Efficacy analysis of single-port intravesical laparoscopic Politano-Leadbetter for primary obstructive megaureter in adolescents / 中华泌尿外科杂志

Objective:To investigate the efficacy of single-port intravesical laparoscopic Politano-Leadbetter in the treatment of adolescent primary obstructive megaureter.Methods:Retrospective analysis was performed on the clinical data of 11 adolescents with primary obstructive megaureter who received single-port intravesical laparoscopic Politano-Leadbetter in Fujian Provincial Hospital from January 2018 to November 2019, including 7 males and 4 females, 8 patients with left stenosis and 3 patients with right stenosis. The mean age was (13.5±2.4) years old, and the mean weight was (49.4±11.2) kg. Before surgery, the anteroposterior diameter of the affected renal pelvis was (3.25±0.69) cm, the maximum diameter of the ureter was (2.25±0.48) cm, the thickness of the affected renal cortex was (1.34±0.52) cm, and the renal function was (36.00±2.86) %. All patients underwent Politano-Leadbetter by single-port intravesical laparoscopic. Suprapubic bladder approach was used to establish a single-hole air bladder channel, and the end of the ureter was dislocated and cut, the submucosal tunnel of the bladder was established, and the end of the ureter was re-embedded. The Politano-Leadbetter ureteral replantation was completed.The dilatation and tortuousness of the affected renal pelvis and ureter and the changes of renal function of the affected kidney were analyzed before and after operation.Results:All operations were completed successfully.The operative time was (95.6±18.5) min, the intraoperative blood loss was (6.8±2.3) ml, the postoperative indwelling catheter time was (4.5±1.8) d, and the average hospital stay was (6.2±2.4) d. Postoperative follow-up time was (13.6±4.3) months.12 months after surgery, the anteroposterior diameter of the affected renal pelvis and the maximum diameter of the ureter were (2.00±0.45) cm and (1.18±0.22) cm, which were significantly lower than those before surgery ( P< 0.05). The thickness of the renal cortex was (2.17±0.49) cm, and the renal function was (44.00±1.41) %, which was significantly increased compared with that before operation ( P<0.05). Diuretic nephrogram showed no mechanical obstruction or no obstruction curve. One patient developed urinary tract infection 6 weeks after operation and recovered after removal of double J tubes.The other patient presented degree I ureteral reflux 6 months and 1 year after surgery, without urinary tract infection and low back pain.All the other children recovered well without postoperative complications.All parents were satisfied with the incision. Conclusions:Single-port intravesical laparoscopic Politano-Leadbetter for the treatment of adolescents with primary obstructed megareter can improve hydronephelectasis of the renal pelvis and renal function of the affected kidney, and overcome the difficulty of injury due to fat pad hypertrophy in the bladder area above the pubic bone and the establishment of conventional pneumo-bladder laparoscopy, the operation effect is ideal, few complications, safe and feasible.

Severe Bladder Outlet Obstruction in a 7-Week-Old Infant Presenting with Features of Prune Belly Syndrome: A Case Report

Prune Belly syndrome is characterized by urinary tract anomalies, deficient abdominal muscle and bilateral cryptorchidism. It has an incidence of about 1 in 50,000 live births with male preponderance in 95%. This is a 7 weeks old male infant that was referred from a peripheral health care centre for a micturating cystourethrography on account of difficulty in micturition, distended abdomen and restlessness since birth. The patient had an abdominal ultrasonography that showed bilateral severe hydronephrosis, megaureters and thick-walled urinary bladder. A micturating cystourethrogram showed pine shaped urinary bladder with bilateral vesicoureteric reflux more marked on the right. Plain abdominal radiograph showed markedly distended abdomen and gas distended bowel loops with thinning of anterior abdominal wall muscles. The referring physician was advised to make a prompt referral of this case to a higher centre for better management. We report the radiologic findings of this case presenting with features of Prune Belly syndrome.

Clinicopathological study of primary obstructive megaureter

Background: Megaureter is a non-specific term implying a spectrum of anomalies associated with pathologically excessive ureteral diameter. It implies no particular unifying pathophysiologic principles but merely groups together a spectrum of anomalies associated with increased ureteral diameter. To analyse the clinical profile and various investigation modalities used in diagnosing primary obstructive megaureter.Methods: This prospective study was conducted in March 2017 to August 2019 at the Institute of Child Health and Hospital for Children (ICH and HC), Egmore, Chennai.Results: The most common presentation was febrile urinary tract infection, second most presentation was asymptomatic patients, on post-natal evaluation of antenatally diagnosed cases. The most common finding on the antenatal scan is uretero-hydronephrosis. Maximum incidence of ureteric size - between 1 and 1.5 cms. 13 patients underwent surgery after an initial period of observation from the time of presentation. These patients belong to the period of infancy. The coincidence of circular muscle hyperplasia and longitudinal muscle hypoplasia was noted in 18 patients.Conclusions: In this study, patients presented during infancy were initially observed, prior to surgical intervention. But those patients presented beyond infancy were evaluated and intervened surgically during the same admission. Cohen’s uretero-neocystostomy through intra-vesical approach is the surgical procedure of choice, in the majority of the cases, in this study.

