More results...

Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Abdominal Radiology, Original Research
Abdominal Radiology, Pictorial Essay
Anthropology and Dental Radiology, Original Research
Breast Imaging, Case Report
Breast Imaging, Original Research
Breast Imaging, Pictorial Essay
Breast Imaging, Review Article
Cardiopulmonary Imaging, Case Report
Cardiopulmonary Imaging, Case Series
Cardiopulmonary Imaging, Education
Cardiopulmonary Imaging, Original Research
Cardiopulmonary Imaging, Pictorial Essay
Cardiopulmonary Imaging, Review Article
Case Report
Case Report, Breast Imaging
Case Report, Cardiopulmonary Imaging
Case Report, Diagnostic Radiology
Case Report, Neuroradiology/Head and Neck Imaging
Case Report, Vascular and Interventional Radiology
Case Series
Case Series, Abdominal Radiology
Case Series, Diagnostic Radiology
Case Series, Musculoskeletal Imaging
Case Series, Vascular and Interventional Radiology
DENTAL ARTICLE
Dental Radiology, Case Report
Dental Radiology, Case Series
Dental Radiology, Original Research
Diagnostic Radiology, Case Report
Diagnostic Radiology, Case Series
Diagnostic Radiology, Original Research
Diagnostic Radiology, Pictorial Essay
Diagnostic Radiology, Review Article
Editorial
Education
Education, Diagnostic Radiology
Education, Imaging science
Education, Original Research
Emergency, Original Research
Erratum
Gastrointestinal Imaging, Case Report
Gastrointestinal Imaging, Case Series
Gastrointestinal Imaging, Original Research
Gastrointestinal Imaging, Pictorial Essay
General and Emergency Radiology, Original Research
General and Emergency Radiology, Review Article
Genitourinary and Gynecologic Imaging, Case Report
Genitourinary and Gynecologic Imaging, Original Research
Imaging Science, Original Research
Interventional Radiology, Original Research
Letter to Editor
Musculoskeletal Imaging, Case Report
Musculoskeletal Imaging, Original Article
Musculoskeletal Imaging, Original Research
Musculoskeletal Imaging, Pictorial Essay
Musculoskeletal Imaging, Review Article
Neuroradiology , Review Article
Neuroradiology Head and Neck Imaging, Pictorial Essay
Neuroradiology, Case Report
Neuroradiology, Pictorial Essay
Neuroradiology/Head and Neck Imaging, Case Report
Neuroradiology/Head and Neck Imaging, Case Series
Neuroradiology/Head and Neck Imaging, Original Research
Neuroradiology/Head and Neck Imaging, Review Article
Neuroradiology/Spine Imaging, Original Research
Notice of Retraction
Nuclear Medicine, Case Report
Nuclear Medicine, Original Research
Nuclear Medicine, Pictorial Essay
Original Article
Original Article, Neuroradiology
Original Research
Original Research Article
Original Research, Cardiopulmonary Imaging
Original Research, Dental Radiology
Original Research, Descriptive Study
Original Research, Diagnostic Radiology
Original Research, Gastrointestinal Imaging
Original Research, Genitourinary and Gynecologic Imaging
Original Research, Musculoskeletal Imaging
Original Research, Neuroradiology/Head and Neck Imaging
Original Research, Nuclear Medicine
Original Research, Vascular and Interventional Radiology
Pediatric Imaging, Case Report
Pediatric Imaging, Pictorial Essay
PICTORIAL ESSAY
Pictorial essay, Musculoskeletal Imaging
Pictorial essay, Neuroradiology/Head and Neck Imaging
PICTORIAL REVIEW
Radiologic-Pathologic Correlation
RADIOLOGICAL-PATHOLOGICAL CORRELATION
Radiology Business, Original Research
Research Article
Review Article
Review Article, Diagnostic Radiology
Review Article, Gastrointestinal imaging
Review Article, Musculoskeletal
Review Article, Musculoskeletal Imaging
Review Article, Vascular and Interventional Radiology
Technical Innovation
Technical Innovation, Cardiopulmonary Imaging
Technical Innovation, Gastrointestinal Imaging
Ultrasound, Case Report
Ultrasound, Original Research
Ultrasound, Review Article
Vascular and International Radiology, Case Report
Vascular and Interventional Radiology, Case Report
Vascular and Interventional Radiology, Case Series
Vascular and Interventional Radiology, Original Research
Vascular and Interventional Radiology, Pictorial Essay
Vascular and Interventional Radiology, Review Article
Vascular and Interventional Radiology, Short Communication
Vascular and Interventional, Original Research

More results...

Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Abdominal Radiology, Original Research
Abdominal Radiology, Pictorial Essay
Anthropology and Dental Radiology, Original Research
Breast Imaging, Case Report
Breast Imaging, Original Research
Breast Imaging, Pictorial Essay
Breast Imaging, Review Article
Cardiopulmonary Imaging, Case Report
Cardiopulmonary Imaging, Case Series
Cardiopulmonary Imaging, Education
Cardiopulmonary Imaging, Original Research
Cardiopulmonary Imaging, Pictorial Essay
Cardiopulmonary Imaging, Review Article
Case Report
Case Report, Breast Imaging
Case Report, Cardiopulmonary Imaging
Case Report, Diagnostic Radiology
Case Report, Neuroradiology/Head and Neck Imaging
Case Report, Vascular and Interventional Radiology
Case Series
Case Series, Abdominal Radiology
Case Series, Diagnostic Radiology
Case Series, Musculoskeletal Imaging
Case Series, Vascular and Interventional Radiology
DENTAL ARTICLE
Dental Radiology, Case Report
Dental Radiology, Case Series
Dental Radiology, Original Research
Diagnostic Radiology, Case Report
Diagnostic Radiology, Case Series
Diagnostic Radiology, Original Research
Diagnostic Radiology, Pictorial Essay
Diagnostic Radiology, Review Article
Editorial
Education
Education, Diagnostic Radiology
Education, Imaging science
Education, Original Research
Emergency, Original Research
Erratum
Gastrointestinal Imaging, Case Report
Gastrointestinal Imaging, Case Series
Gastrointestinal Imaging, Original Research
Gastrointestinal Imaging, Pictorial Essay
General and Emergency Radiology, Original Research
General and Emergency Radiology, Review Article
Genitourinary and Gynecologic Imaging, Case Report
Genitourinary and Gynecologic Imaging, Original Research
Imaging Science, Original Research
Interventional Radiology, Original Research
Letter to Editor
Musculoskeletal Imaging, Case Report
Musculoskeletal Imaging, Original Article
Musculoskeletal Imaging, Original Research
Musculoskeletal Imaging, Pictorial Essay
Musculoskeletal Imaging, Review Article
Neuroradiology , Review Article
Neuroradiology Head and Neck Imaging, Pictorial Essay
Neuroradiology, Case Report
Neuroradiology, Pictorial Essay
Neuroradiology/Head and Neck Imaging, Case Report
Neuroradiology/Head and Neck Imaging, Case Series
Neuroradiology/Head and Neck Imaging, Original Research
Neuroradiology/Head and Neck Imaging, Review Article
Neuroradiology/Spine Imaging, Original Research
Notice of Retraction
Nuclear Medicine, Case Report
Nuclear Medicine, Original Research
Nuclear Medicine, Pictorial Essay
Original Article
Original Article, Neuroradiology
Original Research
Original Research Article
Original Research, Cardiopulmonary Imaging
Original Research, Dental Radiology
Original Research, Descriptive Study
Original Research, Diagnostic Radiology
Original Research, Gastrointestinal Imaging
Original Research, Genitourinary and Gynecologic Imaging
Original Research, Musculoskeletal Imaging
Original Research, Neuroradiology/Head and Neck Imaging
Original Research, Nuclear Medicine
Original Research, Vascular and Interventional Radiology
Pediatric Imaging, Case Report
Pediatric Imaging, Pictorial Essay
PICTORIAL ESSAY
Pictorial essay, Musculoskeletal Imaging
Pictorial essay, Neuroradiology/Head and Neck Imaging
PICTORIAL REVIEW
Radiologic-Pathologic Correlation
RADIOLOGICAL-PATHOLOGICAL CORRELATION
Radiology Business, Original Research
Research Article
Review Article
Review Article, Diagnostic Radiology
Review Article, Gastrointestinal imaging
Review Article, Musculoskeletal
Review Article, Musculoskeletal Imaging
Review Article, Vascular and Interventional Radiology
Technical Innovation
Technical Innovation, Cardiopulmonary Imaging
Technical Innovation, Gastrointestinal Imaging
Ultrasound, Case Report
Ultrasound, Original Research
Ultrasound, Review Article
Vascular and International Radiology, Case Report
Vascular and Interventional Radiology, Case Report
Vascular and Interventional Radiology, Case Series
Vascular and Interventional Radiology, Original Research
Vascular and Interventional Radiology, Pictorial Essay
Vascular and Interventional Radiology, Review Article
Vascular and Interventional Radiology, Short Communication
Vascular and Interventional, Original Research

