RESUMEN
BACKGROUND: Ureteroinguinal herniation is a rare occurrence that is typically diagnosed during the surgical repair of inguinal hernias. CASE PRESENTATION: We present the case of a 4-year-old male who underwent inguinal hernia repair, during which a megaureter was discovered within the hernia sac. The surgical intervention included high ligation of the hernial sac and repositioning of the ureter back into the retroperitoneum. Postoperative investigations confirmed a diagnosis of primary non-refluxing and nonobstructive megaureter. CONCLUSION: Although ureteral herniation is rare in infants, it is crucial to remain vigilant about the possibility of encountering the ureter during hernia repair to prevent potential ureteral injuries. Additionally, any associated urinary tract anomalies should be thoroughly investigated and ruled out.
Asunto(s)
Hernia Inguinal , Enfermedades Ureterales , Humanos , Masculino , Hernia Inguinal/cirugía , Preescolar , Enfermedades Ureterales/cirugía , Enfermedades Ureterales/diagnóstico , Herniorrafia/métodos , Uréter/anomalías , Uréter/cirugíaRESUMEN
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/complicacionesRESUMEN
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 SeguimientoAsunto(s)
Uréter , Enfermedades Ureterales , Fístula Urinaria , Fístula Vascular , Humanos , Fístula Urinaria/diagnóstico por imagen , Fístula Urinaria/etiología , Uréter/diagnóstico por imagen , Enfermedades Ureterales/diagnóstico , Enfermedades Ureterales/diagnóstico por imagen , Fístula Vascular/diagnóstico , Fístula Vascular/diagnóstico por imagen , Arteria Ilíaca/diagnóstico por imagen , Vena Ilíaca/diagnóstico por imagenRESUMEN
Ureteral ectopia is rare and requires surgical treatment after a thorough diagnostic workup. Open surgical techniques for repositioning ectopic ureters have been known for many years and are well described in the literature. However, to the best of our knowledge, no laparoscopic method of correcting this pathology has been described, which, in our opinion, would benefit the animal in terms of the healing process and overall clinical outcomes. This study aimed to evaluate the possibility of laparoscopic treatment of ureteral ectopia, which causes urinary incontinence in dogs. All of the operated ten dogs presented in this study were client-owned females with symptoms of urinary incontinence due to a unilateral intramural ectopic ureter. A three-trocar laparoscopic technique was used to perform the ureteroneocystostomy of the ectopic ureter. In this article, clinicopathological data, imaging features, procedural findings, complications, and short- and long-term outcomes are presented. The procedure was feasible in all cases. No major postoperative complications were observed. Among the minor complications, slight hematuria was observed in three dogs, which resolved spontaneously. In the period of at least one year after surgery, no negative impact of the procedure was observed. Seven of the ten operated dogs regained urinary continence. The remaining three dogs required additional surgery (urethral bulking) because of a lack of improvement after adjuvant pharmacological treatment. Overall, good-to-excellent long-term outcomes can be achieved; however, dogs that remain incontinent after laparoscopic ureteroneocystostomy may require additional treatment.
