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1.
Int J Clin Pract ; 2022: 3343244, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36415697

RESUMO

Purpose: Ureteral access sheaths (UAS) are widely used in retrograde intrarenal surgery (RIRS), and this study aimed to develop a model for predicting the success of UAS placement based on computed tomography. Methods: We analyzed the clinical data of 847 patients who received ureteroscopy. Data on patient and stone characteristics and several computed tomography (CT)-based measurements were collected. A nomogram predicting the success of UAS placement was developed and validated using R software. Results: Two hundred and forty-seven patients were identified. Twenty-five patients (10.1%) failed to pass through the UAS. A model with three factors including the short diameter of ureteral calculi, the short diameter of hydronephrosis, and the diameter of the narrowest part of the renal parenchyma was to be strongly practical and had a high area under the curve on internal validation (80.3%). Using a threshold cutoff of 92%, the sensitivity and specificity for predicting UAS placement were 0.35 and 0.92, respectively. Conclusion: Our study provides a nomogram for predicting the success of UAS placement, and this model could help discriminate patients who are likely to suffer from failed UAS insertion; preoperative ureteral stenting is recommended according to the prediction.


Assuntos
Cálculos Renais , Ureter , Cálculos Ureterais , Humanos , Cálculos Renais/cirurgia , Ureter/diagnóstico por imagem , Ureter/cirurgia , Ureteroscopia/métodos , Cálculos Ureterais/diagnóstico por imagem , Cálculos Ureterais/cirurgia , Tomografia Computadorizada por Raios X
2.
J Int Med Res ; 50(11): 3000605221123671, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36412222

RESUMO

Ganglioneuroma is a rare tumor originating from neural crest tissue of the sympathetic nervous system. We report on an approximately 55-year-old woman who was admitted to hospital with abdominal pain. Surgery revealed a tumor in her right ureter, which was pathologically confirmed as a ganglioneuroma. The patient underwent transabdominal total hysterectomy, bilateral adnexal resection, release of pelvic and intestinal adhesions, right ureteroscopy, right ureter retrograde intubation, right ureteral lesion excision, and ureteral anastomosis. A literature review indicated that most ganglioneuromas are benign tumors. Clinicians may consider total or subtotal tumor resection, depending on the tumor location and patient's condition. The patient's clinical condition may improve after surgery combined with periodic long-term follow-up.


Assuntos
Ganglioneuroma , Ureter , Humanos , Feminino , Pessoa de Meia-Idade , Ganglioneuroma/diagnóstico por imagem , Ganglioneuroma/cirurgia , Ureter/diagnóstico por imagem , Ureter/cirurgia , Ureter/patologia
3.
Transpl Int ; 35: 10754, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36406779

RESUMO

Urinary tract infection (UTI) occurs in 25% of recipients of living-donor kidney transplantation (LDKT). Female sex, age, and anatomical abnormalities have been reported as recipient-related risk factors for UTI after LDKT; few studies have reported donor-related factors. We retrospectively examined UTI occurrence within 5 years of transplantation in recipients (n = 211) who underwent LDKT at our hospital between April 2011 and April 2021. All nephrectomies were performed using a retroperitoneal pure laparoscopic approach. The ureter was dissected at the lower level of the common iliac artery and trimmed to the shortest length, enough to reach the bladder using extra vesicular ureterocystoneostomy with a 3 cm submucosal tunnel. Twenty-nine recipients (13.7%) developed UTI within 5 years, and the median time to onset was 40.0 days. After adjusting for the well-known factors, including recipient sex, graft ureter length was an independent factor for UTI occurrence (HR 1.25, 95% CI 1.02∼1.53, p = 0.028) in the multivariate Cox regression analysis. The long ureter is usually trimmed, and the widest part is used for anastomosis, which may increase the possibility of reflux from the bladder to the ureter in the standard technique. The ureter length may be associated with the incidence of UTI after LDKT.


