ABSTRACT
Ureterocele is a cystic dilatation of the distal sub mucosal part of the ureter. It is a congenital anomaly that may co-exist with other anomalies. It has an incidence 1 in 4000 live births. Patients present with symptoms at paediatric age or may remain asymptomatic till adulthood. Our 30 year old female patient was assessed for a giant orthotropic right ureterocele with obstructive uropathy, in a hospital that has no modern facilities for endoscopic treatment. She then had successful open surgical repair of the ureterocele with satisfactory outcome. Minimally invasive endoscopic treatment options remains the gold standard. Patients from poor resource regions can as well be treated successfully by open surgical repair like our index case presented.
ABSTRACT
Paciente de 29 años de edad, sexo masculino, sin antecedentes clínicos ni quirúrgicos de importancia. Acude al servicio de emergencia con dolor en la fosa iliaca derecha (escala de dolor EVA 6/10). Examen físico: abdomen suave, depresible, doloroso a la palpación en la fosa ilíaca derecha, signos de McBurney dudoso y Rovsing positivo. Se sospecha apendicitis aguda por lo cual se solicita una tomografía multicorte simple y contrastada de abdomen y pelvis que reporta dilatación quística del uréter distal izquierdo en su segmento intravesical, que es compatible con un ureterocele. Diagnóstico diferencial del dolor en la fosa ilíaca derecha: incluye algunos menos comunes como el ureterocele que no debe ser soslayado. (AU)
Subject(s)
Male , Adult , Ureterocele , Signs and Symptoms , TomographyABSTRACT
Ureterocoele is a cystic dilatation of the lower part of the ureter. One of its presentations in the adult population is the presence of a stone, usually a solitary stone, inside the ureterocoele. Authors present a rare case of Ureterocoele with stone in it managed with transurethral deroofing and cystolitholapaxy. This work has been reported in line with the SCARE criteria.
ABSTRACT
El ureterocele es una malformación del sistema urinario relativamente frecuente en niños; sin embargo, el prolapso del ureterocele a través de la uretra es una presentación, en extremo rara. La urorresonancia magnética es la prueba de elección para el diagnóstico definitivo. El tratamiento inicial de un ureterocele prolapsado consiste en la descompresión de la masa. Presentamos el caso clínico de una lactante de 7 meses con duplicación del sistema colector y ureterocele ectópico derecho, que apareció como una masa vulvar.
Ureterocele is a relatively common malformation of the urinary system in children; however, the ureterocele prolapse through the urethra is an extremely rare presentation. Urological nuclear magnetic resonance is the test of choice for definitive diagnosis. Initial treatment of a prolapsed ureterocele involves decompression of the mass. We report the case of a 7-month-old infant with duplication of the collecting system and right ectopic ureterocele appearing as a vulvar mass.
Subject(s)
Humans , Female , Infant , Ureterocele/diagnosis , Prolapse , Ureterocele/complications , VulvaABSTRACT
El cecoureterocele es un ureterocele ectópico, malformación congénita del uréter distal en su desembocadura a la vejiga, que da lugar a un saco membranoso ciego que protruye por la uretra hasta el exterior. Presentamos a una niña de cinco meses y 6 kg de peso que acude para evaluación y manejo de una masa de color violáceo que protruye por el introito vaginal. Al examen físico, buen estado general. FC 134 lpm, TA 93/56 mmHg, FR 38 x´, T 36o C, Sat 02 96 %. Ecografía renal: Riñón izquierdo con una imagen líquida parahiliar compatible con doble sistema colector incompleto con dilatación del segmento proximal. Ecografía vesical: imagen con contenido líquido denso relacionada con el sistema urinario y compatible con ureterocele. Gammagrafía renal DMSA: área hipocaptante en polo superior del riñón izquierdo. Renograma isotópico DTPA: Retención del trazador en pelvis renal izquierda. Corrección quirúrgica consistente en nefrectomía parcial con escisión del polo superior del riñon izquierdo, separación y sección distal del uréter dilatado y resección del ureterocele. Evolución postoperatoria satisfactoria con alta a los dos días de la intervención. El cecoureterocele es una rara malformación de la vía urinaria habitualmente asociada a otras malformaciones corregibles quirúrgicamente. Recomendamos considerar esta posibilidad, en el diagnóstico diferencial de toda masa que protruye por la vagina.
