Ureteral intussusception due to a polyp

Imaging of ureter: a primer for the emergency radiologist

In this review article, we will discuss the gamut of abnormalities involving the ureters. In the emergency department, ureterolithiasis is the most common indication for imaging abdomen and pelvis. However, spectrum of ureteral abnormalities including congenital, infectious and inflammatory, primary and secondary ureteral malignancies, retroperitoneal fibrosis rare described in this article may be encountered. Thus, we will describe acute subacute as well as chronic conditions that may affect ureter. Knowledge of common, as well as rare entities and their imaging features, is of utmost importance to enable appropriate management.

A case of flank pain caused by ureteral intussusception accompanied with ureteral polyp

BACKGROUND

Ureteral intussusception, a rarely reported unique condition, occurs primarily as a complication of ureteric tumours.

CASE PRESENTATION

We present a case of ureteral intussusception accompanied with a large ureteral polyp periodically protruding into the bladder cavity occurring in a 56-year-old man who experienced vague flank pain and intermittent haematuria. The patient was successfully treated by ureteroscopic cauterization combined with partial ureterectomy with reanastomosis.

CONCLUSIONS

This is the first report that describes polyp-related ureteral intussusception using comprehensive and representative ureteroscopic images and video. Our findings suggest that ureteroscopy is vital for diagnosis. Extensive biopsies through ureteroscopy are less invasive, and make it easier to exclude the presence of ureteral malignancies. Ureteroscopic resection of the whole polyp with its stalk and intussusceptum using Holmium: YAG laser did not seem viable in this case. However, cauterization of partial polyp tissues followed by open surgery for segmental resection of the ureter with reanastomosis is helpful in controlling such patient well-being.

Beyond ureterolithiasis: gamut of abnormalities affecting the ureter

Nephrolithiasis is the most common condition involving the ureters. However, various other entities can affect the ureters, albeit less frequently. Imaging plays a crucial role in diagnosis, management, and follow-up of ureteral pathology. In the past decade, computed tomography urography has replaced traditional methods of ureteral imaging due to its high spatial resolution, multiplanar imaging, and rapid acquisition time. More recently, magnetic resonance urography has also been explored in evaluating ureteral abnormalities. In this review, we briefly discuss current imaging techniques used in assessment of the ureters and present a diverse group of diseases affecting the ureters. We begin with primary and secondary ureteral malignancies, followed by uncommon infectious/inflammatory diseases that can involve the ureters including tuberculosis, xanthogranulomatous pyelonephritis, and graft-versus-host disease. We then discuss the imaging characteristics of endometriosis and retroperitoneal fibrosis as two important examples of pelvic and retroperitoneal processes that occasionally obstruct the ureters and present with clinical symptoms similar to that of renal stones. We end with a brief discussion of miscellaneous conditions that affect the ureters, including ureteral hemorrhage, ureteral intussusception, ureteral pseudodiverticulosis, Malacoplakia, and ureteritis cystica. Knowledge of these entities and their characteristic imaging manifestations along with patient's clinical presentation allows accurate diagnosis and timely patient management.

Treatment and outcome of fibroepithelial ureteral polyps: A systematic literature review

INTRODUCTION

Fibroepithelial polyps of the ureter are rare. Cases and small series are reported in the literature. The treatment of choice, outcome and appropriate follow-up regimen remain unclear.

METHODS

We conducted a systematic literature review of papers reporting fibroepithelial polyps of the ureter in adult patients. Articles published before 1980 were excluded.

