Bilateral extraluminal ectopic ureters in a Maine Coon cat / Ureter ectópico extraluminal bilateral em um felino da raça Maine Coon

Ectopic ureters are rarely observed in cats. Therefore, for a better chance of success in the corrective surgical procedure and survival of the patient, diagnosis should be confirmed early. This report illustrates the occurrence of bilateral ectopic ureters in a seven month old Maine Coon cat and describes the medical and surgical management adopted for correction of the abnormality.

A ectopia dos ureteres é raramente observada em gatos. Assim, para aumentar as chances de sucesso do procedimento cirúrgico corretivo e promover a sobrevivência, o diagnóstico deve ser firmado precocemente. O relato em tela ilustra a ocorrência de ureter ectópico bilateral em uma gata Maine Coon, de sete meses, e descrevem-se as manobras médico-cirúrgicas adotadas na correção dessa anormalidade.

Long-term Result in Ureteroneocystostomy for Complete Duplicated Ureters in Renal Transplantation / 대한이식학회지

Duplicated ureters are the most common congenital malformation of the upper urinary tract, but there are few reports on the transplantation of kidneys with duplicated ureters. We introduce different techniques for the ureteroneocystostomy of double ureters and long-term results. We specifically detail the experience of two patients with duplicated ureters at Bong Seng Memorial Hospital from March 1995 to May 2012. In our first case, the top technique of spatulating and suturing duplicated ureters was applied with the bottom technique for double ureteroneocystostomy. The operation time was 4 hours and 45 minutes, while the ureteroneocystostomy took 32 minutes. In the second case a double-armed 4.0 Vicryl suture was placed on each tip of the ureter and both needles passed from the inside out through the bladder wall. The ureters were pulled into the bladder and the suture was tied on the serosa of the bladder. The operation time was 3 hours and 50 minutes, while the ureteroneocystostomy took 15 minutes. Neither urological complications nor urinary tract infections were observed in the follow-up period and no double-J stent was needed. We therefore conclude that these two techniques are available procedures for handling duplicated ureters, with the technique applied in the second case particularly time-effective.

Ureterectomía radical distal por cáncer urotelial y reconstrucción ureteral asistida por robot / Radical distal ureterectomy secondary to an urotelial cancer and ureteral reconstruction robot-assisted: case report

Objective: To report a case of distal ureterectomy with robotic-assisted laparoscopic reimplantation using a Boari flap technique. Material and Methods: We report a 55 year old man with a diagnosis of distal ureteral urothelial carcinoma without multifocality. Results: A radical distal ureterectomy and robotic-assisted laparoscopic vesicoureteral reimplantation using a Boari flap technique was performed with the da Vinci S-HD surgical system. The operative time was 210 minutes, the estimated blood loss was 200 mL. The hospital stay was 48 hours, without perioperative complications. The histopathological study showed a high grade non-muscle invasive urothelial carcinoma of the distal ureter (pT1NxMx) with negative margins. Conclusions: The distal radical ureterectomy with Boari replacement is feasible and more precise with robotic assistance. Its oncological role must be demostrated with a larger number of cases.

Objetivo: Comunicar un caso de tumor ureteral distal tratado con ureterectomía radical y neoimplante vesicoureteral con técnica de Flap Boari asistida por robot. Material y Métodos: Paciente hombre de 55 años, con diagnóstico de carcinoma urotelial de uréter distal sin compromiso multifocal. Resultados: Se realizó ureterectomía distal radical y neoimplante vesicoureteral con Flap Boari asistido por Robot da Vinci S-HD. El tiempo operatorio fue de 210 minutos, con un sangrado estimado de 200 ml. La estadía hospitalaria fue de 48 horas, sin complicaciones perioperatorias. El estudio histológico mostró un carcinoma urotelial de alto grado con infiltración de la lámina propia (pT1NxMx) y márgenes quirúrgicos negativos. Conclusiones: La ureterectomía radical distal con reconstrucción tipo Boari es técnicamente factible y más precisa con la asistencia robótica. Su rol oncológico requiere de validación con mayor número de casos.

