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.

Relationship Between Uncommon Computed Tomography Findings and Clinical Aspects in Patients With Acute Pyelonephritis

PURPOSE: Computed tomography (CT) has become popular in the diagnosis of acute pyelonephritis (APN) and its related complications in adults. The aim of this study was to investigate the relationship between uncommon CT findings and clinical and laboratory data in patients with APN. MATERIALS AND METHODS: From July 2009 to July 2012, CT findings and clinical data were collected from 125 female patients with APN. The six uncommon CT findings (excluding a wedge-shaped area of hypoperfusion in the renal parenchyma) studied were perirenal fat infiltration, ureteral wall edema, renal abscess formation, pelvic ascites, periportal edema, and renal scarring. The clinical parameters analyzed were the age and body mass index of the patients as well as the degree and duration of fever. Laboratory parameters related to inflammation and infection included white blood cell count, C-reactive protein (CRP) level, erythrocyte sedimentation rate, pyuria, and bacteriuria. RESULTS: The most common CT finding was perirenal fat infiltration (69 cases, 55%). A longer duration of fever, higher CRP level, and grade of pyuria were related with perirenal fat infiltration (p=0.010, p=0.003, and p=0.049, respectively). The CRP level was significantly higher in patients with renal abscess and ureteral wall edema (p=0.005 and p=0.015, respectively). CONCLUSIONS: The uncommon CT findings that were related to aggravated clinical and laboratory parameters of APN patients were perirenal fat infiltration, ureteral wall edema, and renal abscess formation. The inflammatory reaction and tissue destruction may be more aggressive in patients with these CT findings.

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.

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

Effectiveness of endoscopic and open surgical management in benign ureteral strictures

OBJECTIVE: To assess the effectiveness of different treatment modalities for benign ureteric strictures. SETTING: Department of Urology, Al-Emiri Hospital, Kuwait. PATIENTS AND METHODS: Twenty four cases [19 unilateral and 5 bilateral] of ureteral strictures were reviewed. Retrograde endoscopic dilatation was tried, initially for all of the strictures. Technical failure was observed in 8/29 [27.5%] strictures. Three of them were negotiated through antegrade endoscopic dilatation, while in 5 of the strictures open surgical repair was required. Both the balloon and fascial dilator were used for endoscopic dilatation; ureteroneocystostomy with or without Boari's bladder flap were the procedures employed for open repair. Of the 29 strictures the majority were secondary to Bilharzial cystitis [66.6%]. Twenty-four [82.7%] strictures underwent endoscopic manipulation and 5 [17.2%] had open repair. Among the 24 strictures that had endoscopic dilatation, 21 [87.5%] were managed in retrograde fashion while in 3 [12.5%] technical failures were due to the inability to canulate the strictured ureter with a guide wire in retrograde fashion. All these patients were treated successfully by antegrade stenting. Among 24 strictures that were initially managed with dilatation and stenting, recurrence was found in 9 [37.5%] patients. The group had open repair, no recurrence was found during the follow up. There was no serious intraoperative or postoperative complications of both the procedures. Patients were followed up with intravenous urography. Endoscopic dilatation is an effective treatment modality for partial benign ureteric strictures. However, open ureteroneocystostomy with or without Boari's flap or Psoas hitch should be reserved for complete or recurrent ureteric strictures. Bilharzial strictures are amenable to endoscopic dilation but recurrence rate is high and re-implantation is frequently required

Ileal interposition for the treatment of a long gap ureteral loss.

We retrospectively reviewed 10 patients (7 males and 3 females) who were treated with ileal interposition for long gap ureteral loss between 1989-1995. The mean patient age was 42 years old (35-52), mean ureteral gap was 18 cms (10-25). The etiology of ureteral loss included: 4 retroperitoneal fibrosis, 2 recurrent stone, 2 after pancreatitis and its complication and 2 after ureteral injury. The mean follow-up was 4 years (2-7). The post operative course was uneventful with no immediate and long term complications detected and there was no metabolic problem. Only asymptomatic bacteriuria in 5 cases (50%) was noted but it was not clinically significant.

