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Hydrocalyx is an obstructed renal calyx from infundibulo-pelvic diminution or stenosis which leads to dilatation of the calyx. It becomes clinically important when associated with flank pains, haematuria, infection, renal impairment or stone formation. On intravenous urography the finding of a cystic dilatation of a calyx that communicates with the renal pelvis supports the diagnosis. This case is A 50-year-old man with recurrent flank pains who was diagnosed with left hydrocalyx on a Computed Tomography Urography (CT Urography). He opted for conservative management. Management of hydrocalyx can be conservative for patients without significant renal damage or symptoms and surgical with nephron sparing intent for those who have severe symptoms and complications.

Purpose We developed a Postural Drainage Lithotripsy System (PDLS) that uses the patient's computed tomography urography (CTU) data to reconstruct the three-dimensional figure of the renal pelvis, provides an individualized inversion and overturning angle and uses gravity to remove residual fragments (RFs). The purpose of this study was to investigate PDLS in the treatment of renal RFs. Methods A stone with a diameter of 4.0 mm was placed in the upper, middle, and lower calyx of the renal model. A total of 60 trials were applied to 20 renal models. The movement trajectory, passage rate, and postural drainage angle of calculi during the treatment of PDLS were observed. Results All of the stones in 60 trials were observed to move during treatment, and 53/60 (88%) were relocated successfully to the renal pelvis. The passage rate of the upper calyx was 14/20 (70%), that of the middle calyx was 20/20 (100%), and that of the lower calyx was 19/20 (95%). Conclusions PDLS can provide individualized inversion and reversal angles and remove stones from the renal model. More clinical trials are needed to verify the above view and evaluate its efficacy.

Objective – We report a case of late-presenting symptomatic ureterovesical junction obstruction after endoscopic treatment of low grade vesicoureteral reflux. Case report – A two-year old girl, with no other underlying conditions, underwent endoscopic Submucosal Transurethral Injection of one ml dextranomer/hyaluronic acid copolymer for grade three VUR on the right side. She recovered uneventfully and remained asymptomatic for one year, when she presented with right-side flank pain. Renal ultrasound showed hydronephrosis with calyceal dilatation and hydroureter. Ureterovesical junction obstruction caused by the bulking agent was suspected on MR urography. A large 2×2 cm mass was found extravesically, clearly obstructing the ureter. After excision of the mass and reimplantation of the ureter, the hydronephrosis settled. Conclusion – However rare it is, ureterovesical obstruction may develop after endoscopic submucosal transurethral injection of dextranomer/hyaluronic acid copolymer. Long-term postoperative follow up may be necessary.

Introduction Pyelocalyceal diverticulum is a rare disease sometimes difficult to distinguish from cysts. We report a case of urothelial carcinoma originating from a pyelocalyceal diverticulum, difficult to distinguish from cystic renal cell carcinoma preoperatively. Case presentation A 51‐year‐old Japanese man complained of gross hematuria. Computed tomography revealed a solid mass in one of the many cystic lesions in the left kidney. He was diagnosed with left cystic renal cell carcinoma and underwent retroperitoneal laparoscopic nephrectomy. Pathological examination revealed high‐grade invasive urothelial carcinoma arising within the renal pyelocalyceal diverticulum. The definitive diagnosis was high‐grade invasive urothelial carcinoma (pT3). In retrospect, the retrograde pyelography findings indicated the cyst and urinary tract connection. Residual ureterectomy and adjuvant chemotherapy were later performed. The patient has since been recurrence‐free. Conclusion Whether cystic renal cell carcinoma is suspected on imaging, pyelocalyceal diverticulum should be considered a differential diagnosis, though unlikely to be encountered in daily practice.

BACKGROUND: To investigate the significance of simultaneous urography of the upper and lower urinary tract of transplanted kidneys combined with computed tomography urography (CTU), computed tomography arteriography (CTA), and computed tomography venography imaging in the planning of open surgery performed to treat any ureteral complications of a transplanted kidney. METHODS: In all, 24 patients with ureteral complications after renal transplantation were admitted, 12 of whom had renal graft ostomy during open surgery. Simultaneous antegrade urography of the upper urinary tract and retrograde cystography of the transplanted kidneys were performed on the patients. With the use of computed tomography imaging results, surgical planning was carried out. RESULTS: All surgeries were successfully completed according to preoperative planning. Three patients underwent end-to-end anastomosis of the ureter and bladder muscle flap, 8 patients underwent ureterocystostomy, and 1 patient underwent an end-to-end ureteral anastomosis. After the follow-up up to now, all the patients had stable renal function, and no complications such as ureteral stenosis or urine leakage have thus far reoccurred in the transplanted kidneys. CONCLUSIONS: When open surgery is required to treat any ureteral complications following renal transplantation, preoperative multiangle imaging can be used to better understand the condition of the transplanted urinary tract and thus aid considerably in surgical planning.

Background Previous classification of renal pelvicalyceal anatomical structure may be difficult to intuitively understand and unpractical for endourological surgery. We aim to put forward a modified Takazawa anatomical classification of renal pelvicalyceal system based on three-dimensional (3D) virtual reconstruction models for endourological surgery. Methods We retrospectively collected data on 225 patients (320 kidneys) in total between Apr. 2017 and Dec. 2020, spatial anatomical structure of renal pelvis and calyces were modeled and corresponding morphological parameters were measured after 3D virtual reconstruction of computed tomography urography (CTU). The modified Takazawa renal pelvicalyceal anatomical classification was advanced based on the renal pelvicalyceal morphological parameters [bifurcated branches of renal pelvis, cross sectional area of renal pelvis and ureteropelvic junction (UPJ), infundibuloureteral angle (IUA), lower pole infundibular calyceal length (IL)] by 3D virtual reconstruction models, and comparison of renal pelvicalyceal system morphological parameters were performed to evaluate the differences in various classification types of renal pelvis and calyces. Results Anatomical structure of renal pelvis and calyces were divided into two main types (Type A and Type B) according to renal pelvic branch patterns. A single pelvis without bifurcated branch was regarded as Type A (62%) and subclassified into three subtypes: Type A1 (22%), Type A2 (27%) and Type A3 (13%), the slimline pelvis was classified as Type A1, the typical pelvis as Type A2 and the broad pelvis as Type A3. A divided pelvis with bifurcated branches was seen as Type B (38%) and subclassified into two subtypes: Type B1 (15%) with the wide and flat lower calyx branch, Type B2 (23%) with the narrow and steep lower calyx branch. Conclusions Previous studies have reported that the visualization and classification of renal pelvicalyceal anatomical structure by endocast, autopsy, ultrasonography and excretory urography, the modified Takazawa classification system based on 3D virtual reconstruction models enables to standardized different anatomical morphology of renal pelvicalyceal system and provide intuitive and concise information on anatomy, thus leading to the improvement in treatment modality.

Spontaneous rupture of renal pelvis (SRRP) is a rare condition resulting in an extravasation of urine into retroperitoneal space. Due to the uncharacteristic symptoms, often mimicking renal colic, its diagnosis may be complicated. Herein, we report a case of a 73-year-old male with a solitary functioning kidney who presented with malaise and right-sided abdominal pain, rapidly followed by anuria. Laboratory tests showed the signs of AKI. Contrast-enhanced CT performed soon after the admission showed nonspecific abnormalities in the right middle abdomen suspected to be either inflammatory infiltration or surgical scarring. Symptomatic treatment was started, and an acute hemodialysis treatment was commenced. After a temporal improvement, the patient’s general condition worsened significantly, with exacerbated pain and massive increase in plasma creatinine. A second contrast-enhanced CT was performed with an addition of urography phase, revealing the extravasation of the contrast media in the location suggesting the rupture of the renal pelvis. The patient was treated successfully by the placement of a double-J ureteral stent into the ureter. Usually, a clear etiology of SRRP can be determined, that is, urinary tract obstruction, but in this case, we could not find a definite cause. It is important to remember that in the presence of a nonspecific abdominal pain and laboratory signs of AKI, a rare cause like SRRP should be taken into consideration. Performing a contrast CT scan with urography phase can save time in establishing a diagnosis and enable immediate urological intervention.

