ABSTRACT
Fibroepithelial polyps in the urinary tract are a rare cause of obstructive uropathy with fewer than 130 cases reported in the literature. In our series, we describe polyps that were missed on preoperative imaging and later found in the operating room during pyeloplasty. It is critical for urologists to be aware of polyps as a potential source of obstruction as they can increase the complexity of a reconstruction and, if missed, may result in a failed repair and persistent obstruction. We hypothesize that performing a retrograde pyelogram prior to ureteric reconstruction will facilitate diagnosis prior to surgical repair.
Subject(s)
Polyps , Ureteral Obstruction , Humans , Polyps/surgery , Polyps/diagnosis , Male , Female , Ureteral Obstruction/surgery , Ureteral Obstruction/etiology , Ureteral Obstruction/diagnosis , Ureteral Neoplasms/diagnosis , Ureteral Neoplasms/surgery , Ureteral Neoplasms/pathology , Middle Aged , AdultABSTRACT
INTRODUCTION AND OBJECTIVES: Nephroureterectomy remains the gold standard treatment option for upper tract tumors. However, segmental ureterectomy may be another option in patients with single kidney, borderline renal function or high medical comorbidities. The aim of this video is to assess the feasibility of robotic surgery as a minimally invasive technique in treatment of a high comorbid patient with ureteric tumor. MATERIALS AND METHODS: Eighty-year old male patient, with a medical history of chronic hypertensive and uncontrolled Diabetes Mellitus, was referred to our department for treatment of ureteric tumor. Patient underwent robot-assisted radical prostatectomy 5 years ago. Patient's Charlson comorbidity index score was 9. Computed tomography showed a 2.5cm right ureteral luminal filling enhancing lesion at lower part of upper 1/3 ureter. We performed diagnostic flexible cystoscopy under local anesthesia to exclude associated lower urinary tract carcinoma, and bladder wash was negative for malignancy. Under general anesthesia patient underwent diagnostic flexible ureteroscopy to confirm mass location, and a retrograde pyelography to rule out additional tumors on the right collecting system. Then, the patient was placed in the full lateral flank position without Table flexion. Ports placement were inserted as follow: a "12mm" optical trocar at pararectal line superior and lateral to umbilicus, two "8mm" robotic trocars cranial and caudal to optical trocar (8cm distance), a "8mm" robotic trocar towards anterior superior ischial spine, and a "12mm" assistant trocar was inserted between umbilicus and pubic bone. The surgical steps are shown in the video. RESULTS: The procedure was performed easily. The total operative time and consol time were 100 and 60 minutes, respectively. Blood loss was 50ml. No reported intraoperative or postoperative complications. Notably, we took full precautions in case of intraoperative failure to complete the procedure successfully, nephroureterectomy was our second option. Postoperative serum creatinine was 1.2mg/dL and length of hospital stay was 2 days. The frozen biopsy showed that the tumor was resected with safe proximal and distal surgical margins. Final histopathology revealed high grade (G3) urothelial carcinoma (pT3), measures (1.3x1.2x0.2cm), associated with carcinoma in situ. CONCLUSION: We affirm that robotic segmental ureterectomy and ureteroureterostomy could be offered safely as a minimally invasive treatment for patients with ureteric tumors and high-risk medical comorbidities. It provides excellent perioperative outcomes and early oncological safety with regard to surgical margins.
Subject(s)
Robotic Surgical Procedures/methods , Ureteral Neoplasms/diagnosis , Urologic Surgical Procedures/methods , Aged, 80 and over , Comorbidity , Humans , Male , Treatment Outcome , Ureter/surgeryABSTRACT
PURPOSE: Diffusion-weighted (DW) magnetic resonance imaging (MRI) provides information about the biophysical properties of tissues such as cell organization and density. DW imaging (DWI) is becoming important in the assessment of malignant tumors. The purpose of our study was to evaluate the capability and reliability of DWI in the evaluation of upper urinary tract urothelial tumors. MATERIALS AND METHODS: DWI was performed in seventeen patients with upper urinary tract urothelial tumor, previously diagnosed by either CT or retrograde pyelography. An histological evaluation was performed after surgical resection. Each MRI was carried out using a 1.5T superconductive magnet MRI system. DWI images were obtained with b value of 1000 s/mm(2) under normal breathing. The apparent diffusion coefficient (ADC) values were measured. RESULTS: In nine patients with renal pelvis tumors and seven patients with ureteral tumors, the lesions were shown as high-signal intensity in the corresponding region on DWI. In one patient with carcinoma in situ (CIS) of the ureter, the lesion was not depicted with DWI. The mean ADC value of the tumor was 1.125 + or - 0.217 x 10(-3) mm(2)/s and was significantly lower than those of the renal parenchyma (1.984 + or - 0.238 x 10(-3) mm(2)/s, p < 0.01) and the urine (2.941 + or - 0.315 x 10(-3) mm(2)/s, p < 0.01). CONCLUSIONS: In our study, the renal pelvic and ureteral tumors except CIS were shown clearly with DWI. Although further studies are required, DWI may take the place of invasive retrograde urography for detecting tumors of the upper urinary tract.
