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1.
BMJ Case Rep ; 17(7)2024 Jul 04.
Artículo en Inglés | MEDLINE | ID: mdl-38964876

RESUMEN

This case report describes a male in his late 40s with a 4 cm pelvic mass compressing the left distal ureter, resulting in left hydroureteronephrosis. Biopsy of the mass was suggestive of a solitary fibrous tumour. The patient underwent a robotic-assisted laparoscopic excision of the left pelvic mass. Intraoperatively, the mass was found to be densely adhered to the ureter, necessitating a left distal ureterectomy and ureteric reimplantation. Subsequent histopathological analysis revealed the mass was a solitary fibrous tumour with no evidence of malignancy.


Asunto(s)
Laparoscopía , Procedimientos Quirúrgicos Robotizados , Tumores Fibrosos Solitarios , Uréter , Obstrucción Ureteral , Humanos , Masculino , Procedimientos Quirúrgicos Robotizados/métodos , Tumores Fibrosos Solitarios/cirugía , Tumores Fibrosos Solitarios/complicaciones , Tumores Fibrosos Solitarios/patología , Tumores Fibrosos Solitarios/diagnóstico por imagen , Laparoscopía/métodos , Uréter/cirugía , Obstrucción Ureteral/cirugía , Obstrucción Ureteral/etiología , Adulto , Neoplasias Pélvicas/cirugía , Neoplasias Pélvicas/complicaciones , Neoplasias Pélvicas/patología , Hidronefrosis/etiología , Hidronefrosis/cirugía
2.
Ned Tijdschr Geneeskd ; 1682024 Jun 05.
Artículo en Holandés | MEDLINE | ID: mdl-38888409

RESUMEN

A 38-year-old woman with urosepsis and persistent unilateral hydronephrosis after antibiotic treatment. Antegrade pyelogram shows urine flow obstruction to the bladder. The whole ureter shows multiple small smooth-walled round lucent filling defects projecting into the lumen. The diagnosis ureteritis cystica was made.


Asunto(s)
Hidronefrosis , Humanos , Femenino , Hidronefrosis/etiología , Hidronefrosis/diagnóstico , Adulto , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/complicaciones , Infecciones Urinarias/tratamiento farmacológico , Antibacterianos/uso terapéutico , Enfermedades Ureterales/diagnóstico , Enfermedades Ureterales/complicaciones
4.
BMJ Case Rep ; 17(6)2024 Jun 27.
Artículo en Inglés | MEDLINE | ID: mdl-38937265

RESUMEN

Giant bladder is a rare condition with varied definitions and causes. It can lead to complications such as urinary tract infections, retrograde urine reflux, pyelonephritis, renal damage and occasionally vascular obstruction. In this case report, we present a man in his 70s with massive urinary retention >7 L and severe bilateral hydronephrosis. The patient underwent a successful Greenlight photovaporisation of the prostate to address underlying bladder outlet obstruction. The surgical procedure resulted in significant improvement in urinary function, enabling the patient to live catheter and infection free, and without renal damage. This case demonstrates that bladder outlet surgery can be useful in selected cases of giant bladder to avoid complications of chronic catheterisation or ongoing retention.


Asunto(s)
Obstrucción del Cuello de la Vejiga Urinaria , Retención Urinaria , Humanos , Masculino , Obstrucción del Cuello de la Vejiga Urinaria/cirugía , Obstrucción del Cuello de la Vejiga Urinaria/etiología , Retención Urinaria/etiología , Anciano , Vejiga Urinaria/cirugía , Vejiga Urinaria/diagnóstico por imagen , Hidronefrosis/etiología , Hidronefrosis/cirugía , Micción/fisiología , Recuperación de la Función , Prostatectomía/efectos adversos , Prostatectomía/métodos , Resultado del Tratamiento
5.
Pediatr Surg Int ; 40(1): 133, 2024 May 16.
Artículo en Inglés | MEDLINE | ID: mdl-38753201