Background Omentum and bowel loops are commonly seen in inguinal hernia. An unusual case of extraperitoneal herniation of ureter was detected in hernial sac with other contents, on computed tomography (CT) urography. Case presentation A 54-year-old male presented with inguinal hernia, with no previous history of surgery or trauma. Pre-operative screening showed a unilateral hydroureteronephrosis involving the pelvicalyceal system and entire ureter. No calculus was visualized in the ureter on ultrasound. On non-contrast CT (NCCT) followed by CT urography, the ureter was seen descending into the hernia sac causing hydroureteronephrosis. The patient subsequently underwent mesh repair surgery of the inguinal hernia with meticulous reduction of the herniated contents including the ureter, resulting in complete resolution of the hydroureteronephrosis. Conclusion An isolated extraperitoneal inguinal herniation of the ureter without concomitant urinary bladder involvement is extremely rare, especially with no prior history of trauma or surgery, as seen in our case. The case also exemplifies the role of pre-operative imaging as a protocol in cases of inguinal hernia to prevent per-operative complications.

OBJECTIVE To present long-term outcome of Yang-Monti ileal ureter, with a focus on patients with mild/moderate loss of kidney function and solitary kidney. PATIENTS AND METHODS Between March 2001 and December 2019, Yang-Monti ileal ureter was performed on 36 patients with ureteric defects and median age 46.5 years. Of these, 4, 14, 15 and 3 patients had stage 1, stage 2, stage 3a and stage 4a chronic kidney disease, respectively; 6 had solitary kidney. Patients were regularly followed for complications, morphological, and functional outcome. RESULTS Ureteric stricture etiology was iatrogenic (16), Bilharzial (7), tuberculous (4), retroperitoneal fibrosis (5), malignancy (3), and gunshot injury (1). The median (range) ureteric defect length was 11 (8-16) cm. Four grade 1/2 postoperative Clavien-Dindo complications were noted. Median follow-up was 68 months (range 12-215). Intestinal obstruction developed in 1 patient and urinary tract infection in 10. At last follow-up, serum creatinine, split renographic clearance, and estimated glomerular filtration rate showed significant improvement compared to preoperative values, in the whole series, in cases with chronic kidney disease (stages 2, 3a and 3b) and solitary kidney. Four cases with chronic kidney disease (stage 3) showed deterioration of the kidney function parameters. Magnetic resonance urography showed improvement of hydronephrosis in most patients. No metabolic complications were noted. CONCLUSION Yang-Monti Ileal ureter is durable and effective in improving kidney function with few complications. It can be safely used in cases of mild/moderate kidney function loss and solitary kidney. A threshold eGFR

Background The incidence of ectopic kidneys is 1:12,000 clinically and 1:900 postmortem. Patients with pelvic mal-rotated kidneys are more susceptible to recurrent urinary tract infections, recurrent renal stones, and renal injury. Fusion of the kidney lower poles is relatively common compared to other types of renal anomalies. Case presentation We present the case of a 36-year-old Sudanese female patient who presented with a long history of recurrent urinary tract infections unresponsive to antibiotics. Ultrasound scan revealed bilateral pelvic kidneys. Computed tomography (CT) urography confirmed bilateral ectopic fused kidneys, with the left kidney mal-rotated (renal pelvis facing upwards and laterally). Kidney infection secondary to vesicoureteral reflux was diagnosed. Antibiotics were prescribed according to culture and sensitivity. The patient responded well to ciprofloxacin. Conclusion A history of recurrent urinary tract infections without an apparent cause is highly suggestive of renal anomaly and should be investigated expediently. Ultrasonography or CT imaging may be utilized to aid in diagnosis. Early recognition may help prevent the high risk of end-stage renal failure associated with anomalies.

Duplex kidney is a common congenital malformation appeared as duplication of pelvis and ureter. However, renal duplication within sinus renalis is an extremely rare variation of the renal collecting system. In this study, we report a case of an asymptomatic kidney disease in a 33-year-old man, who demonstrates abnormal echo of renal sinus anomaly discovered incidentally in ultrasound examination. Computed tomography urography (CTU) exhibited the other small duplex kidney located in renal sinus. In the excretory phase images, the contrast medium within its small renal pelvis could be seen to flow into the right major renal calices. This case exhibited a very rare anatomical variation of duplicated renal malformation.

Background To evaluate the outcome of kidney recipients with ureteral stenosis after treatment with open surgery under magnetic resonance urography (MRU) localization. Methods We assessed 2,256 consecutive kidney transplant recipients between October 2010 and December 2018. Ureteral stenosis was detected by ultrasound, confirmed and positioned by Magnetic Resonance Urography. All patients underwent open ureteral reconstruction. The ureteral stenosis was located according to the location on the MRU during the operation. Surgical complications and recurrence rate were recorded in the stenosis group. Outcomes were compared with those of a matched control group of transplant recipients with no history of ureteric stenosis. Results The incidence of ureteral stenosis in our center was 3.1% (70/2,256). Sixty-four cases (91.4%) were confirmed to have distal stenosis and were reconstructed with ureterovesical re-implantation; six cases (8.6%) were confirmed to have mid-distal stenosis and were subjected to ureteroureterostomy with the use of native ureter. The overall success rate was 100% and the graft function was salvaged in all cases. There was no recurrence of stenosis after a mean follow-up of 38.9±26.3 months. The complication rate was 5.7%. The 110-month graft survival and patient survival were not significantly different between the stenosis and control groups.Conclusions: MRU is an effective method for non-invasive and accurate diagnosis of ureteral stenosis in kidney transplant recipients. Open ureteral reconstruction surgery under MRU localization for treatment of ureter stenosis after kidney transplantation had a high success rate, low recurrence rate and high safety.

Background: Bilateral Ectopic Kidney is uncommon and usually diagnosed during a routine medical checkup. It could be misdiagnosed as an abdominopelvic mass. In-depth knowledge of its presentation will aid in its management. A poor anatomical relation of the kidneys with other abdominopelvic organs could lead to renal complications and surgical errors. This is of gynaecological importance and worthy of discussion for a lady of her reproductive age. Case presentation: A 20-year-old nulliparous lady of African descent presented with a long-standing history of dull lower abdominal pain. The pain has been intermittent and occasionally associated with a sensation of movement in the lower abdomen. She has a regular and normal menstrual cycle and has no lower urinary tract symptoms. Physical examination was unremarkable with intact secondary sexual characteristics. The abdomen was soft, non-tender and without any organomegaly. Abdominal ultrasonography, renal pyelogram and urinalysis were carried out after her consent was sought in accordance with the institution’s protocol. Urine analysis was normal and culture was negative. However further imaging revealed a bilateral pelvic ectopic kidney. Conclusion: Most of the cases reported are usually unilateral ectopic kidneys. It is, therefore, our belief that this information will be useful to medical practitioners such as surgeons, urologists, radiologists and gynaecologists. Such a diagnosis will enable clinicians to follow up with the client and preserve the renal function whiles preventing iatrogenic injuries during surgical procedures.

