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Sørensen SM, Schønheyder HC, Nielsen H. The role of imaging of the urinary tract in patients with urosepsis. Int J Infect Dis 2013; 17:e299-303. [DOI: 10.1016/j.ijid.2012.11.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 10/26/2012] [Accepted: 11/02/2012] [Indexed: 11/30/2022] Open
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Dason S, Dason JT, Kapoor A. Guidelines for the diagnosis and management of recurrent urinary tract infection in women. Can Urol Assoc J 2011; 5:316-22. [PMID: 22031610 PMCID: PMC3202002 DOI: 10.5489/cuaj.11214] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Shawn Dason
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON
| | | | - Anil Kapoor
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON
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Wang IK, Chang FR, Yang BY, Lin CL, Huang CC. The Use of Ultrasonography in Evaluating Adults with Febrile Urinary Tract Infection. Ren Fail 2009; 25:981-7. [PMID: 14669857 DOI: 10.1081/jdi-120026033] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Urinary tract infection (UTI) is a common disease. Controversy exists about the role of radiological evaluation in the patient with urinary tract infection. MATERIALS AND METHODS From April 2001 to December 2001, patients with febrile UTI admitted to Chang Gung Memorial Hospital, Chiayi were prospectively evaluated by ultrasonography. The inclusion criteria of febrile UTI was a body temperature of more than 38 degrees C with a bacterial count of 10(3) or more per mL in a freshly voided midstream or catheterized urine. RESULTS A total of 94 patients were evaluated and all patients recovered. Major abnormal sonograms were present in 17 (18%) of the patients. A history of urolithiasis and a duration of fever > or = 3 days after admission were statistically significant clinical parameters in predicting major abnormal sonogram. Although diabetes mellitus was not statistically significant in predicting major abnormal sonogram, diabetic patients had 2.5 times the likelihood of major structural abnormalities than nondiabetic patients. CONCLUSION Ultrasonographic study of patients with febrile UTI should be limited only to those with a duration of fever > or = 3 days and a history of urolithiasis. Ultrasonographic study should also be considered in febrile UTI patients with diabetes mellitus.
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Affiliation(s)
- I-Kuan Wang
- Division of Nephrology, Chang Gung Memorial Hospital, Pu-tzu City, Chiayi, Taiwan
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Huang SW, Lee CT, Chen CH, Chuang CH, Chen JB. Role of renal sonography in the intensive care unit. JOURNAL OF CLINICAL ULTRASOUND : JCU 2005; 33:72-75. [PMID: 15674831 DOI: 10.1002/jcu.20087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE This study was conducted to evaluate the role of portable renal sonography in the intensive care unit (ICU). METHODS We conducted a retrospective study of 402 ICU patients who underwent renal sonography. We recorded demographic data, underlying disease, type of ICU, renal function test results, etiology of renal failure, need for dialysis, and outcome for patients with acute renal failure (ARF). The indications for and results of sonography were analyzed. RESULTS The most common indication for a renal sonographic examination was ARF (320/402, 79.6%). Hydronephrosis was found in 5 patients with ARF. Chronic renal failure was confirmed by sonography in 40% of the patients with an indeterminate cause of renal failure. In 33% of cases of complicated urinary tract infections, sonography revealed abnormalities. Renal sonography was also useful for follow-up assessment of patients treated with percutaneous nephrostomy and patients with a history of renal tumor, hydronephrosis, adrenal tumor, hematuria of unknown cause, or fever of unknown origin. CONCLUSIONS Since renal disease is common in the ICU, renal sonography is a convenient and useful diagnostic tool in this setting.
