Imaging of Urinary Tract Diverticula

Imaging of Urinary Tract Diverticula

Vladimir M. Builov Imaging of Urinary Tract Diverticula

Vladimir M. Builov Department of X-Ray and MRI RailWay Clinical Hospital Yaroslavl Russia ISBN 978-3-319-05382-0 ISBN 978-3-319-05383-7 (ebook) DOI 10.1007/978-3-319-05383-7 Springer Cham Heidelberg New York Dordrecht London Library of Congress Control Number: 2014938363 Springer International Publishing Switzerland 2014 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher's location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com)

To my family, To my teachers, To my patients

Preface Urinary tract diverticula include pelvicalyceal diverticula (PSD), ureteral diverticula (UD), bladder diverticula (BD), and urethral diverticula (UTHD). Urinary tract diverticula are mainly congenital abnormalities, although they may also be acquired. In most cases the priority method for their diagnostics, especially if there are no clinical implications for a long time, is diagnostic imaging. Its algorithm, the same as most disciplines of radiological diagnostics in urology, includes, first of all, ultrasonography (USG) as well as X-ray and magnetic resonance diagnostics. Treatment methods for urinary tract diverticula vary from case monitoring to surgery which has been mostly endoscopic during the past decades. This monograph comprises a revised, modified, and amended text of Diagnostic Imaging of Renal Diverticula, a book issued in 2007, and rewritten chapters on UT, BD, and UTHD. The book sums up experience in ultrasonic, X-ray, and magnetic resonance diagnostics acquired from 1988 to 2013 in the urology clinic of Yaroslavl Medical Academy, namely, in Avtodisel Clinic Hospital, and in Railway Clinical Hospital at the Yaroslavl Station of the Russian Railways, JSC. We made a special attempt to provide our own observations as well as book data for all aspects of diagnostics of urinary tract diverticula in maximum detail in order to illustrate this study. I would like to express sincere gratitude to my dear colleagues working in the abovementioned institutions, the specialists in ultrasonic and X-ray diagnostics and urologists of Yaroslavl and Moscow for their assistance and kind interest in this study. You are welcome to provide any opinions and especially critical comments on this book. Yaroslavl, Russia Vladimir M. Builov vii

About the Author Vladimir M. Builov MD, PhD, head of the Department of Radiology of Yaroslavl Railway Clinic of JSC Russian Railways, and chief radiologist of the regional directorate of medical support of the Northern railway, branch of JSC Russian Railways. He has been a member of the European Society of Radiology (ESR) since 1995 and the European Society of Urogenital Radiology (ESUR) since 1994. He is an author of more than 160 scientific papers on radiology published in Russia, Germany, France, Italy, Austria, and other countries, as well as 4 books on uroradiology. He is a chief coeditor of the National Manual on Radiation Diagnostics and Therapy in Urology (Moscow 2011). This book covers all aspects of imaging of diverticula of the urinary tract, as well as issues of terminology, classification, statistics, etiology, pathogenesis, clinical aspects, and differential diagnosis. It is richly illustrated with ultrasound, X-ray, and magnetic resonance images. It is the first publication ix

x About the Author in the world that covers all aspects of radiological modalities of the diagnostics of the diverticula of the urinary tract. It is based on personal 25-year experience. This book includes the latest ESUR Guidelines on Safety of Contrast Media (version 8.1). The book is intended for specialists in radiology and urology and medical students. Reviewer Valentin E. Sinitsyn MD, PhD, professor, head of the course of radiology of the faculty of fundamental medicine of M.V. Lomonosov Moscow State University, head of radiology Department of Federal Medical Rehabilitation Center, and president of the European Congress of Radiology (ECR 2014).

Abbreviations BD CAT CL CTU/SCTU/MSCTU ESUR EU LUT MDSCT MRI/MRU MSCT MU MCHCF NGHCF PSD RL RMAPE SCT UB UD USDG USG UTHD UUT VUR XRCM YSMA Bladder diverticulum Computer-aided tomography Contact lithotripsy Computer/spiral/multislice urography European Society of Urogenital Radiology Excretory urography Lower urinary tract Multidetector spiral computer tomography Magnetic resonance imaging/magnetic resonance urography Multislice spiral computer tomography Medical unit, municipal clinical healthcare facility Nongovernmental healthcare facility Pelvicalyceal system diverticulum Remote lithotripsy Russian Medical Academy of Postgraduate Education Spiral computed tomography Urinary bladder Ureteral diverticulum Ultrasound dopplerography Ultrasonography Urethral diverticulum Upper urinary tract Vesicoureteral reflux X-ray contrast medium Yaroslavl State Medical Academy xi

Contents 1 Diagnostics of Pelvicalyceal Diverticula................... 1 1.1 Terms, Classification, and Statistics................... 1 1.2 Etiology and Pathogenesis.......................... 3 1.3 Clinical Diagnostics............................... 4 1.4 Ultrasound Diagnostics............................ 5 1.5 X-Ray Diagnostics................................ 6 1.6 Magnetic Resonance Diagnostics (Magnetic Resonance Imaging and Urography)......... 8 1.7 Differential Diagnostics............................ 10 1.8 Treatment....................................... 13 1.9 Author s Data and Clinical Examples................. 15 1.10 Clinical Examples: Author s Observations............. 17 1.11 Urinary Tract Diverticula Diagnostics and Treatment Algorithms.......................... 17 References............................................ 36 2 Diagnostics of Ureteral Diverticula....................... 39 2.1 Description of the Observation....................... 47 2.2 Algorithm of UD Diagnostics....................... 54 References............................................ 55 3 Diagnostic Imaging of Urinary Bladder Diverticula......... 57 3.1 Epidemiology.................................... 57 3.2 Classification, Etiology, and Pathogenesis.............. 58 3.3 Clinical Diagnostics............................... 59 3.4 Diagnostic Imaging............................... 60 3.5 Treatment of the Urinary Bladder Diverticula........... 65 References............................................ 69 4 Urethral Diverticula................................... 71 4.1 Ray Diagnostics.................................. 71 4.1.1 X-Ray Anatomy of the Urethra................ 71 4.2 Female Urethra Diverticula......................... 73 4.2.1 Etiology, Localization, Pathogenesis, and Pathophysiology of UTHD................ 73 4.2.2 Clinical Picture............................. 75 4.2.3 Diagnostics................................ 77 4.2.4 Differential Diagnostics...................... 82 xiii

xiv Contents 4.3 Male Urethra Diverticula........................... 86 4.3.1 Treatment................................. 87 4.4 Algorithms for UTHD Diagnostics................... 88 References............................................ 89 Appendix................................................ 91