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1.
Hinyokika Kiyo ; 67(1): 17-22, 2021 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-33535292

RESUMO

A 74-year-old woman was transported to an emergency room of a general hospital with sudden left flank pain. After examination, the pain was attributed to left hydronephrosis resulting from left retroperitoneal fibrosis (RF). The pain and renal function improved after left ureteral stenting. Four months after the transportation, she was referred to our hospital for further examination. Her renal function deteriorated again despite successful release of ureteral obstruction. Consequently, the left kidney developed end-stage renal dysfunction at 15 months after symptom onset. Pathological examination of the left dysfunctional kidney removed by laparoscopic surgery to avoid infectious pyelonephritis revealed numerous IgG4-positive plasma cells invading the renal parenchyma. The pathological findings suggested that the renal dysfunction was due to IgG4-related tubulointerstitial nephritis (IgG4-TIN) rather than ureteral obstruction. In the case of RF with decreased renal function, not only retroperitoneal lesion biopsy but also renal biopsy should be considered to diagnose IgG4-TIN and start steroid treatment if necessary.


Assuntos
Nefrite Intersticial , Fibrose Retroperitoneal , Ureter , Obstrução Ureteral , Idoso , Feminino , Humanos , Imunoglobulina G , Rim/patologia , Nefrite Intersticial/complicações , Ureter/cirurgia , Obstrução Ureteral/etiologia , Obstrução Ureteral/cirurgia
2.
Hinyokika Kiyo ; 67(1): 27-30, 2021 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-33535294

RESUMO

A 41-year-old female who suffered local recurrence of cervical cancer after receiving chemoradiotherapy underwent radical hysterectomy, radical vaginal resection, and pelvic and paraaortic lymph node dissection. After surgery, bilateral hydronephrosis due to right ureteral stenosis and left uretero-vaginal fistula occurred. We therefore placed a bilateral ureteral stent. Thereafter, we continued to replace the bilateral ureteral stent once every 3 months, but the replacement of the right ureteral stent became impossible three years after the initial placement. We thus performed bilateral upper urinary tract reconstruction using an ileal ureter with the aim of both eliminating the left ureteral vaginal fistula and resolving the right ureteral stricture.


Assuntos
Hidronefrose , Ureter , Obstrução Ureteral , Adulto , Constrição Patológica , Feminino , Humanos , Íleo , Ureter/cirurgia , Obstrução Ureteral/etiologia , Obstrução Ureteral/cirurgia
3.
BMJ Case Rep ; 14(1)2021 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-33468632

RESUMO

A 53-year-old man presented with lower urinary tract symptoms and recurrent urinary tract infections since last 3 years without being investigated or treated properly. Examination revealed a hard mobile lump in the pelvis, and blood investigations showed raised serum creatinine of 2.9 mg/dL. Subsequent urgent ultrasound scan showed a large urinary bladder stone with bilateral hydroureteronephrosis, and X-ray kidney, ureter and bladder demonstrated a 9 cm×6 cm elliptical radio-opaque shadow in the pelvis. He underwent emergency admission followed by open cystolithotomy on the next day. He was discharged after 48 hours with a urethral catheter. After 2 weeks, his renal function recovered completely; repeat ultrasound scan revealed complete resolution of hydronephrosis. Urethral catheter was removed following a normal cystogram. Uroflowmetry after 6 weeks revealed underlying bladder outlet obstruction, and he was started on alpha blocker which improved his urinary flow.


Assuntos
Hidronefrose/etiologia , Obstrução Ureteral/etiologia , Cálculos da Bexiga Urinária/complicações , Cálculos da Bexiga Urinária/diagnóstico , Humanos , Hidronefrose/diagnóstico por imagem , Hidronefrose/cirurgia , Masculino , Pessoa de Meia-Idade , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/cirurgia , Cálculos da Bexiga Urinária/cirurgia
4.
Urol Clin North Am ; 48(1): 91-101, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218597

RESUMO

Robotically assisted laparoscopic techniques may be used for proximal and distal ureteral strictures. Distal strictures may be approached with ureteroneocystotomy, psoas hitch, and Boari flap. Ureteroureterostomy, buccal mucosa graft ureteroplasty, and appendiceal flap ureteroplasty are viable techniques for strictures anywhere along the ureter. Ileal ureteral substitution is reserved for more extensive disease, and autotransplantation is reserved for salvage situations.


