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Computerized tomography attenuation values can be used to differentiate hydronephrosis from pyonephrosis

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Abstract

Purpose

To determine the diagnostic value of computerized tomography (CT) in differentiating pyonephrosis from hydronephrosis on the basis of attenuation values (Hounsfield unit—HU).

Methods

Data of the patients with grades 1–3 hydronephrosis on abdominopelvic CT, who underwent nephrostomy tube placement for decompression of the collecting system, were retrospectively analyzed. Patient demographics and CT findings were recorded along with the first access urine culture results. Three physicians calculated the surface areas and the attenuation values of the dilated collecting systems using the system software. Mean HU of pyonephrosis and hydronephrosis cases was compared.

Results

A total of 105 patients with the mean age of 47.7 ± 15.5 (range 20–80) were included. The interclass correlation coefficient of three physicians was 0.981 for HU measurement and 0.999 for calculation of collecting system surface area. Of the patients, 47 (44.8 %) had pyonephrosis. Mean surface areas of the collecting system were similar in patients with pyonephrosis and hydronephrosis (1481.13 ± 1562.94 vs. 1612.94 ± 2261.4 mm2, p = 0.735). Urine cultures were positive in all patients with pyonephrosis, whereas 12.7 % of hydronephrosis cases had bacterial in first access urine culture. The HU of the patients with pyonephrosis was significantly higher that that of patients with hydronephrosis (13.51 ± 13.29 vs. 4.67 ± 5.37, p = 0.0001). Having a HU of 9.21 or over diagnosed pyonephrosis accurately with 65.96 % sensitivity and 87.93 % specificity.

Conclusion

Measuring attenuation values of the collecting system may be useful to differentiate pyonephrosis from hydronephrosis. Diagnosing pyonephrosis accurately may avoid septic complications.

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Authors’ contribution

E Yuruk was involved in protocol development and data analysis and wrote the manuscript; M Tuken was involved in data collection and data analysis; S Sulejman was involved in data collection and data analysis; A Colakerol was involved in data management and data analysis; EC Serefoglu was involved in protocol development and edited the manuscript; K Sarica edited the manuscript; AY Muslumanoglu edited the manuscript.

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Authors and Affiliations

  1. Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey

    Emrah Yuruk, Murat Tuken, Suhejb Sulejman, Aykut Colakerol, Ege Can Serefoglu & Ahmet Yaser Muslumanoglu

  2. Department of Urology, Kartal Training and Research Hospital, Istanbul, Turkey

    Kemal Sarica

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  1. Emrah Yuruk
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  2. Murat Tuken
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Correspondence to Emrah Yuruk.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. All applicable international, national and/or institutional guidelines for the care and use of animals were followed.

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Informed consent was obtained from all individual participants included in the study.

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Yuruk, E., Tuken, M., Sulejman, S. et al. Computerized tomography attenuation values can be used to differentiate hydronephrosis from pyonephrosis. World J Urol 35, 437–442 (2017). https://doi.org/10.1007/s00345-016-1888-1

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  • DOI: https://doi.org/10.1007/s00345-016-1888-1

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