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[Retrocaval ureter].  


A 13-year-old boy presented to our clinic with a newly found hydronephrosis, which was caused by a retrocaval ureter. Besides this we noticed a glandular hypospadia. After we made sure that the right kidney had a normal function in the ING, we removed the stenosed ureter segment and performed an end-to-end anastomosis. The DJ stent was removed without any complications 5 weeks after the operation. PMID:15029479

Friebel, N; Bolten, M; Fernandez De La Maza, S



Cell biology of ureter development.  


The mammalian ureter contains two main cell types: a multilayered water-tight epithelium called the urothelium, surrounded by smooth muscle layers that, by generating proximal to distal peristaltic waves, pump urine from the renal pelvis toward the urinary bladder. Here, we review the cellular mechanisms involved in the development of these tissues, and the molecules that control the process. We consider the relevance of these biologic findings for understanding the pathogenesis of human ureter malformations. PMID:23123402

Woolf, Adrian S; Davies, Jamie A



Retrocaval ureter: two case reports.  


Retrocaval ureter also referred to as pre-ureteral vena cava is a rare congenital anomaly with the ureter passing posterior to the inferior vena cava. Though it is a congenital anomaly, patients do not normally present with symptoms until the 3rd and 4th decades of life from a resulting hydronephrosis. We present the first two cases to be reported in Ghana; a 36-year-old male and a 40-year-old female both with right flank pains and associated right hydronephrosis. Diagnoses were confirmed with retrograde ureteropyelogram and both had an open surgical repair of the anomaly. PMID:22359425

Kyei, M Y; Yeboah, E D; Klufio, G O; Mensah, J E; Gepi-Atee, S; Zakpaa, L; Morton, B; Adusei, B



Retrocaval Ureter: The Importance of Intravenous Urography  

PubMed Central

Retrocaval ureter is a rare cause of hydronephrosis. Its rarity and non-specific presentation pose a challenge to surgeons and radiologists in making the correct diagnosis. Differentiation from other causes of urinary tract obstruction, especially the more common urolithiasis, is important for successful surgical management. Current practice has seen multislice computed tomography (MSCT) rapidly replaces intravenous urography (IVU) in the assessment of patients with hydronephrosis due to suspected urolithiasis, especially ureterolithiasis. However, MSCT, without adequate opacification of the entire ureter, may allow the physician to overlook a retrocaval ureter as the cause of hydronephrosis. High-resolution IVU images can demonstrate the typical appearance that leads to the accurate diagnosis of a retrocaval ureter. We reported a case that illustrates this scenario and highlights the importance of IVU in the assessment of a complex congenital disorder involving the urinary tract.

Hassan, Radhiana; Aziz, Azian Abd; Mohamed, Siti Kamariah Che



Iatrogenic Obliteration of Ureter with Spontaneous Recanalization  

PubMed Central

We report an unusual case of spontaneous and complete healing of a severe iatrogenic midureteral injury. Following percutaneous nephrostomy and 3 months on our surgical waiting list, the injured ureter underwent complete spontaneous recanalization. The patient is clinically well with no evidence of recurrent obstruction after 2 years of followup. To our knowledge, this is the first reported case of spontaneous recanalization of an iatrogenically induced complete ureteral obliteration.

Mussari, Ben



Transitional Cell Cancer of the Renal Pelvis and Ureter (PDQ): Treatment  


General Information About Transitional Cell Cancer of the Renal Pelvis and Ureter Transitional cell cancer of the renal pelvis and ureter is a disease in which malignant (cancer) cells form in the renal pelvis and ureter. The ...


[Activation of latent pacemakers in the guinea pig ureter].  


Guinea pig's ureter rhythmogenic autonomous latent pacemaker was shown to generate a significantly higher-frequency rhythm than the pericystic pacemaker. The latent pacemakers of the ureter middle portion can be activated with a breach of electrical conductivity across the organ or with chemical agents (noradrenaline, histamine). PMID:11575129

Kazarian, K V; Vantsian, V Ts; Tiraian, A S; Akopian, R R



Granular cell tumour of the ureter: first case reported  

PubMed Central

A 33-year-old woman presented with nonspecific, colicky pain of the left lower abdomen. Computed tomography (CT) revealed a 2-cm mass engulfing the mid–left ureter. Ureteroscopy and biopsy revealed normal mucosa, and CT-guided biopsy of the mass was nondiagnostic. The patient underwent laparoscopic exploration. A frozen section taken from the mass revealed a granular cell tumour. We excised the whole involved portion of the ureter and performed end-to-end ureteroureteral anastamosis. The postoperative course was uneventful. Examination of a segment of resected ureter revealed a granular cell tumour diffusely infiltrating the wall of the ureter. There were no features suggesting a malignant phenotype. On follow-up, the patient was found to have developed a stricture at the anastomotic area, which was successfully treated with balloon dilatation. To our knowledge, this is the first reported case of a granular cell tumour involving the ureter.

Madi, Rabii; Gokden, Neriman; Greene, Graham



GLI3 repressor controls functional development of the mouse ureter  

PubMed Central

Obstructive and nonobstructive forms of hydronephrosis (increased diameter of the renal pelvis and calyces) and hydroureter (dilatation of the ureter) are the most frequently detected antenatal abnormalities, yet the underlying molecular mechanisms are largely undefined. Hedgehog (Hh) proteins control tissue patterning and cell differentiation by promoting GLI-dependent transcriptional activation and by inhibiting the processing of GLI3 to a transcriptional repressor. Genetic mutations that generate a truncated GLI3 protein similar in size to the repressor in humans with Pallister-Hall syndrome (PHS; a disorder whose characteristics include renal abnormalities) and hydroureter implicate Hh-dependent signaling in ureter morphogenesis and function. Here, we determined that Hh signaling controls 2 cell populations required for the initiation and transmission of coordinated ureter contractions. Tissue-specific inactivation of the Hh cell surface effector Smoothened (Smo) in the renal pelvic and upper ureteric mesenchyme resulted in nonobstructive hydronephrosis and hydroureter characterized by ureter dyskinesia. Mutant mice had reduced expression of markers of cell populations implicated in the coordination of unidirectional ureter peristalsis (specifically, Kit and hyperpolarization-activation cation–3 channel [Hcn3]), but exhibited normal epithelial and smooth muscle cell differentiation. Kit deficiency in a mouse model of PHS suggested a pathogenic role for GLI3 repressor in Smo-deficient embryos; indeed, genetic inactivation of Gli3 in Smo-deficient mice rescued their hydronephrosis, hydroureter, Kit and Hcn3 expression, and ureter peristalsis. Together, these data demonstrate that Hh signaling controls Kit and Hcn3 expression and ureter peristalsis.

Cain, Jason E.; Islam, Epshita; Haxho, Fiona; Blake, Joshua; Rosenblum, Norman D.



Unusual anatomic variation of bilateral ectopic ureters in a dog.  


An unusual anatomic variation of bilateral ectopic ureters was diagnosed in a 6-week-old female Siberian Husky with urinary incontinence. Assessment during surgery revealed bilateral ectopic ureters with a common opening in the proximal portion of the urethra. Ureteroneocystostomy was performed bilaterally. After surgery, intermittent urinary incontinence continued, but was less severe. After resection of a persistent hymen in the 6-month-old dog, incontinence appeared to resolve, but then recurred, and has been controlled by phenylpropanolamine administration. PMID:2599944

Hosgood, G; Salisbury, K; Blevins, W E; Widmer, W R



Contractile effects of endothelins on isolated human ureter.  


The aim of our study was to investigate mechanism of action of endothelins 1, 2 and 3 on spontaneous activity, tone and intraluminal pressure of human ureter. Both longitudinal tension and intraluminal pressure were recorded from the isolated segments of proximal human ureter. Endothelins 1, 2 and 3 (5.35x10(-11) M - 5.05x10(-8) M) produced concentration-dependent tonic contraction and sustained increase in intraluminal pressure of isolated preparations of human ureter. Endothelins 1 and 3 produced also concentration-dependent inhibition of spontaneous, phasic contractions of the isolated preparations. Selective antagonist of ET(A) receptors BQ123 and selective antagonist of ET(B) receptors BQ788 produced significant inhibition of endothelin-1-induced tonic contraction (pA(2)=8.80 and 6.55, respectively) and increase in intraluminal pressure (pA(2)=8.68 and 7.02, respectively), while they did not affect endothelin-1-induced inhibition of spontaneous activity. Endothelin 1 produces increase in tone and intraluminal pressure of isolated human ureter acting on both ET(A) and ET(B) receptors, the first one being functionally more important. Only endothelins 1 and 3 inhibit spontaneous, phasic activity of human ureter, but this effect was not blocked by selective antagonists of ET(A) and ET(B) receptors. PMID:21995893

Jankovic, S M; Jankovic, S V; Stojanovic, V; Stojadinovic, D; Stojadinovic, M; Canovic, D; Stefanovic, S



Peristomal Pagetoid Spread of Urothelial Carcinoma of the Ureter  

PubMed Central

Patients with ostomy including urinary stoma often develop peristomal complications, especially skin damage. The patient in this case was a 69-year old female with a history of urothelial carcinoma of the bladder and left ureter who underwent transurethral resection of a bladder tumor, nephroureterectomy and cystectomy combined with ureterocutaneostomy. Later, she had recurrence of urothelial carcinoma in the remaining ureter that spread to the peristomal epidermis, with a skin appearance resembling Paget’s disease. We report this case based on its clinical significance since we believe it is the first description of this condition in the literature.

Ito, Fumio; Kihara, Ken; Shiomi, Koh; Ishizaki, Sumiko; Tanaka, Masaru; Aiba, Motohiko; Fujibayashi, Mariko; Nakazawa, Hayakazu



Right renal stone on the trajectory of upper left ureter.  


We report a 52-year-old woman with a right renal pelvic stone, mimicking a left upper ureteral stone in a kidney-ureter-bladder film. Computed tomography detected the exact anatomical location of the stone, which was not possible by intravenous urography and ultrasonography. In this study, we discuss diagnostic modalities of the urinary calculi in the light of the literature. PMID:16463144

Ceylan, Kadir; Arslan, Halil; Etlik, Omer; Bayrakli, Hasmet; Yilmaz, Yüksel



Complete necrosis of allograft ureter after cadaveric renal transplantation.  


Complete necrosis of a transplant ureter is a rare complication that needs to be considered early in cases of severe graft dysfunction if successful surgical intervention and restoration of graft function is to be achieved. We report on two cases of this complication occurring in children and discuss the surgical management. Surgical exploration of grafts where there is an early sudden decline in function is imperative as routine imaging will not exclude this potentially treatable problem. PMID:15009847

Sinha, Manish; Lewis, Malcolm A; Riad, Hany; Webb, Nicholas J A



[Injuries of the ureter caused by external force].  


Based on 10 own cases during the past 12 years, and a review of the literature, the subject is divided into classification and correlations, morbidity, aetiology, traumatogenesis and pathomechanisms, pathological anatomy and physiology, diagnostical pathways, therapy and results. There are closed and open injuries of the ureter, isolated and combined ones, and among the latter, combined related and not related. This injury is rare in general; in overseas countries, more often the open and in Central Europe, mostly the closed trauma can be seen. The indirect rupture of the ureter happens by hyperlordosis, the direct rupture by wheel lesion. The prevalence of youth for the indirect mechanism of the injury is explained by the hyperextensibility of the lumbar region in juveniles. Usually, the rupture is located proximally, a distal rupture (pelvic fracture) is an exception. Criteria of the closed injury are urinoma within Gerota's fascia and local resorption, later infection or urosepsis. The open injury is marked additionally by abdominal resorption of urine, followed by uremia and peritonitis. Delayed diagnosis is common, as the trauma causes few symptoms initially. Further, it is often obscured by concomitant injuries. For therapy, the rupture must be closed operatively by suture and splint. The operative approach follows usually the lumbar, but in cases of concomitant abdominal injury the abdominal route. Loss of kidney occurs in 20% and lethal outcome in 10%. PMID:6539014

Sigel, A; Egilmez, A N; Höhn, W



A very unusual anatomical variation and complication of common iliac artery and ureter in retroperitonoscopic ureterolithotomy.  


Anatomical localization of theureter comes along psoas major muscle and crosses over common iliac artery bifurcation. Common iliac artery aneurysm and impacted atherosclerosis are a rare condition that should be differed from the impacted ureter stone to avoid from undesirable complication. In this case, we present a very unusual anatomical variation and complication of common iliac artery and ureter in retroperitonoscopic ureterolithotomy. PMID:21523238

Huri, Emre; Akgül, Turgay; Karakan, Tolga; Sargon, Mustafa; Germiyano?lu, Cankon



Single system ectopic ureter to rectum subtending solitary kidney and bladder agenesis in newborn male  

Microsoft Academic Search

We report a case of a single system solitary ectopic ureter to the rectum with bladder agenesis in a viable newborn male. Only 2 cases of ectopic ureter to the rectum and 18 cases of bladder agenesis have been reported in viable newborns. To our knowledge, this case constitutes the first reported combination of these defects in a living neonate.

Christopher J. Weight; Deepa Chand; Jonathan H. Ross



Robotic uretero-ureterostomy of the retrocaval ureter without excision of the retrocaval segment  

PubMed Central

Robotic reconstruction of the retrocaval ureter is gaining momentum as the method of choice for surgically treating this rare condition. Maintaining the retrocaval ureteric segment further facilitates the procedure. We report a case of a 23-year-old man who underwent intraperitoneal robotic resection anastomosis and repositioning of the retrocaval ureter. We also discuss the advantages of this technique.

Alkhudair, Waleed K.; Seyam, Raouf; Al Zahrani, Hassan M.; Al Otaibi, Mohammed F.; Taweel, Waleed Al



Physiology and Pharmacology of the Human Ureter: Basis for Current and Future Treatments  

Microsoft Academic Search

Introduction: This article sets out to be a review regarding agents that affect contraction and relaxation of the ureter in order to establish a basis for current and future treatments for upper urinary tract obstruction. Material and Methods: A complete review of the English literature using MEDLINE was performed between 1960 and 2007 on ureter physiology and pharmacology with special

A. Erdem Canda; Burak Turna; G. Mehtap Cinar



[Contractile function of ureter in its anomalies in children].  


A study on the testing unit was made of a contractile function of ureteral fragments removed at reconstructive operations for vesicoureteral reflux (VUR), neuromuscular dysplasia (NMD) and pelvoureteral segment stricture (PUSS). The study parameters (wall rigidity, amplitude of the contractions, potassium depolarization contracture, responses to adrenoreactive drugs) in patients with VUR were close to normal, whereas in those with NMD or PUSS changed significantly, especially in PUSS patients. Ureteral contractility impairment was heterogenic in all the groups, varying from intact to lost and did not correlate either with age or the disease stage. The value of functional studies of the ureter in reconstructive surgery for specifying the disease pathogenesis, mechanisms of functional decline and individual prognosis of functional efficiency of the operative intervention is discussed. PMID:11149322

Kirpatovski?, V I; Mudraia, I S; Pugachev, A G; Larionov, I N


A numerical simulation of peristaltic motion in the ureter using fluid structure interactions.  


An axisymmetric model with fluid-structure interactions (FSI) is introduced and solved to perform ureter flow and stress analysis. The Navier-Stokes equations are solved for the fluid and a linear elastic model for ureter is used. The finite element equations for both the structure and the fluid were solved by the Newton-Raphson iterative method. Our results indicated that shear stresses were high around the throat of moving contracted wall. The pressure gradient magnitude along the ureter wall and the symmetry line had the maximum value around the throat of moving contracted wall which decreased as the peristalsis propagates toward the bladder. The flow rate at the ureter outlet at the end of the peristaltic motion was about 650 mm3/s. During propagation of the peristalsis toward the bladder, the inlet backward flow region was limited to the areas near symmetry line but the inner ureter backward flow regions extended to the whole ureter contraction part. The backward flow was vanished after 1.5 seconds of peristalsis propagation start up and after that time the urine flow was forward in the whole ureter length, so reflux is more probable to be present at the beginning of the wall peristaltic motion. PMID:18002170

Vahidi, Bahman; Fatouraee, Nasser



Appearances of the circumcaval ureter on excretory urography and MR urography: A single-center case series  

PubMed Central

Objectives: To describe Magnetic Resonance Urography (MRU) appearances of the circumcaval ureter, a rare congenital cause of hydronephrosis. Materials and Methods: Seven cases of circumcaval ureter, suspected on intravenous urography (IVU), underwent subsequent static MRU using heavily T2-weighted sequences. Results: The various appearances of circumcaval ureter on IVU and MRU were studied and compared. The circumcaval portion of the ureter was especially well seen on axial MRU sections, though this portion was routinely not visualized on IVU. In one case with a ureteric calculus, MRU also depicted a circumcaval course of the ureter, thus providing a complete diagnosis. In yet another case, where a circumcaval ureter was suspected on IVU, MRU proved the actual cause of ureteric obstruction to be a crossing vessel. Conclusion: Static MRU using heavily T2-weighted coronal and axial sequences can make or exclude the diagnosis of circumcaval ureter unequivocally.

Muthusami, Prakash; Ramesh, Ananthakrishnan



Analgesics, Cigarette Smoking, and Other Risk Factors for Cancer of the Renal Pelvis and Ureter1  

Microsoft Academic Search

Results from a population-based case-control study of cancer of the renal pelvis and ureter are reported. Telephone interviews were conducted with 187 residents of Los Angeles County diagnosed with cancer of the renal pelvis and ureter over a 4-year period ending December 31, 1982, and with individually sex-, age- and race-matched neighborhood controls. The major risk factor identified for cancer

Ronald K. Ross; Annlia Paganini-Hill; Joseph Landolph; Vibeke Gerkins; Brian E. Henderson



Single trocar retroperitoneoscopic nephrectomy for dysplastic poorly functioning kidney with ectopic ureter in children.  


This is the first report of a single trocar nephrectomy for poorly functioning dysplastic kidney and ectopic ureter, performed in 5 patients from 2010 to 2011. The mean operative time was 63 min and mean postoperative hospital stay was 31 h. There were no perioperative complications. The single trocar nephrectomy is a feasible and safe procedure for patients with dysplastic kidney and ectopic ureter. PMID:23103130

Liem, Nguyen Thanh; Mai Thuy, Nguyen Thi; Viet, Nguyen Duy; Dung, Le Anh



Real-Time Near-Infrared Fluorescence-Guided Identification of the Ureters using Methylene Blue  

PubMed Central

Background The aim of this study was to determine whether the invisible near-infrared (NIR) fluorescence properties of methylene blue (MB), a dye already FDA-approved for other indications, could be exploited for real-time, intraoperative identification of the ureters. Methods The optical properties of MB were quantified in vitro. Open surgery and laparoscopic NIR fluorescence imaging systems were employed. Yorkshire pigs were injected intravenously with: 0.1 mg/kg MB (n = 8), 10 mg furosemide followed by 0.1 mg/kg MB (n = 6), or 0.5 mg/kg MB (n = 6). The contrast-to-background ratio (CBR) of the kidney and ureters, and MB concentration in urine, were quantified. Results Peak MB absorbance, emission, and intensity in urine occurred at 668 nm, 688 nm, and 20 ?M, respectively. After intravenous injection, doses as low as 0.1 mg/kg MB provided prolonged imaging of the ureters, and a dose of 0.5 mg/kg provided statistically significant improvement of CBR. Pre-injection of furosemide increased urine volume but did not improve CBR. Laparoscopic identification of the ureter using MB NIR fluorescence was demonstrated. Conclusions Ureteral imaging using MB NIR fluorescence provides sensitive, real-time, intraoperative identification of the ureters during open and laparoscopic surgeries.

Matsui, Aya; Tanaka, Eiichi; Choi, Hak Soo; Kianzad, Vida; Gioux, Sylvain; Lomnes, Stephen J.; Frangioni, John V.



Primary mesenchymal chondrosarcoma of the kidney with synchronous implant and infiltrating urothelial carcinoma of the ureter  

PubMed Central

Primary mesenchymal chondrosarcoma of the kidney is rare, and it shows distinct undifferentiated tumor cells and well differentiated cartilagenous components. Also assident infiltrating urothelial carcinoma of the ureter is an extremely rare cancer. We report a case of primary mesenchymal chondrosarcoma occurring in the left kidney with an ipsilateral and distinct distal ureteric implant, and a coexisting infiltrating urothelial carcinoma of the ureter in a 64-year-old man. Histopathological examination and immunohistochemical studuies showed the classic features of mesenchymal chondrosarcoma in kidney, as well as a few infiltrating urothelial in ureter. Multitarget fluorescence in situ hybridization (FISH) suggested that the development of the urothelial carcinoma in the ureter may be triggered or induced by the chondrosarcoma component. The patient died 2?month after left nephro-ureterectomy. This is the first reported case of a primary mesenchymal chondrosarcoma of the kidney with coexisting infiltrating urothelial carcinoma of the ureter. Virtual Slides The virtual slide(s) for this article can be found here:



Bilateral single-system ectopic ureters opening into vaginalized urogenital sinus.  


A 5-year-old female presented with continuous dribbling of urine without any voiding stream since birth. Upon investigations, the bladder neck and both ureters were opening into the vaginalized urogenital sinus and the urethra was absent. Coarctation of the aorta was an associated anomaly. To our knowledge, this is the first report in literature of bilateral single-system ectopic ureters opening into vaginalized urogenital sinus. The report highlights the necessity for consideration of continent diversion in such cases because of the absence of the urethra in addition to an incontinent bladder neck and tiny dysfunctional bladder. PMID:20535301

Singh, Bhupendra P; Pathak, Hemant R; Andankar, Mukund G


Bilateral single-system ectopic ureters opening into vaginalized urogenital sinus  

PubMed Central

A 5-year-old female presented with continuous dribbling of urine without any voiding stream since birth. Upon investigations, the bladder neck and both ureters were opening into the vaginalized urogenital sinus and the urethra was absent. Coarctation of the aorta was an associated anomaly. To our knowledge, this is the first report in literature of bilateral single-system ectopic ureters opening into vaginalized urogenital sinus. The report highlights the necessity for consideration of continent diversion in such cases because of the absence of the urethra in addition to an incontinent bladder neck and tiny dysfunctional bladder.

Singh, Bhupendra P.; Pathak, Hemant R.; Andankar, Mukund G.



Protein kinase A inhibitors selectively inhibit the tonic contraction of the guinea pig ureter to high potassium  

Microsoft Academic Search

1.1. We have investigated the effect of various protein kinase A (PKA) inhibitors on the phasic and tonic components of the response to potassium chloride (KCI) in the guinea pig ureter. All experiments were performed in ureters pretreated with capsaicin (10 ?M for 15 min) to prevent the release of sensory neuropeptides and in the presence of 1 ?M Bay

Carlo Alberto Maggi; Paolo Santicioli; Sandro Giuliani




Microsoft Academic Search

PurposeThe optimal technique of excising the juxtavesical ureter and bladder cuff during laparoscopic nephroureterectomy is still evolving. We report on a novel transvesical needlescopic (2 mm. instrumentation) assisted technique of en bloc retrieval of the juxtavesical ureter and bladder cuff during laparoscopic radical nephroureterectomy for upper tract transitional cell carcinoma.




Cyclooxygenase type 2 is increased in obstructed rat and human ureter and contributes to pelvic pressure increase after obstruction.  


