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@#Transurethral incision of ureterocele (TUI-U) is a simple, quick, less invasive, and less expensive,and an effective procedure for the management of ureteroceles. Several studies have already shownits utility for primary management of ureteroceles but it has also been associated with the need foradditional surgery. The authors reviewed charts of patients from their database to describe the outcomesof TUI-U done in ureteroceles associated with the upper pole moiety of a duplex system. They alsolooked into preoperative patient characteristics and post TUI-U outcomes that could influence theneed for subsequent surgeries.@*MATERIALS AND METHODS@#The authors identified patients from their duplex system database who presentedwith a ureterocele and underwent TUI-U. They reviewed the patient records of 25 patients who wereincluded in the study to determine the outcomes of TUI-U in duplex system ureteroceles. Chi squareand Mann Whitney U tests were used to determine whether preoperative patient features and postTUI-U outcomes were associated with secondary surgery.@*RESULTS@#Out of 65 patients who had duplex system ureteroceles, 25 patients (38.4%) underwent TUI-U at a mean age of 1.51 years old. TUI-U alone was successful in improving the prevalent signs andsymptoms of 15 patients (60%) in this group, while 10 patients (40%) had to undergo subsequentsurgical procedures. Breakthrough urinary tract infection (UTI) post TUI-U was the only patientfactor noted to be significantly associated with a secondary surgery for duplex system ureterocele(p=0.027).@*CONCLUSION@#TUI-U as primary treatment for duplex system ureteroceles is not yet widely accepteddue to reported rates of morbidities and need for secondary surgery. Present data however show thatTUI-U can be used as a primary procedure and even as a definitive procedure for this subset ofpatients with remarkable results in terms of symptoms resolution and improvement of upper tract profiles.
ABSTRACT
Objective To develop a duplex peritoneal dialyzer with controllable dialysate volume.Methods The dialyzer was designed with considerations on safety and convenience,which was composed of a dialysate feeding bag,a drainage bag,a dialysate changing opening,a dialysate taking opening,a dialysate outlet,a delivery flask,a flow control valve and a compensating bar.There were scales calibrated on the dialysate feeding bag and drainage bag to facilitate flux controlling.The openings of the dialysate feeding bag and drainage bag were connected with the dialysate changing opening by adapting pipe,and the dialysate changing opening could fulfill dialysate input and used dialysate drainage.Results The dialyzer realized dialysis based on actual requirements of the patient,decreased the times for connection to prevent infection due to frequent changing,and lowered the incidence rates of corresponding complications such as peritonitis.Conclusion The disposable dialyzer has easy operation,convenience and high safety,and thus is worthy promoting practically.
ABSTRACT
Objective To develop a duplex peritoneal dialyzer with controllable dialysate volume.Methods The dialyzer was designed with considerations on safety and convenience,which was composed of a dialysate feeding bag,a drainage bag,a dialysate changing opening,a dialysate taking opening,a dialysate outlet,a delivery flask,a flow control valve and a compensating bar.There were scales calibrated on the dialysate feeding bag and drainage bag to facilitate flux controlling.The openings of the dialysate feeding bag and drainage bag were connected with the dialysate changing opening by adapting pipe,and the dialysate changing opening could fulfill dialysate input and used dialysate drainage.Results The dialyzer realized dialysis based on actual requirements of the patient,decreased the times for connection to prevent infection due to frequent changing,and lowered the incidence rates of corresponding complications such as peritonitis.Conclusion The disposable dialyzer has easy operation,convenience and high safety,and thus is worthy promoting practically.
