Duplicidad no ectópica del uréter: implicancias clínicas / Non-ectopic duplicity of the ureter: clinical implications

La duplicación del sistema colector renal es la variación más frecuente del sistema urinário y se puede presentar como duplicación completa o incompleta, así como la inserción ectópica en todas las partes del sistema urinario a partir de la parte distal hacia la vejiga. Este artículo presenta uma duplicación completa no ectópica del ureter en el riñón izquierdo de un cadáver de un individuo brasileño, de sexo masculino. Ambos uréteres tenían origen en el hilio renal y continuaban hasta la vejiga urinaria separadamente, desembocando en ostios diferentes, en el área del trígono vesical, donde el ostio perteneciente al uréter que drenaba el polo superior presentó posición distal y lateral en relación al ostio del uréter que drenaba el polo inferior. Esta disposición es uma excepción a la regla de Weigert-Meyer, que indica que el uréter del polo superior, por el hecho de permanecer fijo por más tiempo al conducto mesonéfrico, presenta mayor migración, terminando medial e inferiormente al uréter que drena el polo inferior en 97 % de los casos.

Duplication of the urinary tract is the most frequent variation of this system and may present as complete or incomplete duplication, as well as ectopic insertion throughout all parts of the urinary system from distal to the bladder. This article presents a complete non-ectopic duplication of the ureter in the left kidney of a cadaver of one Brazilian individual of male sex. In this study, both ureters originated in the renal hilum and continued to the urinary bladder separately, opening into different ostia, in the area of the bladder trigone, where the ostium belonging to the ureter that draining the upper pole presented a distal and lateral position in relation to the ostium of the ureter draining the lower pole. This arrangement is an exception to the Weigert-Meyer rule, which indicates that the ureter of the upper pole, due to its longer fixation to the mesonephric duct, presents a greater migration, ending medial and inferior to the ureter draining the inferior pole in 97 % of cases.

Intraureteral and intravenous indocyanine green to facilitate robotic partial nephroureterectomy in a patient with complete ureteral triplication

A patient with a complete right ureteral triplication presented with recurrent pyelonephritis and flank pain that was refractory to medical management. Evaluation showed that the atrophic upper-most renal moiety had been chronically obstructed and was associated with a dilated ureter. Intraureteral and intravenous indocyanine green (ICG) were used as real-time contrast agents intraoperatively to facilitate right robotic partial nephroureterectomy of the diseased system. Intraureteral ICG was used to accurately distinguish the pathologic ureter and associated renal pelvis from its normal counterparts. Intravenous ICG was used to assess perfusion in the right kidney and delineate the margins of diseased renal parenchyma.

Vaginal ectopic ureter diagnosed by magnetic resonance imaging in a child with complete transverse vaginal septum and hydrocolpos

Ectopic ureter draining into the vagina is a rare cause of urinary incontinence. Some cases have been reported in association with malformations of the genitourinary tract, but very few published cases are associated with vaginal septum. Our article describes the case of a girl who presented with hydrocolpos shortly after birth and was found to have a complete transverse vaginal septum. Despite successful correction of this genital anomaly, the patient developed persistent dribbling of clear fluid from the genital area. Extensive testing revealed unilateral kidney dysplasia and probable genital ectopia of the corresponding ureter. Magnetic resonance imaging (MRI) showed insertion of the ureter into the upper third of the vagina. The patient underwent nephroureterectomy of the dysplastic kidney with subsequent improvement in urinary incontinence. Ureteral ectopia is difficult to diagnose with conventional imaging methods (plain radiography, ultrasound, and CT). MRI has proved to be an excellent method for assessment of genitourinary tract conditions, particularly when other diagnostic modalities have failed or are limited, due to the high resolution of MRI scans and the possibility of native image acquisition on all three orthogonal planes. MRI is the best diagnostic modality for visualization of the course and insertion of ectopic ureters, and enables precise surgical correction.

Management of an Iatrogenic Injury in a Crossed Ectopic Kidney Without Fusion

Crossed renal ectopia is a condition in which a kidney is located on the side opposite of its ureteral insertion. Ninety percent of crossed ectopic kidneys are fused to their ipsilateral uncrossed renal unit. Crossed renal ectopia without fusion is rare, with only 62 patients reported in the literature to date. These kidneys may suffer iatrogenic injury during an unrelated surgical intervention. The injury, unless self-limiting, may necessitate the removal of the ectopic kidney. We present a unique case of a dual injury, renal as well as ureteric, in a crossed ectopic kidney without fusion that was successfully managed without surgical excision.

