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1.
Asian J Endosc Surg ; 17(3): e13329, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38807453

RESUMEN

INTRODUCTION: Postoperative ureteral strictures and vesicoureteral reflux after ureteroneocystostomy for kidney transplant can be managed by endoscopic procedures like balloon dilation and endoscopic injections. Complicated/recurrent cases, however, are usually managed by reconstructive surgery. We hereby highlight our technique of robotic-assisted native pyeloureterostomy with indocyanine green (ICG). MATERIALS AND SURGICAL TECHNIQUE: A 57-year-old woman, diagnosed with grade 4 vesicoureteral reflux on her transplanted kidney, was considered a candidate for ureteral reimplantation. After an endoscopic part, where the ICG is inserted into the renal pelvis, we proceed with the robotic native pyeloureterostomy. The renal pelvis of the transplanted kidney was identified with the help of the ICG in firefly mode. After the dissection of the graft pelvis, we performed a tension-free pyeloureterostomy using the native ureter. The postoperative course was uneventful and the patient was discharged on the third postoperative day. DISCUSSION: Robotic-assisted pyelo-ureterostomy appears as a safe and efficient technique for management of complicated urological complications postrenal transplantation using the native ureter. Intrapelvic ICG injection, not possible with open surgery, helps identifying the grafted pelvis thus reducing operative time and avoiding unnecessary dissection of the vascular hilum of the graft. Because of minimal dissection and the short operative time, abdominal drainage is unnecessary and the postoperative course is usually uneventful with a fast discharge from the hospital.


Asunto(s)
Verde de Indocianina , Trasplante de Riñón , Procedimientos Quirúrgicos Robotizados , Ureterostomía , Humanos , Femenino , Persona de Mediana Edad , Ureterostomía/métodos , Reflujo Vesicoureteral/cirugía , Reflujo Vesicoureteral/etiología , Pelvis Renal/cirugía , Colorantes , Complicaciones Posoperatorias/cirugía , Uréter/cirugía , Obstrucción Ureteral/cirugía , Obstrucción Ureteral/etiología
2.
Pan Afr Med J ; 47: 21, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38558555

RESUMEN

An intravesical ureterocele is a rare condition in which a terminal ureter terminates in a cystic dilation of the bladder. We present the case of a 42-year-old female who presented with irritative lower urinary tract symptoms and left lower back pain. Computed tomography (CT) urography revealed ureteral duplication with a ureterocele complicated by upper tract obstruction. Treatment involved endoscopic ureterocelotomy, which successfully relieved symptoms and resolved renal obstruction.


Asunto(s)
Uréter , Obstrucción Ureteral , Ureterocele , Femenino , Humanos , Adulto , Uréter/cirugía , Ureterocele/complicaciones , Ureterocele/diagnóstico , Ureterocele/cirugía , Obstrucción Ureteral/etiología , Pelvis Renal , Endoscopía
3.
Schweiz Arch Tierheilkd ; 166(4): 207-215, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38572822

RESUMEN

INTRODUCTION: This case report describes the long-term success of a subcutaneous ureteral bypass device in a dog for treatment of a ureteral obstruction. The suspected xanthine urolithiasis was secondary to treatment with allopurinol for leishmaniasis. The dog presented initially with lethargy, anuria and abdominal pain. Mild azotemia was found on biochemical analysis and abdominal ultrasound revealed bilateral ureteral obstruction. A subcutaneous ureteral bypass was subsequently placed using a standard surgical technique. The dog recovered uneventfully and the azotemia resolved within days. Follow-up examinations were performed every trimester for over three years and no complications like obstruction of the bypass tubes, urinary tract infection or azotemia were recognized during this follow-up period. Allopurinol was replaced with domperidone as long-term treatment against Leishmaniasis which resulted in a mild increase of the leishmania serum antibody titer. The subcutaneous ureteral bypass placement was successful and safe in this dog and is a valuable alternative in cases of ureteral obstruction also in dogs.


