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Ma W, Gao H, Chang M, Lu Z, Li D, Ding C, Bi D, Sun F. The construction of a nomogram to predict the prognosis and recurrence risks of UPJO. Front Pediatr 2024; 12:1376196. [PMID: 38633323 PMCID: PMC11022601 DOI: 10.3389/fped.2024.1376196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/13/2024] [Indexed: 04/19/2024] Open
Abstract
Objective This study was conducted to explore the risk factors for the prognosis and recurrence of ureteropelvic junction obstruction (UPJO). Methods The correlation of these variables with the prognosis and recurrence risks was analyzed by binary and multivariate logistic regression. Besides, a nomogram was constructed based on the multivariate logistic regression calculation. After the model was verified by the C-statistic, the ROC curve was plotted to evaluate the sensitivity of the model. Finally, the decision curve analysis (DCA) was conducted to estimate the clinical benefits and losses of intervention measures under a series of risk thresholds. Results Preoperative automated peritoneal dialysis (APD), preoperative urinary tract infection (UTI), preoperative renal parenchymal thickness (RPT), Mayo adhesive probability (MAP) score, and surgeon proficiency were the high-risk factors for the prognosis and recurrence of UPJO. In addition, a nomogram was constructed based on the above 5 variables. The area under the curve (AUC) was 0.8831 after self cross-validation, which validated that the specificity of the model was favorable. Conclusion The column chart constructed by five factors has good predictive ability for the prognosis and recurrence of UPJO, which may provide more reasonable guidance for the clinical diagnosis and treatment of this disease.
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Affiliation(s)
- Wenyue Ma
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Hongjie Gao
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Mengmeng Chang
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Zhiyi Lu
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Ding Li
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Chen Ding
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Dan Bi
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Fengyin Sun
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
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Chertin L, Neeman BB, Jaber J, Verhovsky G, Zisman A, Mamber A, Kafka I, Natsheh AE, Koulikov D, Shenfeld OZ, Chertin B, Koucherov S, Neheman A. Our experience with management of congenital urological pathologies in adulthood: What pediatric urologists should know and adult urologists adopt in pediatric practice experience. Curr Urol 2024; 18:7-11. [PMID: 38505161 PMCID: PMC10946651 DOI: 10.1097/cu9.0000000000000228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/19/2023] [Indexed: 03/21/2024] Open
Abstract
Purpose To summarize our experience in the management of congenital anomalies in the kidney and urinary tract (CAKUT) in adults. Materials and methods We conducted a retrospective chart review of all adult patients who underwent primary surgical intervention for CAKUT between 1998 and 2021. Results The study included 102 patients with a median age of 25 (interquartile range, 23-36.5). Of these, 85 (83.3%) patients reported normal prenatal ultrasound, and the remaining 17 (16.7%) patients were diagnosed with antenatal hydronephrosis. These patients were followed-up conservatively postnatally and were discharged from follow-up because of the absence of indications for surgical intervention or because they decided to leave medical care. All studied adult patients presented with the following pathologies: 67 ureteropelvic junction obstructions, 14 ectopic ureters, 9 ureteroceles, and 6 primary obstructive megaureters, and the remaining 6 patients were diagnosed with vesicoureteral reflux. Forty-three percent of the patients had poorly functioning moieties associated with ectopic ureters or ureteroceles. Notably, 67% of patients underwent pyeloplasty, 9% underwent endoscopic puncture of ureterocele, 3% underwent ureteral reimplantation, 6% underwent endoscopic correction of reflux, 7% underwent partial nephrectomy of non-functioning moiety, and the remaining 9% underwent robotic-assisted laparoscopic ureteroureterostomy. The median follow-up period after surgery was 33 months (interquartile range, 12-54). Post-operative complications occurred in 5 patients (Clavien-Dindo 1-2). Conclusions Patients with CAKUT present clinical symptoms later in life. Parents of patients diagnosed during fetal screening and treated conservatively should be aware of this possibility, and children should be appropriately counseled when they enter adolescence. Similar surgical skills and operative techniques used in the pediatric population may be applied to adults.
