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Urology Case Reports Nov 2022Ureteral stenosis is typically seen in the setting of genitourinary tract manipulation or nephrolithiasis. Bilateral idiopathic ureteral stenosis is an exceedingly rare...
Ureteral stenosis is typically seen in the setting of genitourinary tract manipulation or nephrolithiasis. Bilateral idiopathic ureteral stenosis is an exceedingly rare clinical entity that has been described in only a small number of cases. More specifically, we describe a case of idiopathic bilateral, distal ureteral stenosis resulting in hydronephrosis and deterioration of renal function in an adolescent patient. The patient was successfully treated with robotic bilateral ureteral implants. This case brings to light a rare, but clinically relevant, cause of hydronephrosis, highlights the importance of early intervention in minimizing renal dysfunction, and describes a novel treatment option.
PubMed: 36238444
DOI: 10.1016/j.eucr.2022.102245 -
Urologia Internationalis 2011Retrograde exploration of the ureter and kidneys is currently a widely used and well-established procedure to deal with problems of a diagnostic and therapeutic nature... (Review)
Review
Retrograde exploration of the ureter and kidneys is currently a widely used and well-established procedure to deal with problems of a diagnostic and therapeutic nature with reduced invasiveness. The process of miniaturizing the instruments combined with the steady improvement in video quality has continuously amplified its potential applications, maintaining the procedure safe and rapid. During an operation, however, unexpected events may condition a change to the programme or determine the onset of even more serious complications. Our aim is to analyze such events and complications and recommend potential solutions to prevent and/or deal with such happenings.
Topics: Constriction, Pathologic; Endoscopy; Female; Hemorrhage; Humans; Intraoperative Complications; Kidney; Male; Research Design; Surgical Procedures, Operative; Ureter; Ureteral Obstruction; Ureteroscopy
PubMed: 21734359
DOI: 10.1159/000329286 -
BMC Urology Jun 2022For patients with malignant ureteral obstruction or stricture who require long-term internal drainage, plastic double-J stents (DJ stents) represent the mainstay of...
BACKGROUND
For patients with malignant ureteral obstruction or stricture who require long-term internal drainage, plastic double-J stents (DJ stents) represent the mainstay of therapeutic strategies. DJ stents should be replaced at least once every 6 months to avoid infection or obstruction. Although DJ stents are generally replaced under cystoscopy, successful fluoroscopy-guided retrograde replacement of DJ stents in the interventional suite has been described in the literature.
METHODS
Between April 2004 and May 2020, we exchanged 143 DJ stents in 19 male and 22 female patients under fluoroscopic guidance using Nelaton catheters, snare catheters, and 8F DJ stents. All procedures were performed with patients under sedation and local anesthesia. There were 39 patients with malignant ureteral obstruction and two patients with benign ureteral strictures. This study was approved by the Institutional Review Board. Technical success, clinical success, complications, procedure time, and mean interval between two procedures were retrospectively reviewed, and the factors affecting the success rate of the procedure were analyzed.
RESULTS
Obstruction was detected at the abdominal ureter in 4 patients, pelvic ureter in 29 patients, and intravesical ureter in 8 patients. Twenty-six patients underwent two or more sessions of the procedures, whereas 15 patients underwent single-session procedures. Total 34 outpatient-based procedures and 109 inpatient-based procedures were performed. Technical success and clinical success were achieved in 94.4% (135/143) and 93.3% (126/135) procedures, respectively. Mean procedure time was 21.5 min (range 9-192 min). Mean procedure interval was 101.8 days (range 5-306 days). Technical success was negatively affected by male sex and obstruction at the pelvic ureter and was positively affected by previous successful exchange. Left-sided ureteral stent placement and old age negatively influenced clinical success. Septic shock occurred in one patient and was treated with antibiotics.
CONCLUSION
Fluoroscopy-guided trans-urethral exchange of DJ stents is an effective and less painful procedure.
