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Antegrade pyelography (APG) is a useful modality for imaging the upper urinary tract. Little scientific evidence exists concerning optimal pressure while performing an APG. Methods of implementation seem to vary between hospitals as no specific guideline exists. Our aim was to describe current practice patterns in pre-procedural prophylaxis, describe methods of contrast administration, and estimate rate of complications during APG as reported by urologist, in order to stimulate discussion on defining guidelines. A digital questionnaire with 16 questions concerning APG was set out among EAU members via an ESUI twitter link. Fifty urologists from different centers responded. Outcomes were use of antibiotics, used pressure in upper urinary tract, and estimated urosepsis prevalence. Percentages and confidence intervals (95% CI) were calculated. Forty-two percent (95% CI 30–56) of respondents stated that antibiotic prophylaxis was always administered. Fifty-two percent (95% CI 38–65) of urologists sometimes performed a pre-procedural culture. Seventy percent (95% CI 56–81) indicated that administration of contrast during APG was performed using a syringe. A local guideline was only used in 8% of cases (95% CI 2.8–17.9) The self-estimated average percentage of urosepsis as a result of performing an APG was mentioned to be 4% (range 0–20%). Despite a considerable risk of urosepsis, no guideline or consensus exists on how to perform APG. This is urgently needed in order to prevent complications. Low response rate is a major limitation of these findings.

Due to the special anatomy and physiology of the avian urinary system, the value of diagnostic imaging techniques differs from the use in mammals. The diagnostic imaging methods regularly used in practice to evaluate the avian kidneys are often limited to traditional radiography and ultrasonography, whereas other imaging modalities (urography, scintigraphy, computed tomography, MRI) are rarely used. Furthermore endoscopy may be performed and taking a renal biopsy may be considered. The article describes common indications for imaging techniques used to diagnose urinary tract disease as well as its anatomic and pathologic demonstration.

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.

Background and Aim: CT urography is a single comprehensive modality for the diagnosis of patients suspected with hematuria. Hence, the present study was designed to evaluate the efficacy of the diagnostic role of CTU in comparison with other diagnostic modalities. Material and Methods: A total of 83 patients suspected with hematuria between 18-75 years of age presented at the Department of Radio-diagnosis, Kasturba Medical College (KMC), Manipal University, and Mangalore were selected. The patients were subjected to 3 phase CT examination after obtaining informed consent—first was an initial non-contrast phase followed by a nephrographic phase and then pyelographic phase. Patients' demographic details viz. age, gender, and clinical manifestations were recorded. Assessment parameters like sensitivity, specificity, positive predictive value, and negative predictive value were analyzed. Results: The majority of study subjects with hematuria i.e. 28.92% belonged to the age group of 60-70 years followed by 25.30% in 50-60 years and 20.48% fallen in the age group of 40-50 years with male predominance. Ureteroscopy was done for 17 cases, nephroscopy for 4 cases. 6 were radiodense calculi and 2 were radiolucent calculi. USG showed renal, PUJ and one VUJ calculus and hydronephrosis but it was only after CTU ureteric calculi were detected. 9 patients had both renal and ureteric calculi. Cystoscopy was done for 25 cases, out of which 17 cases showed bladder transitional cell carcinoma (TCC). In 14 cases, 11 out of 14 cases showed masses confined to the kidney (