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Affiliation(s)
- Leon Chertin
- Department of Urology, Shamir Medical Center, Zerifin, Israel (Affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel)
| | - Binyamin B. Neeman
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel (Affiliated with the Faculty of Medicine, The Hebrew University, Jerusalem, Israel)
| | - Jawdat Jaber
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel (Affiliated with the Faculty of Medicine, The Hebrew University, Jerusalem, Israel)
| | - Guy Verhovsky
- Department of Urology, Shamir Medical Center, Zerifin, Israel (Affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel)
| | - Amnon Zisman
- Department of Urology, Shamir Medical Center, Zerifin, Israel (Affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel)
| | - Ariel Mamber
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel (Affiliated with the Faculty of Medicine, The Hebrew University, Jerusalem, Israel)
| | - Ilan Kafka
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel (Affiliated with the Faculty of Medicine, The Hebrew University, Jerusalem, Israel)
| | - Ala Eddin Natsheh
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel (Affiliated with the Faculty of Medicine, The Hebrew University, Jerusalem, Israel)
| | - Dmitry Koulikov
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel (Affiliated with the Faculty of Medicine, The Hebrew University, Jerusalem, Israel)
| | - Ofer Z. Shenfeld
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel (Affiliated with the Faculty of Medicine, The Hebrew University, Jerusalem, Israel)
| | - Boris Chertin
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel (Affiliated with the Faculty of Medicine, The Hebrew University, Jerusalem, Israel)
| | - Stanislav Koucherov
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel (Affiliated with the Faculty of Medicine, The Hebrew University, Jerusalem, Israel)
| | - Amos Neheman
- Department of Urology, Shamir Medical Center, Zerifin, Israel (Affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel)
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Sholtes CB, Tranthem LA, Nakamura F, Canalichio K, Goedde M, Choi K. A Contemporary Review of Cryptorchidism Management in Adults: A Rare Presentation of Bilateral Cryptorchidism Presenting as Pelvic Pain in an Adult Patient. Cureus 2024; 16:e52933. [PMID: 38406067 PMCID: PMC10893955 DOI: 10.7759/cureus.52933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
This case report presents a rare case of adult cryptorchidism, found incidentally in a 25-year-old gentleman who initially presented with abdominal and suprapubic pain and was successfully treated with staged orchidopexy. To our knowledge, to date, our case is the first published instance of bilateral cryptorchidism in an adult presenting with nonspecific suprapubic pain. Cryptorchidism is the most common genital abnormality in newborn boys, and due to its association with an increased risk of infertility and malignancy, current management involves surgical correction with orchidopexy by 12 to 18 months of life. Adult presentation of cryptorchidism is very unusual due to early intervention; therefore, bilateral cryptorchidism is even more rare. As a result, current guidelines do not address proper management for adult cryptorchidism. Therefore, after performing a thorough review of the literature on contemporary guidelines for cryptorchidism management, we aim to highlight our approach to management in this rare case of adult bilateral cryptorchidism. We suggest bilateral orchiectomy as the safest option, if the patient is amendable, or bilateral orchiopexy with long-term follow-up for testicular cancer. Although the American Urological Association guidelines recommend orchiectomy for postpubertal cryptorchid children, currently, no explicit guidelines exist for the preferred method of managing adult cryptorchidism. Due to the increased risk of infertility and testicular cancer with cryptorchidism, orchiectomy instead of orchiopexy may be the preferred surgical approach in some instances. Still, in the case of bilateral cryptorchidism, orchiectomy may not always be the most viable solution, making orchiopexy with long-term follow-up for testicular cancer the best option, such as in our case.
