Author/Authors :
Xie, Chong Department of Urology - Zhongshan Hospital - Fudan University - Shanghai, China , Guo, Jianming Department of Urology - Zhongshan Hospital - Fudan University - Shanghai, China , Wang, Guomin Department of Urology - Zhongshan Hospital - Fudan University - Shanghai, China , Wang, Hang Department of Urology - Zhongshan Hospital - Fudan University - Shanghai, China
Abstract :
Background: Ureteropelvic junction obstruction (UPJO) is mostly a benign, congenital
condition that remains an enigma in terms of diagnosis. Despite several advances in
morphological and functional imaging of UPJO, controversies still remain about the
optimal imaging method to diagnose UPJO. Intravenous urography (IVU) has been
standardized and is a familiar technique to urologists, however, its diagnostic efficacy
is not high and thus another examination is usually needed.
Objectives: The aim of this study was to compare CTU and IVU in the assessment of patients
with UPJO.
Patients and Methods: Sixty-one patients with final diagnosis of UPJO received both IVU
and CTU before operation. The CTU examination included three phase axial scan: noncontrast
(phase I), nephrographic phase (phase II), excretory phase (phase III) and CTU
images were obtained by coronal reconstruction of phase I and III. Two radiologists
who were unaware of the findings independently interpreted these examinations.
The diagnosis of both imaging studies were compared with the final diagnosis and
the two examinations were compared by the results of diagnostic accuracy for different
causes of disease.
Results: In our study, the cause of UPJO were mainly crossing vessel, stone disease,
carcinoma, fiber cord compression, congenital distorted uretero-pelvic junction, inflammatory
stenosis, high ureteropelvic junction, ureteral valves and renal duplication
combined with obstruction. The diagnostic accuracy is 85.2% in CTU and 49.2%
in IVU. Although suspicious abnormal findings in IVU were recognized in many patients
(23/61), they were usually inadequate for making accurate diagnosis and further
examinations were thus acquired. As compared with IVU, the operative procedure of
CTU was simpler and the examination time was shorter, however, the cost and the radiation
exposure was larger.
Conclusions: CTU has higher diagnostic efficacy as compared with IVU and could be the
one-stop examination for patient with UPJO. It should be under consideration to have
CTU as the first line diagnostic tool, although more delicate cost-effectiveness evaluation
is needed for conclusion.
