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The Dark Tower (2017 film)
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The Dark Tower
Theatrical release poster
Directed by
Nikolaj Arcel
Produced by
Akiva Goldsman
Ron Howard
Erica Huggins
Screenplay by
Akiva Goldsman
Jeff Pinkner
Anders Thomas Jensen
Nikolaj Arcel
Based on
The Dark Tower
by Stephen King
Starring
Idris Elba
Matthew McConaughey
Tom Taylor
Claudia Kim
Fran Kranz
Abbey Lee
Jackie Earle Haley
Music by
Tom Holkenborg
Cinematography
Rasmus Videbæk
Edited by
Alan Edward Bell
Dan Zimmerman
Production
company
MRC
Imagine Entertainment
Weed Road
Distributed by
Columbia Pictures
Release date
July 31, 2017 (2017-07-31) (Museum of Modern Art)
August 4, 2017 (2017-08-04) (United States)
Running time
95 minutes[1]
Country
United States
Language
English
Budget
$60 million[2]
Box office
$109.9 million[3]
The Dark Tower is a 2017 American science fantasy western film[4] directed and co-written by Nikolaj Arcel. A continuation of Stephen King's novel series of the same name, the film stars Idris Elba as Roland Deschain, a gunslinger on a quest to protect the Dark Tower—a mythical structure which supports all realities—while Matthew McConaughey plays his nemesis, Walter Padick, the Man in Black, and Tom Taylor stars as Jake Chambers, a New York boy who becomes Roland's apprentice.[5]
Intended to launch a film and television franchise, the first installment combines elements from several novels in the eight-volume series, and takes place in both modern-day New York City and in Mid-World, Roland's Old West-style parallel universe. The film also serves as a canonical sequel to the novel series, which concludes with the revelation that Roland's quest is a cyclical time loop; the presence of the Horn of Eld, which Roland carries in the film, indicates that this is the next cycle.[6][7][8]
The Dark Tower premiered at the Museum of Modern Art in New York City on July 31, 2017, and was theatrically released in the United States on August 4, 2017 by Columbia Pictures.[9] It has grossed $109 million worldwide against production budget of $60 million, and received generally negative reviews, with critics calling it "a dull disappointment without any set audience: incomprehensible to newbies, and wildly unfaithful and simplistic to fans of King's books", though Elba's performance earned some praise.[10][11][12][13][14]
Contents
[hide]
1 Plot
2 Cast
3 Development history
3.1 J. J. Abrams (2007–2009)
3.2 Ron Howard (2010–2015)
3.3 Nikolaj Arcel (2015–2017)
4 Production
5 Release
5.1 Promotion
6 Reception
6.1 Box office
6.2 Critical response
7 Future
7.1 Television series
7.2 Sequel
8 References
9 External links
Plot[edit]
Eleven-year-old Jake Chambers experiences visions involving a Man in Black who seeks to destroy a Tower and bring ruin to the world, and a Gunslinger who opposes him. Jake's mother, stepfather, and psychiatrists dismiss these as dreams resulting from the trauma of his father's death the previous year.
At his apartment home in New York City, a group of workers from an alleged psychiatric facility offer to rehabilitate Jake; recognizing them from his visions as monsters wearing human skin, he flees. Jake tracks down an abandoned house from one of his visions, discovers a high-tech portal, and travels to a post-apocalyptic world called Mid-World.
In Mid-World, Jake encounters the last Gunslinger, Roland Deschain who emerged in his visions. Roland is pursuing Walter Padick, the Man in Black who had also appeared in his dreams across a desert, seeking to kill him in revenge for the murder of his father, Steven. He explains that Walter has been abducting psychic children, and is attempting to use their powers to destroy the Dark Tower, a fabled structure located at the center of the universe; this will allow monsters from the darkness outside to invade and destroy reality.
Roland takes Jake to a village to have his visions interpreted by a seer. Learning of Jake's escape and journey to Mid-World, Walter investigates, and realizes that Jake has enough psychic potential to destroy the Tower single-handedly. He kills Jake's stepfather, then interrogates his mother about his visions and kills her. In Mid-World, the seer explains that Roland can find Walter's base of operations in New York.
Walter's minions, the Taheen, attack the village, but Roland kills them. Roland and Jake return to Earth. When Jake returns home to check in on his parents, he finds their remains and breaks down. Roland vows to avenge them and comforts Jake by teaching him the Gunslinger's creed and the basics of gun fighting.
While Roland re-arms himself at a gun store, Walter captures Jake. At his base, he straps Jake to a machine, intending for him to destroy the Tower. Jake uses his psychic powers to alert Roland to his location, and Roland battles his way through Walter's henchmen.
Walter confronts Roland, wounding him. After Jake reminds him of the Gunslinger's creed, Roland recovers and kills Walter with a trick shot after a brief fight. Roland destroys the machine, saving the Tower, Jake and the other children. Afterwards, Roland says that he must return to his own world. He offers Jake a place by his side as his companion, which Jake accepts. The two depart for Mid-World.
