide management decisions and may help plan interventions. The authors' experience after 30 months of using helical CT exclusively in the work-up of ureteral colic has been extremely favorable. Without hesitation, the authors believe that nonenhanced helical CT is the study of choice for the work-up of ureteral calculi.
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PMID:Helical CT and ureteral colic. 1077 66

Unenhanced helical computerized tomography (UHCT) has recently evolved as an accurate imaging modality for determination of the presence or absence of ureterolithiasis in patients with acute flank pain. Functional renal scintigraphy is considered the gold standard for urinary tract obstruction. The objective of this study was to correlate the secondary signs of urinary obstruction on UHCT with findings of functional renal scintigraphy. UHCT was performed in 30 patients admitted to the emergency room with acute flank pain. All patients had a calcified urinary stone identified on UHCT. The location of each urinary stone was classified as ureteral or in the ureterovesical junction. The presence of secondary CT signs of ureteral obstruction was determined for each patient. After oral or intravenous hydration, a technetium-99m diethylene triamine penta-acetic acid renal scan was performed in all patients within 12 h of the CT scan. Follow-up delayed scintigraphic images were obtained at 2 h and 24 h in patients with evidence of ureteral obstruction. The sensitivity, specificity and predictive values of each possible combination of CT findings were determined by comparison with the scintigraphic results. The distal ureter was the most common location for a calculus on UHCT, followed in frequency by the ureterovesical junction, proximal ureter and mid-ureter. The renograms showed high-grade, unilateral obstruction in 12 patients, indeterminate scans in five patients and normal renograms in 13 patients. The sensitivities and specificities of individual CT findings ranged from 50% to 75% and from 8% to 69%, respectively. Perinephric stranding gave the highest positive predictive value (PPV) for obstruction (69% including indeterminate renograms). None of the individual CT findings showed a statistically significant correlation with scintigraphic findings. A combination of one or two positive CT findings had a PPV of only 25% for obstruction. A combination of three or four positive CT findings gave a PPV of 70% for obstruction. Our preliminary study shows that secondary CT signs of ureterolithiasis correlate poorly with the scintigraphic findings and that they do not permit evaluation of the functional status of obstructed kidneys. Even a combination of the most frequent CT findings has a low predictive value, i.e. does not allow a decision to be made as to the most suitable treatment. Therefore, renal scintigraphy should be performed in conjunction with UHCT in all patients with ureteral calculi.
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PMID:The role of renal scintigraphy and unenhanced helical computerized tomography in patients with ureterolithiasis. 1080 18

We report a case of appendiceal abscess complicated with right hydronephrosis in a 67-year-old woman. She visited our department complaining of right flank pain. Intravenous pyelography (IVP) showed hydronephrosis and hydroureter on right and a narrow ureter at the pelvic brim. A pelvic computed tomographic scan revealed a low density area measuring 44 x 37 mm in size, anterior to the right ureter, which was thought to be a pelvic tumor. Further examination did not reveal the origin of the tumor. An exploratory laparotomy was performed. The tumor developed from the cecum and adhered to the right ureter. The appendix was not found. The tumor was resected with the cecum while the ureter was preserved. Histological investigations revealed an appendiceal abscess. The postoperative course was uneventful. IVP after the operation showed the hydronephrosis to have resolved.
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PMID:[Hydronephrosis as a complication of the appendiceal abscess: report of a case]. 1080 76

Extraosseous Ewing's sarcoma/primitive neuroectodermal tumor (ES/PNET) is a rare soft tissue tumor of childhood usually found in the extremities. The authors present the case of a 17-year-old girl who presented with right flank pain and hematuria and during operation was found to have a right ureteral mass. The histopathologic, immunohistochemical, ultrastructural, and cytogenetic characteristics of the excised mass were consistent with extraosseous ES/PNET. This is the first known reported case of extraosseous ES/ PNET of the ureter. The pathologic features and clinical management of this case, as well as a review of the literature, are presented.
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PMID:Ewing's sarcoma/primitive neuroectodermal tumor of the ureter: a case report and review of the literature. 1099 98

In the past decade alternatives to urography have been proposed for the study of patients with renal colic. In 1992 it was suggested to replace urography with KUB and ultrasonography. In 1993 the combination of KUB and ultrasonography followed by urography in unresolved cases was proposed and, in 1995, it was suggested to replace urography with unenhanced helical CT (UHCT). This article illustrates the contribution of UHCT to the study of patients with renal colic and analyses advantages and shortcomings of the technique compared with other diagnostic approaches. Diagnostics of the patient with renal colic is based on the detection of direct and indirect signs which allow identification of not only the calculus, with a sensitivity of 94-100% and accuracy of 93-98% according different authors, but also other signs that can serve to guide patient management and evaluate long-term prognosis. Unenhanced helical CT has the capability to detect extraurinary abnormalities which present with flank pain and mimic renal colic. The examination technique affects the quality of the images and therefore diagnostic accuracy as well as the dose to the patient. With regard to setting parameters, the choice of thickness and table feed should be guided by numerous factors. Multiplanar reconstruction is indicated in the study of the entire ureter course to identify the exact site of the calcification for the urologist to perform an evaluation similar to that obtained by urography. Many authors consider UHCT to be a valuable tool for suggesting the best therapeutic approach. Among these there are also urologists. The evaluation is based on the stone detection, its size and level in the urinary tract. Cost analysis shows that the cost of UHCT is equal to or inferior to the cost of urography. With regard to the dose, different data are reported in the literature. A high pitch (more than 1.5) and a thin collimation (3-mm thickness) are good compromise between quality and dose which can be compared to the dose of normal urography. What is to be done if helical CT is not available? If helical CT is not available, plain film plus ultrasonography should be considered. This approach does not solve all the cases; in unresolved cases urography is indicated. It should also be noted that US has a good sensitivity in detecting other conditions such as biliary lithiasis, acute pancreatitis, acute appendicitis and abdomino-pelvic masses which are responsible for pain that mimics renal colic. In conclusion, IVU should not have any more the priority in investigating the patients with renal colic. Helical CT should be the first choice in imaging a patient with renal colic. If this technique is not available, plain film and ultrasonography should be considered adding urography in unresolved cases.
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PMID:Present-day imaging of patients with renal colic. 1186 8

