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Rivetti G, Marzuillo P, Guarino S, Di Sessa A, La Manna A, Caldamone AA, Papparella A, Noviello C. Primary non-refluxing megaureter: Natural history, follow-up and treatment. Eur J Pediatr 2024; 183:2029-2036. [PMID: 38441661 PMCID: PMC11035438 DOI: 10.1007/s00431-024-05494-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/17/2024] [Accepted: 02/23/2024] [Indexed: 04/23/2024]
Abstract
Primary non-refluxing megaureter (PMU) is a congenital dilation of the ureter which is not related to vesicoureteral reflux, duplicated collecting systems, ureterocele, ectopic ureter, or posterior urethral valves and accounts for 5 to 10% of all prenatal hydronephrosis (HN) cases. The etiology is a dysfunction or stenosis of the distal ureter. Most often PMU remains asymptomatic with spontaneous resolution allowing for non-operative management. Nevertheless, in selective cases such as the development of febrile urinary tract infections, worsening of the ureteral dilatation, or reduction in relative renal function, surgery should be considered. CONCLUSION Ureteral replantation with excision of the dysfunctional ureteral segment and often ureteral tapering is the gold-standard procedure for PMU, although endoscopic treatment has been shown to have a fair success rate in many studies. In this review, we discuss the natural history, follow-up, and treatment of PMU. WHAT IS KNOWN • PMU is the result of an atonic or stenotic segment of the distal ureter, resulting in congenital dilation of the ureter, and is frequently diagnosed on routine antenatal ultrasound. WHAT IS NEW • Most often, PMU remains asymptomatic and clinically stable, allowing for non-operative management. • Nevertheless, since symptoms can appear even after years of observation, long-term ultrasound follow-up is recommended, even up to young adulthood, if hydroureteronephrosis persists. • Ureteral replantation is the gold standard in case surgery is needed. In selected cases, however, HPBD could be a reasonable alternative.
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Affiliation(s)
- Giulio Rivetti
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Pierluigi Marzuillo
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy.
| | - Stefano Guarino
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Anna Di Sessa
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Angela La Manna
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Anthony A Caldamone
- Division of Urology, Warren Alpert School of Medicine at Brown University/Hasbro Children's Hospital, Providence, RI, USA
| | - Alfonso Papparella
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Carmine Noviello
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
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Isac GV, Danila GM, Ionescu SN. Spontaneous resolution and the role of endoscopic surgery in the treatment of primary obstructive megaureter: a review of the literature. Pediatr Med Chir 2023; 45. [PMID: 38112615 DOI: 10.4081/pmc.2023.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023] Open
Abstract
The megaureter accounts for almost a quarter of all urinary tract dilations diagnosed in utero and is the second leading cause of hydronephrosis in newborns, following pyeloureteral junction obstruction. The current standard treatment for progressive or persistent, symptomatic primary obstructive megaureter is ureteral anti-reflux reimplantation, which can be associated with ureteral remodeling or plication. Due to the associated morbidity, postoperative recovery challenges, and the complications that may arise from the open surgical approach, there has been a natural inclination towards validating new minimally invasive techniques. This study reviews the literature, extracting data from three major international databases, from 1998 to 2022. Out of 1172 initially identified articles, only 52 were deemed eligible, analyzing 1764 patients and 1981 renal units. Results show that 65% of cases required surgical intervention, with minimally invasive techniques constituting 56% of these procedures. High-pressure endoscopic balloon dilation was the preferred endourologic technique. The degree of ureterohydronephrosis is considered one of the factors indicating the need for surgery. There is an inverse relationship between the diameter of the ureter and the likelihood of spontaneous resolution. Conditions such as renal hypoplasia, renal dysplasia, or ectopic ureteral insertion strongly indicate a poor prognosis. Endoscopic surgical techniques for treating primary obstructive megaureter can be definitive, firstline treatment options. In selected cases, they might be at least as effective and safe as the open approach, but with advantages like quicker recovery, fewer complications, shorter hospital stays, and reduced costs.
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Affiliation(s)
| | - Gabriela Mariana Danila
- Department of Pediatric Surgery and Urology, Maria Sklodowska Curie Emergency Children Hospital, Bucharest.
| | - Sebastian Nicolae Ionescu
- Department of Pediatric Surgery and Urology, Maria Sklodowska Curie Emergency Children Hospital, Bucharest.
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Ishikawa K. Pyelonephritis with Anomaly of the Ureter and Calculi. Intern Med 2023; 62:3561-3562. [PMID: 37062743 PMCID: PMC10749808 DOI: 10.2169/internalmedicine.1658-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/06/2023] [Indexed: 04/18/2023] Open
Affiliation(s)
- Kazuhiro Ishikawa
- Department of Infectious Diseases, Tokyo Medical University Ibaraki Medical Center, Japan
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Oshima K, Matsumoto F, Matsuyama S, Matsui F. A Case of Solitary Kidney and Single-system Ectopic Ureter Draining Into the Vestibule in an Infant With Müllerian Duct Defect: Was the Bladder Missing? Urology 2023; 181:144-146. [PMID: 37579854 DOI: 10.1016/j.urology.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 08/16/2023]
Abstract
We report a case of a solitary kidney and a single-system ectopic ureter draining into the vestibule in an infant with a Müllerian duct defect. Due to the absence of the upper vagina and uterus, an extremely underdeveloped bladder masqueraded as the vagina, and bladder agenesis was suspected preoperatively. Urinary continence was achieved using staged bladder surgery without augmentation or urinary diversion.
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Affiliation(s)
- Koichi Oshima
- Department of Urology, Osaka Woman's and Children's Hospital, Izumi, Osaka, Japan
| | - Fumi Matsumoto
- Department of Urology, Osaka Woman's and Children's Hospital, Izumi, Osaka, Japan.
| | - Satoko Matsuyama
- Department of Urology, Osaka Woman's and Children's Hospital, Izumi, Osaka, Japan
| | - Futoshi Matsui
- Department of Urology, Osaka Woman's and Children's Hospital, Izumi, Osaka, Japan
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Joshi SS, Dhok AP, Mitra KR, Onkar PM. A rare case of right renal ectopia with ureteral triplication in a 37-year-old male: a case report. Pan Afr Med J 2023; 45:169. [PMID: 37900202 PMCID: PMC10611906 DOI: 10.11604/pamj.2023.45.169.38444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 08/02/2023] [Indexed: 10/31/2023] Open
Abstract
Ureteral triplication is one of the least encountered congenital malformations of the upper urinary tract. We report a case of a 37-year-old male patient with right renal ectopia with triplication of the ureter which was diagnosed via computed tomography (CT) urography. This is an intriguing example because, as we discovered after reviewing the literature, the presentation is distinctive.
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Affiliation(s)
- Sejal Sanjeev Joshi
- Department of Radiodiagnosis, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, India
| | - Avinash Parashuram Dhok
- Department of Radiodiagnosis, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, India
| | - Kajal Ramendranath Mitra
- Department of Radiodiagnosis, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, India
| | - Prashant Madhukar Onkar
- Department of Radiodiagnosis, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, India
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Nakamura M, Kanda S, Kajiho Y, Hinata M, Tomonaga K, Fujishiro J, Harita Y. A case of right hypodysplastic kidney and ectopic ureter associated with bicornuate uterus in a prepubertal girl. CEN Case Rep 2023; 12:122-129. [PMID: 36056295 PMCID: PMC9892399 DOI: 10.1007/s13730-022-00730-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 08/18/2022] [Indexed: 02/05/2023] Open
Abstract
Congenital anomalies of the kidney and urinary tract (CAKUT) are frequently associated with Mullerian anomalies. This can be explained by the fact that Mullerian duct elongation depends on the preformed Wolffian duct during embryogenesis. While CAKUT such as unilateral renal agenesis and multicystic dysplastic kidney are commonly identified prenatally by routine ultrasound, the diagnosis of Mullerian anomalies is often delayed, increasing the risk of complications such as endometriosis or pelvic inflammatory disease. Herein, we report a case of a premenarchal girl who had initially been diagnosed with right multicystic dysplastic kidney. She presented with continuous urinary incontinence at 4 years old and further evaluation by contrast-enhanced computed tomography, cystoscopy, colposcopy, ureterography, and hysterosalpingography led to the final diagnosis of right hypodysplastic kidney and ectopic ureter associated with bicornuate uterus. A strong family history of uterine malformations prompted the examination of the uterus. Genetic testing was suggested but the family declined. She is planned to be referred to a gynecologist at puberty for further assessment. The recognition and screening rate of concurrent Mullerian anomalies in CAKUT patients varies between institutions. Screening for Mullerian anomalies in prediagnosed CAKUT girls may enable to provide timely counseling and to prevent gynecological complications.
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Affiliation(s)
- Misako Nakamura
- Department of Pediatrics, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shoichiro Kanda
- Department of Pediatrics, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Yuko Kajiho
- Department of Pediatrics, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Munetoshi Hinata
- Department of Pathology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kotaro Tomonaga
- Department of Pediatric Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Jun Fujishiro
- Department of Pediatric Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yutaka Harita
- Department of Pediatrics, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Deeg KH. Sonographic differential diagnosis of duplex kidneys. Ultraschall Med 2022; 43:332-353. [PMID: 35488089 DOI: 10.1055/a-1749-5136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Duplex kidneys have two renal pelvises and two ureters, which can join on the way to the urinary bladder but can also enter the bladder separately. A distinction must be made between normal and pathological duplex kidneys. In normal duplex kidneys, both renal pelvises are normal in width, and the upper and lower poles are approximately the same size. Furthermore, ureters are not dilated, and the upper and lower poles of the kidneys are not cystically altered. In contrast, pathological duplex kidneys, occurring in about 50 % of cases, are characterized by dilation of one or both renal pelvises. Additionally, one or both ureters may be dilated. Megaureters may be obstructive or refluxive. If a megaureter is present, a ureterocele must be ruled out, as well as an ectopically opening ureter. A pathological duplex kidney must always be assumed if one pole of the kidney is hypoplastic. Hypoplasia of the upper renal pole is often associated with an obstructive megaureter. Vesicoureteral reflux into the lower pyelon is common in hypoplasia of the lower pole. In the presence of vesicoureteral reflux, the associated (lower) pyelon is dilated when the bladder is full or during micturition. In addition, there is a dilated ureter. On the other hand, the pyelon can have a normal width when the bladder is empty. In rare cases, one pole may be cystically altered in pathological duplex kidneys. In this instance, segmental multicystic dysplastic duplex kidney must be differentiated from segmental multicystic nephroma.