Type II retrocaval ureter causing hydronephrosis in a cat: case report / Ureter retrocava tipo II causando hidronefrose em um gato: relato de caso

Retrocaval ureter (RU) is an abnormal embryonic development of the caudal vena cava (CVC) that leads the ureter to be entrapped dorsal to the CVC. In most cases there is no clinical impact; however, it can cause hydronephrosis. We report a rare case of type II symptomatic retrocaval ureter in a feline treated with nephroureterectomy. A 4-year-old, intact male, mixed breed cat was submitted to abdominal ultrasound and severe right hydronephrosis was diagnosed, with no signs of obstruction. We performed an exploratory celiotomy, in which a displacement of the right ureter dorsal to the CVC was observed. The animal was treated with ureteronephrectomy and recovered well. No intraluminal cause was found, and a urethral catheter could be easily inserted across the ureter length. The real clinical relevance of the RU is unknown, since it is a common find in post-mortem examination without kidney impact and, when significant, is often associated to other causes of ureteral obstructions, such as calculi and strictures. Additionally, in humans, type II RU seldom develops obstruction and hydronephrosis. In our case, due to absence of other causes of obstruction, probably mechanical compression of the CVC against the psoas muscle caused the hydronephrosis.(AU)

O ureter retrocava (UR) é originado por uma falha na formação embriológica da veia cava caudal (VCC), que leva ao aprisionamento do ureter dorsal à VCC. Na maioria dos casos, não há impacto clínico; entretanto, essa anomalia pode causar hidronefrose. Relata-se um raro caso de UR tipo II sintomático em um felino, tratado com nefroureterectomia. O referido animal, sem raça definida, macho intacto de quatro anos de idade, foi submetido à ultrassonografia abdominal, que revelou acentuada hidronefrose direita, sem sinais de obstrução. Realizou-se celiotomia exploratória, na qual foi possível observar o ureter direito dorsal à VCC. O animal foi tratado com nefroureterectomia e se recuperou satisfatoriamente. Nenhuma causa intraluminal foi encontrada e um cateter uretral pôde ser facilmente inserido por todo o comprimento do ureter. A real relevância clínica do UR é desconhecida, visto que é um achado comum em exames post mortem, sem impacto aos rins e, quando significante, frequentemente está associado a outras causas de obstrução ureteral, como cálculos e estenoses. Adicionalmente, em humanos, o UR tipo II raramente desenvolve obstrução e hidronefrose. Neste caso, devido à ausência de outros motivos de obstrução, acredita-se que a compressão mecânica da VCC contra o músculo psoas foi a causa da hidronefrose.(AU)

Efficacy of robot-assisted laparoscopic ureteral reimplantation for primary obstructive megaureter in children / 中华泌尿外科杂志

