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Sonographic features of necrosed renal papillae causing hydronephrosis.

OBJECTIVE: To describe the sonographic appearance of ureteric obstruction due to necrosed papillae.

METHODS: In this study, carried out over 3 years 6 months, patients with diabetes mellitus who had renal colic were studied by sonography.

RESULTS: In 15 patients with hydronephrosis, there was a soft tissue mass of necrosed papillae filling the ureteric lumen at the site of obstruction. Necrosed papillae were seen in medullary cavities of the ipsilateral kidney in 5 patients. Ureteroscopic removal of necrosed papillae was done in 13 patients. One patient was not fit for an invasive procedure.

CONCLUSIONS: When patients predisposed to renal papillary necrosis have renal colic, and sonography fails to show a ureteric calculus, it is best to look for necrosed papillae in the ureter, which may be causing obstruction.

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