RESUMEN

BACKGROUND/OBJECTIVE: Differentiation of uretero-pelvic junction obstruction (UPJO) from non-obstructive dilatation (NOD) is a major challenge. The aim of this retrospective study is to determine whether pyeloplasty prediction score (PPS) could predict the need for surgery and resolution after surgery. METHODS: Among patients with antenatally diagnosed hydronephrosis, those who were stable during post-natal follow-up were considered NOD. The UPJO group were the ones who worsened and underwent pyeloplasty based on conventional indications. All patients with UPJO underwent laparoscopic dismembered pyeloplasty. PPS was determined based on three ultrasound parameters obtained retrospectively: Society of Fetal Urology (SFU) grade of hydronephrosis, transverse anteroposterior (APD), and the absolute percentage difference of ipsilateral and contralateral renal lengths. RESULTS: Among 137 patients included (R:L = 59:73; M:F 102:35), 96 were conservatively managed (NOD), while 41 patients (29%) needed pyeloplasty (UPJO). Mean PPS was 4.2 (1.2) in the NOD group and it was significantly higher at 10.8 (1.63) in the UPJO group (p = 0.001). All patients with PPS > 8 needed a pyeloplasty, while two patients with PPS of 7 needed pyeloplasty due to drop in renal function. PPS cutoff value of >8 had a sensitivity 95%, specificity 100% and a likelihood ratio of 20. Post-pyeloplasty PPS resolution was proportional to the duration of follow-up. CONCLUSIONS: A PPS cutoff value of 8 or above is associated with the presence of significant UPJO. PPS is also useful in the assessment of hydronephrosis recovery post-pyeloplasty. The limitation of PPS: it can only be applied in the presence of contralateral normal kidney.


Asunto(s)
Hidronefrosis , Pelvis Renal , Ultrasonografía , Obstrucción Ureteral , Humanos , Estudios Retrospectivos , Obstrucción Ureteral/cirugía , Obstrucción Ureteral/diagnóstico por imagen , Femenino , Masculino , Hidronefrosis/cirugía , Hidronefrosis/diagnóstico por imagen , Pelvis Renal/cirugía , Pelvis Renal/diagnóstico por imagen , Ultrasonografía/métodos , Lactante , Procedimientos Quirúrgicos Urológicos/métodos , Recién Nacido , Resultado del Tratamiento , Laparoscopía/métodos
6.
Investig Clin Urol ; 65(3): 293-299, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38714520

RESUMEN

PURPOSE: Urinary biomarkers are known to be able to diagnose renal damage caused by obstruction at an early stage. We evaluated the usefulness of urine N-acetyl-beta-D-glucosaminidase (NAG) to determine the prognosis of antenatal hydronephrosis. MATERIALS AND METHODS: From January 2019 to December 2021, a retrospective study was performed on patients with grade 3 or 4 hydronephrosis. We analyzed the ultrasonographic findings and the urinary NAG/Cr ratio between the laparoscopic pyeloplasty (LP) group and active surveillance (AS) group. RESULTS: A total of 21 children underwent LP for ureteropelvic junction (UPJ) obstruction and 14 children underwent AS. The mean age at the time of examination was 3.7 months (1.7-7.5 months) in the LP and 5.2 months (0.5-21.5 months) in the AS (p=0.564). The mean anteroposterior pelvic diameter was 30.0 mm (15.0-49.0 mm) in the LP and 16.7 mm (9.0-31.3 mm) in the AS (p=0.003). The mean renal parenchymal thickness was 2.6 mm (1.2-3.7 mm) in the LP and 3.8 mm (2.9-5.5 mm) in the AS (p=0.017). The urinary NAG/Cr ratio was 26.1 IU/g (9.8-47.4 IU/g) in the LP and 11.1 IU/g (2.6-18.1 IU/g) in the AS (p=0.003). After LP, the urinary NAG/Cr ratio was significantly reduced to 10.4 IU/g (3.4-14.2 IU/g) (p=0.023). CONCLUSIONS: The urinary NAG/Cr ratio, one of the biomarkers of acute renal injury, is closely related to the degree of hydronephrosis. Therefore, it may be useful to determine whether to perform surgery on the UPJ obstruction and to predict the prognosis.


Asunto(s)
Acetilglucosaminidasa , Biomarcadores , Hidronefrosis , Humanos , Acetilglucosaminidasa/orina , Hidronefrosis/orina , Hidronefrosis/diagnóstico por imagen , Hidronefrosis/etiología , Estudios Retrospectivos , Pronóstico , Lactante , Femenino , Masculino , Biomarcadores/orina , Valor Predictivo de las Pruebas , Obstrucción Ureteral/orina , Obstrucción Ureteral/diagnóstico por imagen , Obstrucción Ureteral/complicaciones , Obstrucción Ureteral/cirugía
7.
Anticancer Res ; 44(5): 1947-1954, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38677755