Assuntos
Constrição Patológica/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Ureter/cirurgia , Obstrução Ureteral/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Algoritmos , Constrição Patológica/diagnóstico , Constrição Patológica/etiologia , Árvores de Decisões , Humanos , Íleo/transplante , Mucosa Bucal/transplante , Assistência Perioperatória , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Reimplante , Retalhos Cirúrgicos , Ureter/anatomia & histologia , Ureter/irrigação sanguínea , Obstrução Ureteral/diagnóstico , Obstrução Ureteral/etiologia , Procedimentos Cirúrgicos Urológicos/instrumentação
5.
J Vasc Interv Radiol ; 31(11): 1795-1800, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32962854

RESUMO

This brief report presents 8 patients with silicone-covered metallic stent placement for ureteral strictures refractory to double-J stent placement, following kidney transplantation. Stent removal was successfully performed in 7 patients via antegrade (n = 4) or retrograde (n = 3) access 6 weeks to 6 months after stenting for elective removal (6-month interval, n = 3), urothelial hyperplasia (n = 2), or stent migration (n = 2), and their mean primary ureteral patency after stent removal was 15.4 months (range, 2-27 months). Hematuria (n = 2) and pain (n = 3) occurred, but resolved within 1 week. One stent was removed during reconstructive surgery. During follow-up of mean 22.6 months after stent removal, ureteral strictures recurred in 2 patients.


Assuntos
Cateterismo/instrumentação , Remoção de Dispositivo , Transplante de Rim/efeitos adversos , Stents Metálicos Autoexpansíveis , Silicones , Obstrução Ureteral/terapia , Adulto , Idoso , Cateterismo/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefrostomia Percutânea , Desenho de Prótese , Recidiva , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/etiologia
6.
Medicine (Baltimore) ; 99(37): e22082, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925747

RESUMO

INTRODUCTION: Diabetes insipidus can be a common cause of polyuria and hydronephrosis in the kidneys. However, there is few reported case of urinary obstruction induced nephrogenic diabetes insipidus. PATIENT CONCERNS: A 60-year-old Chinese man came to our hospital with the complaints of polydipsia and polyuria for 1 month. His examination showed chronic kidney disease stage III with eGFR of 48.274 ml/min, and the plasma osmolality was 338.00 mOsm/(kg·H2O) with a urinary osmolality of 163.00 mOsm/(kg·H2O). Moreover, imagological examination of the urinary system showed benign prostatic hyperplasia and hydronephrosis. DIAGNOSIS: He was considered with benign prostatic hyperplasia induced ureter hydronephrosis and nephrogenic diabetes insipidus. INTERVENTIONS: He got the transurethral resection of the prostate to alleviate urinary retention. OUTCOMES: After that, the urine output gradually decreased, and the administered hydrochlorothiazide was stopped due to the improved renal function. CONCLUSION: Our study presents a case of nephrogenic diabetes insipidus caused by urinary obstruction. Differential diagnoses for diabetes insipidus as well as the relationship between nephrogenic diabetes insipidus and urinary obstruction are also considered in this study.


Assuntos
Diabetes Insípido Nefrogênico/etiologia , Hiperplasia Prostática/complicações , Obstrução Ureteral/complicações , Antidiuréticos/uso terapêutico , Desamino Arginina Vasopressina/uso terapêutico , Diabetes Insípido Nefrogênico/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Poliúria/tratamento farmacológico , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata , Obstrução Ureteral/etiologia
7.
J Urol ; 204(6): 1256-1262, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32501124