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Affiliation(s)
| | - Lauren A Tranthem
- Department of Urology, University of Louisville School of Medicine, Louisville, USA
| | - Fumihiko Nakamura
- Department of Urology, University of Louisville School of Medicine, Louisville, USA
| | - Katie Canalichio
- Department of Pediatric Urology, Norton Children's Hospital, Louisville, USA
| | - Michael Goedde
- Department of Urology, University of Louisville Hospital, Louisville, USA
| | - Kellen Choi
- Department of Urology, University of Louisville Hospital, Louisville, USA
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Boswell TC, Maric T, Khoury AE, Farrugia MK. "Urinary tract dilatation and vesicoureteral reflux - Adult outcomes, who should be followed, and how to follow them". J Pediatr Urol 2023:S1477-5131(23)00200-0. [PMID: 37188600 DOI: 10.1016/j.jpurol.2023.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/17/2023]
Abstract
Long-term adult outcomes of children diagnosed with urinary tract dilatation (UTD) and vesicoureteral reflux (VUR) are not clearly documented in the literature. Likewise, follow-up protocols for these patients as they transition through adolescence and into adulthood vary with institution and cultures. Several studies have shown that individuals diagnosed with VUR in childhood are at higher risk of urinary tract infection (UTI) throughout their lives, even in the setting of prior VUR resolution or surgical correction. This is particularly relevant in patients with renal scarring, who are at higher risk of UTIs, hypertension and renal function deterioration in pregnancy. The risk of adverse maternal and fetal outcomes in pregnancy are higher for women with significant chronic kidney disease (CKD). Patients who underwent endoscopic injection or reimplantation should be counselled on the long-term particular risks associated with each intervention, including calcification of ureteric injection mounds, and the potential challenges of future endoscopic procedures following reimplantation. Although there is no evidence for the direct correlation between conservatively managed UTD in childhood, and symptomatic UTD diagnosed in adulthood, all patients should be aware of the long-term risks of persistent upper tract dilatation. Lastly, bladder-bowel dysfunction (BBD) management in adolescence can be more challenging and may contribute to symptomatic recurrence in this age group.
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Affiliation(s)
- Timothy C Boswell
- Division of Pediatric Urology, Children's Hospital of Orange County, Orange, CA, USA; Department of Urology, University of California Irvine School of Medicine, Orange, CA, USA
| | - Tanya Maric
- Fetal Medicine Unit, Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK
| | - Antoine E Khoury
- Division of Pediatric Urology, Children's Hospital of Orange County, Orange, CA, USA; Department of Urology, University of California Irvine School of Medicine, Orange, CA, USA
| | - Marie-Klaire Farrugia
- Department of Paediatric Urology, Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK; Imperial College London, Exhibition Rd, South Kensington, London SW7 2BX, UK.
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Chauhan G, Levy I, Samuel SW. Ureterocele as a cause of chronic intractable abdominal pain. BMJ Case Rep 2021; 14:e245262. [PMID: 34764118 PMCID: PMC8586893 DOI: 10.1136/bcr-2021-245262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 11/03/2022] Open
Abstract
A ureterocele is a submucosal, cystic dilation of the terminal ureter, either congenital or acquired, as it enters the bladder. It is a rare clinical entity that can be entirely asymptomatic and present as an incidental finding or can manifest in the form of distressing symptoms such as unremitting abdominal pain, haematuria, obstructive uropathy, to name a few. The authors present a case of abdominal pain in a 43-year-old woman who was presumptively attributed to various clinical entities and was finally referred to the chronic pain clinic. The patient underwent numerous diagnostic tests, psychological evaluations and therapeutic interventions, including surgeries, over the years that failed to mitigate her symptoms until urologic imaging reported intravesical ureterocele as the underlying disorder. The case report entails the diagnostic challenge faced by the authors along with the clinical characteristics of ureterocele.
