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Birkemeier K. MR Imaging of the Fetal Genitourinary Tract. Magn Reson Imaging Clin N Am 2024; 32:529-551. [PMID: 38944439 DOI: 10.1016/j.mric.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
Fetal MR imaging overcomes many of the technical barriers of ultrasound and is an important diagnostic tool for fetal genitourinary (GU) anomalies. It is suited for evaluation of GU anomalies because of the fluid-sensitive sequences and superior soft tissue contrast. Often GU malformations are part of a multisystem genetic or congenital condition, and imaging the entire fetus with MR adds additional clarity about the extent of disease. It adds confidence to diagnoses of renal agenesis, urinary tract dilation, cystic disease, and tumors. It is particularly useful to delineate anatomy in complex GU malformations. This additional information guides counseling.
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Affiliation(s)
- Krista Birkemeier
- Department of Radiology, McLane Children's Medical Center, Baylor Scott & White Health, Texas A&M School of Medicine, 2401 South 31st Street, MS-01-W256, Temple, TX 76508, USA.
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Moradi B, Golezar MH, Mortazavi Ardestani R, Hassanzadeh S, Jannatdoust P, Banihashemian M, Batavani N. Ultrasound and magnetic resonance imaging features of fetal urogenital anomalies: A pictorial essay. Congenit Anom (Kyoto) 2024; 64:70-90. [PMID: 38586935 DOI: 10.1111/cga.12568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/27/2024] [Accepted: 03/21/2024] [Indexed: 04/09/2024]
Abstract
This pictorial essay focuses on ultrasound (US) and magnetic resonance imaging (MRI) features of fetal urogenital anomalies. Fetal urogenital malformations account for 30%-50% of all anomalies discovered during pregnancy or at birth. They are usually detected by fetal ultrasound exams. However, when ultrasound data on their characteristics is insufficient, MRI is the best option for detecting other associated anomalies. The prognosis highly depends on their type and whether they are associated with other fetal abnormalities.
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Affiliation(s)
- Behnaz Moradi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Yas Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Golezar
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
- Student Research Committee, Faculty of Medicine, Shahed University, Tehran, Iran
| | | | - Sara Hassanzadeh
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Payam Jannatdoust
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Banihashemian
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasim Batavani
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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He K, Wan D, Li S, Yuan G, Gao M, Han Y, Li Z, Hu D, Meng X, Niu Y. Non-contrast-enhanced magnetic resonance urography for measuring split kidney function in pediatric patients with hydronephrosis: comparison with renal scintigraphy. Pediatr Nephrol 2024; 39:1447-1457. [PMID: 38041747 DOI: 10.1007/s00467-023-06224-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Split kidney function (SKF) is critical for treatment decision in pediatric patients with hydronephrosis and is commonly measured using renal scintigraphy (RS). Non-contrast-enhanced magnetic resonance urography (NCE-MRU) is increasingly used in clinical practice. This study aimed to investigate the feasibility of using NCE-MRU as an alternative to estimate SKF in pediatric patients with hydronephrosis, compared to RS. METHODS Seventy-five pediatric patients with hydronephrosis were included in this retrospective study. All patients underwent NCE-MRU and RS within 2 weeks. Kidney parenchyma volume (KPV) and texture analysis parameters were obtained from T2-weighted (T2WI) in NCE-MRU. The calculated split KPV (SKPV) percent and texture analysis parameters percent of left kidney were compared with the RS-determined SKF. RESULTS SKPV showed a significant positive correlation with SKF (r = 0.88, p < 0.001), while inhomogeneity was negatively correlated with SKF (r = - 0.68, p < 0.001). The uncorrected and corrected prediction models of SKF were established using simple and multiple linear regression. Bland-Altman plots demonstrated good agreement of both predictive models. The residual sum of squares of the corrected prediction model was lower than that of the uncorrected model (0.283 vs. 0.314) but not statistically significant (p = 0.662). Subgroup analysis based on different MR machines showed correlation coefficients of 0.85, 0.95, and 0.94 between SKF and SKPV for three different scanners, respectively (p < 0.05 for all). CONCLUSIONS NCE-MRU can be used as an alternative method for estimating SKF in pediatric patients with hydronephrosis when comparing with RS. Specifically, SKPV proves to be a simple and universally applicable indicator for predicting SKF.
