Role of MDCT Urography in Evaluation of Patients with Obstructive Uropathy: A Prospective Study of 50 Patients in a Rural Tertiary Care Hospital

Abstract

Introduction: Obstructive uropathy is a relatively common clinical problem which if not treated timely can lead to irreversible renal damage. Therefore, accurate diagnosis is important for timely management. Aim: The purpose of present study is to assess role Multidetector Computed Tomography (MDCT) urography in evaluation of obstructive uropathy. Materials and Methods: This prospective study was conducted on 50 consecutive subjects presenting with evidence of unilateral or bilateral hydronephrosis and who were referred for CT urography for detection of site and cause obstruction. Subjects with deranged renal function tests, pregnant subjects and those with history of allergy to iodinated contrast media were excluded from the study. Patients with any past history of urinary tract surgery were not considered. CT-scan was performed with Ingenuity CT scanner (128 slice MDCT, Philips Medical Systems). Timed triphasic scans were obtained in all subjects; First phase (non contrast phase), second phase (nephrographic/venous phase) obtained following a delay of 90-100 seconds and a delayed phase (after 8-10 mins) The images were sent to on the workstation with real time Multiplanar Reconstruction (MPR) and Maximum Intensity Projection (MIP) capabilities. Side, site and cause of urinary obstruction were noted based on CT urography findings. Results: Out of 50 subjects, urinary obstruction was unilateral in 45 subjects (90%) in our study. Only 5 subjects (10%) had bilateral urinary obstruction. Most common cause of urinary obstruction was urinary tract calculi seen in 33 subjects (66%). Second most common cause was urinary bladder masses which were causes of unilateral obstruction in 6 subjects (12%) and bilateral obstruction in 2 subjects (4%). Other less common causes were Pelvi-Ureteric Junction (PUJ) obstruction, ureteric stricture and extrinsic compression of ureter by enlarged lymph nodes. Additional other significant findings included enlarged lymph nodes (4 subjects), urinoma formation (2 subjects), recro-vesical fistula (1 subject) and ureterocele (1 subject). Conclusion: MDCT urography is very useful for complete evaluation of obstructive uropathy and allows rapid detection of level and cause of obstruction which is critical for timely and effective management.

Keywords

• kidneys
• pelvi-ureteric junction obstruction
• renal calculi
• urinary bladder