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Affiliation(s)
- Karl-Heinz Deeg
- Pediatric Clinic, University of Erlangen/Nuremberg, Erlangen, Germany
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8
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Kogan MI, Sizonov VV. [Bradis anti-reflux ureterocysto-anastomosis in children with recurrent obstructive megaureter]. Urologiia 2022:5-10. [PMID: 35485808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Congenital ureterovesical junction (UVJ) obstructions quite rarely serve as an indication for ureteral reimplantation, and recurrent obstructions resulting from surgical treatment are even less frequent. Cases of acquired UVJ obstruction following endoscopy and ureteral reimplantation done for vesicoureteral reflux correction are fairly rare. The lack of known publications analyzing treatment of recurrent obstructive megaureter predetermines topicality of our research. PURPOSE Evaluate the efficiency and safety of extravesical anti-reflux uretero-cysto-anastomosis performed using Bradis technique for children with recurrent obstructive megaureter (OM). MATERIALS AND METHODS The work is based on the experience of surgical OM correction in 5 children aged 1 to 4 years, 4 boys and a girl with a recurrent UVJ obstruction following prior ureteral reimplantation for correction of UVJ obstruction (4 children) or vesicoureteral reflux (1 patient). Antenatal UVJ obstruction had been diagnosed in 2 patients. In all cases the examination included urine analysis, its culture study, ultrasonography of the kidneys and urinary tracts, dynamic renal scintigraphy, micturating cystography, and, where indicated, intravenous urography and SCT of the kidneys. All patients underwent Bradis extravesical reimplantation. RESULTS During postoperative care period, a considerable reduction of the dilatation of renal collecting system was accomplished in all five patients along with the differential renal function preserved on the pre-surgery level and a steady remission of urinary tract infection based on clinical manifestations and laboratory findings. CONCLUSIONS The simplicity of Bradis extravesical ureteral reimplantation represents its advantage over intravesical methods. Extravesical approach allows easy ureteral length and width correction. Limited experience of Bradis surgery in pediatric cases of recurrent OM requires confirmation with further randomized clinical trials.
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Affiliation(s)
- M I Kogan
- Rostov State Medical University of the Russian Federation Ministry of Public Health, Rostov-on-Don, Russia
- Rostov Regional Childrens Clinical Hospital, Rostov-on-Don, Russia
| | - V V Sizonov
- Rostov State Medical University of the Russian Federation Ministry of Public Health, Rostov-on-Don, Russia
- Rostov Regional Childrens Clinical Hospital, Rostov-on-Don, Russia
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9
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Maruyama T, Mizuno K, Nishio H, Kato T, Hamakawa T, Ikegami Y, Yasui T, Hayashi Y. Antireflux endoscopic injection therapy in post-pubertal patients via techniques adopted for the dilated ureteral orifice: a retrospective single-center study. BMC Urol 2021; 21:70. [PMID: 33894751 PMCID: PMC8067324 DOI: 10.1186/s12894-021-00842-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/06/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND To investigate the efficacy and safety of endoscopic injection therapy for vesicoureteral reflux in post-pubertal patients with dilated ureteral orifice via modified hydrodistension implantation techniques. METHODS We retrospectively reviewed medical records including operational procedure and clinical course of all consecutive patients over 12 years old with a history of injection therapy. Endoscopic injection of dextranomer/hyaluronic acid copolymer was performed under hydrodistension implantation technique with some modifications in order to inject through dilated ureteral orifice align with the intramural ureter. Technical selections were done according to hydrodistension grade of the ureteral orifice. Voiding cystourethrography was evaluated at 3 months postoperatively. Hydronephrosis was evaluated using ultrasonography preoperatively until 6 months postoperatively. RESULTS From 2016 to 2019, 12 patients (all female, 16 ureteral units; median age 32 [range 15-61] years) underwent endoscopic injection therapy at one of our institutions. We have identified grade II vesicoureteral reflux in 5 ureters, grade III in 8, and grade IV in 3 ureters. Grade 3 ureteral-orifice dilation were presented in 12 ureters (75%), grade 2 in 3 and grade 1 in 1 ureter in the present cases. Postoperatively, vesicoureteral reflux was diminished to grade 0 in 12 ureteral units (75%), decreased to grade I in 3 (9%), and remained grade III in 1 (6%). Three patients reported dull flank pain for several days postoperatively and there was 1 case of acute pyelonephritis. Temporary hydronephrosis was confirmed in 3 ureteral units (19%) at 1 month postoperatively. Median follow-up duration was 23 (range 13-63) months long. Although, 3 patients were experienced f-UTI 1-2 times, repeated VCUG showed no VUR recurrence. CONCLUSIONS According to hydrodistension grade of the ureteral orifice, endoscopic injection therapy via modified hydrodistension implantation technique is an effective and safe treatment for vesicoureteral reflux in post-pubertal female patients with dilated ureteral orifice. While ureteral deformities or a history of anti-reflux surgery may increase the risks, these can be managed with appropriate methods that ensure sufficient mound appearance and height.
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Affiliation(s)
- Tetsuji Maruyama
- Department of Urology, Nagoya City East Medical Center, 2 Wakamizu-cho, Chikusa-ku, Nagoya, 464-8547, Japan
| | - Kentaro Mizuno
- Department of Pediatric Urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Hidenori Nishio
- Department of Pediatric Urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Taiki Kato
- Department of Urology, Nagoya City East Medical Center, 2 Wakamizu-cho, Chikusa-ku, Nagoya, 464-8547, Japan
| | - Takashi Hamakawa
- Department of Urology, Nagoya City East Medical Center, 2 Wakamizu-cho, Chikusa-ku, Nagoya, 464-8547, Japan
| | - Yosuke Ikegami
- Department of Urology, Nagoya City East Medical Center, 2 Wakamizu-cho, Chikusa-ku, Nagoya, 464-8547, Japan
| | - Takahiro Yasui
- Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Yutaro Hayashi
- Department of Pediatric Urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
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He H, Huang Y, Yu L, Li Q, Long X, Li Y, Chen R, Yi X. Unilateral T-shaped incomplete duplex nephrectomy in an adolescent under laparoscopy: A case report. Medicine (Baltimore) 2021; 100:e25187. [PMID: 33761700 PMCID: PMC9282028 DOI: 10.1097/md.0000000000025187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 02/25/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Duplicate kidneys are the most common congenital abnormality of the urinary system. The location of duplicate kidneys varies. We report a case of an adolescent with upper and lower kidneys that are arranged vertically and approximately T-shaped. PATIENT CONCERNS A 16-year-old male teenager was examined for pain in the left side of the waist. The Computed Tomography scan revealed that the left kidney was incompletely duplicated and fused; the left upper urinary tract was incompletely obstructed. DIAGNOSIS The abdominal tomography confirmed the diagnosis of incomplete duplicate kidney. INTERVENTIONS The patient underwent laparoscopic surgery. The failure to ligate the renal pedicle resulted in increased bleeding during the operation and an open ureteral stump. OUTCOMES No urine leakage occurred after the operation. Doppler ultrasound of the urinary system showed no hydronephrosis, and the patient was asymptomatic. CONCLUSION Through this case report, we found that the duplicate kidneys could be arranged in a T-shape under laparoscopy. Although only the supply of the duplicate renal arteries can be ligated during surgical resection, the renal pedicle must also be ligated during the operation if there is a lot of bleeding.
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Affiliation(s)
- HuaJie He
- Department of Urology, Cancer Hospital of Guangxi Medical University & Guangxi Cancer Research Institute, Nanning
| | - YuanBi Huang
- Department of Urology, Cancer Hospital of Guangxi Medical University & Guangxi Cancer Research Institute, Nanning
| | - Lu Yu
- School of Nursing, Kunming Medical University, Kunming, China
| | - QiGuang Li
- Department of Urology, Cancer Hospital of Guangxi Medical University & Guangxi Cancer Research Institute, Nanning
| | - Xian Long
- Department of Urology, Cancer Hospital of Guangxi Medical University & Guangxi Cancer Research Institute, Nanning
| | - YongPeng Li
- Department of Urology, Cancer Hospital of Guangxi Medical University & Guangxi Cancer Research Institute, Nanning
| | - RongChao Chen
- Department of Urology, Cancer Hospital of Guangxi Medical University & Guangxi Cancer Research Institute, Nanning
| | - XianLin Yi
- Department of Urology, Cancer Hospital of Guangxi Medical University & Guangxi Cancer Research Institute, Nanning
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Chabani-Cheballah N, Chauveau H, Lombart M, Hamzy M, Buisson P. Giant neonatal hydronephrosis of the upper pole of a complete duplicated renal system. Arch Pediatr 2021; 28:345-347. [PMID: 33715935 DOI: 10.1016/j.arcped.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/28/2021] [Accepted: 02/21/2021] [Indexed: 11/19/2022]
Abstract
Ureteropelvic junction obstruction (UPJO) in the upper pole of a complete duplicated renal system is extremely rare. We report a case that was diagnosed prenatally and we review 10 cases published in the literature. Diagnoses of adrenal hematoma and cystic neuroblastoma were suspected on prenatal ultrasound, based on the severity of dilatation and the difficulty of identifying the exact origin of this anomaly. Neonatal magnetic resonance imagery (MRI) was subsequently able to show a normal adrenal gland. Surgical management is similar to that of a single-system pyeloureteral junction obstruction. Since this situation is very rare, we believe cystoscopy can be useful to confirm diagnosis of UPJO associated with complete duplication, especially in the absence of preoperative MRI. Among the 11 surgical cases previously published, seven patients underwent pyeloplasty and four heminephrectomy.
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Affiliation(s)
- Nassima Chabani-Cheballah
- Department of Pediatric Surgery, University Hospital Center, Centre Hospitalier Universitaire d'Amiens, 1, rond-point Christian Cabrol, 80054 Amiens cedex 1, France
| | - Henry Chauveau
- Department of Pediatric Surgery, University Hospital Center, Centre Hospitalier Universitaire d'Amiens, 1, rond-point Christian Cabrol, 80054 Amiens cedex 1, France
| | - Melyne Lombart
- Department of Obstetrics and Gynecology, University Hospital Center, Centre Hospitalier Universitaire d'Amiens, 1, rond-point Christian Cabrol, 80054 Amiens cedex 1, France
| | - Mounia Hamzy
- Department of Pediatric Surgery, University Hospital Center, Centre Hospitalier Universitaire d'Amiens, 1, rond-point Christian Cabrol, 80054 Amiens cedex 1, France
| | - Philippe Buisson
- Department of Pediatric Surgery, University Hospital Center, Centre Hospitalier Universitaire d'Amiens, 1, rond-point Christian Cabrol, 80054 Amiens cedex 1, France.
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Omil-Lima D, Gupta K, Prunty M, Miyasaka EA, Joyce EL, Nguyen C, Hannick JH. Bladder Agenesis and Bilateral Ectopic Ureters in an Infant Male With Cystic Renal Dysplasia, Imperforate Anus, and Penoscrotal Transposition. Urology 2021; 156:256-259. [PMID: 33689765 DOI: 10.1016/j.urology.2021.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/11/2021] [Accepted: 02/28/2021] [Indexed: 11/19/2022]
Abstract
Bladder agenesis is a rare congenital anomaly infrequently reported in the literature, with an incidence of 1/600,000 patients.1 Commonly associated with other fatal malformations, the condition is often incompatible with life.2 Prior reports estimate that over 90% of living children born with this malformation are female, owing to renal preservation resulting from low pressure drainage of urine into the vagina, uterus, and vestibule.3,4 Herein we report a rare case of an infant male born with penoscrotal transposition and end stage renal disease secondary to bilateral cystic renal dysplasia found to have concurrent bladder agenesis and bilateral ureteral ectopia.
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Affiliation(s)
- Danly Omil-Lima
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH; Division of Pediatric Urology, University Hospitals, Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Karishma Gupta
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH; Division of Pediatric Urology, University Hospitals, Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Megan Prunty
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH; Division of Pediatric Urology, University Hospitals, Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Eiichi A Miyasaka
- Division of Pediatric Surgery, University Hospitals, Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Emily L Joyce
- Division of Pediatric Nephrology, University Hospitals, Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Christina Nguyen
- Division of Pediatric Nephrology, University Hospitals, Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Jessica H Hannick
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH; Division of Pediatric Urology, University Hospitals, Rainbow Babies & Children's Hospital, Cleveland, OH.
