Marc P. Banner

Endoluminal magnetic resonance imaging in the evaluation of urethral diverticula in women

OBJECTIVES Accurate determination of the size and extent of urethral diverticula can be important in planning operative reconstruction and repair. Voiding cystourethrography (VCUG) is currently the most commonly used study in the preoperative evaluation of urethral diverticula. We reviewed our experience with the use of endoluminal (endorectal or endovaginal) magnetic resonance imaging (eMRI) in these patients as an adjunctive study to VCUG to evaluate whether the MRI provided anatomically important information that was not apparent on VCUG. METHODS A retrospective analysis of all patients with a clinical diagnosis of urethral diverticula undergoing MRI at a single institution was performed. Patients were evaluated with history, physical examination, cystoscopy, VCUG, and eMRI. Endoluminal MRI was retrospectively compared to VCUG with respect to size, extent, and location found at operative exploration. RESULTS Twenty-seven consecutive patients underwent endorectal or endovaginal coil MRI in the evaluation of suspected urethral diverticula. Twenty patients subsequently had attempted transvaginal operative repair of the diverticulum. In 2 patients, eMRI demonstrated a urethral diverticulum, whereas VCUG did not. Operative exploration in these patients revealed a urethral diverticulum. In 14 of 27 patients, the VCUG underestimated the size and complexity of the urethral diverticulum as compared to eMRI and operative exploration. In 13 of 27 patients, the size, location, and extent of the urethral diverticulum on VCUG correlated well with the eMRI and/or operative findings. CONCLUSIONS We have found endorectal and endovaginal coil MRI to be extremely accurate in determining the size and extent of urethral diverticula as compared to VCUG. This information can be critical when planning the approach, dissection, and reconstruction of these sometimes complex cases.

Ureteroarterial Fistula: A Case Report

We report on a patient with a fistula between the right common iliac artery and the distal right ureter who had undergone pelvic exenteration for carcinoma of the uterine cervix. The patient also had received prior radiation therapy and was being treated with an indwelling ureteral stent at the time the fistula developed. Diagnosis was made by an occlusive ureterogram and the lesion was treated successfully with embolization of the common iliac artery.

Magnetic resonance imaging of the penis

Although magnetic resonance imaging (MRI) of the penis is an uncommonly performed examination, MRI can provide valuable information in a wide variety of penile disorders. We describe the techniques and safety issues pertinent to MRI of the penis and then discuss the role and limitations of MRI in the investigation of penile trauma, selected benign diseases, neoplasms, vascular lesions, and penile prostheses.

Bilateral Complete Ureteral Obstruction Secondary to an Abdominal Aortic Aneurysm with Perianeurysmal Fibrosis: Diagnosis by Computed Tomography

The sixteenth case of bilateral ureteral obstruction with anuria secondary to an abdominal aortic aneurysm with perianeurysmal fibrosis is presented. The details of this case clearly indicate the need for a combined vascular and urologic approach to patients with this disorder. A complete preoperative evaluation, including excretory urography, retrograde pyeloureterography, aortography and, when indicated, venacavography, may determine renal and vascular abnormalities that will allow a more definitive and successful management of this difficult problem. Furthermore, we believe that the use of computed tomography is an invaluable tool to define this retroperitoneal disease process and its precise relationship to the ureters.

Fibrous Ureteral Polyps

Twelve cases of fibrous ureteral polyps are presented, illustrating their characteristic radiographic appearances. Two types--a long pedunculated mobile variety having a smooth surface, and a relatively shorter lesion covered with thin, finger-like projections--may be identified. Demonstration of the typical findings on excretory urography and/or retrograde ureterography establishes the diagnosis and permits surgical conservatism. Although no sex preponderance was noted, a wide sex-related age disparity was observed, the involved males being much younger than the females.

Urologic Complications of Crohn's Disease

Crohns disease frequently can affect the genitourinary system, mainly in the form of urinary fistulae and urolithiasis. Diagnostic evaluation of fistulae associated with Crohns disease has improved with the increasing use of computed tomography and MR imaging, along with other diagnostic modalities. Resective surgery is the main treatment in this group of patients. Kidney stones are common because of metabolic derangements and dehydration; however, these can be treated adequately with minimally invasive procedures, such as extracorporeal shock-wave lithotripsy, ureteroscopy, and percutaneous surgery. In addition, medical therapies can prevent recurrent stones.

Renal oncocytoma: further observations and literature review.

Although controversy exists among pathologists regarding the existence of a benign renal adenoma of proximal tubular origin (oncocytoma), certain “typical” angiographic features have been proported to characterize such renal masses. These include “spoke-wheel” vasculature, homogeneous blush, orderly vascular pattern, and absence of vascular puddling or venous shunting. These features may characterize oncocytomas but may also be shared by an occasional renal cell carcinoma. Nonetheless, their demonstration should alert radiologists and surgeons to the possibility that a given renal mass may be a benign oncocytoma. Such a presumptive diagnosis may have significant surgical implications.

High Protein Content: Another Cause of Ct Hyperdense Benign Renal Cyst

A high density renal mass (35 Hounsfield units), which did not enhance after intravenous contrast material proved to be a renal cyst containing a very proteinaceous fluid. The high protein concentration was the apparent cause of the unusually high attenuation values observed. This case is discussed and the causes of hyperdense benign renal cysts on computed tomography are reviewed.

Extrathoracic solitary fibrous tumor of the pelvic peritoneum with central malignant degeneration on CT and MRI

We describe a 61‐year‐old man who presented with an extrathoracic solitary fibrous tumor (SFT) of the pelvic peritoneum with central malignant degeneration as seen on computed tomography (CT), magnetic resonance imaging (MRI), and histopathology. When a central focus of heterogeneity and variable contrast enhancement are identified within a fibrous tumor of the pelvis on CT or MRI, malignant degeneration of an extrathoracic SFT, although rare, should be considered as a diagnostic possibility. J. Magn. Reson. Imaging 2005.

Angiomyolipoma of the renal sinus: diagnosis by percutaneous biopsy

We report a case of angiomyolipoma of the renal sinus discovered incidentally during an evaluation for microscopic hematuria. Diagnosis was confirmed by percutaneous aspiration biopsy performed with magnetic resonance imaging control allowing differentiation of this entity from other fatty tumors of the renal sinus including liposarcoma, lipoma, and sinus lipomatosis.