Korean J Urol.  2013 May;54(5):322-326. 10.4111/kju.2013.54.5.322.

Diagnostic Criteria for Stomal Obstruction of Tubeless Cutaneous Ureterostomy by Use of 99mTc-Mercaptoacetyltriglycine Diuretic Renography

• Kim CJ
• Kubota S
• Murai R

• KMID: 2061514
• DOI: http://doi.org/10.4111/kju.2013.54.5.322

Abstract

PURPOSE
To evaluate 99mTc-mercaptoacetyltriglycine diuretic renograms for diagnosing stomal obstruction in tubeless cutaneous ureterostomy.
MATERIALS AND METHODS
Cutaneous ureterostomy was performed in 29 patients (56 renal units) with a minimum follow-up period of 12 months. Stomal obstruction was evaluated with 99mTc-mercaptoacetyltriglycine diuretic renography 3 months after surgery. Regions of interest were drawn that completely encircled and snugly fit the kidney, renal pelvis, and ureter. The data analyses were performed with half-times to tracer clearance following furosemide (0.5 mg/kg) administration.
RESULTS
The mean half-times to tracer clearance were 6.90+/-6.30, 5.25+/-4.29, and 8.75+/-7.63 minutes in the total, ipsilateral, and contralateral kidneys, respectively, in side relationships between the ureter and the stoma. There were significant differences between the ipsilateral and contralateral kidneys in the mean half-time to tracer clearance (p=0.038). Forty-eight renal units (85.7%) had a half-time to tracer clearance of less than 15 minutes, and all 48 renal units had no hydronephrosis. On the other hand, 5 renal units (8.9%) had a half-time to tracer clearance of more than 20 minutes, and these 5 renal units required the insertion of stent catheters or became atrophic.
CONCLUSIONS
99mTc-mercaptoacetyltriglycine diuretic renography was very useful for diagnosing stomal obstruction of tubeless cutaneous ureterostomy. The upper limit of the half-time to tracer clearance for unobstructed systems was 15 minutes, which allowed for the confident exclusion of stomal obstruction in tubeless cutaneous ureterostomy.

Keyword

Complications; Radioisotope renography; Ureteral obstruction; Ureterostomy; Urinary bladder neoplasms

MeSH Terms

Catheters
Follow-Up Studies
Furosemide
Hand
Humans
Hydronephrosis
Kidney
Kidney Pelvis
Radioisotope Renography
Statistics as Topic
Stents
Technetium Tc 99m Mertiatide
Ureter
Ureteral Obstruction
Ureterostomy
Urinary Bladder Neoplasms
Furosemide
Technetium Tc 99m Mertiatide

Figure

• 

  FIG. 1 99mTc-mercaptoacetyltriglycine diuretic renography and excretory urography in a 61-year-old male patient. (A) Regions of interest (ROI) of diuretic renography for the cutaneous ureterostomy with unilateral stomal creation. (B) Corresponding renogram curves 3 months after surgery. The half-time to tracer clearance was 3.40 minutes in the right kidney. The left kidney did not respond to furosemide administration. (C) Excretory urography showed bilateral grade 2 hydronephrosis 3 months after the surgery. (D) The right kidney showed no hydronephrosis 6 months after surgery, and the stent catheter was indwelled in the left kidney.

• 

  FIG. 2 Half-times to tracer clearance following furosemide administration. The means of the half-time to tracer clearance were 5.25±4.29 minutes and 8.75±7.63 minutes in the ipsilateral and contralateral kidneys, respectively, in side relationships between the ureter and the stoma. There were significant statistical differences between ipsilateral and contralateral kidneys in the means of the half-time to tracer clearance (p=0.038). The bars in bold indicate the average values of the half-time to tracer clearance. The open circles indicate renal units that had no hydronephrosis. The closed circles indicate renal units in which catheter insertion was performed. The closed triangles indicate the renal units that became atrophic without the insertion of a stent catheter. One renal unit did not respond to furosemide administration (#).

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