Prostanoids exert physiological effects on ureteral contractility that may lead to pressure changes and pain during obstruction. In the present study, we examined whether (1) obstruction changes the expression of the two cyclooxygenase (COX) isoforms, COX-1 and COX-2 in human and rat ureters and (2) administration of a selective COX-2 inhibitor influences the pelvic pressure change after experimental ureteral obstruction. Rats were subjected to bilateral ureter obstruction. Ureters were removed and dissected into a proximal dilated and distal non-dilated segment. RNA and protein were extracted and analyzed for cyclooxygenase expression by quantitative polymerase chain reaction and Western blotting. Human ureter samples were obtained from patients undergoing radical nephrectomy. Rat and human ureteral samples were processed for immunohistochemistry. COX-1, but not COX-2 mRNA, was readily detected in the normal rat ureter. COX-2 mRNA and protein expression was increased in the proximal dilated ureter compared to distal non-dilated ureter. This increased COX-2 expression was associated with increased urinary prostaglandin E2 (PGE2) excretion after release of obstruction. Immunohistochemistry showed increased COX-2 labeling in surface epithelium and smooth muscle layers in both rat and human obstructed ureters compared to control ureters. Furthermore, contractile PGE2-EP1 and thromboxane TP receptors were expressed in ureteral smooth muscle. Systemic treatment with the COX-2 selective inhibitor parecoxib (5 mg/kg/day) attenuated the pelvic pressure increase during obstruction. In summary, COX-2 expression is significantly increased in the ureteral wall in response to obstruction in the rat and human ureter and COX-2 activity contributes to increased pelvic pressure after obstruction. PMID:16820795

Nørregaard, R; Jensen, B L; Topcu, S O; Nielsen, S S; Walter, S; Djurhuus, J C; Frøkiaer, J



The fluid mechanics of the ureter from a lubrication theory point of view  

Microsoft Academic Search

The function of a healthy ureter is analyzed in terms of a fluid-mechanical model. To the extent that the Reynolds number is of the order of one, the fundamental equations are shown to reduce to those of the theory of lubrication. It is found that from the point of view of the pressure variation with time (the urometro- gram) the

P. S. Lykoudis; Rudolf Roos



Three-Dimensional Imaging of Ureter with Endoscopic Optical Coherence Tomography  

PubMed Central

OBJECTIVES To verify the ability to identify the layered structures of ureteral wall and to image a segment of ureter in three dimensions with a high speed endoscopic optical coherence tomography (EOCT). METHODS We imaged a porcine ureter ex vivo using a spectral domain EOCT with an specially designed circumferential scanning fiber catheter. The images were correlated with the histology to identify corresponding structures. Three-dimensional images and en face images at different depths from the luminal surface were reconstructed from the multiple cross-sectional images to visualize the layered structure of a segment of the ureter from different perspectives. RESULTS EOCT images can clearly reveal all layers of the ureteral wall as shown in the histological images. Especially, with the specially designed fiber catheter, the light beam was well centered during the rotation and pull back, which allowed constant acquisition of high fidelity images and unambiguous identification of the smooth muscle layers in all images. With high speed EOCT, a segment of ureter (20 mm) can be imaged in less than 90 seconds at a high resolution. CONCLUSIONS With its ability to visualize all layers of the ureteral wall, EOCT imaging offers the potential to stage urothelial cancers that have infiltrated the muscular wall (stage T2). This information will be complimentary to the diagnostic information obtained through ureteroscopic biopsy and CT urogram.

Wang, Hui; Kang, Wei; Zhu, Hui; MacLennan, Gregory; Rollins, Andrew M.



Speedy elimination of ureterolithiasis in lower part of ureters with the alpha 1-blocker – Tamsulosin  

Microsoft Academic Search

Background:Alpha – 1 blockers decrease the tension and release the spasm of smooth muscles and thus lessen the obstruction and irritation symptoms in the lower urinary tract (LUTS). They make a faster passing of calculi from the terminal part of the ureters possible.Objectives:The goal of this study was to objectively assess the improvement of difficulties caused by obstructions in ureterolithiasis

I. Çervenàkov; J. Fillo; J. Mardiak; M. Kope?nú; J. Šmirala; P. Labaš



Large transitional cell carcinoma of the proximal third of the ureter in a young man.  


We report an unusual case of a 37-year-old black man found to have a large transitional cell carcinoma of the proximal third of the ureter. This case is of interest because of the relatively young age of the patient, the upper third ureteral origin of the tumor, and the volume of the tumor burden. PMID:9258319

Ward, D M; Fuselier, H A; Donaldson, D S; Hebert, S J



Laparoscopic Transvesical Resection of an En Bloc Bladder Cuff and Distal Ureter during Nephroureterectomy  

PubMed Central

Objective. The most appropriate technique for excising the distal ureter and bladder cuff during laparoscopic nephroureterectomy is still debated. We report our experience with a pure laparoscopic transvesical method that duplicates the long-standing open transvesical approach. Materials and Methods. Seven men and three women diagnosed with upper tract transitional cell carcinoma were treated with this procedure. Three intravesical ports were inserted, and pneumovesicum was established at 12?mmHg. Transvesical laparoscopic circumferential detachment of the bladder cuff and en bloc mobilization of the last centimeters of the distal ureter were performed, followed by the closure of the bladder defect. Subsequently, a nephrectomy was performed either laparoscopically or using an open flank approach. Results. The median age was 68.5 years. The procedure was completed uneventfully in all cases. The median operating time for distal ureter excision was 82.5 minutes (range 55–120). No complications directly related to the pneumovesicum method were recorded. The median follow-up period was 31 months (range 12–55). During the follow-up period, two patients (20%) died from the disease, and a bladder tumor developed in three cases (30%). Conclusion. The laparoscopic transvesical resection of the en bloc bladder cuff and distal ureter is a reliable, effective, and oncologically safe technique, at least in the midterm.

Giannakopoulos, Stilianos; Toufas, George; Dimitriadis, Charalampos; Giannopoulos, Stavros; Kalaitzis, Christos; Bantis, Athanasios; Patris, Emmanuel; Touloupidis, Stavros



Management of Localized Prostate Cancer and an Incidental Ureteral Duplication With Upper Pole Ectopic Ureter Inserting into the Prostatic Urethra  

PubMed Central

Ectopic ureters are rare congenital malformations of the renal system that most commonly present in females. It is extremely rare to encounter an ectopic ureter in an older man undergoing radical prostatectomy. We report herein a case of a 66-year-old man with prostate cancer and a complete duplication of the left renal collecting system, with an upper pole ectopic ureter and associated normal functioning renal parenchyma entering into the prostatic urethra. This anomaly was incidentally discovered on preoperative magnetic resonance imaging of the prostate. Open radical retropubic prostatectomy and a left ureteroureterostomy were performed.

Marien, Tracy P; Shapiro, Ellen; Melamed, Jonathan; Taouli, Bachir; Stifelman, Michael D; Lepor, Herbert



Human Papillomavirus DNA in Triple Neoplasms of the Cervix, Perianus and Ureter in One Woman  

Microsoft Academic Search

Background: Multiple malignancies of the urogenital tract have been reported. We investigated the etiological role of human papillomavirus (HPV) in the pathogenesis of urogenital cancers. Case: We present a case of cervical squamous carcinoma in a 64-year-old woman who subsequently developed Bowen’s disease in the perianal skin and transitional cell carcinoma of the ureter. HPV DNA was detected in these

Lee-Wen Huang; Hun-Shan Pan; Yu-Hung Lin; Kuang-Yu Chou



Renal pyelic fusion with crossed solitary ureter: Case report and review of literature.  


Renal fusion anomalies are detected incidentally on imaging, with horseshoe kidney being the most common followed by crossed renal ectopia. We report a rare congenital anomaly of renal pyelic fusion with a solitary ureter. Both the renal units were in the normal position and location. This rare anomaly was associated with lumbar vertebral defects, neurogenic bladder, vesico-ureteric reflux, upper tract dilatation and recurrent urinary tract infections. PMID:23432137

Enganti, Bhavatej; Chitekela, Nookinaidu; Nallabothula, Anil Kumar; Lakshmi, Vijaya; Dandu, Rambabu; Samavedi, Srinivas; Subramanian, Srinivasan



[Malakoplakia involving kidney, both ureters and bladder: a case report and review of the literature].  


Malakoplakia is an unusual chronic inflammation characterized macroscopically by pseudotumoral lesions and histologically by the presence of "Michaelis-Gutman" bodies in macrophages. It affects principally the urinary tract and is probably secondary to an unusual macrophagic reaction to recurrent urinary tract infections. If the bladder is the most frequent site of occurrence, the ureters can very rarely be affected resulting in urinary tract obstruction. We presented here a unique presentation of renal, bilateral ureteral and bladder malakoplakia. PMID:23102020

Sarkis, P; Nawfal, G; Mouaccadieh, L; Daou, I; Zanati, M



[The differentiation of rhythmogenic characteristics of the ureter's different regions in guinea pigs].  


Characteristics of rhythmogenic pacemakers of the ureter's perirenal middle and peribladder region morphologically and electrophysiologically are analysed in guinea pigs both in presence of spreading activity and breach of conductivity. It was shown that the action potential's amplitude of the middle region is the highest and duration of the spike activities from perirenal zone is maximal and all three regions are characterised by different functional conditions. PMID:12238362

Kazarian, K V; Vantsian, V Ts; Meliksetian, I B; Tiraian, A S; Akopian, R R



Effects of a non-selective COX inhibitor and selective COX-2 inhibitors on contractility of human and porcine ureters in vitro and in vivo  

PubMed Central

Background and purpose: Anti-inflammatory drugs are used in the treatment of acute renal colic. The aim of this study was to investigate the effects of selective COX-2 inhibitors and the non-selective COX inhibitor diclofenac on contractility of human and porcine ureters in vitro and in vivo, respectively. COX-1 and COX-2 receptors were identified in human ureter and kidney. Experimental approach: Human ureter samples were used alongside an in vivo pig model with or without partial ureteral obstruction. COX-1 and COX-2 receptors were located in human ureters by immunohistochemistry. Key results: Diclofenac and valdecoxib significantly decreased the amplitude of electrically-stimulated contractions in human ureters in vitro, the maximal effect (Vmax) being 120 and 14%, respectively. Valdecoxib was more potent in proximal specimens of human ureter (EC50=7.3 × 10?11?M) than in distal specimens (EC50=7.4 × 10?10?M), and the Vmax was more marked in distal specimens (22.5%) than in proximal specimens (8.0%) in vitro. In the in vivo pig model, parecoxib, when compared to the effect of its solvent, significantly decreased the maximal amplitude of contractions (Amax) in non-obstructed ureters but not in obstructed ureters. Diclofenac had no effect on spontaneous contractions of porcine ureter in vivo. COX-1 and COX-2 receptors were found to be expressed in proximal and distal human ureter and in tubulus epithelia of the kidney. Conclusions and implications: Selective COX-2 inhibitors decrease the contractility of non-obstructed, but not obstructed, ureters of the pig in vivo, but have a minimal effect on electrically-induced contractions of human ureters in vitro.

Chaignat, V; Danuser, H; Stoffel, M H; z'Brun, S; Studer, U E; Mevissen, M



Origin of renal myofibroblasts in the model of unilateral ureter obstruction in the rat  

PubMed Central

Tubulo-interstitial fibrosis is a constant feature of chronic renal failure and it is suspected to contribute importantly to the deterioration of renal function. In the fibrotic kidney there exists, besides normal fibroblasts, a large population of myofibroblasts, which are supposedly responsible for the increased production of intercellular matrix. It has been proposed that myofibroblasts in chronic renal failure originate from the transformation of tubular cells via epithelial–mesenchymal transition (EMT) or from infiltration by bone marrow-derived precursors. Little attention has been paid to the possibility of a transformation of resident fibroblasts into myofibroblasts in renal fibrosis. Therefore we examined the fate of resident fibroblasts in the initial phase of renal fibrosis in the classical model of unilateral ureter obstruction (UUO) in the rat. Rats were perfusion-fixed on days 1, 2, 3 and 4 after ligature of the right ureter. Starting from 1 day of UUO an increasing expression of alpha-smooth muscle actin (?SMA) in resident fibroblasts was revealed by immunofluorescence and confirmed by the observation of bundles of microfilaments and webs of intermediate filaments in the electron microscope. Inversely, there was a decreased expression of 5?-nucleotidase (5?NT), a marker of renal cortical fibroblasts. The RER became more voluminous, suggesting an increased synthesis of matrix. Intercellular junctions, a characteristic feature of myofibroblasts, became more frequent. The mitotic activity in fibroblasts was strongly increased. Renal tubules underwent severe regressive changes but the cells retained their epithelial characteristics and there was no sign of EMT. In conclusion, after ureter ligature, resident peritubular fibroblasts proliferated and they showed progressive alterations, suggesting a transformation in myofibroblasts. Thus the resident fibroblasts likely play a central role in fibrosis in that model.

Picard, Nicolas; Baum, Oliver; Vogetseder, Alexander; Le Hir, Michel



Immunoglobulin G4-Related Systemic Sclerosing Disease: A Case Involving the Ureter and Kidney  

PubMed Central

Immunoglobulin (Ig) G4-related sclerosing disease is a newly defined clinicopathological entity characterized by lymphoplasmacytic infiltration of IgG4-positive plasma cells and varying degrees of fibrosis within affected tissues. Patients usually exhibit multisystem involvement and often respond well to steroid and immunosuppressive therapy. This report presents a case of IgG4-related sclerosing disease involving the ureter and kidney. We hope to bring IgG4-related sclerosing disease to the attention of urologists, because it is an uncommon disease that commonly responds to systemic corticosteroids.

Kim, Sunchan; Kim, Tae Gu; Choi, Seung-Kwon; Kim, Myung Joon; Min, Gyeong Eun; Lee, Hyung-Lae



Ectopic Ureter  


... a special camera for detecting small amounts of radioactivity in the dye (for the renal flow scan). ... the pubis. Lower front of the hip bone. radioactivity: High energy particles emitted by radioactive substances. reflux: ...


Preliminary results of laser tissue welding in extravesical reimplantation of the ureters  

NASA Astrophysics Data System (ADS)

One future use of laparoscopic technology is in extravesical reimplantation of the ureters. Technical difficulty arises, however, when intracorporal fine suturing is necessary. We have assessed the efficacy of laser-activated fibrinogen solder to close vesical muscle flaps over submucosal ureters (Lich-Gregoir technique) in a canine model. Four dogs were subjected to unilateral flap closures via a protein solder consisting of indocyanine green and fibrinogen applied to the serosal surface of the bladder and exposed to 808 nm continuous wave diode laser energy. Contralateral reimplantation was performed using 4 - 0 vicryl muscle flap closures and served as controls. Urinary drainage catheters were left in place for 24 hours postoperatively. At 7 (n equals 1), 14 (n equals 2), and 28 (n equals 1) days following reimplantation, intravenous pyelograms confirmed bilateral renal function and ureteral patency. Disruption of wound closures were considered the point of wound dehiscence, vesical diverticulum, or leakage. At intravesical pressures above 100 cm H2O there was no evidence of wound disruption in either of the groups. However, surrounding normal tissue was noted to disrupt. In conclusion, laser-welded vesical wound closures appear at least as strong as suture closures in the canine model.

Kirsch, Andrew J.; Milton, Daniel T.; Dean, Gregory E.; Oz, Mehmet C.; Libutti, Steven K.; Treat, Michael R.; Nowygrod, Roman; Hensle, Terry W.



[Effect of Bulgarian preparation, Nivalin, on bioelectrical activity of the ureter].  


The authors examined the influence of the Bulgarian preparation Nivalin on the bioelectrical activity of practicaly healthy ureters of cats under the conditions of acute experiment. They used on the average 1,5--2 mg of Nivalin per kg of body weight as the whole amount was used singly and administered intravenously. They found that Nivalin caused the appearence of more frequent bioelectrical complexes of ureters, which in most cases was manifested in two phages--the first almost 1--15 minutes after the injection and the second-after 60--90 minutesmthere was also an improvement of the rhythm of the bioelectrical activity and amplitude changes in bioelectrical complexes. There was stabilization of the obtained effects around two hours after administration of Nivalin under the conditions of the experiment. The authors consider that in this direction the experiments should be continued and should be examined practicaly the therapeutic effect of Novalin on persons with disturbances in the dynamics of urinary pathways. PMID:880911

Tsekov, Ts; Velikov, K; Kulov, N



A Patient with Fibroepithelial Polyp of the Ureter--A Rare Condition Mimicking Malignancy: A Case Report  

PubMed Central

A 61-year-old man presented with hematuria and intermittent right pelvic pain. Intravenous urography showed a tubular filling defect and ureteroscopy a tumor in the right mid ureter. Urine cytology and tumor biopsy showed nonmalignant results. Open surgery was performed, and an intraoperative frozen section revealed a fibroepithelial polyp of the right mid ureter. A fibroepithelial polyp is a rare benign lesion that can occur in childhood but is an important differential diagnosis of an upper urinary tract urothelial cell carcinoma in adults.

Brummeisl, Wolfgang; Fritsche, Hans-Martin; Huber, Elisabeth; Wieland, Wolf F.; Ganzer, Roman



Mixed epithelial and stromal tumor of the kidney with polypoid component extending into renal pelvis and ureter  

PubMed Central

Mixed epithelial and stromal tumor (MEST) of the kidney is an unusual benign neoplasm that predominantly occurs in middle-aged females. It typically appears as a well-circumscribed multiseptate mass with solid components on computed tomography (CT) or magnetic resonance image (MRI), reflecting its characteristics of an admixture of stromal proliferation and epithelial cells consisting of multiple cysts. We present a rare case of 61-year-old woman with MEST, which manifested as a multilocular cystic mass with a polypoid component protruding into the renal pelvis and ureter. To our best knowledge, this is the first case of MEST extending into the ureter.

Horikawa, Masahiro; Shinmoto, Hiroshi; Kuroda, Kenji; Shiomi, Eisuke; Soga, Shigeyoshi; Ito, Keiichi; Tachi, Kazuyoshi; Katsurada, Yuka; Simazaki, Hideyuki; Asano, Tomohiko; Kaji, Tatsumi



Correlation of Traditional Point a With Anatomic Location of Uterine Artery and Ureter in Cancer of the Uterine Cervix  

Microsoft Academic Search

Purpose: Point A, used for dose specification for intracavitary brachytherapy for cervical cancer, is the point at which the uterine artery and ureter cross. This study assessed compatibility of commonly used traditional point A (TPA) and actual anatomic point A (APA). Methods and Materials: We visualized and placed radiopaque clips at the APA during pelvic and paraaortic lymphadenectomy in 11

Kung-Liahng Wang; Yuh-Cheng Yang; K. S. Clifford Chao; Meng-Hao Wu; Hung-Chi Tai; Tze-Chien Chen; Ming-Chao Huang; Jen-Ruei Chen; Tsung-Hsien Su; Yu-Jen Chen



Functional characterization of the vertebrate primary ureter: Structure and ion transport mechanisms of the pronephric duct in axolotl larvae (Amphibia)  

Microsoft Academic Search

BACKGROUND: Three kidney systems appear during vertebrate development: the pronephroi, mesonephroi and metanephroi. The pronephric duct is the first or primary ureter of these kidney systems. Its role as a key player in the induction of nephrogenic mesenchyme is well established. Here we investigate whether the duct is involved in urine modification using larvae of the freshwater amphibian Ambystoma mexicanum

Birgitte M Haugan; Kenneth A Halberg; Åse Jespersen; Lea R Prehn; Nadja Møbjerg



Endoscopic treatment of vesicoureteric reflux with dextranomer/hyaluronic acid copolymer (Deflux): Single-surgeon experience with 48 ureters  

PubMed Central

Purpose: VUR is a common urologic problem in children. Cystoscopic injection of bulking agents (most commonly Deflux) has gained popularity as the first line treatment in the west. However, primarily due to cost factors, it has not gained much popularity in our country. We present our initial experience with cystoscopic Deflux injection for VUR. Materials and Methods: We reviewed our 3-yr experience with the use of Dx/HA (Deflux) for correction of VUR in children and adolescents. All children were evaluated with Ultrasound, MCUG and DMSA renal cortical scan. The indications for surgical correction of VUR included breakthrough infections while on antibiotic prophylaxis, persistent high-grade VUR beyond 3 yrs of age, and presence of significant renal damage on DMSA at diagnosis (in those children presenting with UTI). All children underwent cystoscopic Deflux injection using the standard technique of subureteral injection (0.4-1 ml per ureter). All children received antibiotic prophylaxis for 3-6 months after the injection. USG was done at 1 month and MCUG at 3-6 months after the injection. Results: 33 patients (48 ureters) underwent cystoscopic Deflux injection for correction of VUR. Mean age was 4.5 yrs (1-17 yrs); there were 12 boys and 21 girls. Thirteen children had antenatally diagnosed HDN, while 20 children presented with febrile UTI. All children had primary VUR except one child with persistent VUR 4 yrs after PUV fulguration. The VUR was grade 1-2 in 8, grade 3-4 in 37, and grade 5 in 3 ureters. Every child had at least one ureter with dilating reflux (grades 3,4 or 5). When present, low grade VUR (grade 1or 2) was always on the contralateral side. Only one child received a 2nd injection after 6 months. Follow-up MCUG was done in 28 children (41 ureters). Complete reflux resolution was achieved in 27 ureters (65%), and the reflux was downgraded in 2 (5%). There were no complications of Deflux injection. Conclusions: Endoscopic correction of VUR in children is a safe and effective minimally invasive treatment for VUR. It stops or downgrades VUR in 70% of ureters. At present, we recommend it as a first-line treatment for grades 1-4 VUR requiring surgical management. Cost is the major factor limiting its use in our country.

Chandrasekharam, V. V. S.



Inverted papilloma of the ureter: study of a rare case with emphasis on clinicopathologic implications  

PubMed Central

A 62-year old male patient presented complaining of intermittent macroscopic hematuria. The ultrasonographic investigation revealed a hydronephrosis of remarkable degree with indiscrete renal parenchyma. The abdominal computed tomography scan identified a ureteral lesion with proximal dilatation, hydronephrosis and a functionless ipsilateral renal unit. The retrograde urography showed a 4-cm lesion with multiple filling defects and a smooth contour. The endoscopic examination showed an exophytic lesion, highly suspicious for malignancy. Urine cytology revealed atypia. Right nephroureterectomy was performed and the pathology revealed a ureteral inverted papilloma (UIP). Polymerase chain reaction examination for the presence of human papilloma virus, using GP5+/6+ consensus primers, was negative. The presence UIP should be considered in patients with urotheleal lesions in the ureter when the diagnostic workup for malignancy is inconclusive. The clinical course of the disease seems to be favorable.

Mertziotis, Nikolaos; Kozyrakis, Diomidis; Petrolekas, Andreas; Terzi, Maria; Kapranos, Nikiforos



Effect of Bay K 8644 and ryanodine on the refractory period, action potential and mechanical response of the guinea-pig ureter to electrical stimulation  

Microsoft Academic Search

We have investigated the effect of the dihydropyridine calcium channel agonist, Bay K 8644, and of the plant alkaloid blocker\\u000a of calcium-induced calcium release (CICR) from the sarcoplasmic reticulum, ryanodine, on the refractory period, action potential\\u000a and mechanical response of the guinea-pig isolated ureter to electrical stimulation. All experiments were performed in ureters\\u000a pre-exposed to 10 ?M capsaicin to eliminate

Carlo Alberto Maggi; Sandro Giuliani; Paolo Santicioli



Short-term hemodialysis treatment in dogs and cats with total uretic obstruction.  


This study evaluated the single-pass system for the short-term dialysis treatment of dogs and cats with experimental renal failure. The hemodialyzer was equipped with a thin and highly permeable Cuprophan membrane. Four animals (two dogs and two cats) with total uretic obstruction were dialyzed twice in a one-week period. The vascular access by venipuncture of external jugular vein delivered more than 5 ml/min/kg/body weight of blood repeatedly, even for the cats. The evaluation of the effects of the blood flow, dialysate flow and ultrafiltration pressure revealed that the blood flow was the most important factor for effective dialysis. A 300 ml/min dialysate flow provided enough clearance of blood urea nitrogen and creatinine. The ultrafiltration pressure played an important role in ensuring that the fluid removal was constant. Laboratory studies revealed a 50.0% (range 42.0 to 59.3%) reduction of blood urea nitrogen, a 48.7% (range 42.5 to 58.7%) reduction of creatinine, and a 49.8% (range 34.3 to 66.2%) reduction of inorganic phosphate during the dialysis treatment. No dialysis disequilibrium syndrome was shown by the clinical signs. We conclude that this short-term dialysis using a single-pass system for small animals was sufficiently applicable to dogs and cats, and that the optimal duration of the dialysis was 2 hours. PMID:9308290

Mashita, T; Yasuda, J; Iijima, M; Takiguchi, M; Yamazaki, T; Hashimoto, A



Different muscarinic receptor subtypes mediating the phasic activity and basal tone of pig isolated intravesical ureter.  

PubMed Central

1. We have studied the effects of muscarinic cholinoceptor agonists and specific antagonists on both phasic activity and basal tone of the isolated intravesical ureter of the pig by means of isometric techniques in vitro. 2. Acetylcholine in the presence and absence of physostigmine increased both phasic activity and basal tone of ureteral strips in a concentration-dependent manner. Moreover carbachol, methacholine and oxotremorine-M increased both contractile parameters while bethanechol and McN-A-343 evoked only increases in tone without affecting the frequency of the phasic contractions. 3. The nicotinic receptor blocker, hexamethonium (10(-6)-10(-4) M), failed to modify the contractions evoked by a single dose of carbachol (10(-5) M), whilst the muscarinic antagonist, atropine inhibited both phasic and tonic responses. 4. The muscarinic M1 (pirenzepine), M2 (AF-DX 116 and methoctramine), M3 (4-DAMP, HHSiD and p-F-HHSiD), and putative M4 receptor (tropicamide) antagonists significantly reversed increases in both frequency of phasic activity and baseline tone induced by a submaximal dose of carbachol (10(-5) M). The pIC50 values for inhibition of the induced phasic activity were: atropine (10.16) > 4-DAMP (9.12) > HHSiD (8.22) = methoctramine (7.98) = p-F-HHSiD (7.88 > tropicamide (7.62) = pirenzepine (7.53) = AF-DX 116 (7.45) and for inhibition of basal tone were: atropine (10.73) > 4-DAMP (9.32) > HHSiD (8.65) = pirenzepine (8.43) = p-F-HHSiD (8.38) > methoctramine (7.79) > tropicamide (7.53) > AF-DX 116 (7.04).(ABSTRACT TRUNCATED AT 250 WORDS)

HernA?ndez, M.; SA-monsen, U.; Prieto, D.; Rivera, L.; GarcA-a, P.; Ordaz, E.; GarcA-a-SacristA?n, A.



