Intravesical electrostimulation versus sacral neuromodulation for incomplete spinal cord patients suffering from neurogenic non-obstructive urinary retention.

OBJECTIVES: To compare the efficacy of intravesical electrostimulation (IVES) versus sacral neuromodulation (SNM) in patients with incomplete spinal cord lesions (SCL) and neurogenic non-obstructive urinary retention (N-NOR). METHODS: In this retrospective study, 77 N-NOR patients underwent IVES (minimum 28 sessions), then after returning to voiding baseline symptoms, percutaneous first stage of SNM (lasting for minimum 4 weeks). After the two neuromodulation treatments, responders were categorized as patients experiencing both a 50% reduction of volume per catheterization per ml and a 50% reduction in number of catheterizations per day when comparing the 7-day voiding diaries at the end of both procedures to baselines. New urodynamics were performed subsequently. Responders to first stage of SNM underwent permanent SNM. RESULTS: Forty-eight patients responded to neither of the treatments, whereas 29 responded to both IVES and first-stage SNM. No significant statistical differences (P>0.05) were detected in the voiding diaries. Following the two procedures, the first sensation of bladder filling was either maintained or recovered by all responders, whereas the same 11 patients reached a bladder contractility index of >100. The 29 IVES responders lost their clinical benefits in a mean follow-up of 9.6 months. Only 10 out of the 29 patients became nonresponsive to permanent SNM, in a mean follow-up of 54 months. CONCLUSION: A strict correlation in terms of clinical and urodynamic patterns was demonstrated in patients with incomplete SCL and N-NOR, following IVES and first stage of SNM. However, voiding improvement through IVES was short-term when compared with the effects of permanent SNM.

Ureteral obstructions in dogs and cats: a review of traditional and new interventional diagnostic and therapeutic options.

OBJECTIVE: To describe and review both traditional and newer diagnostic and therapeutic options for canine and feline ureteral obstructions currently being performed clinically in veterinary medicine. DATA SOURCES: A Medline search with no date restrictions was used for this review. HUMAN DATA SYNTHESIS: The human literature would support the use of minimally invasive endourological techniques for the treatment of nearly all causes of ureteral obstructions, whenever possible. This typically includes extracorporeal shockwave lithotripsy, intracorporeal lithotripsy via retrograde ureteroscopy or antegrade percutaneous nephroureterolithotomy, ureteral stenting, percutaneous nephrostomy tube placement, and laparoscopic endopyelotomy. Typically open surgery is only suggested in cases of ureteral or gynecological malignancy when en bloc resection is considered a good option, or when various methods of endourological techniques have failed. VETERINARY DATA SYNTHESIS: The veterinary literature is scarce on the use of interventional endourological techniques for the treatment of ureteral obstructions and has been growing over the last 5 years. The current literature reports the use of extracorporeal shockwave lithotripsy for ureteral stones, as well as the use of ureteral stents for the treatment of trigonal obstructive transitional cell carcinoma, ureterolithiasis, and ureteral strictures. Traditional surgical interventions, like ureterotomy, ureteronephrectomy, and ureteral reimplantation is more vastly reported and accepted. This review will focus on new clinical data using interventional endourological techniques for ureteral obstructions. CONCLUSIONS: Various treatment options for ureteral obstructions are now available for veterinary patients, and the trend away from traditional surgical techniques will hopefully be followed now that they are technically and clinically available for dogs and cats.

Urografía por RM: un método alternativo en la evaluación en pediatría del aparato urinario / MR urography: imaging alternative procedure of the urinary tract in childhood

