Management of full-length complete ureteral avulsion

ABSTRACT Introduction Complete ureteral avulsion is one of the most serious complications of ureteroscopy. The aim of this report was to look for a good solution to full-length complete ureteral avulsion. Case presentation A 40-year-old man underwent ureteroscopic management. Full-length complete avulsion of ureter occurred during ureteroscopy. Pyeloureterostomy plus greater omentum investment outside the avulsed ureter and ureterovesical anastomosis were performed 6 hours after ureteral avulsion. The patient was followed-up during 34 months. Double-J tube was removed at 3 months after operation. Twenty three months after the first operation, the patient developed hydronephrosis because of a new ureter upside stone, then rigid ureteroscopy and holmium laser lithotripsy were used successfully. Conclusion Pyeloureterostomy plus greater omentum investment outside the avulsed ureter and ureterovesical anastomosis may be a good choice for full-length complete ureteral avulsion.

Evaluation of sexual function in patients submitted to ureteroscopic procedures

ABSTRACTObjective:We aimed to evaluate the possible effects of ureteroscopic procedures on the sexual function of both genders.Materials and Methods:A total of 102 sexually active cases (60 male, 42 female) undergoing ureteroscopic procedures were included in this study. Sexual function has been evaluated in detail by using International Index of Erectile Function (IIEF) in male and Female Sexual Function Index (FSFI) forms in female cases both before and 1-month after the procedures. Pre-and postoperative data were evaluated in a comparative manner.Results:The pre-and postoperative mean IIEF scores were 57.86±2.26 and 54.57±2.48 (p=0.19) in males and the mean FSFI scores were 13.58±1.46 and 14.46±1.52 (p=0.41), respectively in females. Evaluation of these values showed that regarding the effects of this procedure on male cases although the total scores for sexual function were not influenced it was observed a significant reduction in the intercourse satisfaction sub-domain (IIEF-IS) in males (p<0.05). In female cases however, unlike the male cases no statistically significant alterations with respect to these scores were noted (p=0.418).Conclusion:Ureteroscopic interventions could have some adverse effects on the sexual function particularly in male cases. However, it is clear that further prospective studies in both genders with large population of cases are certainly needed in order to outline this unresolved but important subject.

Laparoscopia no tratamento do ureter retrocava: relato de caso e revisão da literatura / Laparoscopy in the treatment of retrocaval ureter: a case report and literature review

É apresentado um caso de ureter retrocava em paciente com queixa de dor lombar à direita, tratada após confirmação por tomografia computadorizada de abdome com contraste intravenoso com transposição do ureter direito (ureteroplastia) associada à implantação de cateter duplo J. sem intercorrências. Dessa forma, enfatiza-se a importância dessa malformação como uma das causas de uropatia obstrutiva e o uso de métodos de imagem para diagnosticá-la.

Manejo quirúrgico de la endometriosis vésico-ureteral y sus complicaciones / Surgical management of deep endometriosis

La endometriosis ureteral es una infrecuente localización de endometriosis profunda, que puede condicionar una grave disminución de la función renal de forma silenciosa. Se presenta el caso de una paciente con fibrosis peritoneal secundaria a endometriosis profunda, cuya inespecífica sintomatologia conllevó un retraso diagnóstico, permitiendo el desarrollo de hidronefrosis. Es necesario descartar la presencia de endometriosis profunda en mujeres en edad fértil con hidronefrosis de etiología desconocida.

Deep endometriosis rarely entails ureteral involvement. It may be responsible of asymptomatic loss of renal function. A 35-year-old woman, gravida 1, para 1, was managed for peritoneal fibrosis due to deep infiltrating endometriosis. The nonspecific symptoms let a delayed diagnosis and a subsequent hydronephrosis. It must be excluded the existence of deep endometriosis in women of childbearing age with hydronephrosis of unknown etiology.

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.