Asunto(s)
Coristoma , Enfermedades de los Perros , Laparoscopía , Uréter , Enfermedades Ureterales , Obstrucción Ureteral , Incontinencia Urinaria , Perros , Femenino , Humanos , Animales , Uréter/cirugía , Uréter/patología , Proyectos Piloto , Enfermedades Ureterales/diagnóstico , Enfermedades Ureterales/cirugía , Enfermedades Ureterales/veterinaria , Enfermedades de los Perros/patología , Estudios Retrospectivos , Incontinencia Urinaria/etiología , Incontinencia Urinaria/cirugía , Incontinencia Urinaria/veterinaria , Laparoscopía/efectos adversos , Obstrucción Ureteral/complicaciones , Coristoma/patologíaRESUMEN
OBJECTIVES: Arterio-ureteralï¬stula (AUF) is an infrequent but potentially life-threatening condition. The aim of this study was reviewing the literature to build a ï¬ow-chart useful for an early and effective diagnosis and treatment of this pathology. MATERIALS AND METHODS: A literature search in PubMed was conducted. In addition, retrieved articles were cross-referenced. Data parameters included oncologic, vascular and urological history, diagnostics, treatment, and follow up were collected using a standard template by 2 independent reviewers. RESULTS: A total of 140 cases of AUF out of 172 available in the literature at the time of the review, were considered. All patients presented gross hematuria. Chronic indwelling ureteral catheter (CIUC); history of pelvic surgery (HPS) and history of pelvic radiotherapy (HRT) were present respectively in 81%, 62.1%and 58.6% of the sample. The most predominant location of AUF was at the common iliac artery ureteral crossing. Angiography with provocative measures had the highest diagnostic sensitivity (50%) and endovascular treatment with stent-graft placement across the ï¬stula is the current state of the art treatment choice. CONCLUSIONS: Failure to diagnose can postpone a potentially life-saving targeted therapy and lead to complications. The identiï¬-cation of the Trifecta hematuria, history of pelvic surgery (HPS) and history of pelvic radiotherapy (HPR) would allow the identity-ï¬cation of patients at high risk of AUF, who may beneï¬t from more sensitive early diagnostic investigations such as CT angiography and provocative angiography. The treatment of choice in case of AUF to date consist in endovascular prosthesis placement.
Asunto(s)
Enfermedades Ureterales , Fístula Urinaria , Fístula Vascular , Humanos , Fístula Vascular/diagnóstico , Fístula Vascular/terapia , Fístula Vascular/etiología , Hematuria/etiología , Fístula Urinaria/etiología , Arteria Ilíaca , Enfermedades Ureterales/diagnóstico , Enfermedades Ureterales/terapia , Enfermedades Ureterales/etiología , Diagnóstico Precoz , Stents/efectos adversosRESUMEN
Ureteral injury is one of the major complications related to colorectal and gynecologic procedures. Injuries are sometimes identified intraoperatively, but the diagnosis of ureteral injury is often delayed. Ureterocolic fistula is a relatively rare condition and mostly due to obstructing calculi, diverticular disease of the colon, radiotherapy, cancer, or trauma. Here in, we present a boy with an iatrogenic left ureterocolic fistula following multiple colonic surgeries that were complicated by an un-noticed left ureteric injury. This injury was not diagnosed early and the patient presented later with recurrent UTIs and decreased left differential renal function which necessitated open left nephroureterectomy.
Asunto(s)
Uréter , Enfermedades Ureterales , Fístula Urinaria , Masculino , Humanos , Femenino , Niño , Fístula Urinaria/etiología , Fístula Urinaria/complicaciones , Enfermedades Ureterales/diagnóstico , Enfermedades Ureterales/etiología , Uréter/cirugía , Uréter/lesiones , Colon , Enfermedad IatrogénicaRESUMEN
Ureteritis associated with the immunological disorder is rarely reported, and most cases in this category are small vessel vasculitis and immunoglobulin G4-related disease. Rheumatoid arthritis (RA)-associated ureteritis is uncommon, and underlying aetiology is unclear. We present a patient with ureteritis who had a medical history of RA and was successfully treated with steroids and immunosuppressant. A 49-year-old woman who had been treated for RA and atopic dermatitis suffered from gross haematuria for 5 successive days. Contrast-enhanced computed tomography (CT) showed right-dominant upper urinary tract dilatation with enhanced thickened wall. The haematuria continued accompanied with intermittent right back and lower abdominal pain, and the following CT image taken after 3 months presented the progression to bilateral hydronephrosis. Ureteral stents were placed, and antibiotic therapy was introduced for obstructive pyelonephritis. Ureterocystoscopy and following biopsy from the upper ureteral tract showed a chronic inflammatory change in the histopathology, and we finally considered the stenosing ureteritis to be caused by immune-mediated mechanism related to RA. After starting steroid therapy with methotrexate, therapeutic response was obtained to remove the stents. In the cases of ureteritis or ureteral stenosis of unknown aetiology with a medical history of immunological disorders, we should consider the underlying immune-activated state and try to test contrast-enhanced CT and histological examination before performing a surgical procedure. After excluding the common causes of ureteritis or ureteral stenosis, these tests would support the appropriate diagnosis.