RESUMO

PURPOSE: Obstructive pyelonephritis is considered a urological emergency but there is limited evidence regarding the importance of prompt decompression. We sought to investigate whether delay in decompression is an independent predictor of in-hospital mortality. Secondarily, we aimed to determine the impact of patient, hospital and disease factors on the likelihood of receipt of delayed vs prompt decompression. MATERIALS AND METHODS: Using the National Inpatient Sample from 2010 to 2015, all patients 18 years old or older with ICD-9 diagnosis of urinary tract infection who had either a ureteral stone or kidney stone with hydronephrosis (311,100) were identified. Two weighted sample multivariable logistic regression models assessed predictors of the primary outcome of death in the hospital and secondly, predictors of delayed decompression (2 or more days after admission). RESULTS: After controlling for patient demographics, comorbidity and disease severity, delayed decompression significantly increased odds of death by 29% (OR 1.29, 95% CI 1.03-1.63, p=0.032). Delayed decompression was more likely to occur with weekend admissions (OR 1.22, 95% CI 1.15-1.30, p <0.001), nonwhite race (OR 1.34, 95% CI 1.25-1.44, p <0.001) and lower income demographic (lowest income quartile OR 1.25, 95% CI 1.14-1.36, p <0.001). CONCLUSIONS: While the overall risk of mortality is fairly low in patients with obstructing upper urinary tract stones and urinary tract infection, a delay in decompression increased odds of mortality by 29%. The increased likelihood of delay associated with weekend admissions, minority patients and lower socioeconomic status suggests opportunities for improvement.


Assuntos
Descompressão Cirúrgica/estatística & dados numéricos , Pielonefrite/cirurgia , Sepse/mortalidade , Tempo para o Tratamento/estatística & dados numéricos , Cálculos Ureterais/complicações , Obstrução Ureteral/cirurgia , Adulto , Idoso , Estudos Transversais , Descompressão Cirúrgica/normas , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Minoritários/estatística & dados numéricos , Razão de Chances , Pielonefrite/etiologia , Pielonefrite/mortalidade , Melhoria de Qualidade , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Sepse/diagnóstico , Sepse/etiologia , Sepse/cirurgia , Índice de Gravidade de Doença , Classe Social , Tempo para o Tratamento/normas , Cálculos Ureterais/mortalidade , Cálculos Ureterais/cirurgia , Obstrução Ureteral/etiologia , Obstrução Ureteral/mortalidade
8.
Medicine (Baltimore) ; 99(22): e20386, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481425

RESUMO

Use of polyacrylate-polyalcohol copolymer (PPC) after endoscopic correction (EC) of vesico-ureteral reflux (VUR) is highly effective but is associated with a higher risk of obstructive complications (OC) compared with other implants. We undertook a STROBE compliant retrospective investigation and studied the OC risk factors to increase the practical safety of PPC.Overall, 798 patients (464 [58.1%] girls and 334 [41.9%]) boys) from 5 hospitals in whom PPC was routinely used were evaluated retrospectively. The patients were subdivided into 2 groups. Group I consisted of 754 (94.5%) children (449 [59.5%] girls and 305 [40.5%] boys) without OC. Median age was 41 months [Q1: 18.0; Q3: 81.0]. Group II comprised 44 (5.5%) patients (29 [65.9%] boys and 15 [34.1%] girls) experiencing OC, and their median age was 21.5 months [Q1: 12.0; Q3: 43.0]. Clinical and renal ultrasound examinations were carried out 1 day and 1 month after EC, and then every 6 months after EC. At the follow-up examination approximately 6 months after EC, voiding cysto-urethrography (VCUG) was performed. All patients with OC underwent diuretic renography.OC occurred in 44 (5.5%) of 798 children, in some cases as late as 60 months after endoscopic injection of the bulking agent PPC for correction of VUR. Univariate analysis revealed that younger age (P < .001), higher grade of VUR (P < .001), male gender (P < .001), second injection (P = .003), and EC injection using hydrodistension implantation technique (HIT; P < .001) represented significant risk factors. At multivariate analysis, only male gender (P = .0078), younger age (P = .0044), HIT technique (P < .0001), and second injection (P = .04) represented significant risk factors for the occurrence of OC.We identified young age, male gender, high reflux grade, HIT technique, and second endoscopic injections as factors associated with the risk of OC after EC of VUR using PPC as a bulking agent. Thus, patients who have undergone EC with PPC must be monitored sonographically for occurrence of OC for at least 60 months after the intervention.