Objective To evaluate the clinical efficacy of robot-assisted laparoscopic ureteral reimplantation (RAUR) for primary obstructive megaureter (POM) in children.Methods Twenty-one patients who underwent RAUR for POM in Bayi Children's Hospital between 2017 April and 2018 April were retrospectively analyzed.The study population consisted of 15 boys and 6 girls aged between 2 months and 11 years.Ten patients had left POMs,9 had right POMs and two had bilateral POMs.All patients were preoperatively diagnosed with a POM based on urinary system ultrasonography,magnetic resonance urography,and diuretic renal dynamic imaging.Our main technique key steps include:Under general anesthesia,the patients were placed in a Trendelenburg position approximately 40 degrees from the horizon.An 8.5-mm camera port was placed at the level of the umbilicus.Followed by two 5-mm robotic Trocars placed under direct vision 6 cm to the camera port separately,a 5-mm assistant port was placed on the right upper abdominal quadrants which was located 3 cm from the camera and robotic port.The ureter was identified at the pelvic brim.The peritoneum covering the ureter was incised and the ureter was mobilized to the level of the vesico-ureteric junction.The bladder was filled with 60 ml saline and a 5 cm length and 1.5 cm wide submucosal detrusor tunnel was created.The ureter was transected at the bladder mucosa and the narrowed ureteral segment was discarded.The ureteroneocystostomy was performed using 6-0 absorbable suture.Dissecting the perivesical fascia appropriately and using down-top suturing approach,use of an apical stay stitch,and incorporation of the ureteral adventitia during detrusorraphy.Postoperative complications were analysed using the Clavien-Dindo classification.Success was defined as symptomatic relief,decreased hydronephrosis on ultrasound and no evidence of vesicoureteral reflux on voiding cystourethrography.Results All surgeries were successfully completed without conversion and no intra-operative complication was encountered.The mean operative time was 117.6 ± 18.1 (89-165)min,the mean estimated blood loss was 11.9 ± 4.3 (5-25) ml,the abdominal drainage tubes were removed after a mean of 4.9 ± 1.1 (3-8) days,and the mean postoperative hospital stay was 6.3 ± 1.3(4-10) days.Postoperative complications (Clavien Ⅰ-Ⅱ) occurred in 9.5％ (two patients had recurrent urinary tract infections postoperatively) children,no grade Ⅲ-Ⅳ complication was observed.The pre-operative symptoms in all patients disappeared.One patient had grade Ⅱ VUR on VCUG,who were followed conservatively.Ultrasound at postoperative follow-up showed that the hydronephrosis was disappeared in 20 ureters and significantly decreased in 3 ureters.The success rate was 95.7％ at a mean follow-up of 16.3 ± 4.0 (10-23) months.Conclusion RAUR is a safe and feasible option for the treatment of POM in children with higher success rate and lower complication rate.

Efficacy of robot-assisted laparoscopic ureteral reimplantation for primary obstructive megaureter in children / 中华泌尿外科杂志

Objective@#To evaluate the clinical efficacy of robot-assisted laparoscopic ureteral reimplantation (RAUR) for primary obstructive megaureter (POM) in children.@*Methods@#Twenty-one patients who underwent RAUR for POM in Bayi Children’s Hospital between 2017 April and 2018 April were retrospectively analyzed. The study population consisted of 15 boys and 6 girls aged between 2 months and 11 years. Ten patients had left POMs, 9 had right POMs and two had bilateral POMs. All patients were preoperatively diagnosed with a POM based on urinary system ultrasonography, magnetic resonance urography, and diuretic renal dynamic imaging. Our main technique key steps include: Under general anesthesia, the patients were placed in a Trendelenburg position approximately 40 degrees from the horizon. An 8.5-mm camera port was placed at the level of the umbilicus. Followed by two 5-mm robotic Trocars placed under direct vision 6 cm to the camera port separately, a 5-mm assistant port was placed on the right upper abdominal quadrants which was located 3 cm from the camera and robotic port. The ureter was identified at the pelvic brim. The peritoneum covering the ureter was incised and the ureter was mobilized to the level of the vesico-ureteric junction. The bladder was filled with 60 ml saline and a 5 cm length and 1.5 cm wide submucosal detrusor tunnel was created. The ureter was transected at the bladder mucosa and the narrowed ureteral segment was discarded. The ureteroneocystostomy was performed using 6-0 absorbable suture. Dissecting the perivesical fascia appropriately and using down-top suturing approach, use of an apical stay stitch, and incorporation of the ureteral adventitia during detrusorraphy. Postoperative complications were analysed using the Clavien-Dindo classification. Success was defined as symptomatic relief, decreased hydronephrosis on ultrasound and no evidence of vesicoureteral reflux on voiding cystourethrography.@*Results@#All surgeries were successfully completed without conversion and no intra-operative complication was encountered. The mean operative time was 117.6±18.1(89-165)min, the mean estimated blood loss was 11.9±4.3(5-25)ml, the abdominal drainage tubes were removed after a mean of 4.9±1.1(3-8)days, and the mean postoperative hospital stay was 6.3±1.3(4-10) days. Postoperative complications (Clavien Ⅰ-Ⅱ) occurred in 9.5% (two patients had recurrent urinary tract infections postoperatively) children, no grade Ⅲ-Ⅳ complication was observed. The pre-operative symptoms in all patients disappeared. One patient had grade Ⅱ VUR on VCUG, who were followed conservatively. Ultrasound at postoperative follow-up showed that the hydronephrosis was disappeared in 20 ureters and significantly decreased in 3 ureters. The success rate was 95.7% at a mean follow-up of 16.3±4.0(10-23)months.@*Conclusion@#RAUR is a safe and feasible option for the treatment of POM in children with higher success rate and lower complication rate.