RESUMEN

BACKGROUND/AIM: Recent studies have reported conflicting findings regarding the significance of hydronephrosis (HN) in muscle-invasive bladder cancer (MIBC). The molecular characteristics of MIBC with HN are unclear, therefore, we aimed to address the gaps in previous research and elucidate HN's molecular significance in patients with MIBC. MATERIALS AND METHODS: Clinical, genetic, and imaging information on bladder cancer patients enrolled in The Cancer Genome Atlas were obtained from public databases to analyze the association between the presence of hydronephrosis and genetic alterations and molecular subtyping. A total of 108 patients who underwent total cystectomy for MIBC at the Hiroshima University Hospital were enrolled in the study to verify the association between HN and renal function with patient prognosis. RESULTS: We observed a statistically significant difference in the distribution of molecular subtypes (p=0.0146). The proportion of patients with the luminal papillary subtype was approximately twice as high in patients with HN (48.8%) than in those without HN (25.0%). The mutation frequency of fibroblast growth factor receptor (FGFR) 3 was approximately three-fold higher in patients with HN (20.9%) than in those without HN (7.1%). Multivariate analysis, which considered HN and estimated glomerular filtration rate as confounding factors in our MIBC cohort, revealed that reduced renal function, but not HN, was an independent predictor for overall survival. CONCLUSION: MIBC presenting HN exhibits a high frequency of mutations in the FGFR3 gene. In addition, not HN itself, but reduced renal function due to HN may worsen the prognosis for MIBC.


Asunto(s)
Hidronefrosis , Receptor Tipo 3 de Factor de Crecimiento de Fibroblastos , Neoplasias de la Vejiga Urinaria , Femenino , Humanos , Masculino , Cistectomía , Hidronefrosis/genética , Hidronefrosis/etiología , Mutación , Invasividad Neoplásica , Pronóstico , Receptor Tipo 3 de Factor de Crecimiento de Fibroblastos/genética , Neoplasias de la Vejiga Urinaria/genética , Neoplasias de la Vejiga Urinaria/patología
8.
Asian J Endosc Surg ; 17(2): e13307, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38561598

RESUMEN

INTRODUCTION: This study was performed to evaluate the differences in the perioperative results, renal function, and incidence of hydronephrosis over time between the use of Bricker anastomosis and Wallace anastomosis for robot-assisted intracorporeal ileal conduit urinary diversion (RICIC). METHODS: Fifty-five patients who underwent RICIC at two institutions were evaluated (Bricker, n = 23; Wallace, n = 32). We investigated changes in estimated glomerular filtration rate and hydronephrosis before surgery and at 3, 6, and 12 months after surgery. RESULTS: The patients in the Bricker group were significantly older than those in the Wallace group. The urinary diversion time was significantly longer in the Bricker group. No significant difference in postoperative renal function was observed. Additionally, no significant difference was observed in the incidence of postoperative hydronephrosis. However, the incidence of right hydronephrosis tended to be high overall, especially in the Wallace group. No patients in either group required repair surgery or ureteral stent placement. CONCLUSIONS: In patients undergoing RICIC, there was no difference in postoperative renal function or the incidence of hydronephrosis between Wallace and Bricker anastomosis. Symptomatic hydronephrosis was not observed in either group. The present study showed that each method was equally effective and safe.


Asunto(s)
Hidronefrosis , Robótica , Neoplasias de la Vejiga Urinaria , Derivación Urinaria , Humanos , Íleon/cirugía , Derivación Urinaria/métodos , Cistectomía/métodos , Hidronefrosis/cirugía , Anastomosis Quirúrgica/métodos , Neoplasias de la Vejiga Urinaria/cirugía
9.
World J Urol ; 42(1): 234, 2024 Apr 13.
Artículo en Inglés | MEDLINE | ID: mdl-38613692

RESUMEN

PURPOSE: We aimed to accurately determine ureteral stricture (US) rates following urolithiasis treatments and their related risk factors. METHODS: We conducted a systematic review and meta-analysis following the PRISMA guidelines using databases from inception to November 2023. Studies were deemed eligible for analysis if they included ≥ 18 years old patients with urinary lithiasis (Patients) who were subjected to endoscopic treatment (Intervention) with ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), or shock wave lithotripsy (SWL) (Comparator) to assess the incidence of US (Outcome) in prospective and retrospective studies (Study design). RESULTS: A total of 43 studies were included. The pooled US rate was 1.3% post-SWL and 2.1% post-PCNL. The pooled rate of US post-URS was 1.9% but raised to 2.7% considering the last five years' studies and 4.9% if the stone was impacted. Moreover, the pooled US rate differed if follow-ups were under or over six months. Patients with proximal ureteral stone, preoperative hydronephrosis, intraoperative ureteral perforation, and impacted stones showed higher US risk post-endoscopic intervention with odds ratio of 1.6 (P = 0.05), 2.6 (P = 0.009), 7.1 (P < 0.001), and 7.47 (P = 0.003), respectively. CONCLUSIONS: The overall US rate ranges from 0.3 to 4.9%, with an increasing trend in the last few years. It is influenced by type of treatment, stone location and impaction, preoperative hydronephrosis and intraoperative perforation. Future standardized reporting and prospective and more extended follow-up studies might contribute to a better understanding of US risks related to calculi treatment.