ABSTRACT
La heminefrectomía puede constituir el tratamiento definitivo en el 85% de los pacientes con diagnóstico de doble sistema con uno de los mismos no funcionante. Actualmente el abordaje laparoscópico es de elección tanto por sus resultados estéticos como evolución postoperatoria. Materiales y métodos: se efectuó una revisión y análisis retrospectivo de todos los pacientes operados de heminefrectomía desde el año 2000 a 2014. Resultados: 44 pacientes fueron operados de forma convencional durante el período 2000-2010 y 30 de forma laparoscópica transperitoneal durante el período 2010-2014. La media de duración del procedimiento fue menor para el grupo convencional (89,6 vs 128 min, p = 0,000) mientras que la media de estadía hospitalaria fue menor para el grupo laparoscópico (4,2 vs 5,1, p = 0,19). La tasa de reoperación fue mayor en el grupo convencional (20,4% vs 6,7%, p = 0,18) y la principal causa fue por la presencia un muñón ureteral sintomático. En los controles por centellograma DMSA (en 19 pacientes del segundo grupo) no se objetivó la pérdida de función de la unidad remanente en ningún individuo. Conclusiones: La heminefrectomía es un procedimiento seguro con baja tasa de complicaciones cuya tendencia actual es realizar la cirugía de forma laparoscópica obteniendo resultados similares y menor tasa de complicaciones que en la forma convencional (AU)
Heminephrectomy may be the definitive treatment in 85% of patients diagnosed with a duplex kidney system of which one is not working. Currently, a laparoscopic approach is the treatment of choice because of both esthetic results and postoperative outcome. Material and methods: A retrospective analysis of all patients who underwent heminephrectomy between 2000 and 2014 was conducted. Results: 44 patients underwent conventional surgery in the period 2000-2010 and 30 underwent transperitoneal laparoscopy in the period 2010-2014. Mean duration of the procedure was less in the conventional group (89.6 vs 128 min, p = 0.000), while the mean hospital stay was less in the laparoscopic group (4.2 vs 5.1, p = 0.19). Reoperation rate was higher in the conventional group (20.4% vs 6.7%, p = 0.18) and the main cause was presence of a symptomatic ureteral stump. On DMSA whole body scan controls (in 19 patients in the second group) no loss of function of the remaining unit was observed in any of the patients. Conclusions: Heminephrectomy is a safe procedure with a low complication rate and a current trend to be performed using laparoscopy with similar results and a lower complication rate than in conventional surgery (AU)
Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Kidney/abnormalities , Kidney/surgery , Laparoscopy/methods , Nephrectomy/methods , Treatment Outcome , Urologic Diseases/congenital , Retrospective StudiesABSTRACT
Introducción: El doble sistema excretor (DS) al Cintigrama Renal (CR) DMSA, con asimetría en la función relativa es un hallazgo relativamente frecuente. Evaluamos su incidencia, correlación con ecografía y valores de función relativa. Material y Método: Se seleccionaron los CR DMSA con diagnóstico cintigráfico de DS sin otras alteraciones. Ecografías sin otros hallazgos. Se comparó la función relativa entre riñones con y sin DS y entre riñones con y sin asimetría de tamaño. T-Test para muestras independientes. Se correlacionó el DMSA con la ecografía. Resultados: 79 pacientes en que se dispuso ecografía fueron estudiados. 17 con DS bilateral (21,5 por ciento). 72 por ciento mujeres, promedio de edad: 54,4 meses (1204). Función relativa promedio en riñones con DS unilateral: 51,8 por ciento (43-61 por ciento) y 48,19 por ciento (39-57por ciento) en riñones sin DS. p<0,0001. En riñones con DS y aumentados de tamaño la diferencia con el contralateral fue mayor que en los de igual tamaño. Ecografía concordante con el CR DMSA en 52,63 por ciento. Conclusiones: 1.- La función relativa en riñones con Doble Sistema fue significativamente mayor que en riñones sin Doble Sistema, especialmente cuando existió asimetría en el tamaño renal. Esta condición debe considerarse variante normal para evitar la interpretación errada de riñones contralaterales hipofuncionantes. 2.- En la mitad de los pacientes hubo concordancia con la ecografía en diagnóstico de DS, hallazgo esperable.
