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1.
Curr Urol Rep ; 21(1): 3, 2020 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-31960193

RESUMO

PURPOSE OF REVIEW: In the setting of kidney transplantation, the ureter is a common source for complications. As a result, prevention of ureteral complications and their management is of crucial importance. In this context, the purpose of this review is to summarize recent literature on the ureter in the kidney transplant setting with a special focus on new findings. We conducted a PubMed and Medline search over the last 10 years to identify all new publications related to ureteroneoimplantations, stents and management of complications in the kidney transplant setting. RECENT FINDINGS: Performance of the "Lich-Gregoir" technique for ureteroneocystostomy seems to be favourable in regard to postoperative complications when compared with other methods described in the literature. Moreover, major urologic complications can be further reduced by ureteral stenting. A new approach for management of ureteral strictures in renal transplants is presented. We discussed the usage of a ureteral stent covered with a biostable polymer aiming to prevent tissue ingrowth into the lumen as a new option for management of ureteral stricture in the kidney transplant setting.


Assuntos
Transplante de Rim/métodos , Ureter/cirurgia , Obstrução Ureteral/terapia , Derivação Urinária/efeitos adversos , Derivação Urinária/métodos , Anastomose Cirúrgica/efeitos adversos , Constrição Patológica , Humanos , Stents , Obstrução Ureteral/etiologia
2.
Urology ; 135: 57-65, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31618656

RESUMO

OBJECTIVE: To evaluate differences in the incidence of benign ureteroenteric stricture, we compared stricture rates of robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC) using Surveillance, Epidemiology, and End Results-Medicare data. METHODS: We identified 332 RARC and 1449 ORC performed between 2009 and 2014 to determine stricture rates at 6, 12, and 24 months following surgery. We defined ureteroenteric stricture as the need for procedural intervention. Additionally, we compared the incidence of stricture diagnosis. Multivariable proportional hazards regression was performed to determine factors associated with stricture development. RESULTS: The incidence of ureteroenteric stricture at 6 and 12 months was higher for RARC vs ORC at 12.1% vs 7.0% (P < .01) and 15.0% vs 9.5% (P = .01), respectively. RARC vs ORC stricture incidence at 2 years did not differ significantly at 14.6% vs 11.4% (P = .29). Similarly, the stricture diagnosis rates were significantly lower following ORC at 6, 12, and 24 months (P < .05). In adjusted analysis, RARC (HR 1.64, 95%CI 1.23-2.19) and preoperative hydronephrosis (HR 1.51, 95% CI 1.17-1.94) were associated with the development of stricture. Higher hospital volume was associated with a lower risk of stricture (HR 0.40, 95%CI 0.26-0.63). CONCLUSION: RARC is associated with a higher rate of ureteroenteric stricture diagnosis and intervention on a population-based level that is mitigated by higher hospital volume. A significant study limitation is inability to differentiate extracorporeal vs intracorporeal diversion. However, a stricture complication compounds the financial burden of care and efforts must be pursued to improve this surgical outcome.


Assuntos
Cistectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Obstrução Ureteral/epidemiologia , Derivação Urinária/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Carcinoma de Células de Transição/cirurgia , Constrição Patológica/epidemiologia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Cistectomia/métodos , Feminino , Humanos , Incidência , Intestinos/cirurgia , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do Tratamento , Ureter/cirurgia , Obstrução Ureteral/etiologia , Obstrução Ureteral/cirurgia , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos
4.
Int Braz J Urol ; 45(6): 1266-1269, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808416

RESUMO

We describe the rare case of a 61-year-old female with right ureteropelvic junction (UPJ) obstruction caused by metastatic cholangiocarcinoma. Her past medical history was notable for cholangiocarcinoma treated with neoadjuvant chemoradiation and two orthotopic liver transplants six years earlier. Urology was consulted when she presented with flank pain and urinary tract infection. Diagnostic workup demonstrated right UPJ obstruction. She was managed acutely with percutaneous nephrostomy. She subsequently underwent robotic pyeloplasty and intrinsic obstruction of the UPJ was discovered. Histological examination revealed adenocarcinoma, consistent with systemic recurrence of the patient's known cholangiocarcinoma.


