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Santhalia PK, Mittal D, Gupta AK, Jana M. Utility of ureteric jet: A simple yet useful tool for the evaluation of complex urogenital anomaly. Indian J Radiol Imaging 2018; 28:45-48. [PMID: 29692526 PMCID: PMC5894318 DOI: 10.4103/ijri.ijri_208_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In infants and young children with suspicion of genitourinary tract anomalies, ultrasonography (USG) is usually the first imaging modality. Advantages of USG are well described. In the evaluation of complex congenital urogenital anomalies, ultrasound examination needs to be tailored according to the clinical suspicion and to yield maximum information. Primary megaureter is a congenital anomaly, which is associated with dilatation of ureter above an adynamic segment at the vesicoureteric junction (VUJ). Two different types are described in the literature: refluxing and obstructive. Absence of ureteric jet on USG in conjunction with vesicoureteric reflux (VUR) on voiding cystourethrogram (VCUG) prompts to the diagnosis of refluxing type of obstructed megaureter. Here we describe a case of duplex moiety with refluxing type of obstructed megaureter, where gray-scale USG and real-time color Doppler evaluation of the ureteric jet established the diagnosis. The aperistaltic segment of lower ureter near the VUJ with an absence of ureteric jet for the same moiety suggested the possibility of an obstructed megaureter. VUR was demonstrated on VCUG; thus, pointing toward a diagnosis of obstructed refluxing megaureter.
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Affiliation(s)
- Pranav K Santhalia
- Department of Radiodiagnosis, All India Institute of Radiodiagnosis, New Delhi, India
| | - Disha Mittal
- Department of Radiodiagnosis, All India Institute of Radiodiagnosis, New Delhi, India
| | - Arun K Gupta
- Department of Radiodiagnosis, All India Institute of Radiodiagnosis, New Delhi, India
| | - Manisha Jana
- Department of Radiodiagnosis, All India Institute of Radiodiagnosis, New Delhi, India
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Tenkorang S, Omana JP, Mellas S, Tazi FM, El Ammari JE, Khallouk A, El Fassi MJ, Farih MH. Urolithiasis secondary to primary obstructive megaureter in an adult: a case report. J Med Case Rep 2017; 11:177. [PMID: 28666482 PMCID: PMC5493845 DOI: 10.1186/s13256-017-1342-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/01/2017] [Indexed: 11/15/2022] Open
Abstract
Background Primary obstructive megaureter is relatively uncommon in adults. This condition usually regresses spontaneously or is treated during infancy. It can remain asymptomatic for decades until adulthood when symptoms may manifest in the event of complications or during a routine radiologic imaging. Primary obstructive megaureter has been reported to favor stone formation in the upper urinary tract. Case presentation We present the case of a 35-year-old Moroccan man who had a 10-year history of intermittent left flank pain and hematuria. A computed tomography urogram revealed a left megaureter with giant ureteral and renal calculi. Conclusions Primary obstructive megaureter should be a differential diagnosis in an adult with hydroureteronephrosis associated with urolithiasis especially when there is kidney impairment. Through this case report we will discuss the diagnosis and management of primary obstructive megaureter associated with urolithiasis in adults.
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Affiliation(s)
- Somuah Tenkorang
- Department of urology, Hassan II University Hospital, Fez, Morocco.
| | - Jean-Paul Omana
- Department of urology, Hassan II University Hospital, Fez, Morocco
| | - Soufiane Mellas
- Department of urology, Hassan II University Hospital, Fez, Morocco
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Kajbafzadeh AM, Tourchi A. Concomitant endoureterotomy and dextranomer/hyaluronic acid subureteral injection for management of obstructive refluxing megaureter. J Endourol 2011; 26:318-24. [PMID: 22059739 DOI: 10.1089/end.2011.0256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To present the results of our experience with combined endoureterotomy and endoscopic injection of dextranomer/hyaluronic acid (Deflux) for the treatment of primary obstructive refluxing megaureter (PORM). PATIENTS AND METHODS Eighteen children (12 female, 6 male; mean age-14 months) with 20 PORM units underwent concomitant endoureterotomy and endoscopic subureteral Deflux injection. All patients underwent endoureterotomy at the 6-o'clock position with insertion of a 3F Double-J ureteral stent into the obstructed segment of ureter and subureteral injection of Deflux at the 5-o'clock and 7-o'clock positions. The Double-J stent was left in place with its distal tip fixed with a single knot to the external genitalia for easy removal after 1 week. Patients with refluxing nonobstructive ureter on the contralateral side of the PORM unit (seven children) underwent simultaneous endoscopic subureteral injection of Deflux. Voiding cystourethrography (VCUG) was performed at 6 months, and ultrasonography was performed at 1 week 3, 6, and 12 months postoperatively. RESULTS With a mean follow-up of 30 months, the procedure was uneventful in all patients. Follow-up VCUG showed no evidence of reflux in 15 ureterorenal (75%), significant decrease in reflux grade in 2 (10%), and no change in 3 (15%) in the endoscopic treated PORM units. No evidence of reflux was observed in the treated contralateral refluxing nonobstructive ureters. Ultrasonography revealed no ureterovesical junction obstruction. In 19 ureterorenal (95%) units, there was a complete resolution or decrease in hydroureteronephrosis. CONCLUSIONS The results of this study demonstrate that combined endoureterotomy and subureteral injection of Deflux is safe and effective in the treatment of PORM in selected patients.
