Balloon dilation for failed pyeloplasty in children?

ABSTRACT Objective: Pyeloplasty is considered the gold standard treatment for ureteropelvic junction obstruction (UPJO). However, the failure rate of pyeloplasty is as high as 10% and repeat pyeloplasty is more difficult. This study aimed to evaluate the efficacy of balloon dilatation for failed pyeloplasty in children. Materials and Methods: Between 2011 and 2017, 15 patients, aged 6 months to 14 years, were treated with balloon dilation for restenosis of UPJO after a failed pyeloplasty. Ultrasound and intravenous urography were used to evaluate the primary outcome. Success was defined as the relief of symptoms and improvement of hydronephrosis, which was identified by ultrasound at the last follow-up. Results: All patients successfully completed the operation, 13 patients by retrograde approach and 2 patients by antegrade approach. Thirteen patients were followed for a median of 15 (4 to 57) months and 2 patients were lost to follow-up. Resolution of the hydronephrosis was observed in 5 cases. The anteroposterior diameter (APD) of the pelvis decreased by an average of 12.4 ± 14.4mm. Eight patients needed another surgery. The average postoperative hospital stay was 1.78 ± 1.4 days. Two patients experienced fever after balloon dilation. No other complications were found. Conclusions: Balloon dilatation surgery is safe for children, but it is not recommended for failed pyeloplasty in that group of patients, owing to the low success rate.

Divertículo calicial y su diagnóstico incidental / Calyceal diverticulum and its incidental diagnosis

Introducción: El divérticulo calicial se detecta en 0,21 a 0.60 por ciento de los urogramas excretores. Objetivos: Describir una paciente con diagnóstico incidental de esta anomalía y su seguimiento durante 11 años. Presentación del caso: Durante la realización de un urograma excretor para el estudio de una hidronefrosis en una niña de siete años de edad, se detectó un divertículo calicial en el riñón contralateral y después de 11 años de seguimiento ultrasonográfico no se ha demostrado modificación ni complicación del divertículo. Conclusiones: El divertículo calicial es una anomalía congénita que puede mantenerse sin complicaciones durante años por lo que debe tratarse conservadoramente(AU)

ABSTRACT Introduction: Calyceal diverticulum is detected in 0,21 percent to 0.60 percent of excretory urogram. Objectives: To describe a patient with an incidental diagnosis of this anomaly and her follow up during 11 years. Case presentation: During the performance of an excretory urogram for studying a hydronefrosis in a seven years old girl, a calyceal diverticulum was detected in the contralateral kidney; and after 11 years of ultrasonographic follow-up there has been no modifications or complication related with the diverticulum. Conclusions: Calycial diverticulum is a congenital anomaly that can last years without presenting complications. That is why it must be treated conservatively(AU)

Is a contrast study really necessary prior to ureteroscopy?

This study aimed to evaluate the effect of preoperative imaging techniques on the success and complication rates of ureteroscopy. We performed a retrospective analysis of 736 patients (455 males and 281 females), with a mean age of 45.5±15.2 years (range, 1-88 years), who underwent rigid ureteroscopic procedures for removal of ureteral stones. Patients were divided into 4 groups according to the type of imaging modality used: group I, intravenous urography (n=116); group II, computed tomography (n=381); group III, computed tomography and intravenous urography (n=91), and group IV, ultrasonography and abdominal plain film (n=148). Patients’ demographics, stone size and location, prior shock wave lithotripsy, lithotripsy technique, operation time, success rate, and rate of intraoperative complications were compared among the groups. There were no significant differences in success and complication rates among the groups. The stone-free rate after primary ureteroscopy was 87.1% in group I, 88.2% in group II, 96.7% in group III, and 89.9% in group IV (P=0.093). The overall incidence of intraoperative complications was 11.8%. According to the modified Satava classification system, 6.1% of patients had grade 1, 5.1% had grade 2, and 0.54% had grade 3 complications. Intraoperative complications developed in 12.1% of patients in group I, 12.6% of patients in group II, 7.7% of patients in group III, and 12.2% of patients in group IV (P=0.625). Our findings clearly demonstrate that ureteroscopic treatment of ureteral stones can be safely and effectively performed with no use of contrast study imaging, except in doubtful cases of anatomical abnormalities.

