Renal perfusion changes before and after ESWL: evaluation with color doppler ultrasound in comparison with Magnetic Resonance (MR) perfusion imaging, scintigraphy and big-endothelin-1

130

129 VALUE OF RENAL AND INTRAVESICAL DUPLEX ULTRASONOGRAPHY IN RENAL COLIC

THE ROLE OF DUPLEX DOPPLEROGRAPHY IN CHOICE OF INDICATIONS TO THE DRAINAGE OF KIDNEY IN CASES OF ACUTE OBSTRUCTION OF UPPER URINARY TRACT

DOPPLER

Geavlete Petrisor, Georgescu Dragos, Cauni Victor, Nita Gheorghe Roschin Yurv, Fedorishin

Rodion, Reznikov Dmitriy

“Saint John” Emergency Clinical Hospital, Bucharest, Romania Urology, Regional Clinical Medical Association, INTRODUCTION & OBJECTIVES: The diagnosis of urinary tract obstruction benefit of duplex Doppler ultrasonography (DDU). The study of the resistive index (RI), difference of the RI (DRI) associated with a DDU intravesical recording (ureteral jets) were compared with renographic findings in renal colic. MATERIAL & METHODS: Between October 1998 and January 2001, we studied 377 cases with suspected renal colic by intravenous pyelography (IVP), gray-scale ultrasonography and DDU with determination of the RI, the difference between the RI of ipsilateral and contralateral kidneys (ARI) and the velocity and frequency of the urine bolus (intravesical recording). We considered normal values RIc 0.70 and AR15 0.06. IVP was used as a referee investigation and the ureteral intravesical jets were determinates in standard conditions: 60 minutes no fluid intake before DDU and I5 minutes intravesical recording for each ureteral orifice. All patients came to the hospital between 4 and 12 hours after the onset of the renal colic. RESULTS: We found 4 series of patients: I) Acute (complete) obsrructrd kidney (IVP and dilatation at normal grey-scale, with normal contralateral kidney (n=l53). In this series we found RI&.70 and ARIXl.06 and absent ureteral intravesical jet of the obstructed kidney site in 91%. 2) Acute (complete) obstructed kidney (/VP nonfunctionrrl) without &wrrnalities at normal greyscale, with normal contralateral kidney (n=57). In this series we found RIz0.70 and ARI>O.O6 in 79% of patients, absent or asymmetric ureteral intravesical jet in 80.7% of cases. 3) Incomplete obrtructrdkidrtey (IVP with various degree of uretero-hydronephrosis) with normal contralateral kidney (n=96). In this series we found RIz0.70 and ARIA.06 in 62.5% of patients, asymmetric ureteral intravesical jets in 74% of cases. 4) Normal both kidney (normal IVP) were found in 71 cases (18.8%). In this series we found RI< 0.70 and AR15 0.06 in 90% of cases, normal ureteral intravesical jets in 93%, of cases. The mean RI was 0.76 (SD=0.05) in 306 obstructed kidneys, significantly higher than the mean RI of 0.62 (SD=O.OS) in 448 normal kidneys (P
CONCLUSIONS: Renal DDU associated with intravesical evaluation of ureteral jets could better detect renal obstruction and, as a functional investigation, could have a particular value regarding the evaluation of upper urinary system in renal colic.

Done&k, Ukraine

INTRODUCTION & OBJECTIVES: The fulfillment of extracorporal shock wave lithotripsy in situ in patients with stones in the upper part of uretera accompanies with a certain risk of complications. The elaboration of the indications to urgent drainage operations on patients with acute obstructions of the upper urinary tract by stones before the fulfillment of shock wave lithotripsy is still a very actual problem. MATERIAL & METHODS: We have examined 82 patients with urinary stones in the upper part of the ureter aged from I5 to 65 years. All patients underwent duplex dopplerography of the arcuatal (Arc) and interlobalar (II) arterial blood supply both on the affected side and contralateral one. The resistive index (Ri) was calculated. Doppler examinations of the kidney were performed using ultrasonic scan unit Domier-AI 5200 equipped with convex 3.5 MHz probe. RESULTS: During the examination we obtained non synonymous indexes of the blood supply in obstructed kidney. According to our results we have divided our patients on two groups. The first one included 28 patients (34%) without significant increasing of Ri-0.68 in comparison to the contralateral kidney. We performed extracorporal shock wave lithotripsy in situ. We did not note any significant complications during postoperative period in this group of patients. The second group of patients included 54 persons (66%) with significant increasing of Ri (Arc)-0,0,69, Ri (II)-0,68 in comparison with a standard and indexes of contralateral kidney. Basing on the changes of blood supply in that group of patients we have performed drainage operations. We moved stones into the kidney with following stem setting on 39 (727~) patients. 8 patients (28%) underwent percutaneous punctional nephrostomy with the following course of antibacterial therapy. After the improvement of Ri indexes we performed extracorporal shock wave lithotripsy. CONCLUSIONS: Thus, patients with stones of the upper part of the ureter in cases of increasing doppler indexes both 11 and Arc blood supply (Ri 0,71) should be underwent percutaneous nephrostomy or retrograde movement of the stone into the kidney and setting of _&tent.

