Genitourinary tract radiology at the Mayo Clinic: history portrayed through medical literature.
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Female Urogenital Diseases↗
Biomedical subjects
A J LeRoy
Publications and source records attributed to A J LeRoy.
Percutaneous antegrade endopyelotomy: review of 50 consecutive cases.
Between 1988 and 1993, 50 percutaneous antegrade endopyelotomies were performed for ureteropelvic junction obstruction at this institution. The success of the procedure was based on radiological parameters as well as patient symptomatology. The overall success rate of the procedure was 88%. Endopyelotomy was successful in 9 of 11 patients (82%) who presented after failing previous renal procedures. When endopyelotomy was used as the initial treatment modality the success rate was 90%. These results support the argument that endopyelotomy should be considered as first line therapy for most adults with ureteropelvic junction obstructions [corrected].
Adolescent↗
Diagnosis and treatment of nephrolithiasis: current perspectives.
Urinary stones are a frequent cause of morbidity in persons in affluent industrialized societies. The surgical management of symptomatic stones in the upper urinary tract has changed dramatically in the past generation, largely because of the introduction of progressively less invasive treatment techniques. The concurrent revolution in radiologic imaging and interventional techniques has mirrored the surgical experience. This article reviews the current diagnosis and therapy of nephrolithiasis. An evaluation of the complex metabolic abnormalities present in the population of patients with urolithiasis is beyond the scope of this article, but several good reviews of this subject have been published recently [1-4]. Because primary urolithiasis involving the bladder or urethra is less common and is a separate medical entity, this article is focused on renal and ureteral calculi.
Humans↗
Imaging of complications of laparoscopic cholecystectomy.
Laparoscopic cholecystectomy has gained widespread acceptance for treatment of cholelithiasis. Because radiologists have a primary role in recognizing and treating complications of this surgical technique, we reviewed the clinical records and imaging studies of 29 patients with complications after laparoscopic cholecystectomy. Complications included bile duct injuries (15 cases), retained common bile duct stones (seven cases), cystic duct stump leak (four cases), bowel perforation (two cases), abdominal abscess (two cases), intraperitoneal gallstones (2), and failure to diagnose malignant bile duct obstruction (one case). Twenty-two patients required reoperation, and one patient with bowel perforation died. Eleven of 15 bile duct injuries were imaged prior to hepaticojejunostomy. Nine of 11 were proximal bile duct injuries within 2 cm of the junction of the right and left bile ducts. Endoscopic retrograde cholangiography (ERC) identified the distal extent of injuries, but transhepatic cholangiography (THC) was necessary to fully evaluate the proximal extent of the bile duct abnormalities. ERC was used for diagnosis and treatment of the seven patients with choledocholithiasis. Abdominal films showed intraperitoneal in one patient with bowel perforation, intraperitoneal stones in a second patient, and intraabdominal abscess in one of two patients in whom abdominal films were performed. Computed tomography (CT), done in three patients with bowel perforation or abscess, showed the one duodenal perforation, and the two abscesses. CT also showed bilomas, intraperitoneal gallstones, and unsuspected malignancy. Imaging studies detected and defined complications after laparoscopic cholecystectomy in all cases.
Bile↗
Radiology in the intensive-care unit.
Portable chest radiography is an essential component of clinical patient management in the intensive-care unit. With routine use of this procedure, unexpected cardiopulmonary abnormalities are frequently detected, and malposition or complications of intravascular devices and endotracheal, thoracostomy, or nasogastric tubes are also commonly found. The pulmonary parenchyma may be assessed for changes of acute lung injury, cardiogenic edema, areas of pneumonitis, atelectasis, or other abnormal collections of fluid or air. In mechanically ventilated patients, barotrauma occurs frequently and may be manifested by subtle intrathoracic collections of air. Technical factors may limit the resolution of the anteroposterior chest radiograph obtained at the bedside, but crucial clinical information is often gained. Portable chest radiographic findings, the role of computed tomography and ultrasonography, and interventional radiologic procedures pertinent to patients in the intensive-care unit are reviewed.
Critical Care↗
Early experience with percutaneous cholecystolithotomy.
Percutaneous cholecystolithotomy should be added to the list of alternatives to elective open cholecystectomy for the management of patients with gallstones. Our initial experience with percutaneous cholecystolithotomy in 13 patients (7 men and 6 women who ranged in age from 47 to 83 years) demonstrated that the procedure could be accomplished successfully with acceptable morbidity and no mortality. After a mean duration of follow-up of 10.7 months, only one patient had recurrent cholelithiasis. Because of rapid changes in the therapeutic approach to patients with cholelithiasis, percutaneous cholecystolithotomy may seldom be used.
