The course of alterations in ureteral jet dynamics following kidney transplantation: a prospective observational cohort study

SUMMARY OBJECTIVES To prospectively investigate the alterations and normal ranges of ureteral jet dynamics after double-J-stent (DJS) removal in patients who underwent renal transplantation (RTx). METHODS Patients who underwent RTx were prospectively evaluated between November 2017 and June 2018. After RTx, Doppler ultrasonography (D-US) was performed on all patients after DJS removal. Renal artery resistive index (RA-Ri), renal pelvis anterior-posterior diameter (RP-APD), pelvicalyceal system dilation (PCSD), and ureteral jet flow dynamics (maximum and average velocity; JETmax and JETave) were measured by D-US. Also, patients' demographics, estimated glomerular filtration rate (eGFR) levels, and acute rejection were investigated in the study. Patients were assessed two different times by D-US, about 6 and 12 weeks after DJS removal, and the two different measurements were compared with the Wilcoxon test and Chi-square test. RESULTS A total of 25 patients were evaluated in the study. Nonobstructive PCSD rate (12% vs 8%), JETave (18.8 vs 12.9 cm/sec), and JETmax (29.2 vs 20 cm/sec) levels were significantly decreased (p values are 0.01, 0.010 and 0.014, respectively). In addition, monophasic and square pattern rates were significantly observed to increase over time (p=0.035); however, ureteral jet patterns were correlated between the two different D-US measurements (R=0.225, p=0.032). CONCLUSION After RTx, dilation rate and ureteral jet flow velocities were significantly decreased, and monophasic and square JETpattern rates were significantly increased over time. Ureteral jet dynamics can provide useful information about the follow-up of peristaltic activity in the pelvic-ureteric system.

RESUMO OBJETIVOS Investigar prospectivamente as alterações e as variações normais da dinâmica do jato ureteral após a remoção do J-stent duplo (DJS) em pacientes submetidos a transplante renal (RTx). MÉTODOS Pacientes submetidos a RTx foram avaliados prospectivamente entre novembro de 2017 e junho de 2018. Após o RTx, o D-US foi realizado em todos os pacientes após a remoção do DJS. Índice de resistência da artéria renal (RA-Ri), diâmetro ântero-posterior da pelve renal (AP-DPR), dilatação do sistema pelvicaliceal (PCSD) e dinâmica do jato ureteral (velocidade máxima e média; JETmax e JETave) foram medidos por D-US. Além disso, a demografia dos pacientes, os níveis estimados de taxa de filtração glomerular (eGFR) e a rejeição aguda foram investigados no estudo. Os pacientes foram avaliados em dois momentos diferentes pelo D-US, cerca de 6 e 12 semanas após a remoção do DJS, e as duas medidas diferentes foram comparadas com o teste de Wilcoxon e o teste do qui-quadrado. RESULTADOS Um total de 25 pacientes foi avaliado no estudo. Taxa de PCSD não obstrutiva (12% vs. 8%), JETave (18,8 vs. 12,9 cm/seg) e JETmax (29,2 vs. 20 cm/seg), os níveis foram significativamente diminuídos (valores de p são 0,01, 0,010 e 0,014, respectivamente). Além disso, as taxas de padrão monofásico e quadrado foram significativamente observadas para aumentar ao longo do tempo (p=0,035); no entanto, padrões de jato ureteral foram correlacionados entre as duas diferentes medidas D-US (R=0,225, p=0,032). CONCLUSÃO Após o RTx, a velocidade de dilatação e as velocidades de fluxo do jato ureteral foram significativamente diminuídas e as taxas de JET padrão monofásico e quadrado foram significativamente aumentadas ao longo do tempo. A dinâmica do jato ureteral pode fornecer informações úteis sobre o acompanhamento da atividade peristáltica no sistema pélvico-ureteral.

Different modalities of management of lower uretric calculi

Eighty two patients with lower third ureteric calculi were categorised into 3 group; 27 patients were treated conservatively according to specific radiological parameter; 34 patients were subjected to ureteroscopic manipulation, while 30 patients, underwent open surgery. Comparing the results, the success rates were 70%; 82%; and 100% respectively. We concluded that, ureteroscopy is an alternative modality for lower ureteric stones, it has a low, complication rate provided that, the patients are carefully selected; availability of different ureteroscopic armamentarium, and progress in the surgeon learning curve

Refluxing ureteral stump: a forgotten entity!

