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Currently, the total ureteral avulsion are mainly secondary to ureteroscopy, and it is rarely caused by uterine evacuation clinically. This paper reported a case of total ureter avulsion after uterine evacuation, treating by ileal replacement for ureter under general anesthesia, and the surgical outcome was good. Uterine evacuation is a routine, less risky procedure, but it also can lead to serious complications such as total ureteral avulsion or bladder rupture. For potential high-risk patients with uterine evacuation, preventive measures such as accurate localization under B-ultrasound guidance or pre-operative ureteral stents indwelling are useful to avoid the occurrence of such serious complications. If total ureteral avulsion occurs, ileal replacement for ureter is a viable and effective treatment.
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Ureteral artery fistula (UAF) is a rare complication after long-term indwelling of ureteral stent. In this study, two cases were presented. Both of them underwent pelvic tumor surgery and radiotherapy, and had a history of cutaneous terminal ureterostomy and long-term indwelling of ureteral stents. The first case, a 52-year-old female, was admitted to hospital because of intermittent bleeding from ureteral dermostomy for 1 week on April 2, 2020. CT examination revealed hematocele in the left upper urinary tract, and left nephrectomy was performed.However, bleeding still presented and the distal ureteral resection was performed at the same time, and partial ureteral was ligated. Postoperative diagnostic was ureteral artery fistula. After 8 months of follow-up, no recurrent bleeding presented. Another case, a 82-year-old male, was admitted to hospital because of bleeding at the ureteral dermostomy for an hour on June 15, 2020. Contrast enhanced CT examination revealed intersecting of the left ureter and common iliac artery, and interventional surgery was performed, by which UAF was diagnosed. Embolization of left internal iliac artery and stent implantation of common iliac artery and external iliac artery were performed intraoperatively. The bleeding stopped immediately after the operation, and there was no further bleeding during follow-up of 6 months.
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Objective:To investigate the diagnosis, treatment and prognosis of ureteral endometriosis with hydronephrosis.Methods:A retrospective study was performed of 92 cases diagnosed as ureteral endometriosis with surgery confirmed in Peking University First Hospital from January 2000 to January 2021.Results:The incidence of ureteral endometriosis was 0.9% (92/10 222), with an average age of (40.0±6.0) years. Among 92 cases, urological symptoms and pelvic pain including dysmenorrheal, periodic abdominal pain were the main forms of clinical characteristics, while 11 patients (12%, 11/92) were asymptomatic. All patients with ureteral endometriosis had hydronephrosis and hydroureter before surgery, hydronephrosis were left sided in 48 (52%, 48/92) patients, right sided in 39 (42%, 39/92) patients, both sided in 5 (5%,5/92) patients. The distal and middle sections of ureteral obstructions existed in 73 (79%, 73/92) patients and 19 (21%, 19/92) patients, respectively. Out of the 92 ureteral lesions 71 (77%, 71/92) patients were extrinsic lesions, 21 (23%, 21/92) patients presented intrinsic lesions. Of the 38 cases who took preoperative radionuclide renal dynamic imaging examination, there were 6 (16%, 6/38) cases of mildly damaged, 7 (18%, 7/38) cases of moderately dameged, 14 (37%, 14/38) cases of severely damaged, and 11 (29%, 11/38) cases of normal renal function. Laparotomy was decided in 25 (27%, 25/92) patients, and laparoscopic surgery in 67 (73%, 67/92) patients. In cases of ureteral surgery, ureterolysis, partial ureteral resection and ureterocystoneostomy, partial ureteral resection and end-to-end ureteral anastomosis and nephroureterectomy were undertaken in 52 (57%, 52/92), 20 (22%, 20/92), 12 (13%, 12/92) and 8 (9%, 8/92) patients separately. The median follow up was 108 months (range: 6 to 240 months). During the follow-up period, 68 (87%, 68/78) patients took urinary ultrasound after surgery, and 60 (88%, 60/68) cases of hydronephrosis disappeared, and 8 (12%, 8/68) cases were better than before.Conclusion:Most of the patients with ureteral endometriosis are impaired with renal function, and early surgical treatment could effectively relieve urinary obstruction and promote the recovery of renal function.
