Dr. med. Dirk Manski



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Ureter Ultrasound and Sonography Classification of Hydronephrosis

The indications for ultrasonography of the ureters are comparable to the indications for renal ultrasound (see section renal ultrasound).

Examination Technique

The transducer used for ureter ultrasonography is a sector or curved array probe with 3.5–5 MHz. The examination of the ureters is done in supine position and with inspiration of the patient. In case of unfavorable conditions, a lateral decubitus position is helpful, whereby the side to be examined is raised by 30\textdegree. The kidney is used as an acoustic window, the renal pelvis and the ureteral outlet can be visualized regularly. Intestinal air often prevents the examination of the proximal ureter, the mid portion cannot be examined with ultrasound. The distal part of the ureter is examined in supine position and with full bladder, the bladder is used as an acoustic window.

Hydronephrosis:

The distinction between hydronephrosis or significant urinary tract obstruction is not possible with sonography. The dilatation of the upper urinary tract is classified according to morphological criteria [fig. classification of hydronephrosis]. Consequently, hydronephrosis should be described in the ultrasonography report without judging the significance of the obstruction (Beetz u.a., 2001).


Graduation of hydronephrosis in ultrasonography (Beetz u.a., 2001).
Grade I: echo-free enlargement of the renal pelvis without enlargement of the renal calyces. Clear hyperechoic reflex pattern of the renal sinus and no signs of parenchymatous atrophy.
Grade II: echo-free enlargement of the renal pelvis and renal calyces. Attenuated ultrasound reflex pattern of the renal sinus. No signs of parenchymatous atrophy (preserved papilla tips and sharp fornix angle.
Grade III: prominent echo-free enlargement of the renal pelvis and the renal calices. Missing or marginal imaging of the renal sinus. Signs of organ atrophy: flattening of papillae and blunting of fornices.
Grade IV: massive echo-free enlargement of the renal pelvis and renal calices, loss of borders between renal pelvis and calices. Almost complete atrophy of the renal parenchyma (hydronephrotic sac).
figure Graduation of hydronephrosis in ultrasonography






Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z



References

Singer u.a. 2006 SINGER, Eric A. ; GOLIJANIN, Dragan J. ; DAVIS, Robert S. ; DOGRA, Vikram:
What’s new in urologic ultrasound?
In: Urol Clin North Am
33 (2006), Aug, Nr. 3, S. 279–286


  Deutsche Version: Sonographie der Harnleiter