Alleviation of Kidney Damage Induced by Unilateral Ureter Obstruction in Rats by Rhodiola rosea.  


Abstract Purpose: To evaluate the efficacy of Rhodiola rosea extract in terms of alleviating the renal damage induced by unilateral ureter obstruction (UUO) in rats. Material and Methods: Thirty Wistar albino male rats were divided into five groups: (I) Control, (II) UUO 7 days, (III) UUO 7 days+extract,(IV) UUO 14 days, and (V) UUO 14 days+extract. Seven or 14 days after the initiation of the experimental procedure, the left kidneys of rats in all five groups were removed for histological examination, and their blood was drawn for biochemical measurements. Result: Median malondialdehyde (MDA) and glutathione peroxidase (GPx) levels were, respectively, 39.4 (5.04) nmol/mL and 25.8 (8.01) nmol/minute/mL in group I, 77.9 (12.38) nmol/mL and 5.8 (1.95) nmol/minute/mL in group II, 48.7 (12.1) nmol/mL and 9.1 (2.3) nmol/minute/mL in group III, 58.5 (23.83) nmol/mL and 8.4 (2.1) nmol/minute/mL in group IV, and 44.8 (4.97) nmol/mL and 13.8 (3.73) nmol/minute/mL in group V. There was a statistically significant difference among the groups in terms of MDA and GPx levels (p<0.05 for both). The median numbers of apoptotic cells were 1 (1), 8 (2.25), 3 (1.25), 23.5 (9), and 7 (I) in groups I, II, III, IV, and V, respectively. There was a statistically siginificant difference among the groups in terms of apoptotic cell number (p<0.05). Conclusion: R. rosea extract was shown to alleviate the renal damage induced by UUO through its antioxidant effects. The mechanism by which R. rosea extract causes these effects merits further investigation. PMID:23806024

Uyeturk, Ugur; Terzi, E Hakan; Kemahli, Eray; Gucuk, Adnan; Tosun, Mehmet; Cetinkaya, Ayhan



A mathematical simulation of the ureter: effects of the model parameters on ureteral pressure/flow relations.  


Ureteral peristaltic mechanism facilitates urine transport from the kidney to the bladder. Numerical analysis of the peristaltic flow in the ureter aims to further our understanding of the reflux phenomenon and other ureteral abnormalities. Fluid-structure interaction (FSI) plays an important role in accuracy of this approach and the arbitrary Lagrangian-Eulerian (ALE) formulation is a strong method to analyze the coupled fluid-structure interaction between the compliant wall and the surrounding fluid. This formulation, however, was not used in previous studies of peristalsis in living organisms. In the present investigation, a numerical simulation is introduced and solved through ALE formulation to perform the ureteral flow and stress analysis. The incompressible Navier-Stokes equations are used as the governing equations for the fluid, and a linear elastic model is utilized for the compliant wall. The wall stimulation is modeled by nonlinear contact analysis using a rigid contact surface since an appropriate model for simulation of ureteral peristalsis needs to contain cell-to-cell wall stimulation. In contrast to previous studies, the wall displacements are not predetermined in the presented model of this finite-length compliant tube, neither the peristalsis needs to be periodic. Moreover, the temporal changes of ureteral wall intraluminal shear stress during peristalsis are included in our study. Iterative computing of two-way coupling is used to solve the governing equations. Two phases of nonperistaltic and peristaltic transport of urine in the ureter are discussed. Results are obtained following an analysis of the effects of the ureteral wall compliance, the pressure difference between the ureteral inlet and outlet, the maximum height of the contraction wave, the contraction wave velocity, and the number of contraction waves on the ureteral outlet flow. The results indicate that the proximal part of the ureter is prone to a higher shear stress during peristalsis compared with its middle and distal parts. It is also shown that the peristalsis is more efficient as the maximum height of the contraction wave increases. Finally, it is concluded that improper function of ureteropelvic junction results in the passage of part of urine back flow even in the case of slow start-up of the peristaltic contraction wave. PMID:21303180

Vahidi, Bahman; Fatouraee, Nasser; Imanparast, Ali; Moghadam, Abbas Nasiraei



Effect of Overexpression of Glucose-Regulated Protein 78 and Bcl-2 on Recurrence and Survival in Patients With Ureter Tumors  

PubMed Central

Purpose The utility of the expression of glucose-regulated protein 78 (GRP78) in the evaluation of prognosis depends on the type of tumor. Hence, we aimed to examine the impact of expression of GRP78 and Bcl-2, which are used in the existing prognostic evaluation of ureter tumors, in the evaluation of recurrence and survival rates of ureter tumors. Materials and Methods In 53 patients who had undergone radical nephroureterectomy for a ureter tumor from March 2002 to March 2012, age, sex, T stage, nuclear grade, bladder recurrence, and survival rate were analyzed at the time of the patient's surgery depending on the extent of immunohistochemical expression of GRP78 and Bcl-2. Results GRP78 was overexpressed in 25 patients (47.2%). When GRP78 was overexpressed, there was a high T stage (p=0.001) and nuclear grade (p=0.007) and a lot of bladder recurrence (40.0%, p=0.034). Bcl-2 was overexpressed in 16 patients (30.1%), and there were no significant associations with any risk factors (p>0.05, respectively). In the multivariate analysis regarding bladder recurrence, the recurrence rate was higher with higher pT stage (p=0.048) and when GRP78 (p=0.033) was overexpressed. In the Kaplan-Meier survival analysis, although the survival rate was significantly lower in the group in which GRP78 was overexpressed (p=0.03), there was no correlation between Bcl-2 overexpression and survival rate (p=0.07). Conclusions Patients with ureter tumors who had overexpression of GRP78 had a high T stage and nuclear grade, a lot of bladder recurrence, and a low survival rate. Therefore, if GRP78 is overexpressed in ureter tumor patients, active postoperative follow-up should be carried out.

Park, Chang Hyun; Choi, Mi Sun; Ha, Ji Yong; Kim, Byung Hoon; Park, Choal Hee



Chromophore enhanced laser welding of canine ureters in vitro using a human protein solder: a preliminary step for laparoscopic tissue welding.  


Laser welding of the genitourinary tract has the potential advantage of forming an immediate watertight seal. It may obviate the need for sutures, eliminate the inherent lithogenic reaction to suture, and potentially improve healing. In the current study we employed a KTP-532 laser in vitro to weld canine ureters. Ureters were transected over a stent and immediately repaired using the KTP-532 laser (power density 7.14 W/cm.2, spot size = 0.5 cm.) alone or in combination with different tissue solders. Solders consisted of 40% human albumin alone or with the addition of iron oxide or fluorescein as light absorbing dyes (chromophores). Following the repairs, intraluminal bursting strength and the total energy required to complete the repairs were measured. The KTP laser alone was not able to achieve a satisfactory repair. Successful ureteral repairs were achieved in all solder groups while maintaining ureteral continuity at supraphysiologic pressures. PMID:8345583

Poppas, D; Sutaria, P; Sosa, R E; Mininberg, D; Schlossberg, S



Asymptomatic chronic partial obstruction of a normal ureter following dextranomer/hyaluronic acid copolymer (Deflux®) injection for grade I vesicoureteral reflux.  


Endoscopic management of vesicoureteral reflux with dextranomer/hyaluronic copolymer (Deflux(®), Oceana Therapeutics, Inc., Edison, NJ, USA) has gained widespread acceptance with increasing success rates and minimal morbidity. Formation of a pseudocapsule and calcification are known histologic changes at the injection site. Postoperative ureteral obstruction has been reported in cases of severe voiding dysfunction, neurogenic bladder and abnormal ureteral anatomy. We present a case of chronic asymptomatic obstruction in a normal ureter following injection of 0.7 ml Deflux. PMID:22209086

Arlen, Angela M; Pakalniskis, Brittany L; Cooper, Christopher S



Obstructive uropathy due to prolapsed lower ureters and bladder in patients with severe procidentia: A report of two cases  

PubMed Central

INTRODUCTION Pelvic organ prolape is not uncommon in multi-parous or elderly women. It is one of the rare but important causes of obstructive uropathy. Herein, we report two cases of severe procidentia that were referred with obstructive uropathy due to prolapsed bladder and ureters. PRESENTATION OF CASE The first case was a 78-year-old woman, with severe pelvic organ prolape and secondary bilateral hydroureteronephrosis and post-renal failure. She was treated successfully by bilateral nephrostomy insertion and then pessary insertion. The second case was a 75-year-old woman who referred with the same presentation, but treated surgically with burch colposuspention and synchronous bilateral ureteral stent insertion. DISCUSSION Pelvic organ prolapse is not uncommon in old women. In addition to physical problems of procidentia, it may cause acute renal failure (ARF), chronic renal failure (CRF), and finally end stage renal disease (ESRD) if undiagnosed. CONCLUSION In every aged female case with obstructive uropathy and/or bilateral hydroureteronephrosis with unknown causes, gynecologic examination should be performed for early detection of possible pelvic organ prolapse. Appropriate management is necessary to prevent renal failure from uterine prolapse (UP).

Moslemi, Mohammad Kazem; Abedinzadeh, Mehdi; Nazari, Alireza



IgG4-related disease of the ureter: report of two cases and review of the literature.  


IgG4-related disease (IgG4-RD) is a recently recognized multi-organ fibro-inflammatory lesion characterized by elevated IgG4 serum levels and mass-forming lesions. This condition shows similar histological features independently of the site of origin including storiform fibrosis, obliterative phlebitis, and dense lymphoplasmacytic infiltrate with a conspicuous IgG4-positive plasma cell component. Since this disease has only recently been categorized as a single specific nosologic entity, lesions with these typical morphological features have previously been named in different ways, creating some confusion and making it difficult to identify cases published in the literature. Lesions with features suggesting IgG4-RDs have very rarely been reported in the ureter, and they have been named using the terms "inflammatory pseudotumor" and "idiopathic segmental ureteritis." Herein, we describe the clinicopathological features of ureteral IgG4-RD found in two different patients. An 82-year-old female and a 77-year-old male underwent ureteral resection due to severe ureteral wall thickness and lumen stenosis suggestive of urothelial carcinoma. However, histological examinations showed transmural fibro-inflammatory lesions, with abundant IgG4 plasma cells intermixed with histiocytes, lymphocytes, fibroblasts, and scattered eosinophils. We have also accurately reviewed the literature in order to identify, among lesions diagnosed with different names, examples of ureteral IgG4-related lesions to give the reader a comprehensive overview of this relatively rare inflammatory disease. We suggest using the name "ureteral IgG4-RD" for those lesions showing the same morphological features as IgG4-RDs located elsewhere. PMID:23666067

Marando, Alessandro; D'Ambrosio, Gioacchino; Catanzaro, Francesco; La Rosa, Stefano; Sessa, Fausto



A population-based study of tumours of the renal pelvis and ureter: Incidence, aetiology and histopathological findings.  


Abstract Objective.Carcinoma of the renal pelvis and ureter are unusual tumours and our limited knowledge comes mainly from case reports and small series from large academic hospitals, as a rule without histopathological review. This study reports aetiological and demographical factors as well as clinicopathological findings of all patients in a large geographical region. Material and methods.All patients in western Sweden with a renal pelvic or ureteral tumour diagnosed between 1971 and 1998 (n = 930) were included. Untreated cases were not excluded. Demographic data and results of preoperative examinations were retrieved from the original clinical records. The histopathological slides were reviewed and tumour stage, grade, configuration, presence of carcinoma in situ and angiolymphatic invasion were determined Results.The majority of patients (80%) had invasive or high-grade tumours. Carcinoma in situ was present among 30% of patients with non-invasive high-grade tumours. Angiolymphatic invasion (62%) and solid (non-papillary) growth pattern (84%) were very common among patients with stage T2-T4 tumours. Twenty-three women out of 138 (16.7%) with ureteral carcinoma had a history of abdominal radiotherapy for gynaecological cancer 22 years (median) earlier. Forty-one patients out of 930 (4.4%) had a history of abuse of phenacetin-containing analgesics. Conclusions.This study demonstrates a very high incidence of high-grade upper tract tumours with carcinoma in situ, angiolymphatic invasion and solid (non-papillary) growth pattern, which underscores the malignant character of the disease. The possible association between pelvic radiotherapy and ureteral carcinoma warrants further study. PMID:23634644

Holmäng, Sten; Holmberg, Erik; Johansson, Sonny L



Non-muscle invasive transitional cell carcinoma of the distal ureter and bladder with lung metastasis: A case report and literature review  

PubMed Central

INTRODUCTION Non-muscle invasive transtitional cell carcinoma (TCC) with metastases is exceedingly rare. PRESENTATION OF CASE We report the case of a 78-year old man with an incidental finding of a non-muscle invasive TCC of the left distal ureter during treatment for Duke's B Colon cancer. Following laparoscopic nephro-ureterectomy (LNU) he had two further superficial recurrences in the bladder over a 14-month period which underwent transurethral resection (TUR). On surveillance imaging for his colorectal cancer follow-up a lung nodule was detected and video-assisted thoracic surgical (VATS) resection of the lesion showed it to be TCC in origin. He was referred to oncology for chemotherapy and remains clinically well. DISCUSSION A Literature search found only three other such cases and the ureteric TCC is the most likely source of the metastasis. CONCLUSION This occurrence is exceedingly rare.

Nkwam, Nkwam; Chen, Terng F.



[Comparison of the results of magnetic resonance urography and other examination methods in patients with iatrogenic injuries of the ureter and pelvis-ureteral segment].  


MR urography was made in 25 patients (age 24-70, mean age 48.6 years, 20 females, 5 males) with iatrogenic injury of the upper urinary tract (UUT). A comparison group consisted of 15 patients without nephrostomic drainage who had no contraindications for intravenous contrast preparations. MR urography was performed in frontal and sagittal projections. The examination was made before and 20 min after intravenous injection of 20 mg diuretic. Five patients received additionally excretory MR urography with intravenous injection of magnevist (0.2 ml/kg, 3 ml/s just before the examination). Mean duration of urography was 21 (18-23) min. The results were compared to findings of ultrasound or x-ray investigations, diapevtic ureteroscopy or open surgical intervention. The results were similar to those of x-ray CT. In patients with ureteral obliteration MR urography was less informative than joint antegrade and retrograde ureteropyelography as the ureter could not be visualized beneath the injury. In 2 patients examined with intravenous urography and x-ray CT, definite length of ureteral stricture was obtained only with MR urography. In 5 patients with hydronephrotic transformation MR urography was much more informative than excretory urography. MR urography provided information sufficient for diagnosis. Sensitivity of MR urography and that with diuretic load was 86.8 and 92.3%, respectively. MR urography, even without contrast enhancement, provides images with high resolution sufficient for visualization of the ureter distally of the stricture and is a method of choice in patients with subnormal renal function, intolerance to iodine-containing contrast media, with hyperthyroidism and pregnant women after the first trimester. PMID:19670807

Martov, A G; Gurbanov, Sh Sh; Tokareva, E V; Shcherbinin, S N; Kornienko, S I


Results of a Seven-Year, Single-Centre Experience of the Long-Term Outcomes of Bovine Ureter Grafts Used as Novel Conduits for Haemodialysis Fistulas  

SciTech Connect

Purpose: To report the long-term outcomes of bovine ureter grafts as novel conduits for haemodialysis fistulas. Materials and Methods: Thirty-five patients underwent placement of a total of 40 SynerGraft 100 (SG100; CryoLife Europa{sup Registered-Sign}, Guildford, UK) bovine ureter grafts between April 2002 and February 2009. Prospective data were collected on all patients, including active surveillance with blood flow studies and 6-monthly duplex ultrasound studies. Main outcome measures were primary and secondary patency rates. Results: Mean follow-up time was 97 weeks (range 4-270). Thirteen patients died from unrelated causes during the study period; 12 of these patients had a functioning graft at the time of death. Five patients underwent transplantation, and all had a functioning graft at transplantation. Twelve patients had a functioning graft at the end of the study period. One hundred and ten stenoses were detected, and 97 venoplasty procedures were performed. Of the stenoses, 41.8% were located at the venous anastomosis, 12.7% within the graft, 17.3% in the outflow veins, and 28.1% in central veins. No arterial stenoses were detected. Primary patency rates were 53% at 6 months and 14% at 1 year. Secondary patency rates were 81% at 6 months, 75% at 1 year, and 56% at 2 years. Conclusions: Active surveillance and intervention was able to achieve satisfactory long-term secondary patency for these novel conduits compared with those made of PTFE seen in other studies.

Das, Neelan, E-mail:; Bratby, Mark J.; Shrivastava, Vivek [John Radcliffe Hospital, Department of Interventional Radiology (United Kingdom); Cornall, Alison J. [Churchill Hospital, Department of Nephrology (United Kingdom); Darby, Christopher R. [Churchill Hospital, Department of Vascular Surgery (United Kingdom); Boardman, Philip [Churchill Hospital, Department of Interventional Radiology (United Kingdom); Anthony, Susan; Uberoi, Raman [John Radcliffe Hospital, Department of Interventional Radiology (United Kingdom)



Tumors of the kidney, ureter, and bladder.  

PubMed Central

Neoplastic diseases of the kidneys and urinary collecting system are relatively common, but when detected early, they have an excellent prognosis. Because gross or microscopic hematuria may be an early harbinger of genitourinary pathology, the primary care physician and internist play an integral role in diagnosing these diseases. A high index of suspicion together with a thorough history, physical examination, and appropriate diagnostic studies will enable the correct diagnosis and improved patient management in most cases. Images

See, W. A.; Williams, R. D.



Ultrasound: Renal (Kidneys, Ureters, Bladder) (For Parents)  


... The technician will then move a small wand (transducer) over the gel. The transducer emits high-frequency sound waves and a computer ... a slight pressure on the abdomen as the transducer is moved over it. You'll need to ...


Müllerianosis of ureter: a rare cause of hydronephrosis.  


Müllerianosis of the urinary tract is a very rare and morphologically complex tumor-like lesion. It is composed of several types of müllerian-type lesions, including endometriosis, endocervicosis, and endosalpingiosis. We present a case of ureteral müllerianosis in woman with a history of a cesarean section about 20 years previously but with silent clinical symptoms. She was treated with segmental ureteral resection, followed by ureteroureteral anastomosis. The pathogenesis and treatment of this lesion are discussed. PMID:17572222

Li, Wei-Ming; Yang, Sheau-Fang; Lin, Hang-Ching; Juan, Hsu-Cheng; Wu, Wen-Jeng; Huang, Chun-Hsiung; Wang, Chii-Jye; Li, Ching-Chia



[Synchronously diagnosed and treated triple cancer (rectum-ureter-prostate)].  


A 63-year-old man was admitted for examination of a rectal tumor. A stony hard nodule was palpated in his swollen prostate by rectal examination. The biopsies proved rectal and prostate carcinoma. Transabdominal echogram and DIP showed left hydronephrosis. Left ureteral cancer was suggested by the typical "goblet sign" with retrograde ureterography. Rectal lower anterior resection, left total nephroureterectomy with partial cystectomy, castration and pelvic lymphadenectomy were undertaken synchronously. The pathohistological diagnosis was triple cancer consisting of rectal mucotubular adenocarcinoma, prostatic carcinoma and ureteral transitional cell carcinoma. The diagnosis and treatment of the triple cancer were discussed. PMID:3735681

Mikata, N; Suzuki, M; Ishii, T; Kunisawa, Y; Moriyama, N; Tomoishi, J; Fukutani, K; Kawabe, K; Kuramoto, S; Ihara, O



Bilateral fibroepithelial polyps of ureter in a child.  


Presented here is the first case of bilateral ureteral polyps in a patient under eighteen years of age, with vivid colored intraoperative photographs. The importance of careful identification of the base of the polyp to reduce operative morbidity and the necessity of ureteral reanastomosis rather than simple excision of the polyp in children is emphasized. PMID:2353379

Bartone, F F; Johansson, S L; Markin, R J; Imray, T J



[Placenta percreta with invasion of the bladder, ureter and abdominal wall. Case report].  


Placental acretism is the abnormal adherence beyond the underlying of the uterine muscle. The penetration of the serous is known as placenta percreta. The following is a clinical study of a 28 year old woman, who had undergone 2 previous C-Sections, who had been admitted to the hospital previously with ultrasounds suggestive of placental acretism. The magnetic resonance show with severe infiltration of the myometrium in the anterior and lateral right, extending until the mesentery of the abdomen, top of the bladder and the proximal portion of the urethra as well as the soft tissue of the perinea. Cesarean section was performed at 35 weeks of gestation, once the complete protocol of the placenta previa, had been completed. The placentary tissue invaded the bladder, wide ligament along the entire right side and the posterior pelvis. A hysterectomy was performed in the fundic region, resulting in a live birth, and no complications for the patients. Later an obstetric hysterectomy was performed. It is important to note the exemplary work of the gynecologist, surgeon, urologist, anesthesiologist, neonatal specialist, hematologist and intensive care workers, working together for a common goal: avoiding the morbidity and mortality of the mother and child. PMID:24049980

Ortiz-Villalobos, Roberto Carlos; Luna-Covarrubias, Edith Esmeralda; Serrano-Enríquez, Raymundo Felipe; Laureano-Eugenio, Jorge; Mejía-Mendoza, Martha Leticia; Rodríguez-Rodríguez, José Gilberto



An autoradiographic study of smooth muscle hyperplasia in the swine ureter.  


Autoradiographs of healing ureteral defects demonstrated significant uptake of tritiated thymidine in pigs sacrificed during the first 2 weeks after ureterotomy. The earliest and most heavily labeled tissue was epithelium followed by proliferation of subepithelial connective tissues and smooth muscle of the muscularis. The labeling of significant numbers of myocytes within the muscularis was indicative of smooth muscle replacement by hyperplastic means. The fact that most mitotically active smooth muscle cells were seen in the muscle remnant adjacent to wound margins suggests this as the primary source for new muscle. PMID:870447

Dalley, B K; Bartone, F F; Gardner, P J



Smooth muscle regeneration in swine ureters: a light and electron microscopic study.  


Intubated ureterotomies were performed on 16 juvenile pigs. The animals were killed at intervals of from 2 to 91 days after operation and tissue sections examined with light and electron microscopes. Ureteral wall replacement occurred within the 3 months after operation and included all tissue layers. Epithelialization of the wound surfaces occurred in the 1st week and was accompanied by a connective proliferation. Smooth muscle bridged the defect within 5 weeks and the margins of the muscularis were thickened and cellular in early stages; cells were elongated and extended towards the defect from the muscular remnant. Primitive smooth muscle cells were present at defect margins. This evidence indicates that smooth muscle was replaced by hyperplasia. PMID:972000

Dalley, B K; Bartone, F F; Gardner, P J



Carcinoma of the breast metastatic to the ureter presenting with flank pain and recurrent urinary tract infection.  


Urinary tract infection in the female patient is not an uncommon finding. Flank pain associated with urinary tract infection is usually due to calculus disease or pyelonephritis. In patients with history of breast carcinoma, metastasis to the periureteral area with resulting obstruction should be considered. The incidence of metastatic breast carcinoma presenting in this fashion is as high as 7.8 per cent. This case shows a patient with metastatic lobular carcinoma of the breast with ureteral obstruction, causing flank pain and recurrent urinary tract infection. This report emphasizes the importance of long-term follow-up in patients with history of breast cancer, especially invasive lobular carcinoma, and the high degree of suspicion required to diagnose and institute proper therapy. PMID:8751767

López-Martínez, R A; Stock, J A; Gump, F E; Rosen, J S



JAMA Patient Page: Urinary Tract Infection  


JAMA PATIENT PAGE Urinary Tract Infection White blood cell Bacteria Kidney Ureter Bladder Urethra Urine Ureter Urinary tract anatomy Infected urine B L A D D E R CROSS SECTION T he urinary tract is made up of the bladder, the urethra, the ureters, and the kidney. Urine is made ...


Laparoscopic Repair of Ureteral Transection  

Microsoft Academic Search

Injury to the ureter is a possible complication of laparoscopic surgery. Traditionally, it is repaired by laparotomy. During laparoscopic surgery for bilateral ovarian remnants in a 29-year-old woman, the left ureter was transected. The ureter was repaired by primary end-to-end anastomosis by laparoscopy. The patient recovered uneventfully, and postoperative intravenous puelogram confirmed the repair to be intact.