Assuntos
Resinas Acrílicas/uso terapêutico , Polímeros/uso terapêutico , Obstrução Ureteral/etiologia , Ureteroscopia/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Fatores de Risco , Ureteroscopia/efeitos adversos , Refluxo Vesicoureteral
9.
J Vasc Interv Radiol ; 31(8): 1249-1255, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32457011

RESUMO

PURPOSE: To determine safety and efficacy of retrograde pyeloperfusion for ureteral protection during cryoablation of adjacent renal tumors. MATERIALS AND METHODS: Retrospective review of 155 patients treated with renal cryoablation, including adjunctive retrograde pyeloperfusion, from 2005 to 2019 was performed. Ice contacted the ureter in 67 of the 155 patients who represented the study cohort. Median patient age was 68 years old (interquartile range [61, 74]), 52 patients (78%) were male, and 37 tumors (55%) were clear cell histology. Mean tumor size was 3.4 ± 1.3 cm, and 42 tumors (63%) were located at the lower pole. Treatment-related complication and oncologic outcomes were recorded based on a review of post-procedural images and chart review. RESULTS: Technical success of cryoablation was attained in 67 cases (100%), and technical success of pyeloperfusion was attained in 66 cases (99%). A total of 13 patients (19.4%) experienced SIR major C or D complications related to the procedure, including hemorrhage (n = 4), urine leak (n = 3), transient urinary obstruction (n = 2), pulmonary embolism (n = 1), hypertensive urgency (n = 1), acute respiratory failure (n = 1), and ureteropelvic junction (UPJ) stricture (n = 1). No complications were attributable to pyeloperfusion. Three of 45 patients with biopsy-proven renal cell carcinoma experienced local recurrence resulting in local recurrence-free survival of 92% (95% confidence interval, 81.5%-100%) 3 years after ablation. CONCLUSIONS: Retrograde pyeloperfusion of the renal collecting system is a relatively safe and efficacious option for ureteral protection during renal tumor cryoablation. This adjunctive procedure should be considered for patients in whom cryoablation of a renal mass could potentially involve the ureter.


Assuntos
Carcinoma de Células Renais/cirurgia , Criocirurgia , Neoplasias Renais/cirurgia , Perfusão/métodos , Ureter/lesões , Obstrução Ureteral/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/patologia , Criocirurgia/efeitos adversos , Feminino , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Perfusão/efeitos adversos , Perfusão/instrumentação , Estudos Retrospectivos , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento , Ureter/diagnóstico por imagem , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/etiologia
11.
Transplant Proc ; 52(2): 619-621, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32143757

RESUMO

A urinoma is an unusual complication following renal transplant biopsy that can easily be missed or mistaken for a hematoma. In addition to trauma to the renal collecting system, a degree of urinary tract obstruction is required for urine to leak into the surrounding tissues and form a urinoma, which can in turn cause pressure on surrounding structures. This case report describes a patient who developed ipsilateral leg swelling several months after a renal transplant biopsy. Imaging demonstrated a perirenal transplant fluid collection, which biochemical analysis confirmed to be urine. This was successfully managed with percutaneous nephrostomy and antegrade ureteric stent insertion. The fluid collection persisted as a seroma however, and the patient proceeded to have peritoneal fenestration and marsupialization surgery. To our knowledge, this is the first reported case of urinoma complicating a renal transplant biopsy. This case highlights a diagnosis that can be easily missed and is therefore a potential pitfall for clinicians.


Assuntos
Transplante de Rim/efeitos adversos , Urinoma/etiologia , Urinoma/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Obstrução Ureteral/etiologia
12.
Prog Urol ; 30(3): 155-161, 2020 Mar.
Artigo em Francês | MEDLINE | ID: mdl-32122748