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RESUMEN La frecuencia de la enfermedad herniaria es una de las más altas dentro de los cuadros quirúrgicos. Sin embargo, su asociación al megauréter en el saco herniario o contenido es extremadamente rara y existen pocos reportes en la literatura internacional. El diagnóstico es incidental, ya sea por hallazgo transoperatorio o por estudios contrastados de imagen. Se presenta el caso clínico de un paciente con antecedente de hernia inguinal que fue sometido a una herniorrafia hace veinte años y que se presenta a un servicio de urgencias con un aparente defecto herniario. Además, padece diabetes mellitus que está mal controlada. Durante la estancia hospitalaria se confirma la reaparición de la hernia con un saco que contiene megauréter y adherencias visceroparietales con ciego en posición subhepática.
ABSTRACT Herniation is one of the most frequent surgical conditions. However, the presence of a megaureter in the hernia sac or content is extremely rare. Little has been reported on this topic in the world literature, and its diagnosis has been incidentally reached either as an intraoperative finding or during different contrast imaging studies. This is the clinical case of a patient with a history of inguinal hernia who underwent a herniorrhaphy 20 years ago and presented to the emergency department with a diagnostic impression of a relapsed hernial defect. He also had poorly-controlled diabetes mellitus. During his hospital stay, a diagnosis of relapsed hernia sac containing a megaureter was confirmed, and visceral-parietal adhesions and a subhepatic cecum were found.
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ABSTRACT Vesicoureteral reflux, the retrograde flow of urine from the bladder into the upper urinary tract, is one of the most common urologic diagnoses in the pediatric population. Once detected, therapeutic options for urinary reflux are diverse, ranging from observation with or without continuous low-dose prophylactic antibiotics to a variety of operative interventions. While a standardized algorithm is lacking, it is generally accepted that management be tailored to individual patients based on various factors including age, likelihood of spontaneous resolution, risk of subsequent urinary tract infections with renal parenchymal injury, and parental preference. Anti-reflux surgery may be necessary in children with persistent reflux, renal scarring or recurrent pyelonephritis after optimization of bladder and bowel habits. Open, laparoscopic/robot-assisted and endoscopic approaches are all successful in correcting reflux and have been shown to reduce the incidence of febrile urinary tract infections.
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Humans , Child , Vesico-Ureteral Reflux/surgery , Replantation , Urinary Tract Infections , GoldABSTRACT
Objective To discuss the diagnosis and treatment of unilateral ectopic ureter in children.Methods The clinical data of 41 cases of ureteral ectopic children admitted to our hospital from January 2014 to June 2018 were retrospectively analyzed including the clinical features,diagnosis,surgical treatments.There were 4 males and 37 females patients,aged from 0.4 to 12.7 years,with an average of 3.5 years old.Urinary incontinence was the main manifestation in 35 cases,including 14 cases with urinary tract infection.Preoperative ultrasonography and IVP examination were performed in all the 41 children.The dynamic radionuclide renal imaging was performed in the children who showed no renal inhencement with IVP.There were 27 cases of ipsilateral renal duplication and 9 cases of ipsilateral renal dysplasia.Ectopic fusion of kidney with ipsilateral ectopic ureter has one case on each side,and bilateral renal duplication with ectopic fusion of kidney with left ureteral ectopic in 1 case.The ipsilateral kidneys were normal in 2 cases.There were 27 cases with renal duplication,24 cases with upper renal dysplasia due to upper heminephrectomy,3 cases with well upper renal function,2 cases with lower superior ureteral pelvis anastomosis,and 1 case with ureterocystostomy.Laparoscopic dysplasia nephrectomy was performed on 9 patients with renal dysplasia,and nephrectomy was performed on 3 patients with renal dysplasia with ectopic renal fusion.Ureterocystostomy was performed in 2 cases with normal kidney.Results All 41 patients were followed up for 4-57 months,with an average of 25.3 months.Among the 35 children with urinary incontinence before the operation,33 cases had complete disappearance of urinary incontinence symptoms,and 2 cases had urgent urinary incontinence after the operation,presenting as frequent and small amount of urine discharge,with a strong sense of urination urgency.The micturition interval was shortened,ranging from 30 to 40min in the daytime,and 2 to 3 hours at night.The parents of the children were required to remind them to micturate regularly.Of the 41 cases,3 developed urinary tract infection 6-10 months after operation,and cured by antibiotics without recurrence.Conclusions Ectopic ureter is relatively rare,but urinary incontinence is the most common clinical manifestation.Ultrasound examination could be the preferred examination method.IVP further identified the patients with ectopic ureter who had kidney combined with malformation and renal function.The surgical treatments are mainly based on the corresponding renal function,and the prognosis is good.