More results...

Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Abdominal Radiology, Original Research
Abdominal Radiology, Pictorial Essay
Anthropology and Dental Radiology, Original Research
Breast Imaging, Case Report
Breast Imaging, Original Research
Breast Imaging, Pictorial Essay
Breast Imaging, Review Article
Cardiopulmonary Imaging, Case Report
Cardiopulmonary Imaging, Case Series
Cardiopulmonary Imaging, Education
Cardiopulmonary Imaging, Original Research
Cardiopulmonary Imaging, Pictorial Essay
Cardiopulmonary Imaging, Review Article
Case Report
Case Report, Breast Imaging
Case Report, Cardiopulmonary Imaging
Case Report, Diagnostic Radiology
Case Report, Neuroradiology/Head and Neck Imaging
Case Report, Vascular and Interventional Radiology
Case Series
Case Series, Abdominal Radiology
Case Series, Diagnostic Radiology
Case Series, Musculoskeletal Imaging
Case Series, Vascular and Interventional Radiology
DENTAL ARTICLE
Dental Radiology, Case Report
Dental Radiology, Case Series
Dental Radiology, Original Research
Diagnostic Radiology, Case Report
Diagnostic Radiology, Case Series
Diagnostic Radiology, Original Research
Diagnostic Radiology, Pictorial Essay
Diagnostic Radiology, Review Article
Editorial
Education
Education, Diagnostic Radiology
Education, Imaging science
Education, Original Research
Emergency, Original Research
Erratum
Gastrointestinal Imaging, Case Report
Gastrointestinal Imaging, Case Series
Gastrointestinal Imaging, Original Research
Gastrointestinal Imaging, Pictorial Essay
General and Emergency Radiology, Original Research
General and Emergency Radiology, Review Article
Genitourinary and Gynecologic Imaging, Case Report
Genitourinary and Gynecologic Imaging, Original Research
Imaging Science, Original Research
Interventional Radiology, Original Research
Letter to Editor
Musculoskeletal Imaging, Case Report
Musculoskeletal Imaging, Original Article
Musculoskeletal Imaging, Original Research
Musculoskeletal Imaging, Pictorial Essay
Musculoskeletal Imaging, Review Article
Neuroradiology , Review Article
Neuroradiology Head and Neck Imaging, Pictorial Essay
Neuroradiology, Case Report
Neuroradiology, Pictorial Essay
Neuroradiology/Head and Neck Imaging, Case Report
Neuroradiology/Head and Neck Imaging, Case Series
Neuroradiology/Head and Neck Imaging, Original Research
Neuroradiology/Head and Neck Imaging, Review Article
Neuroradiology/Spine Imaging, Original Research
Notice of Retraction
Nuclear Medicine, Case Report
Nuclear Medicine, Original Research
Nuclear Medicine, Pictorial Essay
Original Article
Original Article, Neuroradiology
Original Research
Original Research Article
Original Research, Cardiopulmonary Imaging
Original Research, Dental Radiology
Original Research, Descriptive Study
Original Research, Diagnostic Radiology
Original Research, Gastrointestinal Imaging
Original Research, Genitourinary and Gynecologic Imaging
Original Research, Musculoskeletal Imaging
Original Research, Neuroradiology/Head and Neck Imaging
Original Research, Nuclear Medicine
Original Research, Vascular and Interventional Radiology
Pediatric Imaging, Case Report
Pediatric Imaging, Pictorial Essay
PICTORIAL ESSAY
Pictorial essay, Musculoskeletal Imaging
Pictorial essay, Neuroradiology/Head and Neck Imaging
PICTORIAL REVIEW
Radiologic-Pathologic Correlation
RADIOLOGICAL-PATHOLOGICAL CORRELATION
Radiology Business, Original Research
Research Article
Review Article
Review Article, Diagnostic Radiology
Review Article, Gastrointestinal imaging
Review Article, Musculoskeletal
Review Article, Musculoskeletal Imaging
Review Article, Vascular and Interventional Radiology
Technical Innovation
Technical Innovation, Cardiopulmonary Imaging
Technical Innovation, Gastrointestinal Imaging
Ultrasound, Case Report
Ultrasound, Original Research
Ultrasound, Review Article
Vascular and International Radiology, Case Report
Vascular and Interventional Radiology, Case Report
Vascular and Interventional Radiology, Case Series
Vascular and Interventional Radiology, Original Research
Vascular and Interventional Radiology, Pictorial Essay
Vascular and Interventional Radiology, Review Article
Vascular and Interventional Radiology, Short Communication
Vascular and Interventional, Original Research
View/Download PDF