Assuntos
Colangiocarcinoma/complicações , Neoplasias Pélvicas/complicações , Neoplasias Ureterais/complicações , Obstrução Ureteral/etiologia , Neoplasias dos Ductos Biliares/patologia , Colangiocarcinoma/secundário , Feminino , Humanos , Hidronefrose/diagnóstico por imagem , Hidronefrose/etiologia , Pessoa de Meia-Idade , Neoplasias Pélvicas/secundário , Tomografia Computadorizada por Raios X , Neoplasias Ureterais/secundário , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/patologia , Urografia
5.
Medicine (Baltimore) ; 98(50): e18415, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852165

RESUMO

RATIONALE: Urinary obstruction are relatively rare complications of autoimmune diseases including systemic lupus erythematosus and systemic vasculitis. It has never been reported in rheumatoid arthritis (RA). PATIENT CONCERNS: We report a case of a female patient with seropositive RA who presented with gross hematuria associated with worsening joint symptoms, found to have acute kidney injury (AKI), bilateral hydronephrosis with bilateral renal pelvis, and ureteral wall thickening. Uroscopy with biopsy demonstrated inflammation without evidence of malignancy. DIAGNOSES: Rheumatoid arthritis related inflammation and obstruction of the urinary tract. INTERVENTIONS: Prednisone 50 mg daily (tapering began 1 month later), iguratimod 50 mg daily, and leflunomide 20 mg daily were prescribed. OUTCOMES: The patient responded well to steroids and immunosuppressive therapy with complete resolution of hematuria, renal injury, and hydronephrosis. LESSONS: Our case showed that RA might cause local inflammation involving the urinary tract which leads to obstruction and AKI.


Assuntos
Artrite Reumatoide/complicações , Obstrução Ureteral/etiologia , Anti-Inflamatórios/uso terapêutico , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/tratamento farmacológico , Progressão da Doença , Feminino , Hematúria/etiologia , Humanos , Hidronefrose/etiologia , Imunossupressores/uso terapêutico , Pessoa de Meia-Idade , Prednisona/uso terapêutico , Obstrução Ureteral/tratamento farmacológico
6.
Beijing Da Xue Xue Bao Yi Xue Ban ; 51(6): 1155-1158, 2019 Dec 18.
Artigo em Chinês | MEDLINE | ID: mdl-31848521

RESUMO

OBJECTIVE: To evaluate the safety and efficacy of endoscopic treatment for ureterovesical junction (UVJ) stenosis in patients with kidney transplantation. METHODS: A retrospective study was conducted among the patients with kidney transplantation diagnosed as UVJ stenosis from 2012 March to 2018 July in Urology and Lithotripsy Center, Peking University People's Hospital. Only the patients who received endoscopic treatment were included, with staged or same-session nephrostomy followed by a retrograde ureteroscopy to evaluate the ureteral stenosis. Incisions with laser, mono- or bipolar energy, or balloon dilation were used to manage the stenosis depending on different situations. Demographic characteristics and clinical data were gathered and analyzed, including age, gender, preoperative serum creatinine, hemoglobin, operation time, success rate, postoperative serum creatinine, hemoglobin, postoperative complications rate, and long-term stenosis recurrence rate. RESULTS: In this study, 13 patients were included (9 males and 4 females). All the UVJ stenoses were diagnosed with preoperative ultrasound, CT scan, MRI, or urethrography. The mean age was 45 years (range 34-57 years). The mean preoperative serum creatinine was 243 µmol/L. Four patients developed UVJ stenosis 1 month after kidney transplantation, while the rest developed long-term stenosis. Fifteen operations were performed in all, of which 14 cases were successful while one failed. The first 8 cases received first-stage nephrostomy and second-stage endoscopic management of the stenosis, while the last 7 cases received the same session surgery. The mean operation time was 95.4 min vs. 68.9 min, and the immediate success rate was 87.5% vs. 100.0% in the first 8 cases and last 7 cases, respectively. The mean decrease of postoperative hemoglobin was 0.6 g/L and mean postoperative serum creatinine was 105 µmol/L. No postoperative fever, severe hematuria, and urine leak were observed. The mean postoperative hospital stay was 2.8 days. Three patients were able to remove ureteral stents and no recurrence was found with a follow-up time of 9, 17, and 82 months. The long-term stenosis recurrence rate was 76.9% (10/13). CONCLUSION: Endoscopic approach for the treatment of UVJ stenosis in patients with kidney transplantation was safe and efficient in our study cohort. However, long term stenosis recurrence rate was high and needed to be paid attention to.


