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Taehan Yongsang Uihakhoe Chi Jan 2020Voiding cystourethrography (VCUG) demonstrates the anatomy of the urinary system and is used to detect the presence/absence of vesicoureteral reflux. It is the most... (Review)
Review
Voiding cystourethrography (VCUG) demonstrates the anatomy of the urinary system and is used to detect the presence/absence of vesicoureteral reflux. It is the most important modality for urological fluoroscopic examination in children. For improved patient care, it is important to understand and perform VCUG appropriately. Therefore, an in-depth review of VCUG protocols and techniques has been presented herein. In addition, tips, tricks, and pitfalls associated with the technique have also been addressed.
PubMed: 36238127
DOI: 10.3348/jksr.2020.81.1.101 -
Kidney International Aug 2016
Topics: Adult; Creatinine; Cystography; Cystoscopy; Edema; Foot; Glomerular Filtration Rate; Hemoglobins; Humans; Hypertension; Lipomatosis; Magnetic Resonance Imaging; Male; Rare Diseases; Tomography, X-Ray Computed; Ultrasonography; Urethra; Urinary Bladder; Urinary Bladder Diseases; Urography
PubMed: 27418096
DOI: 10.1016/j.kint.2016.05.009 -
Journal of Injury & Violence Research Jul 2019Injuries to the bladder are infrequent and commonly result from blunt, penetrating, or iatrogenic trauma. Bladder injuries may be missed as they often present... (Review)
Review
Injuries to the bladder are infrequent and commonly result from blunt, penetrating, or iatrogenic trauma. Bladder injuries may be missed as they often present concomitantly with other abdominal and pelvic injuries; however, early detection and treatment are essential as morbidity and mortality may be significant. Gross hematuria, especially in the setting of pelvic fractures, may be indicative of a bladder injury which can be confirmed with cystography. Extraperitoneal injuries are commonly managed conservatively with catheter drainage while intraperitoneal ruptures traditionally required surgical exploration and closure. Presented is a contemporary review which encapsulates the etiology, presentation, assessment, and management of bladder injuries.
Topics: Adult; Conservative Treatment; Diagnostic Imaging; Early Diagnosis; Humans; Urinary Bladder; Wounds and Injuries
PubMed: 30979861
DOI: 10.5249/jivr.v11i2.1069 -
Tomography (Ann Arbor, Mich.) Oct 2022Computed tomography angiography (CTA) has been the gold standard imaging modality for vascular imaging due to a variety of factors, including the widespread availability... (Review)
Review
Computed tomography angiography (CTA) has been the gold standard imaging modality for vascular imaging due to a variety of factors, including the widespread availability of computed tomography (CT) scanners, the ease and speed of image acquisition, and the high sensitivity of CTA for vascular pathology. However, the radiation dose experienced by the patient during imaging has long been a concern of this image acquisition method. Advancements in CT image acquisition techniques in combination with advancements in non-ionizing radiation imaging techniques including magnetic resonance angiography (MRA) and contrast-enhanced ultrasound (CEUS) present growing opportunities to reduce total radiation dose to patients. This review provides an overview of advancements in imaging technology and acquisition techniques that are helping to minimize radiation dose associated with vascular imaging.
Topics: Humans; Drug Tapering; Magnetic Resonance Angiography; Tomography, X-Ray Computed; Computed Tomography Angiography; Cystography
PubMed: 36287818
DOI: 10.3390/tomography8050219 -
Scientific Reports Feb 2021To evaluate the safety and efficacy of laparoscopic bladder muscle flap reconstruction in the treatment of extensive ureteral avulsion. Patients with full-length (re...
To evaluate the safety and efficacy of laparoscopic bladder muscle flap reconstruction in the treatment of extensive ureteral avulsion. Patients with full-length (re length > 20 cm) and upper ureteral (avulsion length > 10 cm) defects were eligible. All patients were treated with laparoscopic bladder muscle flap reconstruction. Peri-operative information and post-operative complications were recorded. The kidney function, urinary ultrasound or computed tomography (CT), sun-renal function tests emission computed tomography (ECT) and cystography after operation were recorded. Ten patients were included (7 with full-length and 3 with upper ureteral defects). Median age was 56 years and 70% of them were female. The average operation time and blood loss was 124 min and 92.2 ml. There was no treatment-related adverse effects including urinary leakage, renal colic, fever, etc. The median follow-up was 18.5 months (3-39 months). The surgery did not significantly alter the renal function and separation degree of the renal pelvis during long-term follow-up. Double J stents were removed in nine patients (90%) within six months after operation. Only one case was diagnosed with post-operative anastomotic stricture, and subsequently received laparoscopic ipsilateral nephrectomy one year after the reconstruction operation. All cases had normal voiding and pear-shaped cystography. Laparoscopic bladder flap repair is a safe and effective treatment approach together with several advantages for patients with full-length or upper ureteral avulsion.
