Attenuation of partial unilateral ureteral obstruction - induced renal damage with hyperbaric oxygen therapy in a rat model

ABSTRACT Objective: The objective of the present study was to evaluate the effectiveness of HBO therapy on biochemical parameters, renal morphology and renal scintigraphy in rats undergoing chronic unilateral partial ureteral obstruction (UPUO). Material and methods: Thirty-five rats were divided into five equal groups: Control group; Sham group; HBO group; UPUO group and UPUO/HBO group. The effects of HBO therapy were examined using biochemical parameters and histopathological changes. After calculating the score for each histopathological change, the total histopathological score was obtained by adding all the scores. In addition, dynamic renal scintigraphy findings were evaluated. Results: Serum parameters indicating inflammation, serum tumor necrosis factor- alpha, ischemia modified-albumin, IMA/albumin ratio and Pentraxin-3 levels, were observed to be high in the UPUO group and low in the UPUO/HBO treatment group. Similarly, in the treatment group, the reduction in malondialdehyde, total oxidant status and oxidative stress index levels and increase in total antioxidant capacity values were observed to be statistically significant compared to the UPUO group (p<0.001, p=0.007, p<0.001, p=0.001, respectively). The total score and apoptosis index significantly decreased after administration of HBO treatment. Dynamic 99mTc-MAG3 renal scintigraphy also showed convincing evidence regarding the protective nature of HBO against kidney injury. In the UPUO/HBO therapy group, the percentage contribution of each operated kidney increased significantly compared to the UPUO group (41.73% versus 32.72%). Conclusion: The findings of this study indicate that HBO therapy had a reno-protective effect by reducing inflammation and oxidative stress, and preserving renal function after renal tissue damage due to induction of UPUO.

The burden of chronic ureteral stenting in cervical cancer survivors

ABSTRACT Purpose Ureteral obstruction in cervical cancer occurs in up to 11% of patients, many of whom undergo ureteral stenting. Our aim was to describe the patient burden of chronic ureteral stenting in a population-based cohort by detailing two objectives: (1) the frequency of repeat procedures for ureteral obstruction; and, (2) the frequency of urinary adverse effects (UAEs) (e.g., lower urinary tract symptoms, flank pain). Materials and Methods From SEER-Medicare, we identified 202 women who underwent ureteral stent placement prior to or following cervical cancer treatment. The frequency of repeat procedures and rate ratios were compared between treatment modalities. The rates and rate ratios of UAEs were compared between our primary cohort (stent + cervical cancer) and the following groups: no stent + cervical cancer, stent + no cancer, and no stent + no cancer. The “no cancer” group was drawn from the 5% Medicare sample. Results 117/202 women (58%) underwent >1 stent procedure. The frequency of additional procedures was significantly higher in patients who received radiation as part of their treatment. UAEs were very common in women with stent + cancer. The rate of UTI was 190 (per 100 person-years), 67 for LUTS, 42 for stones, and 6 for flank pain. These rates were 3-10 fold higher than in the no stent + no cancer control group; rates were also higher than in the no stent + cancer and the stent + no cancer women. Conclusions The burden of disease associated with ureteral stents is higher than expected and urologists should be actively involved in stent management, screening for associated symptoms and offering definitive reconstruction when appropriate.

Efficacy of Tamsulosin, Oxybutynin, and their combination in the control of double-j stent-related lower urinary tract symptoms

ABSTRACT Introduction and objective Indwelling double J ureteral stents are used routinely in the resolution of ureteral obstruction caused by different etiologies. Evaluation of urinary symptoms related to double-J stent, indicate that these affect 73-90% of patients. We conducted a prospective, randomized study, to evaluate the efficacy of tamsulosin, oxybutinin and combination therapy in improving the urinary symptoms. Methods Patients who underwent ureteral stent placement after ureterolithotripsy (total 51), were randomized into three groups: Group I: Tamsulosin 0.4 mg. once per day(17 patients), Group II: Oxybutinin 5 mg. once per day (17 patients), Group III: Tamsulosin+ oxybutynin once per day (17 patients). All the groups received the drugs for three weeks and completed a Spanish validated Ureteral Stent Symptom Questionnaire (USSQ) at day 7 and 21. Results Repeated measures ANOVA showed mean urinary symptom index score was 22.3 vs. 15.5 in group three (p<0.001) at day 7 and 21 respectively. The mean work performance index was 6.6 vs 8.1 (p=0.049) favoring tamsulosin group, the mean sexual score was 0.5 vs 1.5 (p=0.03). Among additional problems the mean was 7.2 vs 6.2 (p=0.03). No significant difference was noted among pain and general health index. No side effects were reported. Conclusions Combination therapy with tamsulosin and oxybutynin improved irritative symptoms and work performance as well as sexual matters. Combination therapy should be considered for patients who complained of stent related symptoms.