Asunto(s)
Artritis Reumatoide , Enfermedades Ureterales , Femenino , Humanos , Persona de Mediana Edad , Constricción Patológica/complicaciones , Enfermedades Ureterales/complicaciones , Enfermedades Ureterales/diagnóstico , Hematuria/complicaciones , Artritis Reumatoide/complicaciones , Artritis Reumatoide/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
Uretero-iliac artery fistulae represent a urological emergency with considerable mortality. We present 2 cases of a uretero-iliac artery fistula. Nowadays, minimally-invasive endovascular therapy seems to be the treatment of choice. For an optimal outcome, a multidisciplinary team with imminent availability of radiology, vascular surgery, urology and anaesthesia is required.
Asunto(s)
Uréter , Enfermedades Ureterales , Fístula Urinaria , Fístula Vascular , Humanos , Fístula Urinaria/diagnóstico , Fístula Urinaria/cirugía , Arteria Ilíaca/cirugía , Fístula Vascular/diagnóstico , Fístula Vascular/cirugía , Enfermedades Ureterales/diagnóstico , Enfermedades Ureterales/cirugía , StentsRESUMEN
BACKGROUND Endometriosis is a disease characterized by endometrial tissue appearing outside the uterus, mainly involving the peritoneum and pelvic organs. Ureteral endometriosis (UE) is rare, typified by deep infiltrating endometriosis involving the ureter and can result in ureteral obstruction, proximal hydroureter, hydronephrosis, and impairment of renal function. Symptoms may be insidious and nonspecific and may lead to a prolonged disease course. We describe a patient with UE complicated by hydronephrosis. CASE REPORT A 42-year-old woman was admitted to the Urology Department with the incidental discovery of right hydronephrosis. After a thorough examination, she underwent right ureteral mass resection and right ureteral stump anastomosis. The pathology report indicated endometriosis. The patient was given 6 doses of gonadotropin-releasing hormone agonist immediately after surgery, followed by an intrauterine levonorgestrel-releasing system. Postoperative follow-up showed that no recurrence was observed in this year. Here, we briefly summarize the epidemiology, pathogenesis, clinical presentation, imaging, treatment, and prognosis of the disease. CONCLUSIONS UE should be listed as one of the differential diagnoses of unexplained hydronephrosis in women of childbearing age, and those with dysmenorrhea should be cognizant of this disease. Active surgical treatment and long-term management should be carried out to obtain better prognosis.
Asunto(s)
Endometriosis , Hidronefrosis , Uréter , Enfermedades Ureterales , Obstrucción Ureteral , Adulto , Endometriosis/complicaciones , Endometriosis/diagnóstico , Endometriosis/cirugía , Femenino , Humanos , Hidronefrosis/etiología , Uréter/cirugía , Enfermedades Ureterales/complicaciones , Enfermedades Ureterales/diagnóstico , Enfermedades Ureterales/cirugía , Obstrucción Ureteral/diagnóstico , Obstrucción Ureteral/etiología , Obstrucción Ureteral/cirugíaRESUMEN
The article is focused on the problem of diagnosis and surgical treatment of infiltrative forms of endometriosis with lesions of both internal genitalia and urinary tract. A clinical observation of a young woman who underwent a robot-assisted operation on the internal genitals and organs of the urinary system is given. The article emphasizes the need for complete clinical examination in women with suspected endometriosis. The young age of patients, even the absence of bright clinic signs or absence of a long anamnesis of the disease should not exclude the possibility of severe case of endometriosis and the possibility of a combined lesions of pelvic organs. If infiltrative endometriosis is detected, the patients treatment should be carried out in a specialized hospital using modern surgical technologies.