A 6-year-old, intact male, brindled, 30-Lb English Bulldog presented to the Purdue University Veterinary Teaching Hospital with a recurrent history of hematuria, periuria, and lethargy that responded temporarily to antibiotic therapy. The work-up included a complete blood count, serum biochemical profile, complete urinalysis, diagnostic imaging (abdominal radiographs and ultrasound with contrast urography), and exploratory laparotomy. The diagnostic imaging findings and subsequent exploratory revealed a unilateral, intraluminal, right-sided, 3-cm ureteral mass extending from the proximal ureter into the renal pelvis. Subsequently, a unilateral right-sided ureteronephrectomy followed by biopsy with cytopathology/cytology (impression smears) and histopathology of the ureteral mass was performed. The cytopathologic interpretation was benign mesenchymal proliferation with mildly atypical urothelial cells. The association of this mass with vascular tissue and a benign nuclear appearance on cytology is similar to reports of fibroepithelial polyps (FEPs) and myxomatous tumors. Histopathology diagnosed the mass as an FEP. Cytopathology proved useful in the presumptive diagnosis of this benign urothelial polyp. To the authors' knowledge, this is the first report using cytopathology to depict and characterize FEPs in veterinary and human medical literature.

Background Renal artery aneurysms (RAAs) are rare and usually asymptomatic, and some RAAs can be associated with calcifications, which may lead to misdiagnoses as renal calculi, which are then mistakenly treated. Case presentation A 69-year-old female patient was admitted to the hospital with no discomfort and was diagnosed with a large right renal calculus. The ultrasound and computed tomography urography (CTU) scan suggested a large calculus in the right pelvis with hydrops of the kidney. Therefore, we chose percutaneous nephrolithotomy (PCNL) to treat the right renal calculus, but no calculi were found in the renal pelvis. When we removed the mucosa of the renal pelvis with a holmium laser, we observed a fluctuating unruptured aneurysm with calcification. Therefore, the previous diagnosis of a renal calculus was disregarded. The operation was stopped immediately, and then computed tomography (CT) angiography was performed, confirming the right renal aneurysm with calcification. Then, Renal artery aneurysm (RAA) coil embolization was performed. After a long-term follow-up, the patient recovered well. Conclusions The RAA of this patient had calcific changes, which led us to errors in the diagnosis. Hence, it is very important for surgeons to effectively distinguish between renal calculi and aneurysms with ring-like calcifications. Our case report looks back at the thrilling situation during the operation and advises surgeons on how to deal with this situation properly.

OBJECTIVE: To evaluate the diagnostic accuracy of magnetic resonance urography (MRU) and determine its value for detecting ureteric obstruction. METHODS: The electronic databases, including PubMed, Embase and the Cochrane library, were systematically searched for studies published throughout September 2018. The summary of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and receiver operating characteristic (ROC) curves was assessed to evaluate the diagnostic accuracy of MRU. Subgroup analyses were conducted based on the mean age of the included patients (adults or children). RESULTS: Eight studies with a total of 594 patients were included. The summary of the sensitivity and specificity of MRU for diagnosing ureteric obstruction was 0.94 and 0.87, respectively. Furthermore, the pooled PLR and NLR were 7.33 and 0.07, respectively. The DOR of MRU for detecting ureteric obstruction was 95.12. In addition, the summary of the area under the ROC of MRU was 0.96. Finally, the specificity, PLR and area under the ROC of MRU for diagnosing ureteric obstruction in adults were higher than children, while the sensitivity of MRU in adults was lower than children. CONCLUSIONS: These findings suggested a relatively high diagnostic value of MRU for detecting ureteric obstruction. Moreover, the diagnostic accuracy of MRU in adults was higher than in children. KEY MESSAGE: Magnetic resonance urography (MRU) in detecting ureteric obstruction has relatively better sensitivity, specificity, PLR, NLR, DOR and AUC. The diagnostic value, including specificity, PLR and AUC of MRU in adults, was higher than in children, while the sensitivity of MRU in adults was lower than in children.

Ureterosciatic hernia is extremely rare. In ureteral herniation, ureter prolapses occur through either the greater or lesser sciatic foramen. Atrophy of the piriformis muscle, hip joint diseases, and defects in the parietal pelvic fascia are predisposing factors for the development of ureterosciatic hernia. Most symptomatic patients have been treated surgically, with conservative treatment reserved only for asymptomatic patients. To the best of our knowledge, long-term follow-up outcomes after ureterosciatic hernia management are sparse. In this paper, we report the case of a 68-year-old woman who presented with colicky left abdominal pain. After computed tomography (CT) scan and anterograde pyelography, she was diagnosed ureterosciatic hernia with obstructive uropathy. We performed ureteral balloon dilatation and double-J ureteral stent placement. After this minimally invasive procedure, CT scan demonstrated that the left ureter had returned to its normal anatomical position without looping into the sciatic foramen. The patient remained asymptomatic with no adverse events 7 years after the minimally invasive procedures. This brief report describes ureterosciatic hernia successfully managed with minimally invasive procedures with long-term follow-up outcomes.

Caso clínico: Masculino de 49 años, con dolor tipo cólico e intermitente, en fosa renal derecha que irradia hacia flanco derecho, acompañado de náusea y vómito en múltiples ocasiones. Se diagnosticó uréter retrocavo mediante urotomografía. El paciente fue ingresado al servicio de urología. Se realizó uretero-ureteroanastomosis desmembrada derecha con abordaje abierto por lumbotomía. Se encontró dilatación de la pelvis renal y tercio superior de uréter derecho, así como trayecto ureteral que discurre posterior a la vena cava inferior. La evolución postquirúrgica del paciente fue satisfactoria. Relevancia: Es una anomalía congénita rara en la que el uréter pasa por detrás de la vena cava inferior. Solo existen alrededor de 200 casos reportados en el mundo. Implicaciones clínicas: Se presenta hasta en un 70% de los casos con dolor en el flanco derecho que puede ser sordo y persistente o un cólico renoureteral franco. El método de diagnóstico principal es la urotomografía y su tratamiento casi siempre es quirúrgico. Conclusión: Los pacientes con uréter retrocavo pueden o no requerir tratamiento quirúrgico, según su manifestación de síntomas, y de requerirlo se puede realizar cirugía abierta o de mínima invasión ya que aún no existe un estándar de oro quirúrgico descrito.

Congenital abnormalities of the kidney and urinary tract include a wide range of malformations ranging from asymptomatic to life-threatening conditions. Although pediatric urogenital system imaging is based on the use of US (pre- and postnatal), voiding cystourethrography and scintigraphic study, magnetic resonance (MR) urography plays a fundamental role in the classification and management of congenital abnormalities of the kidney and urinary tract, giving an overview of the different clinical pictures, thanks to its panoramicity and high anatomical detail. In fact the anomalies of the urinary tract are phenotypically variable because they can affect simultaneously several segments of different embryonic derivation, with complex clinical pictures; they can appear both as isolated phenotypes or as complex malformative conditions, involving renal parenchyma, collecting system and bladder. A deep knowledge of this complex embryogenesis and its possible phenotypic patterns allows a correct interpretation of MR urography images. We describe the embryology and pathophysiology of congenital abnormalities of the kidney and urinary tract as well as MR urography technique and findings. Congenital abnormalities of the kidney and urinary tract are classified into four groups: (1) obstruction (proximal, middle and distal), (2) budding with respect to the Wolffian duct (site and number of ureter), (3) ascent and rotation (ectopia, malrotation and fusion of kidney) and (4) anomaly of metanephric differentiation (dysplasia, megapolicalycosis).

Crossed fused kidney place in an unusual area are the congenital developmental malformation of urinary tract. There are many variants of ectopic renal presentation. In this malformation both the kidneys are anatomically located at one side of the body over each other and inferior CFRE is the most frequent type observed. The condition is generally asymptomatic and diagnosed as an incidental radiology finding and Multi Detector Computed Tomography (MDCT), urography is the investigation of choice. Autopsy based kidney specimens with gross anomalies can be rich source of knowledge about renal pathology. Keywords: Cross fused renal ectopia, Autopsy kidney findings, Ectopic kidney, and Young male.