Tratamiento endoscópico de estenosis ureteral en paciente con trasplante renal / Endoscopic management of ureteral stenosis in a transplanted kidney

Las complicaciones post trasplante han disminuido gracias a la mejor inmunosupresión y las técnicas quirúrgicas más desarrolladas, pese a ello, la estenosis de la unión ureterovesical se mantiene como una frecuente causa de morbilidad (2 por ciento al 10 por ciento), representando el 70 por ciento de las complicaciones urológicas. El tratamiento mínimamente invasivo endourológico es una opción válida con muy buenos resultados e índices bajos de complicaciones. Presentamos un caso clínico de estenosis ureteral en un paciente trasplantado y describimos su resolución a través de una técnica endourológica anterógrada.

Secondary to a better immunosuppression and surgical techniques post-transplant complications have decreased, however the ureterovesical junction stricture remains a frequent cause of morbidity (2 to 10 percent), representing the 70 percent of urologic complications. The minimally invasive endourological treatment is an alternative treatment with very good results and low complications rates. We present a case of neovesical junction stricture in a transplant patient and describe its resolution through an anterógrada endourological technique.

Evaluation of emergency extracorporeal shock wave lithotripsy for obstructing ureteral stones

PURPOSE: To assess the efficacy of extracorporeal shockwave lithotripsy (ESWL) for ureteral calculi during acute renal colic. MATERIALS AND METHODS: From January 2002 to March 2007, 108 patients were treated by ESWL for obstructing ureteral stones causing acute renal colic. ESWL was performed within 24 hours of the onset of renal colic. RESULTS: The mean age of the patients was 39.5 years (11-72 years). Male/female ratio was 85/23. Mean stone size was 8.45 mm (4-20 mm). They were located in the pelvic (n = 53), iliac (n = 28) or lumbar (n = 27) region. Fragmentation after a single session was complete in 56 patients (52 percent), incomplete in 28 (26 percent), and absent in 24 (22 percent). Patients presenting incomplete fragmentation underwent a second (n = 28) or even a third session (n = 11). Of the 24 patients in whom ESWL had no impact on the stone, 21 underwent ureteroscopy, and in one case open ureterolithotomy for a patient with a hard 17 mm stone, while spontaneous passage occurred in two patients with small stones. CONCLUSION: Emergency ESWL for obstructing ureteral stones has a satisfactory success rate and very low morbidity. The stone-free rate of retreating ureteral calculi with ESWL decreases significantly after failed initial treatment. Stone size may be the main predictive factor for retreatment. We suggest that no more than 3 treatments should be given for a particular stone due to minimal improvement in the subsequent cumulative treatment success rate.

Obstructive uropathy in childhood : a Review

Background: Obstructive uropathy is any affection of the urinary tract characterized by impairment of urine flow through the tract and which; if left untreated; will cause progressive renal damage.Aim: To present an update on obstructive uropathy in children with emphasis on the situation in Nigeria.Methods: Contemporary information on the management of obstructive uropathy was obtained by searching the Medline and adding information from the authors' experience.Results: Obstructive uropathy causes renal impairment in all age groups. The causes in children may be congenital or acquired. The congenital causes include pelvi-ureteric junction obstructions; posterior urethral valves (PUV); urethral atresia; phimosis and meatal stenosis. Associated anomalies include imperforate anus and ver tebral malformations. Acquired causes include calculi; post-traumatic and post-inflammatory strictures and meatal stenosis. Some specific manifestationsare prune-belly syndrome; hydronephrosis and renal failure. Diagnostic investigations include ultrasonog raphy; intravenous urog raphy; cystography and renography. Recent technological advances have impacted on the treatment of the different lesions. These include in utero vesico- amniotic shunt and endoscopic valve ablation for PUV and minimally invasive techniques for urolithiasis. Nephrectomy may be indicated in a unilateral damaged kidney. Not all lesions require treatment. Criteria to select patients for treatment require definition. Occasionally treatment fails because of pretreatment irreversible renal damage. The resulting end-stage renal failure is an indication for renal transplantation.Conclusion: Obstructive uropathy is an important cause of renal impairment. Contemporary advances in the management are yet to become available in developing countries. Compromise treatment options therefore prevail. Adequate treatment is essential to prevent end-stage renal failure

