Evaluation of Ureteric Jet by Color Doppler Ultrasound in Pregnancy

Abstract
Background: Abdominal pain during pregnancy can be caused by many conditions related to diseases of abdomen, urinary system, gynecological and obstetric problems. One of the important conditions causing non obstetrical pain during pregnancy is renal colic. Ureteral jet is the phenomenon that seen when the dense urine from the ureter is expelled into the more dilute urine in the urinary bladder.
Aim of Study: Was to ass ureteric jet by color Doppler ultrasound in pregnant women.
Subjects and Methods: Total number of 75 pregnant patients with singleton pregnancy referred to our Radiology Department from Obstetrics and Gynecology Department, in their second and third trimester, presented with suspected urinary tract infections or hydronephrosis were included in our prospective study.
Renal and bladder grey scale and bladder color Doppler ultrasonography were performed; patient should be full bladder. Ureteral jet angle was also measured as the angle between the direction of the ureteral jet and intraureteral ridge. Patterns of the ureteric jet were also recorded. Doppler ultrasound of the bladder area was performed in a transverse plane while patient supine includes both ureteric orifices to visualize the bilateral ureteral jets and measures the angle. Number of ureteral jets was also recorded for a period of one minute to three minutes. Study was done also in the right and left lateral decubitus position and number of ureteral jets was also recorded for a period of one or three minutes. Right ureteral jets were recorded in left lateral decubitus position whereas left ureteral jets were recorded in the right lateral decubitus position. Renal Ultrasound was done to detect back pressure changes and its severity.
Results: We used Statistical Package for Social Sciences (SPSS) software version 10 for data assessment. Mean age of patients was 23±4 years. Average gestation age was 26.02± 2.56 weeks with minimum and maximum gestation age 21 and 33 weeks respectively. Mean number of ureteral jets seen in supine position at right side was 1.91±1.71 with minimum and maximum number of jets 0 and 4 respectively. Most frequent number of jets was “0” and seen in 36 cases (48%) of the patients.
Back pressure changes diagnosed in 52 patients (69%) was unilateral in 41/52 patients (78%) and bilateral in 11/52 cases (22%). Right kidney back pressure changes were seen in 35 patients and left side 6 cases. Mean ± SD ureteral jet angle was significantly greater in affected units with back pressure (67.9±16.5 degrees) than in non affected units (42.8± 12.2 degrees, p<0.0001). A cutoff angle of 55 degrees or greater was detected in cases with mild back pressure changes in our study. A cutoff angle of 70 degrees or greater was associated with more severe back pressure changes (moderate to severe backpressure changes). Out of 75 patients, 33 cases showing no backpressure changes and the ureteral jet angle was less than 55 degree in both ureteric orifices.
Conclusion: Color/pulse-wave Doppler US is avery useful tool for demonstrating ureteral jets and provides its charac-terization. Change in scanning position from supine to right/left decubitus position to ass ureteric jet in pregnant patients will be helpful and we suggest further studies to evaluate our cutoff angles.