The experience of diagnosis and mangement in coexisting ureteropelvic junction obstruction and nonreflux megaureter / 中华泌尿外科杂志

Objective To investigate the experience of diagnosis and management of coexisting ureteropelvic junction obstruction (UPJO) and nonreflux megaureter (NRM).Methods The retrospective study of UPJO with NRM was based on 10 years information retrieved from January 2005 to December 2015.The data of 13 patients (8 males and 5 females) were available and recorded.Mean age at surgery was 3.7 years old (range 1.8 to 14 years).The diagnosis and mangement were summarized.Coexisting ureterovesical junction obstruction (UVJO) and vesicoureteral reflux,iatrogenic stricture and vesicoureteral reflux were excluded.Intravenous pyelography,voiding cystourethrography,ultrasound and CT reconstruction were performed before operation.Only six patients had an accurate diagnosis as UPJO with UVJO before surgery.Pyeloplasty was the initial surgical management choice for 10 patients,and ureteroneocystostomy in 3 patients.Results UVJO were diagnosed with pyelography techniques in 3 patients after pyeloplasty,while 4 were diagnosed as nonreflux and nonobstruction megaureter.Of the 10 patients who underwent initial pyeloplasty,additional ureteroneocystostomy was required in 3 and the prognosis was good.Additional pyeloplasty was required in 2 of the 3 patients who initially underwent ureteroneoeystostomy.Mean follow-up time from last operation was 23.3 months (6-53 months),the overall prognosis was good.Conclusions It is often difficult to correctly diagnose coexisting UPJO and NRM.In patients with UPJO,it is highly recommended nephrostomy radiography after pyeloplasty to evaluate the distal ureterovesical junction.Initial pyeloplasty is always recommended as first-line therapy.Additional ureteroneocystostomy was required when hydroureteropelvic was aggravated.

A study of primary megaureter Our experience

Amongst the congenital anomalies of the Ureter, Megaureter is one of the commonest, next only to the various types of duplications. Though every dilated and large ureter can be described as Megaureter, Primary obstructive megaureter is the entity wherein the dilated ureter is associated with a short, juxtavesical, narrow, adynamic segment and is not associated with reflux. This is a study of 8 patients who presented with primary obstructive megaureter in the department of urology, Osmania General Hospital, Afzalgunj during 2013-2015. Apart from the clinical presentation of this disorder, the modalities of arriving at the Diagnosis, the associated complications and the management are discussed

MRI Findings of Obstructed Hemivagina and Ipsilateral Renal Agenesis (OHVIRA syndrome) with a Blind Megaureter: Case Report

Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is an uncommon congenital abnormality of the female urogenital tract characterized by the triad of uterine didelphys, obstructed hemivagina, and ipsilateral renal agenesis. A 13-year-old female presented with acute lower abdominal pain. Magnetic resonance imaging (MRI) revealed uterine didelphys, hematometrocolpos, obstructed hemivagina, and right ipsilateral agenesis, consistent with OHVIRA syndrome. Also, a well-defined mass with fluid signal intensity, mimicking adnexal neoplasm was seen in the right lower pelvic cavity adjacent to the posterior wall of the bladder. Vaginal septotomy and drainage of hematometrocolpos were done initially, but unilateral hysterectomy was later performed to relieve the patient's symptoms. The cystic mass in the right lower pelvic cavity was also excised and confirmed as a blind megaureter.

The pathogeny and treatment methods of obstructive megaureter in children / 国际儿科学杂志

Megaureter was put forward firstly by Caulk in 1923.The common causes of children obstructive megeureter have been divided into congenital(congenital ureteral stricture,congenital lower segment ureteral valve,no performance of ureteral distal and ectopic ureter openings),and secondary (urethral valve disease,ureter cyst and polyp,neurogenic bladder and iatrogenic traumatic).Now commonly used surgical treatments has approved by bladder ureter bladder reimplantation,the bladder ureter bladder reimplantation,bladder disc ureteral reimplantation,etc.This paper summarizes the research progress of obstructive megaureter.

Megauréteres, estudio y conducta médica / Megaloureters, study and medical behavior

