title: Feasibility of Antegrade Contrast-enhanced US Nephrostograms to Evaluate Ureteral Patency.
abstract: Purpose To demonstrate the feasibility of contrast material-enhanced ulrasonographic (US) nephrostograms to assess ureteral patency after percutaneous nephrolithotomy (PCNL) in this proof-of-concept study. Materials and Methods For this HIPAA-compliant, institutional review board-approved prospective blinded pilot study, patients undergoing PCNL provided consent to undergo contrast-enhanced US and fluoroscopic nephrostograms on postoperative day 1. For contrast-enhanced US, 1.5 mL of Optison (GE Healthcare, Oslo, Norway) microbubble contrast agent solution (perflutren protein-type A microspheres) was injected via the nephrostomy tube. Unobstructed antegrade ureteral flow was defined by the presence of contrast material in the bladder. Contrast-enhanced US results were compared against those of fluoroscopic nephrostograms for concordance. Results Ten studies were performed in nine patients (four women, five men). Contrast-enhanced US demonstrated ureteral patency in eight studies and obstruction in two. One patient underwent two studies, one showing obstruction and the second showing patency. Concordance between US and fluoroscopic assessments of ureteral patency was evaluated by using a Clopper-Pearson exact binomial test. These results were perfectly concordant with fluoroscopic nephrostogram results, with a 95% confidence interval of 69.2% and 100%. No complications or adverse events related to contrast-enhanced US occurred. Conclusion Contrast-enhanced US nephrostograms are simple to perform and are capable of demonstrating both patency and obstruction of the ureter. The perfect concordance with fluoroscopic results across 10 studies demonstrated here is not sufficient to establish diagnostic accuracy of this technique, but motivates further, larger scale investigation. If subsequent larger studies confirm these preliminary results, contrast-enhanced US may provide a safer, more convenient way to evaluate ureteral patency than fluoroscopy.©RSNA, 2016 Online supplemental material is available for this article.
authors.affiliation: From the Departments of Urology (T.C., M.U., H.C.C., M.S.) and Radiology and Biomedical Imaging (J.M., M.P.K., A.T., P.J., R.G., S.W.), University of California, San Francisco. 505 Parnassus Ave, M-391, San Francisco, CA 94143; and Division of Urology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, The Thai Red Cross Society, Bangkok, Thailand (M.U.).
authors.forename: Thomas
authors.initials: T
authors.lastname: Chi
authors.affiliation: From the Departments of Urology (T.C., M.U., H.C.C., M.S.) and Radiology and Biomedical Imaging (J.M., M.P.K., A.T., P.J., R.G., S.W.), University of California, San Francisco. 505 Parnassus Ave, M-391, San Francisco, CA 94143; and Division of Urology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, The Thai Red Cross Society, Bangkok, Thailand (M.U.).
authors.forename: Manint
authors.initials: M
authors.lastname: Usawachintachit
authors.affiliation: From the Departments of Urology (T.C., M.U., H.C.C., M.S.) and Radiology and Biomedical Imaging (J.M., M.P.K., A.T., P.J., R.G., S.W.), University of California, San Francisco. 505 Parnassus Ave, M-391, San Francisco, CA 94143; and Division of Urology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, The Thai Red Cross Society, Bangkok, Thailand (M.U.).
authors.forename: John
authors.initials: J
authors.lastname: Mongan
authors.affiliation: From the Departments of Urology (T.C., M.U., H.C.C., M.S.) and Radiology and Biomedical Imaging (J.M., M.P.K., A.T., P.J., R.G., S.W.), University of California, San Francisco. 505 Parnassus Ave, M-391, San Francisco, CA 94143; and Division of Urology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, The Thai Red Cross Society, Bangkok, Thailand (M.U.).
authors.forename: Maureen P
authors.initials: MP
authors.lastname: Kohi
authors.affiliation: From the Departments of Urology (T.C., M.U., H.C.C., M.S.) and Radiology and Biomedical Imaging (J.M., M.P.K., A.T., P.J., R.G., S.W.), University of California, San Francisco. 505 Parnassus Ave, M-391, San Francisco, CA 94143; and Division of Urology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, The Thai Red Cross Society, Bangkok, Thailand (M.U.).
authors.forename: Andrew
authors.initials: A
authors.lastname: Taylor
authors.affiliation: From the Departments of Urology (T.C., M.U., H.C.C., M.S.) and Radiology and Biomedical Imaging (J.M., M.P.K., A.T., P.J., R.G., S.W.), University of California, San Francisco. 505 Parnassus Ave, M-391, San Francisco, CA 94143; and Division of Urology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, The Thai Red Cross Society, Bangkok, Thailand (M.U.).
authors.forename: Priyanka
authors.initials: P
authors.lastname: Jha
authors.affiliation: From the Departments of Urology (T.C., M.U., H.C.C., M.S.) and Radiology and Biomedical Imaging (J.M., M.P.K., A.T., P.J., R.G., S.W.), University of California, San Francisco. 505 Parnassus Ave, M-391, San Francisco, CA 94143; and Division of Urology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, The Thai Red Cross Society, Bangkok, Thailand (M.U.).
authors.forename: Helena C
authors.initials: HC
authors.lastname: Chang
authors.affiliation: From the Departments of Urology (T.C., M.U., H.C.C., M.S.) and Radiology and Biomedical Imaging (J.M., M.P.K., A.T., P.J., R.G., S.W.), University of California, San Francisco. 505 Parnassus Ave, M-391, San Francisco, CA 94143; and Division of Urology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, The Thai Red Cross Society, Bangkok, Thailand (M.U.).
authors.forename: Marshall
authors.initials: M
authors.lastname: Stoller
authors.affiliation: From the Departments of Urology (T.C., M.U., H.C.C., M.S.) and Radiology and Biomedical Imaging (J.M., M.P.K., A.T., P.J., R.G., S.W.), University of California, San Francisco. 505 Parnassus Ave, M-391, San Francisco, CA 94143; and Division of Urology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, The Thai Red Cross Society, Bangkok, Thailand (M.U.).
authors.forename: Ruth
authors.initials: R
authors.lastname: Goldstein
authors.affiliation: From the Departments of Urology (T.C., M.U., H.C.C., M.S.) and Radiology and Biomedical Imaging (J.M., M.P.K., A.T., P.J., R.G., S.W.), University of California, San Francisco. 505 Parnassus Ave, M-391, San Francisco, CA 94143; and Division of Urology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, The Thai Red Cross Society, Bangkok, Thailand (M.U.).
authors.forename: Stefanie
authors.initials: S
authors.lastname: Weinstein
mesh_terms: D000328:Adult; D000368:Aged; D003287:Contrast Media; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008297:Male; D045423:Microbubbles; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D011446:Prospective Studies; D014463:Ultrasonography / Q000379:methods*; D014513:Ureter / Q000000981:diagnostic imaging* / Q000503:physiopathology*
chemical_list: D003287:Contrast Media