Cast[edit]
Idris Elba as Roland Deschain
The last of the Gunslingers.[15] On the choice of Elba, director and co-writer Nikolaj Arcel stated, "For me, it just clicked. He's such a formidable man." He added that he had been an admirer of Elba's since The Wire,[15] and stated, "I had to go to Idris and tell him my vision for the entire journey with Roland and the ka-tet. We discussed, who is this character? What's he about? What's his quest? What's his psychology? We tried to figure out if we saw the same guy. And we absolutely had all the same ideas and thoughts. He had a unique vision for who Roland would be."[15] Stephen King himself spoke highly of Elba, stating: "I love it. I think he's a terrific actor, one of the best working in the business now."[15] On the character of Roland, King noted: "For me the character is still the character. It's almost a Sergio Leone character, like the Man with No Name," while remarking, "He can be white or black, it makes no difference to me. I think it opens all kind of exciting possibilities for the backstory."[15]
Matthew McConaughey as Walter Padick, the Man in Black
A ruthless ageless deceiver and sorcerer who seeks to reach the tower and rule over its seemingly infinite kingdoms.[15] On the choice of McConaughey, Arcel stated, "Matthew is an incredible actor who can do anything. That's how I feel about [Walter]. He could do anything."[15] About the character of Padick, Arcel added, "He is this timeless sorcerer, and being a Stephen King fan, I've read and experienced Walter in various iterations," making reference to The Stand and The Eyes of the Dragon.[15] "He has a very interesting way of seeing the world. He sees it with a sort of delight, even though he is obviously on the wrong side of the light-and-dark spectrum. He's someone I've been having a lot of fun with."[15] King made mention of him never having a clear image of the character's face, to which he explained: "I never really thought of him. But [in the movie] he becomes a character who isn't just a mirage that Roland is chasing. The way things are set up, he's right there."[15]
Tom Taylor as Jake Chambers
A young boy whom Roland must call upon to complete his journey, and a son-like figure to Deschain.[15][16][17] Taylor won the role after an international search.[16]
Claudia Kim as Arra Champignon
Fran Kranz as Pimli[18]
Abbey Lee as Tirana
Jackie Earle Haley as Sayre[19]
Katheryn Winnick as Laurie Chambers[20]
Dennis Haysbert as Steven Deschain, Roland's father.
Michael Barbieri as Timmy
José Zúñiga as Dr. Hotchkiss
Alex McGregor as Susan Delgado
Nicholas Hamilton as Lucas Hanson
De-Wet Nagel as Taheen Tech[21]
Development history[edit]
The Dark Tower's protagonist Roland as depicted in the opening credits of another Stephen King adaptation, The Mist (2007)
Efforts to adapt The Dark Tower series for the screen have been ongoing since 2007, with periodic reports and official announcements. The project was shelved, before the rights were transitioned to a different production company. Development experienced starts and stops with various filmmakers and studios at different times, including Universal Films, Paramount, Columbia-Tristar Entertainment, and Lionsgate Entertainment. The adaptation went through three major phases of planning: with J. J. Abrams from 2007 to 2009, Ron Howard from 2010 to 2015, and finally, the current iteration, announced in March 2015, produced by Sony Pictures Entertainment and Media Rights Capital,[22] with Nikolaj Arcel directing and Howard remaining in a producing role.
J. J. Abrams (2007–2009)[edit]
By early February 2007, a film adaptation of The Dark Tower series was in the works. J. J. Abrams, co-creator of the television series Lost, was said to be attached to produce and direct. Carlton Cuse and Damon Lindelof, who co-created Lost with Abrams, optioned The Dark Tower from King for a reported amount of $19, a number that mysteriously recurs throughout the series.[23] According to issue #923 of Entertainment Weekly, King "is an ardent supporter of [Lost] and trusts Abrams to translate his vision" into a film franchise, with Lindelof being "the leading candidate to write the screenplay for the first installment."[24] It was around this time that Marvel Comics launched their graphic novel adaptation of The Dark Tower with The Dark Tower: The Gunslinger Born. Later, in March 2007, Abrams noted in an interview with Wired that the project is "something that we are just now talking about with Stephen, so it's too early for me to say that we're even officially doing it yet just because the thing is in the early stages of discussion."[25]
A year later, in February 2008, Abrams reiterated that The Dark Tower adaptation was in the early stages of development, when interviewed by Reelz Channel.[26] When interviewed by AMC in September 2008, Abrams admitted that the project needs time he does not have because of Lost, especially since he would like to see a seven-film series (the eighth novel was published in 2012). However, in May 2009, Abrams stated to IGN that he and Lindelof were planning on beginning work on The Dark Tower as soon as Lost finished its run.[27] Speaking to MTV News around the same time, Lindelof revealed some apprehension regarding the project, noting that his "reverence for Stephen King is now getting in the way of what any good writer would do first when they're adapting a book, which is take creative license."[28] In a July 2009 interview with C21 Media, Lindelof revealed that he and Cuse had indeed optioned the rights for The Dark Tower, but said he was wary about committing to such an ambitious project: "The idea of taking on something that massive again after having done six seasons of Lost is intimidating and slightly frightening, to say the least."[29]
With these reservations being voiced by the producers, this initial phase of the project came to an end at the end of 2009 after three years, since this was a three-year option. In an interview with USA Today in October 2009, Damon Lindelof stated: "You'll be hard-pressed to find a huger fan of The Dark Tower than me, but that's probably the reason that I shouldn't be the one to adapt it. After working six years on Lost, the last thing I want to do is spend the next seven years adapting one of my favorite books of all time. I'm such a massive Stephen King fan that I'm terrified of screwing it up. I'd do anything to see those movies written by someone else. My guess is they will get made because they're so incredible. But not by me."[30] Finally, in November 2009, Abrams stated that he would not be adapting the series. During an interview with MTV News, Abrams made the following comments: "The Dark Tower thing is tricky. The truth is that Damon and I are not looking at that right now."[31]
Ron Howard (2010–2015)[edit]