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Affiliation(s)
- Kangwen He
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Dongyi Wan
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shichao Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Guanjie Yuan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Mengmeng Gao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yunfeng Han
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaoyan Meng
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Yonghua Niu
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Wang D, Cui M, Chu X, Han X, Liu P, Zhao X, Fan Y. Risk factor of postoperative adverse events among children with duplex kidney undergoing upper pole heminephrectomy: a single-center experience. Front Pediatr 2024; 12:1305456. [PMID: 38742242 PMCID: PMC11089135 DOI: 10.3389/fped.2024.1305456] [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: 10/01/2023] [Accepted: 04/03/2024] [Indexed: 05/16/2024] Open
Abstract
Objective The aim of this study was to identify the risk factors for postoperative adverse events in children with duplex kidney undergoing upper pole heminephrectomy. Methods We collected clinical data from pediatric patients with duplex kidney who underwent upper pole heminephrectomy. Based on the presence or absence of postoperative adverse events, the patients were divided into two groups: an adverse events group (n = 16) and a non- adverse events group (n = 37), using multivariate logistic regression analysis to screen for independent risk factors for postoperative adverse events. Results Through univariate and multivariate analysis, we found that the presence of upper renal ureterocele (P = 0.042, OR = 7.116, 95% CI 1.073-47.172), as well as the presence of accessory renal artery type (P = 0.016, OR = 10.639, 95% CI 1.551-72.978) and other types (P = 0.039, OR = 3.644, 95% CI 0.351-37.836) as the upper kidney's blood supply artery increase the risk of postoperative adverse events, with these differences being statistically significant. Conclusions In pediatric patients with duplex kidney undergoing upper pole heminephrectomy, the presence of upper renal ureterocele and the presence of accessory renal artery type and other types as the upper kidney's blood supply artery are independent risk factors for postoperative adverse events.
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Affiliation(s)
- Denghui Wang
- Department of Pediatric Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengjie Cui
- Department of Pediatric Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiangyang Chu
- Department of Pediatric Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaojiang Han
- Department of Pediatric Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Pengpeng Liu
- Department of Pediatric Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiang Zhao
- Department of Pediatric Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingzhong Fan
- Department of Pediatric Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Flogelova H, Bouchalova K, Smakal O, Halek J, Langova K, Cizkova K. Early diagnosis of solitary functioning kidney: comparing the prognosis of kidney agenesis and multicystic dysplastic kidney. Pediatr Nephrol 2024:10.1007/s00467-024-06360-2. [PMID: 38622348 DOI: 10.1007/s00467-024-06360-2] [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: 12/19/2023] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Individuals with congenital solitary functioning kidney (SFK) are at an increased risk of kidney damage. According to some studies, the risk is higher in unilateral kidney agenesis (UKA) than in unilateral multicystic dysplastic kidney (UMCDK). We hypothesized that with early detection of children with UKA and UMCDK, there would be no difference in the presence of hypertension, proteinuria, and reduced glomerular filtration rate (GFR) between UKA and UMCDK. METHODS Based on a long-term follow-up protocol, we evaluated a cohort of 160 children followed from birth for SFK (84 with UKA and 76 with UMCDK) detected by prenatal or routine neonatal ultrasound screening. Hypertension, proteinuria, and reduced GFR were monitored as markers of kidney damage. We compared the characteristics and outcomes of the subgroups of children with UKA and UMCDK. RESULTS GFR was reduced in 42 (26.2%) children, of whom 41 showed only mild reduction. Hypertension and proteinuria were found in 22 (13.8%) and 14 (8.8%) children, respectively. Combined kidney damage was present in 57 (35.6%) children. The UMCDK and UKA subgroups differed in GFR at final examination, with UMCDK patients being significantly more likely to have normal GFR compared to UKA patients (82% vs. 67%; p = 0.039). CONCLUSIONS One third of the children showed signs of SFK damage, albeit mild. Patients with UKA had reduced GFR significantly more often than those with UMCDK, but did not differ in the rates of hyperfiltration injury or congenital anomalies of the kidneys and urinary tract (CAKUT) in SFK.