INTRODUCTION: Ce rapport de cas décrit le succès à long terme d'une dérivation urétérale sous-cutanée chez un chien pour le traitement d'une obstruction urétérale. L'urolithiase xanthique suspectée était secondaire à un traitement à l'allopurinol contre la leishmaniose. Le chien a d'abord présenté une léthargie, une anurie et des douleurs abdominales. L'analyse biochimique a révélé une légère azotémie et l'échographie abdominale a révélé une obstruction urétérale bilatérale. Une dérivation urétérale sous-cutanée a été mise en place selon une technique chirurgicale standard. Le chien s'est rétabli sans incident et l'azotémie a disparu en quelques jours. Des examens de suivi ont été effectués tous les trimestres pendant plus de trois ans et aucune complication telle qu'une obstruction du tube de dérivation, une infection urinaire ou une azotémie n'a été constatée au cours de cette période de suivi. L'allopurinol a été remplacé par de la dompéridone dans le cadre d'un traitement à long terme contre la leishmaniose, ce qui a entraîné une légère augmentation du titre des anticorps sériques contre la leishmaniose. La mise en place d'une dérivation urétérale sous-cutanée s'est avérée efficace et sûre chez ce chien et constitue une alternative intéressante en cas d'obstruction urétérale, y compris chez les chiens.


Asunto(s)
Azotemia , Enfermedades de los Gatos , Enfermedades de los Perros , Leishmaniasis , Obstrucción Ureteral , Urolitiasis , Animales , Perros , Gatos , Obstrucción Ureteral/etiología , Obstrucción Ureteral/cirugía , Obstrucción Ureteral/veterinaria , Alopurinol/uso terapéutico , Azotemia/veterinaria , Urolitiasis/cirugía , Urolitiasis/veterinaria , Leishmaniasis/veterinaria , Xantinas , Stents/veterinaria , Enfermedades de los Perros/tratamiento farmacológico , Enfermedades de los Perros/cirugía
4.
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
5.
Minerva Urol Nephrol ; 76(1): 97-109, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38426424

RESUMEN

BACKGROUND: The aim of this study was to explore the feasibility of ileal ureter replacement and ileocystoplasty for the treatment of bilateral long-segment ureteral strictures combined with bladder contracture. METHODS: A retrospective review of clinical data from seven patients who underwent bilateral Ileal Ureter Replacement and ileocystoplasty from April 2019 to February 2023 was conducted. The surgeries were performed using open, laparoscopic, and robot-assisted laparoscopic approaches. Baseline characteristics, perioperative, and mid-term results of the patients were collected. Follow-up period of 3-28 months. A detailed description of the technique was reported. RESULTS: The mean age of the patients was 52.86±6.06 years. The average duration of surgery was 365±28.54 minutes, and the estimated intraoperative blood loss was 357.14±184.06 mL. The mean length of harvested ileum was 37.86±8.40 cm. The preoperative serum creatinine level was 88.02±18.05 µmol/L, postoperative day 1 creatinine level was 90.7±12.93µmol/L, postoperative 3-month creatinine level was 93.77±33.34 µmol/L, and the mean creatinine level at the last follow-up was 94.89±27.89µmol/L. The postoperative bladder capacity was 249.43±32.50 mL on average. The average length of hospital stay was 26.57±15.46 days. No complications of Clavien-Dindo grade 3 or higher were observed. During the follow-up period, no patients experienced deterioration of renal function after surgery. CONCLUSIONS: Bilateral ileal ureter replacement and ileocystoplasty are effective surgical technique for the treatment of bilateral long-segment ureteral strictures combined with bladder contracture caused by radiation therapy.


Asunto(s)
Uréter , Obstrucción Ureteral , Humanos , Persona de Mediana Edad , Uréter/cirugía , Vejiga Urinaria/cirugía , Constricción Patológica/cirugía , Creatinina , Obstrucción Ureteral/etiología , Obstrucción Ureteral/cirugía , Íleon/cirugía
6.
Medicina (Kaunas) ; 60(2)2024 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-38399625

RESUMEN

Ureteral involvement by a tumor is common, and both partial and complete obstructions can result in symptoms that are distressing and debilitating, especially in cancer patients for whom the resection of the primary tumor is not considered an option. Maintaining ureteric patency in these patients is a challenge. In addition, in cases where a patient has undergone nephroureterectomy due to primary transitional cell cancer, it becomes necessary to decompress the urinary tract to preserve the contralateral kidney from irreversible damage. This is possibly due to ureteral stenting, both retrograde and anterograde, and percutaneous nephrostomy (PCN). Since imaging plays an important role in the routine monitoring of stents, their more and more increasing use requires radiologists to be familiar with these devices, their correct position, their potential complications, and their consequences. The aim of this review is to offer a comprehensive review of the imaging features of some urinary stents and to show the complications encountered in cancer patients as a direct consequence of an invasive diagnostic or therapeutic procedure. Specifically, we focus on ureteral stents and PCN.


