Transvaginal ultrasound in the detection of ureteral jets

One of the most serious complications of obstetrical and gynecological surgery is the obstruction of one or both ureters. This may be due temporarily to local edema or permanently as a result of sectioning, suturing or tying off the ureter, usually amidst a stormy pelvic surgery. Customary diagnostic tests to detect such ureteral occlusion are cumbersome, complicated, and at times expensive. Sonographic observation of the ureteral jets has been previously published in the literature. This phenomenon is based on differences in specific gravity between the 'fresh' urine ejected by the ureters and that present in the bladder. Previously known to radiologists, the ultrasonographic observation of the ureteral jets has been used only minimally by obstetricians and gynecologists. Hence we designed a study to validate the clinical usefulness of this technique in our field. Transvaginal color Doppler sonography was used to evaluate 20 normal, non-surgical, 17 post-Cesarean delivery and 12 post-total abdominal hysterectomy patients. In addition, three patients with only one functional kidney or ureter were scanned. We evaluated the time to detection of the first jet and the number of jets in 5 min on both sides. In all women, except those with one functional kidney, the urine jets could be detected bilaterally. The time to the detection of the first jet did not differ significantly in the non-surgical. Cesarean or hysterectomy groups. The total number of jets was similar in the non-surgical and Cesarean patients, but was somewhat lower in the group of patients who had a hysterectomy. Transvaginal color Doppler proved to be a simple and accurate technique that could be used to detect ureteral patency in women. In another study performed by us, an additional group of patients was examined using only gray-scale (black and white) transvaginal sonography. In this study, the ureteral jets could also be detected with 100% positive predictive value. This simple method of evaluating ureteral patency was found to be reliable, convenient and less expensive than other currently used imaging modalities. We suggest that it should be used as a first line test in patients suspected of having postoperative ureteral obstruction.