Study of the ureter structure in anencephalic fetuses

Purpose The objective of this paper is to analyze the structure of the ureter in normal and anencephalic human fetuses. Materials and Methods We studied 16 ureters from 8 human fetuses without congenital anomalies aged 16 to 27 weeks post-conception (WPC) and 14 ureters from 7 anencephalic fetuses aged 19 to 33 WPC. The ureters were dissected and embedded in paraffin, from which 5 µm thick sections were obtained and stained with Masson trichrome, to quantify smooth muscle cells (SMC) and to determine the ureteral lumen area, thickness and ureteral diameter. The samples were also stained with Weigert Resorcin Fucsin (to study elastic fibers) and Picro-Sirius Red with polarization and immunohistochemistry analysis of the collagen type III fibers to study collagen. Stereological analysis of collagen, elastic system fibers and SMC were performed on the sections. Data were expressed as volumetric density (Vv-%). The images were captured with an Olympus BX51 microscope and Olympus DP70 camera. The stereological analysis was done using the Image Pro and Image J programs. For biochemical analysis, samples were fixed in acetone, and collagen concentrations were expressed as micrograms of hydroxyproline per mg of dry tissue. Means were statistically compared using the unpaired t-test (p < 0.05). Results The ureteral epithelium was well preserved in the anencephalic and control groups. We did not observe differences in the transitional epithelium in the anencephalic and control groups. There was no difference in elastic fibers and total collagen distribution in normal and anencephalic fetuses. SMC concentration did not differ significantly (p = 0.1215) in the anencephalic and control group. The ureteral lumen area (p = 0.0047), diameter (p = 0.0024) and thickness (p = 0.0144) were significantly smaller in anencephalic fetuses. Conclusions Fetuses with anencephaly showed smaller diameter, area and thickness. These differences could indicate ...

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).

case of dupable duple duplicity and duplexity

Duplication anomalies are quite common with ureteral duplication anomalies being the most frequent. Despite the relatively frequent incidence of a horseshoe kidney and duplication anomalies in any individual patient, the combination of horseshoe kidney and bilateral ureteric duplication is a very rare entity and very few cases have been reported to date. We present a case of a patient with novel combination of horse shoe kidney and congenital renal anomalies and their sequelae

Ectopia ureteral unilateral congênita em uma cadela Teckel Dachshund com pelagem arlequim: relato de caso / Single congenital ureteral ectopy in a female dog Teckel Dachshund with merle colour pattern: case report

O presente relato apresenta a primeira descrição de ectopia ureteral congênita na raça Teckel Dachshund, diagnosticada em uma cadela com pelagem arlequim. O animal, aos dois meses de idade, apresentava sinais de incontinência urinária e cistite bacteriana, sendo submetido a um plano diagnóstico para confirmação de ureter ectópico. A urografia excretora revelou hidroureter direito com desembocadura caudal ao trígono da bexiga. O exame físico do animal evidenciou ainda hérnia inguinal bilateral, o que reforçou a caracterização da origem congênita das alterações. Aspectos de bem-estar animal são também discutidos.

The present work reports the first description of congenital ureteral ectopy in the canine breed Teckel Dachshund, diagnosed in a female dog with merle colour pattern. The two month old animal, presented with continuous dribbling of urine and bacterial cystitis, was subjected to a diagnostic plan for ectopic ureter. The excretory urography showed a right hidroureter, which had an orifice located caudally to the trigone of the bladder. The animal also presented a bilateral inguinal hernia, which confirmed the case description as a multiple congenital anomaly condition. Animal welfare aspects are also discussed.

Laparoscopic ureteropyeloanastomosis in the treatment of duplex system

PURPOSE: Duplex system is one of the most common anomalies of upper urinary tract. Anatomical and clinical presentation determine its treatment. Usually, the upper moiety has a poor function and requires resection, but when it is not significantly impaired, preservation is recommended. Laparoscopic reconstruction with upper pole preservation is presented as an alternative treatment. MATERIALS AND METHODS: Four female patients with duplex system, one presenting with recurrent urinary tract infection and the others with urinary incontinence associated to infrasphincteric ectopic ureter, were treated. Surgical procedure envolved a laparoscopic ureteropyeloanastomosis of the upper pole ureter to the pelvis of the lower moiety, with prior insertion of a double J stent. RESULTS: Surgical time varied from 120 to 150 minutes, with minimal blood loss in all cases. Follow-up varied from 15 to 30 months, with resolution of the clinical symptoms and preservation of the upper moiety function. CONCLUSION: Laparoscopic ureteropyeloanatomosis is a feasible and safe minimally invasive option in the treatment of duplex system.