A cecoureterocele is an ectopic ureterocele, congenital anomaly of the distal ureter at the uretero-vesical junction, consisting in a closed membranous pouch which protrudes through the urethra into the vagina. We present a five months old, 6 kg girl, admitted for assessment and management of a dark red mass protruding through the vagina. On examination, good general health. BP 93/56, HR 134 bpm, RR 38x´, T 36o, O2 Sat 96 %. Renal ultrasound: parahiliar liquid shadow in the left kidney sugesting a duplicated incomplete collecting system with a dilated proximal segment. Bladder ultrasound: dense liquid shadow related to the urinary tract sugesting a ureterocele. DMSA renal gamma scan: poor captation in the upper pole of the left kidney. DTPA isotopic renogram: Retention of the tracer in the left renal pelvis. Surgical correction consisting in a left upper pole partial nephrectomy, separation and distal section of the dilated ureter and resection of the ureterocele. Good postoperative course, discharged two days later. A cecoureterocele is an uncommon congenital malformation of the urinary tract commonly associated with other surgically correctable malformations. We recomend to consider this posibility in the differential diagnosis of any mass protruding through the vagina.
Subject(s)
Humans , Female , Infant , Ureterocele , Congenital Abnormalities , Ultrasonography/instrumentationABSTRACT
Objective To explore the feasibility of tubeless 2 μm laser vaporesection in treating pediatric ureter cysts by ureteroscopy.MethodsClinical data of 33 ureter cysts patients who received tubeless 2 μm laser vaporesections by ureteroscopy were reviewed. The median age of patients was 4 years with a range from 1 to 7 years. The operations were carried out by RevoLix 2 μm laser through ureteroscopy without ureter stents and catheters indwelling.ResultsAll operations were successfully performed. And no serious complications occurred after the operations.ConclusionsTubeless transurethral 2 μm laser treatment by ureteroscopy was a superior micro-invasive surgery method for pediatrics with ureter cysts, with advantages of little blood loss, high safety, convenient operation and infrequent complications.
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Objective To explore the curative effect and security of transurethral holmium laser resection for adult ureterocele.Methods 22 cases with adult ureterocele were retrospectively studied.Eight adult ureterocele cases were male and 14 cases were female.The mean age was 36.5 years (ranged from 20 to 67years).All of the patients were unilateral onset,15 cases on the left side and 7 cases on the right side.The mean course of the disease was 31 months (ranged from 15d to 12 years).The clinical presentations were varied.All 22 cases were treated by tran-surethral holmium laser resection.About one -third of cyst wall were left in order to avoid vesicoureteral reflux and hydronephrosis.Results All 22 cases succeeded uneventfully.The pathologic study confirmed that 22 cases were ure-terocele.The mean hospital stay was 8days (ranged from 6 to 12days).Mean follow -up time was 17 months (12 -26 months),while 2 cases were lost.All 20 cases urine alalysis was normal.Five patients showed no hydronephrosis, while 10 cases showed less hydronephrosis.Cystoscopy showed all 20 cases ureteral healing was smooth,and none showed recurrence of ureterocele.Voiding cystourethrography showed none of vesicoureteral reflux.Conclusion Transurethral holmium laser resection would be a good choice for adult ureterocele,because the treatment has the advantages of simple operation,low requirement of equipment,safety and reliability.Especially for the primary level hospital,transurethral holmium laser resection is worth further clinical promotion.
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La cistitis eosinofílica es una entidad poco común que se caracteriza por la inflamación con infiltrado eosinofílico de la pared vesical. No es muy frecuente en la edad pediátrica con mínimos reportes de casos en la literatura. Presentamos un caso de un paciente de 24 meses, a quien se le diagnostica dicha patología, el manejo instaurado y una revisión de la literatura.
Eosinophilic cystitis is a rare entity characterized by inflammations with eosinophilic infiltration of the bladder wall. It appears infrequently in children, and there are few case reports in medical literature. This paper presents the case of a 24-month-old patient diagnosed with this condition, the treatment that has been established for it, and a review of the literature.