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Ureteropelvic junction obstruction is one of the common causes of hydronephrosis in infancy and childhood. Most cases of ureteropelvic junction obstruction are diagnosed prenatally and are usually asymptomatic. Although less common, older children can experience ureteropelvic junction obstruction that presents with symptoms including flank or abdominal pain. Here, we present the case of a nine-year-old healthy girl who had repeated flank pain and abdominal symptoms, with mild left hydronephrosis, for several months. Computed tomography that was performed during the period of acute flank pain revealed aggravated hydronephrosis on her left kidney, which was secondary to an ureteropelvic junction obstruction. She underwent laparoscopic pyeloplasty, and a crossing vessel that passed the ureteropelvic junction was identified. In addition, we reviewed the current literature of this rare entity.
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Child , Female , Humans , Abdominal Pain , Flank Pain , Hydronephrosis , Kidney , Ureteral Diseases , Ureteral ObstructionABSTRACT
Objective To evaluate the diagnosis and treatment of duplication of the renal pelvis and ureter. Methods The clinical data of 9 patients with duplication of the renal pelvis and ureter who were treated from May 2014 to January 2018 in the Second People′s Hospital of Lianyungang were retrospectively analyzed. Of the 9 cases, 1 case was male, and 8 cases were female. The age range from 6 to 68(40.4 ± 20.6) years. Three cases of duplex kidneys were on the left side, 4 cases on the right side, and 2 cases on the both side. 6 cases had imcomplete duplex systems and 3 cases had complete duplex systems. The diagnosis rate of ultrasound, intravenous urography (IVU), CT scan, magnetic resonance urography (MRU), retrograde pyelography (RPG) was 3/9, 7/8, 5/9, 0/1 and 2/2 respectively. Results One case with simple urinary tract infection was cured by antimicrobial agents, and 1 case with lower ureteral calculus was cured by lithagogue drugs. One case with renal calculus and pyonephrosis in upper moiety of duplex kidney underwent retroperitoneoscopic nephrectomy, 1 case with ureteropelvic junction obstruction and horseshoe kidney underwent division of the isthmus and pyeloplasty, and 2 cases with ureterocele underwent transurethral incision. The clinical symptoms of patients who underwent surgery were cured in all cases. Three cases without complications underwent conservative treatment, and follow-up observation showed no complications. Conclusions Duplication of the renal pelvis and ureter can be diagnosed properly based on imaging data. IVU has a significant advantage, while RPG has high specificity in difficult cases. Treatment should be individualized according to clinical symptoms, complications and other urinary tract congenital anomaly.
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Objective To evaluate the clinical applications of rigid dilatation using double catheter method for ureteric stenosis.Methods The clinical data of 51 ureteric stenosis patients who had underwent rigid dilatation using double catheters method were retrospectively analyzed. Results Among the 51 patients,the ureteroscopy successfully went through the stricture in 46 cases(90.2%),and all patients had no ureteral perforation or laceration.Among the 5 patients in whom ureteroscopy did not go successfully through the stricture,2 cases were placed double J tube,2 cases underwent percutaneous nephrolithotomy,and 1 case underwent two stage ureteral stricture resection and religation.All patients were examined by ultrasound examination 3 months after the treatment,and the degree of hydronephrosis was partial remission. Conclusions The double catheters method is a safe and effective way for rigid dilatation for ureteric stenosis,and it is worth popularizing.