Introducción: megauréter significa un uréter dilatado por encima de 7 mm de diámetro y se clasifica en: refluyente, obstructivo y no refluyente no obstructivo. Objetivo: presentar las características clínico-imaginológicas y evolutivas de pacientes en los que se detectó una anomalía del tracto urinario en el ultrasonido prenatal y en el estudio posnatal se encontró megauréter. Métodos: a todos los niños remitidos a la consulta de nefrología por haberse detectado alguna anomalía del tracto urinario en el ultrasonido materno-fetal, se les realizó ultrasonido renal. Si en el ultrasonido posnatal se encontró dilatación ureterohidronefrótica, se indicó profilaxis con antibiótico y se hizo uretrocistografía miccional, y si no se encontró reflujo vesicoureteral, se realizó gammagrafía dinámica. En 5 de los pacientes se realizó urograma excretor, y en 2 se repitió la gammagrafía. Resultados: entre 318 pacientes remitidos por haberse detectado alguna anomalía del tracto urinario mediante el ultrasonido prenatal entre enero 1ro. de 1996 y 31 de diciembre de 2010, 6 (1,9 por ciento) fueron diagnosticados después del nacimiento como portadores de megauréteres. Los diagnósticos prenatales fueron: dilatación pielocalicial en 4, dilatación pielocalicial en riñón único en 1 y agenesia renal izquierda en 1. La conducta médica inicial fue conservadora en todos, pero fue quirúrgica a los 2 años de edad (reimplantación ureteral) en uno con patrón gammagráfico obstructivo y riñón único. Un paciente con riñón único y patrón no obstructivo estable se mantiene bajo control clínico-imaginológico periódico. Conclusiones: la conducta médica inicial ante un megauréter no obstructivo u obstructivo debe ser conservadora. En los casos de riñón único el control clínico-imaginológico debe ser riguroso para reimplantar el uréter, si aparece aumento progresivo de la dilatación

Introduction: the term megaloureter means a dilated ureter measuring more than 7 cm diameter and it is classified in: with return flow, obstructive and without return flow non obstructive. Objective: to show the clinical-imaging features and evolutionary of the patients with a urinary tract anomaly detected in the prenatal ultrasound and in the postnatal study there was a megaloureter. Methods: all children referred to nephrology consultation due to the presence of some urinary tract anomaly observed in the mother-fetal ultrasound underwent renal ultrasound. If in the postnatal ultrasound there was an uretherohydronephrosis dilatation, a prophylaxis with antibiotics was prescribed and a miction urethra-cystography was performed and if there was not vesicoureteral flow a dynamic scintigraphy was carried out. In the remainder five patients an excretory urogram and in two patients scintigraphy was repeated. Results: among the 318 patients referred due the presence of some anomaly of urinary tract cy prenatal ultrasound from January,1 to December, 31, 2010, six (1,9 percent) were diagnosed with megaureters carriers after birth. The prenatal diagnoses were: pyelocaliectasis in only one kidney in one case and left renal agenesis in other case. The initial medical behavior was conservative in all of cases, but it was surgical at 2 years old (ureteral re-implantation) in one patient with an obstructive scintigraphic pattern and one kidney. A patient with one kidney and a stable obstructive pattern is under a periodical clinical-imaging control. Conclusions: the initial medical behavior in face of a non-obstructive and obstructive megaloureter must to be conservative. In cases of only one kidney the clinical-imaging control must to be strict to reimplantation of the ureter, if there is a progressive increase of dilatation

Duplicación ureteral: A propósito de un caso / Ureteral duplication: a Case Report

Una duplicación de sistemas pielocaliciales, normales o dilatados, puede ser incompleta y ocurrir la fusión de ambos uréteres en uno, antes de desembocar en la vejiga, o completa; ambos uréteres entran en la vejiga a través de dos orificios independientes. Uno de ellos de inserción anormal o ectópica, siendo generalmente el que drena el polo superior. El diagnóstico puede sugerirse por la ecografía abdominal. Se presenta un caso de una paciente de 15 años de edad, con antecedentes patológicos de anemia, que ingresa por fiebre de 39 grados centígrados de varios días de evolución, leucorrea blanquecina no fétida, molestias a nivel del flanco izquierdo, decaimiento y discreta pérdida de peso. Se encontró al examen físico, palidez cutáneo mucosa, puntos pielorrenoureterales izquierdos dolorosos y maniobra de puño - percusión positiva a nivel del flanco izquierdo, los resultados de laboratorio clínico mostraron anemia ligera (10 g/L), eritrosedimentación acelerada(113 mm/h), y leucocitosis, en el análisis de orina leucocituria, cilindruria hialina, y sales de oxalato de calcio. La ecografía abdominal detectó una imagen ecolúcida alargada y tortuosa a nivel del espacio parietocólico izquierdo. La TAC con contraste confirmó el diagnostico ultrasonográfico. La ecografía abdominal demostró su utilidad para el diagnóstico precoz, evaluación del estado anatómico del riñón y estructuras adyacentes, así como para establecer pronóstico y seguimiento del caso.

