Sprematic vein abscess after varicocele embolization - A case presentation.

Testicular varicocele is a dilatation of the pampiniform plexus. It is a common clinical problem affecting 15% of adolescents and adults that may be associated with pain and discomfort, and can affect fertility. Varicocele treatment is associated with a significant improvement in sperm parameters, and pregnancy rate. For endovascular treatment Fibered embolization coils are commonly utilized. Complications associated with coil insertion are rare, but can have serious consequences. Here, we presenting the first reported case of a retroperitoneal abscess following testicular vein coil embolization. The patient underwent successful laparoscopic removal the infected coil followed by full recovery.

Endoscopic bulking materials for the treatment of vesicoureteral reflux: a review of our 20 years of experience and review of the literature.

Purpose. We reviewed our 20 years of experience and the current literature regarding the long-term outcome of endoscopic treatment of vesicoureteric reflux (VUR) using the different tissue bulking substances with a special emphasis on the long-term efficacy. Material and Methods. Our own experience and the current literature on the long-term results after endoscopic treatment using various bulking agents were reviewed. Results. Short-term data following endoscopic treatment of VUR is similar to the various substances and comparable in the majority of the series to the success rate following open surgery. Recently, a relatively high recurrence rate was noticed especially with the use of dextranomer hyaluronic acid (Dx/HA) as a tissue augmenting material which raises the need for further search for alternative substances. Conclusions. Unfortunately, there is a significant shortage of evidence-based literature on the long-term followup after endoscopic correction of reflux with various substances. No doubt, there is a high recurrence rate during long-term followup after Dx/HA injection, and there is probably lack of proper evaluation regarding the long-term efficacy of other bulking materials. These facts demand long-term close observation and long-term studies beyond the routine protocols following endoscopic treatment of VUR and the correct parental counseling upon the endoscopic correction.

Endoscopic treatment of vesicoureteral reflux in an adult population: Can we teach our adult urology colleagues?

OBJECTIVE: Vesicoureteral reflux (VUR) is not well described or understood in adults. Since endoscopic correction of VUR has become a first-line therapy in children, we aimed to evaluate the efficacy of this technique in adult patients. PATIENTS AND METHODS: In 1988-2008, 49 adult patients (6 males, 43 females) with a mean age of 33.6 years (range 18-64) underwent endoscopic treatment of VUR. Reflux was unilateral in 17 (34.7%) and bilateral in 32 (65.3%) patients, comprising 81 renal refluxing units (RRU). Of these, 71 (87.7%) were primary VUR. Reflux was Grade I in 14 (17%), Grade II in 46 (56.8%), Grade III in 17 (21%) and Grade IV in 4 (4.9%) RRU. Median renal function at surgery was 41.2%. Endoscopic correction utilized polytetrafluoroethylene (Teflon) in 38 (77.6%) and dextranomer/hyaluronic acid copolymer in 11 (22.4%) patients. Recurrent febrile urinary tract infection (UTI) was the only indication for surgery. Grade I VUR was treated only in patients with contralateral high-grade VUR. RESULTS: The reflux was corrected in 63 (77.8%) RRU after a single injection, after second injection in 9 (10.6%) and after third in 4 (4.8%) RRU. In 3 (3.5%) RRU, VUR improved to Grade I. In 2 (2.4%), endoscopic correction failed, leading to open reimplantation. One patient with corrected VUR underwent nephrectomy due to non-functioning kidney and recurrent pyelonephritis. Fourteen (28.6%) patients suffered afebrile UTI. Five (10.2%) developed febrile UTI following successful endoscopic correction, leading to a diagnosis of VUR recurrence in two (4.1%) patients. CONCLUSIONS: Endoscopic correction of VUR in adults is a simple and effective procedure, as in pediatric practice.

Renal scarring and urinary tract infection after successful endoscopic correction of vesicoureteral reflux.

