Different patterns of pelvic ureteral endometriosis. What is the best treatment? Results of a retrospective analysis.

OBJECTIVE: Endometriosis is an estrogendependent disease. The incidence of urinary tract endometriosis (UE) increased during the last few years and, nowadays, it ranges from 0.3 to 12% of all women affected by the disease. The ureter is the second most common site affected. The ureteral endometriosis is classified in extrinsic and intrinsic. The aim of this study is to individuate the best treatments for each subset of ureteral endometriosis. MATERIALS AND METHODS: 32 patients diagnosed with surgically treated UE were retrospectively reviewed. The patients were divided into 3 subsets (intrinsic UE, extrinsic UE with and without obstruction). The patients with intrinsic UE (n = 10) were treated with laser endoureterotomy. The patients with extrinsic UE (n = 22) were divided in two subsets with (n = 16) and without (n = 6) hydronephrosis. All the patients underwent ureteral stenting, and resection and reimplantation was performed in the first group, and when the mass was > 2.5 cm (n = 3) Boari flap was performed. Laparoscopic ureterolysis (shaving) was performed in the second group. RESULTS: In the extrinsic subset of UE, we obtained an high therapeutic success (84%). Conversely, in the intrinsic subset there was a recurrence rate of the disease in 6/10 of the patients (60%). CONCLUSIONS: Ureterolysis seems to be a good treatment in extrinsic UE without obstruction. Resection and reimplantation allows excellent results in the extrinsic UE with obstruction. In the intrinsic subset, the endoureterotomy approach is inadequate.

[Classification of hydroureteronephrosis by ultrasonography findings].

A complex examination including blood and urine biochemistry, pyelomanometry, x-ray-radionuclide and endoscopic investigations of the urinary tract as well as ultrasonography with estimation of morphometric and functional parameters of different parts of the urinary tract was conducted in 525 patients with various diseases of the pelvic ureter and urinary bladder complicated by hydroureteronephrosis (HUN) and 50 healthy controls. The findings made it possible to distinguish four stages of HUN: hyperkinetic, dyskinetic, hypokinetic and akinetic. This gradation rests on the results of sonographic assessment of morphofunctional condition of the urinary tract which were compared with findings of the other methods of urological examination. The proposed 4-stage HUN classification based finally only on ultrasonography data describes not only severity of anatomic changes but, indirectly, functional reserves of the upper urinary tract. Sonography is an available, non-invasive, cost-effective method without contraindications. This allows recommendation of this HUN classification for wide application. According to the stage of urodynamic disorder, therapeutic policy is proposed.

Congenital ureteric diverticula in children and adults: classification, radiological and clinical features.

To date, about 100 cases of a blind-ending branch of a bifid ureter have been reported. We present 13 clinically, radiologically and histologically evaluated cases of congenital ureteric diverticulum. We believe this anomaly is not as rare as hitherto believed and suggest the term congenital ureteric diverticulum for a blind-ending branch of a bifid ureter.

[The double-pyelon kidney with special regard to the transport function (author's transl)]. / Uber die Doppelnieren mit besonderer Rücksicht auf die Funktion des Transportsystems

The double-pyelon kidney, i.e. the total or partial duplication of the urinary transport system may involve both diagnostic and therapeutic difficulties. Observations are presented on the strength of 398 cases with total or partial duplication of the upper urinary tract. The incidence rate was 0.7 percent. The various types of duplication are presented with the diagnostic and therapeutic features involved. Transport function is discussed in detail as investigated under ideal physiologic conditions: during excretory urography under the amplifier screen. Aiming at early detection of the congenital anomaly and specification of the appropriate management, a urologic check-up is suggested even with mild presenting symptoms. Special emphasis is given to the consistent day-time enuresis in children over 3 years old, as a possible sign of ectopic ureter. Both children and parents are saved much unpleasantness by early detection, proper management and considerate surgery.

Megaureter: classification, pathophysiology, and management.

The term megaureter does not define a specific pathological condition, because it can be due to different underlying abnormalities. The most used classification includes three groups: refluxing megaureter, associated with vesicoureteral reflux (VUR); obstructive megaureter, associated with urine flow impairment at the vesicoureteral junction; non-refluxing non-obstructive megaureter, if neither obstruction nor reflux can be identified. Each group can be divided into two subgroups: primary megaureter; secondary megaureter. With the advent of antenatal ultrasound an increased number of cases are identified prior to the onset of symptoms. The common used investigation are: urinary tract ultrasound, voiding cystourethrography, urography, serial diuretic renography and pressure-perfusion studies (Whitaker test). The advent of prenatal and neonatal echography has modified the natural history of megaureter. Nowadays non operative management is preferred. Operative intervention is indicated only in these cases: significant impairment to urine flow; worsening renal function during the observation time; recurrent UTI in spite of adequate antibiotic prophylaxis.

Classification of ureteral stenosis and associated strategy for treatment after kidney transplant.