Asunto(s)
Hidronefrosis , Cálculos Ureterales , Urolitiasis , Humanos , Adolescente , Constricción Patológica , Estudios Prospectivos , Estudios Retrospectivos , Urolitiasis/cirugía , Ureteroscopía/efectos adversos , Cálculos Ureterales/cirugía
10.
Clin Imaging ; 109: 110138, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38579501

RESUMEN

PURPOSE: The purpose of this study is to characterize the prevalence and behavior of hydronephrosis of non-refluxing lower moiety of duplex kidneys using MAG-3 diuresis renography. We compare our data to previous case series and ureteropelvic junction obstruction of single systems. MATERIALS AND METHODS: An IRB-approved database of over 5000 diuresis renograms performed in 2025 patients was queried to identify cases of hydronephrosis of lower moiety of duplex kidneys suspicious for ureteropelvic obstruction, excluding those with hydroureter or reflux. Kidney function and post-furosemide drainage parameters on initial and follow-up diuresis renograms were recorded. Medical records and patient outcomes were reviewed. RESULTS: In total, 19 renal units were identified in 18 patients (11 male, 7 female), age range 0.5 months to 17.8 years, including one patient with bilateral lower moiety hydronephrosis. Initial diuresis renograms in 12 asymptomatic patients (13 renal units) with antenatal hydronephrosis demonstrated varying drainage patterns from normal to obstructed. Follow-up studies showed worsening drainage in 3 patients, who all underwent surgery. Drainage improved in 4 patients and remained unchanged in 5 patients (6 renal units). Of the 6 patients presenting with Dietl's crisis, 5 showed obstructive drainage on initial diuresis renogram, 2/5 with decreased function. All 5 obstructed patients underwent surgery. CONCLUSION: Hydronephrosis of the lower moiety of a duplex system is rare and behaves similarly to single systems. The majority are diagnosed antenatally, display a dynamic nature, and may present with acute obstruction. Diuresis renography is a valuable tool in its evaluation and management.


Asunto(s)
Hidronefrosis , Obstrucción Ureteral , Humanos , Masculino , Femenino , Embarazo , Recién Nacido , Renografía por Radioisótopo , Diuresis , Riñón/diagnóstico por imagen , Hidronefrosis/diagnóstico por imagen , Hidronefrosis/cirugía , Furosemida , Obstrucción Ureteral/diagnóstico por imagen
11.
J Urol ; 212(1): 196-204, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38603645

RESUMEN

PURPOSE: We describe long-term outcomes, including UTIs and need for reimplantation, after ureterovesicostomy (UV) as a lasting surgical procedure for children with primary obstructive megaureter (POM). MATERIALS AND METHODS: Children referred to our institution between 2016 and 2023 who underwent refluxing UV were analyzed. POM was defined as hydroureteronephrosis with distal ureteral dilatation > 7 mm and a negative workup for other etiologies of hydronephrosis. We assessed for surgical outcomes, complications, rate of UTI, and improvement in upper tract dilatation. Statistical analyses assessed for change in hydronephrosis metrics over follow-up. RESULTS: Among 183 patients diagnosed with POM, 47 (24%) underwent UV. Median age of presentation, surgery, and follow-up was 2, 9, and 43 months, respectively. A total of 7 patients developed 30-day complications: Clavien-Dindo grade 1 in 2 (transient urinary retention) and grade 2 in 5 (UTIs). During monitoring 14 (30%) developed UTIs and 7 (15%) required ureteral reimplant or UV takedown. After surgery there was a significant decrease in the proportion of patients with high-grade hydronephrosis, anteroposterior renal pelvis diameter, and maximum ureteral dilatation. CONCLUSIONS: Refluxing UV is a safe alternative to cutaneous diversion in POM. Most patients had improvement in upper tract dilatation with an acceptable short-term complication rate and need for reoperation (in comparison to routine later reimplantation). Our experience suggests that monitoring alone after UV is feasible, and that selective subsequent reconstruction is a reasonable strategy.