Asunto(s)
Nefrostomía Percutánea , Uréter , Obstrucción Ureteral , Neoplasias de la Vejiga Urinaria , Humanos , Obstrucción Ureteral/diagnóstico por imagen , Obstrucción Ureteral/etiología , Obstrucción Ureteral/cirugía , Nefrostomía Percutánea/efectos adversos , Nefrostomía Percutánea/métodos , Uréter/diagnóstico por imagen , Uréter/cirugía , Stents/efectos adversos , Estudios Retrospectivos
7.
Br J Surg ; 111(2)2024 Jan 31.
Artículo en Inglés | MEDLINE | ID: mdl-38406883

RESUMEN

Malignant ureteric obstruction (MUO) is frequently encountered in patients with advanced cancers. In the largest study to date, assessing 852 patients from across Scotland, the authors demonstrated the presence of MUO as a marker of advanced disease across cancer types, with poor survival for many patients, even with intervention. There is uncertainty in optimal management of this condition, with marked differences in management between hospitals. Treatment to relieve the obstruction does not guarantee either improvement in kidney function or progression to further oncological treatment. The authors have developed a prognostic tool to estimate outcomes after intervention for MUO, and advocate its use for clinicians along with other data presented for patient counselling.


Asunto(s)
Nefrostomía Percutánea , Uréter , Obstrucción Ureteral , Humanos , Obstrucción Ureteral/etiología , Obstrucción Ureteral/cirugía , Uréter/cirugía , Stents , Estudios Retrospectivos
8.
World J Urol ; 42(1): 92, 2024 Feb 22.
Artículo en Inglés | MEDLINE | ID: mdl-38386090

RESUMEN

PURPOSE: Malignant ureteric obstruction is a significant management challenge. The failure of ureteric stents often leads to long-term nephrostomy tubes. This is delayed for as long as possible due to its' associated morbidity. Several types of ureteric stents are available, however there is little evidence demonstrating which stents are better for preventing progression to nephrostomy tubes. This study looked to determine whether a new 6 French (Fr) polymer stent, 8Fr polymer stent or metallic stent achieved a longer functional duration once the initial polymer ureteric stent failed. METHODS: A retrospective, longitudinal study was performed at a single tertiary institution. All patients who underwent ureteric stenting with a 6Fr polymer stent for malignancy between 2010 and 2020 were included. Patients were followed up until death with ureteric stent in situ or permanent nephrostomy tube insertion. RESULTS: A total of 46 patients (66 ureters) had ureteric stents inserted for malignancy. From initial ureteric stent failure, 10 stents were changed to a new 6Fr polymer stent, 42 were changed to an 8Fr polymer stent and 14 were changed to a Resonance® 6Fr metallic stent. The Resonance 6Fr metallic stent had the longest median functional duration of 14 months (p = 0.012). CONCLUSION: Resonance® 6Fr metallic stents appear to have a significantly longer functional duration than a new 6Fr polymer stent or 8Fr polymer stent, which may allow patients to enjoy a better quality of life and delay permanent nephrostomy tube insertion.


Asunto(s)
Neoplasias , Uréter , Obstrucción Ureteral , Humanos , Uréter/cirugía , Obstrucción Ureteral/etiología , Obstrucción Ureteral/cirugía , Estudios Longitudinales , Calidad de Vida , Estudios Retrospectivos , Stents , Polímeros
9.
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
10.
J Robot Surg ; 18(1): 100, 2024 Feb 28.
Artículo en Inglés | MEDLINE | ID: mdl-38413496