Assuntos
Transplante de Rim , Obstrução Ureteral , Adulto , Feminino , Humanos , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Obstrução Ureteral/etiologia , Ureteroscopia
7.
Medicine (Baltimore) ; 98(44): e17780, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689845

RESUMO

RATIONALE: Foreign bodies related ureteral obstruction and hydronephrosis is rare and usually cause numerous problems for clinical physicians. PATIENT CONCERNS: We report a 36-year-old female who was referred to our hospital due to a 4-year history of dull pain on the left back. DIAGNOSIS: X-ray and abdominal CT revealed a foreign body around the upper part of the left ureter with ureteral obstruction and hydronephrosis. INTERVENTIONS: Laparoscopy was performed and a 3-cm sewing needle was removed successfully. OUTCOMES: After 6 months' follow-up, the patient's ureteral obstruction and hydronephrosis were significantly reduced, and the double-J ureteral stent was removed. LESSONS: This case indicated that ureteral obstruction and hydronephrosis caused by foreign bodies needed to be early diagnosed and located. Invasive therapies rather than conservative treatments are preferred to remove the FBs and relieve obstruction.


Assuntos
Corpos Estranhos/complicações , Hidronefrose/etiologia , Laparoscopia/métodos , Ureter/lesões , Obstrução Ureteral/etiologia , Adulto , Feminino , Corpos Estranhos/cirurgia , Humanos , Hidronefrose/cirurgia , Laparoscopia/instrumentação , Stents , Ureter/cirurgia , Obstrução Ureteral/cirurgia
8.
Transplant Proc ; 51(9): 3080-3083, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31627919

RESUMO

As the field of transplant evolves and patients with chronic disease live longer, retransplant for end-stage renal disease becomes more common because kidney allografts have a limited lifespan. In renal retransplant, graft and patient survival is near equivalent to first-time transplant; however, these procedures present a unique surgical risk profile, especially third and subsequent transplants, which are reviewed in this manuscript. The risk of bowel obstruction in primary kidney transplant recipients is much lower than patients who have undergone laparotomy for second or third transplant because of the retroperitoneal location of the transplanted kidney. Internal hernia is an uncommon cause of small bowel obstruction, particularly after kidney transplant, and often diagnosis and intervention are delayed because of diagnostic uncertainty. We report a case of a 34-year-old man with acute kidney injury and bowel obstruction, whose final diagnosis was an internal hernia around the transplanted ureter of an intra-abdominally placed third renal transplant resulting in ureteric obstruction associated with small bowel obstruction-a case of double obstruction.