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Affiliation(s)
- Shih-Wen Huang
- Division of Nephrology, Department of Internal Medicine, Chang-Gung Memorial Hospital, 123, Ta-Pei Road, Niao-Sung Shang, Kaohsiung Hsien 833, Taiwan
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Surange RS, Jeygopal NS, Chowdhury SD, Sharma NK. Bedside ultrasound: a useful tool for the on-call urologist? Int Urol Nephrol 2002; 32:591-6. [PMID: 11989547 DOI: 10.1023/a:1014421712499] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To assess the accuracy and benefit of urgent bedside ultrasound scanning in urological emergencies by urology trainees. METHODS In this prospective study, 111 patients (86 acute flank pain, 15 renal failure, 10 haematuria) referred as urological emergencies, were scanned for urinary tract abnormalities at the bedside, by a trainee urologist, over 18 months. The ultrasound findings were compared with the results of imaging performed by a consultant radiologist and its influence on clinical management analysed. RESULTS Bedside ultrasound proved life saving in 5 patients (2 pyonephrosis, 2 leaking aneurysms, one bilateral ureteric injury). It significantly influenced management in 11 patients, excluded obstruction in the presence of infection.in 13 patients, helped in early diagnosis in 32 patients and ruled out gross urological pathology in 28 patients. It was misleading in 22 patients, mainly with ureteric colic (where the timing of the test can affect the findings), though the outcome was not adversely affected in any. Bedside ultrasound was reasonably accurate (sensitivity 81% and specificity 92%). CONCLUSIONS Bedside ultrasound is a useful tool to help the decision-making in urological emergencies and reasonably accurate in hands of a trainee urologist. It is especially helpful for excluding obstruction in presence of infection or renal failure. However it has inherent limitations in assessing acute ureteric colic.
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Affiliation(s)
- R S Surange
- Department of Urology, The Royal Oldham Hospital, UK.
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van Haarst EP, van Andel G, Heldeweg EA, Schlatmann TJ, van der Horst HJ. Evaluation of the diagnostic workup in young women referred for recurrent lower urinary tract infections. Urology 2002; 57:1068-72. [PMID: 11377307 DOI: 10.1016/s0090-4295(01)00971-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the current practice of the diagnostic workup in The Netherlands and the clinical relevancy of the outcome of various diagnostic procedures in young women referred for recurrent lower urinary tract infections (UTIs). METHODS A questionnaire was sent to all urologic departments in The Netherlands (n = 104) inquiring about the diagnostic procedures used for recurrent lower UTIs. Furthermore, we performed a prospective study in 100 consecutive young female patients (18 to 40 years old) referred for evaluation of recurrent lower UTIs. All patients underwent a standardized workup: questionnaire, voiding diary, physical examination, urinalysis and culture, abdominal x-ray with ultrasound or intravenous urography, and cystoscopy. RESULTS The response rate to the questionnaires was 92%. The standard procedures were laboratory blood tests in 56%, cystoscopy in 69%, plain abdominal x-ray in 91%, and abdominal ultrasound in 59%. Only 18% of the urologists asked every patient to make a voided urine frequency volume chart. In our group of patients, the radiologic procedures revealed only one relevant abnormality. Cystoscopy confirmed cystitis in 22 patients, but never revealed relevant findings. None of these diagnostic procedures ever contributed to the diagnosis. The 24-hour urine output was less than 1.5 L in 43 patients, which was considered insufficient. The individual self-reports of fluid intake were unreliable. CONCLUSIONS Many Dutch urologists perform an extensive routine workup in patients referred for recurrent lower UTIs. The results of our study revealed that the yield of most diagnostic procedures in these patients is low. The focus in evaluating these patients should be directed toward the behavioral aspects. Thus, the routine workup can be restricted to a voiding diary, urinalysis, and urine culture.
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Affiliation(s)
- E P van Haarst
- Department of Urology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands
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Andrews SJ, Brooks PT, Hanbury DC, King CM, Prendergast CM, Boustead GB, McNicholas TA. Ultrasonography and abdominal radiography versus intravenous urography in investigation of urinary tract infection in men: prospective incident cohort study. BMJ 2002; 324:454-6. [PMID: 11859046 PMCID: PMC65665 DOI: 10.1136/bmj.324.7335.454] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2001] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To compare ultrasonography and abdominal radiography with intravenous urography in the investigation of urinary tract infection in men. DESIGN Prospective study in two hospital departments. Radiological procedures and urological assessments performed on different days by different clinicians SETTING District general hospital. PARTICIPANTS Consecutive series of men (n=114) referred to the department of urology for investigation of proved urinary tract infection. INTERVENTIONS Ultrasonography and intravenous urography of renal tract and assessment of urinary flow rate. Clinical assessment, cystoscopy, urodynamic studies, and transrectal ultrasonography with biopsy. MAIN OUTCOME MEASURES Sensitivity and specificity of ultrasonography and abdominal radiography compared with intravenous urography. RESULTS Important abnormalities were seen in 53 of 100 fully evaluated patients, the most common being a poorly emptying bladder (34). The combination of plain radiographs of kidneys, ureter, and bladder and ultrasonography detected more abnormalities than intravenous urography alone. No important abnormality was missed by this combination (sensitivity 100% and specificity 93%). CONCLUSIONS Ultrasonography with abdominal radiography is as accurate as intravenous urography in detecting important urological abnormalities in men presenting with urinary tract infection. This combination is safer than intravenous urography and should be the initial investigation for such patients. Additional determination of urinary flow rate is useful for the assessment of an incompletely emptying bladder.