PURPOSE: We evaluated renal function and the incidence of urinary tract infection after successful endoscopic correction of vesicoureteral reflux. MATERIALS AND METHODS: From 1988 to 2007, 169 male and 338 female patients (696 refluxing renal units) with a median age of 3.7 years underwent successful endoscopic correction of primary vesicoureteral reflux using polytetrafluoroethylene and dextranomer/hyaluronic acid copolymer. Reflux was grades I to V in 36 (5.2%), 178 (25.6%), 298 (42.7%), 163 (23.4%) and 21 refluxing renal units (3.1%), respectively. Renal ultrasound and (99m)technetium-dimercaptosuccinic acid scan were performed in all patients preoperatively, and in all patients and in 509 of 696 refluxing renal units (73%) postoperatively, respectively. All patients were followed 1 to 20 years (median 13). RESULTS: Preoperatively (99m)technetium-dimercaptosuccinic acid scan revealed scarring in 543 of 696 refluxing renal units (78%). Reflux resolved after 1 injection in 473 refluxing renal units (68%), in 161 (23%) after 2 and in 25 ureters (3.6%) after 3. In 37 refluxing renal units (5.4%) reflux improved to grade I, which required no further treatment. Renal deterioration was noted in 11 of 26 refluxing renal units with initially severe renal scarring (less than 20% uptake on (99m)technetium-dimercaptosuccinic acid scan). The remaining refluxing renal units in this group showed an insignificant 2.3% change in relative function after successful reflux correction (p >0.005). Patients with vesicoureteral reflux downgrading did not show new renal scars. Of the remaining 446 refluxing renal units 27 (6.1%) showed a greater than 5% decrease in relative function without new scarring. Eight children in the polytetrafluoroethylene group and 3 in the dextranomer/hyaluronic acid copolymer group (overall 2.2%) had febrile urinary tract infection after successful endoscopic correction, leading to reevaluation that resulted in the diagnosis of recurrent reflux in 8 (72.7%). A total of 28 children (5.6%) had afebrile urinary tract infection without recurrent vesicoureteral reflux. CONCLUSIONS: Our data show that successful endoscopic correction of vesicoureteral reflux is accompanied by a low incidence of new renal scarring and febrile urinary tract infection. Patients who initially have corrected reflux but who have a febrile urinary tract infection at long-term followup require prompt revaluation to rule out recurrent reflux.

Unilateral vesicoureteral reflux and history of contralateral vesicoureteral reflux warranting routine bilateral endoscopic correction.

PURPOSE: It has been shown that the incidence of de novo vesicoureteral reflux following unilateral endoscopic correction is low and does not justify prophylactic injection into the nonrefluxing ureter. We analyzed whether we should routinely treat each ureter in patients with a history of bilateral vesicoureteral reflux in whom reflux previously disappeared spontaneously on 1 side. MATERIALS AND METHODS: Between 1991 and 2005, 458 children underwent endoscopic correction of unilateral vesicoureteral reflux. Of the children 15 with bilateral vesicoureteral reflux at the beginning of followup showed spontaneous reflux resolution on 1 side. Resolved reflux was grade II to IV in 5, 8 and 2 children, respectively. Mean time to reflux resolution was 3.3 years (range 2 to 5). Reflux corrected endoscopically was grade II to IV in 1, 6 and 8 children, respectively. All children were female and age at endoscopic correction was 2 to 16 years. None of the children had voiding dysfunction at the time of injection. Injection was performed routinely only into the refluxing ureter. Configuration of the orifice of the ureter with resolved vesicoureteral reflux was recorded at injection. RESULTS: Vesicoureteral reflux was corrected in all except 1 ureter, in which reflux was downgraded to grade I. The configuration of the orifice of the ureter with resolved reflux was normal in all children. Of the 15 children 14 (93%) showed recurrent vesicoureteral reflux in previously resolved ureters. Recurrent reflux grade was I to III in 1 (7.1%), 6 (42.8%) and 7 children (50%), respectively. All children required endoscopic correction on the side of recurrence due to high grade reflux in 7 and breakthrough urinary tract infection in the remaining 7. In 2 cases (14.2%) renal scan revealed new renal scarring. CONCLUSIONS: There is a high incidence of recurrent vesicoureteral reflux in previously resolved ureters following endoscopic correction on the contralateral side. Therefore, we recommend routine injection of the 2 ureters in patients with a history of bilateral vesicoureteral reflux.