Reparación de lesiones ureterales distales con el Flap de Boari laparoscópico: experiencia en 13 casos / Distal ureteral reconstruction using laparoscopic Boari Flap: experience in 13 cases

Introducción: El flap de pared vesical tubularizado para el reemplazo del uréter distal (Boari) constituye una excelente alternativa para la reparación quirúrgica de diferentes patologías que involucran la pérdida de parte del uréter distal, facilitando una reconstrucción relativamente simple y sin tensión en las líneas de sutura. En el año 2000 comenzamos una experiencia realizando esta técnica por vía laparoscópica, que detallamos a continuación. Material y Método: Se consideraron candidatos para la técnica a pacientes con patología que condicionara estenosis del uréter distal, con vejiga de capacidad adecuada y con función renal ipsilateral normal. Se incluyeron además pacientes con lesión ureteral en el curso de laparoscopia ginecológica. La técnica es básicamente la misma que se utiliza en cirugía abierta, que incluye la resección del uréter patológico y la construcción de un flap de pared vesical que se tubulariza y se anastomosa sin tensión al cabo distal del uréter remanente. Resultados: En un período de 6 años se operaron 13 pacientes con una edad promedio de 39,5 años (rango de 9 a 71), 7 mujeres y 6 hombres. En 9 casos el diagnóstico previo era estenosis por enfermedad benigna, entre los cuales hubo 2 casos de neoimplante previo con estenosis posterior y dos casos de litiasis ureteral. En 2 casos el diagnóstico fue compatible con lesión actínica del uréter luego de radioterapia por cáncer cervicouterino. En 2 casos el diagnóstico fue tumor ureteral, uno de ellos tumor de células transicionales superficial y de bajo grado y en el otro un papiloma invertido. Hubo dos pacientes operadas por lesión por cirugía ginecológica, una ligadura de uréter inadvertida y una sección de uréter que se reparó en forma inmediata. Hubo un caso de estenosis ureteral por endometriosis. Todos los pacientes han sido controlados con pielografía de eliminación. Hasta el momento no ha habido pérdida de unidades renales ni necesidad de reoperación en ningún paciente...

Background: Tubularized bladder wall flap (Boari flap) is an excellent surgical replacement technique for diseases involving the distal ureter. It allows a simple reconstruction and voids tension in suture lines. Since 2000 we are performing this operation by laparoscopy. Aim: To report the experience with laparoscopic Boari Flap. Material and methods: Retrospective review of patients subjected to a laparoscopic Boari flap. Patients with a distal ureter stricture, with a urinary bladder of adequate capacity and with a normal ipsilateral renal function, were considered eligible for the operation. Patients with ureteral lesions occurring during gynecologic laparoscopy were also included. The technique consists in the excision of the diseased ureter and construction of a bladder wall flap that is tubularized and anastomosed to the distal part of the remaining ureter. Results: Thirteen patients aged 9 to 71 years, (seven females) were operated in a lapse of six years. Nine had a benign ureteral stricture. Among these, two had a previous neo-implant with subsequent stenosis, two had ureteral stones, two had a radiation injury secondary to radiotherapy for cervical cancer, two had ureteral tumors (a transitional cell tumor and an inverted papilloma), two patients had iatrogenic ureteral lesions during gynecological surgery (an inadvertent ureteral ligation and an ureteral sectioning that was repaired and two patients had ureteral stenosis secondary to endometriosis. All patients were followed with intravenous pyelograms. After a mean follow up of 25 months, no patient has lost a kidney or required a new operation. Conclusions: Boari flap is an excellent laparoscopic alternative to replace the distal ureter.

Ureteral calcinosis in juvenile dermatomyositis: successful precocious surgical management

We report a successful surgical intervention to repair bilateral ureteral strictures in a child with juvenile dermatomyositis (JDM) and ureteral calcinosis. This is the fourth reported case in medical literature. A 9-year-old-girl with severe JDM, a rare connective tissue disease characterized by skin and muscles vasculitis, was under immunosuppressive therapy. In the course of the disease, she presented recurrent urinary tract infections. Bilateral ureteral dilation was detected by ultrasound (US) and intravenous pyelogram (IVP). CT scan showed bilateral ureteral calculus. Ureteroscopy revealed bilateral ureteral calcinosis, confirmed by histopathological analysis. Bilateral double-J stents were placed, resulting in transient improvement of ureteral dilation and infection, but only the surgical removal of abnormal ureteral portions was successful. In conclusion, endourological approach is recommended for diagnosis of urinary tract involvement by JDM because radiological evaluation can be misleading. The immunosuppressive treatment and the resection of damaged ureteral segments have allowed the control of urinary complications.