Topics: China; Constriction, Pathologic; Female; Humans; Kidney; Laparoscopy; Male; Middle Aged; Operative Time; Postoperative Complications; Plastic Surgery Procedures; Surgical Flaps; Ureter; Ureteral Obstruction; Urinary Bladder; Urologic Surgical Procedures
PubMed: 33597578
DOI: 10.1038/s41598-021-83518-0 -
Arab Journal of Urology Mar 2015The finding of an incompetent bladder neck (BN) at the time of posterior urethroplasty will necessarily exacerbate the already difficult situation. In such cases the aim... (Review)
Review
The finding of an incompetent bladder neck (BN) at the time of posterior urethroplasty will necessarily exacerbate the already difficult situation. In such cases the aim of the treatment is not only to restore urethral continuity by end-to-end urethral anastomosis, but also to restore the function of the BN to maintain urinary continence. Fortunately, the incidence of incompetence of the BN at posterior urethroplasty is uncommon, usually ≈4.5%. It seems that pelvic fracture-related BN injuries, in contrast to urethral injuries which result from a shearing force, are due to direct injury by the sharp edge of the fractured and displaced pubic bone. The risk of injuries to the BN is greater in children, in patients with a fracture involving both superior and inferior pubic rami on the same side, and in those managed initially by primary realignment. An incompetent BN is suspected by finding an open rectangular BN on cystography, and a fixedly open BN on suprapubic cystoscopy. An incompetent BN can be treated either subsequent to or concomitant with the urethral repair, according to whether a perineal or a perineo-abdominal urethroplasty is used, respectively. Several options have been reported to treat pelvic fracture-related BN incompetence, including reconstructing the BN, forming a new sphincter by tubularisation of a rectangular flap of the anterior bladder wall, and mechanical occlusion by an artificial sphincter or collagen injection. Reconstruction of the BN by the Young-Dees-Leadbetter∗∗ procedure probably provides the most successful results.
PubMed: 26019982
DOI: 10.1016/j.aju.2015.02.004 -
PloS One 2022The purpose of this study was to evaluate and compare positive cystography techniques at 5%, 10%, and 20%, as well as three different double-contrast protocols for...
The purpose of this study was to evaluate and compare positive cystography techniques at 5%, 10%, and 20%, as well as three different double-contrast protocols for detecting radiolucent uroliths with a diameter of less than 3.0 mm in dogs. Six cadavers were used, one was selected at random to represent the negative control, and the others were submitted to urolith implantation in the bladder by urethral catheter. Three radiology professionals blindly accessed ventrodorsal and -lateral projections of each test. Contrast at 20% showed greater diagnostic sensitivity, but with greater difficulty identifying the number and size of the uroliths. Consequently, double-contrast techniques are better and should be used for diagnostic and therapeutic planning. Sensitivity and specificity tests demonstrated that positive 5% cystography and different concentrations of double contrast obtained better results in terms of sensitivity and specificity. However, due to the presence of a greater amount of artifacts in the 5% cystography, it is suggested that double contrast is used for this purpose, especially with the removal of contrast excess (protocol 2).
Topics: Animals; Dog Diseases; Dogs; Radiography; Sensitivity and Specificity; Urinary Bladder; Urinary Calculi
PubMed: 36137162
DOI: 10.1371/journal.pone.0274087 -
Pediatric Radiology Dec 2023A first febrile urinary tract infection (UTI) is a common condition in children, and pathways of management have evolved over time. (Review)
Review
BACKGROUND
A first febrile urinary tract infection (UTI) is a common condition in children, and pathways of management have evolved over time.
OBJECTIVE
To determine the extent to which pediatricians and surgeons differ in their investigation and management of a first febrile UTI, and to evaluate the justifications for any divergence of approach.
MATERIALS AND METHODS
A literature search was conducted for papers addressing investigation and/or management following a first febrile UTI in children published between 2011 and 2021. Searches were conducted on Medline, Embase, and the Cochrane Controlled Trials Register. To be eligible for inclusion, a paper was required to provide recommendations on one or more of the following: ultrasound (US) and voiding cystourethrogram (VCUG), the need for continuous antibiotic prophylaxis and surgery when vesicoureteral reflux (VUR) was detected. The authorship required at least one pediatrician or surgeon. Authorship was categorized as medical, surgical, or combined.
RESULTS
Pediatricians advocated less imaging and intervention and were more inclined to adopt a "watchful-waiting" approach, confident that any significant abnormality, grades IV-V VUR in particular, should be detected following a second febrile UTI. In contrast, surgeons were more likely to recommend imaging to detect VUR (p<0.00001), and antibiotic prophylaxis (p<0.001) and/or surgical correction (p=0.004) if it was detected, concerned that any delay in diagnosis and treatment could place the child at risk of kidney damage. Papers with combined authorship displayed intermediate results.
CONCLUSION
There are two distinct directions in the literature regarding the investigation of an uncomplicated first febrile UTI in a child. In general, when presented with a first febrile UTI in a child, physicians recommend fewer investigations and less treatment, in contrast to surgeons who advocate extensive investigation and aggressive intervention in the event that imaging detects an abnormality. This has the potential to confuse the carers of affected children.
Topics: Child; Humans; Infant; Urinary Tract Infections; Vesico-Ureteral Reflux; Cystography; Antibiotic Prophylaxis; Surgeons; Retrospective Studies
PubMed: 37776490
DOI: 10.1007/s00247-023-05771-x