Aim: Duplex system in DMSA with asymmetry in relative function its a frequent finding. We evaluated the incidence, correlation with sonography and the relative functions in these kidneys. Method: We selected patients with scintigraphic diagnosis of duplex system in the DMSA, without any other scintigraphic lesions and had a normal ultrasound. We compared the relative renal function in kidneys with and without duplex system and in kidney with and without size asymmetry. Independent samples t test was applied. DMSA results were compared with ultrasound. Results: 79 patients had ultrasound. 17 with bilateral DS (21.5 percent). 72 percent women; median age: 54.4 months (1204). Relative function in unilateral DS kidney was 51.8 percent (43-61 percent) and 48.19 percent in kidneys without DS (39-57 percent), p< 0.0001. In kidneys larger and DS the difference in relative function with the contralateral kidney was more important than kidney with similar size. The ultrasound was concordant with DMSA in 52.63 percent of the patients. Conclusions: 1.- The relative function values were significantly higher in kidneys with Duplex System than kidneys without it, especially with asymmetry of the renal size .This condition should be consider a normal variant for to avoid the wrong interpretation of hipofunctioning contralateral kidney. 2.- Half of the patients had duplex system in DMSA scintigraphy and ultrasound, which was predictable.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Kidney/abnormalities , Kidney , Kidney/physiopathologyABSTRACT
PURPOSE: Prenatal sonography resulted in increased recognition of renal duplication anomalies and, therefore, earlier urological referral and evaluation. However, surgical approach in very young children is debating. We attempt to investigate clinical features and to propose the management strategies in patients with prenatally detected ureteroceles. MATERIALS AND METHODS: From 1982 to 1997, there has been 35 patients (47 units) of duplex system ureter in which both preoperative and postoperative imaging studies including DMSA renal scan were available. Among these, detailed diagnosis and treatment of prenatally detected (PreD) ureteroceles associated with duplex system (9 patients or 12 ureteroceles) were assessed compared with post-natally detected (PND) ones (26 patients or 35 ureteroceles). RESULTS: There were 2 males and 7 female patients in PreD group, whose ureteroceles presented as 6 unilateral (right 1, left 5) and 3 bilateral units. There were 3 patients (33%) presented with urinary tract infection in PreD group and 24 patients (92%) in PND group. Functional evaluation by DMSA renal scan revealed that 8 units (67%) were functioning in PreD group while 37% in PND group, which was not significantly different between two groups. Initial treatment in PreD group were performed in 11 units; transurethral ureterocele incision (TUI, 8 units), ureteroureterostomy (UUO, 1) and upper pole nephrectomy (UPNx, 2). Additional surgery was performed in 8 units, all of which were initially performed TUI. When initial functional status of the upper pole (UP) determined by renal scan were analyzed by ultimate mode of treatment, initially nonfunctioning parenchyme resulted in UPNx in 4 units and 8 functioning moiety were led to parenchyme-sparing surgery, implying TUI actually had not modified ultimate clinical course. Taken both PreD and PND together, UUO and ureteral reimplantation showed lower secondary operation rate. CONCLUSIONS: Although statistics did not fully support our clinical impression, patients with PreD ureterocele have higher proportion in preserving UP function compared with that of a PND. Our results shows direct approach to the upper pole according to the functional status is preferred.
Subject(s)
Child , Female , Humans , Male , Diagnosis , Nephrectomy , Referral and Consultation , Replantation , Succimer , Ultrasonography , Ureter , Ureterocele , Urinary Tract InfectionsABSTRACT
We report a case of cecoureterocele with contralateral ureterovesical junction stricture in 1 month-old boy who presented with bilateral hydronephrosis detected by prenatal ultrasonography, Ultrasonography showed bilateral hydronephrosis, left complete duplex system and lect ureterocele. Voiding cystourethrography demonstrated reflux into the left upper moiety through ureterocele with prominent dilatation of the bladder neck and the proximal urethra. Ureteral stricture at right ureterovesical junction was suspected by intraoperative catheterization and retrograde ureteropyelography. Left upper pole nephrectomy with partial ureterectomy, transvesical unroofing of cecoureterocele and bilateral ureteroneocystostomy using Cohen's method were done. Convalescence was unevenful and postoperative voiding cystourethrography revealed no evidence of vesicoureteral reflux, dilated bladder neck or remnant cecoureterocele.