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Paludo ADO, Diaz JO, Menegola C, Cavaleri A, Gorgen ARH, Lucena IRS, Rosito NC, Tavares PM, Rosito TE. Laparoscopic ureteral reconstruction in infant with congenital mid ureteric valve. J Pediatr Urol 2020; 16:859-860. [PMID: 33162333 DOI: 10.1016/j.jpurol.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/17/2020] [Accepted: 10/18/2020] [Indexed: 11/25/2022]
Abstract
Congenital mid ureteric valve (MUV) stenosis is a very rare cause of ureteric obstruction and hydronephrosis (HN) in children. We describe how we manage laparoscopically one case of a patient with congenital MUV. We describe a 6-month-old boy born with antenatal left HN, with an anteroposterior diameter (APD) of 1,5 cm. Follow-up renal ultrasound at 3 months of age showed an increase in left kidney HN, approximately 2.5 cm below the PUJ associated with distal stenosis. Renal scintigraphy with DTPA showed an obstructive pattern. Urography scan showed an abrupt reduction in the caliber of the mid left ureter Based on a preoperative diagnosis of MUV stenosis, we performed a laparoscopic left ureteroplasty. Abrupt tapering of the left ureter at 3 cm from the PUJ was identified. Proximal ureter repair was performed before the resection of the narrowing segment. The two edges of the ureter were spatulated and continuous anastomosis was performed without tension. An antegrade JJ stent was inserted after the posterior part of the anastomosis was done. Patient made an uneventful recovery and was discharged on the first postoperative day. Laparoscopic ureteroplasty is a complex but feasible option to treat patients with congenital MUV stenosis.
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Affiliation(s)
- Artur de Oliveira Paludo
- Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Johanna Ovalle Diaz
- Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Conrado Menegola
- Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Alexandre Cavaleri
- Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, Rio Grande do Sul, Brazil.
| | | | | | - Nicolino Cesar Rosito
- Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Patric Machado Tavares
- Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Tiago Elias Rosito
- Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, Rio Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul, Av. Paulo Gama, 110, Porto Alegre, Rio Grande do Sul, Brazil.
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Abstract
RATIONALE A supernumerary kidney is an extremely rare renal anomaly. Currently, <100 cases are reported in the literature. There are only 2 right unilateral supernumerary kidneys reported in the literature thus far, but no confirmed cases of urothelial carcinoma in supernumerary kidneys. We report a case of a right supernumerary with urothelial carcinoma, which is, to the best of our knowledge, reported for the first time. PATIENT CONCERNS A 73-year-old female patient presented with intermittent, painless, whole course and gross hematuria for about 3 months. Her physical and laboratory examinations did not reveal any significant findings except positive occult blood in routine urine examination. Contrast-enhanced spiral computed tomography revealed a dysplastic supernumerary kidney under the normal right kidney. DIAGNOSES The ureteroscopy showed that the ureter was Y-shaped in the middle part. The medial ureter led to a normal kidney. The lateral ureter was just 2 cm and led to a small cavity in which there was a mass whose biopsy showed urothelial carcinoma. The patient was subsequently diagnosed with a right supernumerary kidney with urothelial carcinoma. INTERVENTION Nephroureterectomy, including the right normal and supernumerary kidneys, and partial cystectomy by laparoscopy were performed after the ureteroscopy. The patient then received 6 cycles of gemcitabine and cisplatin regimen chemotherapy and regular intravesical epirubicin chemotherapy. OUTCOMES No recurrence or metastasis was found on follow-up computed tomography performed 13 months postoperatively. LESSONS A supernumerary kidney is an extremely rare renal anomaly. Malignancy can occur in supernumerary kidneys.
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Affiliation(s)
| | | | | | | | | | - Fei Yang
- Department of Pathology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, P.R. China
| | - Daming Fan
- Department of Pathology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, P.R. China
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Desai TJ, Shah AA, Smith MT, Zderic SA, Long CJ. Management of Vesicoureteral Reflux in a Patient With Recurrent Febrile Urinary Tract Infections, Neurogenic Bladder, and Ureteral Triplication. Urology 2020; 148:264-266. [PMID: 32707269 DOI: 10.1016/j.urology.2020.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/05/2020] [Indexed: 11/19/2022]
Abstract
Ureteral triplication is a rare anomaly with about 100 total cases reported in the literature. In this case presentation, we present a case of ureteral triplication in a young female with a history of neurogenic bladder secondary to L5 lipomeningocele who presented with recurrent febrile urinary tract infections (UTIs) and vesicoureteral reflux despite antibiotic prophylaxis. Given her high grade reflux, she underwent ureteral reimplantation which ultimately led to resolution of her UTIs and reflux. Later in her clinical course, toilet training unmasked additional bladder dysfunction and she was successfully managed with clean intermittent catheterization and anticholinergics. To the best of our knowledge, this is the first case report to describe ureteral triplication, recurrent febrile UTIs and vesicoureteral reflux in the setting of a concomitant neurogenic bladder with a successful outcome.
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Affiliation(s)
- Tej J Desai
- Department of Urology, University of Texas Health Science Center, San Antonio, TX.
| | - Ankur A Shah
- Division of Urology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Matthew T Smith
- Department of Urology, SUNY Downstate Medical Center, Brooklyn, NY
| | - Stephen A Zderic
- Division of Urology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Division of Urology, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Chris J Long
- Division of Urology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Division of Urology, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA
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16
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Sahin TK, Aladag E, Setterzade E, Guven GS, Haznedaroglu IC, Aksu S. Spontaneous subepithelial hemorrhage of renal pelvis and ureter (Antopol-Goldman lesion) in hemophilia A patient with inhibitor: Case report and review of the literature. Medicine (Baltimore) 2020; 99:e20851. [PMID: 32590782 PMCID: PMC7328965 DOI: 10.1097/md.0000000000020851] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION The Antopol-Goldman lesion (AGL), which expresses subepithelial hemorrhage in the renal pelvis, was first defined by Antopol and Goldman in 1948. The objective of this study is to report the first case of AGL in patients with congenital hemophilia and review the relevant literature. PATIENT CONCERNS A 32-year-old male patient diagnosed with congenital hemophilia A (FVIII = %4) with high responding inhibitors (7.4 BU) was admitted to our emergency department with gross hematuria and sudden onset flank pain. DIAGNOSIS Abdominal computed tomography (CT-scan) presented a hyperdense lesion in the left ureteropelvic junction with Hounsfield Units of 56 compatibles with hemorrhage. INTERVENTIONS The patient was given 4500 IU of factor eight inhibitor bypass activity (FEIBA) intravenously twice daily for 5 days. Subsequently, 4500 IU of FEIBA was administrated once a day for 2 days. OUTCOMES The patient's complaints disappeared on the fourth day of treatment. Macroscopic and microscopic hematuria was not seen in the following days. Follow-up CT was done 3 months after discharge and showed normal left renal pelvis without hyperdenosis. Follow-up CT was performed 3 months after discharge and presented normal left renal pelvis with no hyperdense lesion. CONCLUSION Although very rare, AGL should be kept in mind in the differential diagnosis of renal pelvic hemorrhage. In the patient who has an underlying history of coagulopathy nephrectomy can be avoided when there is awareness of AGL.
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Affiliation(s)
| | | | - Emil Setterzade
- Department of Radiology, Faculty of Medicine, Hacettepe University Ankara, Turkey
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Pilichowska E, Ostrowski P, Kotowski MJ, Tejchman K, Ostrowska-Clark K, Ostrowski M, Sieńko J. Transplantation of a Kidney With Duplicated Ureter Harvested From a Donor With Vascular Anomaly in the Form of Double Inferior Vena Cava: A Case Report. Transplant Proc 2020; 52:2533-2535. [PMID: 32307140 DOI: 10.1016/j.transproceed.2020.02.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/28/2020] [Accepted: 02/09/2020] [Indexed: 11/19/2022]
Abstract
During the organ procurement procedure, a surgeon encounters anatomic anomalies not very often but also not uncommonly. These changes may put the success of the transplant into question. Despite the thorough diagnosis of the potential donor, these anomalies are often diagnosed during organ donation. In our paper we present a case of kidney transplantation with duplicated ureter. The organ was collected from a donor with duplicated inferior vena cava. After transplantation, the kidney functioned immediately. Taking into consideration the well-being of the recipient, organs with anatomic abnormalities should be carefully considered for transplantation. This is especially important when there is a constant shortage of organs for transplantation.
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Affiliation(s)
- E Pilichowska
- Department of General Surgery and Transplantation, Pomeranian Medical University, Szczecin, Poland
| | - P Ostrowski
- Department of General Surgery and Transplantation, Pomeranian Medical University, Szczecin, Poland
| | - M J Kotowski
- Department of General Surgery and Transplantation, Pomeranian Medical University, Szczecin, Poland.
| | - K Tejchman
- Department of General Surgery and Transplantation, Pomeranian Medical University, Szczecin, Poland
| | - K Ostrowska-Clark
- Department of General Surgery and Transplantation, Pomeranian Medical University, Szczecin, Poland
| | - M Ostrowski
- Department of General Surgery and Transplantation, Pomeranian Medical University, Szczecin, Poland
| | - J Sieńko
- Department of General Surgery and Transplantation, Pomeranian Medical University, Szczecin, Poland
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18
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Maciel C, Bharwani N, Kubik-Huch RA, Manganaro L, Otero-Garcia M, Nougaret S, Alt CD, Cunha TM, Forstner R. MRI of female genital tract congenital anomalies: European Society of Urogenital Radiology (ESUR) guidelines. Eur Radiol 2020; 30:4272-4283. [PMID: 32221681 PMCID: PMC7338830 DOI: 10.1007/s00330-020-06750-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/22/2020] [Accepted: 02/04/2020] [Indexed: 11/24/2022]
Abstract
Objective To develop imaging guidelines for the MR work-up of female genital tract congenital anomalies (FGTCA). Methods These guidelines were prepared based on a questionnaire sent to all members of the European Society of Urogenital Radiology (ESUR) Female Pelvic Imaging Working Group (FPI-WG), critical review of the literature and expert consensus decision. Results The returned questionnaires from 17 different institutions have shown reasonable homogeneity of practice. Recommendations with focus on patient preparation and MR protocol are proposed, as these are key to optimised examinations. Details on MR sequences and planning of uterus-orientated sequences are provided. Conclusions The multiplanar capabilities and soft tissue resolution of MRI provide superb characterisation of the wide spectrum of findings in FGTCA. A standardised imaging protocol and method of reporting ensures that the salient features are recognised, contributing to a correct diagnosis and classification of FGTCA, associated anomalies and complications. These imaging guidelines are based on current practice among expert radiologists in the field and incorporate up to date information regarding MR protocols and essentials of recently published classification systems. Key Points • MRI allows comprehensive evaluation of female genital tract congenital anomalies, in a single examination. • A dedicated MRI protocol comprises uterus-orientated sequences and vaginal and renal evaluation. • Integration of classification systems and structured reporting helps in successful communication of the imaging findings. Electronic supplementary material The online version of this article (10.1007/s00330-020-06750-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cristina Maciel
- Serviço de Imagiologia, CHVNG/E, Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
- Departamento de Medicina, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Nishat Bharwani
- Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London, W2 1 NY, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Rahel A Kubik-Huch
- Institut für Radiologie, Kantonsspital Baden AG, CH-5404, Baden-Dättwil, Switzerland
| | - Lucia Manganaro
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomo Patologiche, Sapienza Università di Roma, Vle Regina Elena 324, 00161, Rome, Italy
| | - Milagros Otero-Garcia
- Department of Radiology, Hospital Universitario de Vigo, Planta 3 Vela A, Vigo, Spain
| | - Stephanie Nougaret
- Department of Radiology, Montpellier Cancer institute, INSERM, U1194, University of Montpellier, 208 Ave des Apothicaires, 34295, Montpellier, France
| | - Celine D Alt
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Duesseldorf, Germany
| | - Teresa Margarida Cunha
- Serviço de Radiologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Prof. Lima Basto, 1099-023, Lisbon, Portugal
| | - Rosemarie Forstner
- Department of Radiology, Universitätsklinikum Salzburg, PMU, Müllner-Hauptstr. 48, A-5020, Salzburg, Austria.