A cistites eosinofílica é uma entidade invulgar que se caracteriza pela inflamação com infiltrado eosinofílico da parede vesical. Não é muito frequente na idade pediátrica com mínimos reportes de casos na literatura. Apresentamos um caso de um paciente de 24 meses, a quem se lhe diagnostica dita patologia, o manejo instaurado e uma revisão da literatura. Métodos diagnósticos moleculares em tuberculoses
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Cystitis , Ureteral Obstruction , Ureterocele , Urinary Bladder , Cystoscopy , EosinophiliaABSTRACT
Un ureterocele es una dilatación del extremo distal del uréter que se produce en etapa fetal. La incidencia varía según las series entre 1:500-4000 pacientes, predominantemente en niñas. Se presenta el caso de una paciente de color de piel blanca, 50 años de edad, con antecedentes de infecciones repetidas del tracto urinario que acudió a médico de familia porque desde hacía varios meses su cuadro se había exacerbado con varios episodios de disuria, polaquiuria y urgencia miccional. Se recomendó realizar ultrasonido abdominal y acudió al Hospital General Universitario Dr. Gustavo Aldereguía Lima, de Cienfuegos, donde mediante estudio ultrasonográfico abdominal con múltiples cortes se observó una imagen mixta hacia la región media del riñón derecho. En el riñón izquierdo se observó ureteropielocaliectasia con buena diferenciación córtico medular y el uréter dilatado hasta su entrada a la vejiga como imagen ecolúcida redondeada de aspecto quístico intravesical. Por ser un hallazgo poco común se decidió la presentación del caso.
Ureterocele is a dilation of the distal end of the ureter that occurs during fetal stage. Its incidence varies according to the series between 1/500 to 1/4000 patients, predominantly in girls. A case of a 50-year-old white female patient with a history of recurrent urinary tract infections is presented. She attended the family doctor’s office due to the exacerbation of her condition by some episodes of dysuria, urinary frequency and urgency for several months. Abdominal ultrasound was recommended. A complex structure in the middle part of the right kidney was disclosed by a multislice ultrasonography of the abdominal region performed in the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos. Ureteropyelocaliectasis with good corticomedullary differentiation was observed in the left kidney, as well as dilation of the ureter until its entry into the bladder as a cystic intravesical mass. It was decided to report this case given its rare occurrence.
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Hydronephrosis is the most common urogenital anomaly with the potential for obstructive process. And ultrasonography, as a first-line imaging modality, is a useful tool for evaluation of prenatal and postnatal hydronephrosis, even though evaluation of renal function is still needed. In this article, we review the common causes of congenital hydronephrosis and the sonographic findings of those diseases.
Subject(s)
Hydronephrosis , Ureterocele , Vesico-Ureteral RefluxABSTRACT
Relataram-se o quadro clínico, o diagnóstico, o tratamento e o acompanhamento de um cão com ureterocele ectópica e hidronefrose/hidroureter associados. Após as informações obtidas nos exames laboratoriais e de diagnóstico por imagem, o animal foi submetido à ureterocelectomia e à neoureterostomia. O cão apresentou evolução favorável após a conduta terapêutica. Apesar de pouco frequente, a ureterocele deve ser considerada como diagnóstico diferencial em animais jovens com histórico de incontinência urinária.
The clinical features, diagnosis, treatment and monitoring of a dog with an ectopic ureterocele and concomitant hydronephrosis/hydroureter were reported. After the information obtained in laboratory tests and imaging diagnosis, the animal was submitted to ureterocelectomy and neoureterostomy. The dog presented a favorable evolution after the therapy. Although infrequent, the ureterocele should be considered a differential diagnosis in young animals with history of urinary incontinence.