Assuntos
Transplante de Rim , Ureter , Infecções Urinárias , Humanos , Feminino , Ureter/cirurgia , Doadores Vivos , Transplante de Rim/efeitos adversos , Transplante de Rim/métodos , Estudos Retrospectivos , Infecções Urinárias/etiologia , Infecções Urinárias/epidemiologia
4.
Acta Vet Scand ; 64(1): 29, 2022 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-36397093

RESUMO

BACKGROUND: An ectopic ureter is a congenital malformation characterized by caudal displacement of one or both ureteral orifices and is the most common cause of urinary incontinence in young dogs. Complete resolution of incontinence after surgery has been reported in 25-82% of dogs. The aim of this study was to identify preoperative prognostic factors for continence after surgical treatment of dogs with an ectopic ureter. Dogs were included if surgical correction of an ectopic ureter was performed and at least 1 year follow-up was available. RESULTS: Fifty-one dogs met the inclusion criteria. The ectopic ureters were either intramural (91%) or extramural (9%). The ectopic ureters were bilateral in 49% of cases. Overall median follow-up time after surgery was 6.5 years (range 1-13 years). Surgical correction alone resolved urinary incontinence in 47% of cases. Low grade pre-operative incontinence, male sex and pre-operative presence of ureteral or renal pyelum dilation were significantly associated with urinary continence after surgery. CONCLUSIONS: Dogs with severe preoperative incontinence were less likely to become completely continent after surgery, whereas male sex and preoperative dilation of the ureter or renal pyelum were positive prognostic indicators for continence. These results may assist in predicting outcome after surgical correction of ectopic ureters and suggest assessment of pre-operative urethral pressure profiling in future studies.


Assuntos
Doenças do Cão , Ureter , Incontinência Urinária , Cães , Masculino , Animais , Ureter/cirurgia , Ureter/anormalidades , Seguimentos , Prognóstico , Doenças do Cão/cirurgia , Doenças do Cão/etiologia , Incontinência Urinária/etiologia , Incontinência Urinária/cirurgia , Incontinência Urinária/veterinária
5.
Medicine (Baltimore) ; 101(44): e31580, 2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36343058

RESUMO

RATIONALE: Ureteral triplication (UT) is a very rare disorder, with a challenging diagnosis and varied therapeutic methods. In the past, the treatment usually involved heminephrureterectomy of the stunted moiety. Here, we reported a case of complete UT that was treated by laparoscopic triple-ureteral ureteroureterostomy (UU). PATIENT CONCERNS: A 2-year-old girl presented with frequent urine incontinence. Intravenous pyelography and voiding cystourethrography revealed a 3-segment left kidney with pelvi-ureteric dilation of the upper and middle moieties and grade IV to V vesicoureteral reflux. Laparoscopic triple-UU was successfully performed in the child, after which vesicoureteral reflux and urinary incontinence disappeared completely, hydronephrosis was improved, and hemirenal resection was avoided. DIAGNOSIS: Based on the imageological examination results, the final diagnosis of the 2-year-old girl was as follows: left 3 renal pelvis with complete ureteral duplication, combined with upper and middle hydronephrosis, and upper and middle vesicoureteral reflux grade IV to V. INTERVENTION: Laparoscopic triple-ureteral ureteroureterostomy was performed under general anesthesia. OUTCOMES: The patient recovered smoothly without complications after surgery. At 6 months follow-up, ultrasonography of the urinary system showed that hydronephrosis of the dilated kidney segment was attenuated. LESSONS: Laparoscopic triple-ureteral UU was successful in our patient. For children with duplex kidney and multiple ureteral duplications, minimally invasive urinary tract reconstruction can be a suitable intervention.