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Bascietto F, Khalil A, Rizzo G, Makatsariya A, Buca D, Silvi C, Ucci M, Liberati M, Familiari A, D'Antonio F. Prenatal imaging features and postnatal outcomes of isolated fetal duplex renal collecting system: A systematic review and meta-analysis. Prenat Diagn 2020; 40:424-431. [PMID: 31834636 DOI: 10.1002/pd.5622] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 09/11/2019] [Accepted: 11/07/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To perform a systematic review of studies reporting the outcome of fetuses with a prenatal diagnosis of isolated duplex collecting system (DCS). METHODS Inclusion criteria were studies reporting the outcome of fetuses with a prenatal diagnosis of isolated DCS, defined as DCS not associated with other major structural anomalies at the time of diagnosis. The outcomes observed were: imaging features of DCS on prenatal ultrasound, associated anomalies detected exclusively at prenatal follow-up ultrasound and at birth, abnormal karyotype, symptoms at birth (including vesicoureteral reflux [VUR] and urinary tract infections [UTI]), need for and type of surgical approach, complications after surgery, and accuracy of prenatal ultrasound in correctly identifying this anomaly. RESULTS Eleven studies (284 fetuses with a prenatal diagnosis of DCS) were included. On ultrasound, DCS was associated with ureterocele in 70.7% and with megaureter in 36.6% of cases. Worsening of pelvic/ureteric dilatation was reported to occur in 41.3% of fetuses. At birth, 4.3% of fetuses affected by DCS showed associated renal anomalies. After birth, VUR and UTI presented in 51.3% and 21.7% of children respectively, while 33.6% required surgery. Prenatal diagnosis of DCS was confirmed in 90.9% of included cases. CONCLUSION DCS diagnosed prenatally is associated with a generally good outcome. Prenatal ultrasound has a good diagnostic accuracy, while detailed postnatal assessment is required in order to identify associated renal anomalies.
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Affiliation(s)
- Francesca Bascietto
- Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Asma Khalil
- Fetal Medicine Unit, Saint George's Hospital, London, UK
| | - Giuseppe Rizzo
- Department of Maternal and Fetal Medicine, Ospedale Cristo Re, University of Rome Tor Vergata, Rome, Italy
| | - Alexander Makatsariya
- Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Danilo Buca
- Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Claudia Silvi
- Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Matteo Ucci
- Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Marco Liberati
- Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Alessandra Familiari
- Department of Clinical and Community Sciences, University of Milan, and Department of Woman Child and Neonate, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco D'Antonio
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
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20
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Lopes FM, Roberts NA, Zeef LAH, Gardiner NJ, Woolf AS. Overactivity or blockade of transforming growth factor-β each generate a specific ureter malformation. J Pathol 2019; 249:472-484. [PMID: 31400222 PMCID: PMC6900140 DOI: 10.1002/path.5335] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 07/19/2019] [Accepted: 08/06/2019] [Indexed: 12/13/2022]
Abstract
Transforming growth factor-β (TGFβ) has been reported to be dysregulated in malformed ureters. There exists, however, little information on whether altered TGFβ levels actually perturb ureter development. We therefore hypothesised that TGFβ has functional effects on ureter morphogenesis. Tgfb1, Tgfb2 and Tgfb3 transcripts coding for TGFβ ligands, as well as Tgfbr1 and Tgfbr2 coding for TGFβ receptors, were detected by quantitative polymerase chain reaction in embryonic mouse ureters collected over a wide range of stages. As assessed by in situ hybridisation and immunohistochemistry, the two receptors were detected in embryonic urothelia. Next, TGFβ1 was added to serum-free cultures of embryonic day 15 mouse ureters. These organs contain immature smooth muscle and urothelial layers and their in vivo potential to grow and acquire peristaltic function can be replicated in serum-free organ culture. Such organs therefore constitute a suitable developmental stage with which to define roles of factors that affect ureter growth and functional differentiation. Exogenous TGFβ1 inhibited growth of the ureter tube and generated cocoon-like dysmorphogenesis. RNA sequencing suggested that altered levels of transcripts encoding certain fibroblast growth factors (FGFs) followed exposure to TGFβ. In serum-free organ culture exogenous FGF10 but not FGF18 abrogated certain dysmorphic effects mediated by exogenous TGFβ1. To assess whether an endogenous TGFβ axis functions in developing ureters, embryonic day 15 explants were exposed to TGFβ receptor chemical blockade; growth of the ureter was enhanced, and aberrant bud-like structures arose from the urothelial tube. The muscle layer was attenuated around these buds, and peristalsis was compromised. To determine whether TGFβ effects were limited to one stage, explants of mouse embryonic day 13 ureters, more primitive organs, were exposed to exogenous TGFβ1, again generating cocoon-like structures, and to TGFβ receptor blockade, again generating ectopic buds. As for the mouse studies, immunostaining of normal embryonic human ureters detected TGFβRI and TGFβRII in urothelia. Collectively, these observations reveal unsuspected regulatory roles for endogenous TGFβ in embryonic ureters, fine-tuning morphogenesis and functional differentiation. Our results also support the hypothesis that the TGFβ up-regulation reported in ureter malformations impacts on pathobiology. Further experiments are needed to unravel the intracellular signalling mechanisms involved in these dysmorphic responses. © 2019 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Filipa M Lopes
- Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and HealthUniversity of ManchesterManchesterUK
| | - Neil A Roberts
- Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and HealthUniversity of ManchesterManchesterUK
| | - Leo AH Zeef
- The Bioinformatics Core FacilityUniversity of ManchesterManchesterUK
| | - Natalie J Gardiner
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - Adrian S Woolf
- Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and HealthUniversity of ManchesterManchesterUK
- Royal Manchester Children's HospitalManchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUK
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Guliev BG, Komyakov BK. [Laparoscopic ureteropyeloanastomosis in iatrogenic trauma of the upper pole ureter in a duplex kidney]. Urologiia 2019:109-111. [PMID: 31808642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In case of stricture of the lower third of ureter in patients with duplex kidney, ureteroneocystostomy or transureteroureterostomy can be used. Anastomosis of the injured ureter of the upper pole with the pelvis of the lower pole is considered nontypical. In this clinical observation, a 46-year-old patient with iatrogenic trauma of the pelvic part of the upper pole of a duplex kidney successfully undergone laparoscopic ureteropyelostomy. There were no complications; the stent was removed after 4 weeks. During the follow-up examination, the function of both kidneys was within normal range and there were no disturbances in the urine passage in the upper urinary tract. Thus, laparoscopic ureteropyelostomy provided an adequate urine passage from the duplex system kidney through the healthy ureter.
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Affiliation(s)
- B G Guliev
- Department of urology of FGBOU VO North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
- Center of Urology with robot-assisted surgery of City Mariinsky hospital, Saint Petersburg, Russia
| | - B K Komyakov
- Department of urology of FGBOU VO North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
- Center of Urology with robot-assisted surgery of City Mariinsky hospital, Saint Petersburg, Russia
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22
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Tsuji K, Ito A, Kurokawa S, Nakaya T, Yoshimoto T, Kawata H, Tamba-Sakaguchi M, Fukushima N, Oshiro H. Primary carcinosarcoma of the ureteropelvic junction associated with ureteral duplication: A case report. Medicine (Baltimore) 2019; 98:e16643. [PMID: 31393362 PMCID: PMC6708839 DOI: 10.1097/md.0000000000016643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Primary carcinosarcoma of the upper urinary tract is rare. Ureteral duplication is one of the most common urinary tract malformations. Additionally, the association between ureteral duplication and malignancy is unknown. To the best of our knowledge, no cases of malignant tumors diagnosed as carcinosarcoma with ureteral duplication have been reported. We herein report the case of a patient with carcinosarcoma of the ureteropelvic junction associated with incomplete ureteral duplication. PATIENT CONCERNS A 60-year-old Japanese woman presented with painless gross hematuria. She had a history of total hysterectomy and chemotherapy for endometrioid carcinoma 5 years before. She had no history of occupational chemical exposure. DIAGNOSES Radiographic imaging revealed right incomplete ureteral duplication, hydronephrosis, and a polypoid tumor in the ureteropelvic junction of the lower moiety of the right kidney. Urine cytology showed a small amount of degenerated atypical epithelial and nonepithelial cells. The transureteral biopsy specimen showed dysplastic urothelial cells and atypical myoid spindle cells. These findings were indefinite for malignancy. INTERVENTIONS The patient underwent right nephroureterectomy. Pathological examination of the resected tumor showed a biphasic neoplasm composed of carcinomatous and sarcomatous components. The sarcomatous component was immunohistochemically positive for vimentin, desmin, h-caldesmon, and α-SMA and negative for pancytokeratin (AE1/AE3), low molecular weight cytokeratin (CAM 5.2), EMA, E-cadherin, GATA3, uroplakin 2, and p63. Based on these findings, we diagnosed the tumor as carcinosarcoma. OUTCOMES The postoperative course was uneventful. No additional therapy was administered. The patient has remained alive without recurrence for 21 months since surgery. LESSONS Carcinosarcoma can arise from ureteral duplication. Although the majority of carcinosarcomas of the upper urinary tract are diagnosed at an advanced stage and have a poor prognosis, some can have a less aggressive course. Further studies are needed to determine the association between ureteral duplication and malignancy.
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Affiliation(s)
- Kentaro Tsuji
- Department of Diagnostic Pathology, Jichi Medical University Hospital
| | - Atsushi Ito
- Department of Diagnostic Pathology, Jichi Medical University Hospital
| | - Shinsuke Kurokawa
- Department of Urology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Takeo Nakaya
- Department of Diagnostic Pathology, Jichi Medical University Hospital
| | | | - Hirotoshi Kawata
- Department of Diagnostic Pathology, Jichi Medical University Hospital
| | | | | | - Hisashi Oshiro
- Department of Diagnostic Pathology, Jichi Medical University Hospital
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Abstract
INTRODUCTION Retrocaval ureter is a congenital abnormality of the right ureter, which has been shown, in rare cases to cause clinical symptoms, mainly due to the development of ureterohydronephrosis. PURPOSE The purpose of this article is to identify the prevalence of the retrocaval ureter, and to emphasize its clinical and surgical importance. DESIGN A meta-analysis of prevalence, on cases obtained from PubMed, Web of Science, and Scopus databases. RESULTS A total number of 13 studies contained data that allowed us to estimate the prevalence of the retrocaval ureter, which was identified overall in 9 cases, out of 18,493 subjects. The overall prevalence of retrocaval ureter was 0.13%, with a 95% confidence interval between 0.06 and 0.27%. There was no publication bias, all studies being under the funnel. CONCLUSIONS The overall prevalence of retrocaval ureter is 0.13%. Even if this is obviously a rare condition, its presence must be suspected by practitioners, especially in the presence of urological symptoms without a clear cause.