Right sided double inferior vena cava with obstructed retrocaval ureter: Managed with single incision multiple port laparoscopic technique using "Santosh Postgraduate Institute tacking ureteric fixation technique"

Right double inferior vena cava with obstructed retrocaval ureter is an extremely rare anomaly with only a few reported cases in the literature. To the best of our knowledge, this is the first case report describing ureteric repair by use of a single-incision laparoscopic technique. In addition, this report addresses the underlying surgical challenges of this repair and provides a brief review of the embryology of this anomaly. The "Santosh Postgraduate Institute ureteric tacking fixation technique" provides ease of end-to-end uretero-ureteric anastomosis in a single-incision laparoscopic surgery.

Urothelial carcinoma in a pyelocaliceal diverticulum discovered by magnetic resonance urography

Neither computed tomography (CT) nor intravenous pyelography (IVP) alone can diagnose tumors of renal pelvic diverticula, but magnetic resonance urography (MRU) can obtain accurate preoperative information.

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.

Signo radiológico: el lirio caído / Radiology sign: the drooping lily

Abstract: the drooping lily sign, also known as wilting flower, corresponds to an imaginological alteration reported over 40 years ago. Initially described in excretory urography, it represents the appearance of the inferior ureteropelvic renal system with a duplicated collecting system, in which the renal pelvis is horizontal and calices are discreetly directed towards caudal. Despite the current limited use of excretory urography, the drooping lily sign remains valid and of diagnostic use in voiding cystourethrograms (VCUG) (also micturating cystourethrogram (MCUG)), computed tomography urography (CTU) and magnetic resonance urography (MRU).

El signo del lirio caído (drooping lily en la literatura anglosajona), también llamado "flor marchita", corresponde a una alteración imaginológica reportada hace más de 40 años. Inicialmente descrito en pielografía de eliminación, representa el aspecto que adquiere el sistema pieloureteral inferior de un riñón con doble sistema excretor, dado por una pelvis renal de orientación horizontal y cálices que se dirigen discretamente hacia caudal. A pesar de la escasa utilización de la pielografía de eliminación en la actualidad, el signo de lirio caído sigue vigente y resulta de utilidad diagnóstica en uretrocistografía miccional, urografía por tomografía computarizada (UroTC) y urografía por resonancia magnética (UroRM).

Necrosis papilar renal: el diagnóstico de un clásico en la era de la tomografía multidetector / Renal papillary necrosis: the diagnosis of a classic in the era of the multislice computed tomography

La necrosis papilar renal es una condición originada por múltiples factores, con consecuencias variadas incluyendo dentro de ellas el desarrollo de insuficiencia renal terminal y eventualmente la muerte. Su presentación en la pielografía de eliminación demuestra múltiples patrones de excavación papilar, que están muy bien descritos en la literatura clásica. Con el advenimiento de la urografía por tomografía computada multicorte, estos hallazgos han sido refinados, agregándose también nuevos signos, que incluyen, entre otros, la detección de cambios medulares precoces que podrían implicar, en un futuro cercano, un significativo cambio en la evolución y pronóstico de estos pacientes. En esta publicación hacemos una revisión y puesta al día de los aspectos imaginológicos de la necrosis papilar renal.

Renal papillary necrosis is a multifactorial entitiy that encompasses a wide range of consecuences, including end-stage renal impairment or even death. Its appearance on intravenous pyelography pictures reveals multiple patterns of papillary excavation, fairly well defined in traditional literature. With the advent of multislice computed tomography urography these findings have been refined and new radiological signs such as detection of early renal medullary changes, among others, have been added. The application of this imaging modality may translate into significant short-term improvements in the evolution and prognosis of these patients. This paper is intended to provide both a reviewing and an updating of renal papillary necrosis imaging issues.

Papel del 99mTc-DMSA en el diagnóstico de pielonefritis aguda en niños con infección del tracto urinario: a propósito de 114 casos / Role of 99mTc-DMSA in the diagnosis of acute pyelonephritis in children with urinary tract infection: based on 114 cases