Assuntos
Gastroenteropatias , Hidronefrose , Laparoscopia , Ureter , Obstrução Ureteral , Incontinência Urinária , Refluxo Vesicoureteral , Criança , Feminino , Humanos , Pré-Escolar , Refluxo Vesicoureteral/cirurgia , Refluxo Vesicoureteral/etiologia , Estudos Retrospectivos , Ureter/cirurgia , Obstrução Ureteral/etiologia , Pelve Renal , Hidronefrose/cirurgia , Laparoscopia/métodos , Incontinência Urinária/cirurgia , Gastroenteropatias/complicações
6.
J Egypt Natl Canc Inst ; 34(1): 49, 2022 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-36437423

RESUMO

BACKGROUND: Ipsilateral synchronous renal and ureteric tumor is uncommon. Nephron sparing surgery is the standard for small renal masses. Ureteric tumors can be selectively managed with nephron sparing surgery, especially in renal dysfunction. This case report details the management of double malignancy by nephron sparing surgery with robot-assisted approach. CASE REPORT: A 63-year-old gentleman with diabetes presented with history of intermittent gross hematuria for 2 weeks. He was clinically normal. On evaluation, he had grade 4 renal dysfunction (Se. creatinine 4.5 mg%) with mild proteinuria. Magnetic resonance imaging revealed right renal upper polar Bosniak III lesion and right hydroureteronephrosis due to 2 cm ureteric tumor near the vessel crossing. Renogram showed overall GFR of 22 ml/min with 31% (6 ml/min) contribution from the right side. He underwent robot-assisted right partial nephrectomy with distal ureterectomy and Boari flap ureteric reimplantation. Histopathology revealed margins free T2 clear cell carcinoma (kidney) and high-grade T3 transitional cell carcinoma (ureter). His nadir creatinine at 1 year follow-up was 3.3 mg% and no recurrence on MRI, cystoscopy, and ureteroscopy at 1 year. CONCLUSION: Minimally invasive nephron sparing surgery is feasible and reasonable option with satisfactory oncological control even in ipsilateral synchronous renal and ureteric tumors in selected patients with renal dysfunction.


Assuntos
Neoplasias Renais , Robótica , Ureter , Masculino , Humanos , Pessoa de Meia-Idade , Ureter/cirurgia , Ureter/patologia , Creatinina , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Neoplasias Renais/patologia , Nefrectomia/métodos , Rim/diagnóstico por imagem , Rim/cirurgia , Rim/patologia
7.
Medicine (Baltimore) ; 101(45): e31194, 2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36397363

RESUMO

BACKGROUND: Percutaneous nephrostomy (PCN) and Double J stenting (DJS) are the 2 main treatment options of ureteral obstruction. We evaluate which of these 2 methods is superior concerning the course of procedure, postoperative complication and quality of life. METHODS: A detailed review of electronic databases including PubMed, Embase, Cochrane Library, China Biology Medicine disc, China National Knowledge Infrastructure up to February 21st, 2021 was searched. Continuous data were evaluated using mean difference (MD) with 95% confidence interval (CI), while nominal data were analyzed by risk ratio (RR) with 95% CI. Meanwhile, we performed the subgroup analysis based on study design, disease type, sample size, sepsis, DJ diameter, nephrostomy diameter, anesthesia type and guidance under X-ray or ultrasound. RESULTS: There were 18 previous studies included in current study. As a result, we found that there were significant differences in fluoroscopy time (MD = 0.31; 95% CI, 0.14-0.48, P < .001) and hospital stay (MD = 1.23; 95% CI, 0.60-1.85, P < .001). However, no statistic difference was detected in operative time (MD = 5.40; 95% CI, -1.78 to 12.58, P = .140) between the paired groups. Although DJS showed a higher rate of postoperative complications (25.19% vs 17.61%), there was no significant difference in the incidence of complications following DJS and PCN (RR = 0.92; 95% CI, 0.60-1.43; P = .720). Based on the EuroQol analysis, the 2 main treatment options had different impacts on quality of life. The pooled results showed that PCN patients reported more difficulties in self-care compared to DJS patients (RR = 3.07; 95% CI, 1.32-7.14; P = .009). CONCLUSIONS: DJS is a safe and better method of temporary urinary diversion than PCN for management of ureteral obstruction with shorter fluoroscopy time and hospital stay. As for quality of life, patients receiving PCN had a distinct difficulty in self-care compared to those receiving DJS. However, these 2 treatment options often depends on the individual situation.