Objectives: To describe the feasibility and safety of ultrasound-guided percutaneous ante- grade pyelography (US-PAP) in pet guinea pigs (Cavia porcellus) with suspected ureteral obstruction. Materials and methods: Six adult pet guinea pigs (4 females and 2 males, all intact) were evaluated for suspected ureteral obstruction. The mean weight of the guinea pigs was 0.8 ± 0.25 kg (range 0.4–1.1 kg), and mean age was 4.07 ± 1.63 years (range 2–7 years). All ani- mals were free from comorbid diseases, had clinical signs of urologic disease and were referred based on either strong clinical suspicion of, or diagnostic imaging of ureteral obstruction. Data on signalment and clinical examination findings, response to anaesthesia and imaging findings were recorded. Results: Partial ureteral obstruction was confirmed in all guinea pigs but one, in which a complete ureteral obstruction occurred. Uroliths were in both ureters of 5 cases and in both the left renal pelvis and ureters in 1 case. All guinea pigs showed a normal appetite and regular defaecation within 2 h following the procedure. No intraoperative or immediate post- operative complications were encountered after the procedure. The only complication was contrast medium leakages in the subcapsular perinephric, retroperitoneal and, in one case, peritoneal space, which caused no overt clinical consequences afterwards. In one male patient, mobilisation of the ureteral calculus occurred and the urolith was found in the urin- ary bladder on the radiograph taken after contrast medium injection. Clinical significance: The US-PAP technique is a useful, safe and easy-to-perform diagnostic tool in guinea pigs with hydronephrosis and hydroureter.

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.

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.

The treatment of ureteral stricture is a challenging task, especially when multiple strictures are present. Here, we report on a 63-year-old male patient diagnosed with hydronephrosis with left ureteral strictures who was admitted to our hospital. During treatment, a left percutaneous nephrostomy tube was inserted for hydronephrosis. Antegrade and retrograde pyelography were performed simultaneously. The results suggested there were 3 segment ureteral strictures in the left ureter: 2 located in the distal ureter and 1 in the proximal ureter. The treatment choices for multiple ureteral strictures are kidney autotransplantation or an ileal ureteral replacement (IUR), which are both morbid procedures and are technically challenging. With the excellent results of lingual mucosal graft (LMG) in ureteroplasty, this patient underwent a one-stage left ureter reconstruction with combined laparoscopic LMG ureteroplasty and ureterovesical reimplantation. However, disease of the oral mucosa and a reduced bladder volume caused by radio cystitis or chemical cystitis, may limit the use of this technique. Regular postoperative antegrade pyelography and the Whitaker test showed the unimpeded drainage of the left ureter. Based on the satisfactory outcome of this patient, combined laparoscopic LMG ureteroplasty and ureterovesical reimplantation for unilateral multiple ureteral strictures is a viable option that has fewer complications.

Background: The differential diagnosis of pelvis renalis cancer (PRC) from renal cell cancer (RCC) is difficult. Because of that, in this study, we compared the standardized uptake value (SUV) with positron emission tomography-computed tomography (PET-CT) of the RCC and PRC. Methods: Twenty-one patients (12 males, 9 females; age range: 33–74 years; mean age ± standard deviation [SD]: 57.14 ± 17.6) with suspected primary renal cell cancer as Group 1 and 8 patients (6 male, 2 female; age range, 61–81; mean age ± SD, 71.5 ± 5.65) with suspected renal pelvis cancer as Group 2 detected by conventional imaging techniques (CT, magnetic resonance [MR] imaging, ultrasound, intravenous urogram, CT urography, MR urography) underwent fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT imaging between August 2010 and October 2012. Results: Mean age is 57.14 (33–74) years in Group 1 and 71.5 (61–81) years in Group 2, respectively. The mean maximum SUV (SUVmax) value was 4.6 ± 2.1 in RCC group and 16.6 ± 6.9 in PRC group. At the 18-FDG PET/CT scanning, SUVmax value higher in patients with PRC than in the patients with RCC. It was statistically different (P Conclusion: We suggested that PET/CT can be used for the differential diagnosis of renal pelvis tumor and RCC. However, further studies with larger patient number are needed to confirm our suggestion. To clarify the mechanisms of underlying these differences, molecular advanced molecular studies are needed.

INTRODUCTION AND OBJECTIVE:The physiology of hydronephrosis is complex, and a well-established definition of obstruction is lacking. Functional magnetic resonance urography (fMRU) has the capacity ...