RESUMEN

Cystectomy is the gold standard treatment for muscle invasive bladder cancer. Robotic cystectomy has become increasingly popular owing to quicker post- operative recovery, less blood loss and less post-operative pain. Urinary diversion is increasingly being performed with an intracorporeal technique. Uretero-enteric strictures (UES) cause significant morbidity for patients. UES for open cystectomy is 3-10%, but the range is much wider (0-25%) for robotic surgery. We aim to perform systematic review for studies comparing all 3 techniques, to assess for ureteric stricture rates. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement (Page et al. in BMJ 29, 2021). PubMed, Scopus and Embase databases were searched for the period January 2003 to June 2023 inclusive for relevant publications.The primary outcome was to identify ureteric stricture rates for studies comparing open cystectomy and urinary diversion, robotic cystectomy with extracorporeal urinary diversion (ECUD) and robotic cystectomy with intracorporeal urinary diversion (ICUD). Three studies were identified and included 2185 patients in total. The open operation had the lowest stricture rate (9.6%), compared to ECUD (12.4%) and ICUD (15%). ICUD had the longest time to stricture (7.55 months), ECUD (4.85 months) and the open operation (4.75 months). Open operation had the shortest operating time. The Bricker anastomoses was the most popular technique. Open surgery has the lowest rates of UES compared to both robotic operations. There is a learning curve involved with performing robotic cystectomy and urinary diversion, this may need to be considered to decide whether the technique is comparable with open cystectomy UES rates. Further research, including Randomised Control Trials (RCT), needs to be undertaken to determine the best surgical option for patients to minimise risks of UES.


Asunto(s)
Procedimientos Quirúrgicos Robotizados , Obstrucción Ureteral , Neoplasias de la Vejiga Urinaria , Derivación Urinaria , Humanos , Cistectomía/efectos adversos , Cistectomía/métodos , Constricción Patológica/etiología , Constricción Patológica/cirugía , Procedimientos Quirúrgicos Robotizados/métodos , Resultado del Tratamiento , Derivación Urinaria/efectos adversos , Derivación Urinaria/métodos , Neoplasias de la Vejiga Urinaria/cirugía , Obstrucción Ureteral/etiología , Obstrucción Ureteral/cirugía , Estudios Retrospectivos
12.
BMJ Case Rep ; 17(2)2024 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-38373806

RESUMEN

Ureteral endometriosis is rare and can be a silent clinical entity, which can potentially lead to serious complications such as obstructive uropathy, sepsis and renal failure. A high clinical suspicion is required especially in childbearing age groups due to non-specific presentation such as renal colic, recurrent urinary tract infection (UTI), renal failure or asymptomatic hydronephrosis.A woman in her 40s presented with febrile UTI and flank pain. She reportedly suffered from recurrent UTIs in the past. Initial workup revealed an infected, obstructed left renal collecting system with gross hydronephrosis and hydroureter to the distal ureter on a significant gynaecological background of severe endometriosis requiring hysterectomy in the past.CT showed chronic obstructive changes and soft tissue nodules within the renal pelvis with no radio-opaque stones. She underwent emergent ureteric stent insertion. Functional imaging demonstrated only 1% contribution of the left kidney with a preserved estimated glomerular filtration rate of 65 mL/min/1.73 m2Endoscopic evaluation of ureters found extensive soft tissue lesions throughout the dilated left collecting system with biopsy-confirmed endometriosis. Subsequently, she underwent laparoscopic nephroureterectomy due to extensive ureteric involvement and chronically obstructed non-functioning kidney. Histopathology demonstrated completely obstructing ureteral endometriosis.Ureteric obstruction secondary to endometriosis can be due to extrinsic or intrinsic disease. In addition to initial assessment with CT urogram MRI may be helpful to evaluate soft tissue thickening. Endoscopic assessment with ureteroscopy and biopsy is required for tissue diagnosis. Surgery is often the treatment of choice, ranging from ureteroureterostomy, ureteroneocystostomy or nephroureterectomy in severe cases.Ureteral endometriosis is a rare clinical entity, clinicians should remain vigilant about common presentations of this rare entity, early diagnosis and prompt treatment is crucial to prevent progression to renal failure.