Objetivo: Evaluar la utilidad de la gammagrafía renal con 99mTc-DMSA en el diagnóstico de pielonefritis aguda en niños con infección del tracto urinario (ITU), en comparación con la urografía intravenosa (UIV), ecografía renal y cistouretrografía miccional seriada (CUMS). Material y métodos: Se han estudiado 114 niños con sospecha de ITU, en su primer episodio. La técnica isotópica ha consistido en la administración de 2-4 mCi ( 74-148 MBq) de 99mTc-DMSA, obteniéndose imágenes posterior y oblicuas posterior derecha e izquierda con colimador “pinhole”; y anterior y posterior con colimador “plano”a las 2-4 horas. Resultados: La sensibilidad y la especificidad de la gammagrafía renal con 99mTc-DMSA fue del 90 por ciento y 95 por ciento respectivamente. En la ecografía renal fueron del 52 por ciento y 86 por ciento. En la CUMS del 30 por ciento y 90 por ciento. Y en la UIV del 30 por ciento y del 91 por ciento. Estos resultados muestran que la gammagrafía renal con 99mTc-DMSA presentó mejor sensibilidad y especificidad que UIV, ecografía renal y CUMS en el diagnóstico de pielonefritis en niños con ITU. Conclusión: Consideramos la gammagrafía renal con 99mTc-DMSA, como el método inicial de evaluación de ITU, presentando mejor sensibilidad y especificidad que UIV, ecografía renal y CUMS.

Objective: To evaluate the usefullness of the renal scintigraphy with 99mTc-DMSA in the diagnosis of acute pyelonephritis in children with urinay tract infection (UTI), in comparison with intravenous urography (IVU), renal ultrasonography and voiding cystourethrogram. Material and Methods: One hundred and fourteen children with suspected UTI in the first episody. The isotopic technique consisted of administration 2-4 mCi ( 74-148 MBq) 99mTc-DMSA i.v. obtaining posterior and left and right posterior obliques views with pinhole collimator; and posterior and anterior views with parallel hole collimator, after 2-4 hours. Results: The overall sensitivity and specificity for the renal scintigraphy with 99mTc-DMSA was 90 percent and 95 percent respectively. In renal ultrasonography was 52 percent and 86 percent respectively. In voiding cystourethrogram was 30 percent and 90 percent respectively. And in IVU was 30 percent and 91 percent respectively. Conclusion: We consider renal scintigraphy with 99mTc-DMSA, the first method in the evaluation of UTI, with better sensitivity and specificity than renal ultrasonography, voiding cystourethrogram and IVU.

Uro - resonancia en niños / Uro - resonance in children

Ultrasound and nuclear medicine appear to be the modalities of choice when dealing with the imaging study of the urinary system in infants. In children, a CT sean does not have the impact it has had on adults, since pediatric patients present with different pathologies and also because of the peculiar physiological conditions of childhood. The Uro-resonance has emerged as a powerful and useful diagnostic tool, bringing together in a single study anatomical images and functional information as well without the use of ionizing radiation. We review the technical aspeets, anatomical and physiological concepts of the study, while providing examples of current applications in the infant.

El estudio por imágenes del sistema urinario del niño ha estado a cargo del ultrasonido y la medicina nuclear. En el niño, la tomografía computada no tiene el impacto que ha tenido en adultos, por tratarse de patologías diferentes y por las condiciones fisiológicas propias de la edad pediátrica. La Uro-resonancia se proyecta como una herramienta útil, reuniendo en un solo estudio imágenes anatómicas e información funcional, en ausencia de radiación ionizante. Se revisan aspectos de la técnica, conceptos anatómicos y fisiológicos del estudio, adicionando ejemplos de aplicaciones en el niño.

Urografía por tomografía computada multicorte (UroTAC): estudio descriptivo utilizando la técnica de split bolus / Multislice CT urography (Uro-CT): a descriptive study using split bolus technique

Multislice computed tomography provides high spatial and temporal resolution images in addition to high quality multiplanar and three-dimensional reconstructions. As a result of this diagnostic efficacy, the Computed Tomography Urography (Uro-CT) has become the technique of choice for evaluating the urinary tract, virtually replacing the traditional urography examination. At Padre Hurtado Hospital, Santiago, Chile, we conducted a retrospective analysis to review our experience with Uro-CT scanning and split bolus technique, which has the potential to yield a synchronous nephrographic and excretory phase of the urinary system, thus reducing radiation dose for patients, number of images and costs generated by MDCT urography. A series of 31 cases is presented, along with description of techniques applied as well as study main findings.