Topics: Constriction, Pathologic; Female; Fluoroscopy; Humans; Male; Retrospective Studies; Stents; Ureter; Ureteral Obstruction
PubMed: 35706037
DOI: 10.1186/s12894-022-01034-3 -
Journal of Vascular Surgery Cases and... Sep 2020Ureteral complications after open aortoiliac reconstruction for aneurysmal and occlusive disease have been reported previously. However, ureteral complications from...
Ureteral complications after open aortoiliac reconstruction for aneurysmal and occlusive disease have been reported previously. However, ureteral complications from endovascular interventions for iliac artery disease are relatively rare. We describe a case of left ureteral stenosis resulting in hydroureteronephrosis after multiple endovascular interventions involving the left common and external iliac arteries. The intraoperative findings during robotic ureterolysis revealed significant peri-iliac fibrosis and scarring in the area of the iliac stents. This case illustrates that, although uncommon, ureteral stenosis may occur after iliac stenting owing to peristent fibrosis.
PubMed: 32923750
DOI: 10.1016/j.jvscit.2020.07.012 -
Archivos Espanoles de Urologia May 2017To report our initial experience with laparoscopic Boari flap ureteral reimplantation and to review the main technical elements in ureteral reconstructive surgery.
OBJECTIVES
To report our initial experience with laparoscopic Boari flap ureteral reimplantation and to review the main technical elements in ureteral reconstructive surgery.
METHODS
In a 10-year period we performed 23 laparoscopic ureteral reimplantations. Three cases required a Boari flap. Two patients presented ureteral stenosis above the iliac vessels and the third one a urothelial tumor of the pelvic ureter.
RESULTS
Two cases were completed laparoscopically; the third one was electively converted to open surgery to avoid prolonged OR time. Mean operative time was 276 minutes (270-290 min). There were no intraoperative complications. Mean hospital stay was 6.6 days. One patient presented postoperative UTI (Clavien 2). One patient developed with history of sever arteriopathy and aortorenal by pass developed ureteral stenosis proximal to the ureteral reimplantation eight months after the operation.
CONCLUSIONS
Laparoscopic Boari flap ureteral reimplantation is an affective technique for ureteral reconstruction, safe and reproducible, reserved for cases of ureteral pathology in which the distance to bridge between the bladder and the ureteral stump is long.
Topics: Adult; Aged; Cystostomy; Humans; Laparoscopy; Male; Middle Aged; Replantation; Surgical Flaps; Ureter; Ureterostomy
PubMed: 28530623
DOI: No ID Found -
Scientific Reports Feb 2021To evaluate the safety and efficacy of laparoscopic bladder muscle flap reconstruction in the treatment of extensive ureteral avulsion. Patients with full-length (re...
To evaluate the safety and efficacy of laparoscopic bladder muscle flap reconstruction in the treatment of extensive ureteral avulsion. Patients with full-length (re length > 20 cm) and upper ureteral (avulsion length > 10 cm) defects were eligible. All patients were treated with laparoscopic bladder muscle flap reconstruction. Peri-operative information and post-operative complications were recorded. The kidney function, urinary ultrasound or computed tomography (CT), sun-renal function tests emission computed tomography (ECT) and cystography after operation were recorded. Ten patients were included (7 with full-length and 3 with upper ureteral defects). Median age was 56 years and 70% of them were female. The average operation time and blood loss was 124 min and 92.2 ml. There was no treatment-related adverse effects including urinary leakage, renal colic, fever, etc. The median follow-up was 18.5 months (3-39 months). The surgery did not significantly alter the renal function and separation degree of the renal pelvis during long-term follow-up. Double J stents were removed in nine patients (90%) within six months after operation. Only one case was diagnosed with post-operative anastomotic stricture, and subsequently received laparoscopic ipsilateral nephrectomy one year after the reconstruction operation. All cases had normal voiding and pear-shaped cystography. Laparoscopic bladder flap repair is a safe and effective treatment approach together with several advantages for patients with full-length or upper ureteral avulsion.