Assuntos
Obstrução Intestinal/etiologia , Transplante de Rim/efeitos adversos , Reoperação/efeitos adversos , Obstrução Ureteral/etiologia , Adulto , Humanos , Falência Renal Crônica/cirurgia , Masculino
9.
Urology ; 134: 243-245, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31542465

RESUMO

OBJECTIVE: To describe a novel, minimally invasive surgical technique, robotic-assisted laparoscopic dismembered extravesical cross-trigonal ureteral reimplantation for primary obstructive megaureter and to report a case series of 13 patients. METHODS: Thirteen patients between the ages of 10 and 96 months who were diagnosed with primary obstructive megaureter underwent robotic-assisted laparoscopic dismembered extravesical cross-trigonal ureteral reimplantation between April 2017 and May 2019. The principle of this technique is performing an extravesical cross-trigonal ureteral reimplantation with intracorporeal tailoring of the ureter. This provides the advantage of achieving a long tunnel mimicking the Cohen cross-trigonal ureteral reimplantation, without performing the open surgical technique and offers the potential benefits of minimally invasive surgery. Surgical technique is described, demographic data and intra- and/or postoperative parameters are reported. RESULTS: Median age was 26 months (IQR 16-60). Median weight was 15 kg (IQR 10.1-31). Median console time was 113 minutes (IQR 90.5-140). Median postoperative stay was 2.5 days (IQR 1.3-3). Median ureteral diameter decreased from 17 mm (IQR 12.5-18.5) to 3 mm (IQR 0-6.5, P = .001). Median renal pelvis diameter decreased from 28 mm (IQR 20.5-37.8) to 4 mm (IQR 1.5-5, P = .005). Median renal function before surgery was 46% (IQR 24.5-48.5) and following surgery was 42% (IQR 36-42, P = .700). Median T1/2 decreased from 28 minutes (IQR 19.3-30) to 4.5 minutes (IQR 3-5, P = .009). Postoperative complications graded by the Clavien-Dindo classification were apparent in 3 patients (21%). One had grade I complication (fever, resolved spontaneously) and 2 had a Grade II complication (urinary tract infection). CONCLUSION: Robot-assisted cross-trigonal ureteral reimplantation with intracorporeal tailoring is safe, feasible, and reproducible in short-term follow-up.


Assuntos
Laparoscopia , Procedimentos Cirúrgicos Robóticos , Ureter/anormalidades , Ureter/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Pré-Escolar , Humanos , Lactente , Duração da Cirurgia , Complicações Pós-Operatórias , Obstrução Ureteral/etiologia , Obstrução Ureteral/cirurgia
10.
Urology ; 133: e7-e8, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31377257

RESUMO

Fraley's syndrome is a rare cause of obstruction of the collecting system. It results from an extrinsic vascular compression of a calyceal infundibulum by a branch of the renal artery. Clinicians should be aware of this syndrome when facing an isolated dilatation of a calyx, classically an upper pole calyx dilatation, with a defect in the superior infundibulum on CT urography. Here, we pictorially present the conservative surgical treatment of a Fraley's syndrome. After identification of the artery responsible for the obstruction, the infundibulum was opened, uncrossed from the vessel, and closed by an end-to-end anastomosis.


Assuntos
Cálices Renais , Nefropatias/etiologia , Túbulos Renais Coletores , Artéria Renal , Obstrução Ureteral/etiologia , Obstrução Ureteral/cirurgia , Adolescente , Feminino , Humanos , Síndrome
11.
BMJ Case Rep ; 12(7)2019 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-31315842

RESUMO

Pelvic organ prolapse (POP), the transvaginal descent of pelvic organs, can cause mild hydronephrosis but rarely leads to a deterioration in kidney function. We present a case of severe uterovaginal prolapse that caused bilateral ureteral obstruction and led to renal failure and urinary tract infection. During outpatient follow-up, kidney function had already been deteriorating, but POP was not recognised as a causal factor. A longer duration of ureteral obstruction can lead to irreversible kidney damage, and therefore, timely recognition and intervention is of essence. Even in complex cases with various causative factors for kidney injury, the presence of severe POP and kidney injury should prompt the clinician to exclude this cause.