Assuntos
Nefrostomia Percutânea , Ureter , Obstrução Ureteral , Humanos , Nefrostomia Percutânea/efeitos adversos , Nefrostomia Percutânea/métodos , Complicações Pós-Operatórias/epidemiologia , Carbonitrila de Pregnenolona , Qualidade de Vida , Ureter/cirurgia , Obstrução Ureteral/cirurgia , Obstrução Ureteral/etiologia
8.
BMC Surg ; 22(1): 380, 2022 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-36335342

RESUMO

BACKGROUND: Seventy percent of ureteric injuries result from iatrogenic causes with about 75% of these diagnosed in the postoperative period. It may have fatal complications such as sepsis and or renal functional damage increasing morbidity and treatment cost. OBJECTIVE: The study aimed to identify the risk factors for iatrogenic ureteric injuries from open surgical procedures and the intervention outcome in a resource-poor setting. PATIENTS AND METHODS: This was a multi-centre study. The clinical records of patients with iatrogenic ureteric injuries seen between 2015-2021 who were managed at the urology units of the Margaret Marquart Catholic Hospital, and the Ho Teaching Hospital, in the Volta region of Ghana, were retrieved. The data extracted included patients' demographic factors, the clinical presentation, the primary surgery details, the time from surgery to presentation, the intervention offered, and the outcomes. The data were analysed using the Statistical Package for Social Scientists (SPSS) version 24.0. RESULTS: Twelve patients aged between 24-54 years with a total of 19 ureteric injuries were managed. The injuries resulted from a hysterectomy in 10 cases (83.3%), and one each from emergency caesarean section and inguinal hernia repair with traction and transection injuries respectively (16.7%). Seven out of 12 cases were diagnosed 48 h after surgery. Bilateral injuries occurred in 7 cases (14/19 injuries). Intraoperative recognition was common in unilateral injuries and surgeries performed by specialist surgeons. Ureteroneocystostomy (14/19), uretero-ureterostomy (1/19), and open suture release were the management procedures performed as in the intervention. CONCLUSION: Open hysterectomy (83.7%) was the most common procedure leading to iatrogenic ureteric injuries in this study. Intra-operative recognition occurred when trained specialist surgeons performed the surgery. Late presentation with more severe morbidity was found amongst non-specialist surgeons. Thus, improvement in training to allow intra-operative diagnosis should be encouraged in general practitioners to reduce morbidity and improve outcomes.


Assuntos
Traumatismos Abdominais , Ureter , Humanos , Gravidez , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Estudos Retrospectivos , Cesárea , Ureter/cirurgia , Histerectomia , Traumatismos Abdominais/cirurgia , Doença Iatrogênica , Estudos Multicêntricos como Assunto
9.
Actas urol. esp ; 46(8): 504-512, oct. 2022. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-211490