In recent years, medical imaging has made a huge progress in urology. Several diagnostic hypotheses are proposed after a clinical examination, and to select the right diagnosis, one calls upon the complementary examinations, and the imaging comes at first hand, playing a distinguished role. There are different imaging techniques that aid in the exploration of the urinary tract: KUB (Kidney, Ureter, Bladder) radiograph, ultrasound, IVU (IntraVenous Urography), Computed Tomography Urography (Uro-Scan) and Magnetic Resonance Urography (Uro-MRI). Due to the diversity of examinations that allow the diagnosis of different urinary pathologies, there is an importance and a responsibility to choose the most optimal radiological examination for diagnosis of the disease while ensuring the protection and the comfort of the patient during the examination. Thus, the aim of this work is to enquire about the technique used to detect the urological pathologies and to show the most adequate technique for each pathology. For that, a survey was conducted over radiologists, urologists as well as emergency physicians, in hospitals and medical centers, throughout the Lebanese territories. The results found can be summarized by the following points: (1) Uro-Scan is the technique that replaced the IVU, (2) there is a lack of knowledge, use and training on the Uro-MRI technique and (3) the optimal examination technique for almost all urological pathologies is the Uro-Scan.

Background: Calyceal diverticulae and megacalycosis are rare congenital anomalies. The majorities are asymptomatic but they can present with complications. Objective: The objective of this study is to describe the clinical presentations, complications, urographic diagnosis of calyceal diverticulae, megacalycosis, and their treatment. Methods: A descriptive study carried out over 8 years period from March 2012 to December 2019. In three big hospital of Aden province, we collect 15 patients aged from seven to 41 years (mean 13.5 years), our patients were 9 female (60%) and 6 male (40%). They diagnosed incidentally with calyceal diverticulae and megacalycosis by contrasted urography, describing the clinical manifestations, localization, complications, and type of treatment. Results: Sixty percent of patients with calyceal diverticulae and megacalycosis were women and (40%) were men. Clinical manifestations including, dull aching flank and abdominal pain in (40%), acute renal colic (20%), recurrent urinary tract infection (33%), and abdominal pain with a fever of unknown origin in (7%). Calyceal diverticula and megacalycosis were bilateral in (53%) and unilateral in (47%). In the right kidney were (57%), and in the left kidney (43%). In the upper pole of the kidney were (53.3%), middle pole (33.3%), and lower pole (13.3%). Complications occurred in (47%) of patients. They including, urinary stones in (71.4%), hypertension (14.3%), and delayed renal excretion (14.3%). Conservative treatment carried out in (73%) and surgically intervened in (27%). Conclusions: Calyceal diverticula and megacalycosis are rare anomalies. Dull aching flank pain and recurrent urinary tract infections are the most frequent clinical presentations. The most common complications are urinary stones. Conservative treatment is a common type of treatment.

Renal artery aneurysm is defined as the dilated segment of renal artery exceeding twice the diameter of the normal renal artery. As more than half of such aneurysms have the annular calcification, they must be differentiated from the stones. Differential diagnosis of the renal artery aneurysm includes the parapelvical cysts, hydronephrosis and kidney tumors. Renal artery aneurysm can be diagnosed by CT, MRI, as well by ultrasonography and color dopplerography. Unfortunately presence of calcification renders the ultrasonographic examination impossible. In this article we share our own experience of two cases of calcified renal aneurysms diagnosed and treated at our hospital.

Background: Urinary bladder carcinoma is one of the most common tumors among the lower urinary tract, it is the seventh common malignancy and widely distributed in devel-oped countries.Aim of Study: To elucidate the diagnostic potential and additive imaging data obtained with Multi-Detector Computed Tomography (MDCT) in early detection and characterization of urinary bladder neoplastic masses by comparing the result of the study with the conventional cystoscopy results.Patients and Methods: This prospective descriptive study was conducted on forty patients, 36 was men and 4 women. The patients referred to Radio-Diagnosis Department, Ain Shams University Hospitals, Radio-Diagnosis Department in a period 6 months of data collection for suspicious bladder mass(es) after clinical assessment of patient or for further characterization of indeterminate bladder neoplastic mass lesion previously depicted on other radiological investigation as ultrasound examination.Results: A statistically significant difference was found between positive and negative cystoscopic biopsy results for malignancy in relation to presence CT features of malignancy.Conclusion: MDCT urography is useful for examination of patients especially when the CC is contraindicated such as hemorrhage, perforation, difficult to doing it or unsatisfactory in interpretation, and as a complementary technique in the evaluation of areas difficult to evaluate with CC, especially with the MDCT results satisfactory in finding lesions smaller than 5mm. MDCT urography gives us an opportunity for early detection bladder tumors because its reliability and accuracy and our results support that.

Introduction Anatomical changes after surgery and fibrotic adhesions increase the organ laceration risk, including that of the ureter, in recurrent cases and secondary operations. The aim of this study was to investigate the changes in the anatomical localisations of the ureters via computed tomography urography in patients undergoing rectal cancer surgery. Material and methods The study involved prospectively collected data on the changes of ureteral location preoperatively and postoperatively in patients with operated rectal cancer. Distances (mm) of ureters determined midline in the computed tomography urogram phase. Results A total of 18 patients were included. The mean distances between the right (R1 ) and left (L1 ) ureters and the mid-vertebral line before the surgery were 30.9 ±5.4 mm and 34.5 ±9.9 mm, respectively. The postoperative distances between them (R2 and L2 ) were 26.4 ±9.1 mm and 29.5 ±9.9 mm, respectively. The R2 measurement showed that 83.3% (15/18) of the right ureters had deviated medially, whereas 16.7% (3/18) of them had deviated laterally. The L2 measurements showed that 88.8% (16/18) of the left ureters had deviated medially, whereas 11.2% (2/18) of them had deviated laterally. The differences between the preoperative and postoperative measurements of the right and left ureter positions were 4.5 ±9.2 mm and 4.9 ±4.6 mm, respectively, with the displacement in the left ureter being statistically significant (p ≤ 0.001). Conclusions Rectal cancer surgery causes medially deviated changes in the positions of the ureters.

Background: Prenatally diagnosed, hydronehprosis does not mean presence of decompensated obstruction and spontaneously improvement or resolution can occur postnatally. If obstruction persists, the split renal function (SRF) of the diseased kidney will dramatically decrease, and surgical intervention will be necessary. Objective: Evaluation of outcome of pyeloplasty in children with ureteropelvic junction obstruction (UPJO) in renal unit with split function less than 20% and to asses renal function recoverability. Patients and Methods: Cohort (historical and concurrent) study included 88 patients with UPJO with split renal function (SRF) < 20%. Preoperative patient was investigated by abdominopelvic ultrasound, magnetic resonance urography (MRU) or computerized tomography and renal isotope scan. Split renal function and T 1/2 .Preoperative and postoperative were compared. Results of the procedure were evaluated by clinical examination, abdomino-pelvic ultrasound after one month. Urine analysis with culture and sensitivity and renal isotope scan after 6 months. Results: Our study included 88 patients divided into two groups according to SRF (group 1, SRF >20% and group 2, SRF < 20%). Mean preoperative SRF was 31.34 ± 15.27%in all cases, 41.79 ± 7.03% in group 1 and 13.06 ± 4.90% in group 2, which increased postoperatively to 38.35 ± 15.61%, 46.86 ± 8.43% and 20.81 ± 7.67% respectively and this improvement was highly significant. Group 2 included 9 patient with SRF < 10%, mean preoperative SRF was 6.21 ± 2.26% which increased preoperatively to 15.04 ± 7.09% , also in the remaining 23 cases, mean preoperative SRF was 15.74 ± 2.30% increased postoperatively to 23.07 ± 6.75% . Conclusion: Poorly functioning renal unit with SRF < 20%, can show functional improvement and recoverability, so in these renal units, we should not have to rush to nephrectomy and instead of that we can proceed to pyeloplasty.