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Affiliation(s)
- Abdol-Mohammad Kajbafzadeh
- Pediatric Urology Research Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.
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Somogyi R, Oberritter Z, Juhasz Z, Vajda P, Pinter AB. Combination of vesicoureteric reflux and vesicoureteric junction obstruction. ACTA ACUST UNITED AC 2009; 43:501-5. [PMID: 19968585 DOI: 10.3109/00365590903286671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study analysed the association of vesicoureteric reflux (VUR) and vesicoureteric junction obstruction (VUJO) requiring surgical interventions in infants and children. MATERIAL AND METHODS Over 30 years (1975-2004) 423 infants and children were operated on because of VUR, 163 owing to VUJO and 25 patients (33 ureters) with a combination of VUR and obstruction of the vesicoureteric junction on the same side. For both pathological entities ureteral reimplantation was performed along with excision of the narrowed and refluxing distal ureteric segment. The age of patients at surgery ranged from 3 months to 11 years (average 2.6 years). The female to male ratio was 1.4:1. RESULTS Out of the 25 patients (33 ureters), both entities were diagnosed before surgery in 10 of them (15 ureters). In 15 cases (18 ureters), only the VUR was preoperatively diagnosed; however, the VUJO was only suspected and confirmed during the operation. In one refluxing ureter, the obstruction was not diagnosed during subureteric endoscopic injection of the orifice. In five of the 33 ureters, redo reimplantation was necessary because of obstruction (four ureters) or reflux (one ureter). CONCLUSIONS A combination of VUR and VUJO should be taken into consideration in a patient with proven reflux, where the ureter is dilated and tortuous and following urination the hydronephrosis and hydroureter persist or slowly decrease. In such cases long-term prophylaxis and endoscopic treatment are contraindicated but open surgery (reimplantation) is recommended.
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Affiliation(s)
- Reka Somogyi
- Department of Paediatrics, University of Pécs, Pécs, Hungary
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Abstract
INTRODUCTION AND OBJECTIVE The sonographic diagnosis of vesicoureteral reflux (VUR) with contrast-enhanced voiding urosonography (VUS) is gradually increasing. With the introduction of VUS as part of the routine diagnostic imaging modalities for reflux significant reduction in the number of voiding cystourethrographies (VCUG) was possible. Like in VCUG grading of reflux in VUS is becoming more and more relevant. The aim of this study was to find out if there are any sonomorphologic and sonomorphometric parameters that would correlate with reflux grading in VCUG. Furthermore, a reflux grading system for VUS is proposed and the correlation of this grading system tested with the one of VCUG. PATIENTS AND METHODS In one examination session a total of 186 children underwent both VUS and VCUG of whom 89 had VUR in at least one and the same kidney-ureter-unit (KUU) in both diagnostic imagings. The VUS was conducted with intravesical administration of ultrasound (US) contrast medium (Levovist). Ureteral and pelvicalyceal dilatations before administration of US contrast medium and during reflux were documented. Renal pelvic diameter was measured. The density of microbubbles in the renal pelves was scored on a scale of 1-3 (low to high). A grading system for reflux in VUS was set up similar to the international reflux grading system for VCUG with the addition of one more differentiation parameter, namely whether the reflux was primarily in a dilated or non-dilated urinary tract. Reflux grades in VUS were compared with those in VCUG. RESULTS None of the sonomorphologic and sonomorphometric parameters demonstrated any clear cut finding that would simplify reflux grading in VUS. In 59/95 (62%) KUUs the reflux grades were the same in both examinations. In 10/95 (11%) and 26/95 (27%) KUUs, the reflux was graded lower or higher, respectively, in VUS than in VCUG. Fifty-seven percent were in a primarily dilated system and the remaining 43% in a non-dilated one. Seventy percent of KUUs diagnosed as having grade I reflux in VCUG, showed as grade 2 on VUS. CONCLUSIONS A reflux grading system similar to the one used in VCUG can be applied in VUS. Adding the parameter reflux into a primarily dilated or non-dilated ureter and/or pelvicalyceal system may bring in a further dimension to the reflux grading in VUS. Most of the refluxes labelled as grade I in VCUG are actually grade II or higher.
