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The obstruction of the pielo-ureteral junction, in most of the cases, recognizes an intrinsic etiopathogenesis, the presence of a segment ureteral aperistaltic and alteration of the ureteral musculature. The association of GPU stenosis and the presence of vascular anomalous shanks are frequent. The knowledge of this anatomical situation is important for choosing the therapeutic strategy and the surgical technique. The pre-operative diagnosis of the anomalous vase could condition the choice of the technique (endoscopic technique, laparoscopic), opting for open surgery to have a better control of the vascular shank. We have examined the use of the echo-color Doppler to diagnose the presence of anomalous vase. We have studied 13 patients (6 men and 7 women) between 18 and 62 years of age (average 35 years); the side interested by the obstruction was in 8 cases the right and in 5 cases the left. During surgery in 4 cases out of 13 examined anomalous vases were present. The pre-operative color Doppler found 3 anomalous shanks with a negative false, a positive false and 8 negative trues, showing a sensibility of 75%, a specificity of 88% with a global diagnostic ability of the 84%. We therefore believe that the echo-color Doppler is reliable enough in the pre-operative diagnosis of vascular anomalies associated to stenosis of the GPU and that could be used for pre-operative diagnosis of this urological affection.

The ultrasound study of bladder neck and urethral sphincter in men could be performed by means of transrectal ultrasound scan in longitudinal scanning or by probing the surface in transperineal scanning. The endocavitary ultrasound scan study gives the best indications in the evaluation of the bladder neck in men. The neuromuscular bladder dysfunctions' (neurologic bladder), which can be studied by ultrasound scan are dyssinergia, striped detrusor, detrusor-bladder-neck dyssinergia, detrusorial iper-reflexy bladder instability. In paraplegic subjects the exam should be performed in gynecological position or in side decubitus, and micturition is obtained by means of sovrapubic percussion and compression or with prevailing action of the abdominal press. The detrusor-striped dyssinergia is the dysfunction of the bladder where the ultrasound scan results are more meaningful and give the best elements. In these cases, already in basal conditions, could be present a bladder neck half-opened. During micturition there is an ample opening of the bladder neck and of the prostatic urethra, but scarce relaxation of the membranous urethra; sometimes a protrusion of the back lip of the bladder neck could be present too. In iper-reflexy (unstable bladders) and in detrusorial ipo-reflexy, ultrasound scans could result poorly specific and non-significative.

The high number of diagnostic methods for images (ultrasound, computer tomography--CT, magnetic nuclear resonance--MNR) has allowed the urologist diagnosis more precocious of renal masses contributing to increase the survival rate and quality of life of patients affected by renal carcinoma. Although many are the advantages that the ultrasound scan gives to the urologist, still today in presence of ultrasound scan results showing expansive renal masses, probably malignant, many perform a CT or MNR for diagnostic confirmation and tumor extension.

The authors present their diagnostic approach to acute intestinal ischemia. They underline the need for early specific diagnosis because the therapeutic options vary widely in relation to different types of acute intestinal ischemia. Selective arteriography preceded by an aortogram is considered the diagnostic "gold standard". Although at present mesenteric ischemia is a serious, and often lethal, disease, an aggressive therapeutic approach can improve the outcome of this group of patients.