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Affiliation(s)
- Hana Flogelova
- Department of Pediatrics, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Zdravotniku 248/7, 779 00, Olomouc, Czech Republic.
| | - Katerina Bouchalova
- Department of Pediatrics, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Zdravotniku 248/7, 779 00, Olomouc, Czech Republic
| | - Oldrich Smakal
- Department of Urology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Jan Halek
- Department of Neonatology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Katerina Langova
- Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Katerina Cizkova
- Department of Histology and Embryology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
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Zohar Y, Sivan B, Mintz I, Hefer B, Rouvinov K, Shani Shrem N, Mabjeesh NJ. Management of Upper Tract Urothelial Carcinoma in a Double Collecting System Kidney. J Pers Med 2024; 14:158. [PMID: 38392591 PMCID: PMC10890684 DOI: 10.3390/jpm14020158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 02/24/2024] Open
Abstract
Upper tract urothelial carcinoma (UTUC) in a duplex collecting system (DCS) is a relatively uncommon presentation with unclear management guidelines. Herein, we retrospectively reviewed all published cases of DCS with UTUC aiming to suggest personalized clinical care options for future cases. We conducted a systematic search for all cases of UTUC in DCS from published literature using the following keywords: UTUC, urothelial carcinoma (UC), collecting duct carcinoma, and DCS. The cases were summarized based on demographics, clinical presentation, predisposing risk factors, tumor location, management, and follow-up. We present an additional case based on our experience with a 69-year-old female with high-grade (HG) UTUC of the upper moiety in complete DCS. The patient underwent a robotic upper pole hemi-nephroureterectomy (hemi-NU) with a common sheath distal ureterectomy and a bladder cuff, followed by lower pole ureteral reimplantation. Overall, 34 patients with 35 renal units of UTUC in DCS were included and analyzed. To conclude, UTUC of DCS is rare and underreported. Hence, it is difficult to define a standard treatment. Although hemi-NU has been previously described, to the best of our knowledge, this is the first case report of robot-assisted hemi-NU for complete DCS with single-moiety UC.
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Affiliation(s)
- Yarden Zohar
- Department of Urology, Soroka University Medical Center, Faculty of Health Science, Ben-Gurion University of Negev, P.O. Box 151, Be'er Sheva 84101, Israel
| | - Bezalel Sivan
- Department of Urology, Soroka University Medical Center, Faculty of Health Science, Ben-Gurion University of Negev, P.O. Box 151, Be'er Sheva 84101, Israel
| | - Ishai Mintz
- Department of Urology, Soroka University Medical Center, Faculty of Health Science, Ben-Gurion University of Negev, P.O. Box 151, Be'er Sheva 84101, Israel
| | - Ben Hefer
- Department of Urology, Soroka University Medical Center, Faculty of Health Science, Ben-Gurion University of Negev, P.O. Box 151, Be'er Sheva 84101, Israel
| | - Keren Rouvinov
- The Legacy Heritage Oncology Center, Dr. Larry Norton Institute, Soroka University Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, P.O. Box 151, Be'er Sheva 84101, Israel
| | - Noa Shani Shrem
- The Legacy Heritage Oncology Center, Dr. Larry Norton Institute, Soroka University Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, P.O. Box 151, Be'er Sheva 84101, Israel
| | - Nicola J Mabjeesh
- Department of Urology, Soroka University Medical Center, Faculty of Health Science, Ben-Gurion University of Negev, P.O. Box 151, Be'er Sheva 84101, Israel
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Liu X, Li X, Liao L. Abnormal urodynamic changes in post-upper urinary tract dysfunction in ureteral obstruction rat models. Front Physiol 2024; 15:1341220. [PMID: 38362490 PMCID: PMC10867635 DOI: 10.3389/fphys.2024.1341220] [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] [Received: 11/20/2023] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Objects: This study investigated changes in upper urinary tract urodynamics (UUTU) after upper urinary tract dysfunction (UUTD). Methods: The UUTD model was induced through unilateral ureteral obstruction. To measure the renal pelvis volume, and resting pressure. Ureteral electromyography (EMG) and in situ ureteral constriction experiments were performed. Ureteral tissue was obtained for HE and masson staining, IF staining and IHC research to explore the distribution of Piezo1, and the expression of Piezo1 was studied using Western blotting. Results: The study showed that the renal pelvis volumes and the renal pelvis resting pressures gradually increased post surgery in the experimental group. The degree of ureteral tissue edema, cell necrosis and fibrosis gradually increased. The maximum contraction force and frequency of ureter in the experimental group post surgery were significantly higher than in the sham group. Western blotting showed that the expression intensity of Piezo1 gradually increased and was significantly higher than in the sham group. Further analysis of each sub-layer of the ureter revealed that Piezo1 was highly expressed in the urothelium layer, followed by the suburothelium layer, and had low expression in the smooth muscle cell layer. Conclusion: The study observed that morphological and electrophysiological changes in the upper urinary tract may be important mechanisms of abnormal UUTU. Increased expression of the Piezo1 may be a new molecular mechanism of abnormal urodynamics after UUTD.
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Affiliation(s)
- Xin Liu
- Shandong University, Jinan, Shandong, China
- Department of Urology, China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, China
- University of Health and Rehabilitation Sciences, Qingdao, Shandong, China
- China Rehabilitation Science Institute, Beijing, China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Xing Li
- Department of Urology, China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, China
- School of Rehabilitation, Capital Medical University, Beijing, China
| | - Limin Liao
- Shandong University, Jinan, Shandong, China
- Department of Urology, China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, China
- University of Health and Rehabilitation Sciences, Qingdao, Shandong, China
- China Rehabilitation Science Institute, Beijing, China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
- School of Rehabilitation, Capital Medical University, Beijing, China
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Griffith AM, Woodward PJ, Kennedy AM. Troubleshooting Tips for Diagnosing Complex Fetal Genitourinary Malformations. Radiographics 2024; 44:e230084. [PMID: 38127660 DOI: 10.1148/rg.230084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Fetal genitourinary anomalies can present a diagnostic challenge for the radiologist. The absence of a normally located kidney may represent agenesis or be secondary to a fusion or migration abnormality. A dilated renal pelvis should prompt evaluation for a specific cause, including ureteropelvic junction obstruction, reflux, or an obstructed duplicated system. Cystic parenchymal changes are characteristic of a multicystic dysplastic kidney but may also be seen in obstructive cystic dysplasia. There are numerous causes of megacystis including chromosomal (trisomy 18 syndrome), obstruction (posterior urethral valves, urethral atresia), or muscular dysfunction (prune belly syndrome, megacystis microcolon intestinal hypoperistalsis syndrome). Important mimics of a large bladder include hydrocolpos and urogenital sinus or cloacal malformation. Complications of genitourinary malformations are common and include oligohydramnios, urinary ascites, and urinoma. Making an accurate diagnosis often requires additional US views beyond those obtained in the standard fetal survey and occasionally performing fetal MRI. The appropriate use of orthogonal T2-weighted sequences, in conjunction with diffusion-weighted images for evaluation of the kidneys and gradient-recalled-echo sequences for evaluation of T1-hyperintense meconium in the colon, can play an integral role in diagnosis. Accurate diagnosis of fetal genitourinary malformations is vital to direct patient counseling and pregnancy management as outcomes are highly variable. Some conditions can be surgically corrected quite simply, some require multiple complex procedures, and some are lethal. The authors offer troubleshooting tips to narrow the differential diagnosis for four observations: unilateral absent kidney, dilated renal pelvis, cystic renal parenchyma, and megacystis and its mimics. ©RSNA, 2023 Test Your Knowledge questions are available in the Online Learning Center.