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Affiliation(s)
- S J Andrews
- Department of Urology, Lister Hospital, Stevenage, Hertfordshire SG1 4AB
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Dennery MP, Rushton HG, Belman AB. Sonography for the detection and follow-up of primary nonsarcomatous bladder tumors in children. Urology 2002; 59:119-21; discussion 121-2. [PMID: 11796293 DOI: 10.1016/s0090-4295(01)01512-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To report the use of a dedicated renal-bladder sonogram for the detection and follow-up of primary nonsarcomatous bladder tumors in children. METHODS Three children (aged 6 to 12 years) recently presented with nontraumatic gross painless hematuria. All were evaluated initially with renal-bladder sonography. RESULTS Two transitional cell papillomas and one inflammatory myofibroblastic tumor were easily detected initially by sonography in the 3 children. Two were treated with transurethral resection at the time of the confirmatory cystoscopy and one, with an endoscopically unresectable tumor, was treated with excisional biopsy. The use of sonography as the diagnostic tool obviated more invasive and expensive studies, as well as exposure to ionizing radiation. CONCLUSIONS Renal-bladder sonography is the initial imaging modality of choice in the workup for nontraumatic gross painless hematuria in children. Not only is it an excellent screening tool for congenital malformations and renal calculi, it is also very sensitive for identifying primary bladder tumors in children.
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Abstract
Diabetes mellitus has a number of long-term effects on the genitourinary system. These effects predispose to bacterial urinary tract infections in the patient with diabetes mellitus. Bacteriuria is more common in diabetic women than in nondiabetic women because of a combination of host and local risk factors. Upper tract infection complications are also more common in this group. Diabetic patients are at higher risk for intrarenal abscess, with a spectrum of disease ranging from acute focal bacterial pyelonephritis to renal corticomedullary abscess, to the renal carbuncle. A number of uncommon complicated urinary tract infection complications occur more frequently in diabetics, such as emphysematous pyelonephritis and emphysematous pyelitis. Because of the frequency and severity of urinary tract infection in diabetic patients, prompt diagnosis and early therapy is warranted. A plain abdominal radiograph is recommended as a minimum radiographic screening tool in the patient with diabetes presenting with systemic signs of urinary tract infection. Ultrasonography or further radiographic studies such as CT scanning may also be warranted, depending on the clinical picture, to identify upper urinary tract complications early for appropriate intervention.
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Affiliation(s)
- J E Patterson
- Department of Medicine (Infectious Diseases), University of Texas Health Science Center at San Antonio, USA
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Nargund VH, Cumming JA, Jerwood D, Sapherson DA, Flannigan GM, Stewart PA. Ultrasound in urological emergency: results of self audit and implications for training. Int Urol Nephrol 1996; 28:267-71. [PMID: 8899463 DOI: 10.1007/bf02550485] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The efficacy of ultrasound examination by the trainee urologists in the management of urological emergencies admitted in a district general hospital was studied. Fifty patients (100 kidney units) had renal ultrasound performed by urological trainees on acute admission. The results were compared with subsequent definitive radiological investigations. On analysis of 100 renal units there were 7 discordant results, 2 false negatives and 5 false positives achieving 97% specificity (95% confidence interval 93% to 100%) and 84% sensitivity (95% confidence interval 71% to 97%). Adopting 50-patient analysis there was 89% specificity (95% confidence interval 74% to 100%) and 84% sensitivity (95% confidence interval 71% to 97%). These intervals indicate the levels of success to be expected in future studies. The study shows that urological trainees can use ultrasound with high levels of accuracy improving patient management.