Asunto(s)
Endometriosis , Hidronefrosis , Insuficiencia Renal , Uréter , Enfermedades Ureterales , Obstrucción Ureteral , Enfermedades Uretrales , Femenino , Humanos , Endometriosis/complicaciones , Endometriosis/cirugía , Endometriosis/patología , Obstrucción Ureteral/diagnóstico por imagen , Obstrucción Ureteral/etiología , Obstrucción Ureteral/cirugía , Uréter/diagnóstico por imagen , Uréter/cirugía , Uréter/patología , Hidronefrosis/etiología , Hidronefrosis/cirugía , Hidronefrosis/diagnóstico , Pelvis Renal/patología , Insuficiencia Renal/complicaciones , Enfermedades Uretrales/patología , Enfermedades Ureterales/complicaciones , Enfermedades Ureterales/diagnóstico por imagen , Enfermedades Ureterales/cirugía
13.
Urology ; 186: 166-171, 2024 04.
Artículo en Inglés | MEDLINE | ID: mdl-38401810

RESUMEN

OBJECTIVE: To evaluate the outcomes of children with vesicoureteral reflux (VUR) and obstructive megaureter (OM) utilizing various laparoscopic and robot-assisted approaches. MATERIALS AND METHODS: Retrospective review of all pediatric laparoscopic and robot-assisted cases for lower ureter pathology was performed between 2016-2022 in 13 academic centers worldwide. Five surgical approaches were assessed: LEUR, LVCUR, LDECUR, RALUR, and RADECUR. RESULTS: One thousand three hundred forty-three patients (490 boys and 853 girls) with a median age of 30 months (IQR 12-63) were treated at 13 centers. Nine hundred and eight patients (68%) underwent reimplantation due to VUR (unilateral in 818 and bilateral in 90 patients). Four hundred thirty-five (32%) had a surgery due to ureterovesical junction (UVJ) obstruction. Mean length of follow-up was 14 months (IQR 8-33). Median operative time was 202 minutes (IQR 142-220) in the robotic arm compared to 240 minutes (IQR 160-267) in the laparoscopic (P = .45). Intracorporeal excisional tapering was performed in 118 (8%) of the patients. Six patients in the OM group required additional surgery due to progressive obstruction. In the VUR group, 84% underwent voiding cystourethrography postoperatively. 5.6% showed residual reflux. Grade 1-2 Clavien-Dindo complications occurred in 10 patients (0.7%) and 6 (0.4%) in the laparoscopic and robotic arm, respectively. Grade 3 complications occurred in 17 (1.2%) and 8 (0.5%) in both arms, respectively. Surgical success was achieved in 96% of patients. CONCLUSION: Laparoscopic and robot-assisted laparoscopic approaches are simple, safe, and effective for treating all grades of VUR and OM. Robot-assisted approach is beneficial in terms of operative time, intracorporeal suturing, and lower complications rate.


Asunto(s)
Laparoscopía , Procedimientos Quirúrgicos Robotizados , Robótica , Uréter , Obstrucción Ureteral , Reflujo Vesicoureteral , Masculino , Femenino , Humanos , Niño , Lactante , Preescolar , Uréter/cirugía , Procedimientos Quirúrgicos Robotizados/efectos adversos , Reflujo Vesicoureteral/cirugía , Reflujo Vesicoureteral/etiología , Obstrucción Ureteral/cirugía , Obstrucción Ureteral/etiología , Estudios Retrospectivos , Reimplantación , Laparoscopía/efectos adversos , Resultado del Tratamiento
14.
Medicine (Baltimore) ; 103(4): e37057, 2024 Jan 26.
Artículo en Inglés | MEDLINE | ID: mdl-38277516

RESUMEN

BACKGROUND: Cancer of unknown primary (CUP) is a very challenging disease, accounting for 2% to 9% of all new cancer cases. This type of tumor is a heterogeneous tumor whose primary site cannot be determined by standard examination. It has the characteristics of early metastasis, strong aggressiveness, and unpredictable mode of metastasis. Studies have shown that there is no consensus on the treatment of CUP and that there is a wide range of individual differences. In most cases, surgical removal of tumor is the most typical treatment for pelvic tumors. Herein, we report a case of a large pelvic tumor of unknown origin that had compressed the sigmoid colon and ureter and was completely removed by surgery. Postoperative diagnosis was pelvic metastatic squamous cell carcinoma. CASE SUMMARY: A 68-year-old man with pelvic tumor who initially complained of recurrent low back pain and painful urination. The mass was initially diagnosed as a pelvic tumor of unknown origin. The patient underwent complete resection of the tumor by laparotomy. The tumor was pathologically diagnosed as squamous cell carcinoma. CONCLUSION: Based on the treatment experience of this case, surgery alone cannot improve the poor prognosis of CUP. Since chemotherapy and immunotherapy have achieved promising efficacy in various cancers, and immunotherapy has the characteristics of low side effects and good tolerability, we recommend that patients with CUP should receive chemotherapy and/or immunotherapy for better survival outcomes.