Paul K. Tulikangas; Jeffrey M. Goldberg; Inderbir S. Gill



Gemcitabine Hydrochloride and Cisplatin or High-Dose Methotrexate, Vinblastine, Doxorubicin Hydrochloride, and Cisplatin in Treating Patients With Urothelial Cancer

Anterior Urethral Cancer; Localized Transitional Cell Cancer of the Renal Pelvis and Ureter; Posterior Urethral Cancer; Recurrent Bladder Cancer; Recurrent Urethral Cancer; Regional Transitional Cell Cancer of the Renal Pelvis and Ureter; Stage III Bladder Cancer; Transitional Cell Carcinoma of the Bladder; Ureter Cancer; Urethral Cancer Associated With Invasive Bladder Cancer



Gemcitabine, Paclitaxel, Doxorubicin in Metastatic or Unresectable Bladder Cancer With Decreased Kidney Function

Distal Urethral Cancer; Metastatic Transitional Cell Cancer of the Renal Pelvis and Ureter; Proximal Urethral Cancer; Recurrent Bladder Cancer; Recurrent Transitional Cell Cancer of the Renal Pelvis and Ureter; Recurrent Urethral Cancer; Regional Transitional Cell Cancer of the Renal Pelvis and Ureter; Stage III Bladder Cancer; Stage IV Bladder Cancer; Transitional Cell Carcinoma of the Bladder; Urethral Cancer Associated With Invasive Bladder Cancer



Ureteral reaction to suture material.  


Dog ureters were anastomosed end to end using either chromic catgut, polyglycolic acid (PGA), polyglactin-910, or polypropylene sutures. Analysis of luminal diameters, fibrosis, scar vascularity, and inflammatory reaction four and seven months later indicated that in ureters of the uninfected dog the best results were obtained with polyglycolic acid. Ureters anastomosed with catgut gave results that were slightly less acceptable. PMID:6301130

Smith, M W; Bartone, F F; Tan, E C; Gardner, P J



Sorafenib in Treating Patients With Regional or Metastatic Cancer of the Urothelium

Adenocarcinoma of the Bladder; Distal Urethral Cancer; Metastatic Transitional Cell Cancer of the Renal Pelvis and Ureter; Proximal Urethral Cancer; Recurrent Bladder Cancer; Recurrent Transitional Cell Cancer of the Renal Pelvis and Ureter; Recurrent Urethral Cancer; Regional Transitional Cell Cancer of the Renal Pelvis and Ureter; Squamous Cell Carcinoma of the Bladder; Stage III Bladder Cancer; Stage IV Bladder Cancer; Transitional Cell Carcinoma of the Bladder; Urethral Cancer Associated With Invasive Bladder Cancer



Solitary ureteral metastases of renal cell carcinoma.  


Metachronous presentation of metastatic renal cell carcinoma (RCC) to the ureter is extremely rare. We report a solitary metachronous metastatic RCC in the contralateral ureter 14 months after right radical nephrectomy for Fuhrman grade 2 pT3a clear cell disease after the patient re-presented with gross hematuria. The proximal left ureteral lesion was excised followed by ileal-ureteral interposition. Pathologic examination confirmed metastatic RCC. To date, only 51 cases of metastatic RCC to the ureter have been reported, with only 6 occurring metachronously in the contralateral ureter. Also, we report the presence of focal extramedullary hematopoiesis occurring within this metastatic lesion. PMID:16904477

Zorn, Kevin C; Orvieto, Marcelo A; Mikhail, Albert A; Lotan, Tamara; Gerber, Glenn S; Shalhav, Arieh L; Steinberg, Gary D



Dipping Technique for Ureteroileal Anastomosis in Orthotopic Ileal Neobladder: 20-Year Experience in 670 Patients--No Stenosis with Preservation of the Upper Tract  

PubMed Central

Objectives. Many techniques were described for ureteroileal anastomosis in orthotopic bladder substitution, ranging from nonrefluxing to refluxing techniques, all aiming at preservation of the upper tract. We describe our technique of dipping the ureter into the ileal pouch, which is simple and had no complications. Patients and Methods. Our technique implies dipping the ureter in the lateral side of the pouch, in right and left corners, with two rows of four sutures fixing the seromuscular layer of the ureter to the seromuscular layer of the ileal pouch. The procedure was applied in both normal ureteric calibre and dilated ureter. Total number of procedures done was 1,340 ureters in 670 patients after radical cystectomy for invasive carcinoma of the bladder of urothelial and nonurothelial cancer. Results. Followup of patients every six months and onward did not show stenosis in the ureteroileal anastomotic site. Filling of the ureter with contrast dye on ascending pouchogram was observed in patients who had considerably dilated ureters at the time of cystectomy. Normal ureter did not show clinical reflux but radiological filling of the ureter when the intravesical pressure exceeded the leak point pressure. Time to perform the dipping technique was 5–7 minutes for each site. Conclusion. Dipping technique for ureteroileal anastomosis in orthotopic ileal neobladder avoids the incidence of stenosis, preserves the upper tract, is a fast procedure, stands the evaluation in long-term followup, and was practiced successfully for twenty years.

Wishahi, Mohamed M.; Elganzoury, Hosam; Elkhouly, Amr; Mehena, Ahmed



Reflux nephropathy  


Chronic atrophic pyelonephritis; Vesicoureteric reflux; Nephropathy - reflux; Ureteral reflux ... scarred by this reflux. This is called reflux nephropathy Reflux can occur in people whose ureters do ...


Urinoma formation in posterior urethral valves: Relationship to later renal function  

Microsoft Academic Search

A retrospective analysis of radiologically determined individual renal function was performed in five boys who presented in the neonatal period with posterior urethral valves, vesicoureteral reflux and documented urinoma formation. Renal function was evaluated with scintigraphy. There was reflux in eight of ten ureters. Six of these ureters had an associated urinoma and compromised renal function in the neonatal period.

S. K. Fernbach; K. A. Feinstein; M. R. Zaontz



Long-segment ureteral replacement with expanded polytetrafluoroethylene grafts  

Microsoft Academic Search

ObjectivesTraumatic loss of significant lengths of ureter all too often results in nephrectomy when vascularized pedicles of bowel or bladder fail or are not available for substitution. Historically, alloplastic replacement of ureters has failed due to obstruction, bioincompatibility, or graft migration. This study was undertaken to test the performance of ringed expanded polytetrafluoroethylene (PTFE) tube grafts as ureteral replacements in

Edmund S. Sabanegh; James R. Downey; Alvin L. Sago



A radiographic study of urine flow in the domestic fowl  

Microsoft Academic Search

The movement of radiopaque media in the ureters, cloaca, colon and caeca was studied radiographically in 12 in?lay light hybrid hens. During direct screening of the conscious birds after intravenous administration of sodium diacetamidotriiodobenzoate, the contrast medium was observed to pass along the ureters to their distal extremity under the action of ureteral contractions. It accumulated in the coprodeum, which

A. R. Akester; R. S. Anderson; K. J. Hill; G. W. Osbaldiston



Incidence, diagnosis, and treatment of ureteric stenosis in 1298 renal transplant patients  

Microsoft Academic Search

Of 1130 patients who had undergone a total of 1298 kidney transplantations, 40 developed a stenosis of the ureter (3.1%). In all of the transplants, the anastomosis between the ureter and the urinary bladder was established as extravesical ureteroneocystostomy. Up until 1984, in cases where an obstruction in the urinary tract was suspected, the diagnosis was made by an i.

H. Keller; G. Nöldge; H. Wilms; G. Kirste



Neoplasia vesical tras nefroureterectomía por tumores de urotelio superior. ¿La cirugía del uréter distal influye en la evolución?  

Microsoft Academic Search

BLADDER NEOPLASM AFTER NEPHROURETERECTOMY FOR UPPER URINARY TRACT TUMOR. DOES DISTAL URETER SURGERY INFLUX ON THE EVOLUTION? Objective. To compare evolution in patients with urothelial upper tract tumor (UUTT) in whom we performed the classic open appro- ach to the distal ureter with those in whom whe performed the endoscopic approach. We study the bladder recurrences in each group and

Blanco Díez; Armas Molina J; Artíles Hernández JL; Martín Betancor


Ureteric stents: investigating flow and encrustation  

Microsoft Academic Search

Blockages of the ureter, e.g. due to calculi (kidney stones), can result in an increase in renal pelvic pressure. This may be relieved by inserting a stent (essentially a permeable hollow tube). However, a number of complications are associated with stent use. Stents can result in reflux (backflow of urine along the ureter), which will promote recurrent urinary infection and

S L Waters; K Heaton; J H Siggers; R Bayston; M Bishop; L J Cummings; D M Grant; J M Oliver; J A D Wattis



Ureteral obstruction and urinary fistula due to fibrin glue after partial nephrectomy: A case report and review of the literature  

PubMed Central

In the present study, we report the case of a 69-year-old female who developed urinary leakage following partial nephrectomy (PN) to remove left renal masses. The results of CT and MR urography revealed left proximal ureteral obstruction and urinary fistula. Reoperation was performed on the 16th postoperative day to explore the left kidney and ureter in order to relieve the obstruction. The left proximal ureter was found to be enfolded by fibrin glue and showed marked stiffness and adhesion during the reoperation. The lesion of the ureter was resected and the ureter was anastomosed with the routine double-J stent. Pathological examination of surgical specimens revealed fat fibrous scar tissue hyperplasia with inflammatory cell infiltration. The patient recovered completely without exudate. Our experience suggests that care should be taken to avoid touching the ureter with fibrin glue during PN surgery.




Ureteroscopic Lithotripsy Using Swiss Lithoclast for Treatment of Ureteral Calculi: 12-Years Experience  

PubMed Central

Ureteroscopic lithotripsy using Swiss Lithoclast was performed in 411 cases from January 1996 to September 2007 in a single hospital. Medical records of 341 cases, in which Swiss Lithoclast was successfully applied, were available for this retrospective study. We used 9.5Fr and 10Fr Storz rigid ureteroscopes. A success was defined as being free of stone-related symptoms and residual stones larger than 2 mm. Sixty one stones were located in the upper ureter, 49 stones were in the mid ureter, and 231 stones were in the lower ureter. The overall success rate was 93.5%. The success rate of upper ureter stone (80.3%) was significantly lower compared with those of mid (93.8%) and lower (96.9%) ureter stones (P=0.001). The higher the calculi was located within the ureter, the more chance of upward migration there was (P<0.001). The success rate in male patients was lower than in female patients without a statistical significance (P=0.068). The success rate decreased as the size of the stone increased (P<0.001), and as the degree of hydronephrosis increased (P=0.03). Perforation rates were 4.9%, 4.1%, and 2.6% from upper to lower ureter stone group. Ureteroscopic lithotripsy using Swiss Lithoclast is a safe and useful treatment modality for ureteral calculi.

Park, Dong Soo



Robotic Ureterolysis, Retroperitoneal Biopsy, and Omental Wrap for the Treatment of Ureteral Obstruction Due to Idiopathic Retroperitoneal Fibrosis  

PubMed Central

Retroperitoneal fibrosis (RPF) is a rare disorder of unclear etiology characterized by chronic inflammation of the retroperitoneum, which can involve any of the retroperitoneal structures, most notably the ureters, aorta, and vena cava. Historically, open biopsy, ureterolysis, and transpositioning or omental wrapping of the involved ureter(s) have been the preferred surgical treatments of RPF, with success rates greater than 90%. More recently, successful laparoscopic biopsy, ureterolysis, and ureteral omental wrapping and intraperi-tonealization have been described. We report the first case in the literature of idiopathic RPF managed with robotic ureterolysis and laparoscopic omental ureteral wrapping.

Mufarrij, Patrick W; Stifelman, Michael D



Conservative management of ureteral tumor.  


The traditional approach to transitional-cell carcinoma of the ureter has been nephroureterectomy with excision of a cuff of bladder. Evidence indicates that noninvasive transitional-cell tumor of the ureter is amenable to local resection. Five cases are presented in which transitional-cell carcinoma of the ureter was resected locally. None of the patients died from recurrence of their original tumor. It is suggested that the approach to ureteral tumor includes excisional biopsy with frozen section and reconstruction of ureteral continuity in the case of low-grade noninvasive transitional-cell tumor. PMID:21322982

De Wolf, W C; Rodgers, R; Blackard, C



Use of mitrofanoff and yang-monti techniques as ureteric substitution for severe schistosomal bilateral ureteric stricture: a case report and review of the literature.  


Distal ureteric stricture is a common complication of urinary schistosomiasis which is a disease more prevalent in the tropics and subtropics. The surgical management of this complication is more challenging when it affects more than half of both ureters. We report the case of a 17-year-old Nigerian with a long standing recurrent painless terminal hematuria associated with bilateral colicky loin pains. Ultrasound scan showed bilateral hydro ureters and hydro nephrosis with deranged biochemical renal function. The patient had bilateral tube nephrostomy and antibiotic therapy. Definitive bilateral ureteric substitution was done using Mitrofanoff technique for the right ureter and Yang-Montie technique for the left ureter. The patient's renal function became normal and he was discharged home without complication. The related literatures were reviewed. Surgical nonurothelial ureteral substitution is necessary for long, extensive, severe bilateral ureteric strictures so as to prevent progressive renal damage and end stage renal failure. PMID:24027391

Bakari, Abubakar Alhaji; Gadam, Ibrahim Ahmed; Aliyu, Suleiman; Suleiman, Ibrahim; Ahidjo, Ahmed A; Pindiga, Umaru Hamid



Use of Mitrofanoff and Yang-Monti Techniques as Ureteric Substitution for Severe Schistosomal Bilateral Ureteric Stricture: A Case Report and Review of the Literature  

PubMed Central

Distal ureteric stricture is a common complication of urinary schistosomiasis which is a disease more prevalent in the tropics and subtropics. The surgical management of this complication is more challenging when it affects more than half of both ureters. We report the case of a 17-year-old Nigerian with a long standing recurrent painless terminal hematuria associated with bilateral colicky loin pains. Ultrasound scan showed bilateral hydro ureters and hydro nephrosis with deranged biochemical renal function. The patient had bilateral tube nephrostomy and antibiotic therapy. Definitive bilateral ureteric substitution was done using Mitrofanoff technique for the right ureter and Yang-Montie technique for the left ureter. The patient?s renal function became normal and he was discharged home without complication. The related literatures were reviewed. Surgical nonurothelial ureteral substitution is necessary for long, extensive, severe bilateral ureteric strictures so as to prevent progressive renal damage and end stage renal failure.

Bakari, Abubakar Alhaji; Gadam, Ibrahim Ahmed; Aliyu, Suleiman; Suleiman, Ibrahim; Ahidjo, Ahmed A; Pindiga, Umaru Hamid



Pediatric Focused Safety Review: Flomax (tamsulosin ...  

Center for Biologics Evaluation and Research (CBER)

Text Version... 16.8% Calculus of Ureter 10.4% ... among females 1 Source: IMS, Vector One®: Total Patient Tracker. January 2002 through June 2011. ... More results from


Kidney Dysplasia  


... affect the normal kidney. For example, one urinary birth defect causes blockage at the point where urine normally drains from the kidney into the ureter. Another birth defect causes urine to flow from the bladder back up ...


Ureteral Injuries  


... the colon (colectomy) or repair of an abdominal aortic aneurysm, or during ureteroscopy (an examination of the ureter ... Book Mobile Versions VIEW STUDENT STORIES Pronunciations aneurysm aortic aneurysm colectomy computed tomography cutaneous fistula hysterectomy intravenous urography ...


Small cell carcinoma of the urinary tract: a case report  

PubMed Central

Neuroendocrine small cell carcinoma of the urinary tract is rarely encountered and very few cases have been reported in the literature. Herein we describe a case of small cell malignancy located contemporarily in the ureter and the bladder.

Papadaniil, Panteleimon; Stefanakis, Stefanos; Pantazis, Efstathios; Grigorakis, Alkiviadis; Petraki, Konstantina; Malovrouvas, Dimitrios



MPH Urinary Rules: Breeze Training Transcript: Feb 16 07

NATIONAL INSTITUTES OF HEALTH NATIONAL CANCER INSTITUTE SURVEILLANCE, EPIDEMIOLOGY AND END RESULTS (SEER) PROGRAM Breeze Session Multiple Primary and Histology Coding Rules—Renal Pelvis, Ureter and Bladder and Other Urinary Sites February 16, 2007


Urinary Tract Infections  


... kidneys, two ureters, a bladder, and a urethra. Urinary tract infections (UTIs) are the second most common type of infection in the body. You may have a UTI if you notice Pain or burning when you ...


21 CFR 876.5900 - Ostomy pouch and accessories.  

Code of Federal Regulations, 2013 CFR

...material or urine following an ileostomy, colostomy, or ureterostomy (a surgically created opening of the small intestine, large intestine, or the ureter on the surface of the body). This generic type of device and its accessories...



Megaureter visualization on Tc-99m DMSA scintigraphy.  


We present a patient with left-sided obstructed megaureter secondary to neuropathic bladder. He was referred for technetium-99m dimercaptosuccinic acid ((99m)Tc-DMSA) renal cortical scintigraphy to evaluate renal cortical function. Images obtained 4 hr after injection showed significant activity in the dilated left ureter. When the ureter is visualized on DMSA scan, obstructive megaureter should be considered in the differential diagnosis. PMID:16164201

Türkölmez, Seyda; Ors, Derya; Korkmaz, Meliha



Ultrasound-guided percutaneous antegrade pyelography with computed tomography for the diagnosis of spontaneous partial ureteral rupture in a dog.  


A 10-year-old spayed female dalmatian dog developed acute vomiting and abdominal pain. Ultrasound examination of the abdomen showed right hydronephrosis and proximal ureter dilation with mild retroperitoneal free fluid. Computed tomography (CT) of the abdomen confirmed the ultrasonographic findings and revealed, additionally, a right ureteral stone. Spontaneus rupture of the right ureter was confirmed with CT post ultrasound-guided percutaneous antegrade pyelography. Pyeloureteral rupture and the presence of a ureteral stone were confirmed at surgery. PMID:23633712

Specchi, Swan; Lacava, Giuseppe; d'Anjou, Marc-André; Zini, Eric; Auriemma, Edoardo



Robot-Assisted Pyeloplasty  

Microsoft Academic Search

\\u000a Ureteropelvic junction obstruction (UPJO) is defined as a significant, functional alteration in the “transit” of urine due\\u000a to an intrinsic or extrinsic obstruction at the junction between the ureter and the renal pelvis. In the majority of cases,\\u000a its origin is congenital. UPJO is the most common congenital abnormality of the ureter, with an annual reported incidence\\u000a of 5\\/100,000 (Eden

Raymond J. Leveillee; Jorge Bracho; Steve K. Williams; John M. Shields; Charles R. Moore


Lactobacillus gasseri as the cause of septic urinary infection  

Microsoft Academic Search

Summary A 66-year-old patient developed severe urinary stasis due to a concrement in his right ureter; foudroyant septicemia followed.Lactobacillus gasseri was grown from pyoid urine from the right renal pelvis and in two blood cultures, thus suggesting septic urinary infection caused by lactobacilli. The infection was cured by catheterisation of the right ureter and antibiotic treatment with cefotaxime and amoxicillin.

U. Dickgießer; N. Weiss; D. Fritsche



Extended Surgery with En Bloc Resection of the Right Common Iliac Vessels for Lymph Node Metastasis of Mucinous Colon Carcinoma: Report of a Case  

Microsoft Academic Search

We report herein the case of a 63-year-old woman who underwent surgery for recurrent mucinous carcinoma of the cecum. Recurrent\\u000a metastatic lymph nodes had invaded the right common iliac vessels and right ureter, but she had no distant metastases and\\u000a no peritoneal dissemination. Extended surgery with en bloc resection of the right iliac vessels and right ureter, and femorofemoral\\u000a bypass

Kazumitsu Ueda; Hiroyuki Nagayama; Kazuhiro Narita; Mitsuo Kusano; Masahiro Aiba; Makoto Yamada; Toshihiro Takaba; Kennjiro Shirasawa



High incidence of vesico-ureteral reflux in mice with deletion of fibroblast growth factor receptor 2 in kidney mesenchyme  

PubMed Central

Purpose Mice with conditional deletion of fibroblast growth factor receptor 2 (Fgfr2) in metanephric mesenchyme (Fgfr2Mes?/?) have ureteric bud induction abnormalities. Our goal was to determine if Fgfr2Mes?/? mutants developed abnormally positioned ureters predisposing to vesico-ureteral reflux (VUR). Materials and Methods We measured common nephric duct (CND) lengths and assayed for apoptosis in embryonic day (E) 11.5 mice. We performed 3 dimensional (3D) reconstructions of and real time PCR and whole mount in situ hybridization for Fgfr2 in urinary tracts in E15.5 embryos. We performed cystograms followed by 3D reconstructions in postnatal animals. Results Compared with controls, Fgfr2Mes?/? embryos had increased CND lengths (with no differences in apoptosis) indicating cranially displaced ureteric buds. 3-D reconstructions at E15.5 showed low insertions of ureters into the bladder (near bladder necks) in Fgfr2Mes?/? mice. Postnatal Fgfr2Mes?/? mutants had high rates of VUR compared with controls (47.4% vs. 4.0%, p=0.00006). In postnatal mutants with unilateral reflux, the refluxing ureters inserted closer to the bladder neck than non-refluxing ureters. The external ureteral insertional angles at the outer bladder wall (formed by the ureteral insertion points and bladder neck) were greater in mutant refluxing ureters compared to contralateral non-refluxing ureters and to control ureters. At E15.5, Fgfr2 levels were decreased in Fgfr2Mes?/? kidneys compared with controls, but were not statistically different in ureters or bladders. Conclusions Fgfr2Mes?/? mice have ureteric induction abnormalities, associated with abnormal ureteral insertion in the bladder and subsequent VUR, consistent with the Mackie and Stephens hypothesis.

Hains, David S.; Sims-Lucas, Sunder; Carpenter, Ashley; Saha, Monalee; Murawski, Inga; Kish, Kayle; Gupta, Indra; McHugh, Kirk; Bates, Carlton M.



The spectrum of ureteropelvic junction obstructions occurring in duplicated collecting systems  

Microsoft Academic Search

The authors reviewed four cases of ureteropelvic junction obstruction (UPJ) in duplicated systems. Associated abnormalities included contralateral duplication, vesicoureteral reflux, and a case of ipsilateral upper pole ectopic ureter with a dysplastic upper pole moiety. Surgical management included dismembered pyeloplasty, ureteral reimplantation, end-to-side pyeloureterostomy to the upper-pole ureter, and upper-pole heminephrectomy with lower-pole dismembered pyeloplasty. UPJ obstructions occurring in duplicated

James Ulchaker; Jonathan Ross; Frederick Alexander; Robert Kay



Familial ureteral abnormalities syndrome: genomic mapping, clinical findings  

Microsoft Academic Search

.   Abnormal development of the ureter during embryogenesis, when occurring in multiple family members, appears to be a genetically\\u000a determined defect with autosomal dominant inheritance and high penetrance, which can lead to significant kidney damage, renal\\u000a failure, and death. We have studied 48 individuals within a large kindred in which ureteral-related abnormalities (including\\u000a vesicoureteral reflux, ureteropelvic junction obstruction, duplicated ureters,

LuAnn Klemme; Alfred J. Fish; Stephen Rich; Beryl Greenberg; Beverly Senske; Miriam Segall



Differentiation of urinary stone and vascular calcifications on non-contrast CT images: an initial experience using computer aided diagnosis.  


