Tartaglione Girolamo, Ieria Francesco Pio, Bertolo Riccardo, Bove Pierluigi, Vittori Matteo
Department of Nuclear Medicine, Cristo Re Hospital, Rome, Italy.
Department of Surgery, Dentistry, Pediatrics and Gynecology, Urology Unit, University of Verona, Verona, Italy.
World J Nucl Med. 2025 Feb 20;24(2):128-137. doi: 10.1055/s-0045-1802665. eCollection 2025 Jun.
Primary megaureter is a disease defined as the dilatation of the ureter caused by a congenital abnormality of the lower ureteral tract. Adult patients with primary megaureters typically present with no symptoms, making conservative management the preferred treatment. However, if an obstruction is present, we recommend ureteral reimplantation. The major diagnostic challenge is to distinguish which patients need surgical intervention. Ultrasound, computed tomography, and magnetic resonance imaging urogram findings of obstruction may be misleading because they are based on morphological aspects, and persistence of contrast in the upper urinary tract is not specific for obstruction. Renal scintigraphy is the key test for choosing surgical or conservative treatment; historically, the criterion for surgical treatment is the decrease of split renal function (SRF) less than 40%. Unfortunately, SRF might be only an indirect finding of obstruction; otherwise, the 20-minute/peak ratio may offer urologists an earlier, direct, and reliable index of urine outflow in monitoring ureteral flow. This study suggests that the F + 10(sitting position) test, which measures diuretic renography (DR) in a sitting position, is a new and useful way to find out how well primary megaureters are working for diagnosing and treating them. It focuses on the 20-minute/peak ratio that can be found when gravity is favorable. Twenty-eight adult patients (15 males, 13 females) affected by primary megaureter were retrospectively enrolled. Twenty-six patients had unilateral megaureter, and 2 patients had bilateral megaureter, for a total of 30 megaureters radiologically confirmed (16 left, 14 right). In total, we performed twenty-eight 99mTc-mercaptoacetyltriglycine DR in a sitting position using the F + 10 (sitting position) method. In our series, 17 patients received conservative treatment, and 11 patients underwent ureteral reimplantation. Based on the 20-minute/peak ratio values, 17 out of 30 megaureters were diagnosed as obstructed. A discordance between SRF and 20-minute/peak ratio findings has been seen. No side effects were seen. A decrease in SRF is an indirect and late index of obstruction. Twenty-minute/peak ratio measured by DR in sitting position may improve the sensitivity and accuracy of the test for diagnosis of obstructive megaureters.
原发性巨输尿管是一种由输尿管下段先天性异常引起的输尿管扩张疾病。成年原发性巨输尿管患者通常无症状，因此保守治疗是首选治疗方法。然而，如果存在梗阻，我们建议进行输尿管再植术。主要的诊断挑战是区分哪些患者需要手术干预。超声、计算机断层扫描和磁共振尿路造影的梗阻表现可能会产生误导，因为它们基于形态学方面，而上尿路造影剂的持续存在对梗阻并不具有特异性。肾闪烁扫描是选择手术或保守治疗的关键检查；从历史上看，手术治疗的标准是分肾功能（SRF）下降小于40%。不幸的是，SRF可能只是梗阻的间接表现；否则，20分钟/峰值比值可能为泌尿外科医生提供一个更早、直接且可靠的尿液流出指标，用于监测输尿管流量。本研究表明，F + 10（坐位）试验，即在坐位测量利尿肾图（DR），是一种用于诊断和治疗原发性巨输尿管的新的有用方法。它关注在重力有利时可获得的20分钟/峰值比值。
回顾性纳入了28例成年原发性巨输尿管患者（15例男性，13例女性）。26例患者为单侧巨输尿管，2例患者为双侧巨输尿管，经放射学证实共有30条巨输尿管（16条左侧，14条右侧）。我们总共使用F + 10（坐位）方法在坐位进行了28次99mTc - 巯基乙酰三甘氨酸DR检查。在我们的系列研究中，17例患者接受了保守治疗，11例患者接受了输尿管再植术。
根据20分钟/峰值比值，30条巨输尿管中有17条被诊断为梗阻。观察到SRF与20分钟/峰值比值结果之间存在不一致。未观察到副作用。
SRF下降是梗阻的间接和晚期指标。坐位DR测量的20分钟/峰值比值可能会提高梗阻性巨输尿管诊断试验的敏感性和准确性。