RESUMO

Introducción: Los verdaderos beneficios de la colocación perioperatoria de un catéter doble J (CDJ) están siendo ampliamente estudiados debido a sus conocidos efectos secundarios. Sin embargo, todavía no se ha llegado a un consenso en la literatura sobre el diseño óptimo del catéter. Por este motivo, este estudio prospectivo, aleatorizado y simple ciego, tuvo como objetivo comparar la sintomatología asociada a 2 diseños de catéter: el de superficie lisa y el de diseño acanalado.Materiales y métodosEl estudio recogió prospectivamente los datos de 42 pacientes que se sometieron a la colocación de un CDJ entre julio de 2019 y agosto de 2020. Los pacientes se dividieron aleatoriamente en 2 grupos según el diseño del catéter utilizado: en el primer grupo se utilizó el catéter de superficie lisa (control) y en el segundo, el catéter de diseño acanalado (intervención). Después de la cirugía, todos los pacientes completaron el Cuestionario de Síntomas del Catéter Ureteral validado en portugués en 3 momentos del postoperatorio (días 7 y 30 después del procedimiento quirúrgico, y día 30 después de la retirada del catéter).Resultados: No se encontraron diferencias significativas en cuanto al sexo, la edad, la mediana de índice de masa corporal, la lateralidad, el tipo de procedimiento quirúrgico (ureteroscopia flexible, semirrígida o mixta). Los CDJ de superficie lisa se asociaron a una mayor incidencia de dolor en el flanco (52,38 vs. 10%; p=0,006) y de dolor suprapúbico (57,14 vs. 30%; p=0,04) el día 7 después del procedimiento. La regresión lineal mixta mostró, de forma significativa, menos dolor en el flanco (p<0,001) y suprapúbico (p<0,01), y un rendimiento sexual significativamente mejor en el grupo de intervención (p=0,03).ConclusionesLos CDJ con diseño acanalado se asocian a una menor incidencia de dolor en el flanco y suprapúbico, y tienen un impacto menor en el rendimiento sexual de los pacientes. (AU)


Introduction: The true benefits of perioperative JJ stent placement are being widely studied due to its known side effects. However, no consensus has been reached in the literature regarding the best type of stent. This prospective, randomized, single-blinded study therefore aimed to compare the symptomatology associated with two JJ stent designs: smooth-walled and grooved.Materials and methodsThe study prospectively recruited 42 patients who underwent JJ stent placement between July 2019 and August 2020. The patients were randomly divided into two groups according to the JJ stent design used: the smooth-walled stent (control) and grooved stent (intervention) groups. After surgery, all patients completed the Portuguese-validated Ureteral Stent Symptom Questionnaire at three timepoints (days 7 and 30 post-surgical procedure, and day 30 post-stent removal).Results: No significant differences in gender, age, median body mass index, laterality, type of surgical procedure (flexible, semi-rigid or mixed ureteroscopy) were found. Smooth-walled JJ stents were associated with a higher incidence of flank pain (52.38% vs. 10%, P=.006) and suprapubic pain (57.14% vs. 30%, P=.04) on the 7th. post-procedure day. Linear mixed regression showed significantly lower flank (P<.001) and suprapubic pain (P<.01), and significantly better sexual performance in the intervention group (P=.03).ConclusionsUreteral stent with a grooved format are associated with a lower incidence of flank and suprapubic pain and had less impact on the sexual performance of patients. (AU)


Assuntos
Humanos , Dor , Stents/efeitos adversos , Ureter/cirurgia , Ureteroscopia/métodos , Método Simples-Cego , Estudos Prospectivos
11.
J Coll Physicians Surg Pak ; 32(10): 1360-1362, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36205289

RESUMO

Various hydronephrotic, dysplastic or clinical pathologies can accompany ureterocele, which is a cystic dilatation of the intravesical part of the submucosal ureter. However, the development of cancer in the ureterocele is highly unusual. Hematuria is the most common sign, although imaging can also indicate alterations in the wall of the ureterocele. Unfortunately, there is no current guideline for the management of papillary urothelial carcinoma arising from ureterocele. Non-muscle-invasive bladder cancer treatment and follow-up protocols are classically applied. However, the anatomical structure of the ureterocele differs from that of normal bladder tissue. It is unclear whether this difference represents a risk in terms of deep tissue tumour invasion. In addition, tumour cells may migrate to the upper urinary tract due to urinary reflux developing following tumour resection. The management of papillary urothelial carcinoma arising from ureterocele must therefore be specific to that condition. However, this depends on an increase in the number of patients reported in the literature. Our review of the literature revealed very few reports. The present study is therefore particularly valuable from that perspective and describes the clinical management of a patient developing papillary urothelial carcinoma in ureterocele. Key Words: Ureterocele, Bladder, Hematuria, Urothelial carcinoma.


