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10G.M. Mardieva, M.R. Omonov, N.S. Toshpulatova, D.Z. Khasanova
POSSIBILITIES OF COMPLEX RADIOLOGICAL EXAMINATION IN DETECTION OF CONCREMENTS IN THE URINARY TRACTS IN PATIENTS WITH UROLITHIASIS
Urolithiasis (urolithiasis) is one of the leading urologic diseases. Patients suffering from ICD accountfor 30-40% of the total contingent of urolog-ical hospitals. Most often, IBC is seen in people of working age (30-50 years), which makes this problem socially significant. To assess the variety of acting pathogenetic mechanisms of stone formation it is absolutely necessary to have a universal method or a group of methods allowing to determine promptly a complex of main indices and to control their ratio as the pathological process develops, to diagnose recurrences, to monitor postoperative changes.
Key words: comprehensive radiological examination, urolithiasis, urography, ultrasound urography, kidney, ureter, bladder, nodule.
Introduction: Intravenous urography combined with a computed tomography (CT) scan are standard and routinely performed for urolithiasis, but negative X-ray results depend on the chemical composition of the stone: if the molecular weight of the chemical constituent of the stone is equal or close to the molecular weight of the surrounding. A CT scan allows us to visualize the heterogeneity of the structure of the concrement, the presence of a dense envelope, stone nucleus. The peculiarity of the method is the original volumetric character of the scanning, which helps to identify individual anatomical features of the corpus-pelvic system (CPS) and ureter, the degree of anatomical and functional changes of the pelvic-ureteric segment, ureter, bladder,patients with renal colic in whom no. Urinary tract stones are detected using standard examination techniques (urography Ultrasound), multiplanar CT scan with multiplanar reconstructions can accurately identify the location of the stones even Even if they are X-ray uncontrasted, it makes it possible to assess the condition of the urinary tract above and below the level of obstruction without use of contrast agents.
Objective of the study: To evaluate the diagnostic capabilities of the radiological methods as a part of the complex investigation in patients with urolithiasis.
Disease tissues, there will be no shadow of the nodule on the radiograph. For example, stones consisting of uric acid are X-ray-negative and are visualized as a filling defect in the location of the stone. With ascites, abdominal tumors and the kidney itself, shadows of urinary stones may not be detected in 6-10% of cases. In these cases retrograde pyelourethrography, intravenous urography with polyposis examination, CT urography are recommended.
Materials and methods. The data of Complex radiological examination of 40 patients urolithiasis, who were examined and treated Urology departments of the Republican Scientific Center for Emergency Medical Care in Samarkand, and the Department of Roentgenology and Radiology of the Samarkand Medical Institute.
CT scans were performed on "Somatom Emotion Duo" of Siemens (Germany).
Standard programs "Abdomen" and "Pelvis" were used. Technical conditions of abdominal and pelvic cavity X-ray generation voltage was 130 kV, exposure - 250 mA, table pace - 5 mA, 250 mAs, 5 mm table spacing, thickness of tomographic
thickness of the tomographic section was 8 mm. If necessary, the slice thickness
of the slice and the step of the table were reduced if necessary. Scans were performed in the supine position with the patient's hands behind the head.
The axial optical center was placed on the midline of the body. The initial level was determined by topogram (overview digital radiograph) in straight or lateral projections. Spiral scanning was performed with the patient holding his breath of the patient. These conditions allowed us to determine condition of all abdominal, retroperi-toneal and pelvic organs, as well as to assess the structure of abdominal wall and soft tissues, structure of the abdominal wall, soft tissues of the back and visible parts of skeleton.
Contrast enhancement was performed by injecting 100 ml of a nonionic radiographic contrast agent into the ulnar vein. The injection rate was 3 ml/s. The optimal research protocol implied corticomedullary, nephrography and excretory phase images. For corticomedullary phase of contrast acquisition, scanning was started 25 s after the start of injection, nephrographic - 60-80 s, excretory - 3-5 s, excretory phase - at 3-5 minutes. To assess
© G.M. Mardieva, M.R. Omonov, N.S. Toshpulatova, D.Z. Khasanova, 2022.
the condition of ureters and bladder we performed delayed scanning 20 min after the initial study. In addition, with the help of special programs, included into the software of CT tomograph, we carried out thorough topographic and anatomical topofanatomical assessment of the revealed changes by means of construction of reconstructed images in axial, sagittal, frontal planes and other optimal sections.