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Affiliation(s)
- Sorin Hostiuc
- Faculty of Dental Medicine, Department of Legal Medicine and Bioethics, Carol Davila University of Medicine and Pharmacy, Sos.Vitan Barzesti 9, 042122 Sector 4, Bucharest, Romania.
| | - Mugurel Constantin Rusu
- Faculty of Dental Medicine, Department of Anatomy, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ionut Negoi
- Faculty of Medicine, Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Mihai Grigoriu
- Faculty of Medicine, Department of Surgery, University Emergency Hospital Bucharest, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Mihaela Hostiuc
- Faculty of Medicine, Department of Internal Medicine and Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Imamverdiyev SB, Abdurahimova VY. [Successful treatment of an infant with a rare anomaly: iliosacral dystopia of the right kidney and obliteration of the left distal ureter]. Urologiia 2019:102-104. [PMID: 31184026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In the article a rare case of structural anomaly of ureter, namely obliteration, in 1-year-old infant is reviewed. The obliteration was located in the distal part of the left ureter. There was urine leakage through dilated and inflamed wall of the ureter towards right gluteal region with a formation of retroperitoneal abscess. A diagnosis was established based on preoperative MRI and intraoperative antegrade pyeloureterography. Extravesical Lich-Gregoir ureterocystoneostomy was successfully performed.
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Affiliation(s)
- S B Imamverdiyev
- Department of Urology, Azerbaijan Medical University, Baku, Azerbaijan
| | - V Y Abdurahimova
- Department of Urology, Azerbaijan Medical University, Baku, Azerbaijan
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Li K, Hu C, Huang W, Si-Tu J, Lu L, Mao Y, Zhang H, Qiu J, Wang D. A modification with threading cannula needle-assisted 4-point suspension fixation for retroperitoneal laparoscopic pyeloplasty in children with ureteropelvic junction obstruction: a cohort study in single center. Int Urol Nephrol 2018; 51:193-199. [PMID: 30519979 PMCID: PMC6394441 DOI: 10.1007/s11255-018-2048-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/03/2018] [Indexed: 12/25/2022]
Abstract
Purpose To evaluate the effect and safety of modifying a threading cannula needle-assisted suspension fixation in retroperitoneal laparoscopic dismembered pyeloplasty (LDP) for children with congenital ureteropelvic junction obstruction (UPJO). Methods Between December 2012 and December 2017, 45 children (< 14 years of age) with congenital UPJO were divided into two groups. In Group A, children underwent conventional “no-suspension fixation” LDP; and in Group B, “4-point suspension fixation” LDP was performed to lower difficulties and shorten operative time. The perioperative clinical data were recorded and analyzed. Results No statistical difference was found between two groups in preoperative characteristics. The duration of surgery, operative time for completion of anastomosis and the length of postoperative hospital stay in Group B was remarkably shortened than that in Group A, respectively (P < 0.05 for all). There was no significant difference between two groups in terms of postoperative renal pelvic diameter (RPD) decreasing, extubation time and success rates of surgery (P > 0.05 for all). In addition, no recurrent stenosis and urine leakage in both groups, and the postoperative RPD remained at the low level in both groups during the period of follow-up. Conclusions Our modification of the 4-point suspension fixation for retroperitoneal LDP is an effective and safe method for children with UPJO. It can simplify the surgical procedures, lower difficulties (especially in precise anastomotic suturing) and shorten the learning curve. This modification might be of particular interest to urologists for improving treatment of children with UPJO.
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Affiliation(s)
- Ke Li
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, Guangzhou, 510630 Guangdong China
| | - Cheng Hu
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, Guangzhou, 510630 Guangdong China
| | - Wentao Huang
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, Guangzhou, 510630 Guangdong China
| | - Jie Si-Tu
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, Guangzhou, 510630 Guangdong China
| | - Li Lu
- Department of Urology, The Sixth Affiliated Hospital of Sun Yat-sen University, Yuancun Erheng Road 26, Guangzhou, 510655 Guangdong China
| | - Yunhua Mao
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, Guangzhou, 510630 Guangdong China
| | - Huimin Zhang
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, Guangzhou, 510630 Guangdong China
| | - Jianguang Qiu
- Department of Urology, The Sixth Affiliated Hospital of Sun Yat-sen University, Yuancun Erheng Road 26, Guangzhou, 510655 Guangdong China
| | - Dejuan Wang
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, Guangzhou, 510630 Guangdong China
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Abstract
CASE DESCRIPTION 2 fillies, aged 3 months and 1 month, were examined because of urinary incontinence and urine scalding. CLINICAL FINDINGS In horse 1, ultrasonography did not reveal any structural abnormalities of the kidneys; however, unilateral ureteral ectopia was diagnosed cystoscopically. In horse 2, CT revealed bilateral nephropathy, bilateral distended ureters (up to 3.6 cm in diameter), and bilateral ureteral ectopia. Cystoscopy revealed intramural ureteral ectopia with abnormally caudally positioned ureteral ostia in both horses. TREATMENT AND OUTCOME Ureteral ostioplasty was performed under cystoscopic guidance. Laparoscopic scissors (horse 1) or a vessel-sealing device (horse 2) was introduced, and the tissue separating the intramural portion of the ureter from the urethra and bladder was cut longitudinally in a cranial direction toward the trigone. After surgery, both horses were continent and voided normal streams of urine for the duration of the follow-up periods of 20 and 9 months for horse 1 and horse 2, respectively. CLINICAL RELEVANCE Cystoscopically guided ureteral ostioplasty provided an effective and minimally invasive surgical treatment option for correction of ureteral ectopia in 2 fillies.
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Næss-Andresen TF, Haslund A, Bjerre A, Eichstetter WM, Ebner GUW. A woman in her twenties with urinary incontinence. Tidsskr Nor Laegeforen 2018; 138:18-0254. [PMID: 30421735 DOI: 10.4045/tidsskr.18.0254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Lund L. [Not Available]. Ugeskr Laeger 2018; 180:V69537. [PMID: 30259838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Abstract
RATIONALE The duplex ureter is a common anomaly of urinary tract, but preoperative sonography, plain abdominal radiography, or nonenhanced computed tomography (CT) often overlooked it when involved with urinary tract obstruction. In this report, We present a rare case of left Y-shaped bifid ureter and both ureter of upper moiety and common stem were obstructed respectively by 2 calculi. PATIENT CONCERNS A 47-year-old woman was admitted due to 3-day history of left-sided loin pain and low-grade fever. The patient was diagnosed with right renal atrophy and 2 calculi of left ureter associated with severe left hydronephroureterosis, and underwent left percutaneous nephrostomy and left ureterolithotomy without identification of the upper calculus in left ureter in another hospital. DIAGNOSES After transfer of the patient to our hospital, preoperative contrast-enhanced CT detected the left Y shaped bifid ureter and the calculus in upper moiety ureter. INTERVENTIONS The migrated calculus was extracted by left ureterolithotomy. OUTCOMES The patient discharged uneventfully. LESSONS Contrast-enhanced CT should be recommended prior to any surgical procedures involved with upper urinary tract to exclude duplex ureter.
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Affiliation(s)
- Ning Xiao
- Department of Urology
- Continence Research Clinic
- Medical Laboratory Center, The Central Hospital of ShaoYang, University of South China, ShaoYang
| | - Bo Ge
- Department of Urology, The Second Affiliated Hospital of GuiLin Medical University, GuiLin, China
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Horai K, Naito M, Yakura T, Furuya Y, Ohmichi Y, Ohmichi M, Miyaki T, Nakano T. A case of pancake kidney with a single ureter in the retroperitoneal space. Anat Sci Int 2018; 93:563-565. [PMID: 29777511 DOI: 10.1007/s12565-018-0442-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/10/2018] [Indexed: 11/26/2022]
Abstract
The pancake kidney (PK) is a rare type of renal anomaly in which both kidneys completely fuse without an isthmus. In the previous reports, PKs have double ureters and are located in the pelvic cavity. We encountered a rare case of PK with a single ureter, which is located in the left retroperitoneal space, in a 95-year-old female cadaver, which was detected during a dissection course. In our case, the major calyces joined to form a single renal pelvis, which continued as a single ureter. To the best of our knowledge, this is the first report on PK with a single ureter that is located not in the pelvic cavity but in the retroperitoneal space. The knowledge of such anomalous presentation is important to avoid any complications during retroperitoneal surgery.
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Affiliation(s)
- Kasuga Horai
- Department of Anatomy, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Munekazu Naito
- Department of Anatomy, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
| | - Tomiko Yakura
- Department of Anatomy, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Yuka Furuya
- Department of Anatomy, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Yusuke Ohmichi
- Department of Anatomy, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Mika Ohmichi
- Department of Anatomy, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takayoshi Miyaki
- Department of Anatomy, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takashi Nakano
- Department of Anatomy, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
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Lund L, Hansen ST, Diatchikhine M. [Not Available]. Ugeskr Laeger 2018; 180:V69537. [PMID: 29761769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Kagantsov IM, Sizonov VV, Dubrov VI, Bondarenko SG, Akramov NR, Shmyrov OS, Kuzovleva GI, Surov RV, Logval AA. [Uretero-ureteral anastomosis (ureteropyeloanasto-mosis) for the duplicated upper urinary tract in children]. Urologiia 2018:83-88. [PMID: 29901299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The duplex kidney is one of the most common congenital abnormalities of the urinary tract, and various surgical procedures exist for the management of this condition. Depending on the surgeon preferences, patients with duplex kidney may undergo heminephrectomy with ureterectomy using open or laparoscopic approach, uretero-cysto-anastomosis of the ectopic ureter or two ureters in a single block. Recently, there have been reports of inter-ureter anastomoses. Here we report our multicenter experience in open and laparoscopic uretero-ureteral anastomosis (UUA). The study aimed to improve the treatment results in children with urodynamic dysfunction due to the duplicated upper urinary tract. MATERIALS AND METHODS We retrospectively analyzed medical records of 64 children treated from 2007 to 2017. There were 22 (32.8%) boys and 43 (67.2%) girls with mean age 40.2 months at the time of surgery. All of them had duplex kidneys, including 27 (42.2%) right-sided and 37 (57.8%) left-sided. Of them, 15 (23.4%) children underwent distal UUA (DUAA), and 49 (76.6%) had proximal UUA (PUUA). RESULTS After surgery, acute pyelonephritis occurred in three patients. In the early postoperative period, a prolonged urinary leakage from surgical site drainage was observed in three (6.1%) patients after laparoscopic PUUA. One (4.2%) child developed a stumpitis. Thus, complications occurred in 7 (10.9%) children; one of them (1.6%) needed additional treatment. CONCLUSION Distal and proximal UUA is a safe and effective surgical treatment for urinary outflow disorders in patients with the duplicated upper urinary tract, minimizing the risk of the duplex kidney dysfunction.
