{"id":373,"date":"2015-11-04T00:00:00","date_gmt":"2015-11-03T23:00:00","guid":{"rendered":"http:\/\/semmelweis.hu\/symposium\/optimized-method-of-antigrade-pyelo-ureterography-for-exact-localization-of-complete-uretic-occlusion\/"},"modified":"2015-11-06T13:27:28","modified_gmt":"2015-11-06T12:27:28","slug":"optimized-method-of-antigrade-pyelo-ureterography-for-exact-localization-of-complete-uretic-occlusion","status":"publish","type":"page","link":"https:\/\/semmelweis.hu\/symposium\/szimpozium-archiv\/symposium2009-semmelweis\/temak\/optimized-method-of-antigrade-pyelo-ureterography-for-exact-localization-of-complete-uretic-occlusion\/","title":{"rendered":"Optimized method of antigrade pyelo-ureterography for exact localization of complete uretic occlusion"},"content":{"rendered":"\n<p>G\u00e1bor FILKOR<br \/> <em>Department of Urology, Semmelweis University, Budapest, Hungary<\/em><\/p>\n<p><em>Introduction: <\/em>In case of total or subtotal occlusion of the ureters<br \/> contrast medium during the antegrade pyelography procession can<br \/> hardly reach the end point of the occlusion leading to diagnostical<br \/> errors if the examination is performed through the classic method<br \/> of filling the pyelum with a syringe. Also the amount of contrast<br \/> medium to use is doubtful because small amounts are ineffective,<br \/> however large amounts can raise pyelar pressure to a dangerous<br \/> level causing pyelo-tubular reflux and bacteraemia. We performed<br \/> a new method for antegrade pyelography so that we can eliminate<br \/> disadvantages of high-pressure direct syringal filling of the pyelum<br \/> and ineffective diagnostical process.<\/p>\n<p><em>Patients and methods:<\/em> We performed pressure-controlled antegrade<br \/> pyelography in standing position in 16 cases in 2006. Every<br \/> patients was inserted a transrenal drain due to the suspicion of<\/p>\n<p>total ureteral obstruction and threatening of infection some days<em> <\/em>before. We performed the examination after the acute period, free<br \/> of fever. First the patient lied in horizontal position. We filled the<br \/> pyelum with 10 ml non-ionic iodine contrast medium administered<br \/> the syringe directly to the transrenal drain and shooting an X-ray<br \/> film from the kidney. Then in a standing position the drain with the<br \/> emptied urine-bag was conducted over the ipsilateral shoulder from<br \/> front to back. We inserted an 18G-needle 30-40 cm over the spot<br \/> of puncture. A syringe fulfilled with 20 ml of non-ionic iodine contrast<br \/> medium was connected to the needle. Gently press the piston<br \/> the pyelum was filled with the contrast medium in a manner that<br \/> the fluid-column could not reach more than 15 cm in the drain so<br \/> that high pressure in the pyelum could not have arisen. After 5<br \/> minutes walking the second X-ray film was shot.<\/p>\n<p><em>Results<\/em>: The spot of occlusion of the ureter was seldom shown<br \/> by the first X-ray film. The contrast medium could not mix with<br \/> the urine in the pyelum and ureter and intrapyelar pressure could<br \/> reach dangerous levels. In the other hand during pressure controlled<br \/> filling of the pyelum high pressures could be avoided and<br \/> during the 5 minutes -spent in the vertical position- higher specific<br \/> weight contrast medium could stream to the end of ureter<br \/> showing stop position of occlusion or could pass through the<br \/> subtotal occlusion appearing in the bladder too in every case.<br \/> Conclusion: Pressure controlled antegrade pyelography is a safe<br \/> and reliable diagnostic method in case of ureteral occlusion with<br \/> higher diagnostic effect and less iatrogenic complications. We suggest<br \/> that this method can also be safely used in case of<br \/> pyelonephritis because pyelo-parenchymal reflux can be avoided<br \/> by pressure control.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>G\u00e1bor FILKOR Department of Urology, Semmelweis University, Budapest, Hungary Introduction: In case of total or subtotal occlusion of the ureters contrast medium during the antegrade pyelography procession can hardly reach the end point of the occlusion leading to diagnostical errors if the examination is performed through the classic method of filling the pyelum with a &hellip;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":323,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"categories":[],"tags":[],"class_list":["post-373","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/semmelweis.hu\/symposium\/wp-json\/wp\/v2\/pages\/373","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/semmelweis.hu\/symposium\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/semmelweis.hu\/symposium\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/semmelweis.hu\/symposium\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/semmelweis.hu\/symposium\/wp-json\/wp\/v2\/comments?post=373"}],"version-history":[{"count":1,"href":"https:\/\/semmelweis.hu\/symposium\/wp-json\/wp\/v2\/pages\/373\/revisions"}],"predecessor-version":[{"id":407,"href":"https:\/\/semmelweis.hu\/symposium\/wp-json\/wp\/v2\/pages\/373\/revisions\/407"}],"up":[{"embeddable":true,"href":"https:\/\/semmelweis.hu\/symposium\/wp-json\/wp\/v2\/pages\/323"}],"wp:attachment":[{"href":"https:\/\/semmelweis.hu\/symposium\/wp-json\/wp\/v2\/media?parent=373"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/semmelweis.hu\/symposium\/wp-json\/wp\/v2\/categories?post=373"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/semmelweis.hu\/symposium\/wp-json\/wp\/v2\/tags?post=373"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}