Rim em ferradura com cistos e ureter único: relato de caso / Horseshoe kidney with cysts and a single ureter: a case report

O rim em ferradura é a mais comum de todas as anomalias de fusão, ocorrendo em aproximadamente 0,25 por cento da população geral. O rim em ferradura com ureter único é uma rara anomalia. Um paciente do sexo masculino de 60 anos foi admitido para investigação rotineira de triagem. Sua história familiar era negativa para doenças renais e o exame físico foi considerado normal. A tomografia computadorizada revelou um rim em ferradura atípico com cistos e a reconstrução tridimensional na tomografia computadorizada mostrou a presença de um único ureter. O paciente encontra-se assintomático após dois anos de seguimento. Apresentamos um raro caso de paciente portador de rim em ferradura com cistos e ureter único diagnosticado incidentalmente.

Horseshoe kidney is the most common of all renal fusion anomalies, occurring in approximately 0.25 percent of the general population. Horseshoe kidney with only a single ureter is a rare anomaly. A 60-year-old man was admitted to hospital for routine health screening. His family history was negative for kidney diseases, and there was no abnormality in his physical examination. A computed tomography (CT) scan revealed an atypical horseshoe kidney with cysts and three-dimensional spiral CT reconstruction showed the presence of a single ureter. The patient has since been followed up for two years without any signs of clinical disease. We report a rare case of a patient with a horseshoe kidney with cysts and a single ureter that was diagnosed incidentally.

Circumcaval ureter with a synchronous ipsilateral transitional cell carcinoma of the upper urinary tract and the urinary bladder

We report a case of concomitant ureteral transitional cell carcinoma [TCC] developed in a circumcaval ureter associated to an invasive bladder cancer. Diagnosis was made by intravenous urography [IVU] and contrast-enhanced computed tomography [CT] scanner which showed a typical [J] shaped deformity in the dilated proximal ureteric segment with moderate right hydronephrosis and pelvic filling defect associated to bladder filling defect due to a bladder tumor. The patient underwent a radical cystoprostatectomy and nephroureterectomy; no recurrence was detected after a 12 months period of follow-up

Malformaciones de las vías urinarias en un recién nacido: revisión bibliográfica / Malformations of the urinary tract in newborns: bibliographic review

Ante un caso de insuficiencia renal en un recién nacido de 21 días se hallaron en la ecografía imágenes de ectasia renal bilateral, quistes renales, megauréter bilateral y probable ectopia de los mismos.

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.

Pure robotic retrocaval ureter repair

PURPOSE: To demonstrate the feasibility of pure robotic retrocaval ureter repair. MATERIALS AND METHODS: A 33 year old female presented with right loin pain and obstruction on intravenous urography with the classical "fish-hook" appearance. She was counseled on the various methods of repair and elected to have a robot assisted repair. The following steps are performed during a pure robotic retrocaval ureter repair. The patient is placed in a modified flank position, pneumoperitoneum created and ports inserted. The colon is mobilized to expose the retroperitoneal structures: inferior vena cava, right gonadal vein, right ureter, and duodenum. The renal pelvis and ureter are mobilized and the renal pelvis transected. The ureter is transposed anterior to the inferior vena cava and a pyelopyelostomy is performed over a JJ stent. RESULTS: This patient was discharged on postoperative day 3. The catheter and drain tube were removed on day 1. Her JJ stent was removed at 6 weeks postoperatively. The postoperative intravenous urography at 3 months confirmed normal drainage of contrast medium. CONCLUSION: Pure robotic retrocaval ureter is a feasible procedure; however, there does not appear to be any great advantage over pure laparoscopy, apart from the ergonomic ease for the surgeon as well the simpler intracorporeal suturing.

Primary Mucinous Adenocarcinoma of a Seminal Vesicle Cyst Associated with Ectopic Ureter and Ipsilateral Renal Agenesis: a Case Report

Primary adenocarcinoma of the seminal vesicles is a rare neoplasm. Congenital seminal vesicle cysts are commonly associated with unilateral renal agenesis or dysgenesis. To the best of our knowledge, mucinous adenocarcinoma of the seminal vesicle cyst that's associated with an ectopic ureter opening into the seminal vesicle and ipsilateral renal agenesis has not been described in the radiological literature. We report here on the radiological findings of a primary adenocarcinoma of a seminal vesicle cyst in this condition.

Potter's syndrome: a report of 5 cases.

Bilateral renal agenesis or Potter's Syndrome is an extremely rare congenital anomaly associated with oligohydramnios. The infants die off pulmonary hypoplasia. We herewith report five cases of Potter's Syndrome over a span of one year.