P. Rosi

Color Doppler Ultrasonography in the Diagnosis of Vascular Abnormalities Associated with Ureteropelvic Junction Obstruction

PURPOSE To determine if color Doppler ultrasonography is able to identify vascular abnormalities linked to ureteropelvic junction (UPJ) obstruction. PATIENTS AND METHODS We used color Doppler scanning in 21 patients to determine whether there were aberrant vessels. RESULTS The study detected 11 aberrant vessels, resulting in 10 true positives and 9 true negatives. Thus, the overall diagnostic accuracy was 90.4%. CONCLUSION Color Doppler ultrasonography is reliable in the preoperative diagnosis of aberrant vessels associated with UPJ obstruction.

Real-time transrectal sonographic voiding cystourethrography

Transrectal linear array transducer makes possible a sagittal view of the bladder base-plate, prostatic urethra, and membranous urethra yielding an image similar to that obtained with voiding cystourethrogram. This permits lack of time limitation, such as imposed by the use of fluoroscopy, and the possibility of visualizing not only the lumen of the bladder neck and urethra but also the surrounding soft tissue. Using ultrasonographic urodynamics in neuromuscular dysfunctions of the bladder and urinary voiding obstructions we obtained excellent results in patients with detrusor-sphincter dyssynergia and in those with posterior ledge at the bladder neck. Both conditions are clearly visualized, particularly the existence of the posterior ledge which is responsible for the failure of the sphincterotomy in patients with periurethral striated sphincter spasm.

Ultrasound Study of the Ureters and Intrarenal Excretory Tract

Ultrasound was long considered inadequate to assess the ureter. More recently, advances in ultrasound devices, together with the increased interest of operators in this method, have partly modified this view. However, some elements that can make the examination difficult still need to be taken into account, such as the ureter’s deep position in the peritoneum and the interference of the bowel loops and contents.

Functional Ultrasound Study of the Upper Excretory Tract

Ultrasound (US) is still considered one of the most valid methods for diagnostic and preoperative assessment of ectasia of the upper urinary tract. It has extremely high sensitivity (nearly 100 %) for the assessment of hydronephrosis, associated with a very low number of false positives, mostly lipomatosis of the pyelic sinus and parapyelic cysts, and an equally low incidence of false negatives, in cases of so-called intermittent hydronephrosis. The difficulty in achieving a functional type assessment is an important limit of US in the assessment of obstructive upper urinary tract disease.