RESUMO

INTRODUCTION: Urinary complications after kidney transplantation are common and can compromise renal function. While they are mainly attributed to ischemic lesions of the ureter, there is no existing method to evaluate its vascularization during surgery. The aim of the study was to evaluate if indocyanine green, revealed by infra-red light andused to visualize tissue perfusion, could provide an appreciation of the ureter's vascularization during kidney transplantation. METHODS: This feasibility study was conducted over one month, on eleven consecutive kidney transplants. During transplantation, an injection of indocyanine green enabled the surgeon to visualize in real time with an infra-red camera the ureter fluorescence. Its intensity was reported on a qualitative and semi-quantitative scale. Occurrence of urinary complications such as stenosis or ureteral fistula were collected during 6 months. RESULTS: In all of the 11 cases (100%), the last centimeters of the ureters were not fluorescent. Three (27%) ureters were poorly or partiallly fluorescent. Out of these three cases, only one case of urinary fistula occurred, followed by ureteric stenosis. In the series, two fistulas (18%) and two ureteric stenoses (18%) occurred. No side effects were observed. The low number of events did not allow statistical analysis. CONCLUSION: Infra-red fluorescence of indocyanine green could be a simple and innovative way to appreciate the transplant's ureteric vascularization during kidney transplantation. It could help surgeons to identify the level of ureter section and to decide the anastomosis technique, in order to limit urinary complications. LEVEL OF EVIDENCE: 3.


Assuntos
Transplante de Rim , Ureter/diagnóstico por imagem , Fístula Urinária/diagnóstico por imagem , Doenças Urológicas/diagnóstico por imagem , Adulto , Idoso , Estudos de Viabilidade , Feminino , Fluorescência , Corantes Fluorescentes , Humanos , Verde de Indocianina , Masculino , Pessoa de Meia-Idade , Doenças Ureterais/diagnóstico por imagem , Doenças Ureterais/etiologia , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/etiologia , Fístula Urinária/etiologia , Doenças Urológicas/etiologia
14.
Clin Nephrol ; 93(4): 195-202, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32049626

RESUMO

AIM: By observing the expression and distribution of platelet-derived growth factor receptor α-positive (PDGFRα+) cells in ureteropelvic junction obstruction (UPJO), to explore their role in the pathogenesis of children with congenital hydronephrosis. MATERIALS AND METHODS: The control group involved specimens of the normal ureter (nephrectomy for tumor; n = 10), and the UPJO group contained specimens of ureteropelvic junction (UPJ) segment excised during pyeloplasty (n = 30). The specimens were investigated using immunofluorescence for the expression and distribution of PDGFRα+ cells in each group by light microscopy with computerized image analysis. Real-time PCR (RT-PCR) was used to study PDGFRα gene expression levels. In addition, small conductance calcium-activated potassium channel 3 (SK3) and closely associated cells consisting of smooth muscle cells (SMCs), interstitial cells of Cajal (ICCs), and nerve fibers were investigated. RESULTS: PDGFRα+ cells were in close proximity to SMCs, ICCs, and nerve fibers. PDGFRα+ cells expressed SK3 channels, which are found to regulate purinergic inhibitory neurotransmission in SMCs. Regarding the expression of PDGFRα+ cells no significant difference was seen between the two groups, while the expression of SK3 channels in PDGFRα+ cells was significantly decreased in the UPJO group versus the control group. CONCLUSION: This study identified the expression of PDGFRα+ cells in the human UPJ. Our results demonstrate the expression of SK3 channels in PDGFRα+ cells was decreased in UPJO, and SK3 channels may be involved in the pathogenesis of UPJO by perturbing the UPJ peristalsis.


Assuntos
Pelve Renal/patologia , Receptor alfa de Fator de Crescimento Derivado de Plaquetas/análise , Ureter/patologia , Obstrução Ureteral/etiologia , Criança , Pré-Escolar , Constrição Patológica , Humanos , Lactente , Receptor alfa de Fator de Crescimento Derivado de Plaquetas/fisiologia , Canais de Potássio Ativados por Cálcio de Condutância Baixa/fisiologia
15.
BJOG ; 127(7): 859-865, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32037645

