Upper ureter stone targeted for destruction. Treatment of kidney stones can be challenging. I never approach them in a cavalier fashion as complications can happen even in what seems to be a simple setting. This patient has 10mm upper ureteral stone with obstruction of the kidney and a tortuous ureter from prior spine surgery that complicated treatment of her stone. I had to place a nephrostomy tube smd then proceed to definitive stone treatment.
Prostate biopsy is undergoing a period of rapid change. The days of the blind biopsy are gone and the era of the random 12 core biopsy is coming to a close. New technology that is now availaible right here Suffolk County Long Island will revolutionize the evaluation and even the management of prostate cancer.
The Artemis System for prostate biopsy and fusion biopsy is an amazing tool in our fight against prostate cancer. I can see a future of improved detection, less often used radical treatments and focal therapy as a result of this techniques' accuracy.
At present, the technology is available in Suffolk County only though Dr Schoor and Zwanger-Pessiri Radiology. Makes me proud.
EDO, or blockage of the ejaculatory duct, is a rare but treatable cause of severe male factor infertility. Men have severe oligopermia with low volume ejaculate, low to no seminal fructose, and no sperm on post ejaculate UA. TRUST may show dilated seminal vesicles, a dilated ejaculatory duct, and on occasion a midline prostate cyst. Often all findings are not present and a certainly of diagnosis remains elusive. In these cases MRI may help verses the more traditional approach of vasography followed by TUR-ED--resection of the ejaculatory ducts. When the diagnosis is correct, outcome of treatment is dramatic and full fertility can be restored immediately following the procedure.
Some stones can be seen plain as day on a standard x-ray. Follow-up and treatment of these stones is typically easy and straight forward. Yet how does the urologist follow the 15% of stones that can be seen at all on plain X-ray films?
The options are repeat CT scan, which is expensive and the most radiation intensive (albeit very low dose for adults).
Renal sonogram is pretty good for kidney stones, especially larger ones and is totally safe. This modality can also be used to follow ureter stones that are obstructive. Bladder ultrasound can be used to folllow stones at the junction of bladder and ureter, the UVJ. Intravenous urography is the final option. Old school for sure, the IVP as it is known, is still quite good. Disadvantages are that the test is time consuming, requires IV dye that may be allergenic and nephrotoxic to some, and utilizes low dose ionizing radiation.
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