A duplication of the pyelochalycial systems, normal or dilated can be incomplete and the fusion of both ureters in one before entering into the urinary bladder, or complete, both ureters enter into de urinary bladder through two independent orificies, one of them with abnormal or ectopic insertion, generally the one that drains the upper pole can occurr. The diagnosis may be performed by means of an abdominal ultrasound. A fifteen-year old patient with pathological history of anemia, with 39º C of fever for several days, having a whitish non-offensive leukorrhea, left flank pain, asthenia and a light weight reduction was admitted. Observing in the physical examination a mucu-cutaneous paleness, left pyelo-renal-urethral painful points and a positive percussion in left flank in the fist manoeuvre. Laboratory results showed a minor anemia (10g/L), Sedimentation erythrocytes rate (113 mm/h) and leukocytosis. Leukocyturia, hyaline cylindruria and salts of calcium oxalate were observed. Abdominal ultrasound detected an echo-luscent enlarged and twisted image on the level of the left parietal-collic space. Contrast axial computerized tomography (ACT) confirmed the ultrasonographic diagnosis. The abdominal ultrasound is very useful in the early diagnosis, in the evaluation of the anatomic status of the kidney and its adjacent structures; as well as very important to establish the prognosis and follow up of the case.

Megauréter obstructivo primario en pediatría: serie clínica / Primary obstructive megaureter

Introducción: Según imágenes de la urografía excretora, megauréter fue definido como la dilatación ureteral congénita o adquirida. El megauréter obstructivo primario (MOP) se origina por un segmento estenótico y adinámico del uréter distal, produciendo dilatación proximal. Material y método: Estudio de serie de casos de MOP con resolución quirúrgica entre 1996 y 2006, en Hospital Dr. Gustavo Fricke de Viña del Mar. Se analizaron características generales, tipo de cirugía y evolución de función renal. Resultados: Se encontraron 14 casos. Se utilizó la clasificación de Filadelfia (1976) y se adaptó el diagrama de flujo para manejo del megauréter de González y Rodríguez (1996). Se llegó al diagnóstico con ecografía antenatal (6/14 casos), en seguimiento de una infección del tracto urinario (4/14), en estudio de masa abdominal (3/14), y como hallazgo incidental (1/14). Hubo 8 niños y 6 niñas. Diez casos en uréter izquierdo y cuatro en uréter derecho. Cinco niños tuvieron la condición de riñón único. Respecto a la cirugía, en 11 pacientes se efectuó una derivación transitoria (ureterostomía) y sólo en 3 pacientes neoimplante urétero-vesical primario. Seis pacientes fueron operados dentro de los primeros 3 meses de edad. La función renal se conservó en rangos normales excepto en un caso que evolucionó a insuficiencia renal Discusión: La evolución de un megauréter es dinámica e individual, y es difícil predecir el resultado de cada caso, por lo que se recomienda el análisis conjunto de la clínica y los exámenes para diagnosticar y evaluar el estado de cada paciente portador de megauréter.

Introduction: According to images of excretor urogram, megaureter is defined as a congenital or acquired ureteral dilatation. Primary Obstructive Megaureter (POM) originates from an estenotic and a dynamic distal segment of the ureter, generating proximal dilatation. Material and methods: Study of case series in Hospital Dr. Gustavo Fricke, Viña del Mar, Chile. We included totality of POM’s cases with surgical resolution between 1996 and 2006. General characteristics, type of surgery, and evolution of renal function were analyzed. Results: We report 14 cases (8 male). We used the Philadelphia classification system (1976), and we adapted the management flowchart according to González and Rodríguez (1996). Diagnosis was made with prenatal ultrasound (6/14 cases), during follow-up of a urinary tract infection (4/14), in study of abdominal mass (3/14), and as incidental find (1/14). Ten cases were left and four rights. Five cases had the condition in a solitary kidney. In eleven cases an ureterosthomy was used, and in only in three patients we performed a primary ureterovesical neoimplant. Six patients of the series were operated before 3 months of age. At follow-up, renal function was conserved normal except for one case that evolved to renal insufficiency. Conclusion: Megaureter evolution is dynamic and individual, and it‘s difficult to predict the result of every case. Thorough analysis of every patient is recommended.

Laparoscopic ureteroplasty for treatment of congenital obstructive megaureter in children / 中华泌尿外科杂志

Objective To evaluate the efficacy and feasibility of laparoscopie intervention for congenital obstructive megaureter in children. Methods Eleven children with congenital obstructive megaureter(left in 4,right in 7)underwent laparoseopie ureteroplasty.One had congenital ureter oririce stenosis,9 had been diagnosed as simple congenital ureter orifice stricture,1 had recurrent ureter orifice stricture after open ureterovesical reimplantation.B-ultrasound and IVU showed severe hydronephrosis in 7 cases and moderate in 4. Results The operation was successful in all cases and none had urine leakage.The mean operating time was 103.0±35.3 min(range 70-190 min).The mean blood loss was 18.0±9.5 ml(range 10-40 ml)and the mean postoperative hospital stay was 8.0±1.4 d(range 7-10 days).The double J stent was removed 6 weeks after operation.The patients were followed up for 3-24 months(mean,6 months).Cystography showed no reflux in all cases during follow-up. Conclusion Laparoscopical ureteroplasty could be a minimal invasive,less suffering technique for the treatment of congenital obstructive megaureter in children.

