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Nondilated Obstructive Uropathy
0022-534 7/89/1413-0676$02.00/0 Vol. 141, March
THE JOURNAL OF UROLOGY
Copyright© 1989 by The Williams & Wilkins Co.
Printed in U.S.A.
ABSTRACTS rally upon the role of prostatectomy, the third leading expenditure in the Medicare budget. Articles such as this attempt to establish objective criteria to help determine the need for prostatectomy. Patient symptoms still are the most common indication for prostatectomy but data accumulated from such studies and the ongoing Veterans Administration cooperative study may yield more objective criteria to be used in the future. Jerome P. Richie, M.D.
DIAGNOSTIC UROLOGY AND TESTIS CANCER Can Transabdominal Ultrasound Estimation of Postvoiding Residual (PVR) Replace Catheterization C. G. ROEHRBORN AND P. C. PETERS, Department of Surgery, Division of Urology, University of Texas Health Sciences Center, Dallas, Texas Urology, 31: 445-449, 1988
In 81 outpatients the postvoiding residual urine (PVR) using real-time B-mode ultrasonography (3.5 MHz transducer) was measured. For the calculation of the bladder volume the formula for an ellipsoid (V = 4/31r X r, X r2 X r3) was found to be most accurate in predicting the actual volume measured by inand-out catheterization (r = 0.982). Other volume formulas, using only one diameter of the bladder, were found to be much less accurate. For any arbitrary value of PVR, used in determining clinical management, the incidence of misjudgment by ultrasound was negligibly low. We conclude, the sonographic measurement of the PVR as a quick, noninvasive method, should replace catheterization, if the basic equipment is available. Additional information, e.g., prostate size, bladder configuration, diverticula, etc., can be obtained during the procedure without additional costs or loss of time.
Nondilated Obstructive Uropathy A. SPITAL, J. R. VALVO AND A. J. SEGAL, Divisions of Nephrology and Urology, and Departments of Radiology, University of Rochester School of Medicine, Rochester General Hospital, Rochester, New York Urology, 31: 478-482, 1988 Four patients presented with severe renal failure secondary to urinary tract obstruction, yet ultrasonography and/or computed tomography revealed only minimal dilatation in 1 patient and no dilatation in the other three. Two patients had prostate cancer, one had bladder cancer, and one had retroperitoneal fibrosis. In all cases, relief of obstruction led to a dramatic improvement in renal function. These cases, and others in the literature, illustrate that in certain settings severe urinary tract obstruction may be present in the absence of dilatation and hence may be missed by noninvasive imaging techniques. Nondilated obstructive uropathy should be suspected in any elderly patient who presents with the acute onset of oliguria in the absence of an identifiable cause, especially if there is a previous history of malignancy in the pelvis. Left undiagnosed, this potentially reversible cause of renal failure can lead to endstage renal disease.
Editorial Comment: The use of ultrasonography for a variety of urological diagnostic procedures has become more commonplace on the continent than in the United States. Urologists in Europe frequently use their own ultrasound machines for estimation of post-void residual as well as evaluation of the upper urinary system. This study compared estimated bladder volume by ultrasound with measured post-void residual with a high degree of accuracy. Clearly, this noninvasive procedure is worth considering as urologists become more comfortable with the use of ultrasonography. Jerome P. Richie, M.D.
Editorial Comments: Given the plethora of radiological examinations available to image the kidney and urinary tract, one must decide which test to order on a costeffective basis depending upon the clinical scenario. Noninvasive imaging techniques have become popular with our internal medicine colleagues, especially in patients with azotemia or diabetes. In patients with retroperitoneal fibrosis or encasement of the ureter, lack of dilatation may be present and missed by noninvasive imaging techniques. Computerized tomography scans provide an excellent view of the parenchyma but limited knowledge about the renal pelvis and collecting system. I strongly concur that in patients in whom obstruction is suspected definitive studies to exclude obstruction be used in preference to noninvasive imaging techniques. Jerome P. Richie, M.D.
Diagnosis and Grading of Outflow Obstruction
Z. KHAN, M. MIEZA, A. BHOLA AND P. STARER, Department of Urology, Beth Israel Medical Center, New York, New York Urology, 32: 72-77, 1988 Urodynamic data from 66 male patients with obstruction due to benign prostatic hyperplasia were analyzed. Criteria for grading the severity of outflow obstruction based on uroflowmetry, post void residual urine, maximum bladder contraction (Pmax), and pressure during voiding (Pvoid) were developed. In selected cases, voiding cystourethrography also may be needed. These criteria help determine the need for prostatectomy. Unnecessary prostatectomies can then be avoided and can lead to significant reduction in mortality, morbidity, and health care expenses.
Editorial Comment: In this era of cost-consciousness and cost-containment, attention has been focused natu-
Fear of contrast-induced renal injury is leading to the use of ultrasound instead of pyelography to diagnose obstruction. Since falsely normal sonograms can occur further studies are mandatory in patients when obstruction still is suspected. E. Darracott Vaughan, M.D.