RESUMO

OBJECTIVE: To evaluate the feasibility and effect of mesureteral preservation on urinary complications in the context of total mesometrial resection (TMMR), a surgical treatment for cervical cancer. DESIGN: Retrospective cohort study with historic control. SETTING: Single tertiary academic centre. POPULATION: Women older than 18 with primary cervical cancer staged FIGO IB1-IIB enrolled in the prospective Leipzig School MMR study and underwent total mesometrial resection (TMMR) without adjuvant radiation. METHOD: We retrospectively analysed 100 consecutive TMMR procedures which were performed for cancer of the uterine cervix and in which the mesureter was preserved (intervention group, 01/2014-06/2017). We compared this group with the previous 100 consecutive TMMRs, which were performed before the introduction of mesureteral preservation (control group, 09/2010-01/2014). MAIN OUTCOME MEASURES: The occurrence of urological and specifically ureteral complications. RESULTS: Mesureteral preservation was feasible and was associated with a significant decrease in ureteral complications (11% without mesureteral preservation versus 3% with mesureteral preservation, P = 0.049). Furthermore, we found a significant decrease in the number of postoperative percutaneous nephrostomies and re-operations (7% versus none, P = 0.014). There was also a trend towards a decrease in other urinary complications such as postoperative bladder atony and uretero-vaginal fistulas. CONCLUSION: The mesureter constitutes a convenient dissection plane enabling the preservation of lateral ureteral blood supply during TMMR. In our study, maintenance of mesureteral integrity was associated with a significant reduction in ureteral complications. Mesureteral preservation might also be useful in other types of pelvic surgeries that carry a high risk of ureteral damage. TWEETABLE ABSTRACT: Surgical preservation of the mesureter in cervical cancer patients was associated with a reduction in urinary complications.


Assuntos
Complicações Intraoperatórias/prevenção & controle , Mesentério/cirurgia , Tratamentos com Preservação do Órgão/métodos , Exenteração Pélvica , Complicações Pós-Operatórias , Ureter/lesões , Obstrução Ureteral , Neoplasias do Colo do Útero , Feminino , Alemanha/epidemiologia , Humanos , Histerectomia/efeitos adversos , Histerectomia/métodos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Órgãos em Risco , Avaliação de Processos e Resultados em Cuidados de Saúde , Exenteração Pélvica/efeitos adversos , Exenteração Pélvica/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Obstrução Ureteral/diagnóstico , Obstrução Ureteral/etiologia , Obstrução Ureteral/prevenção & controle , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia
16.
Transplant Proc ; 52(2): 527-529, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32061424

RESUMO

This retrospective study describes the incidence and prevalence of ureteral stenosis/obstruction (US/O) in a cohort of 334 renal transplants recipients in our center over the last 5 years and evaluates the risk factors that may influence the occurrence of US/O. The parameters studied included the following: history of prostate disease, smoking, urinary tract infection, renal lithiasis, ureterovesical reflux, presence and level of polar artery, type of ureterovesical anastomosis, delayed graft function, double J catheter, lymphocele, urinoma, acute rejection, prolonged catheterization, post-transplant infravesical obstruction and BK virus infection, age of the donor and recipient, and months on dialysis. Also evaluated were the nadir creatinine and instances of cold ischemia, asystole, reanastomosis, and double J catheter removal. The average incidence of US/O was 7.6% and was significantly correlated with factors of alteration of the uretero-bladder dynamics without finding a relation to vascular factors.


Assuntos
Função Retardada do Enxerto/epidemiologia , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Ureter/patologia , Obstrução Ureteral/epidemiologia , Adulto , Constrição Patológica/epidemiologia , Constrição Patológica/etiologia , Função Retardada do Enxerto/etiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Diálise Renal/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Obstrução Ureteral/etiologia
17.
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
18.
Am J Emerg Med ; 38(5): 1047.e3-1047.e5, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31924441

RESUMO

Spontaneous ureter rupture (SUR) is a rare condition that can present mimicking many acute abdominal diseases. There is no probable explanation of the theoretical mechanism of spontaneous ureter rupture in the literature. Mostly calculus can cause spontaneous ureter rupture with ureteral obstruction. If left untreated, it can lead to life-threatening complications. Herein we report a case of SUR that was occurred due to urinary stone disease in a male patient who presented with abdominal pain. A non-contrast enhanced and a late phase contrast-enhanced abdominal computed tomography (CT) demonstrated the urinary stone disease and contrast extralumination from the proximal part of the left ureter. We also aimed to emphasize the clinical and CT imaging findings of SUR.