Asunto(s)
Uréter , Obstrucción Ureteral , Humanos , Masculino , Femenino , Obstrucción Ureteral/cirugía , Obstrucción Ureteral/etiología , Preescolar , Lactante , Estudios de Seguimiento , Estudios Retrospectivos , Uréter/cirugía , Uréter/anomalías , Uréter/diagnóstico por imagen , Resultado del Tratamiento , Derivación Urinaria/métodos , Derivación Urinaria/efectos adversos , Reflujo Vesicoureteral/cirugía , Reflujo Vesicoureteral/etiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Hidronefrosis/etiología , Hidronefrosis/cirugía , Reimplantación/métodos , Reimplantación/efectos adversos , Cistostomía/métodos
12.
J Int Med Res ; 52(3): 3000605241232968, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38460542

RESUMEN

OBJECTIVE: To retrospectively compare the differences in the surgical efficacy and prognosis of laparoscopic pyeloplasty for hydronephrosis caused by symptomatic versus asymptomatic ureteropelvic junction obstruction (UPJO) in children and determine whether clinical symptoms affect the surgical outcome and prognosis. METHODS: Children who underwent laparoscopic pyeloplasty in our hospital from January 2018 to December 2022 were retrospectively analyzed. The children were divided into symptomatic and asymptomatic groups according to their main symptoms. The primary outcomes were the surgical success rate, change in renal parenchymal thickness, and change in renal pelvis anteroposterior diameter. The secondary outcomes were postoperative complications, reoperation rate, operative duration, intraoperative blood loss, and drainage tube indwelling time. RESULTS: In total, 224 children with UPJO were enrolled; 148 (66.1%) were symptomatic and 76 (33.9%) were asymptomatic. The symptomatic group showed a significantly greater mean change in renal parenchymal thickness, significantly higher surgical success rate, and significantly lower postoperative complication rate. CONCLUSIONS: In the present study, asymptomatic children had a lower surgical success rate, less postoperative imaging improvement, and more postoperative complications than symptomatic children. The presence or absence of clinical symptoms may affect the surgical outcome and prognosis.


Asunto(s)
Hidronefrosis , Laparoscopía , Obstrucción Ureteral , Humanos , Niño , Estudios Retrospectivos , Laparoscopía/efectos adversos , Laparoscopía/métodos , Procedimientos Quirúrgicos Urológicos/métodos , Hidronefrosis/diagnóstico por imagen , Hidronefrosis/cirugía , Hidronefrosis/complicaciones , Obstrucción Ureteral/cirugía , Obstrucción Ureteral/etiología , Complicaciones Posoperatorias/cirugía , Resultado del Tratamiento
13.
World J Urol ; 42(1): 148, 2024 Mar 13.
Artículo en Inglés | MEDLINE | ID: mdl-38478056

RESUMEN

OBJECTIVE: To assess the clinical efficacy of laparoscopic Lich-Gregoir (LLG) and transvesicoscopic Cohen reimplantation (TCR) in the treatment of vesicoureteral junction obstruction (VUJO) and vesicoureteral reflux (VUR). METHODS: This study retrospectively analyzed the clinical data of 66 pediatric patients with VUJO and VUR. They were classified into two groups, undergoing either the laparoscopic Lich-Gregoir operation (LLGO) (n = 35) or transvesicoscopic Cohen reimplantation operation (TCRO) (n = 31). The surgeries were performed between April 2018 and September 2022 at the First Affiliated Hospital of Guangxi Medical University, China. General characteristics, preoperative attributes, postoperative complications, renal function recovery, and improvement of hydronephrosis were compared between the two groups. RESULTS: All surgical procedures were successful with no requirement for reoperation. Both groups were comparable with respect to gender, affected side, weight, and postoperative complications. Nonetheless, the LLGO group contained a greater number of children younger than 12 months. The LLGO group demonstrated superiority over the TCRO group regarding the duration of the operation, intraoperative blood loss, and length of postoperative hospital stay. In contrast, postoperative complications, recovery of renal function, and hydronephrosis improvement did not exhibit statistically significant differences between the two groups. CONCLUSION: Both LLGO and TCRO were demonstrated to be precise, safe, and reliable surgical methods for treating pediatric VUJO and VUR. LLGO ureteral reimplantation offers particular advantages in selecting cases and appears more suitable for children younger than 12 months who have a small bladder capacity.