BACKGROUND The aim of the present study was to describe our totally intracorporeal robotic ileal ureter replacement technique, reporting perioperative and mid-term results and compare it with previous similar experiences, specifically focusing on technical considerations. METHODS Three patients were submitted to robotic ileal ureter substitution for long ureteral defects in our institution during 2019. The procedures were carried out fully intracorporeally. Two patients received a complete replacement of the urinary tract using an ileal segment, while in one patient the lower ureteral stump was maintained, and an ileal-ureter anastomosis was performed distally. Patients' baseline characteristics, as well as perioperative and mid-term results were collected. A detailed description of the technique is reported and compared with prior similar experiences. RESULTS Median operative time was 270 (range 240-300) min. No Clavien-Dindo complication >2 was collected. All patients experienced a fast return to oral intake and canalization. Antegrade pyelography, performed a 1-month follow-up, revealed full passage of the medium contrast in those patients submitted to complete ileal ureter replacement while, in the third one, stenosis at the level of ileal-ureter anastomoses was found. CONCLUSIONS Robotic ileal ureter replacement can be performed completely intracorporeal with optimal results and limited complication rate, in selected cases. According to our considerations, specific surgical steps are needed to reduce the risks related to this procedure, including avoiding partial ileal substitution.

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.

Highlights • Split-bolus CTU has lower radiation dose than single-bolus CTU for all patients. • Radiation dose are positively correlated with body mass index of the patients. • Female and high BMI are significant predictors for higher radiation dose; in contrast, the use of split-bolus CTU is a significant predictor of lower radiation dose. • Females have higher dose reduction proportions than males, which are more than 50%., Objective To compare radiation dose between single-bolus and split-bolus computed tomography urography (CTU). Materials and methods We prospectively enrolled patients undergoing single-bolus and split-bolus CTU from 2019 June to 2020 June. The age, sex and body mass index (BMI) of each patient was recorded and categorized into BMI classes. The radiation dose indices including volumetric computed dose index, size-specific dose estimate, dose length product and effective dose of each patient were compared between 2 CTU groups with calculation of dose reduction proportions (DRPs). Results Seventy-six patients underwent single-bolus (n = 39) and split-bolus (n = 37) CTU. Single-bolus CTU had higher radiation doses than split-bolus CTU and there were statistically significant differences of all radiation dose indices between two CTU groups without and with stratification by sex and BMI classes. The DRPs of volumetric computed dose index, size-specific dose estimate, dose length product and effective dose using split-bolus CTU were 49%, 49%. 50%, and 45%, respectively. Multiple linear regression with an effect size (f2) as 2.24 showed females (p = 0.027) and higher BMI classes (p = 2.38 *10−9) were associated with higher effective doses; and split-bolus CTU, lower effective doses (p = 5.40 *10−15). Using split-bolus CTU, females had consistently higher DRP of all radiation dose indices than males (54–55% versus 40–42%). Overweight patients had the largest DRP as 55% of effective dose. Conclusions Split-bolus CTU could be preferred by its significant radiation dose reduction effect in regard to single-bolus CTU, which was most profound in females and overweight patients.

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.

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.

Three-phase CT urography (CTU) is the gold standard for evaluating the upper urinary tract in patients with hematuria. We aimed to evaluate the accuracy of CTU for detecting upper urothelial cell carcinomas (UCC) in patients with hematuria and negative cystoscopy. Secondly, we aimed to determine the tumor visibility on each CTU phase. This retrospective study included all patients with hematuria referred to CTU after a negative cystoscopy during 2016 and 2017. The original CTU reports were dichotomized as negative or positive. All patient charts were reviewed after a minimum of 18-month follow-up in order to register missed cancers. The results of biopsies and clinical follow-up were used as the reference standard. Two reviewers retrospectively evaluated the tumor visibility of each CT sequence in all true-positive CTUs. We included 376 patients with hematuria who underwent CTU after a negative cystoscopy. Macroscopic and microscopic hematuria occurred in 87% (327) and 13% (49), respectively. The incidence of upper urothelial cell carcinoma was 1.9% (7), and the sensitivity of CTU was 100% (95% CI, 59–100), specificity was 99% (95% CI, 98–100), positive predictive value was 88% (95% CI, 47–99), and negative predictive value was 100% (95% CI, 99–100). The accuracy was 99% (95% CI, 90–100). All UCCs were visible on the nephrographic phase for both reviewers. CTU is highly accurate for detecting upper UCCs. All cases were seen on the nephrographic phase. This suggests that the CTU protocol can be simplified. • CT urography is highly accurate for detecting upper urothelial cell carcinomas. • All cancers were seen on the nephrographic phase. • All cancers were detected in patients with macroscopic hematuria.