Asunto(s)
Endometriosis , Uréter , Enfermedades Ureterales , Endometriosis/complicaciones , Endometriosis/diagnóstico , Endometriosis/cirugía , Femenino , Estudios de Seguimiento , Humanos , Uréter/patología , Enfermedades Ureterales/diagnóstico , Enfermedades Ureterales/cirugía , UrólogosAsunto(s)
Granuloma de Células Plasmáticas , Neoplasias , Uréter , Enfermedades Ureterales , Adulto , Humanos , Hematuria/etiología , Uréter/patología , Enfermedades Ureterales/complicaciones , Enfermedades Ureterales/diagnóstico , Granuloma de Células Plasmáticas/complicaciones , Granuloma de Células Plasmáticas/diagnóstico , Neoplasias/complicacionesRESUMEN
OBJECTIVE: We present two case reports of asymptomatic ureteral endometriosis leading to hydronephrosis. We demonstrate the significance of routine ultrasound scanning of the upper urinary tract in patients with dia gnosed deep infiltrating endometriosis. CASE REPORTS: The first case report describes a symptomatic patient after a surgery for deep endometriosis. After the surgery, she was completely without symptoms, but during regular check-ups she developed progressive hydronephrosis on the right side and it did not respond to conservative treatment. Surgery deliberation of the ureter was indicated. The second case report describes a patient with already developed severe hydronephrosis on the left side. The functional kidney examination proved complete renal loss of the left kidney. Because of recurrent pyelonephritis in the nonfunctional kidney, nephrectomy was indicated. CONCLUSION: Ureteral endometriosis presents a rare, but insidious form of endometriosis, which is very often asymptomatic and diagnosed at a later stage. It can cause a complete silent loss of renal function. Routine ultrasound scanning examination of the upper urinary tract in all patients with diagnosed endometriosis could prevent this severe complication.
Asunto(s)
Endometriosis , Hidronefrosis , Uréter , Enfermedades Ureterales , Endometriosis/diagnóstico , Endometriosis/diagnóstico por imagen , Femenino , Humanos , Hidronefrosis/diagnóstico por imagen , Hidronefrosis/etiología , Ultrasonografía , Uréter/diagnóstico por imagen , Uréter/cirugía , Enfermedades Ureterales/diagnóstico , Enfermedades Ureterales/diagnóstico por imagenRESUMEN
Objective: Although the sarcoidosis is a multisystemic disease that theoretically can affect almost any organ, the presence of sarcoidosis in the male urethra has not been described in the medical literature. We present the first male case of urethral sarcoidosis. Method: A 46 years old male undergoing follow up due to lower urinary tract symptoms was diagnosed of endobronchial sarcoidosis during the preoperative study for internal urethrotomy. After surgery, he presented clinical improvement for one year. Given the worsening, a new internal urethrotomy was tried. As it was impossible due to complexity they took a biopsy of the urethra. The pathology report described non-caseating granulomas compatible with sarcoidosis. After that, medical and endoscopic management of the urethral sarcoidosis was attempted. As it didn't achieve an adequate control, the patient was derivate to the "complex urethral unit" of the Cruces University Hospital. Once it was valuated, it was decided to start immunotherapy and subsequently an urethroplasty with a double oral mucosa graft was performed. Outcomes: During the postoperative period, a urethral catheter was maintained for two weeks. It was removed after no urinary leakage was observed in de cystourethrography. After that the patient remains with good evolution until today. Conclusions: Urethral affectation by sarcoidosis is a therapeutic challenge itself. For a better symptom control and to reduce the recurrences, a dual approach using systemic treatment in combination with local surgical treatment seems necessary (AU)