Asunto(s)
Hidronefrosis , Laparoscopía , Uréter , Reflujo Vesicoureteral , Niño , Humanos , Estudios Retrospectivos , Procedimientos Quirúrgicos Urológicos/métodos , China , Uréter/cirugía , Reflujo Vesicoureteral/cirugía , Resultado del Tratamiento , Laparoscopía/métodos , Reimplantación/métodos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/cirugía , Hidronefrosis/cirugía
14.
World J Urol ; 42(1): 130, 2024 Mar 09.
Artículo en Inglés | MEDLINE | ID: mdl-38460016

RESUMEN

OBJECTIVE: To explore the parameters influencing intraoperative calculi excretion (ICE) during flexible ureteroscopy lithotripsy (fURL) using in vitro simulation experiments. METHODS: 3D-printed human kidney models were used to simulate the elimination of gravel during fURL. The factors influencing the ICE during fURL were analyzed by comparing the effects of different degrees of hydronephrosis (mild, moderate, and severe), surgical positions (supine and lateral position), ratios of endoscope-sheath diameter (RESD) (0.625, 0.725, and 0.825), gravel sizes (0.50-1.00 mm, 0.25-0.50 mm, and 0.10-0.25 mm), and ureteral access sheaths (UASs) (traditional UAS and negative-pressure UAS) on ICE. RESULTS: The impacts of various UAS, RESD, degree of hydronephrosis, surgical positions, and gravel sizes on ICE were all significant (p < 0.05). We found no evidence of multicollinearity for all the independent variables, and the linear regression equation fitted as ICE ( g / min ) = 0.102 + 0.083 ∗ UAS grade - 0.050 ∗ RESD grade - 0.048 ∗ hydronephrosis grade + 0.065 ∗ position grade - 0.027 ∗ gravel size grade (R2 = 0.569). CONCLUSION: Employing negative-pressure UAS, smaller RESD, milder hydronephrosis, lateral position, and smaller gravel size contribute to improved ICE during fURL. Among them, the adoption of negative-pressure UAS had the most substantial effects.


Asunto(s)
Hidronefrosis , Cálculos Renales , Litotricia , Cálculos Ureterales , Humanos , Ureteroscopía , Cálculos Renales/cirugía , Ureteroscopios , Cálculos Ureterales/cirugía
15.
Eur J Pediatr ; 183(5): 2029-2036, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38441661

RESUMEN

Primary non-refluxing megaureter (PMU) is a congenital dilation of the ureter which is not related to vesicoureteral reflux, duplicated collecting systems, ureterocele, ectopic ureter, or posterior urethral valves and accounts for 5 to 10% of all prenatal hydronephrosis (HN) cases. The etiology is a dysfunction or stenosis of the distal ureter. Most often PMU remains asymptomatic with spontaneous resolution allowing for non-operative management. Nevertheless, in selective cases such as the development of febrile urinary tract infections, worsening of the ureteral dilatation, or reduction in relative renal function, surgery should be considered. CONCLUSION: Ureteral replantation with excision of the dysfunctional ureteral segment and often ureteral tapering is the gold-standard procedure for PMU, although endoscopic treatment has been shown to have a fair success rate in many studies. In this review, we discuss the natural history, follow-up, and treatment of PMU. WHAT IS KNOWN: • PMU is the result of an atonic or stenotic segment of the distal ureter, resulting in congenital dilation of the ureter, and is frequently diagnosed on routine antenatal ultrasound. WHAT IS NEW: • Most often, PMU remains asymptomatic and clinically stable, allowing for non-operative management. • Nevertheless, since symptoms can appear even after years of observation, long-term ultrasound follow-up is recommended, even up to young adulthood, if hydroureteronephrosis persists. • Ureteral replantation is the gold standard in case surgery is needed. In selected cases, however, HPBD could be a reasonable alternative.


Asunto(s)
Reimplantación , Uréter , Humanos , Reimplantación/métodos , Uréter/anomalías , Uréter/cirugía , Enfermedades Ureterales/terapia , Enfermedades Ureterales/diagnóstico , Enfermedades Ureterales/congénito , Enfermedades Ureterales/cirugía , Procedimientos Quirúrgicos Urológicos/métodos , Hidronefrosis/etiología , Hidronefrosis/diagnóstico , Hidronefrosis/terapia , Estudios de Seguimiento
16.
Eur J Surg Oncol ; 50(6): 108251, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38492258