Complicaciones urológicas postrasplante renal con técnica de Lich-Gregoir: experiencia de cuatro años / Urological complications following kidney transplantation using Lich-Gregoir technique: a 4-year experience in Mexico

Objetivo: Revisión de las complicaciones urológicas posteriores al trasplante renal en dos centros hospitalarios utilizando la técnica de ureteroneocistostomía extravesical de Lich-Gregoir en un periodo de cuatro años. Material y métodos: Se revisaron los expedientes de 242 pacientes en quienes se llevó a cabo trasplante renal de enero de 2003 a noviembre de 2007. En todos los pacientes se realizó ureteroneocistostomía extravesical. Se informaron todas las complicaciones urológicas y su manejo. Resultados: Se registraron 19 complicaciones en 18 pacientes, con una incidencia de 7.8 %; 16 riñones se obtuvieron de donadores vivos. Las complicaciones más comunes fueron fuga de orina (4.5 %), estenosis urinaria (1.6 %), reflujo vesicoureteral (1.2 %) y necrosis ureteral (0.4 %). La mayoría de los pacientes fueron tratados con sonda de Foley (42 %), colgajo de Boary (26 %) y nefrostomía (15 %). La pérdida del injerto renal se asoció a complicaciones urológicas en 1.23 % Conclusiones: El trasplante renal debe incurrir en pocas complicaciones urológicas, por lo que debe cuidarse los detalles técnicos. La evaluación temprana para corregir las complicaciones reduce la sepsis, morbilidad y el riesgo de pérdida del injerto.

OBJECTIVE: We present a retrospective review of urological complications following kidney transplantation in two medical centers in the Mexican state of Veracruz using Lich-Gregoir extravesical ureteroneocystostomy during a 4-year period. METHODS: Records from 242 patients from January 2003 to November 2007 were reviewed. Standard technique for organ procurement, open nephrectomy and kidney transplant was performed. EVU was used in all patients. Urological complications and management are reported. RESULTS: There were 19 complications recorded in 18 patients (7.8%). Sixteen kidneys were obtained from living donors. Urinary leak was the most common complication (4.5%) followed by ureteral stenosis (1.6%), vesicoureteral reflux (1.2%) and ureteral necrosis (0.4%) Most patients were treated with Foley catheter (42%), Boary flap (26%) and nephrostomy (15%); 1.23% grafts were lost associated with urological complications. CONCLUSIONS: Renal transplantation should incur few urological complications. Attention to technical details should be paid to avoid major complications. Early evaluation to correct complications reduces sepsis, morbidity and the risk of losing graft function.

Results of Surgical Correction in Patients with Vesicoureteral Reflux after Kidney Transplantation / 대한이식학회지

PURPOSE: The prevalence and significance of vesicoureteral reflux (VUR) after kidney transplantation has been varies among authors. While these results suggested that VUR can be a source of repeated infections, which might be a prognostic factor impairing long-term graft function. We evaluated the prevalence, clinical manifestations and diagnostic methods of VUR after living donor kidney transplantation and their proper management with the results of each treatment. METHODS: We reviewed thirty-four patients among five hundreds and thirteen living donor kidney transplant recipients, who developed VUR after the transplantations at our center from June 1998 to June 2003. Twenty-three patients underwent a corrective surgical procedure, ureteroneocystostomy, and we excluded 3 patients who underwent the procedure less than 1 year. The patients were divided into three groups: those with severe VUR underwent a corrective surgical procedure with more than 1 year follow-up (group I, n=20), those with mild VUR underwent a conservative management (group II, n=8) and control group of patients without VUR (group III, n=20). The incidence of urinary tract infection (UTI) and graft function were assessed for 1~7 years. Voiding cystoureterography (VCUG) was performed in patients with recurrent urinary tract infections and reflux was classified from Grade I to Grade IV. RESULTS: We examined immunological and non-immunological risk factors such as age, sex, primary diseases, duration on dialysis, diuresis prior to the treatment, donor selection, the degree of HLA mismatches, cold ischemia time, the incidence of acute rejection. There was no significant demographic difference among study groups except sex (female). Analysis of patients and grafts survival rates revealed no statistical differences among three groups. CONCLUSION: VUR dose not seem to negatively affect graft function if surgical correction were performed in proper period after the diagnosis. The indication of surgical correction of VUR is clinically significant UTIs, UTI sepsis, Grade III or IV VUR. Close attention, proper diagnosis and prompt surgical correction are necessary to minimize the adverse influence of VUR after kidney transplantation.