Objetivo: Pese a que la sarcoidosis es una enfermedad multisistémica que teóricamente puede afectar a casicualquier órgano, no ha sido descrita en la literatura médicala presencia de sarcoidosis en uretra masculina. Presentamos el diagnóstico y tratamiento del primer caso masculinode sarcoidosis uretral.Método: Varón de 46 años en seguimiento por clínicamiccional de vaciado al que se le diagnosticó de sarcoidosis endobronquial durante el estudio preoperatorio para larealización de una uretrotomía interna. Tras la intervenciónpresentó mejoría clínica durante un año. Ante el empeoramiento, se intentó repetir una nueva uretrotomía internasiendo esta imposible y decidiéndose realizar una biopsia.El informe anatomopatológico describió granulomas no caseificantes compatibles con sarcoidosis. Posteriormente seintentó un manejo médico y endoscópico de la sarcoidosis uretral que no logró un adecuado control por lo que sederivó a la unidad de uretra compleja del Hospital Universitario Cruces. Ante los hallazgos se decidió comenzar coninmunoterapia y posteriormente se realizó una uretroplastiacon doble injerto de mucosa oral.Resultado: Durante el postoperatorio se mantuvo unasonda uretral durante dos semanas. Posteriormente se retirótras la realización de una cistouretrografía miccional seriada donde no se apreciaba fuga urinaria permaneciendo elpaciente con buena evolución hasta hoy en día.Conclusiones: La afectación uretral por sarcoidosissupone actuar ante una patología que de por sí es un retoterapéutico. Para un mejor control sintomatológico y reducir las recidivas parece necesario un abordaje doble mediante un tratamiento sistémico farmacológico en combinación con tratamiento quirúrgico local (AU)
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Sarcoidosis/diagnóstico , Sarcoidosis/cirugía , Enfermedades Ureterales/diagnóstico , Enfermedades Ureterales/cirugía , Procedimientos Quirúrgicos Urológicos Masculinos , Procedimientos de Cirugía Plástica , Mucosa Bucal/trasplante , Resultado del TratamientoRESUMEN
A uretero-vaginal fistula (UVF) describes an abnormal connection between the ureter and vagina causing urinary incontinence, frequent infection, and discomfort. Although UVF might be diagnosed after vaginal delivery, infertility treatment or pelvic radiation therapy, gynecological operations, especially total abdominal hysterectomy, remain the leading cause of ureteral injury and formation of UVF. Traditional ureteroneocystostomy was usually the treatment of choice in patients with UVF. Nevertheless, it is now frequently replaced by less invasive endoscopic and percutaneous procedures which are also highly effective and feasible. That is why, ureteral stenting became the first-line treatment in uncomplicated UVF. The aim of this review is to present clinical presentation of UVF and to assess the current state of knowledge about the diagnosis and management of uretero-vaginal fistula with special interest on minimally-invasive methods.
Asunto(s)
Uréter , Enfermedades Ureterales , Fístula Urinaria , Fístula Vaginal , Femenino , Humanos , Histerectomía/métodos , Uréter/lesiones , Uréter/cirugía , Enfermedades Ureterales/diagnóstico , Enfermedades Ureterales/etiología , Enfermedades Ureterales/cirugía , Fístula Urinaria/diagnóstico , Fístula Urinaria/etiología , Fístula Urinaria/cirugía , Fístula Vaginal/diagnóstico , Fístula Vaginal/etiología , Fístula Vaginal/cirugíaRESUMEN
PURPOSE: Arterio-ureteral fistula (AUF) is an uncommon diagnosis, but potentially lethal. Although the number of reports has increased over the past two decades, the true incidence and contemporary urologists' experience and approach in clinical practice remains unknown. This research is conducted to provide insight in the incidence of AUF in The Netherlands, and the applied diagnostic tests and therapeutic approaches in modern practice. METHODS: A nationwide cross-sectional questionnaire analysis was performed by sending a survey to all registered Dutch urologists. Data collection included information on experience with patients with AUF; and their medical history, diagnostics, treatment, and follow-up, and were captured in a standardized template by two independent reviewers. Descriptive statistics were used. RESULTS: Response rate was 62% and 56 AUFs in 53 patients were reported between 2003 and 2018. The estimated incidence of AUF in The Netherlands in this time period is 3.5 AUFs per year. Hematuria was observed in all patients; 9% intermittent microhematuria, and 91% presenting with, or building up to massive hematuria. For the final diagnosis, angiography was the most efficient modality, confirming diagnosis in 58%. Treatment comprised predominantly endovascular intervention. CONCLUSION: The diagnosis AUF should be considered in patients with persistent intermittent or massive hematuria.