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BACKGROUND:The main way for long-segmental ureteral reconstruction may cause a lot of traumas and complications. Therefore, to seek a new repair method is urgent. OBJECTIVE:To investigate the feasibility of a tissue-engineered tubular graft for ureteral reconstruction. METHODS:Bone marrow mesenchymal stem cels and smooth muscle cels of rabbits were seeded into the two surfaces of bladder acelular matrix and cultivated for 7 days. Then the graft was used to prepare a 4-cm long tissue-engineered tubular graft, which was regarded as experimental group. Smooth muscle cels seeded onto the bladder acelular matrix was used to construct the tissue-engineered tubular graft as control group. Twenty-five New Zealand rabbits were randomly divided into experimental group (n=20) and control group (n=5), and two kinds of tubular grafts covered with omentum were implanted into the two groups, respectively, for repair of ureteral defects. Hematoxylin-eosin staining and immunohistochemical detection were performed at 2, 4, 8 weeks after implantation. RESULTS AND CONCLUSION:In the experimental group, hematoxylin-eosin staining showed epithelial coverage and muscle fibers on the lumen of tissue-engineered tubular grafts at 8 weeks after implantation; immunohistochemistry showed that anti-AE1/AE3 antibody and anti-uroplakinⅢa antibody were positive, confirming that there were mature epithelial cels on the lumen of tissue-engineered tubular grafts. In the control group, five rabbits were dead within 2 weeks after removal of ureteral scaffold, and autopsy showed scar formation inside the graft and severe hydronephrosis. These results demonstrate that it is feasible to construct the tissue-engineered tubular graft using bone marrow mesenchymal stem cels and smooth muscle cels into the bladder acelular matrix for ureteral reconstruction. Bone marrow mesenchymal stem cels can potentialy promote urothelial regeneration.
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Objective To investigate strategies of diagnosis and treatment of ureter endometriosis. Methods From 1983 to 2010, the cases registered in Peking Union Medical College Hospital and confirmed as ureter endometriosis by surgery were enrolled in this study. Clinical manifestatios, preoperative examinations, surgical categories and routes, surgical and pathological findings, post-operative medical treatment, relapse and relating factors were collected and studied. Results Totally 46 patieuts with ureter endometriosis underwent one or two surgeries. Forty-eight per cent (22/46) of patients were not be diagnosed with ureter endometriosis pre-operatively, and 46% (21/46) only presented dysmenorrhea or even no symptoms. Ureterolysis (72%, 33/46) and laparotomy (63%, 29/46 ) were the most common surgical category and surgical approach. There were 64% (25/39) of patients had left ureter involved and 80% (37/46) had extrinsic ureter endometriosis. Fifteen per cent (7/46) of patients had relapsed disease with median recurrent time of 24 months (13 -49 months), and they all received second surgeries. Logistic regression analysis showed that only gonadotropin releasing hormone analogue agents were related with recurrence when compared with those patients without medical treatment post-operatively significantly ( OR =23.2, 95% CI:2. 4 -221.7, P =0. 002). Conclusions Ureter endometriosis was related with reproductive tract endometriosis. It has insidious process resulting in difficulty for early diagnosis. It's important to treat pelvic deep infiltrating endometriosis and ovarian endometrioma to prevent ureter from further involvement. Post-operative treatment of pelvic endometriosis is the key point of preventing relapse of ureter endometriosis.
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Retrocaval ureter is a rare cause of hydronephrosis. Its rarity and non-specific presentation pose a challenge to surgeons and radiologists in making the correct diagnosis. Differentiation from other causes of urinary tract obstruction, especially the more common urolithiasis, is important for successful surgical management. Current practice has seen multislice computed tomography (MSCT) rapidly replaces intravenous urography (IVU) in the assessment of patients with hydronephrosis due to suspected urolithiasis, especially ureterolithiasis. However, MSCT, without adequate opacification of the entire ureter, may allow the physician to overlook a retrocaval ureter as the cause of hydronephrosis. High-resolution IVU images can demonstrate the typical appearance that leads to the accurate diagnosis of a retrocaval ureter. We reported a case that illustrates this scenario and highlights the importance of IVU in the assessment of a complex congenital disorder involving the urinary tract.