Management of complete ureteral obstructions with a transluminal puncture technique

INTRODUCTION: The traditional delayed treatment of iatrogenic complete ureteral obstruction is open surgery. An easy endourological technique, transluminal re-canalization of the ureter by guide-wire puncture under fluoro-endoscopic control, which has been performed on 4 patients, is described. SURGICAL TECHNIQUE: With the guidance of C-arm fluoroscopy, by moving the C-arm to different planes, the tip of the ureteroscope is directed to the correct plane to meet the obliterated proximal end of the ureter and under direct vision, transluminal puncture is performed using the stiff end of a 0.035-inch guide wire. Once the stiff end of the guide-wire is in the lumen of the proximal ureter, an ureteral catheter is introduced over the guide wire, the guide wire is then removed and reinserted through the ureteral catheter with its soft end leading and a double J catheter is inserted. Ureteral stricture, if later encountered, is treated with balloon dilatation. RESULTS: Continuity of the ureter was restored in all 4 patients. The double J stents were removed 6 weeks later and a retrograde pyelography revealed resolution of the hydronephrosis without extravasation of urine. CONCLUSION: Although a very satisfactory result was achieved in our cases, more cases are needed to show if it can be an alternative to conventional surgical repair. However, we believe that this minimally invasive technique can be used for short obliterated ureteral segments and neither delays nor does it preclude further management using open surgery.

Abordagem da obstrução de junção ureteropélvica identificada na investigação de hidronefrose fetal: [revisão] / Obstruction of ureteropelvic junction identified by an investigation of fetal hydronephrosis: [review]

Obstrução da junção ureteropélvica é a mais freqüente causa de hidronefrose detectada através da ultra-sonografia fetal. Antes da década de 80 a grande maioria dos casos era diagnosticada em crianças maiores geralmente sintomáticas, com dor abdominal e infecção urinária. Atualmente, a maioria dos casos de aparente obstrução da junção ureteropélvica é detectada na investigação de hidronefrose fetal em lactentes quase sempre assintomáticos. O objetivo dessa revisão é avaliar os aspectos relacionados a etiopatogênese e ao tratamento da obstrução da junção ureteropélvica. Foram revistos os principais estudos clínicos que compararam a abordagem conservadora com a cirúrgica. Essa compilação mostrou que a abordagem conservadora é segura para a maioria dos neonatos assintomáticos com obstrução de junção pieloureteral unilateral e a abordagem cirúrgica deve ser reservada para os casos que apresentem dano ao parênquima renal.

Ureteropelvic junction obstruction is the most frequent cause of prenatally detected fetal hydronephrosis. Before the eighties, most cases were detected in children with symptoms such as abdominal pain and urinary tract infection. Today, most cases of apparent ureteropelvic junction obstruction are identified by investigation of fetal hydronephrosis in asymptomatic infants. The aim of this review is to evaluate the aspects related with the pathogenesis and the approach of the ureteropelvic junction obstruction. The main clinical studies that compared conservative and surgical treatments were compiled. The review shows that the conservative approach is safe for asymptomatic neonates and the surgical procedure should be reserved for cases with damaged renal parenchvma.

Handling 405 cases of ureteric obstruction

This is a retrospective study of 405 cases of adult patients with ureteric obstruction. The aim of the study was to categorize these cases according to the cause of obstruction and its treatment. The medical records of patients with ureteric obstruction were reviewed with regard to the causes of obstruction and how it was treated from January 1995 until June 1995. The causes of obstruction were ureteric stones in 381 cases, a large proportion of the cases [319 patients] were treated by Extra Corporeal Shock Wave Lithotripsy [ESWL]. In 12 cases the cause of obstruction was pelvic tumors, and they were treated by stenting. In 6 other cases ureteric stricture was the cause. In 3 cases the cause of obstruction was retroperitoneal fibrosis, 2 of these cases responded to steroid therapy with stenting.post pelvic surgery, and accidental ureteric ligation caused the obstruction in 3 other cases. Conclusions: Calculus disease is still the most common cause of ureteric obstruction. Extra Corporeal Shock Wave Lithotripsy [ESWL] has been performed successfully in 83% of cases without adjunct modalities. External drainage by percutaneous nephrostomy [PCN] is undoubtedly the most effective form of treating renal obstruction in emergencies

