Obstruction and Infection of the Kidneys and Ureters

  • R. J. Zagoria
Conference paper
Part of the Syllabus book series (SYLLABUS)


In most patients, ureteral obstruction results from an acute process with associated symptoms. Some controversy exists as to which imaging studies are best for investigating suspected ureteral obstruction. At the Wake Forest University School of Medicine, the noncontrast helical computed tomography (CT) is preferred because it is safe and extremely rapid, and the accuracy rate for detecting ureteral stones, the most common cause of ureteral obstruction, exceeds that of other imaging studies. Noncontrast helical CT has an overall accuracy of 97% for diagnosing ureteral stone disease. This far exceeds the accuracy of intravenous urography (IVU) or sonography (US). Regardless of composition, virtually all ureteral stones will have high attenuation values making them readily detectable with CT. Nonmineralized matrix stones and some drug-related stones (protease inhibitors) may not be visible on CT images but these are rarely encountered. Noncontrast helical CT is also highly accurate in demonstrating the size and location of ureteral stones.


Transitional Cell Carcinoma Ureteral Stone Ureteral Obstruction Acute Pyelonephritis Intravenous Urography 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Suggested Reading

  1. Aerts P, Van Hoe L, Bosnians H, et al (1996) Breath-hold MR urography using the HASTE technique. AJR 166:543–545PubMedCrossRefGoogle Scholar
  2. Burge HJ, Middleton WD, McClennan BL, et al. (1991) Ureteral jets in healthy subjects and in patients with unilateral ureteral calculi: comparison with color Doppler US. Radiology 180: 437–442PubMedGoogle Scholar
  3. Cronan JJ (1992) Contemporary concepts for imaging urinary tract obstruction. Urol Radiol 14:8–12PubMedCrossRefGoogle Scholar
  4. Olcott EW, Sommer FG, Napel S (1997) Accuracy of detection and measurement of renal calculi: in vitro comparison of three-dimensional spiral CT, radiography, and nephrotomography. Radiology 204:19–25PubMedGoogle Scholar
  5. Older RA, Stoll HL, III, Omary RA, et al. (1997) Clinical value of renovascular resistive index measurement in the diagnosis of acute obstructive uropathy. J Urol 157:2053–2055PubMedCrossRefGoogle Scholar
  6. Pfister RC, Newhouse JH, Hendren WH (1982) Percutaneous pyeloureteral urodynamics. Urol Clin North Am 9(1):41–49PubMedGoogle Scholar
  7. Platt JF, Ellis JH, Rubin JM (1995) Role of renal Doppler imaging in the evaluation of acute renal obstruction. AJR 379–380Google Scholar
  8. Platt JF, Rubin JM, Ellis JH (1989) Distinction between obstructive and nonobstructive pyelocaliectasis with duplex Doppler sonography. AJR 153:997–1000PubMedCrossRefGoogle Scholar
  9. Platt JF, Rubin JM, Ellis JH (1993) Acute renal obstruction: evaluation with intrarenal duplex Doppler and conventional US. Radiology 186:685–688PubMedGoogle Scholar
  10. Parker MD, Clark RL (1989) Evolving concepts in the diagnosis of xanthogranulomatous pyelonephritis. Urol Radiol 11: 7–15PubMedCrossRefGoogle Scholar
  11. Remer EM, Herts BR, Streem SB, et al. (1997) Spiral noncontrast CT versus combined plain radiography and renal UR after extracorporeal shock wave lithotripsy; cost-identification analysis. Radiology 204:33–37PubMedGoogle Scholar
  12. Rothpearl A, Frager D, Subramanian A, et al. (1995) MR urography: technique and application. Radiology 194:125–130PubMedGoogle Scholar
  13. Sarker SD (1992) Diuretic renography: concepts and controversies. Urol Radiol 14:79–84CrossRefGoogle Scholar
  14. Smith RC, Verga M, McCarthy S, et al. (1996) Diagnosis of acute flank pain: value of unenhanced helical CT. AJR 166:97–101PubMedCrossRefGoogle Scholar
  15. Zagoria RJ, Dyer RB (1991) Radiology of renal infectious disease. Contemp Diagn Radiol 8(14):1–6Google Scholar

Copyright information

© Springer-Verlag Italia 1999

Authors and Affiliations

  • R. J. Zagoria
    • 1
  1. 1.Wake Forest University School of MedicineWinston-SalemUSA

Personalised recommendations