131 RENAL PERFUSION CHANGES BEFORE AND AFTER ESWL: EVALUATION WITH COLOR DOPPLER ULTRASOUND IN COMPARISON WITH MAGNETIC RESONANCE (MR) PERFUSION IMAGING, SCINTIGRAPHY AND BIG-ENDOTHELIN-1 Pingeera

C&mar-Michael*, Pallwein Michael’. Klauser Andrea’, Peschel Georg’ ‘Radiology, University of Innsbruck, Innsbruck, Insbruck, Austria

Leo’, Frauscher Ferdinand’, Reinhard’. Helweg &mot’,

Insbruck, Austria, ‘Urology,

Schocke Bartsch

University

of

INTRODUCTION & OBJECTIVES: We evaluated changes of renal perfusion before and within 24 hours after ESWL by assessing changes of renal resistive index (RI) using color Doppler ultrasound (CDUS), MR perfusion imaging, scintigraphy and big-endothelin-l-values (Big-ET-l). MATERIAL & METHODS: In 23 normotensive patients the RI was measured before, I, 3. 6 and 24 hours after ESWL using CDUS. The RI-values, detected in interlobar/arcuata arteries, were correlated with the findings on MR perfusion imaging, using FLASH STAR sequences, which were performed before and within 24 hours after ESWL. Also changes of renal plasma flow (RPF) in scintigraphy (“gold standard”) and Big-ET-l-values, a potent vasoconstrictor peptide. served as a control for detection of changes in renal perfusion. RESULTS: The RI increased significantly in the treated kidneys from 0.64fO.05 to 0.72ti.06 after ESWL (p=O.OOl). Only in patients older than 60 years (age-group III) the RI continued to increase through 24 hours. The MR perfusion imaging showed a decrease of renal blood flow (RBF) in all agegroups but most significantly in age-group 111.The scintigraphy and the Big-ETI-measurements detected significant changes only in age-group III. The best correlation was found between RI-values and RBF-changes detected by FLASH STAR-imaging. CONCLUSIONS: ESWL obviously causes considerable damage of renal parenchyma, resulting in disturbances of renal perfusion particularly in patients older than 60 years. In comparison with the other methods the RI proved to be a valuable tool in assessing changes of renal perfusion.

132 SERUM

CREATININE

LEVELS

IN RENAL COLIC

PATIENTS

Kleinmann Judy, Coooer Amir, Cipele Helio, Velikanov Sergei. Zisman Amnon, Leibovici Dan, Siegel Yoram, Lindner Arie Urology, Assaf Harofeh Medical Centre, Zerifin, Israel INTRODUCTION & OBJECTIVES: The mainstay of treatment in severe renal colic is the parenteral administration of narcotics or NSAID’s Both influence pain pathways and have been shown to inhibit spontaneous contraction of the ureter. NSAID’s have also been observed to decrease renal blood Row in the obstructed kidney, possibly affecting renal function. We observed that a significant portion of patients with renal colic had high levels of creatinme (Cr). Objectives: To assess the incidence of Cr elevation in patients with renal colic and its significance. MATERIAL & METHODS: Serum Cr was checked in 583 consecutive patients treated for renal colic in the emergency department. Patients with a Cr level above I .2 mg% were hospitalised; received IV hydration and the Cr level was monitored daily. Patients, wphose pain was not relieved sufficiently. were hospitalised as well. Age, gender, duration of pat”, NSAID use prior to hospitahsation, exposure to contrast material. previous history of urolithiasis, time to return of Cr to normal levels, final diagnosis, need for urinary drainage and need for urgent operation were recorded. RESULTS: I I5 patients (20%) had Cr levels above I .2 mgR. I I4 additional patients were hospital&d because of refractory pain. I81 men and 48 women were hospitalised. Cr levels were divided into 4 groups: I) normal, 2) 1.2-l.39 mg’%, 3) I .4-I .59 mg%, 4) above I .6 mg%. Patient’s age was higher in the above I .6 mg% group compared to all other groups (mean 59+1 I vs 43&14). Men had a higher incidence of Cr above I .2 mg% than women (60% vs 15%). There was no significant difference between patients with and without elevated Cr levels regarding patients’ affected side and previous history of stone disease. Use of NSAID’s prior to hospitahsation was found in 48% of patients with normal Cr levels, and in 62%, 5 I % and 53% of patients in groups 2-4 respectively. A urinary calculus was detected in 50% of patients with normal Cr levels and in 63%. 67% and 74% of patients in groups 2-4 respectively. A bilateral urinary pathology was found in 4%,6% 10% and 21% of patients respectively. Cr levels returned to normal within 24 hours in 33%. 21% and 10% of patients in groups 2-4 respectively. In S%,, 21% and 37% of patients in groups 2-4 the Cr level did not return to normal. CONCLUSIONS: There is a significant incidence of high Cr levels in patients with renal colic, that justifies testing Cr levels routinely. Caution is suggested wen treating renal colic patients with drugs that may affect renal function, European

Urology

Supplements

1 (2002) No. 1, pp. 35