Results and discussion. Renal changes in patients with ICD were characterized by anatomical localization, size and number of concrements. A total of 36 concrements were identified in the kidneys of 40 patients with ICD
Thus, unilateral kidney involvement was revealed in 40 patients, 28 of them had concrements were localized in the right kidney and in 14 patients - in the left kidney. В 8 bilateral kidney affection was observed in 27 cases. It was established that stone formation was most frequent in the lower third of the right kidney and in the left kidney, was observed in the lower third of both the right and the left kidneys. It has been shown that CT scanning can reveal the greatest number of kidney concrements in patients with ICD, but in some cases, ultrasound is able to detect concrements that are not visualized by CT. In our study, ultrasound additionally identified 7 concrements in the middle calyx group and 6 in the lower calyx group.
The CT scans were able to detect all the concrements larger than 4 mm, but the ultrasound enabled to detect more of them when the size of size did not exceed the indicated value. Thus, ureteral concrements in were most frequently visualized in the lower third of the ureter, with the left ureter in volvement ureter was diagnosed slightly more frequently than the right one, concrements were detected in the lower third of ureter on both sides, in all the rest cases a unilateral involvement was detected, in all other cases a unilateral involvement was detected.
A CT scan was found to be able to detect all ureteral concrements. Ureteral concrements in patients with ICD. Ultrasound investigation did not reveal concrements in the middle third of the ureters. The review radiography with the use of excretory urography revealed not more than 50% of ureteral concrements were detected at most 50%.
Consequently, CT scan allows accurate identification of all ureteral concrements, assessment of their localization and size, compared to radiographic and ultrasonic methods. Complex radiological examination allowed us to detect 40 nodules in 40 patients with ICD. Thus, among the methods of radiological diagnostics, CT scan reveals the greatest number of concrements in the bladder in ICD. In general, X-rays have the lowest efficacy compared to ultrasound and CT in determining the morphologic signs of IBC. However, it should be performed for the emergency assessment of the anatomical cause of the obstruction, the relationship of the kidneys and ureters and their, the number of ureters, primary differential diagnosis with other diseases. CT is the most effective method in assessment of the kidneys and urinary tract in IBC. It allows to determine the localization of concrements in relation to anatomical structures, with the greatest to most accurately identify concomitant changes and pathology, preliminarily establish the chemical structure of the stone, and conduct differential diagnosis with other diseases with similar with IBC symptomatology. Thus, the CT scan should is the method of choice for routine. Therefore, the CT scan should be used as the method of choice for the routine evaluation of patients with ICD. Ultrasound is highly effective in evaluating renal and bladder concrements, and in some cases, its accuracy may be superior to that of CT scanning. In some cases, its accuracy can be superior to that of CT scanning. Consequently, when comprehensive radiological examination patients with IBC ultrasound should be used for emergency diagnosis in the presence of clinical symptoms, as well as in the absence of CT signs and the presence of clinical symptoms of ICD.
Conclusion: In the emergency setting. IBC in the presence of clinical symptoms of acute pain, ultrasound is the most appropriate tool. An alternative conventional radiological. The traditional radiological examination with intravenous urography can be an alternative. If concrements are detected by ultrasound, it is necessary to stop the acute pain, followed by scheduled radiological examination. In the absence of concrements, according to ultrasound data, it is necessary to perform CT urography. For routine examination of patients with ICD technique of choice is to perform CT investigation with, CT urography.
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MARDIEVA GULSHODMAMATMURODOVNA - candidate of medical sciences, head of department of radiation diagnostics and therapy, Samarkand State Medical Institute
OMONOV MUKHAMMAD RAVSHAN - head of department of radiation diagnostics and therapy, Samarkand State Medical Institute.
TOSHPULATOVA NIGINA SANZHAROVNA - researcher department of postgraduate education in medical radiology, Samarkand State Medical Institute.
KHASANOVA DIYORA ZAFARJONKIZI - resident, faculty of postgraduate education in medical radiology, Samarkand State Medical Institute.