Topics: China; Constriction, Pathologic; Female; Humans; Kidney; Laparoscopy; Male; Middle Aged; Operative Time; Postoperative Complications; Plastic Surgery Procedures; Surgical Flaps; Ureter; Ureteral Obstruction; Urinary Bladder; Urologic Surgical Procedures
PubMed: 33597578
DOI: 10.1038/s41598-021-83518-0 -
European Journal of Obstetrics,... Feb 2017Deep endometriosis, occurring approximately in 1% of women of reproductive age, represents the most severe form of endometriosis. It causes severe pain in the vast... (Review)
Review
Deep endometriosis, occurring approximately in 1% of women of reproductive age, represents the most severe form of endometriosis. It causes severe pain in the vast majority of affected women and it can affect the bowel and the urinary tract. Hormonal treatment of deep endometriosis with progestins, such as norethindrone acetate or dienogest, or estroprogestins is effective in relieving pain in more than 90% of women at one year follow up. Progestins and estroprogestins can be safely administered in the long-term, may be not expensive and are usually well tolerated. Therefore, they should represent the first-line treatment of deep endometriosis associated pain in women not seeking natural conception. However, hormonal treatment is ineffective or not tolerated in about 30% of women, the most common side effects being erratic bleeding, weight gain, decreased libido and headache. Surgical excision of deep endometriosis is mandatory in presence of symptomatic bowel stenosis, ureteral stenosis with secondary hydronephrosis, and when hormonal treatments fail. Surgical treatment is similarly effective as compared to hormonal treatment in relieving dismenorhea, dyspareunia and dyschezia at one year follow up in more than 90% of women with deep endometriosis. Surgical removal of the nodules may require resection of the bowel, ureter or bladder, with possible severe complications such as rectovaginal or ureterovaginal fistula and anastomotic leakage. A thorough counsel with the patient is necessary in order to pursue a therapeutic plan centered not on the endometriotic lesions, but on the patient's symptoms, priorities and expectations.
Topics: Clinical Decision-Making; Disease Management; Endometriosis; Female; Humans; Intestinal Diseases; Physicians; Treatment Outcome; Urologic Diseases
PubMed: 27544308
DOI: 10.1016/j.ejogrb.2016.07.513 -
Frontiers in Veterinary Science 2021A 3-month-old cat weighing 2.62 kg was brought to the VIP Animal Medical Center with vomiting, diarrhea, anorexia, and depression. Laboratory findings confirmed azotemia...
A 3-month-old cat weighing 2.62 kg was brought to the VIP Animal Medical Center with vomiting, diarrhea, anorexia, and depression. Laboratory findings confirmed azotemia with elevated blood urea nitrogen (BUN) (168.9 mg/dl) and creatinine (5.9 mg/dl) and symmetric dimethylarginine (SDMA) (86 μg/dl). Abdominal radiography revealed bilateral renomegaly. Ultrasonography revealed bilateral hydronephrosis and left partial and right complete ureteral obstructions with bilateral focal irregular and circumferential thickenings at ureters. Reduction of bilateral renal function was confirmed through excretory urography on computed tomography. The cat underwent subcutaneous ureteral bypass surgery on the left kidney, right nephrectomy, and bilateral ureterectomy. Histopathology of bilateral ureteral irregular and circumferential thickening revealed bilateral atypical papillary transitional mucosal hyperplasia. Three days after surgery, the left hydronephrosis resolved, and azotemia was almost resolved. This is the first report of successful management of ureteral stenosis with congenital papillary transitional mucosal hyperplasia in a kitten using multimodality imaging.
PubMed: 35187140
DOI: 10.3389/fvets.2021.796638 -
Advances in Urology 2021Ureteral stenosis is one of the most common urological complications following kidney transplantations. It is occurred in 2-10% of patients and poses a significant...