676
THE JOURNAL OF UROLOGY
Copyright© 1989 by The Williams & Wilkins Co.
Printed in U.S.A.
ABSTRACTS rally upon the role of prostatectomy, the third leading expenditure in the Medicare budget. Articles such as this attempt to establish objective criteria to help determine the need for prostatectomy. Patient symptoms still are the most common indication for prostatectomy but data accumulated from such studies and the ongoing Veterans Administration cooperative study may yield more objective criteria to be used in the future. Jerome P. Richie, M.D.
DIAGNOSTIC UROLOGY AND TESTIS CANCER Can Transabdominal Ultrasound Estimation of Postvoiding Residual (PVR) Replace Catheterization C. G. ROEHRBORN AND P. C. PETERS, Department of Surgery, Division of Urology, University of Texas Health Sciences Center, Dallas, Texas Urology, 31: 445-449, 1988
In 81 outpatients the postvoiding residual urine (PVR) using real-time B-mode ultrasonography (3.5 MHz transducer) was measured. For the calculation of the bladder volume the formula for an ellipsoid (V = 4/31r X r, X r2 X r3) was found to be most accurate in predicting the actual volume measured by inand-out catheterization (r = 0.982). Other volume formulas, using only one diameter of the bladder, were found to be much less accurate. For any arbitrary value of PVR, used in determining clinical management, the incidence of misjudgment by ultrasound was negligibly low. We conclude, the sonographic measurement of the PVR as a quick, noninvasive method, should replace catheterization, if the basic equipment is available. Additional information, e.g., prostate size, bladder configuration, diverticula, etc., can be obtained during the procedure without additional costs or loss of time.
Nondilated Obstructive Uropathy A. SPITAL, J. R. VALVO AND A. J. SEGAL, Divisions of Nephrology and Urology, and Departments of Radiology, University of Rochester School of Medicine, Rochester General Hospital, Rochester, New York Urology, 31: 478-482, 1988 Four patients presented with severe renal failure secondary to urinary tract obstruction, yet ultrasonography and/or computed tomography revealed only minimal dilatation in 1 patient and no dilatation in the other three. Two patients had prostate cancer, one had bladder cancer, and one had retroperitoneal fibrosis. In all cases, relief of obstruction led to a dramatic improvement in renal function. These cases, and others in the literature, illustrate that in certain settings severe urinary tract obstruction may be present in the absence of dilatation and hence may be missed by noninvasive imaging techniques. Nondilated obstructive uropathy should be suspected in any elderly patient who presents with the acute onset of oliguria in the absence of an identifiable cause, especially if there is a previous history of malignancy in the pelvis. Left undiagnosed, this potentially reversible cause of renal failure can lead to endstage renal disease.
Editorial Comment: The use of ultrasonography for a variety of urological diagnostic procedures has become more commonplace on the continent than in the United States. Urologists in Europe frequently use their own ultrasound machines for estimation of post-void residual as well as evaluation of the upper urinary system. This study compared estimated bladder volume by ultrasound with measured post-void residual with a high degree of accuracy. Clearly, this noninvasive procedure is worth considering as urologists become more comfortable with the use of ultrasonography. Jerome P. Richie, M.D.
Editorial Comments: Given the plethora of radiological examinations available to image the kidney and urinary tract, one must decide which test to order on a costeffective basis depending upon the clinical scenario. Noninvasive imaging techniques have become popular with our internal medicine colleagues, especially in patients with azotemia or diabetes. In patients with retroperitoneal fibrosis or encasement of the ureter, lack of dilatation may be present and missed by noninvasive imaging techniques. Computerized tomography scans provide an excellent view of the parenchyma but limited knowledge about the renal pelvis and collecting system. I strongly concur that in patients in whom obstruction is suspected definitive studies to exclude obstruction be used in preference to noninvasive imaging techniques. Jerome P. Richie, M.D.
Diagnosis and Grading of Outflow Obstruction
Z. KHAN, M. MIEZA, A. BHOLA AND P. STARER, Department of Urology, Beth Israel Medical Center, New York, New York Urology, 32: 72-77, 1988 Urodynamic data from 66 male patients with obstruction due to benign prostatic hyperplasia were analyzed. Criteria for grading the severity of outflow obstruction based on uroflowmetry, post void residual urine, maximum bladder contraction (Pmax), and pressure during voiding (Pvoid) were developed. In selected cases, voiding cystourethrography also may be needed. These criteria help determine the need for prostatectomy. Unnecessary prostatectomies can then be avoided and can lead to significant reduction in mortality, morbidity, and health care expenses.
Editorial Comment: In this era of cost-consciousness and cost-containment, attention has been focused natu-
Fear of contrast-induced renal injury is leading to the use of ultrasound instead of pyelography to diagnose obstruction. Since falsely normal sonograms can occur further studies are mandatory in patients when obstruction still is suspected. E. Darracott Vaughan, M.D.
676