Factores predictores de conducta en la evaluación inicial de pacientes pediátricos con megauréter primario / Management predicting factors in the evaluation of pediatric patients with primary megaureter

El Megauréter Primario no Refluyente (MPNR) es una patología con alta resolución espontánea. El presente trabajo pretende estudiar como diferentes factores clínicos e imagenológicos objetivados en la evaluación inicial predicen aquellos pacientes que van a requerir conducta quirúrgica. Materiales y Métodos: Se realizó un análisis retrospectivo de pacientes con diagnóstico de MPNR diagnosticados entre el año 1995 y 2005. Se utilizó estadística descriptiva y test de chi-cuadrado. Resultados: Se reclutaron 44 pacientes, incluyendo 8 casos bilaterales (52 megauréteres). El tiempo promedio de seguimiento fue de 23,2 +/- 20,1 meses. La edad mediana de diagnóstico fue de 7,5 meses (rango 1-155 meses), con un 77 por ciento de pacientes masculinos. Un 32 por ciento de los pacientes recibieron tratamiento quirúrgico. No hubo asociación entre la conducta y el género o la forma de presentación. Los pacientes con megauréter izquierdo tuvieron mayor tendencia a ser manejados quirúrgicamente (0,01< p< 0,05), mientras que los bilaterales resolvieron todos médicamente (0,05< p< 0,1). La presencia de ITU durante el seguimiento fue un fenómeno infrecuente (9 por ciento), teniendo una asociación intermedia con la necesidad de tratamiento quirúrgico (0,01< p< 0,05). Una Función Renal Relativa Cintigráfica (FRR) inicial menor a 40 por ciento presentó un VPP=0,67 y un VPN=0,81 para predecir cirugía, con una probabilidad de asociación intermedia (0,01 < p < 0,05). Una Curva de Excreción Cintigráfica Obstructiva (CECO) inicial presentó un VVP=0,82 y un VPN=0,89 para predecircirugía, con una alta probabilidad de asociación (p < 0,01). Una Dilatación Pieloureteral Ecográfica Severa (DPUES) inicial presentó un VVP=0,67 y un VPN=0,89 para predecir cirugía, con una alta probabilidad de asociación (p < 0,01). Al presentarse estas condiciones en conjunto, se obtuvo una mejora importante de los VPP para predecir cirugía, con altas probabilidades de asociación...

Introduction: Primary non refluxing megaureter (PNM) has a high index of spontaneous resolution. The present study evaluates different clinical and imaging factors that may predict the need for surgical management. Material and methods: A retrospective analysis of PNM patients diagnosed between 1995 and 2005was performed. Data was described and analyzed with chi-square test. Results: A total of 44 patients, 8 bilateral cases (52 megaureters total), were analyzed. Mean follow up time was 23,2 +/- 20,1 months. Mean age was 7,5 months (range 1-155 months) with 77 percent of patients being male. A total of 32 percent patients underwent surgical treatment. There was no relation between medical conduct and form of presentation. Left megaureters were mostly treated surgically(0,01< p < 0,05) while bilateral ones were managed expectantly (0,05 < p < 0,1). Urinary infection during follow-up was infrequent (only 9 percent) having an intermediate association with surgical treatment (0,01< p < 0,05). Relative Renal Cintigram Function (RRCF) under 40 percent presented a PPV=0,67 and NPV=0,81 for surgery with and intermediate association probability (0,01< p< 0,05).Obstructive Renal Cintigram Curve (ORCC) presented a PPV=0,82 and a NPV=0,89 for surgery with a high association probability (p < 0,01). Initial Severe Pelvic Hydronefrosis (ISPH) presented PPV=0,67and NPV=0,89 for surgery with a high association probability (p < 0,01). All these conditions put together presented an increased in the PPV for predicting surgery with high association probabilities. Conclusions: Surgical management of PNM is infrequent. Gender and form of presentation were not significantly associated with management. Side and the presence of UTI during follow-up could be used to prognosticate the need for surgery. Prognostic value of RRCF, ORCC and ISPH is defined by their NPV. Renal ultrasound and cintigram are useful in predicting future therapeutic conduct.