Assuntos
Prolapso de Órgão Pélvico/patologia , Prolapso Uterino/complicações , Prolapso Uterino/patologia , Diagnóstico Diferencial , Feminino , Humanos , Hidronefrose/diagnóstico por imagem , Hidronefrose/etiologia , Hidronefrose/cirurgia , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/cirurgia , Insuficiência Renal/etiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Obstrução Ureteral/etiologia , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/etiologia , Prolapso Uterino/classificação , Prolapso Uterino/cirurgia
12.
Curr Urol Rep ; 20(9): 49, 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31289951

RESUMO

PURPOSE OF REVIEW: Endoscopic injection of bulking agents for the treatment of vesicoureteral reflux (VUR) has become a therapeutic alternative to antibiotic prophylaxis and ureteral reimplantation. Although considered as a safe and efficient procedure, several studies have reported cases of ureteral obstruction (UO) after endoscopic correction of VUR. This review article evaluates the present VUR literature to estimate the incidence of UO following endoscopic injection of different substances, while also discussing the impact of injection technique and implant volume. RECENT FINDINGS: Twenty-five publications were identified that provided detailed information on 64 females and 32 males (age range, 7 months-48 years) that developed UO after endoscopic treatment of VUR using dextranomer/hyaluronic acid (Dx/HA), polyacrylate polyalcohol (PP), polydimethylsiloxane (PDMS), calcium hydroxyapatite (CaHA), polytetrafluoroethylene (PTFE), or collagen. There was some variation in the reported incidence of UO among these materials: Dx/HA (0.5-6.1%), PP (1.1-1.6%), PDMS (2.5-10.0%), CaHA (1.0%), and PTFE (0.3%). Postoperative UO was described following subureteric transurethral injection (STING), intraureteric hydrodistension implantation technique (HIT), combined HIT/STING and double HIT. The injected volume ranged widely, also depending on the type of bulking agent: Dx/HA (0.3-3.0 mL), PP (0.3-1.2 mL), PDMS (1.0-2.2 mL), CaHA (0.4-0.6 mL), and PTFE (1.5-2.0 mL). The timing of UO varied from immediately after the procedure to 63 months. Over half of patients showed asymptomatic hydroureteronephrosis on follow-up imaging, whereas the remaining presented with symptoms of acute UO or fever. UO remains a rare complication after endoscopic correction of VUR, generally reported in less than 1% of treated cases, which appears to be independent of the injected substance, volume, and technique. However, long-term follow-up is recommended as asymptomatic or delayed UO can occur, potentially leading to deterioration of renal function.


Assuntos
Materiais Biocompatíveis/efeitos adversos , Endoscopia/efeitos adversos , Obstrução Ureteral/etiologia , Refluxo Vesicoureteral/cirurgia , Resinas Acrílicas/efeitos adversos , Adolescente , Adulto , Criança , Pré-Escolar , Colágeno/efeitos adversos , Dextranos/efeitos adversos , Dimetilpolisiloxanos/efeitos adversos , Durapatita/efeitos adversos , Feminino , Humanos , Ácido Hialurônico/efeitos adversos , Lactente , Injeções , Masculino , Pessoa de Meia-Idade , Politetrafluoretileno/efeitos adversos , Resultado do Tratamento , Adulto Jovem
14.
Ren Fail ; 41(1): 497-506, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31215300