Assuntos
Ruptura Espontânea/etiologia , Ureter/diagnóstico por imagem , Obstrução Ureteral/etiologia , Cálculos Urinários/complicações , Cálculos Urinários/diagnóstico por imagem , Dor Abdominal/etiologia , Meios de Contraste , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
19.
Female Pelvic Med Reconstr Surg ; 26(2): 116-119, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31990799

RESUMO

OBJECTIVES: To determine if there is a difference in rates of surgical complications among patients who have reperitonealization of mesh versus no reperitonealization at time of sacrocolpopexy. METHODS: This was a retrospective cohort study of all patients who underwent sacrocolpopexy at an academic medical center between 2008 and 2017. The medical record was reviewed for the operative method of sacrocolpopexy, concomitant surgeries, intraoperative or postoperative complications, and readmissions. Groups were compared on whether mesh was reperitonealized under pelvic peritoneum or not. RESULTS: A total of 209 patients underwent sacrocolpopexy, with mesh reperitonealization performed in 115 (55%). Demographics were similar in both groups, except race/ethnicity and stage of prolapse. The majority (190 [91%]) of surgeries included concomitant procedures. A total of 18 intraoperative or postoperative complications (8.6%) were recorded. Relative risk of complication with mesh reperitonealization is 0.81 (95% confidence interval, 0.1-1.70). Complications for subjects without mesh reperitonealization included 4 cystostomies, 1 urethrotomy, 3 postoperative ileuses, and 1 small bowel obstruction. Among subjects with mesh reperitonealization, complications included 5 cystotomies, 2 proctotomies, 1 ureteral obstruction, and 1 small bowel obstruction. Rates of hospital readmission among both groups were not significantly different, with 3.2% of subjects without mesh reperitonealization versus 3.5% of mesh reperitonealization patients (P = 0.91) (relative risk, 1.09; 95% confidence interval, 0.38-2.56). CONCLUSIONS: There is no significant difference in rates of complications or readmissions among patients with and without mesh reperitonealization at time of sacrocolpopexy. The only intraoperative complication solely attributed to mesh closure was a case with ureteral obstruction at time of reperitonealization.


Assuntos
Readmissão do Paciente/estatística & dados numéricos , Prolapso de Órgão Pélvico/cirurgia , Peritônio/cirurgia , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Reconstrutivos , Telas Cirúrgicas , Feminino , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Prolapso de Órgão Pélvico/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reoperação/estatística & dados numéricos , Obstrução Ureteral/diagnóstico , Obstrução Ureteral/etiologia
20.
BJU Int ; 125(4): 602-609, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31899838

RESUMO

OBJECTIVE: To determine the long-term safety and efficacy of ureteric reimplantation with psoas bladder hitch (PBH) in patients aged <12 months with unilateral obstructive megaureter (OM). PATIENTS AND METHODS: We retrospectively compared a group of patients aged <12 months (study group) with an group of patients aged ≥12 months (comparison group), who underwent PBH for OM between September 2007 and April 2017, in terms of preoperative patient characteristics, intra- and peri-operative results, and postoperative results. RESULTS: The study group comprised seven infants, five boys and two girls. The median (range) age at the time of PBH was 3 (2-8) months; OM was detected by ultrasonography during the fetal period. The left side was affected in four infants and the right side in three. Four infants had primary OM (POM). In all three infants who had ectopic OM in the complete double renal pelvis and ureter, the OM involved the ureter from the upper half of the kidney. The median (range) follow-up period after PBH was 45 (33-129) months. Comparison of the two groups showed no significant difference in terms of surgical time (P = 0.948) and length of hospital stay (P = 0.125). In both groups, hydroureteronephrosis improved postoperatively in all patients. There was no significant difference between the two groups in terms of postoperative complications, such as vesico-ureteric reflux, febrile urinary tract infection and deterioration of ipsilateral renal function. Notably, no patient underwent reoperation in either group. CONCLUSION: Psoas bladder hitch for unilateral OM including POM appears to be safe and effective in the long term for patients aged <12 months and for those aged ≥12 months. Although not routinely recommended, PBH appears to be a viable option for selected infants with POM.


Assuntos
Ureter/cirurgia , Obstrução Ureteral/cirurgia , Bexiga Urinária/cirurgia , Fatores Etários , Dilatação Patológica/complicações , Feminino , Humanos , Lactente , Masculino , Músculos Psoas , Reimplante , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Ureter/patologia , Obstrução Ureteral/etiologia , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Procedimentos Cirúrgicos Urológicos/métodos
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