Retrocaval ureter a study of 13 cases

The aim of this study was to report our 23-year experience in the diagnosis and treatment of retrocaval ureter. Data from 13 patients with retrocaval ureter were reviewed. Intravenous urography and retrograde pyelography had been used for confirming the diagnosis. All of the patients had been symptomatic and undergone surgery. A control intravenous urography had been performed 6 months postoperatively. The mean age of the patients was 23 years [range, 12 to 37 years]. Twelve patients [92.3%] were men. The clinical manifestations were pyelonephritis in 7 [53.8%], right flank pain in 4 [30.8%], gross hematuria in 1 [7.7%], and ureteral calculus in 1 [7.7%]. All of the patients had type 1 right-sided retrocaval ureter. Associated anomalies were seen in none of the patients. The control intravenous urography showed improvement of renal function. In our patients, the most common cause of referral was pyelonephritis. In symptomatic cases, operation is needed and can improve renal function

Uréter ileal revisitado / Ileal ureter revisited

Introducción: El reemplazo del uréter por un asa desfuncionalizada de íleon fue reportado por primera vez hace más de cien años. En las últimas décadas sus indicaciones y el conocimiento de las técnicas para su utilización se han ampliado enormemente. Material y Método: Se efectúa una revisión de las indicaciones, técnica quirúrgica complicaciones del uréter ileal, a partir del reporte de tres casos clínicos de uso de un segmento de íleon como reemplazo ureteral. Resultados: Entre el año 2001 y 2003, tres pacientes (promedio 28 años de edad) recibieron un segmento de íleon como subtitulo de un uréter severamente dañado. Durante el período de seguimiento (promedio 22 meses) no se objetivaron complicaciones graves derivadas del procedimiento, la necesidad de realizar una nueva diversión urinaria, evidencia de deterioro renal o mortalidad. Conclusiones: El intestino constituye un recurso indiscutible al que puede recurrir el urólogo en su práctica quirúrgica reconstructiva. El uso de un segmento desfuncionalizado de íleon como reemplazo de un uréter dañado, proporciona una alternativa terapéutica segura y reproducible, de proveer el riñón de un drenaje a baja presión, no obstructivo, que preserve la función renal.

Tubercular ureteric strictures

To review the presentation of tubercular ureteric strictures and assesses the role of balloon dilatation and open surgical repair in their management. This was a retrospective review of tubercular ureteric strictures managed between January 1993 and December 2002. The records were analyzed to assess clinical presentation and compare the results of balloon dilatation with open surgical repair. Success was defined as adequate drainage on imaging, no worsening of renal function, no recurrence of symptoms and no requirement of intervention on further follow up. The long term success rates were compared using the t-test for proportion. Of 73 strictures, 88% had lower urinary tract symptoms. Genital abnormalities suggestive of tuberculosis was observed in 40% male patients. Urine examination yielded aseptic pyuria in 85%, positive AFB smears in 36% and positive AFB cultures in 32%. A small capacity bladder and non-functioning renal units were the only consistent findings on intravenous urogram. Nephrectomy was performed in 37% cases due to non salvageable kidneys at presentation. The success rate of stenting fell from 93% on immediate follow up to 59% on a follow-up of 12 months. At 90% success rates on a follow-up of 7 months open surgical repair was superior [p 0.03]. Long term success following balloon dilatation in renal units with good function was 78% compared to 25% for poorly functioning units. [p= 0.01]. Open surgical repair is superior to balloon dilatation in the management of tubercular ureteric strictures. Renal function may predict the success of balloon dilatation

Neoimplante de Gregoir en megauréter obstructivo: ¿es necesaria su remodelación? / Gregoir neo-implant in obstructive megaureter: is its remodelation necessary?

Presentar la experiencia de nuestro hospital en cirugía de neoimplante ureteral con técnica de Gregoir sin remodelación del uréter, en pacientes portadores de megauréteres obstructivos con diámetro uretral sobre 15 mm. Método: Revisión de fichas clínicas e imaginología de pacientes pediátricos con diagnóstico de megauréter obstructivo sometidos a neoimplante de Gregoir entre enero 1992 hasta marzo 2003. Resultados: En el período estudiado, 7 pacientes (8 uréteres) con diagnóstico de megauréter obstructivo fueron sometidos a cirugía de neoimplante de Gregoir de uréter sin remodelación. Hubo 3 hombres y 4 mujeres. El promedio de edad al momento de la cirugía fue de 16,2 meses. El grosor del uréter neoimplantado fue en promedio 28,1 mm. No existieron complicaciones perioperatorias y en su seguimiento ecográfico (promedio 63 meses) se ha visto disminución significativa de la dilatación uretral y pielo-caliciaria. Conclusión: Basados en los resultados encontrados en esta serie clínica, es posible concluir que no siempre es imperativo realizar ajustes al diámetro del megauréter previo a su neoimplante con la técnica de Gregoir, posiblemente debido al automodelaje que produce la técnica en sí.

double J ureteric stent, is it still a faithful friend to urologists?