Asunto(s)
Carcinoma de Células Escamosas , Hidronefrosis , Neoplasias Primarias Desconocidas , Neoplasias Pélvicas , Obstrucción Ureteral , Masculino , Humanos , Anciano , Neoplasias Primarias Desconocidas/patología , Constricción Patológica , Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/cirugía , Carcinoma de Células Escamosas/patología , Hidronefrosis/etiología , Hidronefrosis/cirugía , Obstrucción Ureteral/etiología , Obstrucción Ureteral/cirugía
15.
J Endourol ; 38(3): 290-300, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38185833

RESUMEN

Purpose: To analyze the utility and outcomes of available endourologic options to treat ureteral stricture after kidney transplantation (KT). Methods: A systematic review was carried out for all English language articles from 2000 to 2023 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) standards using EMBASE, MEDLINE, SCOPUS, Google scholar, and Cochrane library. The search term combination for the string was follows: [(Ureteral stricture) OR (ureter stenosis) OR (ureteral stenosis) OR (Stricture ureter) OR (Narrowing ureter) OR (Ureter restriction) OR (ureteral restriction) OR (ureteral narrowing) OR (ureteral obstruction) OR (ureter obstruction) OR (obstructing ureter) OR (obstructive ureter) OR (narrow ureter) OR (ureteral narrow)] AND [(kidney transplant) OR (transplanted kidney) OR (transplant) OR (transplantation)] AND [(management) OR (Robotic) OR (laser) OR (stent) OR (dilatation) OR (dilation) OR (endoscopic) OR (endourological) OR (Urologic) OR (laparoscopic) OR (surgery) OR (treatment)]. Case reports, review articles, animal and laboratory studies were excluded. Risk of bias assessment was conducted using the RoB 2 and ROBINS-I tools. Results: A total of 1102 relevant articles published from 2000 to 2023 were found. After screening of titles and abstracts, a total of 19 articles were included in our systematic review. Ureteral stent/nephrostomy placement, balloon dilatation (ureteroplasty) with or without laser was used as initial approaches whereas follow-up and success rate were analyzed among other parameters. Conclusions: The management of ureteral strictures after KT is challenging and selecting the most appropriate treatment is crucial for successful outcomes. Our review suggests that, an endourologic management is a safe option with good long-term outcomes, especially in short and early strictures.


Asunto(s)
Trasplante de Riñón , Uréter , Obstrucción Ureteral , Humanos , Constricción Patológica/cirugía , Laparoscopía , Estudios Retrospectivos , Uréter/cirugía , Obstrucción Ureteral/etiología , Obstrucción Ureteral/cirugía
16.
Int Urol Nephrol ; 56(6): 1911-1918, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38244116

RESUMEN

BACKGROUND: Laparoscopic ureteroplasty is an effective method for managing ureteropelvic junction obstruction. Despite its high success rate, there remains a subset of patients who do not experience improvement in the hydrops. METHODS: The study retrospectively analyzed the data of 143 patients with ureteropelvic junction obstruction (UPJO) who underwent laparoscopic pyeloplasty (LP) in our hospital from January 2015 to May 2022. Logistic regression was used to analyze the risk factors of recurrence stenosis after UPJO. RESULTS: Out of these patients, 119 had complete clinical data and follow-up records. Among these patients, restenosis occurred in nine cases after the operation. There was a significant statistical difference in blood loss (P < 0.05). Univariate and multivariate logistic regression analysis revealed that the preoperative separation degree of the renal pelvis, cystatin C, and intraoperative blood loss were potential risk factors for recurrent stenosis after primary LP. When divided by split renal function (SRF), the odds ratio (OR) was 7.850 (P = 0.044), indicating that it was an independent risk factor for postoperative restenosis. Similarly, the OR for stenotic segment length was 0.025 (P = 0.011), also indicating it as an independent risk factor for restenosis. The areas under the receiver operating characteristic curve for stenotic segment length and SRF were 0.9056 and 0.7697, respectively. CONCLUSION: In our study, we identified that preoperative renal pelvis separation, cystatin C, and intraoperative blood loss were potential risk factors for postoperative restenosis. SRF and stenosis segment length were independent risk factors for postoperative restenosis.