Subject(s)
Animals , Dogs , Dogs/abnormalities , Ureterocele/diagnosis , Ureterocele/urine , Ureterocele/veterinary , Ureterocele/therapyABSTRACT
Ureterocele é uma dilatação cística do ureter intravesical. A maioria das ureteroceles é diagnosticada no útero ou imediatamente após nascimento durante exames de ecografia na pesquisa de malformações renais. Severas infecções do trato urinário são a apresentação pós-natal mais comum das ureteroceles, mas podem, raramente, sofrer um prolapso e agudamente obstruir a saída da bexiga. Ocorre mais frequentemente em crianças, entretanto quando encontrada em adultos geralmente está associada à unilateralidade, sendo a sua bilateralidade incomum. Nós apresentamos um relato de caso de uma paciente feminina adulta com ureterocele bilateral e com histórias de infecções do trato urinário por repetição (AU)
Ureterocele is a cystic enlargement of the intravesical ureter. Most ureteroceles are diagnosed in the uterus or immediately after birth in ultrasonographic scans searching for renal malformations. Serious infections of the urinary tract are the most common post-natal presentation of ureteroceles, and they may seldom prolapse and obstruct the bladder outlet. It occurs more frequently in children, but it also appears in adults, usually unilaterally, bilaterality being uncommon. Here we describe the case of an adult female patient with bilateral ureterocele with a history of repeated urinary tract infections (AU)
Subject(s)
Humans , Female , Adult , Ureterocele/surgery , Ureterocele/diagnosisABSTRACT
PURPOSE: To review the clinical manifestations, indications and the management outcomes of adult patients with ureteroceles. MATERIALS AND METHODS: Between 1995 and 2006, 20 adult patients (9 females, 3 males) with ureteroceles were investigated for their clinical symptoms, type of ureterocele and renal function. The outcomes of surgical or conservative management, according to the patients' symptoms were also individually analyzed. The median follow-up was 38 months (12-50 months). RESULTS: The ages at diagnosis of the ureteroceles ranged from 19 to 70 years (mean 37.9 years). The ureterocele-related symptoms were flank pain (3), hematuria (1) and lower urinary tract symptoms (4). Two cases were incidentally detected with ultrasound (1) or computed tomography (1), and another 2 patients presented with non-specific flank pain or a hematuria. Eight patients exhibited an intravesical single system and 4 were associated with upper pole of a duplex system. Only one patient had an ectopic ureterocele, in which the orifice was located in the mid-urethra. The ureterocele-related symptoms were managed using a transurethral incision (5) or resection (1) of the ureterocele, with ureteroscopic stone retrieval (2). The symptoms were resolved after surgery, and there were no recurrence of symptoms or any deterioration of the renal function during follow-up. CONCLUSIONS: To diagnose an ureterocele in adult patients requires a high index of suspicion, as not all patients present with the typical clinical manifestations associated in children. Our results suggested that ureterocele-related symptoms are the main indication for surgery in adult patients. While methods with lower morbidity may be a useful, expectant treatment, they may also be an appropriate option for the management of incidentally detected ureteroceles.
Subject(s)
Adult , Child , Female , Humans , Diagnosis , Flank Pain , Follow-Up Studies , Hematuria , Lower Urinary Tract Symptoms , Recurrence , Ultrasonography , UreteroceleABSTRACT
An ectopic ureterocele is a rare condition in the neonate, especially one that protrudes from the outside of vagina as a site of termination of an ectopic ureter. In such a case, the differential diagnosis with inspection between an ectopic ureterocele and other vaginal mass is difficult. As well, recurrent episodes of urinary tract infection and sepsis are common. Recently, incision of an ectopic ureterocele has led to a decrease in compression due to obstruction of the urinary tract and fewer complications arising from surgery of the urinary system in infant. The authors present an example of a interlabial mass that appeared suddenly in a 1 month old neonate in which marsupialization of the prolapsed ectopic ureterocele was carried out.