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Holstein J, Teixeira-Ribeiro A, Meaume S, Teillet L, Faucher N, Moulias R. Y a-t-il un consensus gériatrique face aux infections urinaires en milieu hospitalier ? Med Mal Infect 1995. [DOI: 10.1016/s0399-077x(05)80758-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fellows GJ. Lessons from a tropical regional hospital: a personal view of urology at KCMC, Tanzania. Trop Doct 1995; 25 Suppl 1:68-72. [PMID: 7879276 DOI: 10.1177/00494755950250s121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- G J Fellows
- Department of Urology, Churchill Hospital, Headington, Oxford, UK
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Nargund VH, Lomas K, Sapherson DA, Flannigan GM, Stewart PA. Radiographer-performed abdominal and pelvic ultrasound: its value in a urology out-patient clinic. BRITISH JOURNAL OF UROLOGY 1994; 73:366-9. [PMID: 8199823 DOI: 10.1111/j.1464-410x.1994.tb07598.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To assess the efficacy of radiographer-performed ultrasound examination as a routine investigative procedure in a urological out-patient clinic. PATIENTS AND METHODS A total of 151 patients attending a District General Hospital Urological Out-patient Department underwent an ultrasound examination in the clinic. RESULTS Diagnosis by ultrasound was achieved in 93% of patients. The remaining patients underwent further investigations. Two (1%) patients with normal scans had small bladder tumours. Subsequent intravenous urography in these individuals showed normal upper tracts. CONCLUSION Abdominal and pelvic ultrasound examination performed in the urological out-patient clinic on unprepared patients was the only investigation necessary for evaluation of common problems such as non-specific urinary symptoms, recurrent urinary tract infections and bladder outlet obstruction.
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Affiliation(s)
- V H Nargund
- Department of Urology, Bradford Royal Infirmary, UK
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Spencer J, Lindsell D. Managing urinary tract infection. BMJ (CLINICAL RESEARCH ED.) 1993; 306:210-1. [PMID: 8443510 PMCID: PMC1676561 DOI: 10.1136/bmj.306.6871.210-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Wilkie M, Almond MK, Marsh FP. Managing urinary tract infection: Authors' reply. West J Med 1993. [DOI: 10.1136/bmj.306.6871.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Scott A, Campbell H, Gorman D. Sudden infant death in Scotland. BMJ (CLINICAL RESEARCH ED.) 1993; 306:211-2. [PMID: 8338517 PMCID: PMC1676626 DOI: 10.1136/bmj.306.6871.211-c] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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McNicholas MM, Griffin JF, Cantwell DF. Ultrasound of the pelvis and renal tract combined with a plain film of abdomen in young women with urinary tract infection: can it replace intravenous urography? A prospective study. Br J Radiol 1991; 64:221-4. [PMID: 2021795 DOI: 10.1259/0007-1285-64-759-221] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Urinary tract infection (UTI) is common in women and intravenous urography (IVU) is a frequently requested radiological investigation for recurrent UTI. The aim of this study was to assess whether pelvic and renal ultrasound combined with a plain film of the abdomen (KUB) could replace IVU as the initial radiological investigation in young women with recurrent UTI. Ninety-four young women with recurrent UTI who were referred for IVU were studied. Ultrasound of the pelvis and renal tract was performed, and information obtained from ultrasound and KUB was compared with that obtained from the IVU examination. Patient management was altered as a result of radiological investigation in eight cases. A case of staghorn calculus and a case of pelviureteric junction obstruction were diagnosed by both IVU and ultrasound with KUB. An intrarenal abscess was diagnosed by ultrasound in a patient with a normal IVU. In addition ultrasound demonstrated significant findings in the pelvis, including ovarian and uterine abnormalities and an ectopic and an intrauterine pregnancy. In all cases the patient had symptoms referable to the urinary tract and a history of documented UTI. The KUB did not yield any unsuspected finding not diagnosed by ultrasound, but did serve to delineate more clearly the extent of calculus disease in two patients. We suggest that ultrasound of the pelvis and renal tract combined with a KUB should be the radiological investigation of choice in young women with UTI.
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Affiliation(s)
- M M McNicholas
- Department of Diagnostic Radiology, St Vincent's Hospital, Dublin, Ireland
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Spencer J, Lindsell D, Mastorakou I. Investigation of adults with haematuria: Authors' reply. West J Med 1990. [DOI: 10.1136/bmj.301.6765.1397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cattell WR, Webb JAW, Whitfield HN. Investigation of adults with haematuria. BMJ : BRITISH MEDICAL JOURNAL 1990. [DOI: 10.1136/bmj.301.6765.1396-b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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