Laparoscopical ureteroplasty for treatment of congenital obstructive megaureter (report of 6 cases) / 中华泌尿外科杂志

Objective To describe the ureteroplasty of congenital obstructive megaureter by laparoscopy and to evaluate the efficacy and feasibility of laparoscopic intervention for congenital obstructive megaureter. Methods Six patients with congenital obstructive megaureter were prepared for the laparoscopic surgery.The surgical procedure was briefly described as follows.The dilated ureter was dissected and cut off near the ureter orifice to the bladder by laparoscopy.Next,the free ureter was pulled out through the skin trocar site and was tailored as open surgery.After that,the ureter was placed back to the abdominal cavity and reimplanted laparoscopically into the bladder. Results The operation duration was 2 to 4 h (mean 2.4 h) and blood loss was very little (20～35 ml).No complication developed.The double J stent was removed at 3 months after the operation.Follow-up for half to 2 years showed that all the ureter drainage in the 6 cases was well without any infection. Conclusions Our preliminary result shows that laparoscopic surgery is a safe and effective method for treatment of megaureter.

Imaging Diagnosis of Primary Non-obstructive Megaureter(A Report of 28 Cases) / 实用放射学杂志

Objective To improve recognition and diagnosis of primary non-obstructive megaureter.Methods The authors analyzed the X-ray findings of intravenous urography and B-ultrasonographic manifestations of 28 cases with primary non-obstructive megaureter proved by varied examinations and operations.Results The X-ray and B-ultrasonographic manifestations as follows:in the terminal ureter,there was a short segment,less than 3 cm in length,with normal caliber but adynamic to micturition and the ureter proximal to the adynamic segment was secondarily dilated remarkably.The terminal end of the dilated ureter appeared as drumstick shaped,spindle-shaped,snakehead shaped or rattail shaped.On right time fluoroscopy and B-ultrasonographic observation,a decrease of peristalsis frequency,increase of peristalsis range,interrupted downward convey of peristalsis wave could be noted.Conclusion The contrast urography is the main method,B-ultrasonography and cyctocopy are helpful for the diagnosis of primary non-obstructive megaureter.

A Case of Congenital Nephrogenic Diabetes Insipidus with Megaureter and Megabladder / 대한신장학회잡지

A case of a 37 year-old man of congenital diabetes insipidus is reported. He complained of polydipsia, which began from his youth, drinking about 10 L of water every day. He didn't look ill or mentally retarded. In his family, his only brother has shown similar symptoms and his older sister had no symptom. On radiologic study, both kidneys showed severe hydronephrosis and the bladder was markedly distended. Water deprivation test was performed. The result was consistent with diabetes insipidus and the urine osmolality didn't respond to antidiuretic hormone injection, and he was diagnosed as nephrogenic diabetes insipidus. We began to treat him with thiazide and amiloride. The amount of water he's been drinking daily has decreased to 3-4 L per day. We discuss this case with a brief review of literature.

A pelvic kidney and a contralateral incomplete double collecting system with associated bilateral ectopic obstructive megaureters

A two-month old female child presenting with recurrent febrile urinary tract infection (UTI) was diagnosed to have a single-system pelvic kidney and a contralateral incomplete ureteral duplication with associated bilateral ectopic obstructive megaureters draining into the proximal urethra. Bilateral cutaneous loop ureterostomy was done at that time. Subsequently, she underwent undiversion, transuretero-pyelostomy (double left ureters to right pelvis), right ureteroneocystostomy, and augmentation ureterocystoplasty. Biopsy of the right distal ureter was consistent with megaureter with acute and chronic ureteritis. Repeat IVP post-op showed well-opacified kidneys with no signs of obstruction and a well-distended urinary bladder with moderate post-void residual urine. A high index of suspicion, coupled with meticulous physical examination and rationally combined diagnostic procedures are important to make a diagnosis of a unique combination of rare congenital urologic anomalies. (Author)

A Case of Blind Ending Megaureter: Preoperatively suspected of Adnexal Tumor / 대한산부인과학회잡지

A pelvic mass in women may be gynecologic in origin or it may arise from the urinary tract or bowel. Nonovarian or nongynecologic conditions may be confused with uterine or ovarian mass. The rare congenital megaureter should always be kept in mind as a possible cause of a pelvic mass. Congenital megaureter showed various clinicopathological features and frequently associated with ipsilateral or controlateral upper tract anomalies. Early meticulous imaging surgical correction will lead to excellent result. We experienced a rare case of blind ending megaureter which was suspected adnexal tumor in twenty seven-year-old woman. Here we present the case with brief review of literatures.