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)

Urologic Complication of Extravesical Ureteroneocystostomy in Renal Transplantation / 대한비뇨기과학회지

Since the first successful kidney transplant in 1954, many advances have been made in renal transplantation technique and urinary reconstruction. Recently, there has been increasing interest in the use of extravesical technique to perform ureteroneocystostomy in renal transplantation. From January 1985 to September 1994, 93 patients underwent renal transplant ureteroneocystostomy by an extravesical technique. Complications related to the anastomosis and/or ureter were reviewed. There were 5 total complications, for an over-all urologic complication rate 5.4 percent. Of these complications one was related to the ureteroneocystostomy, for an anastomotic complication rate of 1.07 percent We report our experience with the simple extravesical technique for ureteroneocystostomy that has provided excellent results and minimal morbidities.

Clinical Review of Ureteroneocystostomy / 대한비뇨기과학회지

The art of ureteroneocystostomy represents one of surgery's most successful treatment of a disease process. There are several operative techniques in ureteroneocystostomy and these should be antireflux to preserve renal function. To prevent the reflux, sufficient submucosal length, minimum ureteral manipulation, and adequate buttress making the new orifice near the trigone are stressed. We performed ureteroneocystostomy in 33 patients(46 ureters) in the last 10 years. We evaluate the preoperative causes, operative techniques, postoperative courses and follow up to these cases with review of the articles. The results are as follows . 1. Ureteroneocystostomy was done by Cohen method in 20 ureters, Politano-Leadbetter in 21, Glenn-Anderson in 4, submucosal tunnel with vesico-psoas hitch and Boari flap in 1 ureter. 2. All of twelve ureters(100%) by Cohen were successfully corrected with thirteen successful corrections(81.3%) by Politano-Leadbetter out of sixteen ureters. 3. Postoperative complications were obstruction in 2 ureters. ipsilateral VUR and unimproved renal function in each one ureter.

Extravesical Ureteroneocystostomy in Renal Transplantation / 대한비뇨기과학회지

From January, 1981 to May, l988, 46 patients underwent renal transplant ureteroneocystostomy by a transvesical technique in 12 and extravesical ureteroneocystostomy in 34. There were 2 complications of urine leakage related to the transvesical ureteroneocystostomy, while no instance of complication relates to the extravesical ureteroneocystostomy. Urine leakages were repaired by reoperation of the extravesical ureteroneocystostomy. Renal transplant extravesical ureteroneocystostomy is simple, fast and effective method to reestablish urinary tract continuity and provides minimal complication.

Urological Complications of Extravesical Ureteroneocystostomy in 60 Renal Transplantations / 대한비뇨기과학회지

We evaluated the urologic complications of extravesical ureteroneocystostomy in 60 renal transplantation performed in the Department of Urology, Kosin Medical College during the period from December 1984 to August 1987. The results were as follows 1. Of 60 cases of recipient 39 cases were male and 21 cases were female. In donor and recipient`s relationship, 53 cases related and 7 cases were unrelated. 2. Our incidence of postoperative urologic complications of extravesical ureteroneocystostomy in 60 renal transplantation was 5 cases(8.3%). 3. The details of complications were as follow : 4 cases(6.7%) were ureteral obstruction due to perirenal hematoma and 1 case(1.6%) was ureteral fistula. 4. Treatment of complications were immediate perirenal hematoma removal in ureteral obstruction(4) and silastic drain in ureteral fistula(1). 5. Results and prognosis in complicated cases were good.