In April 2010, five months after Abrams revealed he would no longer pursue his adaptation of The Dark Tower, Universal Pictures was set to produce trilogy of feature films, alternating with two seasons of a television series to bridge gaps between the films. The involved parties included Akiva Goldsman writing the script, Ron Howard directing, and also producing with Brian Grazer and Stephen King.[32] The report was made official by NBC Universal five months later via a press release dated September 8, 2010.[33] In an interview with Entertainment Weekly following the announcement, King stated that "I always thought it would take more than a single movie, but I didn't see this solution coming—i.e., several movies and TV series. It was Ron [Howard] and Akiva [Goldsman]'s idea. Once it was raised, I thought at once it was the solution."[34] A month later, the first Dark Tower film was scheduled to open on May 17, 2013.[35] In December 2010, Howard offered the following in regards to the project's progress: "It is going well, and it has been incredibly stimulating to work on. I really can't stop thinking about it. We've been meeting and talking and I've been reading and researching and just kind of living with it. I hope it goes great. I hope it goes the way we think it will. It never does, really. But sometimes it goes better." Despite Howard's enthusiasm, Universal had not yet greenlit the project at that point.[36][37]
By the end of 2010 and the beginning of 2011, New York Post was reporting that Javier Bardem and Viggo Mortensen were in line to play the lead character of Roland Deschain, and Naomie Harris was being considered for the character of Susannah Dean.[38][39] Speaking on The Howard Stern Show in January 2011 and qualifying his words with the phrase "I don't know if it's going to happen or not", Howard said that after the first film, which would be more action-oriented, a six-episode television miniseries would follow, focusing more on character-driven drama.[40] For his part, Brian Grazer stated around the same time that a casting announcement could be made "within a week."[41]
By April 2011, Mark Verheiden was joining the television portion of the project as executive producer and Akiva Goldsman's co-writer. The same month, Javier Bardem was cast in the role of Roland.[42] However, just a month later, a report in Variety revealed that Universal may seek another studio's help, as the project's budget appeared to be more than they were willing to handle.[43] The Hollywood Reporter wrote later that the project was on the verge of turnaround, and Warner Bros. or Columbia Pictures could potentially take the project on, revealing that Universal had paid $5 million for the rights.[44] Shortly after that, Universal committed to a lower budget for the project and Goldsman began rewriting the script to reflect these changes.[45]
Originally, production was slated to begin in September 2011, but in May 2011 it was being pushed back to February 2012 or early spring. The project was still not greenlit by the studio, which had to happen by July 2011.[46][47] Then on July 18, 2011, Universal decided to cancel development of the entire project due to budgetary concerns.[48] Despite this, Stephen King was confident Howard would see the project through, stating that he was "sorry Universal passed, but not really surprised. I bear them no ill will, and trust Ron Howard to get Roland and his friends before the camera somewhere else. He's very committed to the project."[49] In August 2011, Howard stated that they were "trying to get outside financing to make it, and distribute it through a major [studio]", including the fact that Netflix might be an outlet.[50] Later, in October 2011, Howard confirmed the adaptation is still on track, noting that HBO would now carry the television portion of the project.[51]
By March 2012, Warner Bros. was expressing interested in taking on the project.[52] Several months later, Goldsman delivered a new script for the first film to Warner Bros., and the studio had to make a decision in August 2012 whether to go ahead with the project. As well, Russell Crowe was being talked about as the lead character.[53] On August 20, 2012, Warner Bros. officially passed.[54] At the same time, Media Rights Capital (MRC) was in talks to take over the project from Warner.[55]
In January 2014, Aaron Paul stated that he had a conversation with Howard and was possibly being considered to play Eddie Dean (earlier, in October 2012, Paul had tweeted that the role of Eddie Dean was a "huge dream" of his).[56][57] Following that, a rumor appeared that Liam Neeson was interested in the part of Roland.[58]
Nikolaj Arcel (2015–2017)[edit]
On April 10, 2015, it was announced that Sony Pictures Entertainment with MRC were fast-tracking the project, now with a completely reworked script by Goldsman and Jeff Pinkner. King appeared optimistic, saying: "I'm excited that The Dark Tower is finally going to appear on the screen." Howard appeared to be out as director, but would remain in a producing capacity.[59] By June 2, 2015, Sony was looking to Nikolaj Arcel to direct.[60] Arcel officially signed on July 10, 2015, with him and Anders Thomas Jensen rewriting the script.[61] On August 5, 2015, Sony Pictures Entertainment set the film for a release of January 13, 2017.[62] By November 2015, Matthew McConaughey had been offered the role of the Man in Black (also known as Randall Flagg from The Stand, another role McConaughey had been offered in an upcoming adaptation).[63] In January 2016, it was officially announced that Idris Elba has been cast to play Roland Deschain.[64]
By February 18, 2016, Abbey Lee had been offered the female lead role of Tirana.[65] On March 1, 2016, Entertainment Weekly confirmed the casting of Idris Elba as Roland and Matthew McConaughey as The Man in Black, with shooting set to begin in South Africa in April.[15] On March 5, Sony announced that the film would move back on the schedule from January 13 to February 17.[9] By March 10, 2016, Tom Taylor had been cast as Jake Chambers.[16] Filming began on April 12, 2016.[66][67][68] Abbey Lee, Jackie Earle Haley, and Fran Kranz were added to the cast when filming commenced, while Katheryn Winnick and Michael Barbieri joined the film at the end of April 2016, and Claudia Kim was cast as Arra Champignon in May 2016.[69][70][71][72][73] After poor initial test screenings, Sony contemplated replacing Arcel with "a more experienced filmmaker," but instead producers Ron Howard and Akiva Goldsman advised Arcel on cleaning up the music and narrative of the film.[74]
Production[edit]
The Dark Tower began filming in South Africa in April 2016.[75] The film also shot scenes in New York.[76] In October 2016, the film was screened to test audiences with negative results, with many labeling it confusing and messy. In response, Sony and MRC spent $6 million on reshoots to provide Deschain's backstory.[74]
Release[edit]
At one point, the film was scheduled to be released on February 17, 2017.[citation needed] In November 2016, the film was pushed back to July 28, 2017, after the studio's Jumanji: Welcome to the Jungle was moved from that date.[77] In late March 2017, the film was pushed back again to August 4, 2017, switching places with Sony Pictures Animation's The Emoji Movie.[78]
