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Bladder cancer
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
In these fast-track haematuria clinics, patients will be assessed by clinical history, urine cytology, upper tract imaging, and flexible cystoscopy. There appears to be some difference in detection rates of urological malignancy in patients with dipstick haematuria who are investigated in primary care compared with those referred to hospital haematuria clinics (5,6). Urine cytology alone is of limited usefulness in diagnosing low-grade and low-stage tumours and must be combined with other procedures. High-grade malignant urothelial cancer has tumour cells with lower cohesive potential which are more readily shed and therefore detected in the voided cytology samples. Imaging is most useful in detecting upper tract neoplasms such as renal cell carcinoma or ureteric obstruction with hydronephrosis in patients with advanced muscle-invasive bladder tumours. Ultrasound or CT intravenous urography is used. Cystoscopy in fast-track haematuria clinics is carried out with a flexible cystoscope under local anaesthetic. It allows visualization of the bladder mucosa and biopsy of suspicious areas. In patients with a known history of bladder cancer, treatment of small-volume disease and low-grade superficial tumours can be undertaken using laser ablation. Rigid cystoscopy is carried out under general or regional anaesthesia and is usually reserved for bladder lesions previously detected on imaging or if there is a high index of suspicion that multiple biopsies or resection of extensive superficial tumour will be required.
Urinary system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
For decades, intravenous urography (IVU) has been the primary imaging modality for the evaluation of the urinary tract. More recently, however, other imaging modalities including ultrasonography, and CTU have been used with increasing frequency to compensate for the limitations of IVU in the evaluation of urinary tract disease.
Renal transplantation
Published in Harold Ellis, Operations that Made History, 2018
Subsequently, the patient had both of his diseased kidneys removed; they were shrunken and fibrosed and showed the appearances of diffuse, advanced chronic glomerulonephritis. Following this, the patient's blood pressure stabilised at almost normal levels and his urinary infection cleared. A year after the transplantation the patient was well, normotensive, and carrying on unlimited activity without apparent physical disability. Intravenous urography showed prompt excretion of dye in good concentration, although the ureter appeared somewhat dilated and tortuous.
Preoperative predictors of pathological tumour stage and prognosis may be used when selecting candidates for intensified treatment in upper tract urothelial carcinoma
Published in Scandinavian Journal of Urology, 2021
Bjarte Almås, Stein Øverby, Ole J. Halvorsen, Lars A. R. Reisæter, Birgitte Carlsen, Christian Beisland
A total of 176 (98%) of the patients were examined with a CT scan, 159 (90%) of these with a contrast-enhanced CT, 17 patients were examined with a CT without contrast due to kidney failure. One patient was examined with magnetic resonance imaging only, one with a conventional intravenous urography only and one lacked preoperative radiological examination of the upper urinary tract. All CT scans were re-evaluated by a uro-radiologist (LAR) together with a urologist (BA) and assessed regarding tumour size, location, contrast enhancement, the presence of hydronephrosis, pathological lymph nodes, reactive oedema surrounding the tumour and local invasion into renal parenchyma, the renal pelvis or periureteric tissue. Each variable was considered by the radiologist in each patient to assess if a reliable measurement could be made in that particular case. If for example reliable measurements regarding tumour size and/or contrast enhancement could not be made in one particular case, the variable was recorded as missing in the dataset. This results in a different number of patients available for analysis for each variable, as demonstrated in Table 3.
The diagnostic value of magnetic resonance urography for detecting ureteric obstruction: a systematic review and meta-analysis
Published in Annals of Medicine, 2020
Zhongping Chen, Huayu Huang, Jun Yang, Hongtao Cai, Yali Yu
Obstructive uropathy is a common urologic presentation and a common cause of renal failure. Inadequate treatment for obstructive uropathy will lead to irreversible damage to renal parenchyma [1–3]. The management of obstructive uropathy is based on the precise delineation of reno-ureteral units and accurate estimation of the renal function. Currently, intravenous urography (IVU) combined with ultrasonography is widely used for the evaluation of obstructive uropathy in Asia [4]. However, the limitations of IVU include radiation exposure, contrast allergies, parenchymal visualization, and contraindicate pregnancy, renal failure, and diabetes. Furthermore, its sensitivity and specificity for detecting the cause of obstruction were not high.
Advancements in the clinical management of upper tract urothelial carcinoma
Published in Expert Review of Anticancer Therapy, 2019
Jacob Taylor, Xiaosong Meng, Rashed Ghandour, Vitaly Margulis
Intravenous urography has widely been used for the evaluation of UTUC. However, CT urography (CTU) presently has a higher diagnostic accuracy for UTUC (94.2%-99.6%) than intravenous urography (80.8%-84.9%) and has replaced intravenous urography as the first-line imaging test for investigating patients with a high risk of UTUC [18–20]. CTU has a pooled sensitivity and specificity of 92% and 95%, respectively, from a recent systematic review evaluating the diagnostic performance for UTUC [21]. Intravenous urography may still be appropriate in certain low-risk, younger age groups in an era of increased cost sensitivity [22].