Gábor BÓDY, M. SZÛCS, I. ROMICS
Department of Urology, Semmelweis University Budapest. EBU certified Clinic
Unusual sites of metastases are characteristic of renal cell carcinoma.
Intraocular and intraorbital metastases are approximately 3%
of metastases from RCC primary. Among intraocular metastases
the choroid has been found to be involved in 88%. Herein we present
one case of RRC metastasis to the choroid.
before. We performed the examination after the acute period, free
of fever. First the patient lied in horizontal position. We filled the
pyelum with 10 ml non-ionic iodine contrast medium administered
the syringe directly to the transrenal drain and shooting an X-ray
film from the kidney. Then in a standing position the drain with the
emptied urine-bag was conducted over the ipsilateral shoulder from
front to back. We inserted an 18G-needle 30-40 cm over the spot
of puncture. A syringe fulfilled with 20 ml of non-ionic iodine contrast
medium was connected to the needle. Gently press the piston
the pyelum was filled with the contrast medium in a manner that
the fluid-column could not reach more than 15 cm in the drain so
that high pressure in the pyelum could not have arisen. After 5
minutes walking the second X-ray film was shot.
Results: The spot of occlusion of the ureter was seldom shown
by the first X-ray film. The contrast medium could not mix with
the urine in the pyelum and ureter and intrapyelar pressure could
reach dangerous levels. In the other hand during pressure controlled
filling of the pyelum high pressures could be avoided and
during the 5 minutes -spent in the vertical position- higher specific
weight contrast medium could stream to the end of ureter
showing stop position of occlusion or could pass through the
subtotal occlusion appearing in the bladder too in every case.
Conclusion: Pressure controlled antegrade pyelography is a safe
and reliable diagnostic method in case of ureteral occlusion with
higher diagnostic effect and less iatrogenic complications. We suggest
that this method can also be safely used in case of
pyelonephritis because pyelo-parenchymal reflux can be avoided
by pressure control.