Any of the diseases of the upper urinary tract can develop in the residual distal ureteral stump after simple or radical nephrectomy. This case report describes the history of a patient suffering from reflux in residual ureteric stump, with intense pain. Patient showed remarkable improvement following excision of ureteric stump

Endopielotomía en niños con estenosis ureteropiélica: informe preliminar / Endopyelotomy in children with uretoropyelic stenosis: preliminar report

Se presenta un informe de los 4 primeros casos de estenosis UP operados por vía percutánea (endopielotomía) en el I.N.P. en el período de junio de 1993 a julio de 1994. Se mencionan los detalles de la técnica quirúrgica y los resultados que aunque exitosos, por su número aún pequeño y su tiempo de seguimiento corto, no son concluyentes para definir un criterio de abordaje en nuestra Institución; son similares a los resultados publicados por autores en otras partes del mundo

Functional abnormalities of ureteric motility with a leaky urothelial barrier

A leaky urothelial barrier is a characteristic feature of bilharzial uropathy and renal calculi impaction. The structural evidence of bilharzial uropathy was demonstrated in this study together with its functional consequences. In vitro, the study was conducted on ten lower ureteric rings from patients with bilharzial stricture of lower ureter and ten normal lower ureteric rings from patients treated by cystectomy. It was found that the bilharzial rings display irregular phasic contractions with intermittent bursts of activity while the normal rings display regular rhythmic contractions. On addition of freshly voided human urine [2 ml] to the organ bath, the frequency of contractions and basal tone were significantly increased while the amplitude of contractions was significantly decreased in bilharzial ureters more than in normal ones. The urine induced changes in motility were reversed by H-blocker [Pheneramine maleate] and prostaglandin synthetase inhibitor [Diclofenac sodium]. Histamine [5 micro g / ml] was found to have similar effects to that induced by addition of urine, while prostaglandin F[2] alpha [5 micro g / ml] was found to increase the frequency of ureteric contractions. In conclusion, histamine and prostaglandin F[2] alpha play an important role in mediating the response of human ureter with a leaky urothelium to urine

[Urinary incontinence due to congenital ectopic ureter in a dog]

Ectopic ureter was diagnosed by urography and vaginography in a 3 month old puppy. Clinical signs include urinary incontinance contact dermatitis around vulva and anus. Urography revealed dilatation of the left ureter and pelvic kidny. It was difficult to show clearly the course of ureter into the vagina by this technique. Vaginography was performed under radioscopy facilities and spot radiographs were taken during radioscopy which showed clearly existence of contrast media in the left ureter. No surgical intervention attempted because of owner disagreement. At necropsy both ureter were ectopic but there was not any dilatation of right ureter probably due to the complete emptying of urine into the blader and vagina simultaneously

Vesicoureteric reflux after ureteric dilatation: an experimental study

The present study was designed to evaluate the incidence of delayed [4-6 months] vesicoureteral reflux after dilating the terminal ureter of dogs to 2, 3 and 4 folds the normal calibre [4F]. It was found that 2-fold dilatation is harmless, with no incidence of vesicoureteral reflux, while the 3-fold dilatation carries an incidence of 28.5% of delayed reflux. Four-fold dilatation carries the hazards of 50-66.6% incidence of persistent vesicoureteral reflux using either balloon or teflon dilators, respectively. The implication of these findings for clinical practice are discussed

Ruptura espontánea del ureter / Spontaneous ureteral rupture

La ruptura no traumática del ureter es un cuadro raro. Generalmente está asociado a litiasis y afecta las porciones superiores del ureter. El tratamiento es quirúrgico e incluye el drenaje del urinoma y la reconstrucción de la vía urinaria. Incluso a veces es necesario la Nefrectomía. Se analizan 2 casos clínicos observados en un lapso de 8 años en el Servicio de Urología del Hospital del Salvador. Los dos se trataron quirúrgicamente, realizándose Nefrectomía en un caso, Ureterolitotomía y drenaje en el otro

Management of ureteric stones [a study of 200 cases]

A series of 200 consecutive patients with radiopaque ureteric stones seen at the Urology Department, Postgraduate Medical Institute, Lahore is presented. The age of the patients was between 15-72 years, with a male to female ratio of 3:1. Renal pain was the chief presenting symptom and duration varied between 1 day and 8 years. Majority of the ureteric stones were impacted in the pelvic part of the ureter. The size of the stone varied between 0.3-1.5cm along the transverse diameter. One seventy two patients [86%] were managed conservatively with a success rate of 73%. Twenty six patients [13%] underwent ureteroscopic stone removal with a success rate of 74%. open surgery was performed only in two patients [1%].We conclude that the size of the stone in majority of the patients is such, that they are amenable to conservative or endoscopic procedures. open surgery has less role to play as primary form of treatment in the management of ureteric stone