Trauma to the genitourinary system includes blunt and penetrating injuries to bladder and ureters. These are rare injuries and are overlooked as other abdominal and pelvic injuries often take priority. Delayed diagnosis can lead to significant morbidity and mortality. Computed tomography has taken a central role in the imaging of the ureters and bladder. This article reviews the anatomic relationships, mechanisms of injury, and clinical presentation to help physicians determine when bladder and ureteral injuries should be suspected and further imaging should be pursued. Radiologic evaluation of bladder and ureteral injury with CT cystography and CT urography, respectively, will be reviewed. CT cystography and CT urography are effective tools in identifying potentially serious injuries to the genitourinary system. Timely recognition of these injuries can be crucial for the overall management and prognosis.

Objective. To assess the sensitivity of computed tomography urography (CTU) and magnetic resonance urography (MRU) (native versus contrast-enhanced studies) in patients with traumatic ureteral strictures.Material and methods. The data of 51 CTUs and 34 MRUs made in patients with upper urinary tract injuries were prospectively analyzed. The studies were performed using an Aquilion Prime 160-slice scanner (Toshiba, Japan) and high-field devices at a magnetic field strength of 1.5 Tesla Vantage Atlas (Toshiba, Japan) and at 3.0 Tesla Ingenia (Philips, Netherlands). Excretory urography was also carried out in 92.2% of cases; ultrasound examination was made in 74.5%. The degree of obstruction, its causes, the state of the adjacent structures, and the presence of complications were assessed.Results. All (100%) CTU studies correctly estimated the level of stricture of the ureter; the lower third of the organ was involved most frequently (68.6%). MRU identified traumatic strictures in 94.0% of cases. MRU and CTU could be confined to native series in 51.0 and 27.5% of patients, respectively. MRU more commonly revealed the changes concurrent with injuries: there was diffuse ureter wall thickening in 44.1% (27.5% at for CTU), periureteral fat infiltration in 43.1% (37.2% at CTU), and pelvic fluid accumulation in 9.8% (7.8% at with CTU). The techniques could also establish the presence of sinus tracts: MRU was useful in the preoperative imaging of pathological fistulas in 100%. CTU was able to demonstrate the leakage of a contrast agent and/or its flow into the vagina in 66.7%.Conclusion. MRU demonstrates the sensitivity comparable to that of CTU in detecting ureteral injuries (including in diagnosing complications, such as fistulas) and can be used in patients with contraindications to CTU and, due to the absence of ionizing radiation, for follow-up studies.

Purpose To describe the morphology and function of duplicated collecting systems in pediatric patients undergoing functional MR urography (fMRU). Methods This is a HIPAA compliant IRB approved retrospective study of all patients with duplicated renal collecting systems undergoing fMRU at our institution between 2010 and 2017. Two pediatric radiologists evaluated the studies to determine the presence, morphology and function of duplicated collecting systems using both T2-weighted and dynamic post-contrast fat saturated T1-weighted images. Assessed morphologic features included pelvic and calyceal dilation, partial or complete ureteral duplication, ureteral dilation, ectopic ureteral insertion and ureteroceles. Functional analysis was carried out per moiety. Results A total of 86 examinations (63 girls; 23 boys), median age 2.6 years (Standard Deviation 6.4 years, interquartile range: 0.4–10.3 years) and 107 kidneys (39 right; 30 left and 19 bilateral), which yielded 214 evaluable moieties, were included in the final sample. One hundred and sixty-three (76.1%) of the moieties had normal morphological features and normal functional results (average calyceal transit time and renal transit time of 2 min 28 s and 3 min 16 s, respectively). The remaining 51 moieties (23.8%) were hypoplastic or dysplastic. Seventy-seven (35.9%) had pelvic and calyceal dilation. Slightly more than half of the kidneys had complete ureteral duplication (60/107; 56%); 50 (50/107, 46.7%) had ectopic ureters (23 intra- and 27 extravesical) and 9 (9/107, 8.4%) had ureteroceles. Conclusion fMRU provides comprehensive information regarding the morphology and function of duplicated renal collecting systems in children. In particular, fMRU is useful for assessing barely or non-functioning renal poles and ectopic ureters.

Background: The creation of antireflux mechanism for ureteroileal anastomosis in a low- pressure pouch is controversial and benefits should be weighted by possible morbidity. Different techniques were used as antireflux to preserve the upper urinary tract. Aim of the Work: to evaluate a modification of the subserous extramural tunnel for non-refluxing uretero-ileal anastomosis in orthotopic diversion using Wallace technique in a single trough after 2-year-duration follow up in terms of uretero-ileal anastmosis stricture, reflux and urinary tract infections. Patients and Methods: In all, 100 patients underwent orthotopic urinary diversion after radical cystectomy. Inclusion criteria included age from 30 to 65 years old, negative positive urethral margin, serum creatinine less than 2 mg/dl and tumor stage T2-T3. Exclusion criteria were stricture urethra, single kidney and poor performance status. Patients were followed up by serum creatinine, pouchogram, renal ultrasound and intravenous pyelogram if serum creatinine below 1.5 mg/dl. Results: In all, 2 patients missed follow up and 98 patients were evaluable over 24 months. Mean serum creatinine raised from 1.16 preoperative to 1.20 after 2 years. Reflux has been detected in 3 patients while stricture has affected 3 patients. 9 patients had symptomatic urinary tract infections or being infected with organism other than E.coli that necessitated admission and parenteral antibiotics; three of which were advised to do clean intermittent catheterization. Conclusion: Combining serous-lined extramural tunnel and Wallace techniques is an effective technique and has a comparable result to the other antirefluxing techniques in terms of ureteroileal stricture, reflux and acute pyelonephritis.

Ureteric entrapment within the sacroiliac joint (SIJ) is very rare. However, we experienced a case of a 77-year-old woman who presented with right hydronephrosis during a routine health check. Computed tomography and retrograde pyelography showed entrapment of the right ureter at the level of the SIJ, with a right proximal hydroureter, which was confirmed during surgery. Herein, we described this case and present a review of the literature on similar cases.

Introduction Following renal transplantation, the incidence of malignancies is 3–5 times higher than that of healthy individuals. Among other type of cancers, the risk of urological tumors is also elevated. However, only a few cases of de novo transitional cell carcinomas occurring in renal allografts have been reported. Case report A 63-year-old tertiary transplanted male patient was urgently hospitalized for a painless macroscopic hematuria. Ultrasonography revealed pyelectasis and a hematoma in the renal pelvis. A percutaneous nephrostomy tube was inserted. An anterograde pyelography was performed later, where a filling defect was still observable in the location of the previously reported hypoechoic mass. Contrast-enhanced ultrasonography showed enhancement of the lesion. An ultrasound-guided percutaneous biopsy was performed. The histologic evaluation revealed a high-grade transitional cell carcinoma. A whole-body staging computed tomography scan did not show signs of metastatic disease. The renal allograft was surgically removed. No disease progression was observed during the 21-month follow-up period. Conclusions Painless hematuria and asymptomatic hydronephrosis occurring after kidney transplantation should raise the possibility of urothelial carcinoma in the kidney graft. Contrast-enhanced ultrasound should be considered as a first-line diagnostic modality because it is easily accessible and does not raise concerns about nephrotoxicity or radiation burden.

