Abnormal ureteric jet in obstructed uropathy: A case report

A 40-yr-old male patient experienced a left renal stone that lodged into the distal ureteral orifice in a period of 4 mon, resulting in ureterodynamic changes demonstrated by both color and spectral Doppler ultrasound. The Doppler waveforms of the left ureteric jets changed from a monopeaked type with the stone in the renal pelvis into a flattened type as it lodged in the distal ureter, whereas the waveforms of the right ureteric jets remained normally 2-peaked. As for the spectral analyses of the waveforms, the healthy right side of the ureteral orifice had Vmean (average velocity of urine ejaculation), D (duration of urine ejaculation) and ureterodynamic index (Vmean x D) as 54cm/sec, 5.84sec and 315.36cm, respectively, for the initial test, and 40cm/sec, 7.50sec and 300.00cm, respectively, for the last test (in a 4-mon interval), with all the data within normal limits; whereas the diseased left side had data of 62cm/sec, 4.53sec and 280.86cm, respectively, for the initial test during stone in the lower pelvis, and 5cm/sec, 4.80sec and 24.0cm, respectively, for the last test when the stone had lodged into the distal ureter. There was marked change from data within normal limits to those in the abnormal range, and with occurrence of obstructed uropathy there was a very low Vmean and ureterodynamic index. Hence, we conclude that a combined use of real-time, color Doppler and spectral Doppler ultrasound for the examination of urolithiasis could be a test of great value in evaluation of the condition of obstructed uropathy.