RESUMO

Objectives: To improve the mouse model of relief for unilateral ureteral obstruction (RUUO) and explore the pathological process of renal fibrosis after the obstruction was relieved. Methods: C57BL/6 mice in model group were randomly divided into RUUO group, improved RUUO group, and UUO group. After leaving Unilateral Ureteral Obstruction (UUO) for 3 days, the obstruction was released by reimplantation way in RUUO group and in reimplantation + catheter way in improved RUUO group. C57BL/6 mice in observation group were randomly divided into 1d RUUO group, 3d RUUO group, 7d RUUO group, and 14d RUUO group. Three days after UUO, the obstruction was released by reimplantation + catheter in four groups. We detected the renal volume, H&E, Masson staining, and immunohistochemistry of kidney pathology on the seventh day after RUUO in model group and on the 1st, 3rd, 7th, and 14th day after RUUO in observation group. Results: Comparing with mice in RUUO group, mice in improved RUUO group had lower renal volume, tubular damage score, and collagen area percentage. After the obstruction was relieved, the renal volume decreased gradually within 2 weeks. The tubular damage score in 7d RUUO group was lower than that in 1d RUUO and 3d RUUO group. However, the tubular damage score in 14d RUUO group was higher than that in 7d RUUO group. The tendency of collagen area percentage and α-SMA IOD value were consistent with the tubular damage score. Conclusions: Using the method of reimplantation + catheter, a reliable mice model of RUUO can be got. After RUUO, the de-obstructed kidneys are still in damage and fibrosis state.


Assuntos
Modelos Animais de Doenças , Rim/patologia , Obstrução Ureteral/complicações , Cateterismo Urinário/métodos , Animais , Fibrose , Humanos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Ureter/cirurgia , Obstrução Ureteral/etiologia , Obstrução Ureteral/cirurgia , Cateterismo Urinário/instrumentação , Cateteres Urinários
15.
World J Surg Oncol ; 17(1): 74, 2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31039812

RESUMO

BACKGROUND: To study the outcome and experience of using metallic stents in treating patients with malignant ureteral obstruction (MUO). METHODS: Seventy-six patients with MUO were assigned to the metallic stent group (MSG) or the ordinary polymer stent group (OPSG) according to the different materials. The success rate of the operation, duration of operation, patency rate serum creatinine values ,postoperative complications and QOL scores were compared between the two groups. RESULTS: In the OPSG and MSG, the success rates of the operation were 95.5% and 96.9%, respectively, and the durations of the operation were 20.6 ± 2.2 min and 50.9 ± 10.3 min (P < 0.01), respectively. There was no significant difference between the groups in serum creatinine values at 3 days after the operation (P > 0.05); however, the creatinine values at 3 days after the operation decreased significantly compared with those before the operation (P < 0.01). In the OPSG, there was no significant difference in creatinine values between 3 days and 6 months after operation, while the creatinine values 1 year after operation were increased significantly compared to those at 3 days after the operation (P < 0.05). In the MSG, there was no significant difference among creatinine values at different intervals (P > 0.05). The total rate of post-procedural complication was lower in the MSG than that in the OPSG(P < 0.05). There was no significant difference in the QOL score between the two groups before the operation (P > 0.05); however, the QOL scores at 6 months and 1 year after the operation were higher in the MSG than that in the OPSG(P < 0.05). In the MSG, there was no significant difference in the QOL score between preoperation and 6 months after surgery. Similarly, there was also no difference in the QOL score between 6 months after surgery and 1 year after surgery(P > 0.05). On the contrary, the differences of QOL score in the OPSG group were much significant between disparate time intervals (P < 0.05). CONCLUSIONS: For patients with MUO who require long-term retention of the stent, metallic stents with longer indwelling time are superior to ordinary polymeric stents.


Assuntos
Metais/química , Neoplasias/complicações , Polímeros/química , Stents/estatística & dados numéricos , Obstrução Ureteral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Obstrução Ureteral/etiologia
16.
Urology ; 130: 138-141, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31063764

RESUMO

Fibroepithelial polyps represent a rare cause of intrinsic ureteropelvic junction obstruction in the pediatric population, accounting for less than 5% of cases. Herein, we present this peculiar case of a 10-year-old boy with multiple large intraluminal FEPs resembling Medusa's hair and the challenges associated with its subsequent treatment plan.