The aim is to evaluate the age-related changes and relationship of renal apparent diffusion coefficient (ADC) against the morphological and functional changes detected by functional magnetic resonance urography (fMRU) in children with pelvicalyceal dilation, with suspected or known ureteropelvic junction obstruction. We retrospectively analyzed fMRUs with diffusion-weighted imaging (DWI) of the kidney in 35 subjects (25 males; median age: 7.1 years, range: 0.3–22.7 years) with 70 kidneys (40 with pelvicalyceal dilation and 30 with no pelvicalyceal dilation). Inclusion criteria were pelvicalyceal dilation, the absence of duplex kidneys and no ureteric dilation. DWI was performed with 3 diffusion gradient directions (b values = 0, 200, 500, 800 and 1,000 s/mm2). Metrics for fMRU included calyceal and renal transit times (CTT, RTT), time-to-peak (TTP), differential renal function based on volume (vDRF), Patlak number (pDRF) and combined volume and Patlak number (vpDRF). The grades of pelvicalyceal dilation, cortical thinning and corticomedullary differentiation were evaluated. The relationship between ADC values and the fMRU parameters was analyzed. ADC increases with age in kidneys without pelvicalyceal dilation (R2=0.37, P 0.07). The median ADC of kidneys without pelvicalyceal dilation was 3.73×10−3 mm2/s (range: 2.78–5.37×0−3 mm2/s) and the median ADC of kidneys with pelvicalyceal dilation was 3.82×10−3 mm2/s (range: 2.70–5.70×10−3 mm2/s). There was no correlation between ADC and the absolute differences of vDRF or pDRF (P>0.33). Renal ADC does not correlate with morphological and functional results of fMRU changes in children with pelvicalyceal dilation due to suspected or known ureteropelvic junction obstruction.

The present case study presented a rare autopsy based finding on Crossed fused renal ectopia Crossed fused kidney place in an unusual area are the congenital developmental malformation of urinary tract. There are many variants of ectopic renal presentation. In this malformation both the kidneys are anatomically located at one side of the body over each other and inferior CFRE is the most frequent type observed. The condition is generally asymptomatic and diagnosed as an incidental radiology finding and Multi Detector Computed Tomography (MDCT), urography is the investigation of choice. Autopsy based kidney specimens with gross anomalies can be rich source of knowledge about renal pathology. It is concluded that ectopic kidney is an accidental finding, but awareness regarding this issue and its probable signs and symptoms among general population is the need of hour.

Background With widespread clinical application of imaging techniques, renal space-occupying lesions have been identified at an increasing frequency. Here, we report two rare cases, Castleman disease (CD) and IgG4-related disease (IgG4-RD), presenting primarily with the symptoms and imaging findings of kidney malignancy. Case presentation In case 1, an occupying lesion located in the right renal pelvis was detected using magnetic resonance imaging in a 32-year-old female who presented with hematuria and lumbago. First misdiagnosed as carcinoma of the renal pelvis, the patient underwent right radical nephroureterectomy. However, postoperative pathological and immunohistochemistry studies finally confirmed the diagnosis of CD. In case 2, a 45-year-old male presented with the chief complaint of anuria. Nephrostomy and renal biopsy indicated lymphoma, following which, antegrade urography and computed tomography urography were performed, which revealed bilateral hydronephrosis and mass lesions around the renal pelvis. Partial resection of the masses and frozen section examination indicated the diagnosis of CD. However, the results of postoperative histopathology and immunohistochemistry combined with serum IgG4 were consistent with IgG4-RD. Both the patients recovered well after drug treatment without recurrence of the diseases. Conclusions Inflammatory pseudotumor of CD and IgG4-RD with kidney involvement are primarily diagnosed by postoperative histopathology and can pose a preoperative diagnostic challenge because these lesions can masquerade as kidney malignancy. Therefore, we recommend core biopsy as a nonnegligible procedure to evaluate renal masses and potentially prevent unnecessary surgical treatment.

Crossed fused renal ectopia is a rare congenital anomaly of renal embryogenesis. The majority of such anomalous kidneys are supplied by a single renal artery and drained by two separate ureters. However, drainage by a single common ureter is an unusual variant. Here, we present a 17-year old male with a pelvic pancake kidney drained by a single ureter with associated acute obstructive uropathy diagnosed with ultrasonography and computed tomography urography (CTU). We describe the anatomical peculiarity and diagnostic evaluation of the case.

Objective: To investigate surgical techniques and challenges of laparoscopic in treating pediatric ureteral polyps under laparoscopy.Methods: The clinical data of 7 of pediatric ureteral polyps patients who were admitted to the hospital from July 2015 to January 2020 were analyzed retrospectively. There were 6 males and 1 female from 7.7 to 13.9 years old at the mean age of 10.4. Before surgery, all children performed urinary B ultrasound, magnetic resonance urography (MRU), and renal radionuclide scanning. Six cases were observed on the left lateral and 1 on the right. The lesions of 5 cases were located at the ureteropelvic junction, 1 in the upper ureter and 1 in the middle ureter. The polyps were treated intraoperatively by the resecting of the lesion segment and simple polypectomy to retain the attached part of the original diseased segment of the ureter. All surgeries were performed under laparoscopy and B-ultrasound was performed during follow up after surgery.Results: All 7 surgeries were performed successfully under the laparoscope. The surgery time was 80–110 min, and the average surgery time was 97.5 min. The intraoperative bleeding was 10–25 ml and the average postoperative hospital stay was 6 d. Postoperative hematuria occurred in 1 case. Neither urinary leakage nor urinary tract infection was reported post surgery. Preoperative affected pyelectasis of all patients was 2.0–3.7 cm. Three months postoperatively, the affected pyelectasis was measured at 1.2–3.0 cm. No recurrence of polyps was reported after surgery. During the follow-up to April 2020, there was no significant change in the kidney size of all patients, and hydronephrosis was alleviated compared with that before surgery.Conclusions: Laparoscopy is a safe, effective and minimally invasive surgical technique for pediatric multiple ureteral polyps. The surgery plan was designed according to the location and size of polyps, including segmental ureterectomy of polyps + pyeloureterostomy, segmental ureterectomy of polyps + ureter - ureteral anastomosis.

INTRODUCTION The objective of this study was to compare the frequency and entity, in computed tomography (CT) urography, of streak artefacts on the urinary tract generated by two contrast agents with a different iodine concentration and osmolarity. METHODS Computed tomography scans including an excretory renal phase, performed on adult subjects in the period May-July 2020, were retrospectively evaluated in consensus by three expert radiologists, to detect any streak artefacts located in the urinary tract. Patients were administered either 1.6 mL/kg of Iodixanol 320 mgI/mL or 1.3 mL/kg of Iomeprol 400 mgI/mL. RESULTS In total, 144 CT scans were analysed, subdivided into two groups administered either Iodixanol (71/144 (49.3%) patients) or Iomeprol (73/144 (50.7%) patients). In 41% cases, no beam hardening artefacts were found; among these, 12/59 (20.3%) patients had received Iodixanol and 47/59 (79.7%) Iomeprol. In the Iodixanol group, the mean contrast density on the renal pelvis was 2565.6 HU and streak artefacts occurred in 59/71 cases (83.1%); in 33/59 (55.9%) cases, the artefacts were marked, and in 26/59 (44.1%) minimal. In the Iomeprol group, the mean contrast density on the renal pelvis was 1666 HU and streak artefacts occurred in 26/73 cases (35.6%); in 7/26 (27%) cases, the artefacts were marked and in 19/26 (73%) minimal. CONCLUSION The study data demonstrate a significant difference in the attenuation values of iodine urine in the excretory system between the Iodixanol and Iomeprol group. Iodixanol induced a higher frequency and burden of artefacts, compared to Iomeprol.