Promotion[edit]
An unfinished rough cut of the first trailer leaked online on October 10, 2016, but was later taken down almost all over the internet. On May 3, 2017, a full length trailer was released.[79]
A one-minute television spot titled Connected KINGdom featured Easter eggs of other Stephen King stories through the inter-dimensional setting of the titular location, the Dark Tower. Various references included The Shining (1980), Christine (1983), Cujo (1983), Misery (1990), The Shawshank Redemption (1994), Carrie, and It.[80][81]
Reception[edit]
Box office[edit]
As of September 18, 2017[update], The Dark Tower has grossed $50 million in the United States and Canada and $59.9 million in other territories for a worldwide total of $109.9 million, against a production budget of $60 million.[3]
In North America, The Dark Tower was released alongside the opening of Kidnap, as well as the wide expansion of Detroit, and was projected to gross around $20 million from 3,451 theaters in its opening weekend.[2] It made $1.8 million from Thursday previews at 2,770 theaters, with screenings beginning at 7:19 p.m. as an ode to the 19:19 of Stephen King lore present in the book series, and $7.7 million on its first day.[82] The film went on to debut to $19.5 million, dethroning two-time defender Dunkirk as the top film at the box office, although it was the second lowest gross for a film to finish number one in all of 2017.[83] In its second weekend the film dropped 58.9% to $7.9 million, finishing 4th at the box office.[84]
Critical response[edit]
Critics called The Dark Tower "boring and flavorless" and "incomprehensible to newbies and wildly unfaithful and simplistic to fans of King's books."[85][86] On Rotten Tomatoes, the film has an approval rating of 16% based on 187 reviews, with an average rating of 4/10. The site's critical consensus reads, "Go then, there are other Stephen King adaptations than these."[87] On Metacritic, the film has a weighted average score of 34 out of 100, based on 46 critics, indicating "generally unfavorable reviews".[88] Audiences polled by CinemaScore gave the film an average grade of "B" on an A+ to F scale.[82]
TheWrap's Dan Callahan was critical of the film's sloppiness and poor editing, saying, "The 95-minute culmination of years-long efforts to bring The Dark Tower to the big screen is a complete disaster, a limp, barely coherent shell of a movie."[89] Mike Ryan of Uproxx also criticized the incoherent plot, writing, "I’ve been told that The Dark Tower books are jam-packed with dense plot, wonderful characters, and a sprawling mythology – which is what made the movie so hard to make for all these years. Well, the solution seems to have been to just scrap all that and release a shockingly short 95-minute movie that just kind of glosses over everything to the point that has any meaning or purpose."[90] Eric Vespe of Ain't It Cool News praised Elba's performance, but said the actor was let down by the decision to make Roland a supporting character: "That puts us in a weird position because Elba's a good Roland in a movie that doesn't allow him to actually embody the character in any meaningful way. He's undercut at every turn. The strongest stuff in the film is when Roland and Jake are bonding, but that relationship is so accelerated that there's no room for an arc."[14] Ignatiy Vishnevetsky of The A.V. Club maintained that the film was "ultimately done in by professionalism; it’s a movie that doesn’t seem to love itself, sidestepping its innate strangeness. [...] If you’re making a movie about weaponized psychic kids, Luciferian wizards, and gun-nut knight-cowboys from another dimension, and your only goal is to get from act one to act three as efficiently as possible, what’s the point?"[91] Peter Travers of Rolling Stone described the film as a "major misfire" and an "unholy mess that shouldn't happen to a King, much less a paying customer".[92] Writing for the Chicago Sun-Times, Richard Roeper panned the film with its criticism on the cinematography, special effects and dialogue, referring it as "dull", "mediocre", and "stilted" while calling Matthew McConaughey's performance as the lead villain "terrible" and calling it "the film's unfortunate elements".[93]
Vox's Aja Romano wrote that the film's disjointed narrative structure, favouring fast-paced action over exposition and backstory, gave it a "basic, wondrous glee" that made it "feel more like a Stephen King film than any other Stephen King film since Stand By Me", and applauded its faithfulness to King's fictional multiverse, an idea usually discarded by adaptations.[94]
Future[edit]
Television series[edit]
By September 2016, a television series was scheduled to be released in 2018, with Glen Mazzara as showrunner. Elba and Taylor are set to reprise their roles as Roland and Jake respectively. The series has been confirmed to fill in the backstory to the film, being based on King's The Dark Tower IV: Wizard and Glass, The Dark Tower: The Wind Through the Keyhole and elements of The Dark Tower: The Gunslinger, with a new actor playing young Roland, and Haysbert attached to return as Steven Deschain. Mazzara said that the series will explore "how Walter became the Man in Black, and how their rivalry cost Roland everything and everyone he ever loved", though Mcconaughey's involvement is not locked in.[95][96]
Sequel[edit]
In an interview with Collider, King expressed hope for a sequel film in addition to the television series, suggesting that it should be R-rated, have Roland wearing a hat, and include the "lobstrosities" from The Dark Tower II: The Drawing of the Three.[97] In an interview with ComingSoon.net, Arcel confirmed that The Drawing of the Three would form the basis for the sequel, and that Eddie and Susannah would appear alongside Elba, McConaughey, Taylor and Haley reprising their roles as Roland, Walter, Jake and Sayre respectively.[98]
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Jump up ^ "Ron Howard talks about 'Dark Tower'... and a photography competition". Entertainment Weekly's EW.com.
Jump up ^ Mike Fleming Jr. "Universal Nixes Stephen King's 'Dark Tower' – No Ambitious Film Trilogy Or TV Series - Deadline". Deadline. Archived from the original on 2011-07-20.
Jump up ^ "Stephen King 'Dark Tower'". Entertainment Weekly's EW.com. Archived from the original on 2015-09-01.
Jump up ^ "Back on the rise". Page Six. Archived from the original on 2015-05-19.
Jump up ^ "‘Dark Tower’ Heading To HBO, Says Brian Grazer". Movies Blog. Archived from the original on 2012-01-11.
Jump up ^ Mike Fleming Jr. "Warner Bros In Talks For Stephen King's 'The Dark Tower'; Will Javier Bardem Saddle Up?". Deadline. Archived from the original on 2015-07-16.
Jump up ^ "As Warner Bros. Makes a 'Dark Tower' Decision, Russell Crowe Might Be the New Gunslinger - /Film". Slashfilm. Archived from the original on 2015-09-18.
