shu-508 and Ureteral-Obstruction

To evaluate, in the present long-term follow-up study, contrast-enhanced color Doppler imaging (CDI) findings and the clinical outcome of patients with crossing vessels at the obstructed ureteropelvic junction (UPJ), who underwent laparoscopic pyeloplasty. In a previous study, contrast-enhanced CDI proved capable of detecting crossing vessels at the UPJ.. A total of 23 patients, who had undergone laparoscopic pyeloplasty and displacement of crossing vessels for UPJ obstruction at least 2 years before this study (mean 27 months), underwent contrast-enhanced CDI, intravenous urography, and renography. Contrast-enhanced CDI was performed using intravenously administered Levovist to assess the displacement of the vessels relative to the UPJ. All patients completed analog follow-up pain scales and quality-of-life assessment questionnaires. RESULTS. Contrast-enhanced CDI revealed a cranial displacement (mean 1.3 cm) of the crossing vessels from the UPJ in all 23 cases. Intravenous urography showed a decrease in the degree of hydronephrosis, with a success rate of 100% in low-grade and 86% in high-grade hydronephrosis. The split renal function improved from 39.7% to 48.1%. Analog pain scale measurements demonstrated a mean improvement in pain of 92% (range 73% to 100%) and a mean quality-of-life score of 94 (range 78 to 100).. Our series of patients with crossing vessels at the UPJ treated by laparoscopic pyeloplasty showed an excellent long-term successful outcome. Contrast-enhanced CDI allows for preoperative detection, as well as postoperative assessment, of the displacement of the crossing vessel. We recommend that the presence of a crossing vessel be routinely determined preoperatively, because it may influence the choice of treatment modality and thereby the clinical outcome.

Topics: Adolescent; Adult; Aged; Contrast Media; Female; Follow-Up Studies; Humans; Kidney; Laparoscopy; Male; Middle Aged; Polysaccharides; Treatment Outcome; Ultrasonography, Doppler, Color; Ureteral Obstruction

To investigate the feasibility of imaging crossing vessels at the ureteropelvic junction (UPJ) preoperatively by means of contrast agent-enhanced color Doppler imaging (CDI).. Twenty-nine patients (13 female patients, 16 male patients; age range, 17-76 years; mean age, 45 years) with symptomatic UPJ obstruction were examined with CDI before and after intravenous infusion of the contrast agent. The type (i.e., arterial or venous) and position of the vessel relative to the UPJ (i.e., anterior or posterior) were assessed. The CDI findings were correlated with the surgical findings at laparoscopic pyeloplasty.. Among the 29 patients, crossing vessels were detected with nonenhanced CDI in 15 patients, with enhanced CDI in 22 patients, and with laparoscopy in 23 patients. Enhanced CDI depicted crossing vessels in 22 (96%) of the 23 laparoscopically confirmed cases compared with nonenhanced CDI, which depicted 15 (65%) of the 23 cases. The rate of detecting crossing vessels increased significantly with use of the contrast agent (P < .016, McNemar test).. Compared with nonenhanced CDI, contrast-enhanced CDI significantly improves the detection of crossing vessels at the UPJ and is useful in the presurgical evaluation of UPJ obstruction.

Topics: Adolescent; Adult; Aged; Contrast Media; Feasibility Studies; Female; Humans; Image Enhancement; Infusions, Intravenous; Kidney Pelvis; Laparoscopy; Male; Middle Aged; Polysaccharides; Renal Artery; Renal Veins; Ultrasonography, Doppler, Color; Ureter; Ureteral Obstruction