Assuntos
Nefropatias/complicações , Pelve Renal , Pólipos/complicações , Obstrução Ureteral/etiologia , Criança , Humanos , Nefropatias/patologia , Masculino , Pólipos/patologia
17.
Urologe A ; 58(6): 651-657, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31098652

RESUMO

Defects in ureteral continuity and function can originate from various etiologies such as stricture, radiotherapy, tuberculosis, tumor, trauma or perforation due to iatrogenic injury. The surgical options for the management of ureteral defects are complex and depend on the location of the defect. The aim of the surgical management of ureteral stricture is the reconstruction of an anti-refluxive and nonobstructive flow of urine to preserve kidney function. There are numerous possibilities for the reconstruction of ureteral defects ranging from ureteroneocystostomy with or without psoas-hitch- or Boari-flap to ileal ureteral replacement. Nearly all these techniques can either be done in open surgery or in a laparoscopically or robotic-assisted manner. The technique of robotic-assisted reconstruction of ureteral defects is challenging but offers a great opportunity. The aim of this article is to provide an overview of current surgical procedures in ureteric reconstruction.


Assuntos
Cistostomia/métodos , Íleo/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reimplante/métodos , Retalhos Cirúrgicos , Ureter/cirurgia , Obstrução Ureteral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Feminino , Humanos , Laparoscopia , Estudos Retrospectivos , Resultado do Tratamento , Ureter/anormalidades , Ureter/lesões , Obstrução Ureteral/etiologia
18.
Phytomedicine ; 59: 152917, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30978648

RESUMO

BACKGROUND: The pathology change of renal tubulointerstitial fibrosis is a critical feature of chronic kidney disease (CKD), regardless of the primary insults. The infiltration of inflammatory cells and the consecutive secretion of profibrotic factors are frequently and conspicuously observed during the development of renal fibrosis. Icariin, an active polyphenol of the Epimedium genus, has been found to alleviate the symptoms of chronic diseases like diabetes, neurodegeneration, and heart and renal diseases. The effect and mechanism of icariin on the prevention of CKD-associated renal fibrosis still needed clarification. PURPOSE: The aims of this study were to investigate whether icariin treatment improves the development of CKD-associated renal fibrosis and its possible mechanism. METHODS: An experimental unilateral ureteral obstruction (UUO)-induced chronic renal fibrosis mouse model was used. Mice were orally administered with icariin (20 mg/kg/day) for 3 consecutive days before and 14 consecutive days after UUO surgery. RESULTS: The pathological changes, collagen deposition, and protein expressions of profibrotic factors (transforming growth factor-ß and connective tissue growth factor) and fibrotic markers (α-smooth muscle actin and fibronectin), which were significantly elevated in the kidneys of UUO mice, could be significantly reversed by icariin treatment. Icariin treatment also significantly inhibited the increased Smad2/3 and decreased E-cadherin protein expressions in the kidneys of UUO mice. Icariin treatment prominently mitigated the protein expression of proinflammatory factors like nuclear factor-κB, cyclooxygenase-2, interleukin 1-ß and prooxidative enzyme (NADPH oxidase-4), and it increased the protein expression of antioxidative enzymes (superoxide dismutase and catalase). CONCLUSION: Icariin treatment protects against CKD-associated renal fibrosis via its antifibrotic and anti-inflammatory properties. Icariin may serve as a therapeutic agent in the prevention of CKD-associated renal fibrosis.


Assuntos
Flavonoides/uso terapêutico , Nefropatias/tratamento farmacológico , Rim/efeitos dos fármacos , Obstrução Ureteral/etiologia , Animais , Anti-Inflamatórios/farmacologia , Colágeno/metabolismo , Modelos Animais de Doenças , Fibronectinas/metabolismo , Fibrose/etiologia , Fibrose/prevenção & controle , Masculino , Camundongos , Fator de Crescimento Transformador beta/metabolismo , Obstrução Ureteral/complicações
19.
World Neurosurg ; 126: 581-587, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30880195