Jump up ^ "Warner Bros. Won’t Make The Dark Tower Either". Vulture. Archived from the original on 2015-04-18.
Jump up ^ Mike Fleming Jr. "'Ted' Backer MRC In Talks To Finance Stephen King's 'The Dark Tower'". Deadline. Archived from the original on 2015-07-16.
Jump up ^ "Aaron Paul Met With Ron Howard About Playing Eddie Dean In The Dark Tower". cinemablend.com. Archived from the original on 2015-10-03.
Jump up ^ "Aaron Paul on Twitter". Twitter. Archived from the original on 2016-03-05.
Jump up ^ Mark Reilly. "From the Desk of The Phantom: Ron Howard's Next Movie Likely THE DARK TOWER; Who's Interested in Roland??? - Schmoes Know...". Schmoes Know...
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Jump up ^ Mike Fleming Jr. "‘The Dark Tower’ Movie: ‘Dragon Tattoo’ Writer Nikolaj Arcel To Direct - Deadline". Deadline. Archived from the original on 2015-07-08.
Jump up ^ "Dark Tower Director Confirmed - Blastr". Blastr. Archived from the original on 2015-07-12.
Jump up ^ "Sony Pictures Dates 16 Films Through 2019!". comingsoon.net. August 5, 2015. Archived from the original on August 7, 2015. Retrieved August 5, 2015.
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Jump up ^ Keane, Stuart (January 14, 2016). "‘The Dark Tower' Officially Casts Idris Elba as Roland Deschain, Release Date Of January 2017 Confirmed". Inquisitr. Retrieved February 10, 2016.
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Jump up ^ "The Dark Tower Movie Has Begun Filming". Slashfilm. Archived from the original on 2016-04-15.
Jump up ^ Romano, Nick (April 21, 2016). "‘The Dark Tower’ and ‘Transformers 5’ Expand Their Casts". Collider. Archived from the original on April 24, 2016.
Jump up ^ "‘The Dark Tower’ Adds ‘Mad Max: Fury Road’s Abbey Lee as Female Lead". Collider. February 18, 2016. Archived from the original on April 24, 2016.
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Jump up ^ Lyons, Josh (May 6, 2016). "{EXCLUSIVE} “AVENGERS: AGE OF ULTRON” STAR CLAUDIA KIM JOINS “THE DARK TOWER”". The Tracking Board.
^ Jump up to: a b "‘The Dark Tower’: Clashing Visions, Brutal Test Screenings Plagued Journey to Big Screen". Variety. August 1, 2017.
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Jump up ^ "Man in black! Matthew McConaughey dyes hair darker for his role". Daily Mail. June 30, 2016. Archived from the original on July 1, 2016. Retrieved July 1, 2016.
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^ Jump up to: a b "'The Dark Tower' Opens To $18M+ In Diverse Marketplace: Was The Decade-Plus Battle To The Screen Worth It?". Deadline.com. Retrieved August 5, 2017.
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Jump up ^ D'Allesandro, Anthony. "New Line’s Dollhouse Of Dough: ‘Annabelle: Creation’ Opening To $36M+". Deadline.com. Retrieved August 12, 2017.
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Jump up ^ "‘The Dark Tower’ Review: What The Hell Happened?". Uproxx. August 2, 2017. Retrieved August 3, 2017.
Jump up ^ Vishnevetsky, Ignatiy (Aug 3, 2017). "Stephen King’s fantasy saga is reincarnated as a dud in The Dark Tower". The A.V. Club. Retrieved 7 August 2017.
Jump up ^ Travers, Peter (August 3, 2017). "'The Dark Tower' Review: Blockbuster Take on Stephen King's Epic Is Major Misfire". Rolling Stone. Retrieved August 10, 2017.
Jump up ^ Richard Roeper (August 3, 2017). "Stilted dialogue, McConaughey’s corny villain crumble ‘The Dark Tower’". Chicago Sun-Times. Retrieved August 10, 2017.
Jump up ^ Romano, Aja (August 3, 2017). "The Dark Tower is a flimsy film adaptation, but it’s a great Stephen King movie". Vox. Retrieved August 4, 2017.
Jump up ^ "'The Dark Tower' TV Series Will Adapt Stephen King's 'Wizard and Glass'". Archived from the original on 2016-09-22.
Jump up ^ White, James (August 3, 2017). "Walking Dead Veteran Glen Mazzara To Run The Dark Tower TV Series". Empire. Retrieved August 9, 2017.
Jump up ^ http://collider.com/stephen-king-interview-the-dark-tower/
Jump up ^ http://www.comingsoon.net/movies/features/876489-director-nikolaj-arcel-talks-dark-tower-ending-and-sequels-spoilers#/slide/1
External links[edit]
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Winter's Tale (2014)
The Divergent Series: Insurgent (2015)
Rings (2017)
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The Dark Tower (2017)
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Deep Blue Sea (1999)
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Mindhunters (2004)
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I Am Legend (2007)
Hancock (2008)
The Losers (2010)
Fair Game (2010)
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The Talisman (1984)
It (1986)
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The Plant (2000; unfinished)
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The Colorado Kid (2005)
Cell (2006)
Lisey's Story (2006)
Duma Key (2008)
Under the Dome (2009)
11/22/63 (2011)
Joyland (2013)
Doctor Sleep (2013)
Mr. Mercedes (2014)
Revival (2014)
Finders Keepers (2015)
End of Watch (2016)
Gwendy's Button Box (2017)
Sleeping Beauties (2017)
The Dark Tower series
The Gunslinger (1982)
The Drawing of the Three (1987)
The Waste Lands (1991)
Wizard and Glass (1997)
Wolves of the Calla (2003)
Song of Susannah (2004)
The Dark Tower (2004)
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Richard Bachman novels
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Blaze (2007)
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Different Seasons (1982)
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Just After Sunset (2008)
Full Dark, No Stars (2010)
The Bazaar of Bad Dreams (2015)
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Nightmares in the Sky (1988)
On Writing (2000)
Secret Windows (2000)
Faithful (2004)
"Guns" (2013)
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Cat's Eye (1985)
Silver Bullet (1985)
Maximum Overdrive (1986; also director)
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Sleepwalkers (1992)
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Teleplays
"Sorry, Right Number" (1987)
Golden Years (1991)
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Kingdom Hospital (2004)
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Heroes for Hope (1985)
The Secretary of Dreams (2006)
The Dark Tower (2007–)
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Hydronephrosis
From Wikipedia, the free encyclopedia
Jump to: navigation, search
Hydronephrosis
Specimen of a kidney that has undergone extensive dilation due to hydronephrosis. Note the extensive atrophy and thinning of the renal cortex.