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Affiliation(s)
- Gaurav Chauhan
- Chronic Pain Division, Dept. of Anesthesiology and Chronic Pain Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Isaiah Levy
- Physical Medicine and Rehabilitation, UPMC, Pittsburgh, Pennsylvania, USA
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6
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Complete Renal Duplex System with Obstructing Upper Moiety Ureterocele. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02390-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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7
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Freitas PFS, Barbosa JABA, Cho DH, Boffa ABM, Andrade HS, Arap MA, Duarte RJ, Nahas WC, Srougi M, Srougi V. Short-term outcomes of pyeloplasty vs. nephrectomy in adult patients with ureteropelvic junction obstruction and differential renal function ≤15. Scand J Urol 2021; 55:192-196. [PMID: 33525931 DOI: 10.1080/21681805.2021.1879929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To compare symptom resolution and short-term renal function after pyeloplasty or nephrectomy in adults with ureteropelvic junction obstruction (UPJO) in poorly functioning renal units (PFRU). METHODS Retrospective analysis of adult patients with UPJO and differential renal function (DRF) ≤ 15% who underwent laparoscopic pyeloplasty or nephrectomy. Primary endpoints included symptom resolution and estimated glomerular filtration rate (eGFR) at 12 months. Surgical complications were compared between groups. A secondary analysis was performed comparing baseline and postoperative DRF to evaluate the PFRU recovery potential after pyeloplasty. RESULTS Sixty-three patients were included; 19 underwent pyeloplasty and 44 underwent nephrectomy. The mean age of the cohort was 39.5 ± 13.8 years. Nephrectomy was associated with significantly higher intra-operative blood loss (p = 0.02). Operative time and length of hospital stay were not significantly different between groups. There were three complications in the nephrectomy group, and none in the pyeloplasty group (p = 0.34). Symptom resolution rates were equivalent between groups (73% vs. 76%; p = 0.78). The eGFR variation was not statistically different after pyeloplasty or nephrectomy (+6.2 vs. +0.1 mL/min/1.73m2, respectively; p = 0.18). Patients undergoing pyeloplasty had no significant change in the mean DRF (baseline 9.5 vs. 10%; p = 0.99). CONCLUSION Pyeloplasty can be considered for selected patients with UPJO in PFRU as an organ-sparing alternative to nephrectomy. Although there was no significant gain in mean DRF, pyeloplasty prevented further functional loss and relieved symptoms in most cases in the short-term with at least the same complication rates of nephrectomy.
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Affiliation(s)
- Pedro F S Freitas
- Division of Urology, University of São Paulo Medical School, São Paulo, Brazil
| | - João A B A Barbosa
- Division of Urology, University of São Paulo Medical School, São Paulo, Brazil
| | - David H Cho
- Division of Urology, University of São Paulo Medical School, São Paulo, Brazil
| | - Ana B M Boffa
- Division of Urology, University of São Paulo Medical School, São Paulo, Brazil
| | - Hiury S Andrade
- Division of Urology, University of São Paulo Medical School, São Paulo, Brazil
| | - Marco A Arap
- Division of Urology, University of São Paulo Medical School, São Paulo, Brazil.,Hospital Sírio Libanês, São Paulo, Brazil
| | - Ricardo J Duarte
- Division of Urology, University of São Paulo Medical School, São Paulo, Brazil
| | - William C Nahas
- Division of Urology, University of São Paulo Medical School, São Paulo, Brazil
| | - Miguel Srougi
- Division of Urology, University of São Paulo Medical School, São Paulo, Brazil
| | - Victor Srougi
- Division of Urology, University of São Paulo Medical School, São Paulo, Brazil.,Hospital Moriah, São Paulo, Brazil
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8
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Bitar R, Szklaruk J, Martiniova L, Zurita AJ, Chery LJ, Ravizzini G. 18F-Fluciclovine Uptake in a Ureterocele. Clin Nucl Med 2021; 46:e3-e5. [PMID: 32956112 DOI: 10.1097/rlu.0000000000003272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 60-year-old man with prostate adenocarcinoma status post radical prostatectomy and bilateral pelvic lymph node dissection referred for restaging F-fluciclovine PET/CT due to rising serum prostate-specific antigen levels (1.1 ng/mL at that time of imaging). PET/CT images were obtained from the proximal thighs to the vertex of the skull approximately 3 to 5 minutes after the IV administration of 347.8 MBq (9.4 mCi) of F-fluciclovine. PET/CT imaging demonstrated a focus of abnormally increased F-fluciclovine uptake at the right ureterovesical junction. Subsequent MRI of the pelvis revealed that this focus corresponded to a benign ureterocele.