Tomando como base las secuencias conocidas como RARE, las RM urográficas, se ha planteado como un método alternativo en la evaluación del aparato urinario. Se evaluaron 16 pacientes pediátricos, 11 niñas y 5 varones, con edades entre 4 meses y 14 años. Se investigaron: a) dilatación de la vía excretora, (6 pacientes); b) evaluación de estenosis pieloureterales, 2; c) evaluación postquirúrgica de estenosis pieloureterales, 1; d) riñón en herradura, 1; e) doble vía excretora, 3; f) en reemplazo de U.E., 2 y g) síndrome de regresión caudal, 1 paciente. Se evaluaron en forma adecuada las uropatías obstructivas, determinándose en forma exacta el punto de obstrucción, no así su causa; se logró con las imágenes obtenidas, adecuada discriminación anatómica córtico medular; también fueron satisfactorios los resultados en la evaluación de malformaciones del tipo riñón en herradura y síndrome de regresión caudal. Contrariamente no fueron buenos los resultados en la evaluación de la vía excretora. En conclusión, la RM urográfica actualmente puede ser considerada, un método válido para el estudio del tracto urinario, llegando a reemplazar al U.E. en situaciones específicas; las principales objeciones al método son su costo, las dificultades que presenta en la evaluación de vía excretora no dilatada y la necesidad de anestesiar a los menores de 5 años

Urografía por RM: un método alternativo en la evaluación en pediatría del aparato urinario / MR urography: imaging alternative procedure of the urinary tract in childhood

Tomando como base las secuencias conocidas como RARE, las RM urográficas, se ha planteado como un método alternativo en la evaluación del aparato urinario. Se evaluaron 16 pacientes pediátricos, 11 niñas y 5 varones, con edades entre 4 meses y 14 años. Se investigaron: a) dilatación de la vía excretora, (6 pacientes); b) evaluación de estenosis pieloureterales, 2; c) evaluación postquirúrgica de estenosis pieloureterales, 1; d) riñón en herradura, 1; e) doble vía excretora, 3; f) en reemplazo de U.E., 2 y g) síndrome de regresión caudal, 1 paciente. Se evaluaron en forma adecuada las uropatías obstructivas, determinándose en forma exacta el punto de obstrucción, no así su causa; se logró con las imágenes obtenidas, adecuada discriminación anatómica córtico medular; también fueron satisfactorios los resultados en la evaluación de malformaciones del tipo riñón en herradura y síndrome de regresión caudal. Contrariamente no fueron buenos los resultados en la evaluación de la vía excretora. En conclusión, la RM urográfica actualmente puede ser considerada, un método válido para el estudio del tracto urinario, llegando a reemplazar al U.E. en situaciones específicas; las principales objeciones al método son su costo, las dificultades que presenta en la evaluación de vía excretora no dilatada y la necesidad de anestesiar a los menores de 5 años (AU)

Segmental stenosis of ureter: a late complication of intra-arterial chemotherapy for bladder cancer.

A 54-year-old Japanese male was treated with a single shot of cisplatin-phosphatidylcholine-lipiodol (CPL) suspension due to bladder tumour (stage T2N0M0). Seven months later, a right lower ureteral stenosis developed. The possible cause of ureteral stenosis due to intra-arterial chemotherapy is discussed.

Management of ureteropelvic obstruction in the first year of life.

From July 1971 until December 1978 we treated 19 male and 5 female children less than 1 year old for ureteropelvic junction obstruction. Diagnosis was based on high dose excretory urography with delayed films. Ultrasound was performed in some cases to confirm hydronephrosis. Cystoscopy and retrograde pyelography were not required. Of 32 obstructed kidneys 27 were repaired by dismembered reduction pyeloureteroplasty. Of 8 patients with bilateral involvement 3 underwent unilateral repair only because of lesser contralateral obstruction and 1 underwent unilateral nephrectomy. Of the 27 repairs 20 were protected by nephrostomy or pyelostomy drainage plus a small caliber silicone rubber or polyvinyl stent. Of the 6 non-stented repairs 2 had delayed opening of the repair. A frozen section renal biopsy aided in a decision to repair the kidney in 4 of 6 instances and in 10 other instances a renal biopsy was obtained for prognostic purposes. There were no secondary nephrectomies, although 2 boys required reoperations for a successful result. Instillation pyelography with fluoroscopic monitoring was used to determine when the tubes could be removed. Generally, we removed the stent 4 or 5 days postoperatively and the nephrostomy at a variable time after demonstration of patency of repair. In this group of small children pyelostomy or nephrostomy and intubation of the repair are useful additions to the surgical technique to prevent obstruction of the tiny and delicate infant ureter by anastomotic edema or kinking of the repair.