RESUMO

BACKGROUND: Giant Tarlov cysts are always symptomatic and mimic many serious pathologic entities. We present the largest, to our knowledge, reported Tarlov cyst. CASE DESCRIPTION: A 33-year-old woman with Marfan syndrome suffered from right kidney hydronephrosis because of ureter obstruction, for which she was treated with nephrostomy. Her neurologic examination was unremarkable. The role of magnetic resonance imaging in the management of this case is described. Absence of intractranial hypotension symptoms after cerebrospinal fluid (CSF) overdrainage suggested the presence of a valve-like mechanism. The patient was planned for surgical cyst remodeling by the application of titanium clips. The cyst's neck was exposed through an L5-S2 laminectomy. L5 and S1 laminae were severely eroded. CSF leaked out of the underlying, bulging, and thinned dura at each attempt for clip application. Intraoperatively, multiple responses from the S1, S2, and S3 roots were simultaneously recorded at each stimulation. Therefore, we decided to abandon this technique and performed a nonwatertight duroplasty followed by a layered wound closure instead. A week later, the patient received a lumbar-peritoneal shunt. The patient remained neurologically intact, the cyst shrunk, and the nephrostomy was removed. CONCLUSIONS: Indirect evidence was helpful to assess for the presence of a valve-like mechanism. Intraoperatively, the surgeon must keep on high alert for sacral erosion to avoid inadvertent dural tear and rootlet injury. Finally, lumboperitoneal diversion remains a valid alternative in the management of our giant Tarlov cyst because it reduced the intracystic pressure that resulted in cyst regression.


Assuntos
Hidronefrose/etiologia , Síndrome de Marfan/complicações , Cistos de Tarlov/cirurgia , Adulto , Potencial Evocado Motor , Feminino , Humanos , Hidronefrose/cirurgia , Plexo Lombossacral/fisiopatologia , Imagem por Ressonância Magnética , Nefrostomia Percutânea , Avaliação de Sintomas , Cistos de Tarlov/complicações , Cistos de Tarlov/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Obstrução Ureteral/etiologia , Técnicas de Fechamento de Ferimentos
20.
Urology ; 128: 38-41, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30878681

RESUMO

OBJECTIVE: To assess the intermediate- and long-term effect of high-grade ureteral injuries from ureteral access sheaths. METHODS: Patients undergoing ureteroscopy for upper tract calculi were prospectively enrolled at 2 sites from 2010 to 2015. A 12/14 French sheath was used and the ureter was inspected with a flexible ureteroscope during withdrawal of the sheath and recorded. The videos were then evaluated by 2 blinded endourologists, and any injuries were graded per the Traxer ureteral injury scale. Only high-grade injuries were included. The primary endpoint was defined as ongoing hydronephrosis without an obstructing stone on follow-up imaging indicating a ureteral stricture. Logistic regression analysis was used to assess the relationship between hydronephrosis, ureteral injury, and other patient variables. RESULTS: Fifty-six patients were identified with high-grade ureteral injuries. Sixteen patients (28.6%) were female. Median age was 56.4 years (range 14-85). Median follow-up was 35.8 months (range 0-88). Three patients (5.5%) had hydronephrosis on follow-up imaging, only 1 of whom developed a de novo ureteral stricture. On univariate analysis, hydronephrosis was associated with a shorter stent duration (P = .11) and older age (P = .17). CONCLUSION: Endoscopically identified high-grade ureteral lesions following ureteral access sheath placement do not lead to clinically significant sequelae on intermediate term follow-up, with a stricture rate comparable to those without visible injuries of 1.8%.


Assuntos
Ureter/lesões , Cálculos Ureterais/terapia , Obstrução Ureteral/etiologia , Ureteroscópios/efeitos adversos , Ureteroscopia/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Ultrassonografia , Ureter/diagnóstico por imagem , Cálculos Ureterais/diagnóstico , Obstrução Ureteral/diagnóstico , Adulto Jovem
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