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Affiliation(s)
- Ryan Bitar
- From the The University of Texas Health Science Center at San Antonio, San Antonio
| | - Janio Szklaruk
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lucia Martiniova
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Amado J Zurita
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lisly J Chery
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gregory Ravizzini
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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Ma M, Shen H, Yuan J. Strangulated prolapsed ureterocele causing dysuria in an adult woman. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.18.04903-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Chammas MF, Mitre AI, Arap MA, Hubert N, Hubert J. Learning robotic pyeloplasty without simulators: an assessment of the learning curve in the early robotic era. Clinics (Sao Paulo) 2019; 74:e777. [PMID: 31271586 PMCID: PMC6585868 DOI: 10.6061/clinics/2019/e777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/19/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To analyze our experience and learning curve for robotic pyeloplasty during this robotic procedure. METHODS Ninety-nine patients underwent 100 consecutive procedures. Cases were divided into 4 groups of 25 consecutive procedures to analyze the learning curve. RESULTS The median anastomosis times were 50.0, 36.8, 34.2 and 29.0 minutes (p=0.137) in the sequential groups, respectively. The median operative times were 144.6, 119.2, 114.5 and 94.6 minutes, with a significant difference between groups 1 and 2 (p=0.015), 1 and 3 (p=0.002), 1 and 4 (p<0.001) and 2 and 4 (p=0.022). The mean hospital stay was 7.08, 4.76, 4.88 and 4.20 days, with a difference between groups 1 and 2 (p<0.001), 1 and 3 (p<0.001) and 1 and 4 (p<0.001). Clinical and radiological improvements were observed in 98.9% of patients. One patient presented with recurrent obstruction. CONCLUSIONS Our results demonstrate a high success rate with low complication rates. A significant decrease in hospital stay and surgical time was evident after 25 cases.
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Affiliation(s)
- Mario F Chammas
- Divisao de Urologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mails: /
| | - Anuar I Mitre
- Divisao de Urologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Divisao de Urologia, Hospital Sirio-Libanes, Sao Paulo, SP, BR
| | - Marco A Arap
- Divisao de Urologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Divisao de Urologia, Hospital Sirio-Libanes, Sao Paulo, SP, BR
| | - Nicholas Hubert
- Division of Urology, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Jacques Hubert
- Division of Urology, Centre Hospitalier Universitaire de Nancy, Nancy, France
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Toocheck C, Guerrero T. Tragedy of transition: hypertensive crisis in a young adult secondary to unilateral ureteropelvic junction obstruction following pyeloplasty as an adolescent. BMJ Case Rep 2018; 2018:bcr-2018-225815. [PMID: 30158270 DOI: 10.1136/bcr-2018-225815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 25-year-old man with a history of left ureteropelvic junction (UPJ) obstruction that was corrected surgically at the age of 16 presented with a chief complaint of syncope. He was found to have severe hypertension with evidence of end organ damage on laboratory evaluation. His blood pressure was controlled with intravenous and oral antihypertensives with improvement in end organ dysfunction. Workup for secondary causes of hypertension implicated failed left-sided pyeloplasty with resultant hydronephrosis as the aetiology. The patient was transitioned to an oral antihypertensive regimen and discharged with urological surgery follow-up. Blood pressure control was maintained with oral antihypertensives and a low-salt diet; however, evidence of chronic kidney disease persisted. This case highlights the importance of close follow-up and adequate transition of care in patients with UPJ obstruction who transitioned to adulthood.
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Affiliation(s)
- Corey Toocheck
- Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Tomas Guerrero
- Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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12
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Adult Bilateral Ureteroceles Presenting with Lower Urinary Tract Symptoms and Acute Urinary Retention. Case Rep Urol 2018; 2018:3186060. [PMID: 30046505 PMCID: PMC6038490 DOI: 10.1155/2018/3186060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 05/03/2018] [Indexed: 11/18/2022] Open
Abstract
Ureterocele is a well-known pathologic entity in the pediatric urology population but remains a diagnostic and treatment challenge in the adult population. Adult ureteroceles remain a diagnostic challenge for the adult urologist. Its prevalence is estimated between 1/500 and 1/4000 patients with a wide variety of clinical presentations. We present the case of a 30-year-old female patient who presented with severe lower urinary tract symptoms (LUTS) and acute urinary retention secondary to prolapsing bilateral single-system orthotopic ureteroceles. She was successfully treated with transurethral unroofing of her bilateral ureteroceles and she is currently asymptomatic. This case represents the first reported case of bilateral ureteroceles presenting with severe LUTS and subsequent urinary retention from the prolapse of one of the ureteroceles. We provide a review of the most recent case series of adult ureteroceles and their outcomes. Transurethral unroofing of the ureterocele is a safe and minimally invasive approach for this disease.