The purpose of this study was to develop methods for the differentiation of urinary stones and vascular calcifications using computer-aided diagnosis (CAD) of non-contrast computed tomography (CT) images. From May 2003 to February 2004, 56 patients that underwent a pre-contrast CT examination and subsequently diagnosed as ureter stones were included in the study. Fifty-nine ureter stones and 53 vascular calcifications on pre-contrast CT images of the patients were evaluated. The shapes of the lesions including disperseness, convex hull depth, and lobulation count were analyzed for patients with ureter stones and vascular calcifications. In addition, the internal textures including edge density, skewness, difference histogram variation (DHV), and the gray-level co-occurrence matrix moment were also evaluated for the patients. For evaluation of the diagnostic accuracy of the shape and texture features, an artificial neural network (ANN) and receiver operating characteristics curve (ROC) analyses were performed. Of the several shape factors, disperseness showed a statistical difference between ureter stones and vascular calcifications (p < 0.05). For the internal texture features, skewness and DHV showed statistical differences between ureter stones and vascular calcifications (p < 0.05). The performance of the ANN was evaluated by examining the area under the ROC curves (AUC, A (z)). The A (z) value was 0.85 for the shape parameters and 0.88 for the texture parameters. In this study, several parameters regarding shape and internal texture were statistically different between ureter stones and vascular calcifications. The use of CAD would make it possible to differentiate ureter stones from vascular calcifications by a comparison of these parameters. PMID:19190962

Lee, Hak Jong; Kim, Kwang Gi; Hwang, Sung Il; Kim, Seung Hyup; Byun, Seok-Soo; Lee, Sang Eun; Hong, Seong Kyu; Cho, Jeong Yeon; Seong, Chang Gyu



Socioeconomic evaluation of the treatment of ureteral lithiasis  

PubMed Central

Background and aim: This study attempts to estimate the socioeconomic differences between three major alternatives for the management of upper and lower ureteral lithiasis. Material and methods: Two hundred and forty patients with upper and lower ureteral lithiasis, have been studied retrospectively, divided in six equal groups of forty. These patients have been treated either by extracorporeal shockwave lithotripsy (SWL), or with ureteroscopy with semirigid ureteroscope and the use of pneumatic lithoclast, or with ureteroscopy with flexible ureteroscope and the use of Holmium YAG Laser. For cost calculation, the reimbursement fee paid by insurance to the hospital was taken into account. For the estimation of the social burden, the length of hospital stay and the number of outpatient visits have been included as countable parameters. Results: The percentage of effective stone removal for upper ureter was 81.0% for SWL, 62.5% for ureteroscopy with semirigid ureteroscope and the use of pneumatic lithoclast and, 82.5% for ureteroscopy with flexible ureteroscope and the use of Holmium YAG Laser. The same percentages for lower ureter were 82.5%, 92.5% and 97.5% respectively. The cost of stone removal for both the upper and lower ureter using extracorporeal lithotripsy was significantly higher compared to the other two procedures (median cost for upper ureter 828 € vs 474.50 € and 396 € respectively, and for lower ureter 826 € vs 396 € and 271 €, p<0.001). Regarding the social aspect, SWL is mainly an outpatient procedure, requiring a short hospital stay (for upper ureter 1.63 vs 2.48 and 2.45 respectively and for lower ureter 1.35 vs 2.43 and 2.13days), but needing more and prevailing clinic visits (for upper ureter 1.43 vs 1.45 and 1 respectively and for lower ureter 1.45 vs 1.15 and 0.55 visitsgive numbers, compare), both in outpatient and in accident and emergency (A&E) department. Conclusion: The increase in the expenses with regard to health management indicates the necessity of cost accounting the health programs including the medical procedures as a means to improve the relation between cost and benefit.

Rombi, T; Triantafyllidis, A; Fotas, A; Konstantinidis, T; Touloupidis, S



Use of Ileum as Ureteral Replacement in Urological Reconstruction  

PubMed Central

Purpose We reviewed indications and outcomes in patients undergoing ileal ureter replacement for ureteral reconstruction. Materials and Methods Between December 1989 and September 2007, 105 patients underwent ileal ureter replacement, of whom 14 were excluded from study due to incomplete data. The remaining 91 patients (99 renal units) comprised the study cohort. Results Mean patient age was 46.8 years and mean followup was 36.0 months. Indications for an ileal ureter were stricture following genitourinary surgery in 29 cases (31.9%), radiation induced stricture in 17 (18.7%), nonurological surgery iatrogenic injury in 16 (17.6%) and retroperitoneal fibrosis in 11 (12.1%). Only 4 patients (4.4%) had primary ureteral cancer. Long-term complications included anastomotic stricture in 3 patients (3.3%) and fistula in 6 (6.6%). Serum creatinine decreased or remained stable in 68 patients (74.7%) and hyperchloremic metabolic acidosis developed in 3. No patient complained of excessive urinary mucous production. Conclusions In 68.1% of patients indications for an ileal ureter included radiation induced stricture or iatrogenic injury. The ileal ureter is a reasonable option for long-term ureteral reconstruction with preserved renal function in carefully selected patients.

Armatys, Sandra A.; Mellon, Matthew J.; Beck, Stephen D. W.; Koch, Michael O.; Foster, Richard S.; Bihrle, Richard



Vesicoureteral reflux and voiding dysfunction: a prospective study.  


We prospectively studied 53 young children (45 less than 4 years old) between 1985 and 1988 with primary vesicoureteral reflux (grades I to V, 74 ureters). All patients had elevated bladder pressures during bladder filling and/or voiding on urodynamic evaluation, which sometimes were associated with abnormal perineal muscle activity. Baclofen, flavoxate, dicyclomine and diazepam were given individually or in combination for each type of dysfunction for 12 to 30 months. Reflux disappeared in 68 ureters (91.8 per cent) and it was downgraded in 6 (8.2 per cent). Urodynamic evaluation at the end of treatment revealed normal bladder pressures in 46 children (83.7 per cent of the ureters in which reflux resolved). Another group of 48 children with primary vesicoureteral reflux (grades I to IV, 67 ureters) seen between 1980 and 1985 was reviewed retrospectively. All patients had been treated with prophylactic antibiotics only. Reflux resolved in 53.7 per cent of the ureters, and it was downgraded in 19.4 per cent, unchanged in 22.4 per cent and upgraded in 4.5 per cent. Urodynamic studies performed in 1985 showed that all persistent cases of reflux in the retrospective group had urodynamic findings similar to those found in the prospective group. These data suggest that vesicoperineal incoordination as well as bladder instability can be important factors in causing and perpetuating reflux, and that medical treatment of these factors individually or in combination may affect therapeutic perspectives of this pathological condition. PMID:2746764

Seruca, H



The Inhibition of Ureteral Motility by Periureteral Adipose Tissue  

PubMed Central

Perivascular adipose tissue exerts an anticontractile influence on vascular smooth muscle. This study was conducted to determine whether periureteral adipose tissue (PUAT) could exert a similar influence upon ureteral smooth muscle. Acetylcholine-stimulated (10?7?M–10?4?M) contractile responses of ureteral segments obtained from male Wistar rats were recorded in the presence and absence of PUAT. Ureters with PUAT generated phasic contractile responses with significantly lower frequencies (P < 0.001) and magnitudes (P < 0.001) compared with ureters cleared of their periureteral adipose tissue. Removal of PUAT significantly increased the frequency (P < 0.01) and magnitude (P < 0.01) of the contractile responses. Bioassay experiments demonstrated that ureters with PUAT released a transferable factor that significantly reduced frequencies (P < 0.05), but not magnitudes, of the contractile responses of ureters cleared of PUAT. The nitric oxide synthase inhibitor L-NNA (10?4?M) did not significantly influence the anticontractile effect exerted by ureters with PUAT. This is the first study to demonstrate that ureteral motility is influenced by its surrounding adipose tissue. The PUAT has an anticontractile effect which is mediated by a transferable factor released from the PUAT. The identity of the factor is unknown but does not exert its effect through nitric oxide.

Killian, Lyndsey M.; Bund, Stuart J.



Exaggerated prostaglandin biosynthesis and its influence on renal resistance in the isolated hydronephrotic rabbit kidney.  

PubMed Central

Basal and hormone-stimulated prostaglandin biosynthesis was compared in isolated perfused rabbit kidneys with and without ureteral obstruction. At 72 h there was enhanced responsiveness to bradykinin in the ureter-obstructed hydronephrotic kidney. The amount of prostaglandin-like substance released from the perfused kidneys by 25 ng of bradykinin was 533+/-163 ng from the ureter-obstructed, 28+/-4 ng from the contralateral, and 26+/-3 ng from the normal kidney. The enhanced response was also noted with angiotensin II and with norepinephrine. This exaggerated responsiveness by the ureter-obstructed kidney could not be explained by decreased prostaglandin (PG) destruction or by decreased renal peptide inactivation (bradykinin or angiotensin). There was no enhanced PG biosynthesis with exogenous arachidonate, suggesting there was no increase in cyclo-oxygenase activity in the ureter-obstructed kidney. Renal tubular transport of PG from medulla to cortex was apparently not essential for the enhanced PG biosynthesis to hormone stimulation since the same exaggerated responses were noted during perfusion with the ureter ligated. The cyclo-oxygenase inhibitor, indomethacin, increased basal perfusion pressure in the obstructed kidney and enhanced the magnitude and duration of the renal vasoconstriction produced by angiotensin II in the hydronephrotic kidney. These results suggest that the local exaggerated biosynthesis of PG may be occurring in the cortical resistance vessels and may be important to the alteration in blood flow and excretory function that occur in ureteral obstruction.

Nishikawa, K; Morrison, A; Needleman, P



Ureterolithiasis after Cohen re-implantation - case report  

PubMed Central

Background In the past decades, the widespread use of cross-trigonal ureteral reimplants for the treatment of children with vesicoureteral reflux has resulted in a large population of patients with transversely lying ureters. As this population gets older they will consequently be entering an age group at higher risk for stone and urothelial cancer formation. If ureteroscopy becomes necessary, the transverse position of the ureter makes ureteric access often impossible. Case Presentation We present the case of a young man who not only suffered from urolithiasis due to hyperparathyroidism, but also further jeopardized his treatment by omitting the fact that as a child he underwent Cohen reimplantation of the right ureter. Conclusions This case illustrates the particular difficulties the endoscopist may face in this group of patients. Patients with difficult ureteric access, abnormal anatomy, or those with known cross-trigonal ureteric reimplantations should be managed in a specialised endourology unit.

Chaudhary, Sonal; Lee, Miranda; Andrews, Henry O; Buchholz, Noor NP



Urography with spasmolytics.  


The effects of glucagon (1 mg i.v.) and hyoscine butylbromide (Buscopan 20 mg i.v.) and placebo on the visualization of the pyelocalyceal systems and ureters was compared in a routine urography with abdominal compression in a double-blind, randomized trial comprising 189 kidneys and ureters. The visualization of the ureters in the supine position was highly significantly better than in the prone. In the prone position the ureteral visualization with Buscopan was marginally significantly better than with placebo or glucagon. Otherwise, neither Buscopan nor glucagon improved the pyeloureteral visualization. However, with glucagon the pyelocalyceal visualization was highly significantly poorer than with placebo, and marginally significantly poorer than with Buscopan. PMID:2315637

Kinnunen, J; Saarinen, O; Ahovuo, J; Edgren, J; Laasonen, L; Pietilä, J



Molecular Pathology of Murine Ureteritis Causing Obstructive Uropathy with Hydronephrosis  

PubMed Central

Primary causes of urinary tract obstruction that induces urine retention and results in hydronephrosis include uroliths, inflammation, and tumors. In this study, we analyzed the molecular pathology of ureteritis causing hydronephrosis in laboratory rodents. F2 progenies of C57BL/6 and DBA/2 mice were studied histopathologically and by comprehensive gene expression analysis of their ureters. Incidence of hydronephrosis was approximately 5% in F2 progenies. Histopathologically, this hydronephrosis was caused by stenosis of the proximal ureter, which showed fibrosis and papillary malformations of the proliferative epithelium with infiltrations of B-cell-dominated lymphocytes. Additionally, CD16-positive large granular leukocytes and eosinophils infiltrated from the ureteral mucosa to the muscular layer. Eosinophilic crystals were characteristically observed in the lumen of the ureter and the cytoplasm of large granular leukocytes, eosinophils, and transitional epithelial cells. Comprehensive gene profiling revealed remarkably elevated expression of genes associated with hyperimmune responses through activation of B cells in diseased ureters. Furthermore, diseased ureters showed dramatically higher gene expression of chitinase 3-like 3, known as Ym1, which is associated with formation both of adenomas in the transitional epithelium and of eosinophilic crystals in inflammatory conditions. The Ym1 protein was mainly localized to the cytoplasm of the transitional epithelium, infiltrated cells, and eosinophilic crystals in diseased ureters. We determined that the primary cause of hydronephrosis in F2 mice was ureteritis mediated by the local hyperimmune response with malformation of the transitional epithelium. Our data provide a novel molecular pathogenesis for elucidating causes of aseptic inflammation in human upper urinary tracts.

Ichii, Osamu; Otsuka, Saori; Namiki, Yuka; Hashimoto, Yoshiharu; Kon, Yasuhiro



Radionuclide imaging of rare congenital renal fusion anomalies.  


Demonstration of a congenital renal anomaly plays an important role in the treatment of patients with renal infection. These patients are prone to infections because of coexisting urinary tract anomalies such as duplicated ureter, ureter opening anomalies, and urinary stasis. Assessment of renal parenchymal damage resulting from acute or chronic renal infection is the primary indication for radionuclide imaging with Tc-99m DMSA. In addition, this technique allows congenital anomalies to be identified. The authors review congenital renal fusion anomalies identified in children through Tc-99m DMSA imaging. They conclude that Tc-99m DMSA imaging can reveal important diagnostic information about various congenital anomalies, including fusion anomalies. PMID:12592127

Volkan, Bilge; Ceylan, Emel; Kiratli, Pinar Ozgen



Urolithiasis in an Adult with Primary Obstructive Megaureter: A Case Report  

PubMed Central

This is a rare case of adult primary obstructive megaureter complicated by combined uric acid-oxalate lithiasis of the ureter and renal stones. A 24-year-old male patient presented with frank hematuria on exercise of 4 years duration. The patient had an open surgery in the form of excision of stenotic segment of ureter and left ureteric re-implantation with removal of ureteric and renal stones. Congenital megaureter is a diagnosis that urologists and radiologists need to consider in the setting of isolated distal ureteral dilation, as the diagnosis of adult megaureter may require more involved surgical measures to prevent recurrence of adverse symptoms.

Al-Marhoon, Mohammed S.; Venkiteswaran, Khrishna P.; Shareef, Omar W.



Urolithiasis in an adult with primary obstructive megaureter: a case report.  


This is a rare case of adult primary obstructive megaureter complicated by combined uric acid-oxalate lithiasis of the ureter and renal stones. A 24-year-old male patient presented with frank hematuria on exercise of 4 years duration. The patient had an open surgery in the form of excision of stenotic segment of ureter and left ureteric re-implantation with removal of ureteric and renal stones. Congenital megaureter is a diagnosis that urologists and radiologists need to consider in the setting of isolated distal ureteral dilation, as the diagnosis of adult megaureter may require more involved surgical measures to prevent recurrence of adverse symptoms. PMID:24044065

Al-Marhoon, Mohammed S; Venkiteswaran, Khrishna P; Shareef, Omar W



Percutaneous pyelolysis.  


Pelvi-ureteric junction obstruction has been treated in 3 patients using a percutaneous modification of the Davis intubated ureterostomy technique. A 10-French tube is introduced into the obstructed upper ureter through a percutaneous nephrostomy puncture. Full thickness incision of the upper ureter and pelvi-ureteric junction is then carried out using a standard endoscopic urethrotome. The splint tube and diverting proximal nephrostomy remain in situ for 1 month. Good drainage was established in 2 cases following de-tubing. Further cases are under study. PMID:6852083

Wickham, J E; Kellet, M J



Primary Malignant Melanoma of the Genitourinary Tract with Upper and Lower Tracts Involvement  

PubMed Central

A 91-year-old female presented with lower extremity swelling and shortness of breath. Laboratory analysis revealed elevations in blood urea nitrogen and creatinine along with microscopic hematuria on urinalysis. Computed tomography imaging showed moderate right hydronephrosis with dilatation of the proximal ureter with a soft tissue density at a transition point. Endoscopic evaluation revealed multiple raised, fleshy, and hemorrhagic masses throughout the bladder which are present in both ureters. Biopsy of these lesions revealed malignant melanoma invading the lamina propria. No dermatologic lesions were identified suggesting a primary malignant melanoma of the genitourinary system.

Chan, Robert



Polyglactin 910 suture in urinary tract.  


Cystotomies in guinea pigs and ureteral anastomoses in dogs were sutured with polyglactin 910. Silk and chromic catgut were used as control sutures in the bladders and chromic catgut in the ureters. Three months postoperatively in bladders sutured with polyglactin 910 small epithelial cysts were noted, which increased in size with time. In ureters sutured with polyglactin 910 cystic diverticula were observed eight months postoperatively. Because of the difference of tissue reaction to polyglactin 910 compared with catgut, further long-term studies are urged in different species of animals, prior to the clinical use of polyglactin 910 in the urinary tract. PMID:871044

Bartone, F F; Gardner, P J; Hutson, J C



Renal Cell Carcinoma with Intraluminal Spread of the Entire Upper Urinary Tract  

PubMed Central

We describe an unusual case of renal cell carcinoma (RCC) involving the entire upper urinary tract. A 51-year-old female was referred to us because of macroscopic hematuria. Computed tomography revealed a renal tumor filling renal pelvis and ureter, which turned to be a clear cell RCC after nephroureterectomy.

Kume, Haruki; Hirano, Yoshikazu; Wakita, Toshihiko; Homma, Yukio



Laparoscopic cryosurgery of the kidney in the porcine model: an acute histological study  

Microsoft Academic Search

Objectives. To verify histologically whether cryosurgery of the kidney can be accomplished reproducibly without injuring adjacent structures, using a combination of ultrasound and laparoscopic guidance.Materials and Methods. Six kidneys from three domestic female farm pigs were utilized in the study. Under general anesthesia and after obtaining pneumoperitoneum, the lower pole of the kidney was mobilized laparoscopically and the ureter and

Stephen Y. Nakada; Fred T. Lee; Thomas Warner; Susan G. Chosy; Timothy D. Moon



Lack of major involvement of human uroplakin genes in vesicoureteral reflux: Implications for disease heterogeneity  

Microsoft Academic Search

Lack of major involvement of human uroplakin genes in vesicoureteral reflux: Implications for disease heterogeneity.BackgroundPrimary vesicoureteral reflux (VUR) is a hereditary disorder characterized by the retrograde flow of urine into the ureters and kidneys. It affects about 1% of the young children and is thus one of the most common hereditary diseases. Its associated nephropathy is an important cause of

SONGSHAN JIANG; JORDAN GITLIN; FANG-MING DENG; FENG-XIA LIANG; ANDY LEE; ANTHONY ATALA; Stuart B. Bauer; Garth D. Ehrlich; Sally A. Feather; Judith D. Goldberg; Judith A. Goodship; Timothy H. J. Goodship; MONIKA HERMANNS; FEN ZE HU; Katrin E. Jones; SUE MALCOLM; CATHY MENDELSOHN; Robert A. Preston; Alan B. Retik; Francis X. Schneck; VICTORIA WRIGHT; Xiang Y. Ye; Adrian S. Woolf; XUE-RU WU; HARRY OSTRER; ELLEN SHAPIRO; JUN YU; TUNG-TIEN SUN



Solitary Kidney  


... kidneys remove wastes and extra water from the blood to form urine. Urine flows from the kidneys to the bladder through the ureters. Most people can live a normal, healthy life with one kidney. Taking precautions is wise to protect the kidney function you do have. [ ...


Urothelial lesions in Chinese-herb nephropathy  

Microsoft Academic Search

Rapidly progressive renal fibrosis after a slimming regimen including Chinese herbs containing aristolochic acid (AA) has been identified as Chinese-herb nephropathy (CHN). We reported urothelial atypia in three patients with CHN, with the subsequent development in one patient of overt transitional cell carcinoma (TCC). Therefore, it was decided to remove the native kidneys, as well as the ureters, in all

Jean-Pierre Cosyns; Michel Jadoul; Jean-Paul Squifflet; François-Xavier Wese; Charles van Ypersele de Strihou



Hypertensive retinopathy in a cat  

PubMed Central

A 12-year-old cat presented for sudden blindness was diagnosed with hypertensive retinopathy on the basis of ophthalmologic and ultrasonic examination. Renal failure due to a large intranephric cyst obstructing the right ureter and renal artery was the suggested cause of the systemic hypertension. The cat died 8 hours after unilateral nephrectomy.

Van Boxtel, Sherry A.



[Bladder psoas hitch. Report of 11 cases].  


Bladder psoas hitch is an surgical technique which, in very complicated cases, like repeated failures of vesico-ureteral re-implants or undiversions, allow us to bridge the shortness of the ureter and obtain a good vesico-ureteral reimplant. The surgical maneuver is described and several of the 11 cases operated by this technique are commented. The results are presented. PMID:8357727

Piro, C; Dargallo, T; Soto, R; Martín, J A; Gosálbez, R



Biomimetic propulsion for a swimming surgical micro-robot  

Microsoft Academic Search

A surgical micro-robot that swims inside the human ureter is proposed to provide a novel and minimally invasive method of kidney stone destruction. Inspired by the swimming mechanisms of bacteria such as E. coli, the robot utilizes biomimetic synthetic flagella composed of multiwalled carbon nanotubes that are driven into a rotating helical shape by a micro motor. Design aspects are

Jon Edd; Sébastien Payen; Boris Rubinsky; Marshall L. Stoller; Metin Sitti



Career of the Month: An Interview With Urologist Chad DeRosa  

NSDL National Science Digital Library

The organs, tubes, muscles, and nerves that work together to create, store, and carry urine make up the urinary system. Urologists are surgeons that focus on diseases of this system--which includes the kidneys, ureters, bladder, supporting muscles and liga

Sullivan, Megan



Clinical Application of Fiber-Optic Pyeloureteroscope  

Microsoft Academic Search

The authors have succeeded in passing the fiberscope up to the kidney by the transurethral procedure and taking photographs and movies of renal calyx, pelvis and ureter for the first time in the world. Our long cultivated dream on pyeloureteroscope has come true. When these improvements, which the authors just mentioned, have been achieved and an ideal pyeloureteroscope has been

H. Takayasu; Y. Aso; T. Takagi; T. Go



Long-term outcome of idiopathic retroperitoneal fibrosis treated with surgical and\\/or medical approaches  

Microsoft Academic Search

Background. Retroperitoneal fibrosis is a severe disease that affects the ureters, causing renal insufficiency in three-quarters of patients. The optimal treatment is far from being established. Methods. Seventeen patients with idiopathic retro- peritoneal fibrosis and ureteral entrapment followed in our unit for at least 1 year were selected for this study. At presentation 13 patients had renal insufficiency. All patients

Gabriella Moroni; Beniamina Gallelli; Giovanni Banfi; Sandro Sandri; Piergiorgio Messa; Claudio Ponticelli




EPA Science Inventory

Abstract The environmental toxicant 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) produces cleft palate (CP) and hydronephrosis (HN) in mice. The etiology of these defects involves hyperproliferation of epithelial cells of the secondary palatal shelf and ureter, respectively. ...


Micropapillary urothelial carcinoma of the upper urinary tract: Clinicopathologic study of five cases.  


We report 5 cases of micropapillary urothelial carcinoma (MPUC) involving the renal pelvis (2), renal pelvis and ureter (2), and proximal ureter (1). The patients were 2 women and 3 men, ages 65 to 92 years (mean, 76.0 years). All tumors showed a high-grade transitional cell carcinoma component, and in 3 cases, there also were areas of in situ carcinoma. The case involving only the ureter occurred in a 65-year-old man with a history of nephrectomy 12 years previously for urothelial carcinoma of the renal pelvis. The tumor recurred in the ureteral stump. In all cases, areas displaying micropapillary architecture were observed. In 2 cases the micropapillary areas were noninvasive; in 1 case a pure invasive pattern was seen; and in 2 cases a mixed invasive and noninvasive pattern was present. the micropapillary pattern was invasive; and the case involving the ureteral stump contained invasive and noninvasive micropapillary carcinoma. All patients died of their tumors from 3 to 24 months after initial diagnosis. MPUC involving the renal pelvis and ureter is associated closely with advanced stages of disease and has highly aggressive behavior. Recognition of this growth pattern is important for prognosis and avoiding misdiagnosis with papillary renal cell carcinoma and other tumors. PMID:16753597

Perez-Montiel, Delia; Hes, Ondrej; Michal, Michal; Suster, Saul



Long-term nephrostomy in an adult male spinal cord injury patient who had normal upper urinary tracts but developed bilateral hydronephrosis following penile sheath drainage: pyeloplasty and balloon dilatation of ureteropelvic junction proved futile: a case report  

Microsoft Academic Search

INTRODUCTION: The consequences of spinal cord injury upon urinary bladder are readily recognised by patients and health care professionals, since neuropathic bladder manifests itself as urinary incontinence, or retention of urine. But health care professionals and persons with spinal cord injury may not be conversant with neuropathic dysmotility affecting the ureter and renal pelvis. We report an adult male patient

Subramanian Vaidyanathan; Bakul M Soni; Peter L Hughes; Gurpreet Singh; Paul Mansour; Tun Oo



Use of the mitrofanoff principle in urinary reconstruction  

Microsoft Academic Search

The Mitrofanoff principle for continent reconstruction of the lower urinary tract may be summarized as: 1) the use of a narrow catheterizable conduit (appendix or ureter) brought to the skin; 2) anti-refluxing connection of the conduit for catheterization to the reservoir to provide continence; 3) a large low pressure leak-proof urine storage reservoir (bladder, augmented bladder, or colon segment); 4)

John W. Duckett; Howard Mc C. Snyder



Ureteropyeloscopy: the diagnostic and therapeutic approach to upper tract urothelial tumors  

Microsoft Academic Search

Rigid transurethral ureteropyeloscopy allows many standard cystoscopic procedures to be extended into the upper urinary tract, including endoscopic diagnosis, surveillance, and occasionally primary treatment. This endoscopic method has been used to investigate 59 patients suspected to have urothelial malignancies of the ureter or renal pelvis. Of the 54 patients in whom the procedure was successfully completed (90%), 27 were found

Jeffry L. Huffman; Michael J. Morse; Harry W. Herr; Pramod C. Sogani; Willet F. Whitmore; William R. Fair



Increased fluid intake and adequate dietary modification may be enough for the successful treatment of uric acid stone.  