Translate this page into:

CASE REPORT
2014
:4;
27
doi:
10.4103/2156-7514.133261

Ureterovesical Opaque Densities after Ureterovesical Reflux Injection Therapy: Diagnostic and Therapeutic Dilemma

Department of Urology, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran

Address for correspondence: Dr. Hamed Akhavizadegan, Department of Urology, Baharloo hospital, Behdari Street, Rahahan square, Tehran, Iran. E-mail: h-akhavizadegan@tums.ac.ir

Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Disclaimer:
This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.

Abstract

Primary vesicoureteral reflux can be treated by injection of a bulking agent into the wall of the ureterovesical junction. Over time, the bulking agent can get calcified. Radiological images of the area show findings that mimic those seen in ureterovesical junction calculi. In this report, we present the imaging findings of this phenomenon and discuss its challenging aspects.

Keywords

Bulking agent
calcification
collagen
ureterovesical stone
vesicoureteral junction
vesicoureteral reflux

INTRODUCTION

Bulking agent injection is now a standard treatment for patients with grade 1-3 primary vesicoureteral reflux (VUR). Patients with higher grades and secondary types of VUR show an unacceptably high failure rate when treated with injections of a bulking agent.[1] Collagen has been used for many years as a bulking agent in ureterovesical orifice and bladder neck to treat VUR and incontinence.[2] Collagen, however, can get calcified in the tissue,[2] a process that can cause a series of problems for patients. We present a case of a patient in whom calcified injected collagen showed imaging features mimicking ureteral stone.

CASE REPORT

A 15-year-old girl presented with moderate degree of right flank pain for 2 weeks. Pain was localized on the right side, altered with change in position, and did not relate to any particular organ. Physical examination and urine analysis were normal. The patient had been treated successfully for bilateral grade 2 VUR when she was 3 years old. A kidney ureter bladder (KUB) radiography was requested and the report indicated presence of bilateral ureteral stone [Figure 1]. Ultrasonography showed bilateral ureterovesical junction (UVJ) stone and mild stasis in both kidneys, which was compatible with the findings of the non-enhanced spiral abdomino-pelvic computed tomography (CT) scan [Figure 2]. However, diethylene triamine pentaacaetic acid (DTPA) scan with furosemide injection and radionuclide cystography (RNC) scan ruled out obstruction and relapse of VUR. Calcification of bilateral intravesical collagen injected to treat her VUR 12 years earlier was responsible for the positive findings on KUB, ultrasonography, and spiral CT. The patient was referred to the physiotherapist for her low back pain. The pain improved with treatment.