Objective To model the risk of radiation-induced malignancy from computed tomography urography (CTU) in evaluation of gross hematuria and contrast this with the benefits of urinary tract cancer detection when compared to renal ultrasound. Methods A PUBMED-based literature search was performed to identify model inputs. Estimates of radiation-induced malignancy rates were obtained from the Biological Effects of Ionizing Radiation VII report with dose extrapolation using the linear no-threshold model. Results Male gender and age over 50 years were associated with a relative risk of upper tract malignancy of 2.04 and 2.95, respectively. The risk of upper tract malignancy missed by renal ultrasound ranged from 0.055% in females under 50 to 0.51% in males over 50. Risk of CTU-induced malignancy with associated loss of life expectancy ranged from 0.25% and 0.027 years in females under 50 to 0.08% and 0.0054 years in males over 50. For CTU to be superior to renal ultrasound, an undiagnosed upper tract malignancy would have to carry a loss of life expectancy of 49.2 years in females under 50, 13.4 years in males under 50, 2.6 years in females over 50, and 1.1 years in males over 50. Conclusion In low-risk patients, CTU for evaluation of gross hematuria may carry a significant risk of radiation-induced secondary malignancy relative to the diagnostic benefit offered over renal ultrasound

Aim: The value of the peripheral blood lymphocyte subpopulation ratios and tumor diameter for prognosis in bladder cancer (BC) patients needs to be explored. Materials & methods: A total of 161 male BC patients and 68 male normal controls were retrospectively reviewed. The value of combining predictor consisted of both CD4+CD25+/CD4+ and computed tomography urography tumor diameter (CTU-D) on stage, overall survival (OS) and recurrence probability was analyzed by logistic regression, Kaplan–Meier method and log-rank test. Results: The combining predictor was a statistically independent risk for stage; dramatic differences in OS and recurrence probability were found between the combining predictor-high (cut-off point >0.08) and combining predictor-low groups (cut-off point ≤0.08). Conclusion: The combining predictor could be a significant predictor for advanced stage, OS and recurrence probability in male patients with BC.

Computerized tomography urography is used to evaluate patients with gross or microscopic hematuria. Computerized tomography urography is a high radiation dose scan and, thus, it confers a higher risk of secondary malignancy. A computerized tomography urography split bolus protocol reduces radiation exposure but it may reduce sensitivity. In this study we used a theoretical cohort of patients with hematuria in which to model the risk of missing malignancies against the benefit of averting secondary malignancies.We calculated the prevalence of renal cell carcinoma and upper tract urothelial carcinoma in patients with hematuria by pooled analysis of cohort studies, which in conjunction with split bolus sensitivity allows for the estimation of missed malignancies. The number of prevented secondary malignancies was calculated from lifetime attributable risk estimates. Sensitivity analyses were run to determine the minimum sensitivity required for a net population benefit.Estimates of split bolus computerized tomography urography sensitivity ranged from 80% to 100% (mean 95.2%). At the low estimate of 80% sensitivity split bolus computerized tomography urography was beneficial in men and women with microscopic hematuria at ages less than 50 and less than 60 years, respectively. An increase in sensitivity to 90% improved the benefit 1 decade in each gender, representing 68.8% of patients with microscopic hematuria. The overall population of patients with microscopic hematuria benefited from split bolus computerized tomography urography at 91.1% sensitivity. However, in patients with gross hematuria the threshold for an overall population benefit was high at 98.4% sensitivity.Exposure to ionizing radiation risks causing secondary malignancy. These data indicate that split bolus computerized tomography urography may be performed safely in 70% of the population of patients with microscopic hematuria. However, it is not currently advisable in patients with gross hematuria or in other patients at high risk.

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.

Upper urinary tract urothelial carcinoma is staged using the TNM classification of malignant tumors. Preoperative TNM is important for treatment planning. Computed tomography urography is now widely used for clinical survey of upper urinary tract carcinoma because of its diagnostic accuracy. Computed tomography urography is recommended as the first-line imaging procedure in several guidelines. Several reports stated that computed tomography urography is also useful for staging. However, no educational and practical reviews detailing the T staging of upper urinary tract urothelial carcinomas using imaging are available. We discuss the scanning protocol, T staging using computed tomography urography, limitations, magnetic resonance imaging, computed tomography comparison and pitfalls in imaging of upper urinary tract urothelial carcinoma. A recent study reported the high diagnostic accuracy of computed tomography urography with respect to T3 or higher stage tumors. To date, images that show a Tis-T2 stage have not been reported, but various studies are ongoing. Although magnetic resonance imaging has lower spatial resolution than computed tomography urography, magnetic resonance imaging can be carried out without radiation exposure or contrast agents. Magnetic resonance imaging also offers the unique ability of diffusion-weighted imaging without contrast agent use. Some researchers reported that diffusion-weighted imaging is useful not only for detecting lesions, but for predicting the T stage and tumor grade. We recommend the appropriate use of computed tomography and magnetic resonance while considering the limitations of each modality and the pitfalls in upper urinary tract urothelial carcinoma imaging.

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. This article reviews the published literature on CTU protocol optimization, including contrast bolus timing, dose reduction, reconstruction algorithms, and ancillary practices. 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.

Congenital obstructive Uropathies are a leading cause of Chronic Kidney Disease in children. The gold-standard for renal functional imaging is Diuretic Renal Scintigraphy. Different alternatives to Renal Scintigraphy have been suggested, many of them based on Magnetic Resonance Imaging (MRI). The accurate morphologic details of MRI with its more specific application - MR-Urography are well known. The prospect of adding functional information is very attractive, as it will make the MRU a comprehensive “all in one” examination for obstructive uropathies. We chose to investigate DCE MR urography and DTI as tools for the evaluation of congenital obstructive uropathies. Also, we suggest a different technique that describes the urinary flow in the collecting system – phase contrast imaging of the urinary flow in the renal pelvis. Therefore we performed three different studies, all with different sets of patients.

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.

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.

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.

Background: Obstructive uropathy is an important cause of chronic renal failure in children. Obstruction of the urinary tract blocks adequate urine flow. It causes urine stasis, and predisposes the child to asymptomatic bacteruria (ABU) that needed to be followed up to early detect symptomatic UTI. Objective: Screening of ABU in children who were suffering from obstructive uropathy to avoid unnecessary use of antibiotics, early detection and treatment of children who developed symptomatic urinary tract infection (UTI), and relation between type of obstructive uropathy and body growth. Patients and methods: Cross sectional descriptive study was conducted on 50 children with different types of obstructive uropathy. They were selected according to certain inclusion and exclusion criteria from Pediatric Nephrology and Urology outpatient clinics at Al- Hussein University Hospital. Their ages ranged from 2.2 to 11 years. They were subjected to full medical history, complete clinical examination, and routine investigations including renal function tests, urine analysis, urine culture, and imaging studies (included pelvi-abdominal ultrasonography, magnetic resonance urography, renal scan and voiding cystourethrogram). Results: Obstructive uropathy was more common in males (62%) than females (38%), while ABU was common in females. The growth of our patients was not affected by different types of obstructive uropathy. 68% of patients had no bacterial growth, while 32% had bacterial growth in urine culture. The commonest organism was E coli (56.25%). Glomerular filtration rate (GFR) was not significantly affected by different types of obstructive uropathy. Conclusion: Obstructive uropathy can predispose to colonization of bacteria in urinary tract and development of asymptomatic bacteruria especially in females that needs to be followed up. Follow up is needed to early detect symptomatic UTI.

Emphysematous pyelonephritis (EPN) is a life-threatening renal infection characterized by the formation of gas within the renal parenchyma and collecting duct system, as well as perinephric tissues. We herein report a case of bilateral EPN accompanied by the urinary tract infection caused by spherical growth of Candida albicans in a patient with underlying diabetes mellitus and prostate cancer. The diagnosis was assisted by computed tomography, urography, and gram staining. Despite immediate percutaneous catheter drainage and a 4-week course of antifungal treatment, the C. albicans infection was refractory, as indicated by continuous isolation from the urine, and the patient eventually died. A local autopsy of urinary organs revealed C. albicans in the renal tissue. EPN caused by Candida species frequently occurs in men, and almost all cases have underlying poorly controlled diabetes. This condition is subject to delayed diagnosis, which may lead to extended disease and high mortality. Candida species should be considered as causative microorganism for refractory EPN in patients with poorly controlled diabetes who are receiving antibiotic treatment. Gram staining may contribute to an early diagnosis of EPN caused by Candida species, which may require long-term antifungal therapy.

Introduction: MR urography has been utilised to evaluate entire urinary system with advantage of not using ionizing radiation. Differentiate between physiological hydronephrosis from pathological is main concern in pregnant patients. Early identification of hydronephrosis in cases of ca cervix is required for better prognosis. So, present study was conducted to asses hydronephrosis in these patients with MR urography. Materials and Methods: A cross sectional prospective study was carried out on sonographically detected hydronephrosis in thirty Obstetric & Gynaecology patients including 17 pregnant women. Discussion: MR urography was performed using two techniques- static and excretory urography. Static MR Urography utilizes urine as a static fluid for demonstration of bilateral ureters whereas contrast is used in excretory urography. In instances of pregnant patients, physiologic dilatation exhibited a trademark decreasing tapering due to extrinsic obstruction of the middle third of the ureter by the uterus, more common on the right side. High sensitivity had been accounted for detection of urinary tract dilatation and identification of the site of obstruction. Conclusion: MR urography provides excellent imaging of entire urinary system giving exact etiology of hydronephrosis in cases of pregnant patients as well as in cases of carcinomas of female pelvis origin without use of ionising radiation. Keywords: Hydronephrosis, MR urography, Ca cervix.

Objective To investigate the anatomic relationship between ureter and oblique lateral interbody fusion access by using contrast-enhanced computed tomographic urography. Methods Contrast-enhanced computed tomographic urography data of 234 patients were retrospectively analyzed. The angle of inclination (∠α) of bilateral ureters, the angle between bilateral surgical accesses (∠β), the insertion angle of surgical access (∠γ), and the angle between ureter and outer margin of ipsilateral surgical access (∠e) at L2/3, L3/4, and L4/5 levels were measured and analyzed. Results ∠α gradually increased from L2/3 to L4/5. ∠β gradually decreased from L2/3 to L4/5, and at each level the left-sided ∠β was larger than right-sided ∠β. ∠e were positive at L2/3 and left-sided L3/4. The right-sided ∠e at L3/4 and the bilateral sided ∠e at L4/5 were negative, and the right-sided ∠e at L4/5 had the largest absolute value. Conclusions The bilateral ureters gradually descents from the lateral margin to the anteromedial margin on the surface of psoas major muscle. The range of bilateral surgical accesses for oblique lateral interbody fusion gradually decreases from L2/3 to L4/5, and the left-sided access is larger than the right-sided when at the same level. Ureters at the right-sided L3/4 level and bilateral L4/5 levels are at high risk of being injured. In particular, the right ureter at the L4/5 level is most likely to be injured.