To assess the side effects and long term complications of double-J ureteric stents .The records of all patients who were stented by using double-J-Ureteric stents to relieve ureteric obstruction or in the course of endourological management of urolithiasis - were reviewed 50 patients with morbidity and complication due to the D.J. Stents [35 Males, 15 Females] were followed up with plain x-ray, ultrasound. 20 patients were found to complain of fever, symptoms of bladder irritability and flank pain, treated with antibiotics, analgesics and antispasmodics. 8 patients had migration of the stent, 6 with proximal migration, 2 with distal migration, 2 with spontaneous fragmentation of the stent, 20 patients had encrustations and stones formed around the double J stents and treated accordingly. The double J ureteric stents are of great importance and helpful to urologists but may have side effects and complications that may add to the patient's morbidity. So follow up regularly and early interference is mandatory to prevent these complications

Bifid scrotum, perineal hamartoma and high imperforate anus: a case report

This is a case report of a newborn patient with imperforate anus, urethro-colonic fistula, perianal hamartoma, and bifid scrotum. Successful staged repair of these anomalies is described together with review of the embriology related to the case

Uretero-arterial fistula: a case report and review of the literature

We report the case of a uretero-arterial fistula (UAF) formation in a 68 years old male who had previously undergone an Aortobifemoral graft. He got complicated with occlusion and infection of the right lower extremity requiring a right hip disarticulation for its management. This was followed by groin infection and graft protusion, managed by transabdominal resection of the right graft limb, at which time the right ureter was lacerated and repaired. Several months later, he presented with gross hematuria found to be secondary to UAF. The diagnostic and management steps leading to this patient care will be reviewed, together with a review of the literature pertinent to this case report

Empleo de la sutura microquirugica en la transureteroureterostomia / Use of microsurgical suture in transureteroureterostomy

Utilizando 5 perro beagles, se realizo la tecnica de la transureteroureterostomia y se aplicaron los procederes de la sutura microquirurgica; se derivo el ureter izquierdo a traves del derecho mediante puntos discontinuos seromusculares, con hilo de sutura de poliamida 10-0 monofilamento y aguja curva espatulada: el objetivo fue demostrar la superioridad de la tecnica microquirurgica sobre el metodo usualmente empleado. Se exponen los resultados radiologicos y anatomopatologicos obtenidos a los 3, 4 y 6 meses, los que demuestran,radiograficamente, ausencia de lesiones renales y de los sistemas excretores, con buen funcionamiento de la trasureteroureterostomia; y anatomopatologicamente, tanto en el estudio macroscopico como en los cortes histologicos de los rinones y del sitio de la anastomosis se comprobo la ausencia de lesiones renales, asi como reconstruccion de todos los planos de la pared del ureter. Esta tecnica de derivacion mediante la microcirugia puede constituir la operacion alternativa ideal cuando no sea posible la sutura termino-terminal

Duplicaçåo pieloureteral com ureter ectópico vulvar / Duplication of the upper urinary tract with vulvar ectopic ureter

Os autores apresentam um caso de duplicaçåo pieloureteral completa com ureter ectópico vulvar em mulher de 37 anos de idade. A principal queixa era o corrimento vaginal com evoluçåo de 20 anos. A clínica, diagnóstico e tratamento såo discutidos

Experiencia con el cateter uretral (Pig Tail) / Experience in the urethral catheter (Pig Tail)

Se presenta la experiencia en el empleo del cáteter uretral "pig tail" en 14 pacientes portadores de uropatía obstructiva de diferente etiología (estenosis post sección quirúrgica del ureter, litiasis ureteral, estenosis por tuberculosis, metástasis retriperitoneal, etc.) que ha requerido la colocación del cáteter para lograr una derivación urinaria interna