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Affiliation(s)
- April M Griffith
- From the Department of Radiology and Imaging Sciences, University of Utah Health, 30 N Mario Capecchi Dr, 2nd Floor South, Salt Lake City, UT 84112
| | - Paula J Woodward
- From the Department of Radiology and Imaging Sciences, University of Utah Health, 30 N Mario Capecchi Dr, 2nd Floor South, Salt Lake City, UT 84112
| | - Anne M Kennedy
- From the Department of Radiology and Imaging Sciences, University of Utah Health, 30 N Mario Capecchi Dr, 2nd Floor South, Salt Lake City, UT 84112
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Humphries A, Speroni S, Eden K, Nolan M, Gilbert C, McNamara J. Horseshoe kidney: Morphologic features, embryologic and genetic etiologies, and surgical implications. Clin Anat 2023; 36:1081-1088. [PMID: 36708162 DOI: 10.1002/ca.24018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 01/29/2023]
Abstract
The horseshoe kidney (HSK) is the most common congenital abnormality of the upper urinary tract with an incidence of approximately 1 in 500 in the general population. Although individuals with HSK are often asymptomatic, they are at increased risk for neoplasms, infections, ureteropelvic obstruction secondary to lithiasis or vascular compression. Direct injury from trauma is increased in these individuals as is the risk of intraoperative complications secondary to damage involving the typically complex renal or adrenal vascular supply. We briefly review etiological factors including renal and urinary system embryology, genetic mutations, abnormalities related to faulty cell signaling, aberrant cell migration, and other possible causes including environmental exposures and trauma. In addition, we call attention to factors that might influence the success of surgical procedures in patients with HSK. We argue that an understanding of possible etiologies of the HSK and its different subtypes may be useful when planning surgical procedures or considering risk-benefit ratios associated with different surgical options. We briefly present the organization of a HSK in a 100-year-old male demonstrating an unusual vascular supply discovered during a dissection laboratory session in a medical school anatomy course. We describe the structure of the HSK, the position and relationships of the HSK to other structures within the abdomen, and the associated vascular relationships.
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Affiliation(s)
- Audrey Humphries
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Samantha Speroni
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Kristin Eden
- Department of Basic Sciences Education, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Michael Nolan
- Department of Basic Sciences Education, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Carol Gilbert
- Department of Basic Sciences Education, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - John McNamara
- Department of Basic Sciences Education, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
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Kovačević N, Hočevar M, Vivod G, Merlo S. Vascular and Urinary Tract Anatomic Variants Relevant to Para-Aortic Lymphadenectomy in Women with Gynecological Cancers. Cancers (Basel) 2023; 15:4959. [PMID: 37894326 PMCID: PMC10605252 DOI: 10.3390/cancers15204959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/08/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Para-aortic lymphadenectomy is an essential part of gynecologic oncologic surgical treatment. The surgeon should be aware of the complex usual anatomy and its common variants. METHODS Between January 2021 and May 2023, 58 women underwent para-aortic lymphadenectomy for gynecologic malignancies. RESULTS Vascular and urinary tract anatomic variants were retrospectively reviewed from the prospective institutional database and results were compared with preoperative contrast-enhanced abdominal CT. Of these 58 women, 47 women had no vascular or urinary tract variants. One woman had a double inferior vena cava, two patients were found to have a retro-aortic left renal vein, four had accessory renal arteries, two had a double left ureter, one had a ptotic kidney in the iliac fossa, and one patient had bilateral kidney malrotation. Anatomic variants in the preoperative CT were described by a radiologist in only two patients, and additional vascular and urinary tract variants were found incidentally at the time of surgery. CONCLUSIONS Acknowledgment of vascular and urinary tract variants is helpful for the surgeon to establish an appropriate surgical plan and to avoid iatrogenic surgical trauma.