Assuntos
Carcinoma de Células de Transição , Ureter , Ureterocele , Neoplasias da Bexiga Urinária , Hematúria/etiologia , Humanos , Ureter/cirurgia , Ureterocele/complicações , Ureterocele/diagnóstico , Ureterocele/cirurgia , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/cirurgia
12.
Eur Rev Med Pharmacol Sci ; 26(18): 6671-6677, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36196737

RESUMO

OBJECTIVE: The aim of our study is to investigate the efficacy and safety of laparoscopic ureterolithotomy operation in elderly patients with large and impacted ureteral stones. PATIENTS AND METHODS: Between January 2011 and July 2021, 66 elderly patients with impacted, > 15 mm upper and middle ureteral stones underwent laparoscopic ureterolithotomy in our center. The data for all patients were evaluated retrospectively. RESULTS: The mean age of the patients was 65 ± 5.43 years. The mean stone size was 20.2 ± 2.5 mm. The mean operation time was 93.6 ± 13.2 minutes. Among patients, 16 (24.2%) had history of unsuccessful shock wave lithotripsy and 12 (18.1%) patients had history of ureterorenoscopy. Stone-free rate was 95.4% in all patients. Modified Clavien grade 1 complications were seen in 18 patients (27.2%), but no significant perioperative and postoperative complications were observed. Urinary extravasation lasting 5, 7 and 9 days was observed in 5 patients (7.5%) who were treated conservatively. The mean hospital stay was 3.4 ± 1.52 days. The patients were asymptomatic at the 6th week post-op follow-up, and no stones were seen on direct X-ray and abdominal ultrasonography. Intravenous urography and non-contrast tomography (NCCT) taken 3 months later did not show any obstruction or stenosis in the ureter. CONCLUSIONS: Laparoscopic ureterolithotomy can be considered as the first treatment option for elderly patients with impacted and large ureteral stones, thanks to its high success and acceptable complication rates.


Assuntos
Laparoscopia , Ureter , Cálculos Ureterais , Idoso , Humanos , Laparoscopia/efeitos adversos , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Ureter/cirurgia , Cálculos Ureterais/diagnóstico por imagem , Cálculos Ureterais/etiologia , Cálculos Ureterais/cirurgia , Ureteroscopia/métodos
13.
Can J Urol ; 29(5): 11323-11325, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36245204

RESUMO

Non-urothelial malignant ureteral obstruction (MUO) causes hydronephrosis, renal damage and infectious sequelae. The overall condition, symptoms, and plans for systemic therapy inform urologic intervention. In well-selected cases, there is a role for definitive reconstruction. We describe a robotic-assisted distal ureterectomy and reimplant for definitive repair of obstructive metastatic melanoma.


Assuntos
Melanoma , Procedimentos Cirúrgicos Robóticos , Ureter , Neoplasias Ureterais , Humanos , Melanoma/complicações , Melanoma/cirurgia , Ureter/cirurgia , Neoplasias Ureterais/complicações , Neoplasias Ureterais/patologia , Neoplasias Ureterais/cirurgia , Procedimentos Cirúrgicos Urológicos
14.
BMJ Case Rep ; 15(10)2022 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-36316058

RESUMO

A standard surgical treatment of distal ureteric defects is represented by the ureteroneocystostomy-ureteric reimplantation. However, the procedure involves an anatomical alteration of the ureterovesical (neo)junction that often hinders the retrograde catheterisation of the reimplanted ureter.We describe a case of antegrade ureterolithotripsy (AULT) in a psoas-hitch reimplanted ureter. A woman with severe left hydronephrosis supported by a subcentimetric proximal ureteral stone in a psoas-hitch reimplanted ureter was referred to our unit. Retrograde ureteroscopy was unsuccessful due to impossibility in incannulating the ureteral neo-orifice. Following the placement of a percutaneous nephrostomy, percutaneous AULT through ureteral sheath was successfully performed with complete treatment of the stone.AULT may represent a viable alternative in the management of ureteral stones when the upper urinary tract is not amenable to retrograde ureteroscopy. In experienced hands, the procedure is straightforward and may avoid the adoption of transabdominal approaches.