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Affiliation(s)
- I M Kagantsov
- Republican Childrens Clinical Hospital, Syktyvkar, Russia
- Pitirim Sorokin Syktyvkar State University, Syktyvkar, Russia
- RostSMU of Minzdrav of Russia, Rostov-on-Don, Russia
- Childrens Hospital 2, Minsk, Republic of Belarus
- Clinical Emergency 7, Volgograd, Russia
- Kazan State Medical University of Minzdrav of Russia, Kazan, Russia
- Morozovskaya Childrens City Clinical Hospital, Moscow
- Childrens City Clinical Hospital No. 9, Moscow, Russia
- Regional Childrens Clinical Hospital, Kemerovo, Russia
- Cherepovets Childrens City Hospital, Cherepovets, Russia
| | - V V Sizonov
- Republican Childrens Clinical Hospital, Syktyvkar, Russia
- Pitirim Sorokin Syktyvkar State University, Syktyvkar, Russia
- RostSMU of Minzdrav of Russia, Rostov-on-Don, Russia
- Childrens Hospital 2, Minsk, Republic of Belarus
- Clinical Emergency 7, Volgograd, Russia
- Kazan State Medical University of Minzdrav of Russia, Kazan, Russia
- Morozovskaya Childrens City Clinical Hospital, Moscow
- Childrens City Clinical Hospital No. 9, Moscow, Russia
- Regional Childrens Clinical Hospital, Kemerovo, Russia
- Cherepovets Childrens City Hospital, Cherepovets, Russia
| | - V I Dubrov
- Republican Childrens Clinical Hospital, Syktyvkar, Russia
- Pitirim Sorokin Syktyvkar State University, Syktyvkar, Russia
- RostSMU of Minzdrav of Russia, Rostov-on-Don, Russia
- Childrens Hospital 2, Minsk, Republic of Belarus
- Clinical Emergency 7, Volgograd, Russia
- Kazan State Medical University of Minzdrav of Russia, Kazan, Russia
- Morozovskaya Childrens City Clinical Hospital, Moscow
- Childrens City Clinical Hospital No. 9, Moscow, Russia
- Regional Childrens Clinical Hospital, Kemerovo, Russia
- Cherepovets Childrens City Hospital, Cherepovets, Russia
| | - S G Bondarenko
- Republican Childrens Clinical Hospital, Syktyvkar, Russia
- Pitirim Sorokin Syktyvkar State University, Syktyvkar, Russia
- RostSMU of Minzdrav of Russia, Rostov-on-Don, Russia
- Childrens Hospital 2, Minsk, Republic of Belarus
- Clinical Emergency 7, Volgograd, Russia
- Kazan State Medical University of Minzdrav of Russia, Kazan, Russia
- Morozovskaya Childrens City Clinical Hospital, Moscow
- Childrens City Clinical Hospital No. 9, Moscow, Russia
- Regional Childrens Clinical Hospital, Kemerovo, Russia
- Cherepovets Childrens City Hospital, Cherepovets, Russia
| | - N R Akramov
- Republican Childrens Clinical Hospital, Syktyvkar, Russia
- Pitirim Sorokin Syktyvkar State University, Syktyvkar, Russia
- RostSMU of Minzdrav of Russia, Rostov-on-Don, Russia
- Childrens Hospital 2, Minsk, Republic of Belarus
- Clinical Emergency 7, Volgograd, Russia
- Kazan State Medical University of Minzdrav of Russia, Kazan, Russia
- Morozovskaya Childrens City Clinical Hospital, Moscow
- Childrens City Clinical Hospital No. 9, Moscow, Russia
- Regional Childrens Clinical Hospital, Kemerovo, Russia
- Cherepovets Childrens City Hospital, Cherepovets, Russia
| | - O S Shmyrov
- Republican Childrens Clinical Hospital, Syktyvkar, Russia
- Pitirim Sorokin Syktyvkar State University, Syktyvkar, Russia
- RostSMU of Minzdrav of Russia, Rostov-on-Don, Russia
- Childrens Hospital 2, Minsk, Republic of Belarus
- Clinical Emergency 7, Volgograd, Russia
- Kazan State Medical University of Minzdrav of Russia, Kazan, Russia
- Morozovskaya Childrens City Clinical Hospital, Moscow
- Childrens City Clinical Hospital No. 9, Moscow, Russia
- Regional Childrens Clinical Hospital, Kemerovo, Russia
- Cherepovets Childrens City Hospital, Cherepovets, Russia
| | - G I Kuzovleva
- Republican Childrens Clinical Hospital, Syktyvkar, Russia
- Pitirim Sorokin Syktyvkar State University, Syktyvkar, Russia
- RostSMU of Minzdrav of Russia, Rostov-on-Don, Russia
- Childrens Hospital 2, Minsk, Republic of Belarus
- Clinical Emergency 7, Volgograd, Russia
- Kazan State Medical University of Minzdrav of Russia, Kazan, Russia
- Morozovskaya Childrens City Clinical Hospital, Moscow
- Childrens City Clinical Hospital No. 9, Moscow, Russia
- Regional Childrens Clinical Hospital, Kemerovo, Russia
- Cherepovets Childrens City Hospital, Cherepovets, Russia
| | - R V Surov
- Republican Childrens Clinical Hospital, Syktyvkar, Russia
- Pitirim Sorokin Syktyvkar State University, Syktyvkar, Russia
- RostSMU of Minzdrav of Russia, Rostov-on-Don, Russia
- Childrens Hospital 2, Minsk, Republic of Belarus
- Clinical Emergency 7, Volgograd, Russia
- Kazan State Medical University of Minzdrav of Russia, Kazan, Russia
- Morozovskaya Childrens City Clinical Hospital, Moscow
- Childrens City Clinical Hospital No. 9, Moscow, Russia
- Regional Childrens Clinical Hospital, Kemerovo, Russia
- Cherepovets Childrens City Hospital, Cherepovets, Russia
| | - A A Logval
- Republican Childrens Clinical Hospital, Syktyvkar, Russia
- Pitirim Sorokin Syktyvkar State University, Syktyvkar, Russia
- RostSMU of Minzdrav of Russia, Rostov-on-Don, Russia
- Childrens Hospital 2, Minsk, Republic of Belarus
- Clinical Emergency 7, Volgograd, Russia
- Kazan State Medical University of Minzdrav of Russia, Kazan, Russia
- Morozovskaya Childrens City Clinical Hospital, Moscow
- Childrens City Clinical Hospital No. 9, Moscow, Russia
- Regional Childrens Clinical Hospital, Kemerovo, Russia
- Cherepovets Childrens City Hospital, Cherepovets, Russia
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Nardo B, Montalti R, Pacile V, Bertelli R, Beltempo P, Cavallari G, Puviani L, Licursi M, Stefoni S, Cavallari A, Faenza A. The First Case of Ureteral Duplication in a Combined Liver-Kidney Transplantation. Int J Artif Organs 2018; 29:698-700. [PMID: 16874675 DOI: 10.1177/039139880602900708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim Kidney transplantation with ureteral duplication may represent a doubled risk factor in terms of ureteral stenosis or necrosis with urinary leakage usually from the site of ureteroneocystostomy. The incidence of complete duplication is very low at 0.19%. We report a kidney with ureteral duplication in the specific setting of multiorgan transplantation since it could be considered a adjunctive risk factor for urological complications. Methods The recipient was a 67-year old man, suffering from terminal renal insufficiency. He was also affected by HCV-related cirrhosis. The patient had been waiting for the combined transplantation for 27 months and in the last two months his hepatic function dramatically worsened. The donor was a 53-year old man who died of non-traumatic subarachnoid hemorrhage. Good HLA compatibility was observed between donor and recipient. During harvest both kidneys presented a complete ureteral duplication. So the ureters were freed together with a wide cuff of periureteral tissue and dissected distally. No vascular abnormalities were noted during the removal of either kidney. The grafts were flushed with University of Wisconsin solution and stored in the same solution. Results The liver was reperfused after 9 hours of cold ischemia. Subsequently the kidney was vascularized after 15 hours of cold ischemia. Urine production occurred immediately after revascularization. Two separated ureteroneocystostomies with a single antireflux technique were performed. Cyclosporine and steroids were given. Post-operative course was uneventful and liver and kidney function were normal. The 7-day cystography was normal. The 6, 12, 24 month ultrasonographies showed no signs of hydronephrosis or hydroureter. After 28 months renal cancer was diagnosed and the patient underwent a right nephrectomy. The liver-kidney recipient had excellent hepatic and renal function for 84.7 months. He died of malignancy from de novo tumor. Conclusions On the basis of this experience, a kidney with an ureteral duplication, while rare, can be satisfactorily used also in combined liver-kidney transplantation.
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Affiliation(s)
- B Nardo
- Department of Surgery, Intensive Care Unit and Transplantations, S. Orsola Hospital, University of Bologna, Bologna, Italy.
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Affiliation(s)
- Souhail Regragui
- Urology-B-Department, Avicenne Hospital, University Mohammed V, Rabat, Morocco
| | - Amine Slaoui
- Urology-B-Department, Avicenne Hospital, University Mohammed V, Rabat, Morocco
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Bumbu GA, Berechet MC, Nacer K, Bumbu G, Maghiar OA, Bratu OG, Vicaş RM, Ţica O, Bumbu BA. Clinical, surgical and morphological assessment of the pyeloureteral syndrome. Rom J Morphol Embryol 2018; 59:1173-1177. [PMID: 30845298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Obstruction of the pyeloureteral junction (PUJ) is by far the most common cause of hydronephrosis in children, with an incidence of one in 1000-2000 newborns. Also, the obstruction of the PUJ is the most common cause of prenatal hydronephrosis, accounting for 80% of the cases. The aim of this study is to observe and discuss first the efficacy of described surgery procedures and second the microscopic modifications of the PUJ (abnormalities of smooth muscle tissue, inflammation and fibrosis). One hundred and eleven children with a diverse urological pathology with an average age of 11.57 years were operated between 2011 and 2015 in Urology Clinic of Oradea, Romania. Of these, 20 children (11 boys and nine girls) with congenital hydronephrosis by junction syndrome required surgical correction. The surgical techniques used were Anderson-Hynes dismembered pyeloplasty, non-dismembered Scardino procedure and the Hellström procedure. Operator interventions were performed by subcostal lombotomy with or without partial XII rib resection. The average operator time was between 40 and 50 minutes. None of the patients required blood transfusions. Average hospitalization was seven days. All patients were monitored through the Ambulatory Pediatric and Urological Service. Anderson-Hynes operation is the main procedure to solve the obstructive syndromes of the PUJ. It can be performed without stentings of the ureter as originally described by the author, but also by protecting anastomosis with a urinary diversion, such as JJ catheter, ureteronephrostomy or ureteropyelostomy. Even though clinical and imaging studies are sufficient for diagnose of PUJ syndromes, morphology and histology bring essential data regarding the age of the lesions.
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Affiliation(s)
- Gheorghe Adrian Bumbu
- Department of Surgery, Faculty of Medicine and Pharmacy, University of Oradea, Romania;
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Costa S, Carriço A, Valente F. Prenatal diagnosis of left isomerism with normal heart. BMJ Case Rep 2017; 2017:bcr-2017-223097. [PMID: 29133586 PMCID: PMC5695494 DOI: 10.1136/bcr-2017-223097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2017] [Indexed: 11/03/2022] Open
Affiliation(s)
- Sara Costa
- Department of Gynecology–Obstetrics, Centro Hospitalar Universitário do Algarve—Unidade de Portimão, Portugal
| | - Ana Carriço
- Department of Pediatric Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Portugal
| | - Francisco Valente
- Department of Gynecology–Obstetrics, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Portugal
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Bhatti V, Koratala A. Evolution of a neglected ureteral stent. Intern Emerg Med 2017; 12:1075-1076. [PMID: 28093661 DOI: 10.1007/s11739-017-1605-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 01/06/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Vikrampal Bhatti
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, P.O. Box 100224, Gainesville, FL, 32610, USA
| | - Abhilash Koratala
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, P.O. Box 100224, Gainesville, FL, 32610, USA.