Subject(s)
Kidney Neoplasms/diagnosis , Ureteral Neoplasms/diagnosis , Aged , Aged, 80 and over , Diffusion Magnetic Resonance Imaging , Female , Humans , Male , Middle Aged , Neoplasm Staging , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
Purpose: Diffusion-weighted (DW) magnetic resonance imaging (MRI) provides information about the biophysical properties of tissues such as cell organization and density. DW imaging (DWI) is becoming important in the assessment of malignant tumors. The purpose of our study was to evaluate the capability and reliability of DWI in the evaluation of upper urinary tract urothelial tumors. Materials and methods: DWI was performed in seventeen patients with upper urinary tract urothelial tumor, previously diagnosed by either CT or retrograde pyelography. An histological evaluation was performed after surgical resection. Each MRI was carried out using a 1.5T superconductive magnet MRI system. DWI images were obtained with b value of 1000 s/mm2 under normal breathing. The apparent diffusion coefficient (ADC) values were measured. Results: In nine patients with renal pelvis tumors and seven patients with ureteral tumors, the lesions were shown as high-signal intensity in the corresponding region on DWI. In one patient with carcinoma in situ (CIS) of the ureter, the lesion was not depicted with DWI. The mean ADC value of the tumor was 1.125 ± 0.217 x 10-3 mm2/s and was significantly lower than those of the renal parenchyma (1.984 ± 0.238 x 10-3 mm2/s, p < 0.01) and the urine (2.941 ± 0.315 x 10-3 mm2/s, p < 0.01). Conclusions: In our study, the renal pelvic and ureteral tumors except CIS were shown clearly with DWI. Although further studies are required, DWI may take the place of invasive retrograde urography for detecting tumors of the upper urinary tract.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Kidney Neoplasms/diagnosis , Ureteral Neoplasms/diagnosis , Diffusion Magnetic Resonance Imaging , Neoplasm Staging , Reproducibility of Results , Sensitivity and SpecificitySubject(s)
Adenocarcinoma/diagnosis , Adenocarcinoma/surgery , Endoscopy/methods , Endosonography/methods , Ureteral Neoplasms/diagnosis , Ureteral Neoplasms/surgery , Ureterostomy/methods , Adenocarcinoma/pathology , Aged , Biopsy , Cystoscopy , Female , Hematuria/etiology , Humans , Neoplasm Staging , Ureteral Neoplasms/complications , Ureteral Neoplasms/pathology , Ureteral Obstruction/complications , Ureteral Obstruction/diagnosisABSTRACT
OBJECTIVES: To report the rare case of a patient with a ureteral polyp. METHODS: We describe the case of a 55-year-old female patient receiving care at the Celia Sanchez Manduley University Hospital in Manzanillo, Cuba, who was fortuitously diagnosed of a fibroepithelial polyp of the right ureter during the work up and treatment of an ovarian tumor. RESULTS: This case is the first of its kind in this hospital after 22 years, which confirms the rarity of ureteral tumors, specifically those of benign etiology. The absence of symptoms, specifically hematuria and pain, does not correspond to the reviewed articles. The chosen treatment was exeresis of the polyp at its base and frozen biopsy, followed by re-establishment of the urinary passage, as various authors recommend. Currently the endoscopical approach is recommended for its multiple advantages. CONCLUSIONS: We conclude that this disease is very rare, may have a symptomatic course and the treatment of choice is surgery with very good results.