RESUMEN

OBJECTIVES: Sarcomatoid renal pelvis carcinoma (SRPC) is a rare variant of RPC. We aimed to summarize the clinicopathological features and prognostic factors of SRPC. METHODS: In this retrospective study, we collected data from 24 patients with SRPC who were treated at the Department of Urology, Affiliated Hospital of Qingdao University between 2008 and 2021. The clinicopathological features of the patients were obtained from their medical records to evaluate the diagnosis, prognostic factors, and response to systemic therapy. RESULTS: Immunohistochemical staining revealed that cytokeratin was expressed in 19 patients with SRPC, while vimentin was expressed in all patients. Computer tomography showed these tumors as low-density (n = 12) or mixed-density masses, with or without necrotic areas (n = 12). All patients showed different degrees of enhancement on computed tomography. Lymph node metastasis was present in 6 patients and distant metastasis in 5. The median survival of all patients was 28 months. Patients without metastasis had a median survival of 46 months compared with 18 months in those with metastasis (P < 0.05). Necrosis had no significant influence on prognosis (P > 0.05). The median survival of patients with and without hydronephrosis was 18 and 104 months (P < 0.05). Among patients without metastasis, those without hydronephrosis survived longer than those with hydronephrosis (104 vs 18 months, P < 0.05), and necrosis had no effect on prognosis. In patients with metastasis, necrosis and hydronephrosis had no effect on prognosis (P > 0.05). CONCLUSION: The prognosis of SRPC is poor, and the clinical stage, particularly the presence of distant metastasis, has a significant impact on prognosis.


Asunto(s)
Neoplasias Renales , Pelvis Renal , Humanos , Femenino , Persona de Mediana Edad , Masculino , Neoplasias Renales/patología , Neoplasias Renales/terapia , Estudios Retrospectivos , Anciano , Pelvis Renal/patología , Adulto , Pronóstico , Metástasis Linfática , Vimentina/metabolismo , Tomografía Computarizada por Rayos X , Tasa de Supervivencia , Queratinas/metabolismo , Hidronefrosis/etiología , Nefrectomía , Carcinoma de Células Renales/patología , Carcinoma de Células Renales/terapia , Necrosis
17.
J Laparoendosc Adv Surg Tech A ; 34(4): 371-375, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38502848

RESUMEN

Aims: Retroperitoneoscopic simple nondismembered pyeloplasty (SNDP) with da Vinci Si assistance was developed because of a possible risk for alignment shift after retroperitoneoscopic diamond-shaped bypass pyeloplasty (Diamond-Bypass; DP). Outcomes of SNDP and DP were compared. Materials and Methods: For SNDP, a small longitudinal incision is made on the border of the dilated pelvis and narrowed ureter at the ureteropelvic junction (UPJ). Extending this incision toward the pelvis allows identification of mucosa while maintaining the integrity of surrounding tissues that are so thin and fragile that they will not influence lumen alignment. Data for DP were obtained from a previously published article. Results: For SNDP (n = 3), mean age at surgery was 2.67 years (range: 1-4), mean operative time was 176 minutes. Mean postoperative Society of Fetal Urology (SFU) grades for hydronephrosis were 1.2, 0.7, and 0.6, 1, 2, and 3 months after stent removal, respectively. Postoperative diethylenetriaminepentaacetic acid (DTPA) was normal (n = 3). For DP (n = 5) mean age at surgery was 4.3 years (range: 1-14), mean operative time was 189 minutes. Mean postoperative SFU grades were 2.8, 2.2, and 1.6, respectively. Postoperative DTPA was normal (n = 4) and delayed (n = 1). All SNDP and DP were asymptomatic by 3 months after stent removal. Conclusion: Both SNDP and DP have favorable outcomes. If the UPJ is located at the lowest end of the renal pelvis, SNDP may improve hydronephrosis more quickly.


Asunto(s)
Hidronefrosis , Laparoscopía , Uréter , Obstrucción Ureteral , Humanos , Lactante , Preescolar , Niño , Adolescente , Uréter/cirugía , Obstrucción Ureteral/cirugía , Obstrucción Ureteral/complicaciones , Laparoscopía/efectos adversos , Pelvis Renal/cirugía , Hidronefrosis/etiología , Ácido Pentético , Procedimientos Quirúrgicos Urológicos/efectos adversos , Resultado del Tratamiento
19.
Sci Rep ; 14(1): 4214, 2024 02 20.
Artículo en Inglés | MEDLINE | ID: mdl-38378755