Subject(s)
Humans , Infant, Newborn , Male , Catheterization , Catheters , Constriction, Pathologic , Convalescence , Dilatation , Hydronephrosis , Neck , Nephrectomy , Ultrasonography , Ultrasonography, Prenatal , Ureter , Ureterocele , Urethra , Urinary Bladder , Vesico-Ureteral RefluxABSTRACT
Renal dysplasia results from aberrant histogenesis in metanephric differentiation. It is characterized morphologically by abnormal organization and a persistence of primitive structures, such as cartilage, undifferentiated mesenchyme, and immature tubules. Six cases of renal dysplasia from five children and one adult are reviewed. Five patients were female and one patient was male. The chief complaint was urinary incontinence in four patients, dysuria in one patient, and the sixth patient suffered from vesicoureteral reflux. No evidence of family history of renal dysplasia in any patient was seen. According to Risdon's classification, three cases were hypoplastic dysplasia, one case was dysplasia in a duplex system, one case was dysplasia in a triplex system, and one case was dysplasia with vesicoureteral reflux. The ipsilateral ectopic ureteral orifice was identified in four patients, two of which drained into a Gartner's duct cyst, and the orifice was suggested in one patient. On histologic examination, all cases showed primitive ducts surrounded by concentrically arranged primitive mesenchyme. Nests of metaplastic cartilage were observed within the stroma in three of the six cases.
Subject(s)
Adult , Child , Female , Humans , Male , Cartilage , Classification , Dysuria , Mesoderm , Ureter , Urinary Incontinence , Vesico-Ureteral RefluxABSTRACT
Ureterocele, congenital dilatation of the terminal or intramural portion of the ureter, may be classified as either simple or ectopic and has a broad spectrum of presentation, anatomy and treatment must be individualized. From February, 1986 to March, 1994, our experiences with 8 single system ureteroceles and 12 duplex system ureteroceles were reviewed. Their presentation, radiographic findings, operative management and postoperative results were discussed. The patients in this series were distribution from 1 year old to 66 years old and the male and female ratio was 4:16. The most presenting symptom was flank pain, affecting 7 cases, and ureterocele was associated with ureteral stone: 7 cases, VUR: 2 cases, renal cyst: 1 case, and IgA nephropathy:1 case. In 8 cases of single system ureterocele, Transurethral incision(TUI) of ureterocele in 1 case, ureterocelectomy with ureteroneocystostomy in 3 cases were done. In 12 cases of duplex system ureterocele, TUI of ureterocele in 2 cases, heminephrectomy with partial ureterocelectomy in 2 cases were done. After operation was done, there was no evidence of complication. We conclude that the surgical approach to the problems associated with a ureterocele is modified by patient age, renal anomaly and the pathological condition of the lower urinary tract.
Subject(s)
Aged , Female , Humans , Male , Dilatation , Flank Pain , Immunoglobulin A , Ureter , Ureterocele , Urinary TractABSTRACT
An ectopic ureteral orifice inserts at a point other than the trigone of the bladder. Ectopic ureteral orifices in a girl commonly are associated with complete ureteral duplication comprises only 10 to 12 per cent of such patients. Continuous incontinence in a girl with an otherwise normal voiding pattern after toilet training is the classic sign of an ectopic ureteral orifice. Here, we report a 3-years-old girl who was admitted to our hospital due to continuous urinary incontinence and managed with the diagnosis of bilateral ectopic ureteral orifices associated with bilateral complete ureteral duplication.
Subject(s)
Female , Humans , Diagnosis , Toilet Training , Ureter , Urinary Bladder , Urinary IncontinenceABSTRACT
The clinical observation was made on 25 cases of partial nephrectomy in Department of Urology, Yonsei University College of Medicine, during the period from 1976 to 1981 (June) and following results were obtained. 1) The age distribution was from minimal 4 months up to 64 years old and among 13 cases of duplicated system disease, below 10 years old child group was 8 cases. 2) The causes of diseases were analysed like this: duplicated system; 13 cases, renal stone; 6 cases renal tuberculosis; 3 cases, A-V malformation; 1 case, renal cyst; 1 case, renal abscess; 1 case. 3) Upper pole resection was done in 18 cases and lower pole resection was done in 7 cases. Among 6 cases of renal stone, 4 cases were involved in longer pole and among 13 cases of duplicated system, 12 cases were involved in upper pole. 4) Persistent urinary fistula occurred in 4 cases as post-operative complication and among these 4 cases secondary nephrectomy was needed in 3 cases. 5) Among these 25 cases, transfusion was needed in 20 cases during operation and the mean amount of transfused blood was 504cc. in these 20 cases.