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Ureteropelvic Junction Obstruction and Parathyroid Adenoma: Coincidence or Link? Case Rep Nephrol 2017; 2017:9852912. [PMID: 29181209 PMCID: PMC5664328 DOI: 10.1155/2017/9852912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 09/11/2017] [Accepted: 09/25/2017] [Indexed: 11/25/2022] Open
Abstract
Congenital ureteropelvic junction obstruction (UPJO) is the most common cause of upper urinary tract obstruction in children. It is generally diagnosed in the routine work-up during antenatal period and is characterized by spontaneous recovery. It can be associated with urolithiasis; hence further investigation should be carried out. We report the case of a 15-year-old boy, who is known to have right UPJO, presented with right renal colic and discovered to have bilateral kidney stones. Further studies showed primary hyperparathyroidism and genetic analysis revealed a CDC73 mutation (initially HRPT2). We believe that association of UPJO and PHPT is a rare coincidence that can be linked. Careful work-up of children with UPJO and urolithiasis is recommended to exclude an underlying metabolic disease. Surgical correction can be evitable as treatment of the primary cause can lead to complete dissolution of kidney stones and improvement of the medical condition.
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Law YXT, Sagir IK, Tan GLL. A solitary urothelial tumor arising from one of bilateral ureteroceles. Int Braz J Urol 2017; 43:990-993. [PMID: 28792188 PMCID: PMC5678536 DOI: 10.1590/s1677-5538.ibju.2017.0087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/07/2017] [Indexed: 11/22/2022] Open
Affiliation(s)
- Yu Xi Terence Law
- Department of Urology, National University Hospital, National University Health System, Singapore
| | - Irfan Khan Sagir
- Department of Pathology, National University Hospital, National University Health System, Singapore
| | - Guan Lim Lincoln Tan
- Department of Urology, National University Hospital, National University Health System, Singapore
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15
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Ateş F, Soydan H, Okçelik S, Çırakoğlu A, Yılmaz İ, Malkoç E, Karademir K. Clinical and histopathological results of the adult patients with unilateral cryptorchidism. Turk J Urol 2016; 42:74-9. [PMID: 27274891 PMCID: PMC4857921 DOI: 10.5152/tud.2016.47886] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/16/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the clinical and histopathological results of adult unilateral cryptorchidism patients. MATERIAL AND METHODS Data from adult unilateral cryptorchidism patients that underwent orchiectomy in our clinic between between January 2004 and March 2013 were retrospectively evaluated. Patients were divided into three groups as intra-abdominal, inguinal canal and superficial inguinal region according to the location of the undescended testes. Patients were also grouped according to their testicular volume (<4 cc, 4.1-12 cc, and >12 cc). Histopathology results of orchiectomy specimens were classified as follows: 1. Sertoli cells only, testicular atrophy and vanished testis (anorchia) 2. Hypospermatogenesis, and 3. Maturation arrest. Patients were grouped as normospermia, azoospermia and oligo/astheno/teratospermia groups according to semen analysis results. Correlations between testicular localization, testicular size, semen analysis and pathology results were evaluated. Incidental tumor detection rates were also calculated. RESULTS Two hundred and forty-four adult unilateral cryptorchidism patients underwent orchiectomy in our clinic. There was no a significant relationship between location of the testis and testicular pathology results (p=0.707). Most common semen analysis results was normospermia in patients with high testicular volume group however azoospermia and oligoasthenospermia observed commonly in patients with low testicular volume group. There was a significant relationship between testicular volume and semen analysis results (p=0.023). No significant relationship was observed between semen analysis and pathological results (p=0.929). After an evaluation of all factors with possible effects on the semen analysis results, only testicular volume (p=0.036) was found to have a significant impact. Only one case (0.4%) was incidentally diagnosed seminoma after a review of 233 patients with available histopathological results on record. CONCLUSION Adult unilateral cryptorchidism has a minimal effect on male fertility or even this effect can be overlooked. Low detection rates of incidental germ cell tumors also make an orchiectomy decision questionable in such cases.