RESUMEN

Augmentation cystoplasty (AC) is an effective surgical procedure for patients with neurogenic bladder whenever conservative treatments have failed. The present study aimed to determine the risks of metabolic complications, malignancy, long-term outcomes and histopathologic changes of native bladder and the augmented intestine after AC in children with neurogenic bladder. Pediatric patients < 18 years who underwent AC between 2000 and 2020 were enrolled. Early postoperative complications, long-term outcomes and histopathologic changes in mucosal biopsies of native bladder and the augmented intestine after AC were reviewed. Twenty-two patients with a mean age of 7.6 ± 4.4 years were included. The ileum was used in 19 patients and the sigmoid colon in 3 patients. The length of hospital stay was 14.8 ± 6.8 days. Post-operatively, the urinary continence rate improved from 22.7 to 81.8% (p < 0.001). Hydronephrosis resolved in 17 of 19 patients. Vesicoureteral reflux resolved in 16 (64.0%) of the refluxing ureter units and was downgraded in 7 (28.0%). Grades of hydronephrosis and reflux significantly improved following AC (p < 0.001). The estimated glomerular filtration rate also significantly increased (p = 0.012). Formation of urinary tract stones was the most frequent late complication (in 8 patients, 36.4%). Life-threatening spontaneous bladder perforation occurred in 1 patient. After a mean follow-up of 13.4 ± 5.9 years, there were no cases of mortality, new-onset symptomatic metabolic acidosis, or changes in serum electrolytes. Of the 17 patients who were followed for > 10 years, no cases of malignancy or metaplastic changes were identified in the native bladder or augmented bowel epithelium. AC is a safe and effective procedure with low surgical and metabolic complication rates. In addition, AC provides a satisfactory continence rate and long-term protection of renal function, increases functional capacity, and regresses reflux and hydronephrosis. Individualized surveillance is recommended for the early identification of urolithiasis and metabolic disturbances.


Asunto(s)
Reflujo Gastroesofágico , Hidronefrosis , Neoplasias , Vejiga Urinaria Neurogénica , Humanos , Niño , Preescolar , Vejiga Urinaria Neurogénica/complicaciones , Vejiga Urinaria Neurogénica/cirugía , Estudios Retrospectivos , Colon Sigmoide , Complicaciones Posoperatorias/etiología , Reflujo Gastroesofágico/complicaciones , Hidronefrosis/complicaciones , Neoplasias/complicaciones
20.
Arch Esp Urol ; 77(1): 113-118, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38374021

RESUMEN

BACKGROUND: The conventional approach for managing ureteral stenosis involves the placement of a double-J stent. In recent years, the utilisation of Allium ureteral stent (URS) has emerged as a novel treatment alternative for ureteral stenosis. Allium URS has several advantages over traditional stents, including an extended indwelling time and reduced incidence of complications. The number of cases reported worldwide on the use of Allium URS in the treatment of ureteral stenosis is currently limited. In this paper, we present the details of a case involving the use of an Allium URS to treat ileal-ureteral anastomotic stenosis in a 67-year-old patient. We aim to assess the feasibility of using Allium URS in such cases. CASE PRESENTATION: A 67-year-old Chinese woman was referred to our hospital for the treatment of left lumbago. Urography showed left ileal-ureteral anastomotic stenosis. Computed tomography (CT) revealed severe hydronephrosis in the left kidney. Subsequently, an Allium URS was implanted via ureteroscopy. We found no instances of haematuria, lumbago or urinary tract irritation during the follow-up period. After 8 months, the patient was readmitted because of left lumbago. CT re-examination revealed that the left hydronephrosis had modestly improved. The Allium URS had detached and showed stone formation on its surface. For further treatment, ureteroscopy was performed and a new Allium URS was implanted. At 3-month follow-up, CT re-examination demonstrated that the stent had dislodged again but that the hydronephrosis in the left kidney had remarkably improved. Cystoscopy revealed that the stent had completely detached and that wall stones had attached on this surface. The stent was removed via cystoscopy. After 1 month, CT scanning showed that the left hydronephrosis of the patient had almost disappeared. CONCLUSION: Allium URS is effective in the treatment of hydronephrosis caused by ileal-ureteral anastomotic stenosis. Although complications, such as haematuria, lumbago and urinary tract irritation, are rare, complications, such as stent displacement and stone formation, may occur. Hence, caution must be exercised when considering the use of Allium URSs in the treatment of patients with ileal-ureteral anastomotic stenosis.


Asunto(s)
Allium , Hidronefrosis , Dolor de la Región Lumbar , Cálculos Ureterales , Obstrucción Ureteral , Femenino , Humanos , Anciano , Hematuria/etiología , Constricción Patológica/cirugía , Constricción Patológica/complicaciones , Dolor de la Región Lumbar/complicaciones , Obstrucción Ureteral/cirugía , Obstrucción Ureteral/etiología , Ureteroscopía/métodos , Hidronefrosis/complicaciones , Stents/efectos adversos , Cálculos Ureterales/complicaciones , Resultado del Tratamiento
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