Asunto(s)
Enfermedades Ureterales , Fístula Urinaria , Fístula Vascular , Estudios Transversales , Hematuria/epidemiología , Hematuria/etiología , Humanos , Stents/efectos adversos , Encuestas y Cuestionarios , Enfermedades Ureterales/diagnóstico , Enfermedades Ureterales/epidemiología , Enfermedades Ureterales/etiología , Fístula Urinaria/etiología , Fístula Vascular/diagnóstico , Fístula Vascular/epidemiología , Fístula Vascular/etiologíaRESUMEN
PURPOSE: Arterio-ureteral fistula (AUF) is an uncommon diagnosis, but increasingly reported and potentially lethal. This systematic review comprehensively presents risk factors, pathophysiology, location and clinical presentation of AUF aiming to increase clinical awareness of this rare but life-threatening condition, and to put this entity into a contemporary perspective with modern diagnostic tools and treatment strategies. MATERIALS AND METHODS: This review was performed according to the PRISMA (Preferred Reporting Items for a Systematic Review and Meta-Analysis of Individual Participant Data) guidelines. A literature search in PubMed® and EMBASE™ was conducted. In addition, retrieved articles were cross-referenced. Data parameters included oncologic, vascular and urological history, diagnostics, treatment, and followup, and were collected using a standard template by 2 independent reviewers. RESULTS: A total of 245 articles with 445 patients and 470 AUFs were included. Most patients had chronic indwelling ureteral stents (80%) and history of pelvic oncology (70%). Hematuria was observed in 99% of the patients, of whom 76% presented with massive hematuria with or without previous episodes of (micro)hematuria. For diagnosis, angiography had a sensitivity of 62%. The most predominant location of AUF was at the common iliac artery ureteral crossing. AUF-specific mortality before 2000 vs after 2000 is 19% vs 7%, coinciding with increasing use of endovascular stents. CONCLUSIONS: AUF should be considered in patients with a medical history of vascular surgery, pelvic oncologic surgery, irradiation and/or chronic indwelling ureteral stents presenting with intermittent (micro)hematuria. A multidisciplinary consultation is necessary for diagnosis and treatment. The most sensitive test is angiography and the preferred initial treatment is endovascular.
Asunto(s)
Enfermedades Ureterales , Fístula Urinaria , Fístula Vascular , Humanos , Factores de Riesgo , Enfermedades Ureterales/diagnóstico , Enfermedades Ureterales/fisiopatología , Enfermedades Ureterales/terapia , Fístula Urinaria/diagnóstico , Fístula Urinaria/fisiopatología , Fístula Urinaria/terapia , Fístula Vascular/diagnóstico , Fístula Vascular/fisiopatología , Fístula Vascular/terapiaRESUMEN
We describe a case of congenital giant megaureter in a 16-year-old female. She presented with a 5-day history of abdominal distention, right flank pain and tenderness. Right pyelonephritis was suspected. Computerized tomography showed a large cystic abdominal mass with no appreciably functioning left kidney causing secondary compression of the contralateral right ureter. A left upper nephroureterectomy was performed, draining over 3.5 L of fluid. Our experience suggests that congenital giant megaureter should be considered in the differential for pediatric patients presenting with a cystic abdominal mass.