Background Ureteral obturator hernia is a rare condition, usually found accidentally during imaging examinations, or found during surgery. Ureteral hernia can easily lead to ureteral obstruction and hydronephrosis. Long-term hydronephrosis may lead to kidney damage and infection, and eventually cause kidney failure. As of December 31, 2020, there are only 2 literature reports. Case presentation This article reports a 67-year-old female patient with no symptoms. The computed tomography (CT) scan of the urinary system to show the left kidney and ureter had hydrops. The CTU imaging of the urinary tract revealed the left ureter pelvis herniated into the parietal pelvic fascia was accompanied by tortuosity and left hydronephrosis. She underwent laparoscopic abdominal wall hernia repair on April 29, 2020, and she recovered well. Conclusions Ureteral obturator hernia is an uncommon condition. The clinical symptoms are non-specific, including unclear abdominal pain, until the appearance of obstructive diseases of the urinary tract, such as renal insufficiency, urinary tract infection, kidney stones, and uremia. A comprehensive review of the literature shows that it is difficult to make an accurate diagnosis based on physical examination alone.Early urography can improve the possibility of accurate diagnosis. When a patient suffers from impaired renal function, timely surgical treatment can avoid deterioration of renal function.

The use of an ileal segment is a standard method for urinary diversion after radical cystectomy. Unfortunately, utilization of this method can lead to numerous surgical and metabolic complications. This study aimed to assess the tissue-engineered artificial conduit for urinary diversion in a porcine model. Tissue-engineered tubular polypropylene mesh scaffolds were used for the right ureter incontinent urostomy model. Eighteen male pigs were divided into three equal groups: Group 1 (control ureterocutaneostomy), Group 2 (the right ureter-artificial conduit-skin anastomoses), and Group 3 (4 weeks before urostomy reconstruction, the artificial conduit was implanted between abdomen muscles). Follow-up was 6 months. Computed tomography, ultrasound examination, and pyelogram were used to confirm the patency of created diversions. Morphological and histological analyses were used to evaluate the tissue-engineered urinary diversion. All animals survived the experimental procedures and follow-up. The longest average patency was observed in the 3rd Group (15.8 weeks) compared to the 2nd Group (10 weeks) and the 1st Group (5.8 weeks). The implant’s remnants created a retroperitoneal post-inflammation tunnel confirmed by computed tomography and histological evaluation, which constitutes urostomy. The simultaneous urinary diversion using a tissue-engineered scaffold connected directly with the skin is inappropriate for clinical application.

Background Bladder flap has been shown to be a feasible treatment for distal ureteral stenosis; this technique has been improved such that it can be used to address complex urinary tract obstructions. The purpose of the present study was to describe a surgical technique of ureteroplasty with a bladder onlay flap, which consists of a nontransecting and terminal augmented anastomosis, for repairing recurrent distal strictures of the ureter. Methods We retrospectively reviewed 6 patients who underwent this procedure between May 2018 and November 2019. These patients were diagnosed with distal ureteral stenosis and had previously undergone ureteroneocystostomy (one with a Boari flap) but suffered recurrence of flank pain. Patient characteristics, perioperative data and follow-up outcomes were gathered. The success of the operation was judged by symptomatic relief (subjective success) and improved radiographic imaging and renal function (objective success). Results Preoperative computed tomography urography (CTU) showed hydronephrosis in all patients: severe hydronephrosis was observed in 83.3% of patients (5/6), and moderate hydronephrosis was observed in 16.7% (1/6). The mean stricture length was 2 cm. The mean operating time, estimated blood loss and postoperative hospital stays of the six patients were 193.3 min (160-270 min), 41.5 mL (10-58 mL) and 8.2 days (6-11 days), respectively. No serious complications (Clavien-Dindo grade ≥3) occurred during or after the operations. The mean follow-up time was 24.5 months (range, 14 to 29). The objective success rate was 83.3% (5/6), and the subjective success rate was 100%. Conclusions Our technique of ureteroplasty with a bladder onlay flap by nontransecting and terminal augmented anastomosis is feasible and improves the recovery rate after the repair of recurrent distal ureteral stenosis. Patients who have had previous unsuccessful surgeries might benefit from this approach.

Urinary system stones are frequently encountered in the community. Together with technological developments, introduction of new treatment procedures such as extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy and retrograde intrarenal surgery has further reduced morbidity, mortality and hospitalisation time of patients. In order to maximise success and to reduce complications of these procedures, it is necessary to evaluate anatomy and morphological differences of kidney collector system before the procedure. This study was conducted for the purpose of determining the morphology of the kidney collector system and the negative anatomic factors of the lower pole in autopsy cases performed in our institution.Eighty two kidney units obtained from 41 autopsy cases conducted in Faculty of Medicine Department of Forensic Medicine, Sivas Cumhuriyet University between September 2017 and September 2018 were included in the study. Percentages were found as 78% for intrarenal pelvis, 13.4% for borderline pelvis, 6.1% for extrarenal pelvis and 2.4% for pelvic nonexistence. When pelvicalyceal anatomy was evaluated, percentages were found as 32.9% for bicalyceal, 26.8% for tricalyceal, 20.7% for multicalyceal, and 19.5% for unclassified calyceality. When it was evaluated according to opening of calyces into the renal pelvis based on Sampaio classification, percentages were found as 30.5% for AI, 17.1% for type II, 28% for BI, 18.3% for BII, and 6.1% for unevaluated part. Infundibular lengths of kidney's lower pole were detected as under 3 cm in 39% and over 3 cm in 61% of all cases. Infundibulopelvic angles of kidney's lower pole were measured as under 70o in 42.7% and over 70o in 57.3% of all cases.In our study, there was no statistically significant difference between the right and left kidneys in terms of collecting system morphology and lower pole's negative anatomical factors. Only infundibular length which is one of the collecting system morphology and lower pole's negative anatomical factors were statistically shorter in females than males. There was no difference in terms of other parameters.In conclusion, the findings of this study are largely consistent with the results of similar studies. This reveals that renal collecting system morphology and negative anatomic factors in the lower pole collecting system in human are roughly similar. In clinical practice, pre-treatment computed tomography and, if necessary, magnetic resonance urography evaluation of the lower pole negative anatomic factors may contribute to gain preliminary information about both the clearance of stone fragments especially after shock wave lithotripsy and retrograde intrarenal surgery procedures and perioperative complications proactively.

The aim of this report is to present our experience of performing transurethral laser incision for management of ectopic ureter orifice stenosis in adult patient. A 61-year-old male was presented with right flank pain. Computed tomography urography showed right complete double collecting system, upper moiety hydroureteronephrosis, and parenchymal thinning of the upper moiety. Cystoscopy showed right ectopic ureter orifice on the prostatic part of the urethra. Transurethral laser incision was performed at the 12 o'clock position of the stenotic orifice with Thulium laser. This report showed that transurethral laser incision was a minimally invasive procedure with good result.

Objectives The aim of the study was to describe renal pelvis (RP) and ureteral ultrasonographic measurements in a population of cats with confirmed benign ureteral obstruction (UO) by antegrade pyelography. The secondary objective was to further describe clinical findings associated with minimally dilated obstructed kidneys in an attempt to better understand its occurrence. Methods Retrospective case series of cats diagnosed with benign UO were confirmed by antegrade pyelography. Medical records were reviewed and signalment, diagnostic imaging results, serum creatinine (SCr) concentration and urine culture results were recorded. Each obstructed kidney was categorized into two groups: group 1 included all RP measurements ⩽4 mm and group 2 included all RP measurements >4 mm. Results A total of 82 cats with 114 obstructed ureters met the inclusion criteria. Fifty (61%) cats had a unilateral UO and 32 (39%) had a bilateral UO. Thirty (26%) kidneys were included in group 1 while 84 (74%) were included in group 2. Nine (8%) kidneys had an RP dilation ⩽2 mm. Median RP and ureteral diameters were 6.6 mm (range 1.1–37.0 mm) and 3.2 mm (range 0.0–11.0 mm), respectively. RP size correlated positively with ureteral diameter in the study population ( P Conclusions and relevance Feline UO may be associated with minimal RP dilation and the severity of RP and ureteral dilation can be highly variable. Absence of significant RP dilation does not rule out UO in cats.