Hematuria evaluation remains a common problem, particularly in patients who smoke and are at risk for urothelial tumors. Lifetime surveillance of the urothelium is often required once urothelial cancer is diagnosed. Computed tomography urography (CTU) has exquisite sensitivity and specificity for identification of renal and urothelial lesions. The examination is well accepted by patients and physicians. Possible harms include radiation exposure and contrast-induced nephropathy. MR imaging is also an accurate test, but requires longer exam times, and may not demonstrate stones. We present the technical and interpretation skills required to use MR urography and CTU effectively.

Arterio-ureteral fistula (AUF) is a rare, but life-threatening disease that causes massive hematuria. We present a case of a 43-year-old female with AUF successfully treated with coil embolization and deployment of endovascular stents, along with a literature review. AUF symptoms most commonly occur with intermittent hematuria. AUF can occur in association with ureteral stenting, radiation, and prior pelvic or vascular surgery. Arteriography or ureteral pyelography are recommended as the most effective diagnostic strategies. Recent treatment efforts have focused on the use of endovascular stenting techniques as an alternative to open surgery.

Renal imaging (scintigraphy, intravenous urography (IVU) and computed tomography urography (CTU)) are non-invasive procedures that provide information essential in the diagnosis and treatment of renal disorders. The importance of these procedures notwithstanding, radiation exposure to the different tissues and organs could result in diverse reaction possibilities of varying severity. Accordingly, patient dose measurement of such exposures represent an essential step in seeking radiation dose optimization. Present study seeks to quantify effective doses for paediatric patients undergoing renal scintigraphy, IVU and CTU procedures using technetium-99m-diethylene-triamine-pentaacetic acid. Patients population consist of 116 patients (68 boys and 48 girls) were investigated using an Orbiter 37 single-head gamma camera, a digital imaging system and a dual-slice CT detector unit. Patient effective doses were estimated, administered activity ranging between 37.0 and 129.5 MBq per procedure. The mean effective dose and range (in mSv) for renal scintigraphy, CT Urography and IVU procedures were 1.0, 0.98 and 0.6 mSv per procedure respectively. The associated radiation risk estimates per procedure range between 80 and 130 cancers per one million procedures. Patients undergoing renal scintigraphy and CTU procedures received comparable doses such that if CT parameters are optimized this then allows the referring physician to consider the best diagnostic outcome regardless of modality selected.

Context: A ureteral stricture is a serious complication of ureteroscopy (URS) that was reported in the literature in highly variable rates from 0.2% to 24%. Aims: Our aims are to estimate the incidence and to detect the risk factors of ureteral stricture after URS. Settings and Design: This is a prospective, case-series study. Materials and Methods: During the period from May 2015 to August 2016, 251 adult patients underwent 263 URS for the treatment of 304 ureteral stones. Postoperative regular follow-up was done for 12 months by ultrasound. Computed tomography urography and diuretic renogram were performed for the cases developed hydronephrosis to confirm and detect the level of the stricture. Statistical Analysis: IBM SPSS Statistics for Windows, Version 19.0, Armonk, NY: IBM Corp. used for data analysis. Chi-square and Fisher's exact tests were used to compare between qualitative variables. Mann–Whitney test was used to compare between two quantitative variables in case of nonparametric data. Multiple logistic regression analysis was done to measure the risk factors. P value was considered statistically significant when

BACKGROUND: Most congenital anomalies of the urinary tract present with hydronephrosis. Some are physiological while others pathological. Ultrasound, micturating cyst urethrography, dynamic renal scintigraphy, intravenous urography, dynamic and static magnetic resonance urography are used for examination. Currently, renal arterial Doppler resistance index is used as complimentary mechanism. This study assesses our experience in resistive index measurement in differentiating obstructive from non-obstructive hydronephrosis in children.METHODS: A cross-sectional study of forty-two infants and children (

