Evaluation of ureteric jet flow with Doppler ultrasonography during manual compression

Abstract

Objective: This study aimed to distinguish between obstructive and non-obstructive dilation of the upper urinary tract using ureterovesical jet flow analysis with Doppler ultrasonography (US) and manual flank compression. Materials and methods:The study enrolled 54 patients (11 women, 43 men; mean age 27.5 years) with unilateral hydronephrosis. All but 2 pregnant patients underwent the Doppler US and the reference standard test [intravenous pyelogram (IVP)] after standardized hydration. The distended urinary bladder was visualized in the transverse plane to evaluate both ureteral orifices simultaneously. During and after compression of each flank, the jet flows were recorded in Doppler mode. The jet flows were quantified by calculating the longitudinal extent of the color spread into the bladder on both sides. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the test for determining the degree of obstruction were evaluated statistically. Results:Ureterovesical jet flow could not be visualized with flank compression in 4 cases. Three of these cases had complete obstruction on IVP. In the 22 cases that had markedly reduced flow compared to the contralateral side on Doppler US, the IVP showed similar stasis. In the 19 cases that had mildly diminished flow compared to the contralateral side on Doppler US, no significant difference was detected in the pyelogram and nephrogram phases on IVP.Conclusion: Doppler examination of the ureterovesical jet flows during flank compression may be a good diagnostic method for evaluating the degree of obstruction, especially in patients in whom magnetic resonance imaging or computerized tomography is contraindicated. Gereç ve yöntem:Çalışmaya tek taraflı hidronefroz tespit edilmiş 54 olgu (11 kadın, 43 erkek; ortalama yaş 27.5 yıl) dahil edildi. Hidrasyon düzeyi standardize edilerek, tüm hastalara Doppler US inceleme ve 2 gebe olgu dışındaki diğer tüm hastalara referans standart test olarak intravenöz piyelografi (İVP) yapıldı. Her iki üreter orifisi görülecek şekilde distandü mesane yatay pozisyonda görüntülendi. Renal lojun kompresyonu sırasında ve sonrasında oluşan jet akımlar Doppler mod ile kaydedildi. Mesane içerisine doğru gelişen renk saçılımının uzunluğu dikkate alınarak jet akımlar kantifiye edildi. Obstrüksiyon derecesinin ayırımında sensisitivite, spesifite, pozitif ve negatif prediktif değerler istatistiksel olarak hesaplandı. Bulgular: Üreterovezikal bileşke akımı toplam 4 olguda hiç gözlenemedi. Bunlardan biri hariç diğer üçün-de İVP ile de tam obstrüksiyon rapor edilmişti. Kalan olguların 22'sinde, Doppler US'de karşı tarafa göre kısalmış jetler sözkonusu iken, İVP'de de bununla uyumlu nonprogresif staz görüldü. Diğer 19 olguda, Doppler US'de karşı tarafa göre hafif azalmış jetler sözkonusu iken İVP incelemelerinde piyelogram ve nefrogram fazlarında anlamlı fark tespit edilmemişti. Sonuç:Özellikle manyetik rezonans görüntüleme veya bilgisayarlı tomografinin kontrendike olduğu olgularda, renal lojların manu...

Value of neutrophil-to-lymphocyte ratio in predicting surgical intervention for hydronephrosis during pregnancy

“…It has been suggested that absence of jets should be confirmed in contralateral decubitus patient position. 7 MRI utilizes nonionizing radiation, and provides high sensitivity and specificity without the need for contrast. 20 MRI is confirmed as a safe imaging method, with no known teratogenic effects.…”

“…It has been suggested that absence of jets should be confirmed in contralateral decubitus patient position. 7…”

“…Various alternative methods have been described in the literature, such as measuring renal vascular resistance with Doppler Ultrasonography (USG) and investigating the presence of ureteral jet flow. 7 But none of these alone produced optimal results.…”