Classification and external resources
Specialty
Urology, nephrology
ICD-10
N13.0-N13.3
ICD-9-CM
591
DiseasesDB
6145
MedlinePlus
000506 000474
MeSH
D006869
[edit on Wikidata]
Hydronephrosis—literally "water inside the kidney"—refers to distension and dilation of the renal pelvis and calyces, usually caused by urinary retention due to obstruction of the free flow of urine from the kidney. Untreated, it leads to progressive atrophy of the kidney.[1] One or both kidneys may be affected.[2] In cases of hydroureteronephrosis, there is distention of both the ureter and the renal pelvis and calices.[3]
Play media
Video explanation
Contents
[hide]
1 Signs and symptoms
2 Causes
3 Pathophysiology
4 Diagnosis
4.1 Imaging studies
4.2 Grading
5 Treatment
6 Prognosis
7 References
8 External links
Signs and symptoms[edit]
The signs and symptoms of hydronephrosis depend upon whether the obstruction is acute or chronic, partial or complete, unilateral or bilateral. Hydronephrosis that occurs acutely with sudden onset (as caused by a kidney stone) can cause intense pain in the flank area (between the hips and ribs). Historically, this type of pain has been described as "Dietl's crisis".[4][5] Conversely, hydronephrosis that develops gradually will generally cause either attacks of a dull discomfort or no pain. Nausea and vomiting may also occur. An obstruction that occurs at the urethra or bladder outlet can cause pain and pressure resulting from distension of the bladder. Blocking the flow of urine will commonly result in urinary tract infections which can lead to the development of additional stones, fever, and blood or pus in the urine. If complete obstruction occurs, kidney failure may follow.[6]
Blood tests may show impaired kidney function (elevated urea or creatinine) or electrolyte imbalances such as hyponatremia or hyperchloremic metabolic acidosis. Urinalysis may indicate an elevated pH due to the secondary destruction of nephrons within the affected kidney. Physical examination may detect a palpable abdominal or flank mass caused by the enlarged kidney.
Causes[edit]
Hydronephrosis is the result of any of several abnormal pathophysiological occurrences. Structural abnormalities of the junctions between the kidney, ureter, and bladder that lead to hydronephrosis can occur during fetal development. Some of these congenital defects have been identified as inherited conditions, however the benefits of linking genetic testing to early diagnosis have not been determined.[7] Other structural abnormalities could be caused by injury, surgery, or radiation therapy.
Compression of one or both ureters can also be caused by other developmental defects not completely occurring during the fetal stage such as an abnormally placed vein, artery, or tumor. Bilateral compression of the ureters can occur during pregnancy due to enlargement of the uterus. Changes in hormone levels during this time may also affect the muscle contractions of the bladder, further complicating this condition.
Sources of obstruction that can arise from other various causes include kidney stones, blood clots, or retroperitoneal fibrosis.[8]
The obstruction may be either partial or complete and can occur anywhere from the urethral meatus to the calyces of the renal pelvis.Hydronephrosis can also result from the reverse flow of urine from the bladder back into the kidneys. This reflux can be caused by some of the factors listed above as well as compression of the bladder outlet into the urethra by prostatic enlargement or impaction of feces in the colon, as well as abnormal contractions of bladder muscles resulting from neurological dysfunction or other muscular disorders.[6]
Pathophysiology[edit]
This section needs more medical references for verification or relies too heavily on primary sources. Please review the contents of the section and add the appropriate references if you can. Unsourced or poorly sourced material may be challenged and removed. (June 2016)
Obstruction that occurs anywhere along the upper urinary tract will lead to increased pressure within the structures of the kidney due to the inability to pass urine from the kidney to the bladder. Common causes of upper tract obstruction include obstructing stones and ureteropelvic junction (UPJ) obstruction caused by intrinsic narrowing of the ureters or an overlying vessel.
Obstruction occurring in the lower urinary tract can also cause this increased pressure through the reflux of urine into the kidney. Common causes include bladder dysfunction (such as neurogenic bladder) and urethral obstruction (such as posterior urethral valves in male infants) or compression (such as from prostatic hypertrophy in older male adults).
Anything that causes obstruction leads to increased pressure being transmitted to the delicate tissues that make up the filtration system within the kidneys, which could eventually result in infection, stone formation, or loss of function. Additional complications arising from obstruction of the lower urinary tract include the stagnation of urine flow which can also lead to infection in the bladder. Obstruction may be a result of a tumour in the pelvis compressing the ureters or urethra, for example in patients with advanced cervical cancer (stage IIIA to IVB).
Diagnosis[edit]
Ultrasound picture of hydronephrosis caused by a left ureteral stone.