A 48-year-old female was found to have right flank pain at another hospital and transabdominal ultrasonography showed right hydronephrosis. She was referred to our department for further examination. She had undergone right oophorectomy and total hysterectomy 3 years before. Intravenous pyelography showed right hydronephrosis and retrograde pyelography revealed ureteral stenosis at the lower portion of the right ureter. Endometriosis had developed at the site of previous surgery on the appendix. A mass was formed in an extensive area including the endometriotic lesion, due to adhesion following previous surgery or other reasons, and extended to the retroperitoneum, thereby inducing right ureteral stenosis. The postoperative course was uneventful. The pathological diagnosis was endometriosis of the residual appendix.
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PMID:[Right ureteral stenosis due to endometriosis occurring in the residual appendix: report of a case]. 1121 9

Pyeloureteritis cystica, characterized by multiple bubbly filling defects on urography and caused by inflammatory stimuli, is a rare disorder of the ureter. It commonly affects older people. Diagnosis is established by radiological studies. Antibiotics should be given if urinary tract infection is present. Up to now, no other specific treatment can be used to cure this disorder. We report a case of pyeloureteritis cystica associated with urinary tract infection and a ureteral stone in a young woman who presented with hematuria and bilateral flank pain. The pyeloureteritis cystica had a bead-like appearance on intravenous pyelogram and retrograde pyelogram as well as in magnetic resonance urography. The diagnosis and treatment of this disorder are discussed. Magnetic resonance urography can provide high-resolution of coronal images of the entire urinary tract without the use of contrast agents or ionizing radiation. However, the cost of the procedure is a major concern.
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PMID:Pyeloureteritis cystica: case report. 1129 79

Two cases of retrocaval ureter are reported that were successfully treated by a laparoscopic approach. Case 1 was a 20-year-old woman who presented with symptoms of a right ureter stone. Case 2 was a 23-year-old woman who had suffered from recurrent right flank pain with gross hematuria. A transperitoneal approach was used for case 1, and a retroperitoneal approach was used in case 2. Both were successfully treated with laparoscopic ureteroureterostomy using an intracorporeal suture technique. Laparoscopic surgery should be the first choice for retrocaval ureter not only because of the minimal invasiveness but also because of the cosmetic advantage compared to conventional open surgery. Further technical and instrumental advances are essential for intracorporeal suturing.
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PMID:Laparsocopic ureteroureterostomy for retrocaval ureter. 1134 57

Inverted papilloma of the upper urinary tract is a rare lesion and the differential diagnosis with transitional cell carcinoma is really hard. A case of 49 year-old male with recurrent right flank pain is reported. Excretory urogram suggested a filling defect involving the right mid ureter and bilateral retrograde pyelogram that confirmed a solitary filling defect in the right mid-ureter, while selective urinary cytology was positive for transitional cell carcinoma G1. Conservative therapy was carried out and 2 years follow-up with several excretory urograms and ultrasound studies revealed no recurrence.
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PMID:[Unusual case of inverted papilloma in a fibro-epithelial polyp of the ureter]. 1134 17

We report a case of primary small cell carcinoma of the ureter with squamous cell and transitional cell carcinomatous components associated with ureteral stone, which is unique in that the patient has remained free of tumor recurrence for 36 months after the surgery without adjuvant chemotherapy or radiotherapy. A 60-yr-old man presented himself with a right flank pain. Computed tomography revealed an ill-defined mass and a stone in the lower one third of the right ureter, and hydronephroureterosis above the stone-impacted site. The patient underwent right nephroureterectomy and stone removal. Upon gross examination, a 3.8 x 1.8 x 1.2 cm white and partly yellow mass was noted in the anterior part of the ureter, resulting in indentation of the ureteral lumen on the posterior side. Light microscopic examination revealed that the mass was mainly composed of small cell carcinoma, and partly squamous cell and transitional cell carcinomatous components. The overlying ureteral mucosa and renal pelvis also contained multifocal dysplastic transitional epithelium and transitional cell carcinoma in situ. There was no vascular invasion, and the surgical margins were free of tumor. The small cell carcinomatous component was positive for chromogranin, neuron specific enolase, synaptophysin, and pancytokeratin but negative for high molecular-weight cytokeratin (K-903) by immunohistochemistry.
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PMID:Small cell carcinoma of the ureter with squamous cell and transitional cell carcinomatous components associated with ureteral stone. 1174 66


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