OBJECTIVES: Ureteral stenosis is a common complication after a kidney transplant. Treatment for ureteral stenosis ranges from interventional procedures to open surgery. The aim of this study is to present classification for ureteral stenosis and recommend the targeted strategy for effective treatment. MATERIALS AND METHODS: Twelve cases of ureteral stenosis were diagnosed among 193 kidney transplants, of which 91 were from a live donor and 102 from a deceased donor. The mean age was 46.22 ± 13.23 years. The diagnosis of ureteral stenosis includes serum creatinine elevation, hydronephrosis, and presence of stricture on a pyelogram. The criterion for classification is based on the severity of stricture. RESULTS: One of ureteral stenoses was classified as grade 1, six were grade 2, and five were grade 3. Of 12 cases, 10 were live-donor kidney transplant, 4 had lymphocele, and 2 had a hematoma after transplant. The corresponding strategy for each grade of ureteral stenosis is as follows: grade 1, ureteral stent reinsertion; grade 2, cutting balloon dilatation or endoscopic incision of stenosis; grade 3, open surgery urinary tract reconstruction. All cases were successfully treated using these strategies. CONCLUSIONS: This classification of ureteral stenosis provides guidance for effective management and avoids unnecessary procedures. In this series, ureteral stenosis was significantly associated with a live donor and surgical complications.

Classification of female genito-urinary tract fistula: a comprehensive review.

INTRODUCTION AND HYPOTHESIS: The aim of this paper is to review proposed classifications for genito-urinary fistulae. METHODS: A comprehensive literature review of historical texts, peer review publications, and abstracts was used to compile a listing of the existing genito-urinary fistula classification systems. RESULTS: The absence of an accepted standardized classification for female genito-urinary fistulae has resulted in the proliferation of a number of individually devised categorizations. Fistulae are described by size, location, degree of vaginal scarring, and type (whether it involves the bladder, rectum, intestines, uterus, etc). In addition, most classification systems have not been subjected to outcomes research, making them primarily descriptive in nature. CONCLUSIONS: There is a lack of consensus among fistula surgeons in adopting a standardized classification system or systems. Comparative assessment of studies and outcomes is not possible without a standardized classification system. Currently, there is no accepted standardized classification for female genito-urinary fistula.

A simple classification of wide ureters.

A simple classification of abnormal ureters is presented which categorises the ureters according to the presence or absence of 3 factors, namely reflux, bladder outlet obstruction and ureteric obstruction. It has been devised to try to rid the literature of many confusing and obsolete terms and it is hoped that this new classification may become internationally accepted.

[Blind ureters. Proposed classification and study of the national statistics with the contribution of 2 cases]. / Los ureteres ciegos. Propuesta de clasificación y estudio de la estadistica nacional, con aportacion de dos casos.

The authors put forward the bases for a classification of the different kinds of B.U., according to the direction which it takes, the situation of the blind end and the accompanying, renoureteral malformations in the system itself. They review the Spanish statistics in which 38 cases of 6 kinds are compiled, included among the 15 in the classification suggested, as well as presenting two of their own. They refer to the possible ischemic cause of this anomaly.

[Ureteritis]. / Le ureteriti.

We relate our experience about ureteritis, especially non specific ureteritis. The traumatic, radiation ureteritis will be discussed in others chapters. Most cases of ureteritis are infective, and may be due to any of the organism normally found in urinary tract infections, particularly Escherichia Coli, staphylococci, streptococci, enterococci, proteus and pyocyaneus. It is really primary, but it usually ascending from an associated cystitis, descending from pyelonephritis, or due to direct spread from and adjacent inflammatory lesion such as appendicitis or salpingitis. The infection may also reach the ureter by lymphatic spread, particularly from the prostate and seminal vesicles. Any associated abnormalities of the ureter, such as stricture, megaloureter, ureterocele, and so on, will naturally predispose to infective ureteritis. As ureteritis is rarely primary, the first step in treatment must be toward the elucidation and cure of any underlying lesion. Thus calculi, cystitis, pyelitis, and so on, will need appropriate therapy, and this in itself will considerably improve or cure the ureteritis, and specially in the more acute cases. In the chronic cases with stricture formation, dilation or even excision of the stenosed portion may be required. For the treatment of the strictures we want emphasize the role of the ureteral stenting thinking its use is necessary to preserve the renal function.

Ureteral obstructions and leaks after renal transplantation: outcome of percutaneous antegrade ureteral stent placement in 44 patients.

PURPOSE: To analyze the outcome of percutaneous antegrade ureteral stent placement for treatment of ureteral stenoses and leaks after renal transplantation. MATERIALS AND METHODS: Antegrade pyelography and percutaneous ureteral stent placement were performed in 45 patients with ureteral obstruction (n = 40), leak (n = 3), or both (n = 2). Obstructions were graded as mild, moderate, or complete, and as early (< or = 3 months after transplantation) or late (> 3 months). RESULTS: The outcome of stent placement was successful in 25 (57%) patients (average follow-up, 30 months). The ureteroneocystostomy (UNC) was the most common site of obstructions (22 of 41), leaks (four of five), and successful outcomes (16 of 22). Moderate obstructions were most common (29 of 41) and responded best to treatment (17 of 29). Eighteen (69%) of 26 early obstructions and five (33%) of 15 late obstructions were successfully managed percutaneously. All complications (12 of 45 patients) were minor, with infections the most common (n = 7). No mortality or allograft loss was attributable to stent placement. CONCLUSION: Ureteral stents are safe and effective for the treatment of obstructions and leaks and are particularly effective for early and UNC obstructions. These stents may also be useful for temporary drainage.