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Affiliation(s)
- Ferhat Ateş
- Department of Urology, Gülhane Military Medical Academy Haydarpaşa Training Hospital, İstanbul, Turkey
| | - Hasan Soydan
- Department of Urology, Gülhane Military Medical Academy Haydarpaşa Training Hospital, İstanbul, Turkey
| | - Sezgin Okçelik
- Clinic of Urology, Beytepe Military Hospital, Ankara, Turkey
| | | | - İsmail Yılmaz
- Department of Pathology, Gülhane Military Medical Academy Haydarpaşa Training Hospital, İstanbul, Turkey
| | - Ercan Malkoç
- Department of Urology, Gülhane Military Medical Academy Haydarpaşa Training Hospital, İstanbul, Turkey
| | - Kenan Karademir
- Department of Urology, Gülhane Military Medical Academy Haydarpaşa Training Hospital, İstanbul, Turkey
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Mackenzie DC, Sajed D, Noble VE. Diagnosis of megaureter by point-of-care ultrasound. J Emerg Med 2014; 47:e1-e3. [PMID: 24199726 DOI: 10.1016/j.jemermed.2013.08.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 05/20/2013] [Accepted: 08/15/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Presentation of congenital megaureter in adult life is rare; patients usually become symptomatic in childhood. CASE REPORT A 32-year-old man presented to the Emergency Department (ED) with dyspnea, tongue swelling, and a rash, which he attributed to amoxicillin he had taken shortly prior to onset of symptoms. He was hypotensive on arrival to the ED. To further evaluate the hypotension, point-of-care ultrasound of the heart, lungs, and abdomen were performed while treatment for anaphylaxis was initiated. Ultrasound examination did not identify a cause for hypotension, but the treating physician noted an anechoic structural abnormality posterior to the bladder, suggestive of megaureter. The patient responded well to treatment of anaphylaxis; further history and diagnostic imaging subsequently confirmed a diagnosis of congenital megaureter. CONCLUSION We report an unusual case of congenital megaureter, identified by point-of-care ultrasound performed to evaluate hypotension. Clinicians performing limited ultrasound examinations must be attentive to incidental findings that will require follow-up.
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Affiliation(s)
- David C Mackenzie
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Dana Sajed
- Department of Emergency Medicine, Harborview Medical Center, Seattle, Washington
| | - Vicki E Noble
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
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(99m) T c-DTPA Study to Validate an Experimental Model of Ureteral Obstruction in Rabbits: Preliminary Results. Adv Urol 2013; 2013:929620. [PMID: 24489538 PMCID: PMC3891748 DOI: 10.1155/2013/929620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 10/11/2013] [Accepted: 10/15/2013] [Indexed: 11/17/2022] Open
Abstract
Objective. To create a ureteral obstruction experimental model that can be proved through (99m)Tc-DTPA renal scintigraphy and histopathological studies, without causing total renal function loss. Materials and Methods. Ten New Zealand white rabbits were submitted to a surgical experiment to create a model of unilateral obstruction to urinary flow. Surgery procedure provided unilateral ureteral obstruction (left kidney) to urinary flow and posteriorly was evaluated by (99m)Tc-DTPA renal scintigraphy and histopathological study. (99m)Tc-DTPA renal study was performed to detect and quantify signs of obstruction and to evaluate renal function. Statistical analysis was performed through the Student t-test with a significance level of P<0.05. Results. Nine of the ten rabbits presented left renal unit obstruction and one nonobstructive on the (99m)Tc-DTPA and histopathological studies. All the right renal units, which were not submitted to surgical procedure, were nonobstructed by the studies. There was a general agreement between scintigraphy and histopathological results in both groups. Conclusion. The experimental model promoted the creation of ureteral obstruction in rabbits, confirmed by nuclear medicine scintigraphy and histopathology, and could be used in further studies to better understand urinary obstruction.