Ureteroneocystostomy for Vesicoureteral Reflux in Children / 대한비뇨기과학회지

The deleterious effects of infected urine refluxing into the collecting system are well documented. The resultant renal scarring, parenchymal atrophy and interference with renal growth and function are recognized sequela that may profoundly affect the future of these children. Prevention of reflux nephropathy depends upon early identification off reflux and appropriate management with continuous antibiotic chemoprophylaxis or surgical correction. The ultimate goal of therapy for vesicoureteral reflux, whether medical or surgical , aims at protecting the kidney from scarring, improving the pre-existing renal function and allowing the fulfillment of renal growth potential. We report 11 patients(19 kidneys) with vesicoureteral reflux treated with ureteroneocystostomy during the past 4 years. Follow-up over 3 months was possible in 9 patients who have had no evidence of recurrent pyelonephritic episodes. In 9 patients(15 ureters), performed postoperative I.V.P. and V.C.U.G., reflux was disappeared in 8(14 ureters) and still persisted in only 1(1 ureter) with grade I. And 13 kidneys have been improved radiographically, but 2 which had been shown unilateral atrophy and contralateral compensatory hypertrophy, have not been changed postoperatively. Renal scarring in 8 kidneys(42%), associated with severe reflux(more than grade IV) and infection, have not been improved postoperatively, but the development of new scars and the progression of established scars have not been observed.

Psoas Hitch Ureteroneocystostomy / 대한비뇨기과학회지

The Psoas hitch procedure is a universal approach for ureteral reimplantation in all diseases of the distal ureter. Digital ureteral defect due to iatrogenic lesion and chronic inflammation such as tuberculosis, congenital ureteral anomalies including complicated reflux in child are the main indications for the Psoas hitch plasty. We performed ureteroneocystostomy with Psoas hitch procedure in l4 patients in recent 3 years. We evaluate the preoperative state. operative technique, postoperative course and follow-up of these cases and report with the review of the articles. The results were as follows: l. Fourteen cases included 7 ureteral injuries by 3 cases of transabdominal hysterectomy and 4 cases of ureterolithotomy, 3 chronic inflammatory stricture ie. tuberculosis, 2 traffic accidents, l bladder CA. in bladder diverticulum, 1 con genital megaureter. 2. Psoas hitch ureteroneocystostomy was done by submucosal tunnel with Psoas hitch in 9, end to side with Psoas hitch in 3, submucosal tunnel with Psoas hitch and Boari flap in 2 cases. 3. There were improvements in all l4 cases without ureterovesical stenosis or VUR. And functional capacity of the bladder has been well preserved. Postoperative complications were UTI in 3 cases.

Ureteroneocystostomy / 대한비뇨기과학회지

Complications of ureteroneocystostomy are relatively rare. Nevertheless, it would be desirable to use and operative approach that would prevent all complications. Based on our experiences with ureteroneocystostomy during the last 5.6 years, the causes, the operative methods and results were discussed. The results were as follows 1. Ureteroneocystostomy was performed in cases of primary reflux( 7 ureters), megaureter (6), ectopic ureter(5), posterior urethral valve(4) and ureterocele(3) as congenital causes. Acquired causes were iatrogenic ( 7 ureters) , tuberculosis(6), bladder ca(3) and traumatic ureteral injury(2) And causes of remained three ureters couldn`t be seeked. 2. Thirty nine of forty six ureters was performed with the method of submucosal tunnel and 7 with end to side. Among them 11 ureters with diffuse ureteral stricture were combined with the method of Vesico-psoas hitch. 3. Thirty five of thirty eight ureters was successfully corrected. Postoperative complications were contracted VUR in 2 cases, ipsilateral VUR, obstruction and unimproved renal function in each one case.