Asunto(s)
Pelvis Renal , Laparoscopía , Recurrencia , Obstrucción Ureteral , Procedimientos Quirúrgicos Urológicos , Humanos , Obstrucción Ureteral/cirugía , Obstrucción Ureteral/etiología , Masculino , Femenino , Pelvis Renal/cirugía , Estudios Retrospectivos , Laparoscopía/efectos adversos , Factores de Riesgo , Adulto , Persona de Mediana Edad , Constricción Patológica/etiología , Procedimientos Quirúrgicos Urológicos/métodos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Adulto Joven , Uréter/cirugía , Adolescente
18.
J Vasc Interv Radiol ; 35(3): 404-408, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-37939999

RESUMEN

PURPOSE: To evaluate the feasibility of percutaneous transluminal ureteral biopsy (PTUB) combined with percutaneous nephroureteral stent placement for ureteral obstruction under fluoroscopy. MATERIALS AND METHODS: From September 2011 to July 2021, 37 patients (27 men and 10 women; median age, 65.0 years) who experienced ureteroscopic biopsy failure or refused or were unable to undergo ureteroscopic biopsy underwent PTUB for ureteral obstruction during nephroureteral stent placement under fluoroscopic guidance. Data on technical success, early adverse events, and radiation dose were collected. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy (OA) of PTUB were analyzed. RESULTS: The technical success of PTUB was 89.2%, with a mean irradiation dose of 76.9 mGy·cm2 ± 12.2. A total of 67.6% (25/37) of the cases were correctly diagnosed with malignancy, whereas 8 cases were confirmed to be true negatives. There were 4 false negatives and no false positives. PTUB had a sensitivity, specificity, PPV, NPV, and OA of 86.2% (25/29), 100% (8/8), 100% (25/25), 66.7% (8/12), and 89.2% (33/37), respectively. Eleven patients (29.7%) experienced Grade 1 adverse events (transient aggravated hematuria). CONCLUSIONS: PTUB appears to be a safe and effective alternative to ureteroscopic biopsy for ureteral obstruction.


Asunto(s)
Obstrucción Ureteral , Masculino , Humanos , Femenino , Anciano , Obstrucción Ureteral/diagnóstico por imagen , Obstrucción Ureteral/etiología , Obstrucción Ureteral/terapia , Resultado del Tratamiento , Stents , Estudios Retrospectivos , Biopsia/efectos adversos , Instrumentos Quirúrgicos
19.
J Pediatr Urol ; 20(1): 67-74, 2024 02.
Artículo en Inglés | MEDLINE | ID: mdl-37783596