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Objective To assess the symptoms of patients due to indwelling double ureteral stent and their impact on quality of life. Methods Sixty patients were assessed by the specific questionnaire. Average time of indwelling stent was 21.4 d. All patients finished the special questionnaire when the stent was removed by cystoscope, including specific urinary symptoms, IPSS (international prostate symptom score), VAS (visual analogic scale) and QOL (quality of life). To assess the pain feeling, the patients were divided into 3 groups by varied methods of anesthesia, including local anesthesia, balance anesthesia and general anesthesia. Results Insertion or removal of ureteral stents with local anesthesia provoked pain in 11 of 12 (91%) patients and 8 of 10 (80%) patients in balance anesthesia group. But 38 patients of general anesthesia group did not feel any pain when inserting stents. In 54 of 60 (90%) patients, the indwelling catheter provoked one or several urinary symptoms: nocturia (70%), frequency (65%), urgency (60%), tenesmus (58%), dysuria (52%), hematuria (35 % ) and incontinence (30 %). 75 % of the patients experienced pain, in the flank and lower abdomen. 29 (48 %) patients were found to be unsatisfied with their quality of life due to the indwelling stent. Among them, 18 (62%) patients demonstrated that the provoked overactive bladder symptoms were the main influence factor of QOL, compared with 5(17 %) patients complaining pain feeling. Conclusions Urinary symptoms and pain associated with indwelling double J ureteral stents could interfere the daily activities and 50 % of patients were found reduced quality of life. Overactive bladder symptoms were the main influence of QOL during the time of indwelling stent.
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Se presenta un caso clínico y los hallazgos imagenológicos de una pioureterohidronefrosis en una paciente de 4 años de edad, sin antecedentes patológicos, con historia de 5 días de evolución con dolor abdominal, fiebre de 38,2ºC, dolor en hipocondrio y flanco izquierdo con ocupación del fondo de saco lateral izquierdo al tacto rectal.
A case of a 4 year old girl with no pathologic background, with pyoureterohydronephrosis is presented. The history was 5 days of abdominal pain and fever (38,2 Cº), and an occupation of the left recess in the rectal digital examination.Imagenologic studies demonstrate pyoureterohydronephrosis.
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Humans , Female , Child, Preschool , Urethral Diseases/complications , Hydronephrosis/diagnosis , Hydronephrosis , Urethral Diseases/surgery , Nephrostomy, PercutaneousABSTRACT
Objective To report the experience on the ureteroscopic treatment of ureteral fibro-epithlial polyp by Holmium:YAG laser resection.Methods Of five cases,the polyp was located in the upper 1 third of the ureter in 2 cases,and in middle 1 third or ureter in 2 cases,in lower 1 third of ureter in 1 case.The length of the polyps ranged from 3 to 16 cm.Three patients presented with flank pain,4 with hematuria and 1 with hydronephrosis.Five patients underwent rigid ureteroscopic treat-ment.TUR was performed in the 2 polyp cases with prolapsing from the ureteral orifice.A Holmium:YAG laser was used to resect ureteral polyps.At the end of the procedure,a 7 F double-J ureteral stent was placed and indwelling for 6- 8 weeks.Results All operations were successfully done.The pathologic diagnosis were fibroepithelial polyp.Histologically,the polyps were composed of a central fibrovascular core surrounded by hyperplastic benign urothelium.The stroma of polyp consis-ted of fibrous connective tissue with minimal cellular infiltration,and occasional epithelial cell nests were seen.The average length of hospital stay was 3 d (range 2 to 5).The mean follow-up was 24 months (range 3 to 51),and all patients remained no recurrence.One patient developed a ureteral stricture 3 months after the treatment,and relieved by endoscopic incision by Holmium:YAG laser.Conclusion Endoscopic management of ureteral fibroepithelial polyps could be a treatment modality with minimal morbidity and good treatment results.
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Objective To study the effectiveness of the complete ureterel reconstruction using bladder flap after cadaveric renal transplantaion.Methods In 13 recipients with complete necrosis of ureter after renal transplant from July 1995 to October 2003, tubelike bladder flaps were applied to ureteraplasty substitute for the necrosis ureter. Artificial pyeloureterostomy was performed and double T tubes were used as the stents. Routine drainage-tubes were placed in incisions. Results All patients were successful in ureteral reconstruction. The renal function of 10 patients was improved significantly 4 weeks postoperation. Nephrectomy was performed in one patient because of severe circumrenal infection 7 days after operation. One-year survival rate of recipients and allografts was ~100 % (13/13) and ~92.3 % (10/13) respectively. Urine reflow occurred in 2 patients during a follow-up of 12 months. Conclusion The use of bladder flap for ureteral reconstruction is an effective technique for total autograft ureteral necrosis.
