| Urinary obstruction is a common, frequently encountered disease. It produces serious damage in clinic, especially the damage of upper urinary tract obstruction. For upper urinary tract obstruction, the symptom of uronephrosis appears and become serious gradually in the early stage. Firstly, static renal pelvic pressure increases continuingly. Then effective filtration pressure of renal glomerulus begins to decrease until it stops. Finally, back flow of urine leads to denaturation, inutility and interstitial fibrosis of renal tubule. In the early stage, partial urine is dependent on pyelovenous, lymphatic, pyelotubular backflow as well as pyelosinus extravasations. In these ways the pressure of renal pelvis and renal tubule can be relieved. However, uronephrosis can be aggravated again. Consequently, nephridial tissue lacks oxygen and is ischemic, renal parenchyma begins to atrophy, become thin and lose functions until renal failure. Therefore, decompression of earlier urinary drainage is the key to recover renal function.In early phase, percutaneous nephropyelostomy is guided by X-rays in clinic. Recently, with the development of ultrasound interventional technique, ultrasonic guided percutaneous nephropyelostomy is being applied widely, especially in my hospital. Usually patients are urgent, as ultrasonic machine is convenient to move to patients'bedside for therapeutic puncture. It easily satisfies the demand of emergency treatment. In addition, modern medicine requires advanced techniques with low pain and high efficiency today. Compared with puncture without the guideline or under the guide of X-rays in the past percutaneous nephropyelostomy, ultrasonoscopy can instantaneously and dynamically display the degree of diseased kidney effusion, parenchyma thickness and renal vascular distribution, directly observe implantation angle of puncture needle, immediately correct the direction, avoid damaging important viscera, enlarging veins as well as avoid complications in maximum. What's more, for most of uncertain pathogeny or the following diagnoses and treatment required to introduce the equipment of sacculus, seal wire and percutaneous nephroscope set through orificium fistulae, percutaneous nephropyelostomy is the fist step of therapeutic schedule of urinary obstruction, the success of which is essential to continue the following treatment. This technique guided by ultrasound is more objective and reliable to achieve high success ratio and control complications.After operation, the more popular and direct diagnostic mode of iconography in clinic is that diodone (contrast media) is injected through orificium fistulae and then is used to antegrade urography (antegrade urinary tract radiography). Then patients are required to transfer iconographic department to further check. It is said that the procedures are too complicated and cause the delay of diagnosis time. At the same time, the patients are transferred repeatedly. Consequently, these procedures do not only contribute to inconvenience, but influence patients nursing negatively. A few patients may be allergic to iodine preparation, this will cause the direct and effective means cannot be used. Recently, after three generational improvements to acoustic contrast agent, it has been rather mature in the application of blood vessel ways. Is it the time to consider it can be applied in non blood vessel way? If it can be used as a tracer in upper urinary tract development, Antegrade upper urinary tract contrast-enhanced ultrasound will be possible and there will be an alternative diagnostic mode of iconography in clinic, which will provide patients with convenience. Accordingly, we will attempt to directly apply ultrasound contrast agent (UCA) in upper urinary tract. Then the feasibility and accuracy of it will be evaluated.The objection of this investigation was 46 patients with upper urinary tract obstruction (7 of it with bilateral upper urinary tract obstruction),during the procedure of drainage of percutaneous puncture of renal pelvis, a dose of 0.2 ml SonoVue agents (59mg per 5ml) dissolved in 50 ml sterilized saline was administered through injecting into the renal pelvis via the puncture tube. Antegrade contrast agent movement with in upper urinary tract was continuously monitored under CPS model. On the end of contrasting procedure, liquid with agents with in the urinary tract was extracted thoroughly until the hyperecho of agents decreased significantly. The conclusion of this and patients underwent IVP or MRU was compared by retrospective comparative analysis. The diagnostic values of them were classified into 3 grades:Grade 0:no diagnostic value,Grade 1:localization of the lesion was possible; Grade 2:both localization and characterization was possible. The diagnostic values of the three examinations were compared.46 patients all success angiography and with 53 sides of kidney successful puncture for once. The movement of agent in upper urinary tract during operation was observated continuously, to make sure the integrity of the upper urinary tract, the site and level of obstruction, the position of ureteral orifice and the property of partial obstruction. All these above all proved by surgical treatment. Among 46 patients,24 with ureteral calculi,2 with ureteral tumor,14 with other parts of the tumor invade ureter.(3 with recurrent of ovarian cancer,2 with recurrent of colorectal cancer),2 with urinary tract tuberculosis,4 with urinary tract malformation,2 with urinary tract rupture,5 with urinary tract stenosis caused by inflammation.Complication of this operation was less,10 with the complication of lumbago, symptoms disappear spontaneously after two or three days; 10 appears hematuria,3 of them were microscopic hematuria,2 of them were gross hematuria secondary,this was disappeared after the treatment with hemostatic drugs.The complications of urinary caused by agent were never appear in clinical observation.The diagnostic value of CEUS was greater than IVP, Statistical significance has not been found between CEUS and MRU.From 2005, this technique began with ureterodialysis diagnosis, until now contrast-enhanced ultrasound has been successfully applied in biliary tract, uterine cavity, alimentary tract and other ten different fields. It makes up the deficiency of conventional ultrasonic diagnosis and assists in resolving many medical cases. Some relating academic essays have been published. From 2007, Antegrade upper urinary tract contrast-enhanced ultrasound has been considered as a conventional test mode after percutaneous nephropyelostomy. Although used dose of contrast medium was reduced to 0.2 ml, contrast medium could still meet requirement of development. From 2010, further improvement has been achieved. Contrast-enhanced ultrasound from vein and urography can diagnose the cause of obstruction and observe the change of renal function in terms of iconography. Nevertheless, it has to also be admitted that ultrasonic contrast has its limitations. First of all, due to restrictions of ultrasonic imaging principle, contrast media cannot present boundaries of viscera clearly and sharply. Secondly, the ultrasonic detector is too small to display a complete image in same picture for a big viscus. However, just these limitations push us to continuously explore and further develop the ultrasonic medicine. We are willing to devote ourselves to ultrasonic medicine.
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