Advances in Nephrourology

Advances in Nephrourology
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The most serious complication in the cases with solitary kidney is related to the arterial system. PCNL has a wide spectrum of arterial complications. The most important issue in these complications is decision on how to diagnose the condition. CT gives valuable information in demonstrating the lesion during the early arterial phase of the complications. Disadvantages of the procedure are use of contrast medium and difficulty of performing selective angiography at the time of diagnosis. Magnetic resonance imaging enables more accurate diagnosis but nephrogenic fibrosis is an important complication Selective renal angiography is the gold standard of diagnosis.

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The main advantage of selective renal angiography is possibility of performing simultaneous endovascular intervention 13 , which is the most appropriate treatment modality for arterial complications TAE by direct percutaneous intervention is another therapeutic method. The procedure involves coil embolization of content of the pseudoaneurysm under guide of Doppler US. Important disadvantages of the procedure include arterial injury, intervention on one of the main segmental arteries, occurrence of hemorrhage to require nephrectomy all of which are unique complications of the intra-arterial intervention , use of contrast medium, and exposure to radiation.

This method reduces the risk of partial or total nephrectomy due to hemorrhage especially in the patients with solitary kidney. The method is fast and effective, and may reduce mortality and morbidity by sparing the renal tissue.

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Thus, it is recommended as first-line treatment for active hemorrhage due to pseudoaneurysm in the kidney In the patient presented here, using contrast medium for conventional selective renal angiography posed cumulative risk because of development of serious arterial complication and consequent acute renal failure. The contrast medium used in selective renal angiography is nephrotoxic. This problem indicates that therapeutic alternatives are very important.

Doppler US and direct percutaneous embolization may be useful in treatment of arterial complications in the patients with solitary kidney. Using heparin during hemodialysis for treatment of acute renal failure due to hemorrhage and hypotension in such patients reflects a paradoxical situation. Determining and entering the accessory renal arteries under the guide of Doppler US prior to scheduled PCNL may reduce arterial complications in the patients with solitary kidney. In conclusion, standard PCNL is a safe procedure in the patients with solitary kidney.

Arterial complications of the PCNL, however, are very important in these patients. In the case of arterial complication, early diagnosis and treatment are of vital importance. Using contrast medium demands special attention in the patients with solitary kidney. Selective percutaneous angiographic intervention and endocoil treatment are gold standard of therapy. Direct percutaneous intervention under the guide of Doppler US, however, is an alternative therapeutic method in terms of lowering complications. This method may be preferred in patients with solitary kidney. Fernstrom I, Johansson B.

Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol. Complications in percutaneous nephrolithotomy. Eur Urol. Transcatheter embolization of biopsy-related vascular injuries in renal allografts. Long-term technical, clinical and biochemical results.

Acta Radiol. Intra-arterial embolization of lumbar artery pseudoaneurysm following percutaneous nephrolithotomy. Australas Radiol. Treatment of renal-vascular injury by transcatheter embolization: immediate and long-term effects on renal function. J Endourol.

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Endovascular management of iatrogenic renal vascular injuries complicating percutaneous nephrolithotripsy: Role of renal angiography and superselective coil embolisation. J HK Coll Radiol. Is percutaneous nephrolithotomy in solitary kidneys safe? Ureteroscopic versus percutaneous treatment for medium-size cm renal calculi.

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Comparison of percutaneous nephrolithotomy and retrograde flexible nephrolithotripsy for the management of cm stones: a matched-pair analysis. BJU Int. Flexible ureterorenoscopy versus miniaturized PNL for solitary renal calculi of mm size. World J Urol. Outcomes of percutaneous nephrolithotomy in patients with solitary kidneys: a single-center experience. Nephrogenic systemic fibrosis: risk factors and incidence estimation. Emergency endovascular embolization of traumatic intrarenal arterial pseudoaneurysms with N-butyl cyanoacrylate.

Clin Radiol. COX-2 inhibitor celecoxib prevents chronic morphine-induced promotion of angiogenesis, tumour growth, metastasis and mortality, without compromising analgesia. Br J Cancer. Direct percutaneous embolization of renal pseudoaneurysm. Nephro-Urology Monthly: 6 5 ; e Published Online: September 5, Article Type: Case Report. Received: March 17, ACR appropriateness criteria Currently, the ACR assigns each imaging modality an appropriateness rating by disease indication.

Table 2 Summary of ACr appropriateness criteria for genitourinary conditions. EAU guidelines The EAU releases updated guidelines on a yearly basis, striving to produce reports that are free from bias and to present a balanced view of risks and benefits. Common clinical nephrourological scenarios CT is strongly justified and frequently used in many common urological clinical scenarios, as outlined in the guidelines.

Incidental renal mass Ultrasonography provides the most cost-effective method of defining and confirming a benign cyst, which, with a prevalence rate of 2. Renovascular hypertension Renovascular hypertension, caused by reduced perfusion pressure to one or both kidneys, is most commonly associated with underlying renal artery stenosis Evaluation of a potential renal donor The role of imaging in potential renal donors includes evaluation of renal vascular anatomy and exclusion of any urinary tract disease stone disease, renal or urothelial tumour, and renal vascular disease Optimizing CT for urological conditions The second fundamental principle of radiation protection in medicine is that medically justified exams should be technically optimized.

Typical dose levels in terms of effective dose for a routine CT examination of the abdomen and pelvis over various time periods.

Typical effective doses for common imaging examinations that use ionizing radiation. Adjusting tube potential and current Tube current, which is linearly related to the applied radiation dose, should be adjusted to most efficiently deliver the required radiation dose as a function of patient size at each anatomical level that is scanned.

Iterative reconstruction All major CT manufacturers now offer the option of iterative reconstruction, which aims to substantially reduce the radiation dose while maintaining adequate image quality. Imaging of pregnant patients Pregnancy is known to alter the anatomy and physiology of the urinary system Conclusions Guidelines from leading professional organizations, including the ACR and the EAU, demonstrate that CT imaging is essential in evaluating nephrourological conditions.

CT scans are commonly performed in nephrourology, for indications including suspected stones and renal masses. Even taking the very low potential risk of malignancy into account, such a risk must be considered in the context of the clinical benefit of performing the scan, and elimination of unnecessary CT examinations is the first step towards managing risk.

Optimization of the scanning technique is essential, so that the necessary clinical information can be gathered with minimization of the radiation dose.

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Acknowledgements The project described was supported by grant number DK from the National Institutes of Health. Footnotes Competing interests C.

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References 1. Three-dimensional spiral CT angiography of the abdomen: initial clinical experience. Radiology , — Miller JM et al.

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