Subject(s)
Polyps , Ureteral Neoplasms , Female , Humans , Middle Aged , Polyps/diagnosis , Polyps/surgery , Ureteral Neoplasms/diagnosis , Ureteral Neoplasms/surgeryABSTRACT
The transrectal route is currently the preferred one for the performance of prostatic and seminal vesicles biopsies, and its safety and good tolerance are well proved. Transrectal ultrasound, further to be commonly used to guide these biopsies, enables this route to be used for the biopsy of other pelvic organs or masses. However, this has been used only rarely for other organs than prostate or seminal vesicles. We reported a case where a transrectal biopsy was used to diagnose a suspected ureteral metastasis from a rectal adenocarcinoma. The anatomo-pathological study showed that the mass was an urothelial carcinoma of the ureter
Subject(s)
Humans , Male , Aged , Biopsy , Ultrasonography , Ureteral Neoplasms/diagnosisABSTRACT
Context: The association of primary carcinoma of the ureter and lithiasis is extremely rare. We report a rare case of a primary carcinoma of the ureter with corariform calculus. Case Report: 60-year-old phaeodermal female, reported a history of right-side nephritic colic, hyperthermia and pyuria during the past 20 years andhad received treatment for urinary infections a number of times. The first clinical presentation was related to lithiasis and the tumor had not been shown up by excretory urography, cystoscopy or ultrasonography. Two months after the calculus had been eliminated, the patient began to have serious symptoms and a grade III transitional cell carcinoma of the ureter was discovered. Total nephroureterectomy and M.V.A.C. (Metrotrexate + Vinblastina + Doxo Rubicina + Cisplatina) chemotherapy were tried unsuccessfully. In this report we emphasize the diagnostic difficulty caused by the concomitant presence of the two pathologies. In our opinion, the rapid evolution in this case is directly related to the high grade of the tumor.
Subject(s)
Middle Aged , Humans , Female , Ureteral Neoplasms/complications , Carcinoma, Transitional Cell/complications , Urinary Calculi/complications , Ureteral Neoplasms/diagnosis , Ureteral Neoplasms/drug therapy , Carcinoma, Transitional Cell/diagnosis , Carcinoma, Transitional Cell/drug therapy , Fatal OutcomeABSTRACT
Herein we report a case of malignant primary tumor of the ureter that had been seen and treated in the Department of Urology of Hospital Docente Clinico Quirurgico "10 de Octubre", in Havana, Cuba. The incidence, possible etiology, classification, forms of presentation, diagnosis, treatment and prognosis of this disease entity are discussed. The national and the world literature are reviewed.
Subject(s)
Carcinoma, Transitional Cell , Ureteral Neoplasms , Carcinoma, Transitional Cell/classification , Carcinoma, Transitional Cell/diagnosis , Carcinoma, Transitional Cell/surgery , Hematuria/diagnosis , Hematuria/etiology , Humans , Male , Middle Aged , Ureteral Neoplasms/classification , Ureteral Neoplasms/diagnosis , Ureteral Neoplasms/surgeryABSTRACT
Paciente de 60 anos foi submetido à ureteroscopia por suspeita de tumor do ureter, confirmado pela biópsia que revelou carcinoma papilífero de células transicionais. O tratamento consistiu na eletrocauterizaçäo endoscópica do tumor. Onze dias após, foi ressecada a porçäo acometida do ureter e o exame anatomopatológico revelou ausência de neoplasia
Subject(s)
Middle Aged , Humans , Male , Cautery , Endoscopy , Ureteral Neoplasms/diagnosis , Urography , Ureteral Neoplasms/pathology , Ureteral Neoplasms/surgeryABSTRACT
Se presenta nuestra experiencia de ureterorenoscopía con cirugía endoscópica intracavitaria con el instrumento rígido de Pérez-Castro. Se ha aplicado a 74 pacientes con éxito en 65 casos (88%), en 37 casos se efectuó cirugía endoscópica además, efectuando extracciones de cálculos con Sonda Dormia, toma de biopsis en 2 tumores, uno ureteral y otro de cáliz superior, y un caso de extracción de cuerpo extraño. (Cateter ureteral). En 3 casos se utilizó ultrasonido para destruír bajo visión directa cálculos ureterales grandes
Subject(s)
Humans , Male , Female , Ureteral Calculi/diagnosis , Ureter/surgery , Endoscopy , Ultrasonic Therapy , Ureteral Neoplasms/diagnosis , Urologic Surgical ProceduresABSTRACT
Relata-se um caso de pólipo fibrovascular do ureter esquerdo em paciente portadora de duplicidade renoureteral completa à esquerda, cujas manifestaçöes clínicas se caracterizam por apresentar surtos de infecçäo e pela presença de tumor, o qual, emergindo de um dos meatos ureterais esquerdos, provoca sangramento e obstruçäo uretral intermitente. A propósito dessa rara patologia, discutem-se tópicos do diagnóstico e tratamento dos tumores ureterais, assinalando as peculiaridades que envolvem este caso inédito, bem como a conduta cirúrgica adotada. Esta consistiu na abordagem direta do ureter comprometido e a ressecçäo por fulguraçäo da base do pólipo. O seguimento é de 24 meses, sem recidiva tumoral