Upper Urinary Tract Flashcards
What are the grades and appearances of hydronephrosis?
Hydronephrosis may be graded on a four-point system, where Grade 1 refers to minimal calyceal dilatation, seen following induced diuresis or as a result of abdominal compression. Grades 2–4 refer to mild, moderate and severe hydronephrosis, respectively.
What is the TNM staging of ureteric and renal pelvis masses?
TX Primary tumour cannot be assessed
T0 No evidence of primary tumour
Ta Papillary non-invasive carcinoma Tis Carcinoma in situ
T1 Tumour invades subepithelial connective tissue
T2 Tumour invades the muscularis
T3 (For renal pelvis only) Tumour invades beyond muscularis into peripelvic fat or the renal parenchyma
T3 (For ureter only) Tumour invades beyond muscularis into periureteric fat
T4 Tumour invades adjacent organs, or through the kidney into the perinephric
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in a single lymph node, 2 cm or less in greatest dimension
N2 Metastasis in a single lymph node, more than 2 cm but not more than 5 cm in greatest dimen-sion; or multiple lymph nodes, none more than 5 cm in greatest dimension
N3 Metastasis in a lymph node, more than 5 cm in greatest dimension
MX Distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis
What are the principal radiological features of TCc?
The principal radiological features of TCC of the ureter are: (A) an intraluminal filling defect with surrounding ureteric dilatation; (B) cupping of contrast medium around the upper or lower convex margin of the lesion; (C) contiguity of the lesion with the ureteric wall; (D) a stippled appearance caused by contrast material entering the interstices of the tumour; and (E) varying degrees of proximal obstruction.
What are the radiological features of renal TB?
Urographic features of TB include ureteric dilatation (47%), calcification (31%) and calyceal abnormalities (18%). Ureteric changes are those of ulceration, oedema and thickening, progressing to multifocal ureteric strictures.
What are extraluminal causes of ureteric obstruction?
Large pelvic tumours - Ovarian lesions, uterine fibroid, cancer of cervix, prostate, rectosigmoid
Retroperitoneal - Lymphoma, metastasis, sarcoma, desmoid
Strictures - Postoperative, radiation, trauma, ureteric infection (tuberculosis, schistosomiasis), idiopathic
RP fibrosis - Idiopathic, perianeurysmal
Inflammaton - Tuberculosis or fungal adenitis, sarcoidosis, malacoplakia, chronic granulomatous disease
Vasculitis - Wegener’s, polyarteritis, Churg–Strauss syndrome
Lipomatosis - Henoch–Schönlein purpura, epidermolysis bullosa, amyloidosis, reaction to foreign substances
Pregnancy - Hydronephrosis of pregnancy, extrauterine pregnancy, ovarian vein thrombophlebitis
Gynae - Endometriosis, pelvic inflammatory disease, uterine prolapse, hydrocolpos
GIT - Crohn’s disease, diverticulitis, appendicitis, pancreatitis, gastrointestinal malignancy
What are the bladder causes of ureteric obstruction?
Tuberculosis is the classical cause of a severely scarred, contracted bladder. Other causes of bladder contraction include schistosomiasis, radiation, interstitial cystitis, cyclophosphamide cystitis, hypertrophic neuropathic bladder, diffuse infiltrating transitional cell carcinoma and lupus erythematosus. Benign prostatic hypertrophy (BPH) is the commonest cause of bladder outlet obstruction in older men.
What are the CT secondary causes of renal stones?
Ureteric dilatation, Collecting system dilatation, Nephromegaly, Perinephric and periureteric stranding