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Affiliation(s)
- Kassa Darge
- Department of Pediatric Radiology, Institute of Radiodiagnostic, University Children's Hospital, Josef-Schneiderstrasse 27/B34, 97080, Wuerzburg, Germany.
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Affiliation(s)
- A A Shokeir
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
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THE URODYNAMIC RELATIONSHIP OF RENAL PELVIC AND BLADDER PRESSURES, AND URINARY FLOW RATE IN RATS WITH CONGENITAL VESICOURETERAL REFLUX. J Urol 1998. [DOI: 10.1097/00005392-199807000-00068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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ANGELL SCOTTK, PRUTHI RAJS, SHORTLIFFE LINDAD. THE URODYNAMIC RELATIONSHIP OF RENAL PELVIC AND BLADDER PRESSURES, AND URINARY FLOW RATE IN RATS WITH CONGENITAL VESICOURETERAL REFLUX. J Urol 1998. [DOI: 10.1016/s0022-5347(01)63074-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- SCOTT K. ANGELL
- Department of Urology, Stanford University Medical Center, Stanford, California
| | - RAJ S. PRUTHI
- Department of Urology, Stanford University Medical Center, Stanford, California
| | - LINDA D. SHORTLIFFE
- Department of Urology, Stanford University Medical Center, Stanford, California
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Nguyen HT, Kogan BA. Upper urinary tract obstruction: experimental and clinical aspects. BRITISH JOURNAL OF UROLOGY 1998; 81 Suppl 2:13-21. [PMID: 9602791 DOI: 10.1046/j.1464-410x.1998.0810s2013.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- H T Nguyen
- Department of Urology, University of California School of Medicine, San Francisco, USA
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Abstract
Neonatal hydronephrosis is being detected with increasing frequency. The majority of these cases have a tendency to resolve during infancy. Hydronephrosis is an anatomical entity that is not synonymous with obstruction. Review of the pathoembryology, the pathophysiology, the diagnostic techniques currently used and the natural history of hydronephrosis is given. The management and the controversies involved are discussed.
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Affiliation(s)
- B M Tripp
- Department of Surgery, Montreal Children's Hospital, McGill University, Quebec, Canada
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Affiliation(s)
- B Blyth
- Division of Urology, Children's Hospital of Philadelphia, Pennsylvania
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Faccioli F. Tecnica E Complicanze Della Chirurgia Endoscopica Dell'Ostio Ureterale. Urologia 1985. [DOI: 10.1177/039156038505245s04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tokunaka S, Koyanagi T, Matsuno T, Gotoh T, Tsuji I. Paraureteral diverticula: clinical experience with 17 cases with associated renal dysmorphism. J Urol 1980; 124:791-6. [PMID: 6777506 DOI: 10.1016/s0022-5347(17)55667-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
We report our experience with 17 cases of paraureteral diverticula seen in the last 12 years. These 17 cases represent a particular group of patients with ureteral reflux in that they often had ureteral obstruction too. Early operative intervention is recommended. There is a trend towards renal dysmorphism and dysplasia as the position of the ureteral orifice laterlizes in the diverticulum. A paraureteral diverticulum was considered to be the developmental extravesical expansion of the terminal ureteral end by virtue of the caudally positioned ureteral bud in the wolffian duct.
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Abstract
Eight ureters in 6 male patients have been shown radiographically and dynamically to exhibit both reflux and obstruction. The greater the degree of obstruction the more dilated the upper urinary tract. Reflux may be considerable, but in severely obstructed ureters it may be minimal. Both urologists and radiologists should be aware of this unusual association. When it occurs patients should not be managed conservatively, but should have their ureters reimplanted.
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Abstract
The unusual combination of reflux and obstruction as seen in 8 of a series of 40 unduplicated ureters reimplanted for reflux is presented, with particular reference to the mechanical obstructing factors which can be demonstrated. These involve the extravesical rather than the intravesical ureter so that separate pathologic mechanisms for obstruction and reflux must be postulated. This unusual obstruction/reflux combination appears to be more common than is generally recognized, and the need for its early recognition and surgical correction contrasts with the less urgent indications for operative intervention in ureteric reflux alone.
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