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Mohamed F, Jehangir S. Coexistent duplication of urethra and a refluxing ectopic ureter presenting as recurrent epididymo-orchitis in a child. BMJ Case Rep 2017; 2017:bcr-2017-220278. [PMID: 28928250 PMCID: PMC5747647 DOI: 10.1136/bcr-2017-220278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2017] [Indexed: 11/03/2022] Open
Abstract
Congenital anomalies of the kidney and urinary tract (CAKUTs) occur in 3-6 per 1000 live births, accounting for most cases of paediatric end-stage kidney disease.1 However, the molecular basis of CAKUT and anomalies of the external genitalia is poorly understood. We, herein, describe a case with left recurrent epididymo-orchitis with a coexistent urethral duplication and an ectopic ureter with an ipsilateral non-functioning kidney, which is, to the best of our knowledge, the first reported case of its kind. This case may bring about a paradigm shift in our comprehension of the development of the two entities. Understanding the pathogenesis may help develop preventive and renal preservation strategies. The Sonic hedgehog gene and bone morphogenetic protein 4 play crucial roles in preventing anomalies of the ureters and the external genitalia. In this article, we look at possible molecular pathways that could explain the synchronicity of this rare entity.
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Affiliation(s)
- Ferzine Mohamed
- Department of Paediatric Surgery, Christian Medical College and Hospital Vellore, Vellore, India
| | - Susan Jehangir
- Christian Medical College and Hospital Vellore, Vellore, India
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Mukherjee E, Maringer K, Papke E, Bushnell D, Schaefer C, Kramann R, Ho J, Humphreys BD, Bates C, Sims-Lucas S. Endothelial marker-expressing stromal cells are critical for kidney formation. Am J Physiol Renal Physiol 2017; 313:F611-F620. [PMID: 28539333 PMCID: PMC6148306 DOI: 10.1152/ajprenal.00136.2017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/05/2017] [Accepted: 05/22/2017] [Indexed: 11/22/2022] Open
Abstract
Kidneys are highly vascularized and contain many distinct vascular beds. However, the origins of renal endothelial cells and roles of the developing endothelia in the formation of the kidney are unclear. We have shown that the Foxd1-positive renal stroma gives rise to endothelial marker-expressing progenitors that are incorporated within a subset of peritubular capillaries; however, the significance of these cells is unclear. The purpose of this study was to determine whether deletion of Flk1 in the Foxd1 stroma was important for renal development. To that end, we conditionally deleted Flk1 (critical for endothelial cell development) in the renal stroma by breeding-floxed Flk1 mice (Flk1fl/fl ) with Foxd1cre mice to generate Foxd1cre; Flk1fl/fl (Flk1ST-/- ) mice. We then performed FACsorting, histological, morphometric, and metabolic analyses of Flk1ST-/- vs. control mice. We confirmed decreased expression of endothelial markers in the renal stroma of Flk1ST-/- kidneys via flow sorting and immunostaining, and upon interrogation of embryonic and postnatal Flk1ST-/- mice, we found they had dilated peritubular capillaries. Three-dimensional reconstructions showed reduced ureteric branching and fewer nephrons in developing Flk1ST-/- kidneys vs. CONTROLS Juvenile Flk1ST-/- kidneys displayed renal papillary hypoplasia and a paucity of collecting ducts. Twenty-four-hour urine collections revealed that postnatal Flk1ST-/- mice had urinary-concentrating defects. Thus, while lineage-tracing revealed that the renal cortical stroma gave rise to a small subset of endothelial progenitors, these Flk1-expressing stromal cells are critical for patterning the peritubular capillaries. Also, loss of Flk1 in the renal stroma leads to nonautonomous-patterning defects in ureteric lineages.
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Affiliation(s)
- Elina Mukherjee
- Rangos Research Center, Children's Hospital of Pittsburgh of University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Division of Nephrology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Katherine Maringer
- Rangos Research Center, Children's Hospital of Pittsburgh of University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Division of Nephrology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Emily Papke
- Rangos Research Center, Children's Hospital of Pittsburgh of University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Division of Nephrology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Daniel Bushnell
- Rangos Research Center, Children's Hospital of Pittsburgh of University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Division of Nephrology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Caitlin Schaefer
- Rangos Research Center, Children's Hospital of Pittsburgh of University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Division of Nephrology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Rafael Kramann
- Division of Nephrology and Clinical Immunology, Rheinisch-Westfälische Technische Hochschule, Aachen University, Aachen, Germany
| | - Jacqueline Ho
- Rangos Research Center, Children's Hospital of Pittsburgh of University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Division of Nephrology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Benjamin D Humphreys
- Renal Division, Washington University School of Medicine, St. Louis, Missouri; and
| | - Carlton Bates
- Rangos Research Center, Children's Hospital of Pittsburgh of University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Division of Nephrology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Sunder Sims-Lucas
- Rangos Research Center, Children's Hospital of Pittsburgh of University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;
- Division of Nephrology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
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Haque F, Kaku Y, Fujimura S, Ohmori T, Adelstein RS, Nishinakamura R. Non-muscle myosin II deletion in the developing kidney causes ureter-bladder misconnection and apical extrusion of the nephric duct lineage epithelia. Dev Biol 2017; 427:121-130. [PMID: 28478097 DOI: 10.1016/j.ydbio.2017.04.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/27/2017] [Accepted: 04/29/2017] [Indexed: 01/23/2023]
Abstract
In kidney development, connection of the nephric duct (ND) to the cloaca and subsequent sprouting of the ureteric bud (UB) from the ND are important for urinary exit tract formation. Although the roles of Ret signaling are well established, it remains unclear how intracellular cytoskeletal proteins regulate these morphogenetic processes. Myh9 and Myh10 encode two different non-muscle myosin II heavy chains, and Myh9 mutations in humans are implicated in congenital kidney diseases. Here we report that ND/UB lineage-specific deletion of Myh9/Myh10 in mice caused severe hydroureter/hydronephrosis at birth. At mid-gestation, the mutant ND/UB epithelia exhibited aberrant basal protrusion and ectopic UB formation, which likely led to misconnection of the ureter to the bladder. In addition, the mutant epithelia exhibited apical extrusion followed by massive apoptosis in the lumen, which could be explained by reduced apical constriction and intercellular adhesion mediated by E-cadherin. These phenotypes were not ameliorated by genetic reduction of the tyrosine kinase receptor Ret. In contrast, ERK was activated in the mutant cells and its chemical inhibition partially ameliorated the phenotypes. Thus, myosin II is essential for maintaining the apicobasal integrity of the developing kidney epithelia independently of Ret signaling.
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Affiliation(s)
- Fahim Haque
- Department of Kidney Development, Institute of Molecular Embryology and Genetics, Kumamoto University, Kumamoto, Japan
| | - Yusuke Kaku
- Department of Kidney Development, Institute of Molecular Embryology and Genetics, Kumamoto University, Kumamoto, Japan
| | - Sayoko Fujimura
- Liaison Laboratory Research Promotion Center, Institute of Molecular Embryology and Genetics, Kumamoto University, Kumamoto, Japan
| | - Tomoko Ohmori
- Department of Kidney Development, Institute of Molecular Embryology and Genetics, Kumamoto University, Kumamoto, Japan
| | - Robert S Adelstein
- Laboratory of Molecular Cardiology, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ryuichi Nishinakamura
- Department of Kidney Development, Institute of Molecular Embryology and Genetics, Kumamoto University, Kumamoto, Japan.
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Ahmed M, Alhassan A, Sadiq MA, Lawal AT, Bello A, Maitama HY. Variable presentation of retrocaval ureter: Report of four cases and review of literature. Niger Postgrad Med J 2017; 24:126-129. [PMID: 28762369 DOI: 10.4103/npmj.npmj_48_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Retrocaval ureter is a rare anomaly in which the ureter passes behind the inferior vena cava due to abnormal embryogenesis. Very few cases have been reported from Africa. Although the anomaly is congenital, patients become symptomatic in the third or fourth decade of life. We reviewed the records of four patients with the diagnosis of retrocaval ureter and managed in our centre between January 2010 and December 2016. Three patients presented with recurrent colicky right flank pain while one was asymptomatic. Two patients each had Type I and Type II retrocaval ureters, respectively. Surgical repairs were achieved in the three symptomatic cases and recovery was uneventful. Retrocaval ureter, though congenital, manifests in young adults and it may be symptomatic. Pre-operative diagnosis may be difficult when the lesion is high and mimics pelviureteric junction obstruction. Thus, a high index of suspicion is required for pre-operative diagnosis. Under-reporting and asymptomatic cases may account for the low incidence.
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Affiliation(s)
- Muhammed Ahmed
- Department of Surgery, Division of Urology, Ahmadu Bello University, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Abdullahi Alhassan
- Department of Surgery, Division of Urology, Ahmadu Bello University, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Muhammad Abubakar Sadiq
- Department of Surgery, Division of Urology, Ahmadu Bello University, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Ahmad Tijjani Lawal
- Department of Surgery, Division of Urology, Ahmadu Bello University, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Ahmad Bello
- Department of Surgery, Division of Urology, Ahmadu Bello University, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Hussaini Yusuf Maitama
- Department of Surgery, Division of Urology, Ahmadu Bello University, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
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42
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Caliskan S. Bilateral Ureteral Duplication of Complete Left and Incomplete Right Side with Lower Pole Kidney Stone. J Coll Physicians Surg Pak 2017; 27:S65-S66. [PMID: 28302252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 11/26/2016] [Indexed: 06/06/2023]
Abstract
Bilateral ureteral duplication is a very rare anomaly, a result of two separate ureteric buds arising from a mesonephric duct. Most of the patients are asymptomatic and diagnosed incidentally. Recurrent urinary tract infections, incontinence, haematuria, stone formation and flank pain are common clinical symptoms. Intravenous urography, computed tomography urography, and magnetic resonance imaging are the diagnostic modalities. In this report, a case of bilateral ureteral duplication with stone formation in the lower pole of the right kidney is presented along with its management.
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Affiliation(s)
- Selahattin Caliskan
- Department of Urology, 1 Hitit University, Corum Training and Research Hospital, Turkey
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Ahmed A. Ipsilateral Renal Agenesis With Megaureter, Blind End Proximal Ureter And Ureterocele In An Adult. J Ayub Med Coll Abbottabad 2017; 29:150-153. [PMID: 28712197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We reporting unilateral renal agenesis with ipsilateral ureterocoele, mega ureter and blind end proximal ureter in same patient first time as case report and has not been so far reported in local or international literature. Ultrasound, CT scan and intravenous pyelography performed which confirm the case. Patient presented with left lumber and pelvic pain on and off and history of recurrent urinary tract infection.
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Affiliation(s)
- Ateeque Ahmed
- Department of Radiology, Dow University of Health Sciences, Civil Hospital Karachi, Pakistan
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Landa-Juárez S, Guerra-Rivas A, Salgado-Sangri R, Castillo-Fernandez AM, de la Cruz-Yañez H, Garcia-Hernandez C. [Laparoscopic ureterovesical repair for megaureter treatment]. CIR CIR 2016; 85:196-200. [PMID: 27842760 DOI: 10.1016/j.circir.2016.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 08/10/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND An alternative treatment for obstructive and refluxing obstructive megaureter with ureterovesical junction maintenance through laparoscopy is proposed. MATERIAL AND METHODS The series consists of 8 cases, all of them studied because of prenatal hydronephrosis or febrile urinary tract infection. Seven were diagnosed with obstructive megaureter and one with obstructive refluxing megaureter. The procedure consisted in incising the stenotic portion of the ureter longitudinally and maintaining its posterior wall attached to the bladder, the anterior wall of the ureter was anastomosed transversally to the bladder mucosa in order to liberate the obstruction. RESULTS Two of the 8 cases were women and 6 were male. They were aged between 5 months and 11 years (average age of 2.9 years). The surgical time varied between 90 and 120min, with a 48h hospital stay. The permanence of the vesical catheter and the double J stent was of 48h and 6 weeks, respectively. A female patient developed febrile urinary tract infection one week after the surgical procedure. The rest of the patients remained asymptomatic, with normal urinalysis and quarterly urine culture results. Six months after the procedure, the ultrasound showed improvement of the ureteral diameter and of the pyelocaliceal ectasia. The average follow-up was of 2 years. DISCUSSION The handling of stenosis with longitudinal incision of the ureter and transverse anastomosis to the bladder mucosa, seems promising. The laparoscopic approach allows to identify clearly the longitude of the stenotic segment and join with relative precision such opening with the one of the vesical mucosa.