Subject(s)
Female , Humans , Infant , Infant, Newborn , Diagnosis, Differential , Sepsis , Ureter , Ureterocele , Urinary Tract , Urinary Tract Infections , VaginaABSTRACT
Purpose: We reviewed our experience in the management of ureteroceles in children as we selected the surgical method according to the patients' age and the differential function of the affected renal unit. Materials and Methods: Thirty-six children (10 boys, 26 girls) with ureteroceles who received surgical management between 1991 and 2003 and were followed up for at least 12 months postoperatively were the subjects of this study. Age at operation ranged from 1 month to 10 years (median 6.5 months) and patients were followed up for an average of 43 months postoperatively (12-103 months). Results: Twenty patients had functioning renal units, 16 including 4 infants, of which received transurethral incision (TUI), 3 ureteroureterostomy and 1 ureteroneocystostomy after ureterocelectomy. Eight of the 16 patients (50%) who received TUI developed de novo vesicoureteral reflux (VUR), 5 of whom requiring secondary open procedure. Of the 16 patients with nonfunctioning renal units who received either heminephrectomy or nephrectomy, 6 required secondary open procedures for persistent ureteral obstruction or bladder outlet obstruction. On follow-up, of the 20 patients with initially functioning renal units, 19 maintained preoperative level of renal function and all remained free of urinary tract infection (UTI). Conclusions: In surgical approach to the ureteroceles, individualization with respect to the function of the affected unit and the age of the patient appears to be effective in controlling UTI and preserving the renal function. TUI, despite the high rate of de novo VUR, may be a useful option in immediate decompression of the obstructed urinary tract in the face of acute UTI especially in younger children.
Subject(s)
Child , Humans , Infant , Decompression , Follow-Up Studies , Nephrectomy , Ureteral Obstruction , Ureterocele , Urinary Bladder Neck Obstruction , Urinary Tract , Urinary Tract Infections , Vesico-Ureteral RefluxABSTRACT
PURPOSE: Our experience of upper moiety in the complete duplex system was retrospectively analyzed to determine its optimum management. MATERIALS AND METHODS: Between 1988 and 2003, 27 patients were treated with the complete duplex system. Fifteen patients had ureterocele (9 intravesical, 6 ectopic) and the other 12 had an ectopic ureter. In all cases, excretory urography, ultrasonography, voiding cysto-urethrogram (VCUG) and dimercaptosuccinic acid (DMSA) renal scan were performed. The initial treatment was performed using salvage (transurethral incision or ureteropyelostomy) or non-salvage procedures (upper pole nephrectomy or nephrectomy). The median follow-up was 30 (13-48) months. RESULTS: The 27 patients were divided into three groups based on the function of the upper moiety from the DMSA renal scan - or=15%; 11 patients (group C). In group A, upper pole nephrectomy was performed in 9 patients, a total reconstruction in 3 and a nephrectomy in 1. In group B, an upper pole nephrectomy was initially performed, with an ureteropyelostomy and transurethral incision (TUI). In group C, all patients received a transurethral incision as the initial treatment. The ipsilateral renal function was well conserved in the cases of upper pole nephrectomy, with no complications. Patients initially receiving salvage procedures showed a significant improvement and conservation of the ipsilateral renal function, but 4 patients required additional operative management due to moderate to severe vesicoureteral reflux (VUR), recurrent urinary tract infection and decreased renal function of the upper moiety. CONCLUSIONS: Salvage procedures are a preferable adequate therapeutic modality for the complete duplex system with a well conserved renal function.
Subject(s)
Humans , Follow-Up Studies , Gene Duplication , Nephrectomy , Retrospective Studies , Succimer , Ultrasonography , Ureter , Ureterocele , Urinary Tract Infections , Urography , Vesico-Ureteral RefluxABSTRACT
Ureterocele, a rare condition, is a congenital saccular dilation of terminal portion of the ureter. Presented here is a case report of a patient who had complaints of recurrent urinary tract infection and right loin pain. The ultrasonography followed by intravenous pyelography proved it to be the case of ureterocele.
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PURPOSE: The histological changes in the upper pole of excised duplex kidneys with ureterocele were reviewed and the histological variations with respect to age and ureterocele position were assessed. MATERIALS AND METHODS: During the last ten years, 10 patients with duplex system ureterocele underwent an upper pole nephrectomy. A total of 10 specimens, of which 4 and 6 were diagnosed at younger than 1 year old and older than 1 year old, and 5 each involving intravesical and ectopic locations, respectively, were available for independent review by a single pathologist. Histological lesions were classified into the 5 categories; chronic interstitial inflammation, interstitial fibrosis, tubular atrophy, glomerulosclerosis and dysplasia. Each category was divided into moderate/severe histological lesions (greater than 25% involvement) and minimal/mild lesions (25% or less involvement). RESULTS: Chronic interstitial inflammation, interstitial fibrosis, tubular atrophy, glomerulosclerosis and dysplasia in each of the specimens were graded as moderate/severe (greater than 25% involved) in 50, 50, 60, 10 and 80% of the subjects, respectively. The ureteroceles detected at an early stage were not associated with less severe upper pole histological lesions. Also, no pathological differences were observed when comparing specimens according to the ureteroceles positions. CONCLUSIONS: It appears that the histological lesions observed may not be progressive or reversible. Therefore, it is suggested that enhancement of the upper pole renal function seems unjustified in the light of the histological evidence, and the goals of clinical management should focus on preventing complications and secondary procedures.