RESULTS

The search yielded 144 papers, of which 68 met the inclusion criteria. A reference scan from the included 68 yielded an additional 7 new articles. In total, our study included 75 articles (68 + 7). A total of 134 patients were described. Most patients had a single lesion (range: 1-10). The median length of the polyp was 4.0 cm (range: 0.4-17.0). The percentage of polyps resected endoscopically increased from 0% before 1985 to 67% after 2005. Two perioperative complications were reported in 72 procedures (2.8%): a deep venous thrombosis and a case of mesenteric lymphadenopathy. Both of these occurred after open surgery. Follow-up data were available for 57 patients. The median follow-up was 12 months (range: 1-180). Four patients (7.0%) developed recurrent complaints: 2 had urinary stones, 1 had a ureteral stricture and 1 had recurrence of the polyp. Three of these events followed endoscopic resection, and occurred within a year after the procedure.

CONCLUSION

Endoscopic resection of fibroepithelial polyps seems to be safe and effective. It is minimally invasive and should be considered the gold standard where endoscopic expertise is available. We advise follow-up imaging by computed tomographic intravenous urography after 3 months and ultrasound after 1 year to detect late complications.

Ureteral intussusception associated with a fibroepithelial polyp: a case report

We present a case of a 67-year-old man with intussusception of the right ureter associated with a fibroepithelial polyp. The concentric sign and line sign are characteristic radiological findings in intussusception, and these findings could be seen in the present case. Although this entity is rare, its radiological findings are specific. Multidetector row computed tomography and its multiplanar reconstruction make the diagnosis feasible, although the qualitative diagnosis of the tumor was difficult.

Calculus-related ureteral intussusception: A case report and literature review

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We present the first reported case of calculus-related ureteral intussusception.

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We examine the literature regarding other causes of ureteral intussusception.

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We provide an hypothesis for the development of calculus-related intussusception.

Introduction

Ureteral intussusception is a rarely reported condition, primarily as a complication of ureteric tumours. Fewer than 30 case reports have been made. This case represents the first reported case, to our knowledge, of ureteral intussusception caused by a ureteric calculus.

Presentation of case

We present the case of a 70 year old man with a history of conservatively managed renal calculi, in whom obstructive ureterolithiasis was incidentally detected. Retrograde pyelography and ureteroscopy revealed intussusception of the ureter around a calculus. Extensive biopsies revealed no evidence of tumour, and the intussusception resolved following stone clearance.

Discussion

Literature review of previously reported cases of ureteral intussusception revealed 26 cases, of which 22 were secondary to tumour and 4 were secondary to surgical procedures. We propose a mechanism by which calculus-related ureteral intussusception may occur, and suggest treatment for this condition.

Conclusion

Calculus-related ureteral intussusception is a rare condition, of which this represents the only case report. Management of the condition should involve excluding the presence of tumour, and then clearing the stone, avoiding the use of a basket for retrieval of fragments.

Ureteral intussusception: a case report and literature review

We present the case of a 64-year-old man with intussusception of the right ureter as a complication of an underlying transitional cell carcinoma. To our knowledge, this is the first case report that illustrates ureteral intussusception by both multidetector computerized tomography and magnetic resonance imaging. Although ureteral intussusceptions are thought to be associated with benign masses, our comprehensive review of the literature demonstrates that almost half of the cases are associated with underlying malignancy.

Large ureteral fibroepithelial polyp lacking epithelium due to ischemic infarction

We describe a woman with flank pain and hydronephrosis. Computed tomography (CT) urography and maximum intensity projection (MIP) reformatted images clearly showed that a long finger-like intraluminal filling defects mass in the left middle ureter. The pathologic biopsy by ureteroscopy revealed that the lesion mainly consists of benign fibrinoid necrosis. A large soft smooth, spindle-like, dark brown mass (approximately 13.5 cm in length) was identified in left middle ureter when open surgery was performed. The segment of the ureter part attached to the stalk of the polyp was excised, then a dismembered ureteroplasty was performed. Pathologic examination revealed that the total polyp was an ischemic infarction, characteristic of cellular swelling, tissue degeneration, fibrinoid necrosis, and thrombosis in its vessels. The surface of the polyp was hardly covered with urothelium, but fibroepithelial polyp was still diagnosed. There was no recurrence during the 3 years of follow-up.