Hydronephrosis due to a kidney stone at the ureteral vesicular junction seen on CT
Prenatal diagnosis is possible,[9] and in fact, most cases in pediatric patients are incidentally detected by routine screening ultrasounds obtained during pregnancy.[10] However, approximately half of all prenatally identified hydronephrosis is transient, and resolves by the time the infant is born, and in another 15%, the hydronephrosis persists but is not associated with urinary tract obstruction (so-called non-refluxing, non-obstructive hydronephrosis). For these children, regression of the hydronephrosis occurs spontaneously, usually by age 3. However, in the remaining 35% of cases of prenatal hydronephrosis, a pathological condition can be identified postnatally.[11]
Diagnostic workup depends on the age of the patient, as well as whether the hydronephrosis was detected incidentally or prenatally or is associated with other symptoms.Blood tests (such measurement of creatinine) are typically indicated, though they must be interpreted cautiously. Even in cases of severe unilateral hydronephrosis, the overall kidney function may remain normal since the unaffected kidney will compensate for the obstructed kidney.
Urinalysis is usually performed to determine the presence of blood (which is typical for kidney stones) or signs of infection (such as a positive leukocyte esterase or nitrite). Impaired concentrating ability or elevated urine pH (distal renal tubular acidosis) are also commonly found due to tubular stress and injury.
Imaging studies[edit]
Imaging studies, such as an intravenous urogram (IVU), ultrasound, CT or MRI, are also important investigations in determining the presence and/ or cause of hydronephrosis. Whilst ultrasound allows for visualisation of the ureters and kidneys (and determine the presence of hydronephrosis and / or hydroureter), an IVU is useful for assessing the anatomical location of the obstruction. Antegrade or retrograde pyelography will show similar findings to an IVU but offer a therapeutic option as well. Real-time ultrasounds and color-flow Doppler tests in association with vascular resistance testing helps determine how a given obstruction is effecting urinary functionality in hydronephrotic patients.[12]
In determining the cause of hydronephrosis, it is important to rule out urinary obstruction. One way to do this is to test the kidney function. This can be done by, for instance, a diuretic intravenous pyelogram, in which the urinary system is observed radiographically after administration of a diuretic, such as 5% mannitol, and an intravenous iodine contrast.[13] The location of obstruction can be determined with a Whittaker (or pressure perfusion) test, wherein the collecting system of the kidney is accessed percutaneously, and the liquid is introduced at high pressure and constant rate of 10ml/min while measuring the pressure within the renal pelvis. A rise in pressure above 22 cm H2O suggests that the urinary collection system is obstructed. When arriving at this pressure measurement, bladder pressure is subtracted from the initial reading of internal pressure. (The test was first described by Whittaker in 1973 to test the hypothesis that patients' whose hydronephrosis persists after the posterior urethral valves have been ablated usually have ureters that are not obstructed, even though they may be dilated.)[12]
Kay recommends that a neonate born with untreated in utero hydronephrosis receive a renal ultrasound within two days of birth. A renal pelvis greater than 12mm in a neonate is considered abnormal and suggests significant dilation and possible abnormalities such as obstruction or morphological abnormalities in the urinary tract.[12]
The choice of imaging depends on the clinical presentation (history, symptoms and examination findings). In the case of renal colic (one sided loin pain usually accompanied by a trace of blood in the urine) the initial investigation is usually a spiral or helical CT scan. This has the advantage of showing whether there is any obstruction of flow of urine causing hydronephrosis as well as demonstrating the function of the other kidney. Many stones are not visible on plain X-ray or IVU but 99% of stones are visible on CT and therefore CT is becoming a common choice of initial investigation. CT is not used however, when there is a reason to avoid radiation exposure, e.g. in pregnancy.
For incidentally detected prenatal hydronephrosis, the first study to obtain is a postnatal renal ultrasound, since as noted, many cases of prenatal hydronephrosis resolve spontaneously. This is generally done within the first few days after birth, although there is some risk that obtaining an imaging study this early may miss some cases of mild hydronephrosis due to the relative oliguria of a newborn. Thus, some experts recommend obtaining a follow up ultrasound at 4–6 weeks to reduce the false-negative rate of the initial ultrasound.[14] A voiding cystourethrogram (VCUG) is also typically obtained to exclude the possibility of vesicoureteral reflux or anatomical abnormalities such as posterior urethral valves. Finally, if hydronephrosis is significant and obstruction is suspected, such as a ureteropelvic junction (UPJ) or ureterovesical junction (UVJ) obstruction, a nuclear imaging study such as a MAG-3 scan is warranted.
Bilateral hydronephrosis due to a bladder cancer
Massive hydronephrosis as marked by the arrow.
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Hydronephrosis on US[15]
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Stone causing hydronephrosis[15]
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Stone causing hydronephrosis[15]
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Urine jets[15]
Grading[edit]
The Society of Foetal Ultrasound has developed a grading system for hydronephrosis, initially intended for use in neonatal and infant hydronephrosis, but it is now used for grading hydronephrosis in adults as well:[16]
Grade 0 – No renal pelvis dilation. This means an anteroposterior diameter of less than 4 mm in fetuses up to 32 weeks of gestational age and 7 mm afterwards.[17] In adults, cutoff values for renal pelvic dilation have been defined differently by different sources, with anteroposterior diameters ranging between 10 and 20 mm.[18] About 13% of normal healthy adults have a transverse pelvic diameter of over 10 mm.[19]
Grade 1 (mild) – Mild renal pelvis dilation (anteroposterior diameter less than 10 mm in fetuses[17]) without dilation of the calyces nor parenchymal atrophy
Grade 2 (mild) – Moderate renal pelvis dilation (between 10 and 15 mm in fetuses[17]), including a few calyces
Grade 3 (moderate) – Renal pelvis dilation with all calyces uniformly dilated. Normal renal parenchyma
Grade 4 (severe) – As grade 3 but with thinning of the renal parenchyma
Treatment[edit]
Left sided hydronephrosis in a person with a single kidney. Stent is also present.
Left sided hydronephrosis in a person with a single kidney. Stent is also present.
Treatment of hydronephrosis focuses upon the removal of the obstruction and drainage of the urine that has accumulated behind the obstruction. Therefore, the specific treatment depends upon where the obstruction lies, and whether it is acute or chronic.