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Affiliation(s)
- Nina Kovačević
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (N.K.); (M.H.); (G.V.)
- Faculty of Medicine, University of Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia
- Faculty of Health Care Angela Boškin, Spodnji Plavž 3, 4270 Jesenice, Slovenia
| | - Marko Hočevar
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (N.K.); (M.H.); (G.V.)
- Faculty of Medicine, University of Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia
| | - Gregor Vivod
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (N.K.); (M.H.); (G.V.)
- Faculty of Medicine, University of Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia
| | - Sebastjan Merlo
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (N.K.); (M.H.); (G.V.)
- Faculty of Medicine, University of Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia
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Corrales M, Sierra A. Retrograde intrarenal surgery for stones associated with renal anomalies: caliceal diverticulum, horseshoe kidney, medullary sponge kidney, megacalycosis, pelvic kidney, uretero-pelvic junction obstruction. Curr Opin Urol 2023; 33:318-323. [PMID: 37014757 DOI: 10.1097/mou.0000000000001093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
PURPOSE OF REVIEW Nowadays, due to the increase of imaging diagnosis, we identify easily renal anomalies, and we can choose between a wide range of armamentarium to treat symptomatic stones in those challenging cases. However, there is a lack of evidence and consensus on its use. The aim of this narrative review is to collect all the available data about safety and efficacity of retrograde intrarenal surgery (RIRS) in the treatment of kidney stones associated to a renal anomaly. RECENT FINDINGS Renal anomalies are uncommon findings and even more if it has to be associated with renal stones. After a literature review of the past 2 years, there are a small number of studies that compare the outcomes in patients who have been treated with minimally invasive modalities and they are mainly focus on RIRS. SUMMARY It is of extreme importance to know the advances on the stone treatment in anomalous kidneys. With the development of new laser technologies, RIRS is becoming a more interesting technique with high success rate and safety. Further studies are needed to make an accurate statement about the adequate surgical technique for each renal anomaly and also, clinical trials using new laser technologies.
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Affiliation(s)
- Mariela Corrales
- Sorbonne University GRC Urolithiasis no. 20 Tenon Hospital Sorbonne University, Department of Urology AP-HP, Tenon Hospital, Paris, France
| | - Alba Sierra
- Department of Urology, Hospital Clinic, University of Barcelona, Barcelona, Spain
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12
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Zheng Y, Wang Y, Ren S, Wang D. Crossed fused renal ectopia with hydronephrosis: A case report. Asian J Surg 2023:S1015-9584(23)00240-3. [PMID: 36990817 DOI: 10.1016/j.asjsur.2023.02.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/15/2023] [Indexed: 03/29/2023] Open
Affiliation(s)
- Yang Zheng
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610054, China; Department of Robotic Minimally Invasive Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Yaoqian Wang
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610054, China; Department of Robotic Minimally Invasive Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Shangqing Ren
- Department of Robotic Minimally Invasive Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, 610072, China.
| | - Dong Wang
- Department of Robotic Minimally Invasive Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, 610072, China.