Ureteral stenosis is one of the most common urological complications following kidney transplantations. It is occurred in 2-10% of patients and poses a significant problem to the patients as it may lead to permanent damage to renal damage. Identification of risk factors is important to prevent the incidence of ureteral stenosis. Thus, we aim to determine the risk factors of ureteral stenosis in the Indonesian population. This is a retrospective analysis of 487 kidney transplant patients performed in Cipto Mangunkusumo Hospital between 2014 and 2018. We collected and compared donor and recipient demography data in recipients who developed ureteral stenosis and recipients who did not develop ureteral stenosis. Ureteral stenosis was defined as the presence of hydronephrosis from ultrasound and increased number of serum creatinine. The overall incidence of ureteral stenosis post-kidney transplantation in our center is 6.6% (32 from 487 patients) from January 2014 until June 2018. We found that older donor and recipient age more frequent in developing ureteral stenosis post-kidney transplantation ( < 0.001). We also found that donors with number of arteries more than 2 ( < 0.001) and prolonged warm ischemic time ( < 0.05) are more frequently to develop ureteral stenosis post-kidney transplantation. There is no association between type II diabetes mellitus and hypertension with ureteral stenosis in this study. Donor age, recipient age, donor number of arteries more than 2, and prolonged warm ischemia time are associated with ureteral stenosis after kidney transplantation.
PubMed: 33510785
DOI: 10.1155/2021/2410951 -
BMC Urology Nov 2021To report the long-term efficacy and complications of the augmentation uretero-enterocystoplasty (AUEC), including augmentation cystoplasty with simultaneous...
OBJECTIVES
To report the long-term efficacy and complications of the augmentation uretero-enterocystoplasty (AUEC), including augmentation cystoplasty with simultaneous ureteroplasty and ureteral anti-reflux implantation in a single center.
METHODS
We retrospectively reviewed clinical records, video-urodynamic data, and magnetic resonance urography of 210 patients who underwent the procedure for refractory lower urinary tract dysfunction (LUTD) from 2003 to 2019. International vesicoureteral reflux (VUR) and upper urinary tract dilatation (UUTD) grading systems were applied to assess upper urinary tract function, and post-operative complications were assessed.
RESULTS
Mean age was 28.1 years, with a mean follow-up time of 57.4 months. A total of 338 ureters were simultaneously re-implanted, and ureteroplasty was performed on all ureters. There was a significant postoperative improvement in the bladder capacity, intravesical pressure, and compliance (P < 0.05). VUR improvement rate was 97.7% and postoperative improvement of UUTD presented in 72.5% ureters. Mean serum creatinine (Scr) level was significantly improved compared to preoperative Scr values (226.0 ± 89.4 μmol/L vs. 217.5 ± 133.9 umol/L, P < 0.05). The 1.0% patients had unacceptably postoperative urinary incontinence and 85.4% preoperative megaureters were improved. Primary complications included metabolic acidosis (9.5%), vesicoureteral anastomosis stenosis (6.2%), persistent VUR (2.7%), urinary calculi (6.6%), and intestinal dysfunction requiring laparotomy (3.3%).
CONCLUSION
In the study, a large series of patients treated with a complex surgical procedure was reported. It is novel, as this case series represents patients with aggressive surgical correction of VUR, ureteral tortuosity and upper tract dilation at the time of AC. AUEC was shown to have a positive role in treating patients with refractory LUTD associated with hydronephrosis and ureteral dilatation, stenosis or obstruction, with or without high- or low-pressure VUR. It was effective in improving renal function and protecting the UUT function from further deterioration in most patients with renal insufficiency.
Topics: Adolescent; Adult; Aged; Anastomosis, Surgical; Child; Child, Preschool; Female; Humans; Ileum; Lower Urinary Tract Symptoms; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Time Factors; Treatment Outcome; Ureter; Urinary Bladder; Urologic Surgical Procedures; Young Adult
PubMed: 34847903
DOI: 10.1186/s12894-021-00927-z