Introduction Congenital hydronephrosis (CH) is a condition with dilated renal pelvis with or without dilation of renal calyces. Aim To examine the role of magnetic resonance urography in the detection of congenital hydronephrosis in comparison to dynamic renal scintigraphy (DRS). Patients and methods Resarch included 58 (n=58) patients with diagnosis of congenital unilateral or bilateral dilatation of kidney duct system. Each patient had a one-time or multiple hospitalization at the Nephrology Department of the Pediatric Clinic, with performed: ultrasound which confirmed CH, voiding cystourethrography / voiding urosonography was confirmed based on which the vesicoureteral reflux (VUR) was established / excluded, dynamic renal scintigraphy and magnetic urography (analysis was made by CHOP-fMRU software) on the basis of which the uterine anatomy and the relative renal function were evaluated. Results Male patients were represented in 40 cases (69%). The average age was 4.4 ± 4.3 years with the youngest patient at the age of 2 months, and the oldest was 17 years old. According to diagnostic entities, the most common diagnosis was ureteropelvic junction (UPJ) obstruction in over half of cases (30 or 51.7%), followed by subjects with ureterovesical junction (UVJ) obstruction (11 or 19%), VUR was recorded in 9 (15.5%) cases, and pyelon fissus in 7 (12.1%), and one case (1.7%) was recorded with bilateral megaureter. Comparison of the value of the renal function obtained with DRS and CHOP-fMRU methods shows that there were no statistically significant differences between two methods. In the case of right kidney, the mean DRS value was 53.4 ± 18.4% (range 13-100%), while CHOP-fMRU was 51.8 ± 22.4 (range 0-96.7%). In the case of left kidney, the average value according to the DRS method was 46.9 ± 18.9% (range 0-87%) and according to CHOP-fMRU 47.6 ± 21.5% (range 8.3-100%). The correlation coefficients of both right and left kidneys show a highly statistically significant correlation between these two methods. Conclusion Magnetic resonance urography in the pediatric population in CH based on results should be an integral part of the management of these patients, especially in congenital obstructive uropathy, in complex and associated congenital anomalies, as it provides morphological and functional data on the state of the kidneys and urinary tract.

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.

Purpose To investigate the effect of diagnostic ureteroscopy (URS) on the delay to surgical treatment of upper tract urothelial carcinoma (UTUC) detected by imaging and the risk of intravesical recurrence. Materials and methods We undertook a retrospective case-note analysis of all patients who underwent radical nephroureterectomy (NUU) from November 2012 to July 2019. We identified those who underwent diagnostic ureteroscopy prior to NUU as Group 1 and those who did not undergo diagnostic URS as Group 2. Perioperative and pathological parameters were compared between both groups. Kaplan-Meier and Log-Rank analyses were used to compare delay to NUU and the intravesical recurrence (IVR) free survival. Cox regression models were employed to analyze the risk factors of intravesical recurrence. Results Out of 69 patients with a mean age of 71.3 years and a mean follow-up of 48.5 months, 49 (71%) underwent URS while 20 (29%) did not. The mean time between the computerized tomography urography (CTU) and surgery was 86 days with URS and 59 days in the control groups(p=0.007). Intravesical recurrence in year one postoperatively was 28.2 % in the URS group vs 5.9% in the control group (p=0.04). The Kaplan-Meier curve showed improved, yet insignificant, IVR-free survival for the control group (Log-Rank p-value=0.21). In multivariate Cox regression analysis, concomitant bladder carcinoma was an independent risk factor for IVR (HR, 15.01; 95%CI, 3.311 - 68.07; p=0.0004). Intravesical mitomycin-c was a protective factor (HR 0.154; 95%CI 0.025 - 0.922; p=0.040). Conclusion In our retrospective single-unit study, diagnostic ureteroscopy for CTU-detected upper tract urothelial carcinoma delayed definitive surgical treatment. Furthermore, it was associated with a significantly increased risk of early intravesical recurrence. URS can provide useful information and reassurance prior to major surgery but must be used with caution in light of these findings.