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Huang R, Tian J, Jiang W. Pure laparoscopic radical nephroureterectomy for complicated renal pelvis carcinoma combined with horseshoe kidney: A case report and literature review. Front Oncol 2022; 12:1030626. [DOI: 10.3389/fonc.2022.1030626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022] Open
Abstract
We reported a case of pure laparoscopic radical nephroureterectomy for complicated renal pelvis carcinoma combined with horseshoe kidney (HSK). The aim was to present a case report and review of the literature about renal pelvis carcinoma combined with HSK. The case report includes a history of patient data. The pure laparoscopic radical nephroureterectomy was provided with the informed consent of the patient. A 53-year-old patient was diagnosed with a right renal pelvis mass with HSK. We performed laparoscopic radical nephroureterectomy with partial cystectomy and horseshoe renal isthmus amputation. Histopathological features, computed tomography urography (CTU), and angiography (CTA) confirmed the diagnosis of renal pelvis carcinoma combined with HSK. The tumor was removed, and the patient had an uneventful recovery. Renal pelvis carcinoma combined with HSK is a rare case. Due to severe anatomical abnormalities, this disease is a major challenge for urologists. We share our successful case for readers to learn from.
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14
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Madaan PK, Ghasi RG. Conventional uroradiology with excretory urography: a forgotten art? Br J Radiol 2022; 95:20210949. [PMID: 34990261 PMCID: PMC9153722 DOI: 10.1259/bjr.20210949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Excretory urography (EU) had been the most frequently performed imaging modality for uroradiology in the past. With the advances in ultrasonography, and development of cross-sectional urography with CT and MRI, EU is now seldom performed. Consequently, there has been a decline of expertise in this technique. However, EU has multiple advantages such as dynamic nature, easy availability, low cost and radiation burden. These render it potentially very valuable in specific indications like congenital anomalies, urothelial lesions and urinary leaks. This review intends to emphasize the current day relevance of excretory urography, outline the key points of the technique, and describe the pearls and pitfalls of interpretation.
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Affiliation(s)
| | - Rohini Gupta Ghasi
- Department of Radiodiagnosis, VMMC and Safdarjung Hospital, New Delhi, India
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15
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Acharya PT, Ponrartana S, Lai L, Vasquez E, Goodarzian F. Imaging of congenital genitourinary anomalies. Pediatr Radiol 2022; 52:726-739. [PMID: 34741177 DOI: 10.1007/s00247-021-05217-2] [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: 04/09/2021] [Revised: 08/12/2021] [Accepted: 10/05/2021] [Indexed: 11/29/2022]
Abstract
Congenital genitourinary anomalies are among the most frequent types of birth defects in neonates. Some anomalies can be a significant cause of morbidity in infancy, while others remain asymptomatic even until adulthood and can be at times the only manifestation of a complex systemic disease. The spectrum of these anomalies results from the developmental insults that can occur at various embryologic stages, and an understanding of the formation of the genitourinary system is helpful in the evaluation and treatment of a child with a congenital genitourinary anomaly. Imaging plays an essential role in the diagnosis of congenital genitourinary anomalies and treatment planning. In this article, we highlight the embryologic and characteristic imaging features of various congenital genitourinary anomalies, demonstrate the utility of different imaging modalities in management, and review specific imaging modalities and protocols for image optimization.
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Affiliation(s)
- Patricia T Acharya
- Department of Radiology, Children's Hospital Los Angeles, 4650 Sunset Blvd., Mailstop #81, Los Angeles, CA, 90027, USA. .,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. .,Loma Linda University School of Medicine, Loma Linda, CA, USA.
| | - Skorn Ponrartana
- Department of Radiology, Children's Hospital Los Angeles, 4650 Sunset Blvd., Mailstop #81, Los Angeles, CA, 90027, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lillian Lai
- Department of Radiology, Children's Hospital Los Angeles, 4650 Sunset Blvd., Mailstop #81, Los Angeles, CA, 90027, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Evalynn Vasquez
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Urology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Fariba Goodarzian
- Department of Radiology, Children's Hospital Los Angeles, 4650 Sunset Blvd., Mailstop #81, Los Angeles, CA, 90027, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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