Die Ureterabgangsstenose ist eine angeborene oder erworbene Fehlbildung mit Obstruktion im Bereich des pyeloureteralen Übergangs. Es werden intrinsische von extrinsischen oder kombinierten Engen unterschieden. Die laparoskopische (konventionell oder robotisch assistierte) kontinuitätstrennende Nierenbeckenplastik nach Anderson-Hynes ist das Standardverfahren in der Therapie der Ureterabgangsstenose.
The entity primary renal lymphoma is controversial and rare. We report a case in a 60-year-old man. Computed tomography revealed a large, homogeneous, retroperitoneal mass with 14.8 × 11.5 cm size arising from the right kidney. An ultrasound guided percutaneous biopsy was performed and the tumour was diagnosed histopathological as non-Hodgkin lymphoma. The patient was treated by systemic chemotherapy and thereafter a nephrectomy was performed. Primary renal lymphoma is a controversial and infrequent disease. However, there is growing evidence that it does exist.
OBJECTIVE To investigate whether a mechanism of action of α‐blockers on lower urinary tract symptoms (LUTS) involves improved perfusion of the LUT. PATIENTS, SUBJECTS AND METHODS The accuracy of perfusion measurements using transrectal colour Doppler ultrasound (TRCDUS) and colour pixel density (CPD) was initially confirmed in a porcine model. Following this confirmation, measurements were taken from four healthy male volunteers and 19 patients with LUTS. The urinary bladder was filled slowly (50 mL/min) with 0.2 m KCl, which resembles the osmolarity of concentrated urine, and evaluated by cystometry. In parallel, TRCDUS and measurement of the CPD of the LUT were performed. The patients with LUTS were then treated with daily α‐blocker (0.4 mg tamsulosin) for 5 weeks and urodynamic variables as well as perfusion were evaluated again. RESULTS In the healthy men, perfusion of the LUT increased considerably (157%) during filling of the bladder to a mean ( sd ) maximum cystometric capacity (C max ) of 481 (28.9) mL. All the patients with LUTS had a reduced mean C max during filling with KCl at 322.4 (58.5) mL. The mean CPD in the urinary bladder and the prostate were only increased by 58.4% during filling with KCl. After α‐blocker therapy the mean C max during filling with KCl rose to 382.5 (42.9) mL; furthermore, perfusion of the LUT measured by CPD was significantly increased (132.8%). CONCLUSIONS The present data strongly suggest that LUTS are associated with chronic ischaemia of the prostate and urinary bladder. α‐blockers increase perfusion in the LUT and C max . These results might explain the therapeutic effects of α‐blockers on LUTS.
In the first paper in this section, the authors from Austria compare plain film plus transabdominal native‐tissue harmonic ultrasonography with unenhanced CT for the diagnosis of urinary calculi in patients with acute flank pain. In this prospective study, they found that CT is the most accurate method of diagnosis, but that the other method of diagnosis compared favourably, with excellent results. OBJECTIVE To compare plain film kidney, ureter and bladder radiography (KUB) with transabdominal native tissue harmonic imaging ultrasonography (NTHI‐US) vs unenhanced computed tomography (CT) for the diagnosis of urinary calculi in patients with acute flank pain. PATIENTS AND METHODS In all, 112 patients who presented to the urological department with clinical suspicion of ureteric calculi were included. These patients had KUB with NTHI‐US and unenhanced CT. Of the 112 patients, 14 were lost to follow‐up and therefore excluded. For the remaining 98 patients (53 men, 45 women; mean age 43.3 years, range: 19–74) the KUB with NTHI‐US findings were compared with the CT findings, which served as the ‘gold standard’. RESULTS In all, 75 patients were confirmed to have ureteric calculi. KUB with transabdominal NTHI‐US detected 72 of the 75 patients with calculi (sensitivity 96%, specificity 91%, and accuracy 95%). Unenhanced CT detected urolithiasis in all 75 patients (sensitivity, specificity and accuracy of 100%). Both techniques showed further extra‐urinary pathologies. CONCLUSION This prospective study shows that CT is the most accurate technique for detecting urolithiasis. However, KUB with transabdominal NTHI‐US is an alternative to unenhanced CT with comparable results.