Obstruçäo urinária aguda / Acute urinary tract obstruction

Os autores abordam os aspectos clínicos mais relevantes para o diagnóstico e tratamento da obstruçäo urinária aguda, tanto do trato urinário superior, quanto do inferior. O tema é desenvolvido com base nas causas etiológicas mais freqüentes, bem como nas condutas atuais específicas para a soluçäo de urgência. Além da revisäo sucinta da literatura säo expostas orientaçöes decorrentes da experiência acumulada pela equipe nos últimos 30 anos

Tratamiento radiológico-endoscópico de la obstrucción de la unión pieloureteral / Radiologic-endoscopic treatment of the pieloureteral union

El presente trabajo es el primer reporte sobre el uso del catéter Acucise en Venezuela. 6 pacientes con obstrucción del tracto urinario superior, (obstrucción de la unión pieloureteral), fueron tratados mediante incisiones internas con el catéter acucise. El tiempo operatorio promedio fue de 48 minutos y el período promedio fue de 48 minutos y el período promedio de hospitalización fue de 2 días. Se utilizó anestesia peridual en todos los casos. El seguimiento promedio fue de 12 meses. Las evaluaciones postoperatorios se realizaron en base a mejoría clínica, urogramas excretores y renogramas isotópicos. Se obtuvieron resultados exitosos en el 83 por ciento de los casos (mejoría clínica y radiológica). Esta experiencia preliminar, aunque limitada, permite concluir que el tratamiento de la obstrucción del tracto urinario superior con el catéter Acusive es efectivo y seguro, pudiendo convertirse en una alternativa menos invasiva que la endopielotomía endoscópica.

Ureteric stent: the outcome of long term drainage

A report of four patients with long term ureteric double-J stents is presented. The indications for stenting and the complications are discussed. After five months, all of the stents caused problems and they did not adequately drain the kidneys. It is recommended that long term ureteric stents should be changed every four months to prevent fragmentation of the stents and also to prevent hydronephrosis

Diagnóstico de insuficiencia renal aguda / Diagnosis of acute renal failure

La insuficiencia renal aguda es una disminución o el cese brusco de la excreción de los productos finales del metabolismo que normalmente son eliminados por el riñón y las consecuencias que esto acarrea en la homeostasis de los líquidos orgánicos. Generalmente se acompaña de oliguria o anuria. Clásicamente se divide en causas prerrenales, cuando es consecutiva a un estado de hipoperfusión renal y que es rápidamente reversible al mejorar el estado hemodinámico del paciente; causas post-renales cuando es consecutiva a obstrucción del flujo urinario y que también es reversible al eliminar dicha obstrución, y causas renales cuando se establece una lesión en el parénquima renal propiamente dicho, (éstas pueden ser glomerulares). El diagnóstico sindromático temprano y e esclarecimiento de la etiopatología son muy imporantes, tanto para el tratamiento oportuno como para el pronóstico.

Estenosis ureteropiélica en niños: experiencia de 100 casos operados / Ureteropielic stenosis in children: Experience of 100 report cases

Se presentan 100 casos (87 pacientes) de estenosis uretopiélitica tratados quirúrgicamente en el Instituto Nacional de Pediatría entre los años de 1973-1986; un total de 87 casos fueron corregidos con éxito en la primera cirugía; 4 más en la segunda y otros dos en una tercera intervención con procedimientos más especializados y siete pacientes fueron nefrectomizados de primera intención por atrofia renal. Se comentan los puntos más importantes del diagnóstico clínico, de laboratorio y gabinete, así como un análisis de los resultados y tratamiento quirúrgico.

El empleo del cateter uretral doble-pigtail en complicaciones urológicas / The use of double pigtail ureteral catheter in urological complications

Los autores presentan su experiencia de 55 pacientes con complicaciones urológicas tratadas con el cateter ureteral doble pigtail. Las indicaciones para el empleo de este cateter fueron: la obstrucción ureteral por metástasis retroperitoneales, en cirugía ureteral compleja y en fístula de la vía urinaria alta. En general esta técnica endourológica no se asocia a complicaciones y ayuda al Urólogo a ser menos invasivo y mas conservador