Subject(s)
Humans , Atrophy , Fibrosis , Inflammation , Kidney , Nephrectomy , UreteroceleABSTRACT
PURPOSE: A complete duplicated collecting system complicated with an ectopic ureter or ureterocele results in renal damage due to a ureteral obstruction or reflux. The clinical outcome of ureteropyelostomy in complicated complete duplicated collecting system was evaluated. MATERIALS AND METHODS: 20 children received a ureteropyelostomy for either an ectopic ureter or ureterocele with a complete duplicated collecting system anomaly. The median age was 3.2 months. Of the children, 11 had ureteroceles including 7 cecoureteroceles, and 9 had ectopic ureters. The associated anomalies were 3 UPJ obstructions of the lower pole and 9 VUR. All received a ureteropyelostomy. The lower pole ureter was used as the common ureter except in 2 cases with a lower ureter in poor condition. A lower pole pyeloplasty was combined in 3 cases with UPJ obstructions of the lower pole. A distal ureteral stump was left open except in the cecoureterocele in order to prevent VUR. Their clinical courses were followed up with an ultrasonogram and 99mTc-DMSA scan. The median follow-up after surgery was 17.8 months. RESULTS: A reduced upper pole hydronephrosis was observed in 19 patients and an improvement in the differential renal function was noted in 17 patients on the follow-up studies. All ureteroceles had either disappeared or were reduced in size. 7 patients showed an intermittent asymptomatic bacteriuria and 1 patient showed symptomatic UTI who required an ureteroneocystostomy during the follow-up. CONCLUSIONS: A ureteropyelostomy is recommended as a first-line treatment modality for patients with a complicated complete duplicated collecting system owing to the lower chance of secondary surgery, the prevention of deterioration in the bladder function and the possibility of early correction.
Subject(s)
Child , Humans , Bacteriuria , Follow-Up Studies , Hydronephrosis , Technetium Tc 99m Dimercaptosuccinic Acid , Ultrasonography , Ureter , Ureteral Obstruction , Ureterocele , Urinary BladderABSTRACT
PURPOSE: A complete duplicated collecting system complicated with an ectopic ureter or ureterocele results in renal damage due to a ureteral obstruction or reflux. The clinical outcome of ureteropyelostomy in complicated complete duplicated collecting system was evaluated. MATERIALS AND METHODS: 20 children received a ureteropyelostomy for either an ectopic ureter or ureterocele with a complete duplicated collecting system anomaly. The median age was 3.2 months. Of the children, 11 had ureteroceles including 7 cecoureteroceles, and 9 had ectopic ureters. The associated anomalies were 3 UPJ obstructions of the lower pole and 9 VUR. All received a ureteropyelostomy. The lower pole ureter was used as the common ureter except in 2 cases with a lower ureter in poor condition. A lower pole pyeloplasty was combined in 3 cases with UPJ obstructions of the lower pole. A distal ureteral stump was left open except in the cecoureterocele in order to prevent VUR. Their clinical courses were followed up with an ultrasonogram and 99mTc-DMSA scan. The median follow-up after surgery was 17.8 months. RESULTS: A reduced upper pole hydronephrosis was observed in 19 patients and an improvement in the differential renal function was noted in 17 patients on the follow-up studies. All ureteroceles had either disappeared or were reduced in size. 7 patients showed an intermittent asymptomatic bacteriuria and 1 patient showed symptomatic UTI who required an ureteroneocystostomy during the follow-up. CONCLUSIONS: A ureteropyelostomy is recommended as a first-line treatment modality for patients with a complicated complete duplicated collecting system owing to the lower chance of secondary surgery, the prevention of deterioration in the bladder function and the possibility of early correction.