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Affiliation(s)
- Sergio Landa-Juárez
- Servicio de Urología, Hospital de Pediatría «Silvestre Frenk Freud», Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
| | - Alejandra Guerra-Rivas
- Servicio de Urología, Hospital de Pediatría «Silvestre Frenk Freud», Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Ramón Salgado-Sangri
- Servicio de Urología, Hospital de Pediatría «Silvestre Frenk Freud», Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Ana María Castillo-Fernandez
- Servicio de Urología, Hospital de Pediatría «Silvestre Frenk Freud», Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Hermilo de la Cruz-Yañez
- Servicio de Urología, Hospital de Pediatría «Silvestre Frenk Freud», Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Carlos Garcia-Hernandez
- Departamento de Estudios de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
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Abstract
OBJECTIVE To evaluate and compare outcomes in cats following ureteral surgery or ureteral stent placement. DESIGN Retrospective case series. ANIMALS 117 cats. PROCEDURES Data regarding signalment, history, concurrent disease, clinical signs, clinicopathologic tests, surgical procedures, and perioperative complications (including death) were recorded. Follow-up data, including presence of signs of chronic lower urinary tract disease, chronic urinary tract infection, reobstruction, and death, if applicable, were obtained by records review or telephone contact with owners. Variables of interest were compared statistically between cats treated with and without stent placement. Kaplan-Meier analysis and Cox regression were performed to assess differences in survival time between cats with and without ureteral stents. RESULTS Perioperative complications referable to the urinary tract were identified in 6 of 43 (14%) cats that had ≥ 1 ureteral stent placed and 2 of 74 (3%) cats that underwent ureteral surgery without stenting. Perioperative mortality rates were similar between cats with (4/43 [9%]) and without (6/74 [8%]) stents. After surgery, signs of chronic lower urinary tract disease and chronic urinary tract infection were significantly more common among cats with than cats without stents. Nineteen of 87 (22%) cats with follow-up information available had recurrent obstruction; incidence of reobstruction did not differ between cats with and without stents. Median survival time did not differ between the 2 groups. CONCLUSIONS AND CLINICAL RELEVANCE The potential for signs of chronic lower urinary tract disease and chronic infection, particularly among cats that receive ureteral stents, warrants appropriate client counseling. Judicious long-term follow-up for detection of reobstruction is recommended.
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46
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Rickard M, Lorenzo AJ, Braga LH. Renal Parenchyma to Hydronephrosis Area Ratio (PHAR) as a Predictor of Future Surgical Intervention for Infants With High-grade Prenatal Hydronephrosis. Urology 2016; 101:85-89. [PMID: 27713070 DOI: 10.1016/j.urology.2016.09.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/19/2016] [Accepted: 09/21/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore the potential value of an objective assessment, renal parenchyma to hydronephrosis area ratio (PHAR), as an early predictor of surgery. METHODS Initial sagittal renal ultrasound (US) images of patients prospectively entered into a prenatal hydronephrosis database from January 2008 to January 2016 with baseline Society for Fetal Urology (SFU) grades III and IV prenatal hydronephrosis, without vesicoureteral reflux, were evaluated using the National Institutes of Health-sponsored image processing software. PHAR, anteroposterior diameter, SFU grade, and urinary tract dilation risk categories were contrasted with nuclear scan data (differential renal function and drainage time [t1/2]) and analyzed for predictive value in determining the decision to proceed with surgery by drawing receiver operating characteristic curves. RESULTS Out of 196 infants (162 male; 138 left sided hydronephrosis), 58 (30%) underwent surgery to address obstruction. Surgical patients compared with those managed conservatively had longer t1/2 (60 vs 18 min; P < .01) and lower differential renal function (46 vs 50%; P = .01). Of the initial US parameters, PHAR (area under the curve = 0.816; P < .001) had a better predictive performance than anteroposterior diameter, SFU grade, or urinary tract dilation classification. PHAR values correlated with subsequent parameters obtained on nuclear scan. CONCLUSION PHAR is a promising parameter that can be estimated on presentation US to help predict future need for surgery in newborns with high-grade hydronephrosis.
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Affiliation(s)
- Mandy Rickard
- Department of Surgery and McMaster Pediatric Surgery Research Collaborative, McMaster University, Ontario, Canada; Clinical Urology Research Enterprise (CURE) Program, McMaster Children's Hospital, Ontario, Canada
| | - Armando J Lorenzo
- Division of Pediatric Urology, Department of Surgery, The Hospital for Sick Children and University of Toronto, Ontario, Canada.
| | - Luis H Braga
- Department of Surgery and McMaster Pediatric Surgery Research Collaborative, McMaster University, Ontario, Canada; Clinical Urology Research Enterprise (CURE) Program, McMaster Children's Hospital, Ontario, Canada; Division of Urology, Department of Surgery, McMaster University, Ontario, Canada
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Rubenwolf P, Herrmann-Nuber J, Schreckenberger M, Stein R, Beetz R. Primary non-refluxive megaureter in children: single-center experience and follow-up of 212 patients. Int Urol Nephrol 2016; 48:1743-1749. [PMID: 27492776 DOI: 10.1007/s11255-016-1384-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 07/22/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Primary non-refluxing megaureter (pMU) is a multifaceted and challenging congenital pathology of the urinary tract. We report our 23-year experience with this anomaly in terms of presentation, diagnostic work-up and management. MATERIALS AND METHODS We retrospectively reviewed the medical records of 212 children diagnosed with pMU between 1986 and 2009 at our institution. Mean follow-up was 45.17 (0-192) months. RESULTS Of the total, 168 (79 %) children presented with upper urinary tract dilation on perinatal ultrasound screening. In 44 (21 %) patients, the diagnosis was made following diagnostic work-up of a urinary tract infection (UTI, 18 %) or flank pain (3 %). In total, 203 of 254 pMUs (79.9 %) were successfully treated conservatively during the 23-year observation period. Forty-eight children (23 %) underwent ureteric reimplantation. UTIs occurred in 91 of 212 children (43 %). Of these, 41 (45 %) occurred despite antibacterial infection prophylaxis. Within the past three decades, there has been a marked shift from surgical toward conservative therapy at our institution. CONCLUSION Neonatal renal ultrasound is the method of choice to timely identify children with pMU and, alongside dynamic renography, to monitor the clinical course. Nowadays, only a minor subset of children with asymptomatic course requires surgical correction. Antibacterial prophylaxis has the potential to reduce the risk of febrile UTIs. Prospective randomized studies are warranted to provide evidence of the beneficial effect of antibacterial prophylaxis.
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Affiliation(s)
- P Rubenwolf
- Department of Urology, Division of Pediatric Urology, Mainz University Medical Center, Mainz, Germany.
| | - J Herrmann-Nuber
- Department of Pediatrics, Division of Pediatric Nephrology, Mainz University Medical Center, Langenbeckstr.1, 55131, Mainz, Germany
| | - M Schreckenberger
- Department of Nuclear Medicine, Mainz University Medical Center, Mainz, Germany
| | - R Stein
- Department of Urology, Division of Pediatric Urology and Reconstructive Urology, Mannheim University Medical Center, Mannheim, Germany
| | - R Beetz
- Department of Pediatrics, Division of Pediatric Nephrology, Mainz University Medical Center, Langenbeckstr.1, 55131, Mainz, Germany
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48
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Zotti A, Poser H, Chiavegato D. Asymptomatic double ureteral stricture in an 8-month-old Maine Coon cat: An imaging-based case report. J Feline Med Surg 2016; 6:371-5. [PMID: 15546769 DOI: 10.1016/j.jfms.2004.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2004] [Indexed: 10/26/2022]
Abstract
Congenital ureteral strictures are rare both in human and veterinary medicine. While the diagnosis is generally made after a symptomatic or febrile urinary tract infection, we report here a case in which this condition represented an incidental finding during routine ultrasonography. To the best of the authors' knowledge imaging findings of a double monolateral ureteral stricture have not previously been reported.
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Affiliation(s)
- Alessandro Zotti
- Department of Veterinary Clinical Sciences, University of Padua, Faculty of Veterinary Medicine, Viale dell'Università 16, Agripolis, 35020 Legnaro (PD), Italy.
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49
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Vasic NG, Nikolic O, Boskovic T. Unilateral Blind Ending Ureter with Vesicoureteral Reflux and Associated Renal Agenesis -Multidetector Computed Tomography Imaging Findings. Urol J 2016; 13:2657-2658. [PMID: 27085570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 04/13/2016] [Indexed: 06/05/2023]
Affiliation(s)
- Nada G Vasic
- Department of Radiology, Primary Health Care Center "Novi Sad", Novi Sad 21000, Serbia
| | - Olivera Nikolic
- Center of Radiology, Clinical Center of Vojvodina, Novi Sad 21000, Serbia
| | - Tatjana Boskovic
- Center for Radiology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica 21208, Serbia
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Leitão TP, E Silva RP, Barata S, Guerra A, Osório F. Laparoscopic Psoas Hitch Double Ureteral Re-implantation in the Duplex Urinary System for Treatment of Ureterovaginal Fistula. Surg Technol Int 2016; 28:170-176. [PMID: 27121408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Although laparoscopy is widely established for ablative urologic procedures, pelvic reconstructive procedures are still mostly performed by open-surgery. As urologists continue to introduce advanced laparoscopic skills to reconstructive urologic procedures, we present our experience with a laparoscopic psoas hitch double ureteral re-implantation in a patient with an ureterovaginal fistula and an ipsilateral duplex urinary system. MATERIALS AND METHODS A 42-year-old patient presented with continuous involuntary urine loss from the vagina after an abdominal hysterectomy. A double modified Lich-Gregoir ureteral re-implantation with a psoas hitch was performed, using a 4-port laparoscopic approach. RESULTS There were no post-operative complications and the cystography at post-operative day 14 revealed good positioning of the psoas hitch, with no leak or reflux. At three-months follow-up, the patient is completely dry and asymptomatic. CONCLUSION Laparoscopic ureteroneocystostomy with psoas hitch for the treatment of lesions of the distal ureter is a possible, safe, and effective way to resolve a complex urologic situation with minimally invasive surgery. Laparoscopy is becoming the standard approach to urologic pelvic reconstructive procedures, even in the most complex cases.
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Affiliation(s)
- Tito Palmela Leitão
- Urology Department, Centro Hospitalar Lisboa Norte, Faculdade de Medicina de Lisboa, CAML, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | | | - Sónia Barata
- Obstetrics and Gynecology Department, Centro Hospitalar Lisboa Norte, Hospital Santa Maria, Lisboa, Portugal
| | | | - Filipa Osório
- Head of Minimally Invasive Surgery Unit, Obstetrics and Gynecology Department, Hospital da Luz, Faculdade de Medicina de Lisboa, CAML, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
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