La tomografía computada multicorte permite obtener imágenes de alta resolución espacial y temporal además de reconstrucciones multiplananes y tridimensionales de gran calidad, lo que ha hecho que la Urografía por Tomografía Computada (UroTAC) se convierta en la técnica de elección para la evaluación del tracto urinario, reemplazando prácticamente a la urografía tradicional. En el Hospital Padre Hurtado, revisamos nuestra experiencia con UroTAC y técnica de "split bolus" que permite obtener simultáneamente una fase nefrográfica y excretora del sistema urinario mediante una sola adquisición, lo que disminuye la dosis de radiación al paciente, el número de imágenes y los costos de la UroTAC estándar. Presentamos una serie de 31 pacientes estudiados, describiendo la técnica y los principales hallazgos obtenidos en ellos.

Calidad de la imagen radiográfica abdominal en píelo grafía intravenosa / Quality of the image abdominal radiográfica in tweets him intravenous graph

La pielografía intravenosa es considerada como una pieza importante en el abordaje de la patología del tracto urinario. Su precisión diagnóstica depende en parte, de la calidad de la imagen radiográfica, motivo por el cual ésta debe evaluarse con el fin de favorecer un diagnóstico seguro y confiable, con valores de dosis de radiación razonables para el paciente.Con tal propósito se realizó un estudio descriptivo, retrospectivo, transversal en el Departamento de Radiología del Hospital Dr. Roberto Calderón G., sobre el cumplimiento de los criterios de calidad de la imagen radiográfica del abdomen para pielografía intravenosa, llevado a cabo durante l período de Julio a Diciembre del año 2007. Se tomó una muestra de 65 estudios que cumplieron los criterios de inclusión, realizando lectura de las radiografías con un índice muy bueno de confiabilidadintraobservador de 0.85, e interobservador de 0.82.Se encontró que los criterios de posicionamiento y los referidos a la información diagnóstica de las proyecciones de abdomen cumplen con los requisitos básicos de calidad de imagen para su interpretación dentro de parámetros aceptables, permiten la identificación de detalles necesarios que posibiliten una adecuada interpretación de las patologías presentes. Sin embargo, la radiación recibida porel paciente posiblemente sea mayor a los parámetros de referencia. Laaceptabilidad de nuestros estudios está dentro de límites adecuados...

Late presentation of posterior urethral valve: two case reports / Apresentação tardia de válvula de uretra posterior: relato de dois casos

CONTEXT: Posterior urethral valve (PUV) is a widely known condition affecting males that generally presents prenatally or at birth. PUVs have also been occasionally described in literature in cases diagnosed during adolescence or adulthood. CASE REPORT: This report presents two late PUV cases, one in a teenager and the other in an adult. Both cases had had clinical signs of urinary tract infection and obstructive urinary symptoms. The diagnoses were made by means of voiding cystourethrography and urethrocystoscopy. Endoscopic valve fulguration was the treatment chosen for both. Their follow-up was uneventful.

CONTEXTO: Válvula de uretra posterior (VUP) é uma conhecida malformação congênita urinária, geralmente diagnosticada em exames ultra-sonográficos pré-natais ou ao nascimento. Raramente, esta doença pode ser encontrada em adolescentes e em adultos. RELATO DE CASOS: Este artigo mostra dois casos de VUP, encontrados em um adolescente e em um adulto. Ambos apresentavam sinais clínicos de infecção do trato urinário e sintomas obstrutivos infravesicais. Os diagnósticos foram realizados por uretrocistografia miccional e uretrocistoscopia. Fulguração endoscópica das válvulas foi o tratamento de escolha para ambos os casos. O acompanhamento demonstrou melhora importante dos sintomas após o tratamento.

Results of renewed glenn-anderson technique in reimplantation of refluxing or obstructed lower end ureter [25 patients]

The aim of this study is to analyze the efficacy and outcome of distal tunnel ureteral reimplantation in refluxing and obstructed lower end ureter. The present study included 25 patients[17 males and 8 females], selected from Al-Azhar University Hospital [New Damietta], at the period between April 2005 and April 2007, Glenn-Anderson advancement [distal tunnel] ureteral reimplantation was performed in 10 patients with refluxing ureter [8 patients with secondary reflux and 2 patients with primary reflux], and 15 patients with obstructed lower end ureters. The success rate At 3 months improvement was observed in 20 cases [80, 0%] while at 9 months success rate was 88% and at 18 months success rate was 92%, The results of the present work revealed that the Glenn-Anderson technique [intravesical ureteral reimplantation] is a suitable and excellent for treatment of both refluxing or obstructed lower end ureter [stricture] whatever the cause

