Smith T P, Hunter D W, Letourneau J G, Cragg A H, Darcy M D, Castaneda-Zuniga W R, Amplatz K
Department of Radiology, University of Minnesota Hospital and Clinic, Minneapolis 55455.
AJR Am J Roentgenol. 1988 Sep;151(3):507-10. doi: 10.2214/ajr.151.3.507.
We reviewed our experience with 51 renal transplants to evaluate the accuracy of antegrade pyelography as compared with that of sonography and nuclear renography in the diagnosis of transplant obstruction. Also, the results of percutaneous treatment were analyzed in 44 of these patients. Obstruction was clinically suspected in all of the patients (increased serum creatinine levels and decreased urine output). Antegrade pyelography showed obstruction in 44 (86%) of the 51 patients, and nephrostomy drainage catheters were inserted. Sonography showed pyelocaliectasis in all 49 cases in which it was performed; in 42, the pyelocaliectasis was due to obstruction (14% false-positive rate). Nuclear renography showed obstruction in only six (18%) of 33 cases in which it was performed; all six cases proved to be obstructed (0% false-positive rate and 82% false-negative rate). Twenty-two (50%) of the 44 patients treated with nephrostomy drainage were managed successfully without surgical intervention; seven of these 22 required balloon dilation of ureteric strictures in addition to catheter decompression of the collecting system. The average duration of catheterization required for successful percutaneous treatment was 35 days. This experience suggests that antegrade pyelography has a definite role in the workup of patients suspected of having renal transplant obstruction. The percutaneous access permits successful catheter drainage. Compared with antegrade pyelography, sonography is reasonably accurate in determining the presence of urinary obstruction, although false-positive diagnoses are found in a substantial number of patients. Nuclear renography is not, however, a useful indicator of obstruction owing to its high false-negative rate. Percutaneous treatment of urinary obstruction in transplantation patients proves successful in approximately 50% of cases.
我们回顾了51例肾移植的经验，以评估顺行肾盂造影与超声及核素肾造影相比，在诊断移植肾梗阻方面的准确性。此外，还对其中44例患者的经皮治疗结果进行了分析。所有患者临床上均怀疑有梗阻（血清肌酐水平升高和尿量减少）。顺行肾盂造影显示51例患者中有44例（86%）存在梗阻，并插入了肾造瘘引流导管。超声检查在其检查的所有49例病例中均显示肾盂扩张；其中42例肾盂扩张是由梗阻引起的（假阳性率为14%）。核素肾造影在其检查的33例病例中仅显示6例（18%）有梗阻；所有这6例均证实有梗阻（假阳性率为0%，假阴性率为82%）。44例接受肾造瘘引流治疗的患者中有22例（50%）在未进行手术干预的情况下获得成功治疗；这22例患者中有7例除了进行收集系统的导管减压外，还需要对输尿管狭窄进行球囊扩张。经皮治疗成功所需的平均置管时间为35天。这一经验表明，顺行肾盂造影在疑似肾移植梗阻患者的检查中具有明确作用。经皮穿刺可成功进行导管引流。与顺行肾盂造影相比，超声在确定尿路梗阻的存在方面相当准确，尽管在相当数量的患者中存在假阳性诊断。然而，由于核素肾造影的假阴性率高，它不是梗阻的有用指标。移植患者尿路梗阻的经皮治疗在大约50%的病例中证明是成功的。