International audience; Introduction: This study aimed to evaluate the concordance in tumor stage and grade between ureteroscopic (URS) biopsy and radical nephroureterectomy (RNU) in patients with upper tract urothelial carcinoma (UTUC).Patients and methods: Records of 1,214 UTUC patients who had undergone URS biopsy followed by RNU were included. Univariable and multivariable logistic regression analyses were performed to identify factors contributing to the pathological upstaging.Results: The concordance between URS biopsy-based clinical and RNU pathological staging was 34.5%. Clinical understaging occurred in 59.5% patients. Upstaging to muscle-invasive disease occurred in 240 (41.7%) of 575 patients diagnosed with ≤cT1 disease. Of those diagnosed with muscle-invasive disease on final pathology, 89.6% had been clinically diagnosed with ≤cT1 disease. In the univariable analyses, computed tomography urography (CTU)-based invasion, ureter location, hydronephrosis, high-grade cytology, high-grade biopsy, sessile architecture, age, and women sex were significantly associated with pathological upstaging (P < .05). In the multivariable analyses, CTU-based invasion and hydronephrosis remained associated with pathological upstaging (P < .05). URS biopsy-based clinical and pathological gradings were concordant in 634 (54.2%) patients. Clinical undergrading occurred in 496 (42.4%) patients.Conclusions: Clinical understaging/undergrading and upstaging to muscle-invasive disease occurred in a high proportion of UTUC patients undergoing RNU. Despite the inherent selection bias, these data underline the challenges of accurate UTUC staging and grading. In daily clinical practice, URS biopsy and CTU offer the most accurate preoperative information albeit with limited predictive value when used alone. These findings should be considered when utilizing preoperative, risk-adapted strategies.

Introduction The protocol for preparation of computed tomography urography (CTU) examinations at our hospital was changed in 2013 to improve the quality of urinary bladder filling in the excretory phase. The aim of this study was to evaluate the quality of urinary bladder filling on CTU after different doses of furosemide were administered to patients with macroscopic hematuria. Methods The cohort was 215 patients who underwent elective CTU due to macroscopic hematuria between 2014 and 2018. 5 mg furosemide were administrated to 100 patients, 2.5 mg to 100 patients and 0 mg to 15 patients. Contrast medium layered bladders were excluded, leaving 193 patients: 92, 89 and 12 in each group. Urinary bladder volume was calculated in corticomedullary (CMP) and excretory phase (EP). Bladder distension was classified as satisfactory or not. Attenuation of bladder content in EP was noted. Results Average volume in EP was 370 ± 224 ml (28–1052) after 5 mg furosemide, 274 ± 120 ml (43–628) after 2.5 mg and 180 ± 104 ml (53–351) after 0 mg. 85% of the bladders were satisfactory distended after 5 mg, 80% after 2.5 mg and 58% after 0 mg. Average attenuation was 266 ± 89 HU (103–524) after 5 mg, 362 ± 156 HU (118–948) after 2.5 mg and 761 ± 331 HU (347–1206) after 0 mg. The differences in volume and attenuation were significant. Conclusion 5 mg furosemide is preferred rather than 2.5 mg in preparation for CTU examinations of patients with macroscopic hematuria. There was no difference between the doses concerning rate of satisfactory bladder distension, but the higher dose resulted in larger bladder volume and more suitable attenuation of bladder content. Implications for practice Development of CTU-image quality could improve bladder cancer diagnostics.

To predict natural ureter lengths based on clinical images. We reviewed our image database of patients who underwent multiphasic computed tomography urography from January 2019 to April 2020. Natural ureteral length (ULCTU) was measured using a three-dimensional curved multiplanar reformation technique. Patient parameters including age, height, and height of the lumbar spine, the index of ureteral length using kidney/ureter/bladder (KUB) radiographs (C-P and C-PS) and computed tomography (ULCT) were collected. ULCTU correlated most strongly with ULCT. R square and adjusted R square values from multivariate regression were 0.686 and 0.678 (left side) and 0.516 and 0.503 (right side), respectively. ULCTU could be estimated by the regression model in three different scenarios as follows: ULCT + C-P ULCTUL = 0.405 $$\times$$ × ULCTL$$+$$ + 0.626 $$\times$$ × C-PL – 0.508 cm ULCTUR = 0.558 $$\times$$ × ULCTR$$+$$ + 0.218 $$\times$$ × C-PR + 6.533 cm ULCT ULCTUL = 0.876 $$\times$$ × ULCTL$$+$$ + 6.337 cm ULCTUR = 0.710 $$\times$$ × ULCTR$$+$$ + 9.625 cm C-P ULCTUL = 0.678 $$\times$$ × C-PL$$+$$ + 4.836 cm ULCTUR = 0.495 $$\times$$ × C-PR$$+$$ + 10.353 cm We provide equations to predict ULCTU based on CT, KUB or CT plus KUB for different clinical scenarios. The formula based on CT plus KUB provided the most accurate estimation, while the others had lower validation values but could still meet clinical needs.

Urothelial carcinoma (UC) is the fourth most frequent tumor in Western countries and upper tract urothelial carcinoma (UTUC), affecting pyelocaliceal cavities and ureter, accounts for 5–10% of all UCs. Computed tomography urography (CTU) is now considered the imaging modality of choice for diagnosis and staging of UTUC, guiding disease management. Although its specificity is very high, both benign and malignant diseases could mimic UTUCs and therefore have to be well-known to avoid misdiagnosis. We describe CTU findings of upper urinary tract carcinoma, features that influence disease management, and possible differential diagnosis.

Introduction & Objectives Nephrogenic adenoma is a rare benign metaplastic lesion of the urothelium. The objective of this video is to describe the surgical technique in the case of a patient with persistent hematuria, presence of 25 mm filling defect in the pelvis and inferior calyceal region and histological result of nephrogenic adenoma after percutaneous resection, an exceptional location Materials & Methods 30-year-old woman consulted for persistent hematuria. Urinary cystoscopy and cytology were negative. Urography CT scan showed a 25 mm filling defect in the right renal pelvis. After retrograde flexible ureteroscopy observing sessile tumor, percutaneous surgery is considered, because during flexible ureteroscopy the visualization and approach were not safe and good. The patient was placed in a modified Valdivia position. Ascending pyelography was performed observing pyelocaliceal filling defect of 25 mm. Needle puncture guided by x-ray and ultrasound, flexible guide step and expansion with metal dilators with Amplatz sheath passage 16.5/17.5 fr. We started with minipercutaneous tract due to the localization of lesion (pyelocaliceal) and to decrease the chance of bleeding during initial access. Access with nephroscope, biopsy and vaporization with holmium laser. Due to the size of the lesion, Amplatz sheath was removed and dilatation with high pressure balloon was completed up to 30 fr caliber. A resectoscope with bipolar energy was introduced and the lesion was resected to the tumor base. A nephrostomy tube and simple ureteral catheter were placed. Results Twenty-four hours after surgery, a nephrostomy catheter was removed. Forty-eight hours after surgery, the bladder catheter and ureteral catheter were removed and the patient was discharged. The histological result confirmed the diagnosis of the initial biopsy: Nephrogenic adenoma. Six months after surgery, the patient is asymptomatic, and with normal CT Urography, without appreciating the defect of filling prior to surgery. Conclusions Although holmium laser is the standard treatment, percutaneous treatment of symptomatic benign tumors of the upper urinary tract with bipolar energy is a viable choice, since it allows the preservation of the renal unit, with minimal morbidity and excellent results.

Background: Castleman Disease (CD) of the kidney is extremely rare. In this study, we have presented a case of CD of the left kidney and comprehensively described the findings of computed tomography urography. Case Presentation: The case involved unusual imaging characteristics of the focal central cystic area. Conclusion: The small and regular cyst-like structures and the hyperdense mass relative to the renal parenchyma in plain scans might help distinguish the CD of the kidney from other hypervascular tumors.