Aged↗
Dissolution of cholesterol gallbladder stones by methyl tert-butyl ether administered by percutaneous transhepatic catheter.
We treated 75 patients with symptomatic cholesterol gallstones by dissolving the stones with methyl tert-butyl ether (MTBE) instilled into the gallbladder through a percutaneous transhepatic catheter. The MTBE was continuously infused and aspirated manually four to six times a minute, for an average of five hours per day for one to three days; the treatment was monitored by fluoroscopy. The placement of the catheter and the administration of MTBE caused few side effects or complications, and treatment did not have to be stopped in any patient for this reason. In 72 patients there was complete dissolution of stones or more than 95 percent dissolution. Among 21 patients who were completely free of stones after treatment, 4 had recurrence of stone formation 6 to 16 months later. The other 51 patients had residual debris, which spontaneously cleared completely in 15 patients within 6 to 35 months; only 7 with persisting debris have had symptoms. Five of the initial 6 patients treated, but only 1 of the next 69 patients, have required surgery during follow-up periods of 6 to 42 months. We conclude that the dissolution of gallstones by MTBE delivered through a percutaneous transhepatic catheter is a useful alternative to surgery in selected patients with symptomatic cholesterol stones. Further study will be necessary to establish the long-term effectiveness of this treatment and its appropriate role in the management of the various types of gallstones.
Adult↗
Low-osmolality contrast media: a current perspective.
Intravascular radiographic contrast media play a major role in diagnostic imaging. Recently, low-osmolality contrast media (LOCM) have become available in the United States. Because of their lower osmolality, these new agents cause fewer undesirable physiologic effects and fewer adverse reactions than do conventional agents after intravascular administration. Unfortunately, the cost of LOCM is substantially higher than the cost of conventional contrast media. Appropriate use of these newer, more expensive contrast agents must be based on a thorough knowledge and understanding of their chemistry, physiologic features, and relative safety. Some questions remain about these new agents. Further studies are needed to determine the nephrotoxicity of LOCM relative to that of conventional agents. In addition, LOCM have less anticoagulant capacity than do the conventional media; therefore, clotting may occur when the LOCM and blood mix in syringes and small catheters. This potential decrease in anticoagulation and its clinical implications should be further investigated. Finally, the mortality rate associated with use of LOCM needs to be determined in future studies in large numbers of patients.
Contrast Media↗
Primary lymphoma of the bladder.
A case of primary lymphoma of the bladder is presented with a review of the literature. A brief discussion of secondary involvement of the bladder by lymphoma is included.
Adult↗
Intravenous urographic technique.
In these times of rapid advances in radiographic imaging, intravenous urography should be performed in an optimal way. The urographic examination should involve consultation between the referring physician and the radiologist. Necessary patient information should be accessible. McClennan said "patient selection for urographic studies should be efficacious with the radiologist exerting appropriate control so that the urogram is truly a consultative imaging service integrated into the total patient management." We share this view, and it is an extension of the philosophy of practice emphasized by other leaders in uroradiology. Cost containment, new imaging technologies, risk/benefit considerations, and evolving patterns of patient care have had a significant influence on genitourinary tract imaging. In addition, current debate about contrast media, digital radiography, efficacy, and utilization will undoubtedly have an influence on imaging during the next decade. Utilization of intravenous urography has decreased significantly in the past 15 years. Our volume of examinations has declined approximately 50% since 1970. This decline in our practice is attributed to several complex factors such as previous overutilization of screening urography for hypertension; the impact of US and CT for evaluation of obstruction, retroperitoneal disease (adenopathy and fibrosis), renal failure, and renal masses; concern about contrast medium-induced renal failure; and fewer repeat studies because of improved quality of intravenous urography in general radiology practice. In addition, overutilization of urography in patients with hematuria, prostatism, history of urinary tract infection, etc, continues to be debated in the medical community. In our integrated group practice, we have also observed overutilization of "high-tech" procedures in lieu of urography for evaluation of suspected urinary tract disease. Swings of the pendulum are inevitable in diagnostic imaging because of evolving technology and the art of medical practice. Although some differences of opinion about the details of urographic technique and indications for urography may exist, most would agree on the philosophy of producing a high-quality urographic examination. That philosophy focuses on producing the highest quality examination in each patient so that a diagnosis of normal or abnormal can be made accurately and confidently. Failure to demonstrate the entire urinary tract is a common cause of diagnostic error and one that can largely be eliminated by careful attention to the technical details of the examination.
Contrast Media↗
Indwelling ureteral stents: percutaneous management of complications.
Complications of indwelling ureteral stents were managed percutaneously in 13 patients. These complications consisted of three fractured, three heavily encrusted, and seven migrated stents. While most ureteral stent malfunctions are routinely managed with retrograde techniques, the percutaneous approach allows effective clinical management in selected cases in which extensive renal stone material or brittle intrarenal stent fragments are present or when previous surgery or ureteral strictures do not permit a retrograde approach. Fluoroscopically guided removal of migrated stents and percutaneous endoscopic techniques, for complex cases such as those requiring stone removal, were successful and without complications.
Adult↗
Percutaneous removal of renal calculi.
Percutaneous removal of symptomatic renal and ureteral calculi evolved in the early 1980s, replacing standard surgical stone removal operations because of reduced patient morbidity and shortened hospitalizations. A wide variety of instruments designed to work through the percutaneous track are available to remove or fragment nearly all renal calculi. Success rates of this modality are excellent, and major complications are few. Despite the wide applications of extracorporeal shock-wave lithotripsy, percutaneous stone removal methods will continue to be needed in some patients.
Dilatation↗
Extracorporeal shock-wave lithotripsy.
Extracorporeal shock-wave lithotripsy is a new technique for treatment of symptomatic renal and upper ureteral calculi. After biplanar fluoroscopic localization of the targeted calculus, serial shock waves cause calculus disintegration, with subsequent spontaneous transurethral passage of the fragments. Excellent clinical results and patient enthusiasm have resulted. Physicians using extracorporeal shock-wave lithotripsy must also be adept at percutaneous, ureteroscopic, and standard surgical stone removal methods to deal with complex clinical stone presentations.
Humans↗
Percutaneous removal of kidney stones: review of 1,000 cases.
We report the results of 1,000 consecutive patients who underwent percutaneous removal of renal and ureteral stones. Removal was successful for 98.3 per cent of the targeted renal stones and 88.2 per cent of the ureteral stones. Complications, evolution and technique are discussed. Percutaneous techniques are an effective way to handle the majority of renal calculi and these techniques will continue to be important as shock wave lithotripsy becomes more widespread in the United States.
Blood Transfusion↗
The etiology and treatment of delayed bleeding following percutaneous lithotripsy.
In 1,032 percutaneous stone manipulations the incidence of significant, documented or presumed vascular injuries was 0.9 per cent. Seven cases of pseudoaneurysm, arteriovenous fistula or vascular lacerations were found, all of which were diagnosed angiographically. The patients were treated successfully with transcatheter embolization techniques. Two additional patients experienced delayed bleeding, presumably from vascular injuries, which resolved spontaneously with conservative therapy. Arteriography should be performed in these patients with serious postoperative bleeding. Embolization of the peripheral vessel is preferable to flank exploration.
Aged↗
Colon perforation following percutaneous nephrostomy and renal calculus removal.
Two patients had colonic perforation as a result of percutaneous nephrostomy placement followed by track dilatation and renal calculus removal. We present the technical aspects of nephrostomy placement and stone removal, as well as the clinical diagnosis and management of these cases. Both patients recovered well with conservative therapy and required no surgical intervention. This report reviews the anatomic considerations for percutaneous nephrostomy in patients undergoing renal stone removal.
Adult↗
Percutaneous removal of small ureteral calculi.
Percutaneous renal and ureteral stone removal procedures are widely practiced. A new technique is described for removal of small symptomatic ureteral calculi using small (less than or equal to 14 French) tearable sheaths and standard stone retrieval baskets placed through acute percutaneous nephrostomy tracks. This fluoroscopically-guided technique was successful in 60 of 64 patients, who ranged from 16 to 88 years old. Subsequent endoscopic percutaneous calculus removal was successful in the four failures. The use of these small sheaths over previously described large tracks has produced no major complications, short hospital stays, and minimal patient disability.
Humans↗
Percutaneous ultrasonic lithotripsy.
Percutaneous renal calculus removal has evolved rapidly over the past 4 years. Percutaneous ultrasonic lithotripsy (PUL), based on access to the kidney via a percutaneous nephrostomy track, consists of fragmentation and removal of calculi under visual nephroscopic control. Clinical experience has proven this modality to be safe, reliable, and effective for treatment of symptomatic renal calculus disease. This article reviews our PUL technique and results.
Dilatation↗