Asunto(s)
Enfermedades Ureterales/diagnóstico , Dolor Abdominal/etiología , Adolescente , Dilatación Patológica/complicaciones , Dilatación Patológica/congénito , Femenino , Humanos , Enfermedades Ureterales/complicaciones , Enfermedades Ureterales/congénito , Enfermedades Ureterales/patologíaRESUMEN
OBJECTIVES: Ureteral stenosis is a serious complication of flexible ureteroscopy. How to predict the possibility of stricture before surgery is an important topic. This research retrospectively studied the influence of preoperative hydronephrosis on ureteral stenosis after flexible ureteroscopy, to explore whether the preoperative hydronephrosis could predict postoperative ureteral stenosis. METHODS: We conducted a retrospective study on patients who received flexible ureteroscopy in our hospital for upper ureteral calculi from January 2015 to June 2018. Patients were followed-up for 36 months after surgery, and intraoperative and postoperative complications were recorded. We divided patients into the mild hydronephrosis group and moderate to severe hydronephrosis group. Preoperative clinical baseline data of the patients were adjusted by propensity matching score analysis. Differences of intraoperative ureteral injury, operative time, postoperative ureteral stricture, and SFR one month after surgery was statistically analyzed. Kaplan-Meier's method and Log-rank test were used to compare the differences in the cumulative incidence of ureteral stenosis between the two groups. Cox regression was used to compare the hazard ratio of ureteral stenosis between the two groups. RESULTS: A total of 447 patients with 469 sides surgery were included, including 349 sides in the mild hydronephrosis group and 120 sides in the moderate to severe hydronephrosis group. Twenty-nine patients with 30 sides developed ureteral stenosis. Before and after propensity, the incidence of ureteral stricture matching analysis was 6.4% and 8%, respectively. There were statistical differences in ureteral stricture and injury, but the statistical differences in SFR and operation time were inconsistent. Kaplan-Meier showed a significant difference in the cumulative incidence of ureteral stenosis between the two groups. CONCLUSIONS: Patients with moderate to severe hydronephrosis before surgery were more likely to have an intraoperative ureteral injury and postoperative ureteral stricture after FRUS. Preoperative hydronephrosis is an important predictor of ureteral stricture.
Asunto(s)
Constricción Patológica/etiología , Hidronefrosis/diagnóstico , Periodo Preoperatorio , Cálculos Ureterales/cirugía , Enfermedades Ureterales/etiología , Ureteroscopía/efectos adversos , Constricción Patológica/diagnóstico , Estudios de Seguimiento , Humanos , Hidronefrosis/etiología , Complicaciones Intraoperatorias/diagnóstico , Estimación de Kaplan-Meier , Complicaciones Posoperatorias/diagnóstico , Puntaje de Propensión , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Enfermedades Ureterales/diagnóstico , Obstrucción Ureteral/diagnóstico , Obstrucción Ureteral/etiologíaRESUMEN
AIM: Secondary uretero-arterial fistulas (SUAF) are uncommon, underrated and threatening for any patient. Gross hematuria is a clinical symptom of this pathology for patients with history of pelvic radiotherapy, complex pelvic surgery or long-term ureteral stenting. The purpose of this work is to assess risk factors, diagnosis and treatment of SUAF. METHODS: Monocentric and retrospective series of 6 new cases illustrated by a literature review through MedLine and Pubmed using the keywords "arterio-ureteral fistula", "arterio iliac fistula" and "ilio-ureteral fistula". We excluded uretero-arterial fistula following vascular surgery. RESULTS: Our series included 4 men and 2 women. All patients had a history of complex pelvic surgery and long-term ureteral stenting. Three patients had history of pelvic radiotherapy. They all had inaugural macroscopic haematuria episode. Two fistula cases were diagnosed on 5 repeated CT-scans. In 2 out of 5 cases, arteriography highlighted the fistula. Fistulas were generally located at the left common iliac artery. An endovascular stent was placed in 5 out of 6 cases. One patient needed open surgery. After treatment, 3 patients remained alive, 3 patients died either by a fistula relapse or by complications late in the treatment. CONCLUSION: SUAF are uncommon, but serious. Today, there is no specific recommendation regarding complex treatment of these fistulas. Endovascular stents seem to be a good therapeutic option. LEVEL OF PROOF: 3.