RESUMEN

INTRODUCTION AND OBJECTIVE: Ureteral reimplantation of the dilated ureter in infants is challenging; however, some patients with primary obstructive megaureter (POM) in this age group require intervention due to clinical or radiological progression. We sought to determine if high pressure balloon dilation (HPBD) can serve as a definitive treatment for POM in children under one year of age, or as a temporizing measure until later reimplantation. MATERIALS AND METHODS: All patients from a single institution who underwent HPBD between October 2009 and May 2022 were retrospectively reviewed. Patients were excluded if older than 12 months or diagnosed with neurogenic bladder, posterior urethral valves, or obstructed refluxing megaureter. Patients with prior surgical intervention at the ureterovesical junction were excluded. Indications for surgery included progressive hydroureteronephrosis or urinary tract infection (UTI). Balloon dilation was performed via cystoscopy with fluoroscopic guidance, followed by placement of two temporary ureteral stents. Primary outcomes were improvement or resolution of megaureter and rates of subsequent reimplantation. Secondary outcomes included total number of anesthetics and postoperative UTIs. RESULTS: Fifteen infants with median age of 7.6 months (IQR 3.8-9.7) underwent HPBD. Twelve (80%) patients were detected prenatally and 3 (20%) after a UTI. Indication for surgery was progressive hydroureteronephrosis in 10 patients (67%) and UTI in five (33%). All had SFU grade 3 or 4 hydronephrosis on preoperative ultrasound and median distal ureteral diameter was 13 mm. Median follow up was 2.9 years. Twelve (80%) succeeded with endoscopic treatment: 7 patients had an undetectable distal ureter on ultrasound at last follow-up, 5 were improved with median distal ureteral diameter of 7 mm. Three patients (20%) required ureteral reimplantation due to progressive dilation, all with grade 4 hydronephrosis and distal ureteral diameters were 11, 15, and 21 mm. Six patients (40%) required two anesthetics to complete endoscopic treatment. Among those, 4 patients required initial stent placement for passive dilation followed by a second anesthetic for HPBD weeks later. Two patients underwent repeat HPBD following postoperative proximal migration of the ureteral stents. All 15 patients had an additional anesthetic for removal of stents. Five patients (33%) were treated for a symptomatic UTI (4 febrile, 1 afebrile) with the stents indwelling but there were no UTIs in the group following stent removal. CONCLUSION: Balloon dilation is a practical option for treatment of POM in infants, and in most cases (80%) avoids subsequent open surgery (over median 2.9 years of follow-up).


Asunto(s)
Anestésicos , Hidronefrosis , Uréter , Obstrucción Ureteral , Infecciones Urinarias , Niño , Lactante , Humanos , Obstrucción Ureteral/etiología , Obstrucción Ureteral/cirugía , Estudios Retrospectivos , Dilatación , Uréter/cirugía , Cistoscopía , Hidronefrosis/etiología , Hidronefrosis/cirugía , Resultado del Tratamiento
20.
Int J Urol ; 31(1): 45-50, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-37740658

RESUMEN

PURPOSE: To identify the risk factors for adverse outcomes after pediatric pyeloplasty. METHODS: We conducted a retrospective review of all children under the age of 14 years who underwent primary pyeloplasty for unilateral ureteropelvic junction (UPJ) obstruction at a single teaching hospital in Tunisia between January 1, 2013, and December 31, 2022. RESULTS: A total of 103 patients were included. Median age of patients at surgery was 27 months (interquartile range [IQR], 13-44). On ultrasound, median renal pelvic anteroposterior diameter was 3.2 cm (IQR, 2.3-4), and the median renal cortex thickness (RCT) was 2.5 mm (IQR, 2-3.5). Median differential renal function (DRF) on preoperative radionuclide renal scan was 40% (IQR, 30-46). Postoperative adverse outcomes occurred in 28 patients (27.2%). These included 19 cases of urinary tract infections (UTIs), 11 cases of UPJ restenosis, four cases of UPJ leakage, two cases of urinoma, and two cases of diversion-related complications. Multivariate logistic regression analysis revealed two factors significantly and independently related to postoperative negative outcomes: RCT <3 mm and DRF > 50%. CONCLUSION: Our study demonstrated that preoperative RCT on ultrasound of less than 3 mm and preoperative DRF on radionuclide renal scan of more than 50% were independent risk factors for adverse outcomes following pediatric pyeloplasty. These factors could be of interest in identifying, early on, patients who will develop postoperative negative outcomes, giving them more attention and support, and explaining the prognosis to the patient and family.


Asunto(s)
Hidronefrosis , Uréter , Obstrucción Ureteral , Niño , Humanos , Lactante , Preescolar , Adolescente , Riñón/diagnóstico por imagen , Riñón/cirugía , Uréter/cirugía , Pelvis Renal/diagnóstico por imagen , Pelvis Renal/cirugía , Obstrucción Ureteral/diagnóstico por imagen , Obstrucción Ureteral/etiología , Obstrucción Ureteral/cirugía , Estudios Retrospectivos , Factores de Riesgo , Radioisótopos , Resultado del Tratamiento , Hidronefrosis/diagnóstico por imagen , Hidronefrosis/etiología , Hidronefrosis/cirugía
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