Assuntos
Hidronefrose , Ureter , Cálculos Ureterais , Feminino , Humanos , Ureter/cirurgia , Reimplante , Cálculos Ureterais/cirurgia , Ureteroscopia
15.
Pan Afr Med J ; 43: 5, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36284889

RESUMO

Many complications due to double j (DJ) stent placement have been reported. DJ stent knotting is a rare complication, with only a few cases reported in the literature. We presented a case of DJ stent knotting and reviewed the literature regarding this complication. We reported a 20-year-old man with a history of cystinuria and ureteral stone managed with retrograde ureteroscopy and holmium laser three months ago. The patient comes for DJ stent removal. Firstly, we tried to remove the DJ stent via the cystoscopic procedure, which failed. A fluoroscopic image revealed a knotted DJ stent lodged at the ureteropelvic junction and was removed via holmium laser ureteroscopic procedure without complications. In conclusion, when cystoscopic procedure with simple traction fails to remove DJ stents, multimodality urological procedures such as holmium laser should be tried, especially in patients with urolithiasis predisposing factors.


Assuntos
Ureter , Cálculos Ureterais , Masculino , Humanos , Adulto Jovem , Adulto , Ureter/cirurgia , Ureteroscopia/métodos , Cálculos Ureterais/cirurgia , Stents/efeitos adversos , Pelve Renal
16.
Int J Clin Pract ; 2022: 7518971, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36120665

RESUMO

Purpose: Insertion of a ureteral access sheath (UAS) may fail in some patients in retrograde intrarenal surgery (RIRS), and this study aimed to seek preoperative risk factors for the failure of 12/14F UAS placement. Methods: We retrospectively analyzed 260 consecutive patients who underwent RIRS between May 2020 and March 2022 at our institution. Data on patient and stone characteristics and several computed tomography (CT)-based measurements were collected and compared between the success and failure UAS placement groups. Results: Twenty-nine (11.2%) patients failed to insert the UAS. Age, gender, height, weight, stone side, stone location, length of history, and computed tomography (CT)-based parameters were not significant differences between the two groups. Univariate logistic regression analyses showed sex (female/male) (odds ratio: 0.287 and 95% CI [0.107, 0.722], p=0.013), length of history 15-31 days (odds ratio: 0.315 and 95% CI [0.102, 0.974], p=0.045), length of history >31 days (odds ratio: 0.202 and 95% CI [0.051, 0.805], p=0.023), and diameter of the ipsilateral common iliac artery (odds ratio: 1.285 and 95% CI [1.018, 1.623], p=0.035) were associated with UAS placement. Conclusion: Our study indicated that males, the short length of history, and the short diameter of the ipsilateral common iliac artery were the risk factors for the failure of UAS placement.


Assuntos
Cálculos Renais , Ureter , Feminino , Humanos , Cálculos Renais/diagnóstico por imagem , Cálculos Renais/cirurgia , Masculino , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Falha de Tratamento , Ureter/diagnóstico por imagem , Ureter/cirurgia
17.
Am J Case Rep ; 23: e937172, 2022 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-36059136

RESUMO

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.


Assuntos
Endometriose , Hidronefrose , Ureter , Doenças Ureterais , Obstrução Ureteral , Adulto , Endometriose/complicações , Endometriose/diagnóstico , Endometriose/cirurgia , Feminino , Humanos , Hidronefrose/etiologia , Ureter/cirurgia , Doenças Ureterais/complicações , Doenças Ureterais/diagnóstico , Doenças Ureterais/cirurgia , Obstrução Ureteral/diagnóstico , Obstrução Ureteral/etiologia , Obstrução Ureteral/cirurgia
18.
BMC Urol ; 22(1): 146, 2022 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-36076193