Extravesical ureteral reimplantation in stricture lower end ureter

Ureteral stricture is a problem that always has confronted the surgeons. Traditionally, stricture occurs most often in the ureter injured at operation and repair of the stricture has been accomplished by open surgical management. The aim of the work was to evaluate the extravesical ureteral reimplantation in stricture lower end ureter. The study was carried out on 11 patients [8 males and 3 females] with stricture lower end ureter, selected from Al-Azhar University Hospital [New Damietta] between April 2005 to April 2007. All cases were submitted to full history taking, clinical examination and laboratory investigations [urine analysis, blood urea and serum creatinine]. Imaging studies in the form of abdominopelvic ultrasound and excretory urography both pre and postoperatively. In addition to ascending cystography postoperatively at 3, 9 and 18 months. Post operative follow up by Ultrasound revealed improvement in 8 patients out of 10 with pervious moderate hydronephrosis while 2 patients show stabilization. In one patient with severe hydronephrosis shows stabilization without further deterioration. Using excretory urography followup, 6 patients of grade II hydronephrosis and 4 patients of grade III hydronephrosis showed improvement while in one patient with grade IV hydronephrosis remained stabilized. Hospital stay ranged from 5 to 6 days. The results of the present study demonstrated that extravesical ureteral reimplantation is a reliable procedure with a low complication rate, and we have found that this approach is applicable to many different situations but is especially advantageous for ureteral tailoring and the vesical psoas hitch since retrovesical exposure is excellent

Shock wave lithotripsy for lower calyceal stone

To evaluate the effect of SWL, anatomical influence on fragmentation and stone clearance. The success of Shock Wave Lithotripsy [SWL] arises from effective fragmentation and stone clearance. One hundred patients [65 males and 35 females] with lower calyceal stones treated with SWL were enrolled in the study and analyzed retrospectively, at Al-Azhar Lithotripsy Unit, Al-Hussein University Hospital. Stone was single in 90 patient and multiple in 10 patients. Regarding stone radiodensity, the stones were hyper dense in 35 patients, dense in 50 patients and radiolucent in 15 patients. Those patients were divided into two groups, Group I includes 60 patients, they were considered to be completely stone free 6 months after SWL, and forty patients were having residual stones in Group II. The mean size of stones in group I was 0.9cm in diameter, while in group II the mean size was 1.7cm. The PC angle, diameter of lower calyx infudibulum and lower pole calyceal pattern were determined from intravenous urography. Residual stones were found in 100% of patients with PC angle<90°, in 100% of patients with an infundibular diameter<4mm, and in 100% of patients with complex lower calyceal pattern. From the presenting results the PC angle, lower calyx infundibular diameter and anatomy of lower pole calyx SWL for lower calyceal stones

Ultrasound guided percutaneous nephrolithotomy [PCNL] in the prone position, novel technique

Because PCNL is frequently difficult and time consuming relatively high radiation doses may be absorbed by the surgeon and other members of the interventional team in addition to the patient. A novel technique ultrasound guided percutaneous nephrolithotomy in the prone position with no radiation risk on patients, doctors and medical personnel has been tried. Twenty nine patients underwent Ultrasound guided percutaneous nephrolithotomy [PCNL] in the prone position between January 2001 and January 2007, 18 males and 11 females their ages ranged between 15 and 71 years [mean age 42.9 +/- 14.2 years]. Only in 13 patients stone was single and in 3 patients it was recurrent. All patients fulfill our inclusion criteria. The whole procedure was performed under ultrasound guidance in the operating room by urologists. No imaging or exposure to radiation has occurred during all steps of the operation. We used Nephromax balloon dilator 10 cm length; deflated 10 CH; inflated 30 CR [Nephromax; Boston Scientific, Natick, MA]. Twenty six patients were stone free[86.6%]. Auxiliary procedures were needed in 3 patients only, ureteroscopy and double J in one patient to treat leakage of urine on closure of nephrostomy tube, and ESWL in two patient for small non targeted stones. one failure due to Slippage of the system outside kidney. our complications were treated conservatively which include minimal pelvic perforation in 3 patients, minimal perirenal extravasations in one patient, pain in 14 patients, fever in 3 patients and urinary tract infection in patients. Ultrasound guided percutaneous nephrolithotomy in the prone position is safe and easy to learn technique with no radiation risk on patients, doctors and medical personnel. It is advisable to replace standard PCNL especially in radiolucent stones. Nephromax balloon is an easy, one step, with minimal bleeding, rapid tract dilator and minimal complications compared with other modalities