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

Ruptura espontánea de la vía urinaria superior. A propósito de un caso / Spontaneous rupture of the upper urinary tract. Report of one case

Se presenta un caso de ruptura espontánea del uréter que clínicamente se manifestó con dolor abdominal intenso y en el que se encontró infección urinaria por Klebsiella. Se revisan los posibles factores causales, el diagónstico clínico y el tratamiento

Ureteral injuries: a complication of hysterectomy

Ureteric injury is an important complication following hysterecotomy which a General surgeon or Urologist is called upon to deal with. A prospective study of nine such patients referred to the authors for management is presented. The mean age of patients was 36 years. Commonest [66.7%] presentation was postoperative anuria, the rest [33.3%] presented with urinary fistulae. All these injuries followed either elective abdominal or caesarian hysterectomies. Majority [89%] of these were operated by relatively junior gynaecologists. All these patients were operated upon. In five patients who had suture entrapment of both ureters, delegation with or without stenting was done. In four patient ureteroneocystostomy was done for ureteric transection. All patients were cured and discharged from the hospital with a mean stay of 11 days

Tratamiento quirúrgico actual del megauréter / Current surgical treatment of megaurether

Presentamos una modificación a la técnica de Hedren para el tratamiento del magauréter. Realizamos ureteroplastía con reinplante vesicoureteral en 12 uréteres de siete pacientes. Los criterios para realizar la ureteroplastia fueron: 1) pacientes con historia de infeccioón de vías urinarias y deterioro de la función renal; 2) Imposibilidad de alcanzar una relación de 4:1 entre la luz ureteral y la longitud del túnel submucoso. Las diferencias con respecto a la técnica de Hendren son: a) no respetamos la irrigación medial del uréter; b) disecamos al uréter más allá de los vasos hipogástrico; c) hacemos énfasis especial en la disección de la adventicia; d) reinplantamos al uréter con la técnica de Cohen. Todos los pacientes mejoraron en la función renal, hubo disminución en la dilatación ureteral, ausencia de infecciones de vías urinarias y reflujo vesiculoureteral. No se han presentado otras complicaciones.

Actinomicosis uterina causante de ureterohidronefrosis: reporte de un caso / Uterine actinomycosis causing hydroureteronephrosis: report of a case

Se realiza un recuento de las causas en la actinomicosis, su modo de trasmisión, período de incubación, diagnóstico y tratamiento de la misma. Se destaca la rareza de la afección, con la aparición de algunos órganos infectados. Presentamos un infrecuente caso de actinomicosis uterina confundida en el diagnóstico con una litiasis ureteral radiotransparente

Ureteral involvement in stage I xanthogranulomatous pyelonephritis--(a case report).

A case of xanthogranulomatous pyelonephritis (Stage-I: Nephric) with ureteral involvement is described. The patient had undergone right nephrectomy with the working diagnosis of calculus pyonephrosis and non-functioning kidney. Histopathological examination of the nephrectomy specimen revealed xanthogranulomatous pyelonephritis confined to the kidney and non-contiguous involvement of ureter. Post-operative recovery was uneventful and there had been no evidence of disease recurrence till one year's follow-up.

Corrección de fistula ureterovaginal post-histerectomia: reporte de un caso / Correction of post-hysterectomy ureterovaginal fistula: report of a case

Una mujer de 44 años fue admitida en el Departamento de Ginecología del Hospital Gíneco-Obstétrico Isidro Ayora, presentando cuadro de Leiomioma abortivo pediculado. La paciente fue sometida a una histerectomía abdominal extrafacial total. Después de 22 días de la cirugía presentó una fístula uretero-vaginal derecha, la cual fue reparada más tarde por la técnica de Boary-Ockerbland, 8 semanas después de extirpado el útero; se obtuvo excelentes resultados