succimer and Urinary-Calculi

Over the past 10 years new imaging and interventional techniques have drastically changed the ease and scope of urologic diagnosis and treatment. It is both rewarding and exciting to approach each clinical problem with a broad armamentarium of available studies, always seeking the most efficient and direct route to diagnosis. Similarly, radiologic interventional techniques are potentially applicable to a multitude of problems and should be innovatively considered in the urologic patient including patients in the pediatric age group.

Topics: Abscess; Child; Child, Preschool; Female; Humans; Hydronephrosis; Ileum; Infant; Iodohippuric Acid; Kidney; Kidney Diseases; Male; Pentetic Acid; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Tomography, X-Ray Computed; Ultrasonography; Ureteral Obstruction; Urethra; Urinary Bladder; Urinary Calculi; Urinary Diversion; Urologic Diseases; Vesico-Ureteral Reflux

17 children from 18 months to 16 years old were treated by ESWL for calculi of the upper urinary tract using a Sonolith 3000 lithotriptor. 31 calculi (5 to 60 mm) have been treated on 16 renal units and 3 pelvic ureters. The renal parenchyma of all treated kidneys was considered normal on preoperative ultrasound and IVU; 8 patients had a preoperative DMSA. The treatment required 1 to 4 sessions delivering 400 to 3000 shocks per session and 400 to 6000 shocks per treatment at 14 kV. Within three months post treatment, 14 patients (88.23%) were stone free and 3 patients had residual fragments (2 needed further surgical extraction). With a follow up of three months to five years, all patients have a normal blood pressure, serum creatinine and sterile urine. In no instance, IVU or ultrasound revealed a lesion imputable to ESWL. Seven patients had a DMSA six months or more after the last session; 4 of these were normal but the three other patients had a loss of function and an heterogeneous fixation on the treated side. These preliminary results confirm that ESWL is efficient for upper urinary tract calculi destruction in children. However ESWL seems to be susceptible to induce parenchymal damage, detected by DMSA, whose incidence and long term effects particularly on blood pressure need further evaluation.

Topics: Adolescent; Child; Child, Preschool; Follow-Up Studies; Humans; Infant; Kidney Diseases; Lithotripsy; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Treatment Outcome; Urinary Calculi

Eighteen patients were evaluated before and 5 weeks after the first treatment with extracorporeal shock wave lithotripsy (ESWL) using abdominal plain radiography, 131I-hippuran probe renography, and 99mTc-dimercaptosuccinic acid scintigraphy. In 6 patients no urolithiasis was present on the post ESWL plain radiograph, in 7 the size had decreased, and in 5 the stone mass was unchanged. The renograms were within normal range in the 6 patients who were cured by ESWL, whereas this was the case for only 4 of the 12 who still had renal calculi. In 2 patients pelvic stones had descended into the ureter after ESWL, and the renograms indicated obstruction. Another 3 patients had ureteral stones, whereas in the remaining 7 patients only pelvic stones were found on the plain radiographs. In no patient did the scintigrams reveal scars. It is concluded that abdominal plain radiography of the urinary tract and probe renography are complementary and sufficient in the monitoring of patients with urolithiasis post ESWL.

Topics: Adult; Aged; Female; Humans; Iodine Radioisotopes; Iodohippuric Acid; Kidney; Lithotripsy; Male; Middle Aged; Organotechnetium Compounds; Radiography; Radioisotope Renography; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Calculi

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Kidney; Lithotripsy; Male; Middle Aged; Organometallic Compounds; Radioisotope Renography; Succimer; Sulfhydryl Compounds; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Calculi; Urinary Tract Infections

Radionuclide renography and renal scanning techniques are ideally suited to the initial and follow-up evaluation of patients with obstructive uropathy. While other modalities are superior in their ability to provide anatomic information, the radionuclide study yields functional information for each kidney without the necessity to resort to invasive studies. In addition, the Nuclear Medicine study is well suited to the evaluation of obstruction where serial studies often are required because of a lower radiation burden compared to urography. This lower radiation dose is especially important in obstruction because of the recurrent nature of several kinds of obstructive uropathy and because of the high incidence in the pediatric age group. The ability to control urine flow rate during the procedure through dehydration or administration of diuretics is an additional benefit. Increasing availability of computerization of nuclear medicine procedures as well as interest in studies employing physiologic intervention (including the diuresis renogram) have assured an important place for radionuclide studies in the evaluation of patients with urinary obstruction.

Topics: Adult; Aged; Female; Furosemide; Humans; Iodine Radioisotopes; Iodohippuric Acid; Kidney Diseases; Male; Pentetic Acid; Pyelonephritis; Radiation Dosage; Radioisotopes; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Tomography, Emission-Computed; Urinary Calculi; Urinary Tract; Urination Disorders