Uric acid stones are the most readily dissolvable of all types of urinary stones. The present paper describes two patients with uric acid stones in kidney and ureter, whom we have treated successfully only by a combination of increased fluid intake and adequate dietary modification. PMID:23503881

Chae, Ji Yun; Kim, Jong Wook; Kim, Jin Wook; Yoon, Cheol Yong; Park, Hong Seok; Moon, Du Geon; Oh, Mi Mi



Smooth Muscle Physiology, Past and Future  

Microsoft Academic Search

The history of smooth muscle physiology from the work of Engelmann on the ureter (1869) to the introduction of intracellular electrodes by Bulbring (1954) is outlined. Attempts at classifying smooth muscles are discussed. The observation that passive shortening has an inhibitory effect during twitches and contractures of the turtle aorta indicates the presence of a feedback mechanism like that demonstrated

E. Bozler



Ureteral Displacement due to a Migrated Intrauterine Contraceptive Device  

Microsoft Academic Search

Perforation of the uterus is rare but potentially fatal. During puerperium when the uterus is small and its wall is thin, the risk of perforation increases. We report a rare complication from an intrauterine contraceptive device (IUD) which caused deviation of the right ureter in a 31-year-old woman who presented with complaints of insomnia and abdominal pain. Our case shows

Akif Sirikci; Kemal Sarica; Metin Bayram



Multiple endocrine neoplasia (MEN) II  


... neck Fever High blood pressure Rapid heart rate Thyroid nodules Imaging tests used to identify tumors may include: Abdominal CT scan Imaging of the kidneys or ureters MIBG scintiscan MRI of abdomen Thyroid scan Ultrasound of the thyroid Blood tests are ...


LAD1, the Linear IgA Bullous Dermatosis Autoantigen, Is a Novel 120-kDa Anchoring Filament Protein Synthesized by Epidermal Cells  

Microsoft Academic Search

This study characterizes a novel basement membrane component that is the target of autoantibodies in patients with linear IgA bullous dermatosis. Tissue surveys showed that this protein localized to the epidermal side of 1 M NaCl split skin and to basement membranes in cornea, oral mucosa, esophagus, intestine, kidney collecting ducts, ureter, bladder, urethra, and thymus, but was absent in

M. Peter Marinkovich; Ted B. Taylor; Douglas R. Keene; Robert E. Burgeson; John J. Zone



Telocytes in the urinary system  

PubMed Central

Background Telocytes, a new type of interstitial cells, have been identified in many organs in mammals. The present studies aimed at investigating the ultrastructure, distribution and interactions of telocytes with surrounding cells in the urinary system of rats, to confirm the existence of telocytes in kidneys, ureter and urinary bladder. Methods Samples of kidney, ureter, or urinary bladder were harvested for the ultrastructure by the electron microscope. The primary culture of telocytes was performed to investigate the dynamic alterations. Results Telocytes mainly located in the sub-capsular space of kidney, or between smooth muscle bundles and in the lamina propria of ureter and urinary bladder. Telocytes established numerous contacts with macrophages in the sub-capsular space of kidney, or with smooth muscle cells, nerve endings as well as blood capillaries in the ureter and urinary bladder. The complete morphology of telocytes with telopodes was observed clearly through the primary cell culture from the kidney tissues of rats. Conclusions Our data evidenced the existence of telocytes in the urinary system, which may contribute to the tissue reparation and regeneration.



Bilateral ureteral obstruction in a cat due to a ureteral transitional cell carcinoma  

PubMed Central

A 15-year-old cat was presented with a history of lethargy and vomiting. Serum biochemistry revealed severe azotemia. Ultrasonography revealed a small left kidney and hydronephrosis of the right kidney. There was an abdominal mass between the kidneys. Necropsy revealed a mass circumflexing both ureters and histopathology confirmed a diagnosis of transitional cell carcinoma.

Cohen, Liat; Shipov, Anna; Ranen, Eyal; Bruchim, Yaron; Segev, Gilad



Effect of urine on semen quality in turbot ( Psetta maxima)  

Microsoft Academic Search

The deleterious effects of urine contamination on the quality of spermatozoa were observed in turbot (Psetta maxima). In order to overcome this problem, two methods of sperm collection were compared to evaluate on urine contamination. When collected by stripping, the mean contamination rate of sperm by urine was 15.3% (urine volume: sperm volume). The catherization of ureter prior to sperm

Catherine Dreanno; Marc Suquet; Elizabeth Desbruyères; Jacky Cosson; Hervé Le Delliou; Roland Billard



Ureteral Complications in Renal Transplantation: A Comparison of the Lich-Gregoir Versus the Taguchi Technique  

Microsoft Academic Search

ObjectiveModifications of the Lich-Gregoir extravesical ureteroneocystostomy have become the standard technique for management of the ureter during renal transplantation. We performed a comparative outcome examination of the standard Lich-Gregoir technique and the Taguchi or “one-stitch” technique.

R. S. Lee; R. Bakthavatsalam; C. L. Marsh; C. S. Kuhr



Forgotten stent leading to complex panurinary stone: single-sitting endourologic management  

PubMed Central

A case of forgotten and fragmented JJ ureteral stent with significant complex, panurinary stone bulk (stone in kidney, ureter and bladder) was managed in a single sitting using mechanical lithotrite for bladder and ureteral components and percutaneous nephrolithotripsy for the renal component.

Singh, Dharamveer; Goel, Apul; Ahmed, Nisar; Singh, Bhupendra P



Your Kidneys  


... Pee The waste that is collected combines with water (which is also filtered out of the kidneys) to make urine (pee). As each kidney makes urine, the urine slides down a long tube called the ureter (say: yu - REE-ter) and collects in the bladder, a storage sac that holds the urine. When the bladder ...


Progress in Management of Ureteric Stones  

Microsoft Academic Search

Most symptomatic urinary stones are found within the ureter. Depending on stone localisation and size, a substantial portion is able to pass the upper urinary tract spontaneously. This process may take days to weeks and the patient has to receive sufficient analgetic and spasmolytic medication. There is some evidence, that alpha-adrenoreceptor blockade supports expulsion of praevesical stones.Standard and least invasive

Thomas Knoll; Peter Alken; Maurice Stephan Michel



Selective suppression of some components of spontaneous activity in various types of smooth muscle by iproveratril (verapamil)  

Microsoft Academic Search

Intra- and extracellular measurements of electrical activity were recorded simultaneously with tension development from isolated preparations of taenia coli, portal vein, stomach and ureter of the guinea-pig. Iproveratril (verapamil) inhibits electrical and mechanical activity in parallel in spontaneously active preparations of taenia coli and portal vein. Spike discharges and second-rhythm (SR) oscillations are both suppressed in the electrical activity. In

K. Golenhofen; E. Lammel



Treatment of vesicoureteral reflux in children by endoscopic injection of Teflon  

Microsoft Academic Search

From November 1986 to April 1990, 326 refluxing ureters in 197 children were treated by endoscopic injection of Teflon paste. Complications were observed in only 3 cases: 1 child had immediate bilateral ureteral stenosis requiring surgery at 48 h. In 1 case it was impossible to probe 1 ureteral orifice after injection, and Cohen reimplantation was immediately performed; in a

H. Dodat; P. Takvorian; E. Sabatier; V. Frering; A. Ennassih



Intussusception technique for use in duplicated system.  


Removing a ureter by intussuscepting it into the bladder has been described previously; but so far use of this technique was thought to be contraindicated in the presence of a duplicated system. We have modified this technique so that intussusception can now be used in a duplicated system as well. Two cases are presented. PMID:3898515

Hussain, M B; Bartone, F F



The Role of Stent Placement in Laparoscopic Ureteroureterostomy: Experimental Porcine Model  

PubMed Central

Objective: Laparoscopic ureteral surgery is becoming increasingly common; however, advanced laparoscopic skills are required due to the precise suturing involved. Because of the size of the ureter and need for careful mucosal apposition to prevent stricturing, there is less room for error than with larger lumens, as in pyeloplasty. We sought to identify whether the presence of a stent is beneficial or a hindrance in performing ureteroureterostomy both for the novice and more experienced laparoscopist. Materials and Methods: Eight ureteroureteral anastomoses were performed on each ureter of a 50 kg female pig for a total of 16 anastomoses. Eight were performed with a stent in place, and 8 were performed without a stent. An equal number with and without a stent were performed by a novice and an experienced laparoscopist. Anastomoses were graded by time to complete and quality of the anastomosis. Quality was graded by the presence and size of defects and patency of the lumen. Results: The overall times required for ureteral division and spatulation, initial stitch placement, completion of the anastomosis, and total time for the stented vs. nonstented procedures were 4.3 vs. 2.2 minutes (P=0.05), 4.2 vs. 4.4 minutes (P=0.16), 10.4 vs. 13.5 (P=0.22) minutes, and 18.3 vs. 20.1 minutes (P=0.49), respectively. For stented and nonstented ureters, 3 vs. 5 anastomoses were found to have no or very small gaps, 5 vs. 1 anastomosis were found to have large gaps, and 0 vs. 2 anastomoses were found to have occluded lumens, respectively. Conclusions: For both the novice and experienced surgeon, presence of a stent did not affect the overall time to complete a ureteroureteral anastomosis despite the significantly longer time needed to divide and spatulate the ureter. There were no occlusions when the ureteral stent was placed prior to suturing, which may indicate a reduced risk of “back-walling” the ureter.

Picard, Jonathan



Real-Time Intraoperative Ureteral Guidance Using Invisible Near-Infrared Fluorescence  

PubMed Central

Purpose Invisible near-infrared (NIR) light is safe and penetrates relatively deeply through tissue and blood without altering the surgical field. Our hypothesis is that NIR fluorescence imaging will enable visualization of ureteral anatomy and flow, intraoperatively and in real-time. Materials and Methods The carboxylic acid form of NIR fluorophore IRDye™800CW (CW800-CA) was injected intravenously and its renal clearance kinetics and imaging performance quantified in 350 g rats and 35 kg pigs. High-performance liquid chromatography (HPLC) and electrospray-time of flight (ES-TOF) mass spectrometry were used to characterize CW800-CA metabolism in the urine. The clinically available NIR fluorophore ICG was also used via retrograde injection into the ureter. Using both NIR fluorophores, ureters were imaged under conditions of steady state, intraluminal foreign bodies, and injury. Results In rat models, the highest signal-to-background ratio (SBR) for visualization occurred after intravenous (IV) injection of 7.5 ?g/kg CW800-CA, with values of ? 4.0 and ? 2.3 at 10 min and 30 min, respectively. In pig models, 7.5 ?g/kg CW800-CA clearly visualized normal ureter and intraluminal foreign bodies as small as 2.5 mm in diameter. Retrograde injection of 10 ?M ICG also permitted detection of normal ureter and pinpointed urine leakage caused by injury. ES-TOF mass spectrometry, and absorbance and fluorescence spectral analysis, confirmed that the fluorescent material in urine was chemically identical to CW800-CA. Conclusions A convenient IV injection of CW800-CA, or direct injection of ICG, permits high sensitivity visualization of ureters under steady state and abnormal conditions using invisible light.

Tanaka, Eiichi; Ohnishi, Shunsuke; Laurence, Rita G.; Choi, Hak Soo; Humblet, Valerie; Frangioni, John V.



Comparison of retrograde endo-pyelotomy and endo-balloon rupture of the ureteropelvic junction in a porcine model.  


Excellent results and durable success have been achieved with antegrade and retrograde endo-pyelotomy for treating primary and secondary ureteropelvic junction obstruction. Recently, a 30F dilating balloon was used to rupture the ureteropelvic junction (ENDOBRST) with encouraging results. While balloon distention of the ureteropelvic junction is a technically simpler procedure than endo-pyelotomy, clinical and laboratory data comparing the 2 methods are lacking. In an acute and chronic animal study we compared endo-pyelotomy via a ureteral cutting balloon incision to balloon rupture (that is 30F) of the normal ureteropelvic junction in each of 20 female farm pigs. Eight pigs were harvested acutely after treatment, and a macroscopic and histological examination of the treated ureteropelvic junction was completed. In 11 chronic pigs after endo-pyelotomy a 7F double pigtail ureteral stent was placed bilaterally and then removed after 6 weeks. Evaluation in the chronic group consisted of a furosemide washout renogram and retrograde pyelogram immediately preoperatively and 6 weeks after stent removal. The animals were likewise harvested 6 weeks after stent removal. One control pig underwent passage of the balloon cutting catheter and balloon dilating catheters without activation or dilation, respectively. Ureteral stents were placed bilaterally for 6 weeks and the pig was otherwise treated similarly to the other chronic study animals. In the acute group all ureters after endo-pyelotomy demonstrated retroperitoneal extravasation of contrast material. At harvest the ureters had been cleanly incised along a length of 3 to 4 cm. through the adventitial layer. In contrast, the balloon treated ureters showed free retroperitoneal extravasation in only half of the animals. Among the balloon treated ureters 7 of 8 had a linear tear of varying length (1 to 5 cm.) involving all but a thin adventitial layer of tissue. Histologically, the endo-pyelotomy ureters demonstrated a clean, linear transmural incision with virtually no destruction of surrounding tissue in 6 cases. In the remaining 2 cases an incision into but not completely through the muscular layer was observed. The balloon treated ureters showed a perforation through the muscular wall in 7 cases. However, periureteral hemorrhage and urothelial loss were common findings. In the chronic group infection and continued urine extravasation from the endo-pyelotomy site resulted in a 45% mortality rate. Of the surviving 6 pigs 83% of the balloon treated and 67% of the endo-pyelotomy pigs had a patent ureteropelvic junction by retrograde pyelogram and renogram. Histologically, the 2 sides were indistinguishable, with both showing mild fibrosis and chronic inflammation.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:7966717

Pearle, M S; Moon, Y T; Endicott, R C; Gardner, S M; Humphrey, P; Clayman, R V



Subtle renal duplication as an unrecognized cause of childhood incontinence: diagnosis by magnetic resonance urography  

PubMed Central

Urinary incontinence in young girls who have been toilet trained may be due to an ectopic ureter inserting below the urinary sphincter. This diagnosis is frequently delayed, is psychologically distressing, and may be missed at physical examination. Findings at ultrasound evaluation may be subtle and imaging with computed tomography or intravenous urography exposes young patients to ionizing radiation. We report two cases of girls with urinary incontinence where magnetic resonance (MR) urography revealed subtle renal duplication which implied the presence of an ectopic duplicated ureter with infrasphincteric insertion. These cases stress the importance of examining the kidneys, rather than the perineum, at MR, ultrasound and intravenous urogram evaluation, and show the value of MR urography as a safe alternative to computed tomography and intravenous urography for making this diagnosis.

Lipson, Jafi A.; Coakley, Fergus V.; Baskin, Laurence S.; Yeh, Benjamin M.



A case of endometrioma causing ureteric obstruction.  


A 32 years old married woman presented at the outpatients' department with the complaints of pain lower abdomen and irregular heavy menstrual bleeding for last 6 months. She was married for 7 years and attended an infertility clinic. Diagnostic laparoscopy was carried out there which revealed an endometrioma arising from right overy. On bimanual examination a mass was palpable in the right fornix. USG and Intervenous pyelography were advised. The diagnosis was confirmed endometrioma from right ovary and right sided ureter as hydro-ureter and there was hydronephrosis. She was operated and the endometrioma was resected out. She was discharged on 10th postoperative day with the advice to take tablet danazol (400) orally daily for 2 months. PMID:20839569

Pati, S; Rakshit, Bibek Mohan; Mukhopadhyay, Amitava



The role of interventional radiology in urologic tract trauma.  


The kidney is the third most common abdominal organ to be injured in trauma, following the spleen and liver, respectively. Several classification systems convey the severity of injury to kidneys, ureter, bladder, and urethra. The most commonly used classification scheme is the American Association for the Surgery of Trauma (AAST) classification of blunt renal injuries, which grades renal injury according the size of laceration and its proximity to the renal hilum. Ureteral injury is graded according to its extent relative to the circumference of the ureter and the extent of associated devascularization. Bladder injury is graded according to its location relative to the peritoneum. Urethral injury is graded according to the extent of damage to surrounding anatomic structures. Although these classification schema may not be always used in common parlance, they do help delineate most important features of urologic tract injury that impact patient management and interventions. PMID:23204640

Mani, Naganathan B S; Kim, Lauren



Endoscopic Treatment of Vesicoureteral Reflux in Children with Dextranomer/Hyaluronic Acid--A Single Surgeon's 6-Year Experience  

PubMed Central

Endoscopic treatment for vesicoureteral reflux (VUR) has become an established alternative to long-term antibiotic prophylaxis and ureteral reimplantation. We present the outcome of endoscopic treatment with dextranomer/hyaluronic acid copolymer (Deflux) for VUR in children by a single surgeon at our institute from October 2003 to October 2009. We reviewed the cases of 150 patients (total 239 ureters), 56 girls (37%) and 94 boys (63%), with a mean age of 2.2 years and a median followup of 2.5 years (range 3–68 months). Among the 239 ureters treated, 67.4% (161/239) were cured with a single injection, and a second and third injection raised the cure rate to 86.6% (207/239) and 88.3% (211/239), respectively. None had postoperative ureteral obstruction.

Chen, Hou-Chuan; Yeh, Chou-Ming; Chou, Chia-Man



Comprehensive Management of Upper Tract Urothelial Carcinoma  

PubMed Central

Urothelial carcinoma of the upper urinary tract represents only 5% of all urothelial cancers. The 5-year cancer-specific survival in the United States is roughly 75% with grade and stage being the most powerful predictors of survival. Nephroureterectomy with excision of the ipsilateral ureteral orifice and bladder cuff en bloc remains the gold standard treatment of the upper urinary tract urothelial cancers, while endoscopic and laparoscopic approaches are rapidly evolving as reasonable alternatives of care depending on grade and stage of disease. Several controversies remain in their management, including a selection of endoscopic versus laparoscopic approaches, management strategies on the distal ureter, the role of lymphadenectomy, and the value of chemotherapy in upper tract disease. Aims of this paper are to critically review the management of such tumors, including endoscopic management, laparoscopic nephroureterectomy and management of the distal ureter, the role of lymphadenectomy, and the emerging role of chemotherapy in their treatment.

Koukourakis, Georgios; Zacharias, Georgios; Koukourakis, Michael; Pistevou-Gobaki, Kiriaki; Papaloukas, Christos; Kostakopoulos, Athanasios; Kouloulias, Vassilios



Intravenous radionuclide cystography for the detection of vesicorenal reflux  

SciTech Connect

Intravenous radionuclide cystography using a single intravenous injection of 99mtechnetium diethylenetriaminepentaacetic acid, provides information on individual kidney function, coarse anatomy and vesicorenal reflux. This study investigates the effectiveness of intravenous radionuclide cystography in detecting reflux. In 58 children intravenous radionuclide cystography detected 53 ureters with reflux compared to 32 detected by voiding cystography. This difference was investigated further with patients in whom other test suggested reflux. While there was no statistically significant difference for patients having pyelonephritis or hydronephrosis, intravenous radionuclide cystography detected significantly more ureters with reflux in patients with abnormal ureteral orifices or infected urine and, therefore, predisposed to reflux. Intravenous radionuclide cystography is a more comprehensive and sensitive test for vesicorenal reflux than voiding cystography.

Pollet, J.E.; Sharp, P.F.; Smith, F.W.; Davidson, A.I.; Miller, S.S.



Ureteral polypoid endometriosis causing hydroureteronephrosis.  


A 44-year-old Japanese woman presented with a left low back pain. Abdominal ultrasonography revealed the left hydroureteronephrosis. She had the past history of endometriosis interna 3 years before. Retrograde pyelography showed the defect in the ureter, and on ureteroscopy, a polypoid mass was identified. Biopsy specimen from the ureteral mass showed endometrioid epithelia and edematous endometrial stroma, immunohistochemically positive for progesterone receptor (PgR), estrogen receptor (ER), and CD 10. For the lesion (endometrioma), partial resection of the ureter and ureteroneocystostomy with Boari flap were performed. The resected specimen showed a 2-cm polypoid mass. Histologically, the lesion was ureteral endometriosis. The postoperative course was uneventful, the patient showed no evidence of local recurrence after the initial resection and continues to be under close follow up. Urinary tract involvement of endometriosis is uncommon. Endometriosis should be included in the differential diagnosis of ureteral strictures in sexually active young females. PMID:19332929

Kondo, Takeshi


Chronic obstructive uropathy due to uretero-inguinal hernia: A case report  

PubMed Central

INTRODUCTION Inguinal hernia in men is common but uretero-inguinal hernia is very rare. PRESENTATION OF CASE A 85-year-old obese man presented with chronic obstructive uropathy with previous renal ultrasound showing bilateral enlarged kidneys and hydronephrosis. The medical history revealed a 3-year history of a noticeable bilateral partial reducible inguinoscrotal herniae associated with urinary symptoms. Progress CT scan showed very large inguinal herniae, which were predominantly fat-containing with the ureters herniated, and both kidneys were displaced inferiorly. DISCUSSION Uretero-inguinal hernia in patients with native kidneys is rare, but cases of renal failure secondary to uretero-inguinal hernia have also been reported previously in the literature with two anatomical variations have been reported – paraperitoneal and extraperitoneal types. Endourological and surgical procedures are rarely straight-forward because of tortuosity of the herniated ureter. CONCLUSION Although uretero-inguinal hernia is rare, it can be the cause of chronic renal impairment.

Won, Andy Chuk Moon; Testa, Gerard



[Medical expulsive therapy facilitated by alpha 1 adrenoceptor antagonist].  


In 2002, speedy elimination of ureterolithiasis in the lower part of ureter was first reported with the alpha 1 blocker. Thereafter, there are a lot of reports including meta-analysis about tamsulosin. In 2011 EAU Guidelines on Urolithiasis, it is the most important to establish effective MET (medical expulsive therapy) to facilitate spontaneous stone passage. Alpha 1 blockers are the preferred agents for MET. As a basic evidence for MET, we reported that alpha 1a and 1d AR subtype mRNA was highly expressed in the human ureter and that alpha 1A AR is the main participant in the human ureteral contraction. It is published newly in Japanese Guidelines on Urolithiasis revised edition to schedule to be published soon. PMID:21960238

Itoh, Yasunori; Niimi, Kazuhiro; Hirose, Yasuhiko



The Role of Interventional Radiology in Urologic Tract Trauma  

PubMed Central

The kidney is the third most common abdominal organ to be injured in trauma, following the spleen and liver, respectively. Several classification systems convey the severity of injury to kidneys, ureter, bladder, and urethra. The most commonly used classification scheme is the American Association for the Surgery of Trauma (AAST) classification of blunt renal injuries, which grades renal injury according the size of laceration and its proximity to the renal hilum. Ureteral injury is graded according to its extent relative to the circumference of the ureter and the extent of associated devascularization. Bladder injury is graded according to its location relative to the peritoneum. Urethral injury is graded according to the extent of damage to surrounding anatomic structures. Although these classification schema may not be always used in common parlance, they do help delineate most important features of urologic tract injury that impact patient management and interventions.

Mani, Naganathan B.S.; Kim, Lauren



Ureteral rupture from aberrant Foley catheter placement: a case report.  


We present the case of a 59 year old female with history of severe neurologic dysfunction from advanced multiple sclerosis who presented with lethargy and oliguria several hours after urethral Foley catheterization. A contrast-enhanced CT scan of the abdomen/pelvis showed an aberrantly placed Foley catheter with its balloon inflated in the proximal left ureter, a rare complication of Foley catheterization with only 5 other cases reported. Incomplete ureteral rupture was demonstrated and confirmed by a followup CT scan in the urographic phase. One of our institution's Interventional Radiologists then placed a nephroureteral stent across the injured ureter to facilitate healing. The patient expired 9 days after the procedure from unrelated sepsis from a chronic stage IV decubitus ulcer, so long term monitoring could not be performed. Following description of our case, we conduct a literature review of presentations, imaging characteristics, and treatment of ureteral Foley catheter placement. PMID:23372873

Baker, Kevin S; Dane, Bari; Edelstein, Yudell; Malhotra, Ajay; Gould, Elaine



[Medical management of acute renal colic - there is more than hydration and Buscopan®...].  