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Objective To evaluate the preoperative diagnosis and treatment of primary non-specific ureteritis,and to better understand this disease.Methods Three cases of primary non-specific ureteritis (1 man and 2 women)were reported.Their age was 28,38,68 years,respectively.One ease was found to have hydronephrosis on B-ultrasound at physical examination with no symptoms,and 2 had abdominal pain. The lesions were detected in lower part of the ureter in 2 cases,and in middle in I.The patients were diag- nosed preoperatively with combined use of MRU and ureteroscopy.Partial resection of the diseased part of the ureter was performed in all the cases.Results Pathological findings confirmed the diagnosis of non-spe- cific ureteritis.Microscopy showed necrotic tissue and inflammatory cell infiltration of ureteral mucosa,dilated and congested blood vessels,hypertrophic muscular layer,and proliferation of fibrous tissue.During the fol- low-up of 2 years,the patients had no symptoms and were free from hydronephrosis.Conclusions The eti- ology of primary non-specific ureteritis is unclear,and no typical symptoms can be found clinically.Combined use of MRU and ureteroscopy is helpful for definite diagnosis of the disease.Partial resection of the diseased part of the ureter has good results.
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Objective To assess the laparoscopic technique combined with open surgical technique in pyeloplasty.Methods Overall,45 patients with ureteropelvic junction obstruction underwent laparo- scopic dissection of the renal pelvis and upper ureter transperitoneally,and pyeloplasty was performed through a expanded trocar-incision(extension of 1-2 cm)as open surgery was performed.Results The opera- tion was successful in all 45 patients.The mean operative time was 58 min(range,40-85 min),and the mean blood loss was 22 ml(range,15-30 ml).No complication was observed during and after operation. Follow-up for 3-36 months was available in 34 patients.Intravenous urography(IVU)showed no obstruc- tion of the anastomotic stoma,and B-ultrasound indicated relief of hydronephrosis.Conclusions Laparo- scopic approach combined with open surgery in pyeloplasty is an effective way to treat ureteropelvic junction obstruction.This technique can simplify the operative manipulation and shorten the operative time without more trauma to the patients.It is worth general application in clinical practice.
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Objective To summarize the causes of failed drainage of double J ureteral stents following ureteroscopy. Methods From June 2000 to March 2003,the double J ureteral stents were placed for 3972 patients (2184 males and 1788 females)following ureteroscopy.The stents were placed through retrograde approach in 3138 cases,through antegrade approach in 1497 cases.The patients were followed up until the ureteral stents were retrieved. Results Of the 4635 cases,failed drainage of double J ureteral stent was found in 115 cases (2.48%).The main causes were severe extra luminal obstruction,serious steinstrasse,severe ureteral stricture and overperiod placement of ureteral stents. Conclusions Correctly identifying the indications for ureteroscopy and the placement of double J ureteral stents as well as close follow up are the keys to reduce the failure rate of drainage of double J ureteral stents following ureteroscopy.
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Objective To summarize the experience in diagnosis and treatment of ectopic ureter in children. Methods A total of 22 cases (21 females and 1 male;mean age of 4 years,range from 1 month to 12 years) of ectopic ureter were analyzed retrospectively.Of them,17 cases had unilateral ectopic ureters and 5,bilateral.Normal,divided urination accompanied by abnormal leakage of urine occurred in 18 cases;completely continous leakage of urine in 3;and obstruction of upper urinary tract with infection of urinary system in 1.Fourteen cases had opening of ectopic ureters in vaginas,4 in urethras,3 in vestibula and 1 in bladder necks. Results Of the 22 cases 20 underwent surgical procedures.Of the 20 cases,11 had total nephrectomy and 7,partial nephrectomy.After the operation,leakage of urine disappeared,but 3 cases had syndrome of ureteral stump remnant.One case who underwent bilateral ureter-bladder reimplantation had mild urinary incontinence after the operation.One case who had vesica replaced with rectum was followed up for 5 years,the post-operative result was excellent. Conclusions It is of critical importance to establish definite diagnosis and to select appropriate mode of operation for the successful treatment of ectopic ureter in children.