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The development of interventional uroradiologic techniques has had a major impact on the care of the urologic patient by allowing nonoperative treatment of many disease processes. This article will review percutaneous nephrostomy with emphasis on urologic calculi, interventional therapy for neoplasms and trauma of the urinary tract, diagnosis and treatment of renovascular hypertension, and the management of complications following renal transplantation.

Diuretic renography remains the noninvasive functional study of choice in patients with hydronephrosis resulting from apparent UPJ obstruction. Meticulous attention to proper patient preparation, radiopharmaceutical selection, furosemide dosage and administration, and image interpretation and an awareness of potential pitfalls are essential for accurate diagnosis. For most patients, the F + 20 protocol is sufficient, however; the F-15 protocol allows clarification in cases of equivocal baseline F + 20 studies. Invasive antegrade techniques such as the Whitaker pressure/perfusion test are best reserved for patients in whom the diagnosis remains equivocal after diuretic renography, or in patients with massive hydronephrosis or renal insufficiency. New standardized protocol guidelines should help to ensure studies that are reproducible in different nuclear medicine laboratories.

Computed tomography (CT) plays a significant role in establishing the diagnosis in clinically equivocal cases of renal infection, determining the extent of the disease process, and assessing its complications. Gas, calculi, renal parenchymal calcifications, hemorrhage, and masses can be revealed with unenhanced CT. A subsequent study with contrast enhancement is crucial for the complete evaluation of patients with renal infection in order to demonstrate the areas of altered nephrogram that occur as a result of the inflammatory process and to identify complications. In this article we review a spectrum of renal inflammatory disease, with illustrations of the CT findings in representative cases. We also review the role and potential pitfalls of fast scanning techniques that can image a particular phase of the nephrogram in a renal infection. In acute pyelonephritis, enhanced CT scans obtained during the cortical nephrographic phase typically demonstrate solitary or multifocal hypodense areas with obliteration of the corticomedullary differentiation. Delayed images obtained during the excretory phase are frequently more helpful in defining the extent of the disease process, identifying the complications such as renal abscess, and confirming the presence of urinary obstruction than are early images.

We report a case of pseudosarcomatous fibromyxoid tumor of the bladder in a 23-year-old man with a 2 month history of painless gross hematuria, which was studied by biphasic contrast-enhanced helical CT. CT demonstrated a 2 cm diameter polypoid enhancing mass in the anterior bladder wall. The lesion measured 103 and 91 HU on early and delayed images, respectively. Increased contrast enhancement was attributed to a histologically highly vascular myxoid stroma.

Ultrasound and CT scan play complimentary roles for the evaluation of indeterminate renal masses. Fast MR imaging with and without gadolinium is performed for characterization of renal masses when patients have a contraindication to iodinated contrast material. Radiologists have a primary role in detecting and managing indeterminate renal masses.

Extracorporeal lithotripsy has a high incidence of postprocedure biliary colic and slow disappearance of gallstones. This situation has led to the development of a new technique which has been successful in four patients and consists of percutaneous cholecystostomy, direct stone visualization, and fragmentation of gallstones with a percutaneous lithotripter. All patients had a functioning gallbladder, stone diameter less than 30 mm, and abdominal pain secondary to cholelithiasis. The procedure was performed in a two day hospitalization. Initially, under general anesthesia, the gallbladder was intubated with a 21 gauge needle and guidewire and the tract dilated to #30 French. A nephroscope was advanced into the gallbladder through a rigid sheath. All gallstones were visualized, fragmented with a percutaneous lithotripter, and extracted. After a postoperative cholecystocholangiogram, an self-retaining catheter was placed in the gallbladder for an average of 2.5 days. Three of the four patients were discharged from the hospital in two days without any complications. A fourth patient had a small bile leak treated with antibiotics. After an average of 13 months follow-up, all patients had a normal ultrasound or oral cholecystogram and no biliary tract symptoms. This technique is safe and efficient in removing gallstones and has no recurrence of gallstones in the 13 month follow-up period.

Adequate radiologic demonstration of the extent of renal injury following blunt abdominal trauma is an important guide to therapy. Traditionally, the evaluation has been based on urographic and/or angiographic studies. This report details the results of computed tomographic (CT) evaluation of suspected renal injuries in ten patients. Renal injuries were demonstrated by CT in nine of these patients. Abnormalities demonstrated were subcapsular/perinephric hematomas, intrarenal hematomas, renal lacerations, segmental infarcts, and contrast material extravasation. This study suggests that CT is valuable in providing further definition of urographic abnormalities and in avoiding the necessity for angiography in otherwise stable patients.

The scintigraphic findings on bone imaging in two patients with extensive lower extremity periostitis secondary to venous insufficiency are presented. One of these patients had bilateral disease. The use of [67Ga]citrate scanning in an attempt to exclude concurrent osteomyelitis is also addressed.

Until now, CT has been utilized very little in the evaluation of the bluntly traumatized patient. Based on our early experience, we have attempted to demonstrate the CT features of a spectrum of injuries. Much of this information is new and additional studies will have to be performed to elucidate fully the benefits of computed tomography in the diagnosis of trauma. A method of study has been outlined which stresses the use of intravascular, oral, and, when needed, rectal contrast materials for study in these patients.

The development and refinement of computed tomography have revolutionized the diagnostic evaluation of patients in urologic practice. This article reviews the applications and interpretation, as well as the limitations, of renal computed tomography and compares this modality with other imaging studies of the kidney.

Calyceal diverticula are infrequently seen during routine urography. When present, one must look for important associated complications. Two patients had ureteral obstruction in conjunction with "ballooned" calyceal diverticula. This rare combination may give rise to the erroneous diagnosis of a renal mass.

Three straightforward radiologic examinations are the cornerstone of the diagnosis of a wide variety of urinary tract pathology that may be encountered in the emergency department. This article reviews some technical aspects of the examinations, the radiologic findings, and some controversial aspects of the diagnosis and subsequent management of these patients.

Extraperitoneal bladder ruptures secondary to blunt trauma are caused by fractures of the bony pelvis 95 per cent of the time. A static cystogram is the only way to diagnose the lesion definitely. We have treated our 41 patients successfully with catheter drainage alone despite extensive urinary extravasation. Eighty-seven per cent of the ruptures will be healed in 10 days, and virtually all will be healed in 3 weeks.

With the widespread acceptance of ultrasonography and computed tomography for the evaluation of renal masses, the role of guided renal cyst puncture in the evaluation of a suspected renal cyst has undergone revision in recent years. In this article, the authors review the technique, interpretation, and complications of diagnostic cyst puncture and attempt to define its current diagnostic and therapeutic indications.