Renal colic is generated by hyperperistalsis of the obstructed ureter. Peristalsis is modulated by (among others) alpha-receptors (contraction), beta-receptors (relaxation) and prostaglandins (PG F2alpha: contraction, PG E1/E2: relaxation). Non-steroidal anti-inflammatory drugs (NSAID) are highly effective in pain relief and should always be given in the absence of contraindications. The same is true for metamizole, whereas Buscopan® is not superior to placebo. For most severe pain, opioids are indicated. alpha-blockers and calcium channel blockers dilate the distal ureter and increase the likelihood of spontaneous stone passage by up to 65%. Overhydration of patients has no advantage, but carries the risk of pelvic rupture with urine extravasation and infection. Stones of/above diameter 7 mm are unlikely to pass spontaneously and should be interventionally removed. PMID:21365560

Hess, B



Deletion (11)(q14.1q21)  

SciTech Connect

The authors report on a 4-year-old girl with moderate development delay, horseshoe kidney, bilateral duplication of the ureters with right upper pole obstruction, hydronephrosis and nonfunction, and subsequent Wilms tumor of the right lower pole. She had an interstitial deletion of the long arm of chromosome 11 involving the region 11(q14.1q21). 22 refs., 2 figs., 1 tab.

Stratton, R.F.; Lazarus, K.H.; Ritchie, E.J.L. [Southwest Texas Methodist Hospital, San Antonio, TX (United States); Bell, A.M. [Nichols Institute, Los Angeles, CA (United States)



Technetium-99m DMSA imaging and the obstructed kidney.  


Although several authors have claimed that the function of an obstructed kidney could be overestimated on Tc-99m DMSA imaging, the clinical importance of such an overestimation has not been well documented. Partial obstruction of one ureter was created in a rat, and a relative Tc-99m DMSA uptake was obtained 4 hours after intravenous injection. By puncture of the isolated obstructed kidney, it was shown that the function of that kidney was overestimated by at least 17%. PMID:3013481

Piepsz, A; Ham, H R; Roland, J H; Froideville, J L; Kinthaert, J; Hall, M; Verboven, M; Collier, F



Lynch syndrome: the influence of environmental factors on extracolonic cancer risk in h MLH1 c.C1528T mutation carriers and their mutation-negative sisters  

Microsoft Academic Search

Lynch Syndrome (LS) is a cancer susceptibility syndrome caused mostly by mutations in the mismatch repair genes, hMLH1, hMSH2 and hMSH6. Mutation carriers are at risk of colorectal and endometrial cancer and, less frequently, cancer of the ovaries, stomach,\\u000a small bowel, hepatobiliary tract, ureter, renal pelvis and brain. The influence of environmental factors on extracolonic cancer\\u000a risk in LS patients

M. M. Groen-Blokhuis; G. E. Pietersen; P. A. Goldberg; U. Algar; L. Van der Merwe; N. Mbatani; A. A. Vorster; R. S. Ramesar



Molecular Pathology of Murine Ureteritis Causing Obstructive Uropathy with Hydronephrosis  

Microsoft Academic Search

Primary causes of urinary tract obstruction that induces urine retention and results in hydronephrosis include uroliths, inflammation, and tumors. In this study, we analyzed the molecular pathology of ureteritis causing hydronephrosis in laboratory rodents.F2 progenies of C57BL\\/6 and DBA\\/2 mice were studied histopathologically and by comprehensive gene expression analysis of their ureters. Incidence of hydronephrosis was approximately 5% in F2

Osamu Ichii; Saori Otsuka; Yuka Namiki; Yoshiharu Hashimoto; Yasuhiro Kon



Pitfalls of cholescintigraphy. A case report  

SciTech Connect

A /sup 99m/Tc PIPIDA scan was performed in a young auto accident victim who had a transient rise in serum bilirubin level. Initially, the stasis of activity in the right ureter was mistaken for activity in the common bile duct. Misinterpretation of biliary imaging studies can be prevented with awareness of pitfalls and readiness to obtain delayed images and additional images in different projections.

Strickler, S.; Park, H.M.



Results of surgery for vesicoureteral reflux in children: 6 years' experience in an Asian country  

Microsoft Academic Search

From January 1990 to December 1995, a total of 181 patients underwent reimplantation of 318 ureters for primary vesicoureteral\\u000a reflux (VUR); 87.8% received bilateral reimplantation. Surgical indications included breakthrough infection (35%), high-grade\\u000a (?IV) reflux (33%), or both (29%). The operative success rate was 99.4% at 3 months postoperatively and 100% ultimately. The\\u000a complications included: contralateral sequential reflux in 3.9%, postoperative

J.-C. Sheu; Y.-H. Huang; P.-Y. Chang; N.-L. Wang; T.-C. Tsai; F.-Y. Huang



Phase II multicentre study of docetaxel plus cisplatin in patients with advanced urothelial cancer  

Microsoft Academic Search

A multicentre phase II trial was undertaken to evaluate the activity and toxicity of docetaxel plus cisplatin as first-line chemotherapy in patients with urothelial cancer. Thirty-eight patients with locally advanced or metastatic transitional-cell carcinoma of the bladder, renal pelvis or ureter received the combination of docetaxel 75 mg m?2 and cisplatin 75 mg m?2 on day 1 and repeated every

X García del Muro; E Marcuello; J Gumá; L Paz-Ares; M A Climent; J Carles; M Sánchez Parra; J L Tisaire; P Maroto; J R Germá



In vitro adherence of type 1-fimbriated uropathogenic Escherichia coli to human ureteral mucosa.  

PubMed Central

Type 1-fimbriated Escherichia coli isolated from patients with urinary tract infections adhered in vitro to the epithelial cell surface of an excised human ureter. The bacteria also adhered to a mucous coating and to Formalin-fixed human ureteral mucosa. D-Mannose strongly inhibited such adherence. The bacteria in their nonfimbriated phase lacked the ability to adhere. We concluded that type 1 fimbriae play a role, at least in part, in upper urinary tract infections in humans. Images

Fujita, K; Yamamoto, T; Yokota, T; Kitagawa, R



Robotically assisted radical laparoscopic prostatectomy in a patient with ectopic ureteral insertion into the prostate  

Microsoft Academic Search

Robotically assisted laparoscopic radical prostatectomy (RaLRP) has become an alternative surgical treatment option for patients\\u000a with localized prostate cancer. Rare anatomic variations result in modification of established techniques. We describe the\\u000a first successful completion of RaLRP for localized prostate cancer in a patient with coexisting complete left ureteral duplication\\u000a and ectopic insertion of the upper pole moiety ureter into the

Scott G. Hubosky; John W. Davis; Robert W. Given; Michael D. Fabrizio



Endoscopic treatment for vesicoureteral reflux: How important is technique?  


PURPOSE: Endoscopic dextranomer/hyaluronic acid (Dx/HA) injection by subureteric transurethral injection (STING) or hydrodistention implantation technique (HIT) for treatment of vesicoureteral reflux (VUR) has variable results with HIT reporting better outcomes. We determined outcomes with each technique comparing reflux resolution rates and evaluating predictors of treatment success and failure. METHODS: Univariate and multivariate analysis compared 163 patients (246 ureters) who underwent a single endoscopic Dx/HA injection from December 2001 to April 2010. Data on pre, peri, and post-operative variables were prospectively collected. Resolution was defined as no reflux on voiding cystourethrogram (VCUG) at 3 month follow up. Calculated ellipsoid volume (CEV) of Dx/HA mounds was defined as (4/3?(height/2) × (length/2) × (width/2)) based on post-operative ultrasound dimensions. RESULTS: Ureter resolution was 79.75% and 80.84% for STING and HIT, respectively (p = 0.86). Patient resolution was 70.0% and 74.3% for STING and HIT, respectively (p = 0.57). Multivariate ureter analysis revealed lower pre-operative grade (p = 0.004) and injected Dx/HA volume 0.80-1.00 mL (p = 0.039) as predictors of success. CEV <0.20 mL (p = 0.002) and CEV/injected-volume <25% (p = 0.006) were predictors of failure. Volcano morphology (p = 0.004) and lower pre-op grade (p = 0.015) were predictors of success for STING and HIT, respectively. CONCLUSIONS: We found no differences in ureter or patient resolution between endoscopic Dx/HA injection techniques STING or HIT. Lower pre-operative grade and moderated Dx/HA volume were predictors of success regardless of technique. PMID:23769202

Watters, Sean T; Sung, Jennifer; Skoog, Steven J



[Pyeloureteral plastic operation with or without ureteral intubation].  


Application of ureteral splint in corrective operations of the pyeloureteral segment represents still a problem to be discussed, arising diverse opinions regarding its effectiveness. A number of authors consider ureteral intubation as a necessary condition in plastic surgery of pyelone and ureter. Another group of authors reject it and consider it to be unnecessary and even dangerous, due to the possibility of it to cause additional infection and unnecessary traumas due to the splint. In this paper the author presents the postoperative early and late complications, as well as the final results of 34 corrective operations of the pyeloureteral segment, carried out with intubation, and 34 other operations without application of ureter intubation. By comparison of the obtained results it has been concluded that: (1) urinary fistula as an early complication is also possible in the case of operation with splint: (2) postoperative infection is slightly smaller and preoperational existing infection rapidly decreases in the case of operations without splint: (3) postoperational calculosis and stenosis at the place of operation were observed in higher percentage in operations with splint: (4) postoperational hospitalization period was longer for patients operated with splint compared to those operated without splint: and (5) the percentage of successful operations, regardless the stage of pyelocalics dilatations, was higher for operations without intubation of ureter. Based upon these information and the X2 test results author of this paper considers pyeloureteral intubation in pyeloureteral plastics unnecessary, except in extraordinary cases, such as secondary correction of pyeloureteral segment, heavy peripyeloureteritis, narrow and fibrose ureter, multiple and other stenosis, uncertain anastomosis and danger of necrosis at the edges of anastomose where intubation is still required. PMID:7164730

Vlaski, I



First temporal and spatial quantification of single-shot electrohydraulic lithotripsy in vitro  

Microsoft Academic Search

Single electrohydraulic lithotripsy (EHL) discharges from a human ureter were analyzed with a mechanical high-speed motion analysis camera. We found a cavitation bubble, at 650 mJ, 4–11 mm in size, with a lifetime of 400–500 µs. Varying sizes and lifetimes were found using single-shot analysis, as well as in different shot-sequences. This supports similar observations by recent investigations of cavitation

R. Corleis; R. Vorreuther; U. Engelmann; U. Schaarschmidt; B. Morgenstern



Recurrent flank pain caused by eosinophilic ureteritis mimicking urinary stone disease: A case report  

Microsoft Academic Search

Flank pain is caused by a variety of pathologies of which urinary stone disease is the most frequent. Eosinophilic ureteritis\\u000a is a rare stenosing condition of the ureter. Eosinophilic ureteritis can cause flank pain and\\/or unilateral hydronephrosis.\\u000a On pathological examination it is characterised by a marked infiltration of the submucosal layers by eosinophils. A relationship\\u000a of this condition with atopy,

G. Sergeant; K. Slabbaert; P. Werbrouck



Primary angiosarcoma of the bladder in a young female  

Microsoft Academic Search

Our case report pertains to a 32-year-old woman initially presenting with left flank pain and gross haematuria throughout her urinary stream. CT of her kidney\\/ureter\\/bladder (CT KUB) revealed ureteric dilatation to the level of the bladder without evidence of renal calculus and subsequently a stent was inserted. She represented a month later with contralateral flank pain, and a transuretheral resection

Richard R Warne; Jeremy S L Ong; Bret Snowball; Justin B Vivian



T-type Ca 2+ channels in non-vascular smooth muscles  

Microsoft Academic Search

T-type Ca2+ current has been recorded in smooth muscle myocytes, and associated interstitial cells, isolated from the gastro-intestinal tract, urinary bladder, urethra, prostate gland, myometrium, vas deferens, lymphatic vessels and airways smooth muscle. By contrast, current through such channels has not been recorded from other tissues, such as the ureter. Whilst the properties of this Ca2+ current are similar in

C. H. Fry; G. Sui; C. Wu



Retrograde Approach to a Diverticular Kidney Stone through a Vesicoureteral Cohen's Reimplantation: A Novel Surgical Technique  

PubMed Central

Cohen's technique is the standard treatment of vesicoureteral reflux in children. Its disadvantage is still the classic difficulty in subsequent retrograde ureteral access, requiring the use of percutaneous techniques in the treatment of kidney stones. We describe a novel surgical technique for retrograde catheterization of an adult ureter by a flexible ureterorenoscope, thereby facilitating the treatment of a symptomatic diverticular kidney stone. We compare our technique to other methods described in the literature.

Khalil, Fahd; Tligui, Mohamed; Traxer, Olivier



Excretory System Activity  

NSDL National Science Digital Library

This activity from Darcy Hartley-Pinard will help elementary school teachers demonstrate the structures and process of the excretory system. The class will use a diagram of a human body and everyday items including straws, uncooked spaghetti, yarn and kidney beans to recreate the veins, arteries, kidneys, ureters, bladder and urethra. This activity is useful for younger students to visualize and connect with the processes that take place in their own bodies.

Hartley-Pinard, Darcy



Multiple, Bilateral Fibroepithelial Polyps Causing Acute Renal Failure in a Gastric Cancer Patient  

PubMed Central

We report a case of primary fibroepithelial polyps (FEPs) in the middle of both ureters in a patient with advanced gastric cancer and acute renal failure. Ureteral FEPs are rare benign lesions, and multiple, bilateral lesions are extremely rare. To our knowledge, this report is the seventh case of bilateral FEPs in the literature. Our case has clinical implications because FEPs should be considered as a cause of ureteral obstruction inducing acute renal failure in advanced gastric cancer.

Kim, Sun-Ouck; Youn, Chul Woong; Im, Chang Min; Jung, Sung Il; Oh, Kyung Jin; Kwon, Dongdeuk; Park, Kwangsung; Ryu, Soo Bang



Renal function at steady state in a toad ( Bufo viridis ) acclimated in hyperosmotic NaCl and urea solutions  

Microsoft Academic Search

Kidney function of the euryhaline toad Bufo viridis was studied in animals acclimated to tap water and solutions of NaCl (230 and 500 mosmol · kg-1 H2O) and urea (500 mmol · l-1) in steady-state conditions. An ureter was eatheterized for continuous urine collection and blood was sampled from an iliac artery. A single injection of 3H-inulin served for estimation

S. Shpun; U. Katz



Urolithiasis in pregnancy  

Microsoft Academic Search

Urolithiasis is the most common cause of urological-related abdominal pain in pregnant women after urinary tract infection.\\u000a The disease is not uncommon during pregnancy occurring in 1\\/200 to 1\\/2,000 women, which is not different from the incidence\\u000a reported in the nonpregnant female population of reproductive age. During pregnancy, the frequency of stone localization is\\u000a twice as higher in the ureter

Stavros Charalambous; Asterios Fotas; D. E. E. Rizk



Serum and glucocorticoid-regulated kinase 1 is upregulated following unilateral ureteral obstruction causing epithelial–mesenchymal transition  

Microsoft Academic Search

Obstructive nephropathy leads to chronic kidney disease, characterized by a progressive epithelial-to-mesenchymal cell transition (EMT)-driven interstitial fibrosis. To identify the mechanisms causing EMT, we used the mouse model of unilateral ureteral obstruction and found a rapid and significant increase in serum- and glucocorticoid-regulated kinase-1 (SGK1) expression in the kidneys with an obstructed ureter. Knockout of SGK1 significantly suppressed obstruction-induced EMT,

Jizhong Cheng; Luan D Truong; Xiaoqian Wu; Dietmar Kuhl; Florian Lang; Jie Du



Salmonella Infection after Surgery of Small Intestine Foreign Bodies  

Microsoft Academic Search

Objective: To report the first case of Salmonella enterica serotype choleraesuis infection after surgery for small intestine foreign bodies. Clinical Presentation and Intervention: A 52-year-old woman presented to our hospital with the chief complaint of left abdominal pain for 1 day. The plain kidney-ureter-bladder film and abdominal computed tomography scan showed foreign bodies in the peritoneum. Metallic foreign bodies in

Jiun-Nong Lin; Chung-Hsu Lai; Chun-Kai Huang; Hsing-Chun Chung; Shiou-Haur Liang; Hsi-Hsun Lin



Vesicovaginal Fistula and Ureteral Injury During Pelvic Surgery  

Microsoft Academic Search

Because of the proximity of the bladder and ureters to the uterus, iatrogenic injuries are a well-described complication of\\u000a gynecologic surgery. If unrecognized, complications such as vesicovaginal fistula (VVF) and ureterovaginal fistula (UVF) may\\u000a occur. VVF ranks as the second most common genitourinary tract injury, with the second highest cause of malpractice claims\\u000a (1,2). Given the morbidity suffered by the

Craig V. Comiter; Christina Escobar


Cytogenetic Analysis of Upper Urinary Tract Transitional Cell Carcinomas  

Microsoft Academic Search

Ten primary (nine regular and one post-radiation) upper urinary tract transitional cell carcinomas (TCC), i.e., tumors of the renal pelvis and ureter, were obtained from 10 patients following nephroureterectomy and processed for cytogenetic analysis after short-term culturing. Clonal chromosomal aberrations were found in eight tumors. While 10 karyotypically related and\\/or unrelated clones were detected in the post-radiation tumor, cytogenetic monoclonality

Imad Fadl-Elmula; Ludmila Gorunova; Nils Mandahl; Peter Elfving; Rolf Lundgren; Christer Rademark; Sverre Heim



Experimental defect in rabbit urethra repaired with acellular aortic matrix  

Microsoft Academic Search

Urethral reconstruction following failed hypospadias repair or post-traumatic chronic stricture requires adequate amounts\\u000a of tissue. Many surgical techniques utilizing different types of biological tissues have been attempted: (a) vascularized\\u000a skin flaps from the prepuce, scrotum or penile shaft; (b) full-thickness free skin grafts; (c) vesical or buccal mucosa grafts;\\u000a (d) ureter; artery; vein and appendix tissue. More recently, biodegradable polymers

P. P. Parnigotto; M. T. Conconi; P. G. Gamba; P. Midrio



Epithelial transformation of metanephric mesenchyme in the developing kidney regulated by Wnt4  

Microsoft Academic Search

THE kidney has been widely exploited as a model system for the study of tissue inductions regulating vertebrate organogenesis1,2. Kidney development is initiated by the ingrowth of the Wolfian duct-derived ureteric bud into the presumptive kidney mesenchyme. In response to a signal from the ureter, mesenchymal cells condense, aggregate into pretubular clusters and undergo an epithelial conversion generating a simple

Kevin Stark; Seppo Vainio; Galya Vassileva; Andrew P. McMahon



Urological Injuries in Polytrauma  

Microsoft Academic Search

\\u000a In patients with multiple traumas urological injuries can be frequently found. The incidence is highest in renal injuries\\u000a although it is located safely in the retroperitoneum. Injuries of the ureter in trauma patients are rare, most of the ureteral\\u000a lacerations being iatrogenic. Gross hematuria can be a symptom of almost all kind of urological associated traumas. In most\\u000a patients the

David Pfister; Axel Heidenreich


N-terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) Concentrations in Hemodialysis Patients: Prognostic Value of Baseline and Follow-up Measurements  

Microsoft Academic Search

BACKGROUND: Increased N-terminal pro-B-type natri- uretic peptide (NT-proBNP) concentrations are asso- ciated with increased cardiovascular mortality in chronic hemodialysis patients. Previous studies fo- cused on prevalent dialysis patients and examined sin- gle measurements of NT-proBNP in time. METHODS: We measured NT-proBNP concentrations in 2990 incident hemodialysis patients to examine the risk of 90-day and 1-year mortality associated with baseline NT-proBNP

Orlando M. Gutierrez; Hector Tamez; Ishir Bhan; James Zazra; Marcello Tonelli; Myles Wolf; James L. Januzzi; Yuchiao Chang; Ravi Thadhani


Indications and Outcomes of Ureteroscopy for Urinary Stones  

Microsoft Academic Search

Since the earliest reports on ureteroscopic techniques by Marshall, Goodman, and Lyon et al., technologic advances and physician\\u000a innovation have dramatically expanded the diagnostic and therapeutic applications for ureteroscopy (1–3). Although uretero scopic techniques were initially limited to diagnostic evaluation of the distal ureter, the development\\u000a and ongoing refinement of semi-rigid and flexible ureteroscopes now make nearly all areas of

Matthew T. Gettman; Joseph W. Segura


980-nm diode laser and fiber optic resectoscope in endourological surgery  

Microsoft Academic Search

The 980 nm Ceralas D50 diode laser, produces homogeneous lesions on tissues of different nature. In our endourological tests we used the Ceralas D50 coupled with Comeg 24 ch laser resectoscope, and we treated 22 patients: n.5 bladder cancers, n.3 uretero pelvic junction obstructions, with hydronephrosis, n.3 urethra stenosis, n1 ureter stenosis, n.4 multiple upper tract transitional cell carcinomas, n.6

Walter Cecchetti; Stefano Guazzieri; Andrea Tasca; M. dal Bianco; Filiberto Zattoni; Francesco Pagano



CT urography: a comparison of strategies for upper urinary tract opacification.  


A consensus is yet to be reached regarding the best strategy for ensuring maximum ureteric delineation during CT urography (CTU). In this study we have compared various CTU protocols to try to establish the best method for ureteric delineation. Saline infusion in the supine position, saline infusion in the prone position, furosemide administration (10 mg, iv) and buscopan administration (20 mg iv) with saline infusion in the prone position were tried in four groups, each having 15 patients who were undergoing CTU. The pelvicalyceal system and ureter were divided into six segments, to each of which an opacification score was assigned (0, unopacified segment; 1, less than 50% opacified segment; 2, 50-99% of the segment opacified; or 3, completely opacified segment) and the results compared. Furosemide administration resulted in complete opacification of 93% of the ureters (28 of 30). In the distal (below the sciatic notch) ureter, the mean score with furosemide was 2.9, while that with saline, supine and prone positioning was 1.87 and 1.83, respectively, and this difference was highly significant (P = 0.0002 and P = 0.0001). It was also significantly higher than the buscopan group (score 2.3, P = 0.002). Also in the lower (the iliac crest to the sciatic notch) and upper (above the iliac crest) ureter, furosemide had significantly higher scores than saline infusion in either position. Saline infusion in the supine and prone positions had very similar scores in all segments that were less than the buscopan group, but this difference was not statistically significant. During CT urography, furosemide administration in low doses is the most effective and convenient technique for ureteric opacification. PMID:17039364

Sanyal, Rupan; Deshmukh, Amol; Singh Sheorain, Virender; Taori, Kishor



Chitosan: effects on wound healing in urogenital tissue: preliminary report.  


We conducted a survey of the effect of chitosan on wounds of the genitourinary system in dogs. Wounds were made in the kidney, ureter and penile foreskin. Chitosan caused no adverse effects on urogenital wound healing. A decrease in fibrosis was seen in the wounds treated with chitosan in all tissues studied. These observations suggest that the morbidity of urogenital surgery may be decreased by treating the wounds with chitosan. PMID:3184286

Bartone, F F; Adickes, E D



Resolution of vesicoureteral reflux during medical management in children  

Microsoft Academic Search

A retrospective study was performed to evaluate the results of medical management of primary vesicoureteral reflux (VUR) in infants and children. The charts of 105 patients (74 boys, 31 girls) with 167 refluxing ureters were reviewed. The age at diagnosis ranged from 3 days to 9.2 years (mean 1.3±1.9 years). The mean duration of follow-up was 2.4±1.5 years. We found

Fu-Yuan Huang; Tsuen-Chiuan Tsai



Continent urinary diversion after radical cystectomy: 3 years' experience.  


The authors performed 27 continent urinary diversions among 36 urinary diversion operations between 1992 and 1995. Fifteen orthotopic diversions (14 ileal neobladders, 1 sigma neobladder) and 12 Mainz pouch II were created. During these 3 years, 4 patients died after operation. Tumour progression was observed in four patients. Three ureteral and 1 urethral stricture developed, 1 patient had complete incontinence (after Mainz pouch II operation) and another three had stress and night incontinence. In 12 patients a modified Hautmann operation was performed (modified by the authors) and the ureters were implanted in a 15 cm long tubular afferent ileum. Also they changed the conventional Goodwin technique for ureter implantation in Mainz pouch II operation and instead they used the Paquin technique for ureter reimplantation in the sigma. The authors concluded according to the literature and their own results that continent urinary diversion (ileal or sigma neobladder or Mainz pouch II) could be the first choice after radical cystectomy to achieve for these patients a better quality of life. PMID:9119636

Samodai, L; Zámori, A; Kelemen, I; Kovács, L



Laparoscopic conservative management of ureteral endometriosis: a survey of eighty patients submitted to ureterolysis  

PubMed Central

Background this study aims to evaluate the effectiveness and safety of laparoscopic conservative management of ureteral endometriosis. Methods Eighty cases of histologically confirmed endometriosis affecting the ureter, 10 of which with bladder involvement were prospectively studied. In detail, patients were 13 women with ureteral stenosis (7 with hydronephrosis), 32 with circular lesions totally encasing the ureter, and 35 with endometriotic foci on the ureteral wall, but not completely encasing it. They were submitted to laparoscopic ureterolysis with or without partial cystectomy, ureteroneocistostomy. The rate of surgical complications, the recurrence rate, the patients' satisfaction rate was assessed during 22 months (median) follow-up. Results Laparoscopic ureterolysis was employed for all patients and set free the ureter from the disease in 95% of cases, whereas ureteroneocystostomy was necessary for 4 patients showing severe stenosis with hydronephrosis, among which 2 had intrinsic endometriosis of the ureteral muscularis. Three post-surgery ureteral fistulae occurred in cases with ureteral involvement longer than 4 cm: two cases were successfully treated placing double J catheter, the third needed ureteroneocistostomy. During follow-up, ureteral endometriosis recurred in 2 patients who consequently underwent ureteroneocystostomy. Most patients expressed high satisfaction rate throughout the whole follow-up period. Conclusion laparoscopic ureterolysis is effective and well tolerated in most cases of ureteral endometriosis. Ureteroneocystostomy is a better strategy for patients with extended (more than 4 cm) ureteral involvement or with severe stenosis with or without hydronephrosis.