A Clinical Review of the Ureteroneocystostomy / 대한비뇨기과학회지

Primary vesicoureteral reflux, distal ureteral obstruction or stricture and injuries are the main indications for the ureteroneocystostomy There are several operative techniques in ureteroneocystostomy and these should be antireflux to preserve renal function. To prevent the reflux, sufficient submucosal length, minimum ureteral manipulation, adequate butters and making the new orifice near the trigone are stressed. We performed ureteroneocystostomy in 19 patients(20 ureters) in last 10 years. We evaluate the preoperative state, operative technique, postoperative course and follow up of these cases and report with the review of the articles Results were 1. 19 cases included 5 VUR, 6 ureteral injuries by transabdominal hysterectomy, 3 bladder tumors involving ureteral orifices, 2 ureteroceles with obstruction and 3 chronic inflammatory strictures. 2. Ureteroneocystostomy were done by Cohen in 4, Glenn-Anderson in 2, Politano-Leadbetter in 3, Boari-Kuss in 5, Paquin in 2 and fish-mouth in 3 cases 3. Ureteral stent and suprapubic cystostomy were made in all cases but one. Duration of stenting was 4-14 days and cystostomy was 6-14 days. 4. There were improvements in 16 cases, but failed in 2 ureters of reflux cases.

Experimental Ureteroneocystostomy in Dogs: Simple Free end Method and Modified Politano-Leadbetter Method / 대한비뇨기과학회지

Politano-Leadbetter method has been widely used in ureteroneocystostomy these days, we encounter some cases not suitable for this method, For example, in case the ureter was not properly long enough or in the process of making submucosal tunnel vesical mucosa happens to be irregulary dissected due to vesical inflammation, other useful method of vesicoureteral reimplantation is necessary. therefore, instead of making the submucosal tunnel, enough length of the intravesical ureter, which was the most important factor in preventing vesicoureteral reflux, was made protruded into the bladder lumen with free end method and modified Politano-Leadbetter method. these maneuvers well permit value-like flatting or closing of the distal ureteral segment during periods of increased intravesical pressure. We have performed experimental ureteroneocystostomy in 8 dogs, 16 ureters with simple free end method (group 1) and modified Politano-Leadbetter method(group 2)in two groups and two dogs were used as control. The procedure of free end method is a no-tunnel `drop-in` with a long segment protruding into the bladder lumen and that of modified Politano-Leadbetter method is as follows. The intravesical ureter is placed beneath the incised bladder mucosa without submucosal tunnelling and the spatulated distal end of the ureter is sutured with bladder mucosa. In control group ureteroneocystomy was performed by Politano-Leadbetter method. The roentgenographic findings and gross appearance of the kidney and ureter were observed in the 5 weeks after the operation. The anastomosis site was also observed histologically. The results obtained were as follows: 1. No vesicoureteral reflux was found cystographically in both group. 2. Hydronephrosis and obstruction at the anastomosis site were found in one out of 8 ureters in each group by intravenous urography. 3. Renal enlargement and chronic inflammation and fibrosis at the anastomosis site were noted in one out of 8 ureters in each group by gross and microscopical examination. 4. In group 2, modified Politano-Leadbetter method, it was found that the intravesical ureter was covered by regenerated vesical submucosal tissue microscopically. Through this study it is concluded that these two methods are useful to be performed for the ureteroneocystostomy when the submucosal tunnel technique is not suitable.

Urologic Complications in 125 Renal Transplantations and Comparison between Intravesical and Extravesical Uretero Neocystostomy / 대한비뇨기과학회지

We evaluated the complications of intravesical and extravesical ureteroneocystostomy in 125 renal transplantations performed in the Department of Urology, Catholic Medical College between March 1969 and July 1982. The following results were obtained: 1. Of 125 cases of the recipient 105 cases were male and 20 cases were female. 2. Intravesical ureteroneocystostomy was performed by Politano-Leadbetter method in 66 cases and extravesical ureteroneocystostomy by the similar ones reported by MacKinnon in 59 cases. 3. Our incidence of urological complications in the 125 renal transplantations was 9.7% (12 cases). 4. Postoperative complications developed in 11 of the 66 who underwent intravesical ureteroneocystostomy and in 1 of the 59 who underwent extravesical ureteroneocystostomy. 5. The details of the complications were as follows: 6 were ureteral obstruction, 4 ureteral leakage, 1 bleeding from anastomosis site and 1 was urine leakage from anastomosis site. 6. Operative methods for urological complications were ureteroureterostomy in ureteral obstruction 161 and ureteral leakage (3), ureteroneocystostomy in ureteral leakage (1), simple suture in bleeding (1) and urine leakage (1) from anastomosis site. 7. This method of extravesical ureteroneocystostomy in renal transplantation was easy and fast and has a low complication.