RESUMO

BACKGROUND: Oblique lumbar interbody fusion (OLIF) surgery has been performed as a minimally invasive lateral lumbar fusion technique in recent years. Reports of operative complications of OLIF are limited, and there are fewer reports of ureteral injuries. CASE PRESENTATION: A 62-year-old Chinese woman diagnosed with "lumbar spondylolisthesis (L4 forward slip, I degree)" underwent OLIF treatment. The surgical decompression process was smooth, and the cage was successfully placed. After the expansion sleeve of OLIF was removed, clear liquid continuous outflow from the peritoneum was found. The patient was diagnosed with a ureteral injury. The urological surgeon expanded the original incision, and left ureteral injury anastomosis and ureteral stent implantation were performed. The patient was changed to the prone position and a percutaneous pedicle screw was placed in the corresponding vertebral body. The patient was indwelled with a catheter for 2 weeks, and regular oral administration of levofloxacin to prevent urinary tract infection. After 2 months, the double J tube was removed using a cystoscope. One year after surgery, the symptoms of lumbar back were significantly improved, and there were no urinary system symptoms. However, the patient needed an annual left ureter and kidney B-ultrasound. CONCLUSION: Ureteral injury is a rare complication and is easily missed in OLIF surgery. If the diagnosis is missed, the consequences can be serious. Patients should undergo catheterization before the operation and hematuria should be observed during the operation. We emphasize the careful use of surgical instruments to prevent intraoperative complications. In addition, after withdrawing the leaf in the operation, it is necessary to carefully observe whether a clear liquid continues to leak. If ureteral injury is found, one-stage ureteral injury repair operation should be performed to prevent ureteral stricture.


Assuntos
Fusão Vertebral , Espondilolistese , Ureter , Feminino , Humanos , Complicações Intraoperatórias/etiologia , Vértebras Lombares/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Espondilolistese/complicações , Espondilolistese/cirurgia , Resultado do Tratamento , Ureter/cirurgia
20.
BMC Urol ; 22(1): 150, 2022 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-36104697

RESUMO

OBJECTIVES: To investigate the outcomes of internal ureteral stents in comparison with ureteroscopy (URS) for pregnant women with urolithiasis. DATA SOURCES: Relevant studies published from January 1980 to June 2022 were identified through systematic literature searches of MEDLINE, EMBASE, Web of Science and the Cochrane Library. METHODS OF STUDY SELECTION: A total of 499 studies were initially identified. We included pregnant women in any stages of gestation who underwent double-J (D-J) stent insertion only or ureteroscopy for the treatment of urolithiasis; for a study to be included, the number of participants needed to exceed 10. This systematic review was registered on the PROSPERO website (Reference: CRD42020195607). RESULTS: A total of 25 studies were identified with 131 cases undergoing serial stenting and 789 cases undergoing URS. The pooled operative success rate was 97% for D-J stent insertion and 99% for URS. Only a few patients passed stones spontaneously after serial D-J stenting. The pooled stone free rate (SFR) in URS operations was about 91%. For internal ureteral stent therapy, the rate of normal fertility outcomes was 99%, although the pooled incidence of complications was approximately 45%. For group receiving URS treatment, the rate of normal fertility outcome was 99% and the pooled incidence of complications was approximately 1%. However, the pooled rate of premature birth and abortion were the similar between the two groups (< 1%); the rate of serious complications was also similar between the two groups. CONCLUSIONS: Although internal ureteral stents may cause more minor complications, both ureteroscopy and internal ureteral stents showed had low rates of adverse effects on fertility outcomes when used to treat pregnant women with symptomatic urolithiasis. Evidence suggests that URS may have a greater advantage for pregnant patients with urinary stones when conditions permit. Since, it has been proven to be safe and effective, internal ureteral stents could be considered in emergency or other special situations.


Assuntos
Ureter , Cálculos Ureterais , Urolitíase , Feminino , Humanos , Gravidez , Stents/efeitos adversos , Ureter/cirurgia , Cálculos Ureterais/terapia , Ureteroscopia/métodos , Urolitíase/complicações , Urolitíase/cirurgia
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