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Mohseni MG, Hosseini SR, Salavati A, Dadgari S. Ureterocele associated with renal agenesia presented as a pelvic mass in an adult. IRANIAN JOURNAL OF RADIOLOGY 2013; 10:45-7. [PMID: 23599714 PMCID: PMC3618906 DOI: 10.5812/iranjradiol.10262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Revised: 09/23/2012] [Accepted: 10/28/2012] [Indexed: 11/16/2022]
Abstract
Adult ureteroceles are generally known as simple ureteroceles with minimal obstructive effects 1 that can usually be managed endoscopically. Such pathology presented with acute abdominal pain and fever in a 32-year-old man with left renal agenesia, a cranial blind left ureter and left obstructed ureterocele. The retained secretions were suppurative.
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Affiliation(s)
- Mohammad Ghasem Mohseni
- Department of Urology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Reza Hosseini
- Department of Urology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author: Seyed Reza Hosseini , Department of Urology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Tel.: +98-2166701041, Fax: +98-2166737741, E-mail:
| | - Alborz Salavati
- Department of Urology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Christofides A, Swallow T, Parkinson R. Contemporary Management of recurrent UTI in adult females. JOURNAL OF CLINICAL UROLOGY 2013. [DOI: 10.1177/2051415812472433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The management of recurrent UTI is subject to significant variation and patients may fall under the care of a variety of specialties. We review the pathogenesis, investigation and management of this group of patients. Accurate diagnosis of UTI is the cornerstone of successful management, and careful interpretation of MSU results is needed. Although prophylactic antibiotic regimes are often successful, the emergence of antibiotic resistance mandates the cautious use of antibiotics and consideration of other initial therapies where possible.
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Prolapse of a single-system ureterocele causing urinary retention in an adult woman. Int Urogynecol J 2013; 24:1761-3. [PMID: 23417311 DOI: 10.1007/s00192-012-2040-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Accepted: 12/29/2012] [Indexed: 10/27/2022]
Abstract
A 41-year-old woman presented with pelvic pain and a bulge from her urethra. On physical examination, she was noted to have a mucosal bulge from her urethra that intermittently squired urine. Further imaging showed single systems on both sides, no stones, and mild left-sided hydroureteronephrosis with a ureterocele. The ureterocele was endoscopically incised and excised, resolving her symptoms.
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Berger MB, Larson KA, DeLancey JO. An incidental finding: routine cystoscopy after pelvic floor reconstruction surgery revealed a bladder mass. Am J Obstet Gynecol 2010; 203:518.e1. [PMID: 20887969 DOI: 10.1016/j.ajog.2010.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 07/07/2010] [Accepted: 08/16/2010] [Indexed: 10/19/2022]
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Abstract
Kidney and urinary tract malformations are among the most frequent developmental defects identified in newborns. Ranging from asymptomatic to neonatal lethal, these malformations represent an important clinical challenge. Recent progress in understanding the developmental origin of urinary tract defects in the mouse and other animal models suggests a new framework for the interpretation of these defects in humans. Gene inactivation studies in mice provided invaluable information on the formation of the Wolffian duct, a central component of embryonic renal development, on ureter and kidney induction as well as on distal ureter maturation. All three developmental processes are crucial for normal urinary tract morphogenesis. A failure to complete these developmental steps is responsible for a spectrum of kidney and urinary tract malformations including renal agenesis, renal dysplasia, vesicoureteral reflux, hydroureter, hydronephrosis and ureterocele. Surprisingly, distal ureter maturation, the process by which the ureter is displaced from the Wolffian duct to its final position within the bladder wall, has only recently been characterized at the morphological level. Anomalies in this process are emerging as a major source of urinary tract developmental defects. This review is aimed at bridging the current knowledge on the morphological and molecular events identified in the mouse, together with clinical observations of urinary tract malformation in humans.
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Affiliation(s)
- N Uetani
- Goodman Cancer Centre, Department of Biochemistry, McGill University, Quebec, Canada
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