Experimental Studies on Extravesical Ureteroneocystostomy in Dogs / 대한비뇨기과학회지

We have performed experimental bilateral extravesical Ureteroneocystostomy in dogs. The technique of procedure was as follows : A longitudinal myotomy incision was made near the bladder dome directed forward the bladder neck for 2cm and then separated to allow the mucosa to pout. A 1 cm incision was then made in the bladder mucosa at the distal end of the detrusor incision. Excess ureter was excised and the ureter spatulated for 1 cm. A 6-0 Prolene suture was then placed at each apex and fullthickness of ureter anastomosed to the bladder mucosa in one layer with a continuous, nonlocking stitch. The myotomy incision was then closed over the ureter with interrupted 4-0 chromic catgut. The surgical wound was closed without drains. The roentgenographic findings and gross findings of the ureter and kidney were observed on the 3 wks after the operation For microscopic observation of the ureteroneocystostomy site were observed. The results are as follows: 1. Retrograde cystographic finding showed on ureterovesical reflux in 6 dogs. 2. Intravenous urographic findings were no hydronephrosis and dye were well drained into the bladder, except 1 dog which showed severe hydronephrosis on right kidney and mild hydronephrosis on left kidney. 3. Gross findings of ureter and kidney revealed no obstruction and renal enlargement, except one dog showed incomplete bilateral obstruction on ureteroneocystostomy site.

A Clinical Observation on Ureteroneocystostomy / 대한비뇨기과학회지

Ureteroneocystostomy may be used in the cases of the vesicoureteral reflux, reteral stricture, ectopic ureteral orifice, ureterovaginal fistula and damage on the lower part of ureter during operation. 0nce ureteroneocystostomy is decided on every effort should be made to perform an antireflux procedure. The results of ureteroneocystostomy have improved consistently during last 20 years, but cases of reflux and postoperative ureterovesical obstruction are still encountered. A clinical study was made on 8 cases who had been performed ureteroneocystostomy at the Department of Urology, Jeonbug National University, Medical School from January 1978 to February 1980. The results were as follows` 1. The age of the patients ranged from 14 to 56 years, most common in fifth decade. The sex ratio was 3:1, with female 6 and male 2. 2. Underlying diseases for ureteroneocystostomy were ureteral stricture, megaloureter, ectopic ureteral orifice and vesicoureteral reflux. 3. 3 Ureters were performed with the method of paquin procedure, 2 ureters with the combination of paquin with Psoas-bladder hitch procedure, one ureter with the combination of Boari flap with Psoas-bladder hitch procedure, one ureter with Politano-Leadbetter procedure and one ureter with Lich procedure 4. Relatively good results of ureteral reimplantation were obtained in distal ureteral stricture, ectopic ureteral orifice and vesicoureteral reflux, except one case of megaloureter in which nephroureterectomy was performed later due to adynamic ureter 5. Complications were followed as persistent pyuria in one case and urine leakage in one case, and nephroureterectomy for adynamic ureter in one case.

Extravesical Ureteroneocystostomy in Renal Transplantation / 대한비뇨기과학회지

10 cases of renal transplantation was performed in Han Yang University from April, 1978 to August, 1978. And we used the technique of extravesical ureteroneocystostomy for anastomosis of transplant ureter to recipient bladder. The ureteral complication was occurred in 1 case, that was ureteral leakage, in all of them.

Clinical Observation of Ureteroneocystostomy on 15 Cases / 대한비뇨기과학회지

Reimplantation of the ureter into the bladder may be necessary in the cases of uretero-vaginal fistula, ureteral stricture, ectopic ureteral orifice and vesico-ureteral reflux. Ureteroneocystostomy was done in 15 patients who were consisted of 9 cases of ureteral stricture, 5 cases of uretero-vaginal fistula, and 1 case of ectopic ureteral orifice respectively. The excellent results following ureteral reimplantation by means of Boari bladder flap operation with psoas-bladder hitch technique in uretero-vaginal fistula and with triangular flap technique were presented here.