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[Duplex Doppler ultrasound value in upper urinary tract obstruction ]
P Geavlete1, D Georgescu, V Cauni
1Clinica de Urologie, Spital Clinic de Urgenţă Sfântul Ioan Bucureşti Sos. Vitan-Bârzeşti 13, 75669 Bucureşti. geavlete@net4u.ro
Chirurgia (Bucharest, Romania : 1990)
|May 7, 2003
Summary
Duplex Doppler ultrasonography (DDU) effectively assesses ureteral obstruction. It aids in predicting spontaneous stone passage and evaluating chronic obstruction, establishing DDU as a key functional imaging tool for obstructive uropathy.
Area of Science:
- Urology
- Diagnostic Imaging
- Nephrology
Background:
- Ureteral obstruction, both acute and chronic, presents diagnostic challenges.
- Accurate assessment of obstruction is crucial for timely intervention and patient management.
- Existing imaging modalities may have limitations in functional evaluation of ureteral obstruction.
Purpose of the Study:
- To determine the value of duplex Doppler ultrasonography (DDU) in the diagnostic protocol for patients with acute or chronic ureteral obstruction.
- To evaluate the efficacy of DDU parameters, including resistive index (RI) and ureteral jet characteristics, in differentiating obstruction severity and predicting stone passage.
- To assess the utility of DDU in chronic ureteral obstruction, particularly in cases related to malignancy and retroperitoneal involvement.
Main Methods:
- Prospective study involving 177 cases of acute ureteral stone obstruction and 78 cases of chronic ureteral obstruction.
- Duplex Doppler ultrasonography (DDU) was employed, including gray scale echography, resistive index (RI), delta RI, and ureteral jet analysis (amplitude, velocity, frequency).
- Evaluation of RI changes after double J stenting in chronic obstruction cases.
Main Results:
- In acute obstruction, RI and delta RI values demonstrated sensitivity and specificity in predicting obstruction and spontaneous stone passage.
- Ureteral jet evaluation significantly increased the predictive value, with the presence of a jet correlating with higher spontaneous passage rates (63%) versus absence (5%).
- In chronic obstruction, DDU parameters showed moderate sensitivity and specificity; double J stenting led to a significant decrease in RI.
Conclusions:
- Duplex Doppler ultrasonography (DDU) is a valuable functional imaging method for investigating obstructive uropathy.
- DDU parameters, especially when combined with ureteral jet analysis, provide important information for diagnosing ureteral obstruction and predicting outcomes.
- The study supports the integration of DDU into the standard investigative protocol for patients with obstructive uropathy.