15-year-old female with bilateral flank pain, which was suspected to be due to stones in bilateral ureterovesical junction, later diagnosed as due to calcification of collagen used 12 years earlier to treat vesicoureteral reflux. Kidney ureter bladder graphy shows bilateral UVJ calcifications (arrow).
Figure 1
15-year-old female with bilateral flank pain, which was suspected to be due to stones in bilateral ureterovesical junction, later diagnosed as due to calcification of collagen used 12 years earlier to treat vesicoureteral reflux. Kidney ureter bladder graphy shows bilateral UVJ calcifications (arrow).
15-year-old female with bilateral flank pain, which was suspected to be due to stones in bilateral ureterovesical junction, later diagnosed as due to calcification of collagen used 12 years earlier to treat vesicoureteral reflux. Spiral CT scan of pelvis without intravenous and oral contrast shows bilateral UVJ calcifications (arrows).
Figure 2
15-year-old female with bilateral flank pain, which was suspected to be due to stones in bilateral ureterovesical junction, later diagnosed as due to calcification of collagen used 12 years earlier to treat vesicoureteral reflux. Spiral CT scan of pelvis without intravenous and oral contrast shows bilateral UVJ calcifications (arrows).

DISCUSSION

Endoscopic therapy for VUR has gained popularity because of elimination of invasive surgical procedures in children. In addition, it has an acceptable success rate and a low level of complications.[1] Although a transition has occurred in the material of choice from Teflon to collagen and now to hyaluronic acid copolymers. However, we do find patients who were treated with collagen now in the second decade of their life. Calcification of injected collagen has been described since 1994.[23] The injected material, being a foreign body, can induce inflammatory response that leads to tissue calcification.[4] This calcification has been reported to be symptomatic with some patients reporting episodes of stone passing, hematuria, and even obstruction.[4] This is the second case report of ureterovesical injection calcification presenting as a ureteral stone during differential diagnosis[4] and the first report of its imaging. Unlike the first case report where the patient presented with renal colic and passing of stone, our patient was completely asymptomatic, except for positional non-related flank pain. There is no difference between a ureteral stone and calcification of injected collagen, when viewed by different imaging modalities like KUB [Figure 1], CT scanning [Figure 2], and also ultrasound examination. This similarity is because of the place where the bulking agent is injected. In doubtful cases, as in our case, UVJ obstruction can be ruled out by DTPA nuclear scan in which glomerular filtration of injected nuclear radioisotope reveals any obstruction in the upper urinary tract. There are also other challenging issues. The diagnosis of UVJ stone in the presence of UVJ calcification, possibility of ureteral stone passing (in a patient with renal colic) after UVJ injection therapy, and the probability of recurrent VUR after ureteral intervention (in which calcified ureteral orifice will tolerate dilatation to pass the ureteroscope) remain to be studied. VUR can be assessed by RNC in which a radioisotope passing to the bladder via the urethral catheter reveals presence of VUR.

CONCLUSION

The standard treatment for grade 1 and 3 primary VUR is injection of a bulking agent into the UVJ. Clinicians should be aware that calcification of bulking agent like collagen can occur and they need to differentiate this from ureterovesical stones on imaging findings.

Source of Support: Nil

Conflict of Interest: None declared.

REFERENCES

  1. , , . Usefulness of concomitant autologous blood and dextranomer/hyaluronic acid copolymer injection to correct vesicoureteral reflux. J Urol. 2012;188:948-52.
    [Google Scholar]
  2. , , . Physical and histological behavior of a new injectable collagen (GAX65) implanted into the submucosal space of the mini-pig bladder. J Urol. 1995;154:812-5.
    [Google Scholar]
  3. , , , , . Histological behavior of glutaraldehyde cross-linked bovine collagen injected into the human bladder for the treatment of vesicoureteral reflux. J Urol. 1994;152:632-5.
    [Google Scholar]
  4. , , , , . Symptomatic calcification of subureteral collagen ten years after injection. Urology. 2007;69:982.e1-2.
    [Google Scholar]

Fulltext Views
6,018

PDF downloads
3,204
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections