Mysterious ureteral migration of a wooden toothpick from the digestive tract: case report and diagnostic considerations

ABSTRACT Migration of foreign bodies into the urinary tract is a rare event. In certain instances, to unravel the way that objects arrived in the urinary tract is not easy. We report the case of an accidentally swallowed wooden toothpick that migrated and was found in the left ureterovesical junction, protruding into the bladder. Even though the computed tomography scan is widely employed to evaluate the urinary tract, this resource does not have a good sensitivity for detecting foreign bodies. Our report presents an insight into the best imaging approach if wooden toothpicks are suspected. In the present case, the endoscopic treatment was possible with an uneventful outcome and a complete resolution of symptoms.

How I do it open distal ureteroureterostomy for ectopic ureters in infants with duplex systems and no vesicoureteral reflux under 6 months of age

ABSTRACT We describe a step by step technique for open distal ureteroureterostomy (UU) in infants less than 6 months presenting with duplex collecting system and upper pole ectopic ureter in the absence of vesicoureteral reflux (VUR).

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.

Easy resolution of severe obstructive kidney injury

SUMMARY Chronic constipation is a common diagnosis with a high prevalence in the elderly. Constipation affects the quality of life of sick individuals, bringing several clinical complications.

RESUMO A obstipação crônica é um diagnóstico com alta prevalência comum em idosos. A constipação afeta a qualidade de vida das pessoas doentes, carregando muitas complicações clínicas.

Simplified method using kidney / ureter / bladder x-ray to determine the appropriate length of ureteral stents

ABSTRACT Purpose: To investigate a method to determine the appropriate length of ureteral stents, given that the stent length may lead to exacerbation of urinary symptoms if the stent crosses the bladder midline. Materials and Methods: We retrospectively reviewed the position of the distal curl of the ureteral stent using kidney/ureter/bladder (KUB) radiographs after ureteroscopic lithotripsy in 165 patients who underwent placement of 24- or 26-cm ureteral stents. According to the KUB findings, we categorized the position of the distal curl of the ureteral stent into two groups. In Group 1, the stents did not cross the midline (appropriate length); in Group 2, the stents crossed the midline (inappropriate length). We assessed several patient parameters (sex, height, body mass index, and stone side) and the index of ureteral length using KUB radiographs ("C-P") and computed tomography (CT, "P-V"). Multivariate analysis was performed to identify the most significant factors affecting the position of ureteral stents. We also calculated the cutoff points of the receiver operating characteristic (ROC) curve of C-P and P-V for the position of ureteral stents. Results: The multivariate analysis showed that C-P was the most significant factor affecting the position of ureteral stents (p < 0.001) in patients with 24- and 26-cm ureteral stents. Comparison of the ROC curves of C-P and P-V showed that C-P was superior to P-V (p < 0.01) in patients with 24- and 26-cm stents. Conclusion: The use of KUB radiographs was effective and simple in determining the appropriate length of ureteral stents.

Ureter ectópico extramural em um cão Labrador Retriever: relato de caso / Ectopic ureter extramural in a Labrador Retriever dog: a case report

A ectopia ureteral é uma enfermidade congênita que se caracteriza quando um ou ambos os ureteres apresentam-se inseridos fora do seu local anatômico, com a inserção ocorrendo no útero, no colo da bexiga, na uretra ou na vagina, devido a uma diferenciação anormal dos ductos mesonéfricos e metanéfricos. Nos machos, a inserção pode ocorrer também nos ductos deferentes e na próstata. A incontinência urinária é o sinal clínico mais comumente associado ao ureter ectópico. O presente relato descreve um caso de ureter ectópico extramural unilateral, em um cão da raça Labrador Retriever de sete anos de idade, corrigido cirurgicamente, e mostra a importância dos exames radiográfico contrastado e ultrassonografia.(AU)

Ureteral ectopia is a congenital disease that is characterized when one or both ureters are shown inserted outside their anatomic site, with the possible insertion in the uterus, bladder neck, the urethra or vagina due to abnormal differentiation of ducts mesonephrics and metanephrics. In males the insertion can also occur in the vas deferens and prostate. Urinary incontinence is the most common clinical sign associated with ectopic ureter. This report describes a case of unilateral extramural ectopic ureter in a dog of the Labrador Retriever breed at seven years old surgically corrected, and shows the importance of contrast radiographic examination and ultrasound.(AU)

Is intravesical stent position a predictor of associated morbidity?

PURPOSE: Temporary drainage of the upper urinary tract by use of internal ureteral stents is a common procedure that is often associated with a variety of symptoms. The role of intravesical stent position in associated morbidity is controversial. MATERIALS AND METHODS: The German version of the ureteral stent symptom questionnaire (USSQ) was completed by 73 patients with an indwelling ureteral stent the day before stent removal. Intravesical stent position was classified into 3 categories by x-ray before stent removal. The influence of intravesical stent position on USSQ score was analyzed, including subscores and single items. RESULTS: Intravesical stent position showed no significant influence on associated morbidity. The median USSQ total score in all patients was 77.5 (range, 30-147). Patients with ipsilateral stents (69.0; range, 30-122) tended to have lower total scores than did those with tangential (86.5; range, 30-122) or contralateral (77.0; range, 31-147) stents, but the differences were not statistically significant (p=0.35). The USSQ subscores for urinary symptoms (p=0.80), body pain (p=0.80), general health (p=0.16), work performance (p=0.07), additional problems (p=0.81), and all of the USSQ single items of interest in the context of stent length also did not differ significantly between the three groups. CONCLUSIONS: Intravesical stent position did not significantly influence associated morbidity in our study. An appropriate stent length should be chosen to avoid dislocation. However, complex calculations of optimum stent length, time-consuming manipulations, and costly stock holding of various stent sizes to obtain the perfect stent position do not seem worthwhile.

Laparoscopic ureterolithotomy for upper ureteric calculi.

Laparoscopic ureterolithotomy was performed on 10 patients with upper ureteric stones indicated for open ureterolithotomy after failed prior minimally invasive approaches. Stone size ranged from 7 to 15 mm. (mean 9.3). The routes of approach were all done transperitoneally except in one case in which the retroperitoneal route was initially attempted and later converted to transperitoneal route due to contracted space and unclear landmarks. Stones were all removed successfully with the operating time ranging from 120 to 270 min. (mean 181.5). The only significant complication encountered was urine leak interval postoperatively which were long in 4 patients in whom ureterotomy was not sutured. The longest urine leak interval was seen in a patient whose ureterotomy was neither sutured nor stented. Postoperative pain was rewarding in that seven patients required a single dose of 50 mg of pethidine, two required only oral paracetamol and one required no analgesic at all. Postoperative hospital stay ranged from 5 to 23 days which was actually overwhelmed by urine leak complication. Recovery period was satisfactory which ranged from 10 to 28 days (mean 18.1). Overall laparoscopic ureterolithotomy offers an alternative procedure to open ureterolithotomy with the advantages of minimal postoperative pain and short recovery period.

Ureteric obstruction by shotgun pellet "pellet colic".

Acute renal colic from retained missiles is an unusual and interesting delayed complication of missile injuries to the abdomen. It must be considered in patients who present with symptoms of renal colic following gunshot and shotgun wounds with retained missiles. We report a case of acute ureteral obstruction secondary to a migrating intraluminal projectile 3 days after a shotgun wound to the back.

value of radiology in the diagnosis and management of indwelling ureteric catheter encrustation

To stress the value of radiology in the diagnosis and management of encrustations forming on indwelling double-J ureteric stents introduced prior to extracorporeal shock wave lithotripsy [ESWL]. King Fahd Military Medical Complex; Dhahran Radiology and Urology Departments. All patients in whom there were difficulties with stent removal after lithotripsy. Seven of 40 patients [17.5%] developed encrustation, five on the lower J of the stent and two at both ends Fluoroscopy was done in all patients in whom there was difficulty with stent removal to assess mobility and confirm the site of possible encrustation. Plain abdominal radiography and tomography were helpful in showing opaque encrustation while excretory urography was needed for radiolucent ones. Ureteric stenting is used during ESWL to allow easy passage of stone fragments and facilitate internal drainage of urine. Encrustation may develop on stents and cause obstruction or difficulty to removal. Radiology helped in the early diagnosis of encrustation and its further management

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