Acute obstruction of the upper urinary tract is usually treated by the insertion of a nephrostomy tube. Chronic upper urinary tract obstruction is treated by the insertion of a ureteric stent or a pyeloplasty.
Lower urinary tract obstruction (such as that caused by bladder outflow obstruction secondary to prostatic hypertrophy) is usually treated by insertion of a urinary catheter or a suprapubic catheter.Surgery is not required in all prenatally detected cases.[20]
Prognosis[edit]
The prognosis of hydronephrosis is extremely variable, and depends on the condition leading to hydronephrosis, whether one (unilateral) or both (bilateral) kidneys are affected, the pre-existing kidney function, the duration of hydronephrosis (acute or chronic), and whether hydronephrosis occurred in developing or mature kidneys.
For example, unilateral hydronephrosis caused by an obstructing stone will likely resolve when the stone passes, and the likelihood of recovery is excellent. Alternately, severe bilateral prenatal hydronephrosis (such as occurs with posterior urethral valves) will likely carry a poor long-term prognosis, because obstruction while the kidneys are developing causes permanent kidney damage even if the obstruction is relieved postnatally.
Hydronephrosis can be a cause of pyonephrosis - which is a urological emergency.[21]
References[edit]
Jump up ^ Kumar, Vinay; Fausto, Nelson; Fausto, Nelso; Robbins, Stanley L.; Abbas, Abul K.; Cotran, Ramzi S. (2005). Robbins and Cotran Pathologic Basis of Disease (7th ed.). Philadelphia PA: Elsevier Saunders. pp. 1012–4. ISBN 0-7216-0187-1.
Jump up ^ Tamparo, Carol (2011). Fifth Edition: Diseases of the Human Body. Philadelphia, PA: F. A. Davis Company. p. 441. ISBN 978-0-8036-2505-1.
Jump up ^ NDI Foundation: hydroureteronephrosis Archived 2009-07-07 at the Wayback Machine. Retrieved on Jan 4, 2009
Jump up ^ "Dietl's crisis". medcyclopaedia.com. 2012. Retrieved 2012-05-01. [dead link]
Jump up ^ Mergener, K; et al. (December 1997). "Dietl's crisis: a syndrome of episodic abdominal pain of urologic origin that may present to a gastroenterologist". Am J Gastroenterol. 92 (12): 2289–91. PMID 9399772.
^ Jump up to: a b "Hydronephrosis: Merck Manuals Home Health Handbook". New Jersey: Merck and Co., Inc. 2009. Retrieved November 5, 2010.
Jump up ^ Toka HR, Toka O, Hariri A, Nguyen HT (July 2010). "Congenital anomalies of kidney and urinary tract". Semin. Nephrol. 30 (4): 374–86. PMID 20807610. doi:10.1016/j.semnephrol.2010.06.004.
Jump up ^ Koh JS, Wong MY, Li MK, Foo KT (September 1998). "Idiopathic retroperitoneal fibrosis with bilateral lower ureteric obstruction—a case report with literature review". Singapore Med J. 39 (9): 416–7. PMID 9885722.
Jump up ^ Estrada CR (July 2008). "Prenatal hydronephrosis: early evaluation". Current Opinion in Urology. 18 (4): 401–3. PMID 18520762. doi:10.1097/MOU.0b013e328302edfe.
Jump up ^ Woodward, M; Frank, D (January 2002). "Postnatal management of antenatal hydronephrosis". BJU Int. 89 (2): 149–156. PMID 11849184. doi:10.1046/j.1464-4096.2001.woodward.2578.x.
Jump up ^ Carmody, JB; Carmody, RB (December 2011). "Question from the clinician: management of prenatal hydronephrosis". Pediatr Rev. 32 (12): e110–2. PMID 22135428. doi:10.1542/pir.32-12-e110.
^ Jump up to: a b c Kay, Robert, M.D. "Evaluation of Hydronephrosis in Children" in Urology Secrets, 2nd Ed. by Resnick & Novick; 1999, Hanley & Belfus
Jump up ^ Dr. Asmita Parikh LCEH (Bom)., "Intravenous Pyelography"; Indian Journal of Homeopathic Medicine, Vol 31, No 2; available at homeoint.org
Jump up ^ Aksu, N; et al. (September 2005). "Postnatal management of infants with antenatally detected hydronephrosis". Pediatr Nephrol. 20 (9): 1253–9. PMID 16025288. doi:10.1007/s00467-005-1989-3.
^ Jump up to: a b c d "UOTW #10 - Ultrasound of the Week". Ultrasound of the Week. 22 July 2014. Retrieved 27 May 2017.
Jump up ^ Laurence S Baskin. "Overview of fetal hydronephrosis. Version Version 29.0". UpToDate. Retrieved 2017-04-25. Last updated Apr 20, 2017
^ Jump up to: a b c Page 189 in: V. D'Addario (2014). Donald School Basic Textbook of Ultrasound in Obstetrics & Gynecology. JP Medical Ltd. ISBN 9789351523376.
Jump up ^ Page 78 in: Justin Bowra, Russell E (2011). Emergency Ultrasound Made Easy, Edition 2. Elsevier Health Sciences. ISBN 9780702048722.
Jump up ^ Emamian SA, Nielsen MB, Pedersen JF, Ytte L (1993). "Sonographic evaluation of renal appearance in 665 adult volunteers. Correlation with age and obesity". Acta Radiol. 34 (5): 482–5. PMID 8369185.
Jump up ^ Onen A (December 2007). "Treatment and outcome of prenatally detected newborn hydronephrosis". J Pediatr Urol. 3 (6): 469–76. PMID 18947797. doi:10.1016/j.jpurol.2007.05.002.
Jump up ^ Longmore, Murray (2014). Oxford Handbook of Clinical Medicine. Oxford: Oxford University Press.
External links[edit]
Hydronephrosis Diagnosis and Treatment at SSM Health St. Louis Fetal Care Institute
Hydronephrosis symptoms, diagnosis, treatment and general information
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