Camanni, Marco; Bonino, Luca; Delpiano, Elena Maria; Berchialla, Paola; Migliaretti, Giuseppe; Revelli, Alberto; Deltetto, Francesco



Appendicovesicostomy (and variations) in bladder reconstruction.  


Bladder reconstruction using bowel segments was advanced when intermittent catheterization proved so acceptable. Access to the reservoir by way of the urethra is often not possible in children, especially boys. Implantation of the isolated appendix into the bladder remnant or colon segment similar to a ureteral reimplant provides a continence mechanism with ready catheter access (the Mitrofanoff principle). Since 1982 we have applied this principle in 41 pediatric cases of bladder reconstruction (64% boys). Primary diagnoses included bladder exstrophy (46%) and myelomeningocele (34%). Extending the concept of a flap valve continence channel with a narrow tube into the reservoir, segments of tapered ileum and ureters were also used (appendix 61%, ileum 12%, ureter 27%). Results of continence (100%) and uncomplicated catheterization (93%) have been satisfactory. Unfortunately, the longer the experience (average 3.2 years of followup), the more stone formation we experienced (32%), which is due to mucus production and bacteriuria as the stone nidus. There were 2 deaths, including 1 from a renal stone obstructing the ureter with sepsis and 1 a likely suicide. Reoperation was required for 3 stomal revisions, 2 bowel obstructions and 7 stone removals in 3 of the 6 cases in which the bladder neck was closed. Unique aspects of these reconstructions are presented, such as our current preference to bury the stoma in the umbilicus (7 cases), placement of the ureteral segment into the perineum as a neourethra and an unusual conjoined twin reconstruction. PMID:8437267

Duckett, J W; Lotfi, A H



Surgical complications in kidney transplantation in nonhuman primates.  


Surgical complications are important causes of graft loss in the nonhuman primate kidney transplantation model. We reviewed the incidence and intervention methods in 182 kidney transplantations performed in our lab recently 2 years in Cynomolgus monkeys. There were six renal artery thromboses (3.3%), eight urine leakages (4.4%), and five ureteral stenoses (2.7%). All renal artery thrombosis cases were found within 3 days after surgery. Urine leakage appeared from the 5th to 12th day after surgery and all cases were caused by ureter rupture. Reexploration was performed in five cases to reanastomose ureter with stent. Four cases reached long-term survival. The rest one died of graft rejection. Ureteral stenoses were found in long-term survival cases. Ureter reanastomoses with stent were performed in two cases. The postoperative renal functions of these two monkeys recovered to normal and they survived until study termination. From this large number of study, our experience indicated that kidney transplantation in the nonhuman primate is a safe procedure with low complications. Reexploration is recommended for salvage of the graft with urine leakage and ureteral stenosis. PMID:20049911

Song, Lijun; Qi, Shijie; Dun, Hao; Hu, Yanxin; Ma, Anlun; Yu, Guang; Xiong, Zuquan; Zhu, Shenyun; Wang, Xiang; Xu, Dasheng; Li, Gang; Shang, Yupu; Kinugasa, Fumitaka; Sudo, Yuji; Bai, Jieying; Zeng, Lin; Daloze, Pierre; Chen, Huifang



Laparoscopic management of sacral neurinoma causing hydronephrosis.  


We report the case of a sacral neurinoma, which presented with mild hydronephrosis, due to compression of the right ureter, in a 71-yr old woman admitted to our hospital with recurrent urinary tract infections. CT and MRI detected a 4 x 4 cm mass pressing on the right ureter at the sacral level, in continuity with the second sacral foramen. Given this finding, the mass was thought to be of presumable neurogenic origin. In order to both reach a conclusive diagnosis and relieve the compression of the ureter, a laparoscopic resection of the mass was performed. Surgery was successful and the pathologic examination revealed a sacral Antoni A neurinoma. Neurinomas, also called Schwannomas, are uncommon benign nerve sheath tumors arising from Schwann cells. Their diagnosis can be extremely difficult due to their aspecific symptoms and the lack of pathognomonic characteristics on imaging exams. Therefore, histopathologic evaluation is essential in establishing the diagnosis. Surgical resection seems to be the best approach, both for diagnostic and therapeutic purposes. PMID:22610845

Giona, Simone; Oderda, Marco; Garbossa, Diego; Peraldo, Francesca; Soria, Francesco; Gurioli, Alberto; Gontero, Paolo



Critical role of cyclooxygenase-2 activation in pathogenesis of hydronephrosis caused by lactational exposure of mice to dioxin  

SciTech Connect

Congenital hydronephrosis is a serious disease occurring among infants and children. Besides the intrinsic genetic factors, in utero exposure to a xenobiotic, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), has been suggested to induce hydronephrosis in rodents owing to anatomical obstruction in the ureter. Here, we report that hydronephrosis induced in mouse pups exposed lactationally to TCDD is not associated with anatomical obstruction, but with abnormal alterations in the subepithelial mesenchyma of the ureter. In the kidneys of these pups, the expressions of a battery of inflammatory cytokines including monocyte chemoattractant protein (MCP)-1, tumor necrosis factor {alpha} (TNF{alpha}) and interleukin (IL) -1{beta} were up-regulated as early as postnatal day (PND) 7. The amounts of cyclooxygenase (COX) -2 mRNA and protein as well as prostaglandin E2 (PGE{sub 2}) were conspicuously up-regulated in an arylhydrocarbon-receptor-dependent manner in the TCDD-induced hydronephrotic kidney, with a subsequent down-regulation of the gene expressions of Na{sup +} and K{sup +} transporters, NKCC2 and ROMK. Daily administration of a COX-2 selective inhibitor to newborns until PND 7 completely abrogated the TCDD-induced PGE{sub 2} synthesis and gene expressions of inflammatory cytokines and electrolyte transporters, and eventually prevented the onset of hydronephrosis. These findings suggest an essential role of COX-2 in mediating the TCDD action of inducing hydronephrosis through the functional impairment rather than the anatomical blockade of the ureter.

Nishimura, Noriko [Research Center for Environmental Risk, National Institute for Environmental Studies, Tsukuba 305-8506 (Japan)], E-mail:; Matsumura, Fumio; Vogel, Christopher F.A. [Department of Environmental Toxicology and Center for Environmental Health Sciences, University of California, Davis, CA 95616 (United States); Nishimura, Hisao [Department of Human Sciences, Aichi Mizuho University, Toyota 470-0394 (Japan); Yonemoto, Junzo [Research Center for Environmental Risk, National Institute for Environmental Studies, Tsukuba 305-8506 (Japan); Yoshioka, Wataru [Laboratory of Environmental Health Sciences, Center for Disease Biology and Integrative Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033 (Japan); Tohyama, Chiharu [Research Center for Environmental Risk, National Institute for Environmental Studies, Tsukuba 305-8506 (Japan); Laboratory of Environmental Health Sciences, Center for Disease Biology and Integrative Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033 (Japan)], E-mail:



Intraoperative electron-beam radiotherapy and ureteral obstruction  

SciTech Connect

Purpose: To quantify the risk of ureteral obstruction (UO) after intraoperative electron-beam radiotherapy (IOERT). Methods and Materials: One hundred forty-six patients received IOERT of 7.5 to 30 Gy to 168 ureters; 132 patients received external radiotherapy. Results: Follow-up ranged from 0.01 to 19.1 years (median, 2.1 years). The rates of clinically apparent type 1 UO (UO from any cause) after IOERT at 2, 5, and 10 years were 47%, 63%, and 79%, respectively. The rates of clinically apparent type 2 UO (UO occurring at least 1 month after IOERT, excluding UO caused by tumor or abscess and patients with stents) at 2, 5, and 10 years were 27%, 47%, and 70%, respectively. Multivariate analysis revealed that the presence of UO before IOERT (p < 0.001) was associated with an increased risk of clinically apparent type 1 UO. Increasing IOERT dose (p < 0.04) was associated with an increased risk of clinically apparent type 2 UO. UO rates in ureters not receiving IOERT at 2, 5, and 10 years were 19%, 19%, and 51%, respectively. Conclusions: Risk of UO after IOERT increases with dose. However, UO risk for ureters not receiving IOERT was also high, which suggests an underlying risk of ureteral injury from other causes.

Miller, Robert C. [Division of Radiation Oncology, Mayo Clinic, Rochester, MN (United States); Haddock, Michael G. [Division of Radiation Oncology, Mayo Clinic, Rochester, MN (United States); Petersen, Ivy A. [Division of Radiation Oncology, Mayo Clinic, Rochester, MN (United States); Gunderson, Leonard L. [Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona (United States); Furth, Alfred F. [Cancer Center Statistics Unit, Mayo Clinic, Rochester, MN (United States)



Laparoscopic Ureteroneocystostomy: Modification of Current Techniques  

PubMed Central

Purpose To review the feasibility of laparoscopic ureteroneocystostomy with extracorporeal eversion of the ureteral end in various distal ureteral lesions. Materials and Methods We conducted a retrospective review of 5 laparoscopic procedures of ureteroneocystostomy with extracorporeal eversion of the ureteral end. Of these, 4 patients (range, 45 to 54 years) had distal ureter stricture or obstruction after gynecological surgeries for endometriosis or a large uterine myoma. One patient (male, 67 years) had low-grade distal ureter cancer. The laparoscopic procedure was combined with cystoscopic insertion of a ureteral stent and extracorporeal eversion of the ureter through the 10-mm port on the affected side. Results The laparoscopic ureteral reimplantations with and without a psoas hitch in patients with distal ureteral lesions was successful in all patients. The mean operation time was 137 minutes (range, 104 to 228 minutes). Two patients underwent additional psoas hitch. In all patients, short-term success was confirmed by voiding cystourethrography and intravenous pyelography conducted 3 months after the operation. The mean follow-up of the entire group was 12 months (range, 3 to 30 months). We noted no major or minor complications over the follow-up period. Conclusions The technique of laparoscopic ureteroneocystostomy for benign or malignant ureteral strictures continues to evolve. Surgeons should be versatile with various options and technical nuances when dealing with these cases. Simple modifications of laparoscopic ureteroneocystostomy with extracorporeal eversion of the ureteral end, nonreflux extravesical anastomosis, and simultaneous cystoscopy will be crucial to the ease of performance and a successful outcome.

Ahn, Jae Hyun; Han, Ji-Yeon; Nam, Jong Kil; Lee, Sang Don; Chung, Moon Kee



Visualization of Proteus mirabilis Morphotypes in the Urinary Tract: the Elongated Swarmer Cell Is Rarely Observed in Ascending Urinary Tract Infection  

PubMed Central

Proteus mirabilis, a common cause of nosocomial and catheter-associated urinary tract infection, colonizes the bladder and ascends the ureters to the proximal tubules of the kidneys, leading to the development of acute pyelonephritis. P. mirabilis is capable of swarming, a form of multicellular behavior in which bacteria differentiate from the short rod typical of members of the family Enterobacteriaceae, termed the swimmer cell, into hyperflagellated elongated bacteria capable of rapid and coordinated population migration across surfaces, called the swarmer cell. There has been considerable debate as to which morphotype predominates during urinary tract infection. P. mirabilis(pBAC001), which expresses green fluorescent protein in both swimming and swarming morphotypes, was constructed to quantify the prevalence of each morphotype in ascending urinary tract infection. Transurethral inoculation of P. mirabilis(pBAC001) resulted in ascending urinary tract infection and kidney pathology in mice examined at both 2 and 4 days postinoculation. Using confocal microscopy, we were able to investigate the morphotypes of the bacteria in the urinary tract. Of 5,087 bacteria measured in bladders, ureters, and kidneys, only 7 (0.14%) were identified as swarmers. MR/P fimbria expression, which correlates with the swimmer phenotype, is prevalent on bacteria in the ureters and bladder. We conclude that, by far, the predominant morphotype present in the urinary tract during ascending infection is the short rod-the swimmer cell.

Jansen, Angela M.; Lockatell, C. Virginia; Johnson, David E.; Mobley, Harry L. T.



Matrix Metalloproteinases MMP2 and MMP9 Are Produced in Early Stages of Kidney Morphogenesis but Only MMP9 Is Required for Renal Organogenesis In Vitro  

PubMed Central

We analyzed matrix metalloproteinase (MMP) production by 11-d embryonic mouse kidneys and the effects of these enzymes on subsequent renal organogenesis. In vivo, immunolocalization of metalloproteinases by laser scanning confocal microscopy and zymograms of kidney lysates showed that the mesenchyme of embryonic kidneys synthesized both MMP9 and MMP2 enzymes. In vitro, embryonic kidneys also secreted both enzymes when cultured in a medium devoid of hormone, growth factor, and serum for 24 h during which T-shaped branching of the ureter bud appeared. We then evaluated the role of MMP2 and MMP9 in kidney morphogenesis by adding anti-MMP2 or anti-MMP9 IgGs to the culture medium of 11-d kidneys for 24 or 72 h. Although it inhibited activity of the mouse enzyme, anti-MMP2 IgGs had no effect on kidney morphogenesis. In contrast, anti-MMP9 IgGs with enzyme-blocking activity impaired renal morphogenesis, in a concentration-dependent manner, by inhibiting T-shaped branching and further divisions of the ureter bud. This effect was irreversible, still observed after inductive events and reproduced by exogenous tissue inhibitor of metalloproteinase 1 (TIMP1), the natural inhibitor of MMP9. These data provide the first demonstration of MMP9 and MMP2 production in vivo by 11-d embryonic kidneys and further show that MMP9 is required in vitro for branching morphogenesis of the ureter bud.

Lelongt, Brigitte; Trugnan, Germain; Murphy, Gillian; Ronco, Pierre M.



Imaging of stone disease in pregnancy.  


Renal colic is the most frequent non-obstetric cause for abdominal pain and subsequent hospitalization during pregnancy. Intervention is necessary in patients who do not respond to conservative treatment. Ultrasound (US) is widely used as the first-line diagnostic test in pregnant women with nephrolithiasis, despite it is highly nonspecific and may be unable to differentiate between ureteral obstruction secondary to calculi and physiologic hydronephrosis. Magnetic resonance imaging (MRI) should be considered as a second-line test, when US fails to establish a diagnosis and there are continued symptoms despite conservative management. Moreover, MRI is able to differentiate physiologic from pathologic dilatation. In fact in the cases of obstruction secondary to calculi, there is renal enlargement and perinephric edema, not seen with physiological dilatation. In the latter, there is smooth tapering of the middle third of the ureter because of the mass effect between the uterus and adjacent retroperitoneal musculature. When the stone is lodged in the lower ureter, a standing column of dilated ureter is seen below this physiological constriction. MRI is also helpful in demonstrating complications such as pyelonephritis. In the unresolved cases, Computed tomography remains a reliable technique for depicting obstructing urinary tract calculi in pregnant women, but it involves ionizing radiation. Nephrolithiasis during pregnancy requires a collaboration between urologists, obstetricians, and radiologists. PMID:23771120

Masselli, Gabriele; Derme, Martina; Laghi, Francesca; Polettini, Elisabetta; Brunelli, Roberto; Framarino, Maria Luisa; Gualdi, Gianfranco



Family Caregiver Palliative Care Intervention in Supporting Caregivers of Patients With Stage II-IV Gastrointestinal, Gynecologic, and Urologic Cancers

Healthy, no Evidence of Disease; Localized Transitional Cell Cancer of the Renal Pelvis and Ureter; Metastatic Transitional Cell Cancer of the Renal Pelvis and Ureter; Psychosocial Effects of Cancer and Its Treatment; Recurrent Bladder Cancer; Recurrent Cervical Cancer; Recurrent Colon Cancer; Recurrent Gastric Cancer; Recurrent Ovarian Epithelial Cancer; Recurrent Ovarian Germ Cell Tumor; Recurrent Pancreatic Cancer; Recurrent Rectal Cancer; Recurrent Renal Cell Cancer; Recurrent Transitional Cell Cancer of the Renal Pelvis and Ureter; Recurrent Urethral Cancer; Recurrent Uterine Sarcoma; Regional Transitional Cell Cancer of the Renal Pelvis and Ureter; Stage II Bladder Cancer; Stage II Renal Cell Cancer; Stage II Urethral Cancer; Stage IIA Cervical Cancer; Stage IIA Colon Cancer; Stage IIA Gastric Cancer; Stage IIA Ovarian Epithelial Cancer; Stage IIA Ovarian Germ Cell Tumor; Stage IIA Pancreatic Cancer; Stage IIA Rectal Cancer; Stage IIA Uterine Sarcoma; Stage IIB Cervical Cancer; Stage IIB Colon Cancer; Stage IIB Gastric Cancer; Stage IIB Ovarian Epithelial Cancer; Stage IIB Ovarian Germ Cell Tumor; Stage IIB Pancreatic Cancer; Stage IIB Rectal Cancer; Stage IIB Uterine Sarcoma; Stage IIC Colon Cancer; Stage IIC Ovarian Epithelial Cancer; Stage IIC Ovarian Germ Cell Tumor; Stage IIC Rectal Cancer; Stage III Bladder Cancer; Stage III Pancreatic Cancer; Stage III Renal Cell Cancer; Stage III Urethral Cancer; Stage IIIA Cervical Cancer; Stage IIIA Colon Cancer; Stage IIIA Gastric Cancer; Stage IIIA Ovarian Epithelial Cancer; Stage IIIA Ovarian Germ Cell Tumor; Stage IIIA Rectal Cancer; Stage IIIA Uterine Sarcoma; Stage IIIB Cervical Cancer; Stage IIIB Colon Cancer; Stage IIIB Gastric Cancer; Stage IIIB Ovarian Epithelial Cancer; Stage IIIB Ovarian Germ Cell Tumor; Stage IIIB Rectal Cancer; Stage IIIB Uterine Sarcoma; Stage IIIC Colon Cancer; Stage IIIC Gastric Cancer; Stage IIIC Ovarian Epithelial Cancer; Stage IIIC Ovarian Germ Cell Tumor; Stage IIIC Rectal Cancer; Stage IIIC Uterine Sarcoma; Stage IV Bladder Cancer; Stage IV Gastric Cancer; Stage IV Ovarian Epithelial Cancer; Stage IV Ovarian Germ Cell Tumor; Stage IV Pancreatic Cancer; Stage IV Renal Cell Cancer; Stage IV Urethral Cancer; Stage IVA Cervical Cancer; Stage IVA Colon Cancer; Stage IVA Rectal Cancer; Stage IVA Uterine Sarcoma; Stage IVB Cervical Cancer; Stage IVB Colon Cancer; Stage IVB Rectal Cancer; Stage IVB Uterine Sarcoma; Ureter Cancer



Salt adaptation in Bufo bufo  

PubMed Central

1. The capacity of adaptation of toads (Bufo bufo) to environments of high salinity was studied and the relative importance of skin, kidney and urinary bladder in controlling the balance of water and salt was assessed. 2. Toads were kept in NaCl solutions of 20, 50, 110, 150 and 220 mM and studied in their fourth week of adaptation. A group of animals considered as `control' was kept in wet soil with free access to water. Plasma, ureter urine, and bladder and colon contents were analysed for sodium, potassium, chloride and osmolality, and total body sodium and water were determined. Absorption of water and 22Na through the skin, and water flow and sodium excretion through the ureter, of intact animals was studied. Hydrosmotic water transport through the isolated urinary bladder of `control' and adapted animals was determined. The effects of pitressin and aldosterone on the water and sodium balance are described. 3. The survival rates of toads kept in saline concentrations up to 150 mM were identical to that of `control' animals, but half of the animals kept in 220 mM died within 4 weeks. 4. There is a linear correlation between the sodium concentrations and osmolality of plasma and of the external media. 5. The sodium concentration in colon contents rose with rising external concentrations, up to values higher than the values in plasma. 6. Sodium concentrations and osmolalities of ureter and bladder urine increased in adapted animals, the values for bladder urine becoming much higher than those for ureter urine in animals adapted to 110, 150 and 220 mM. 7. Total body water, as a percentage of total weight was kept within very narrow limits, although the total body sodium increased with adaptation. 8. Absorption of water through the skin for the same osmotic gradients was smaller in adapted than in `control' animals. 9. The ureteral output of water of toads adapted to 110 and 150 mM-NaCl was larger than the water absorption through the skin. 10. Skin absorption of sodium was lower in animals adapted to concentrated saline solutions than in `control' animals. 11. Sodium output by the ureter was identical to skin absorption in `control' animals adapted to 20, 50 and 110 mM-NaCl but was higher in animals adapted to 150 mM-NaCl. 12. Aldosterone increased the absorption of sodium in `control' and adapted toads, but at all dose levels absorption by control was greater than by adapted animals. 13. The stimulation of water absorption by vasopressin in vivo or in isolated bladders was not modified in animals adapted to high salinities.

Ferreira, H. G.; Jesus, C. H.



Sonographic screening for urinary tract abnormalities in patients with Schistosoma haematobium infection: pitfalls in examining pregnant women.  

PubMed Central

In areas where Schistosoma haematobium is endemic, urinary schistosomiasis and pregnancy are frequently concomitant; however, both these conditions may produce similar urinary tract changes in ultrasound scans and hence their differential diagnosis may be difficult. In patients with urinary schistosomiasis, focal and/or diffuse urinary bladder wall changes are frequently detected ultrasonically. Dilatation of one or both ureters and progressive hydronephrosis may be observed in more severe cases. Satisfactory ultrasound examination of the urinary bladders of pregnant women is generally not feasible because mechanical compression by the fetus or transitory lower urinary tract infection hampers adequate filling of the bladder. Pregnancy itself is frequently associated with dilatation of one or both ureters and/or hydronephrosis; this is due to hormonal factors, infection, or compression of one or both ureters by the enlarged uterus and growing fetus. Hence, when sonography of the urinary bladder is not feasible such pregnancy-associated changes are virtually indistinguishable from those caused by S. haematobium, and may be incorrectly attributed to the latter. Pregnant women, therefore, should be excluded from ultrasonic surveys of urinary schistosomiasis. In contrast, ultrasound scans of adolescents and of women with positive parasitological findings and/or pathological alterations in the urinary tract should include examination of the uterus in order to assess whether the woman is pregnant; thereby, misinterpretation of sonographic findings can be avoided. Pregnant women with significant hydronephrosis must be closely followed up by an obstetrician since this condition may indicate a complication of the pregnancy; in some cases only a postpartum examination will permit definitive diagnosis. Images Fig. 1

Richter, J.; Wagatsuma, Y.; Aryeetey, M.; Feldmeier, H.



Ureteral frozen sections at the time of radical cystectomy: reliability and clinical implications  

PubMed Central

Background: We hypothesized that the incidence of ureteral abnormalities on frozen section analysis (FS) at the time of radical cystectomy is much lower than historical values and that FS has minimal impact on outcomes. We also sought to determine the accuracy of FS and the associated costs. Methods: We reviewed the records of 301 patients who underwent a radical cystectomy for urothelial carcinoma of the bladder (UC) between March 2000 and January 2007. The ureteral margins were sent for FS and subsequent permanent hematoxyllin and eosin (H&E) sections and results were compared. Analyses were performed to determine the costs of FS and if any association was present with the pathological stage of the primary bladder tumour and regional lymph nodes, the presence of urothelial carcinoma in situ of the bladder (CIS) and survival outcomes with the FS. Results: We identified 602 ureters for this study. The incidence of CIS or solid urothelial carcinoma in the ureter was 2.8%. The presence of CIS of the bladder and prostatic urethra was significantly associated with a positive FS (p = 0.02). The FS were not associated with survival outcomes. The cost to pick up 1 patient with any abnormality on FS was $2080. The cost to pick up 1 patient with CIS or solid urothelial carcinoma of the ureter on FS was $6471. Conclusion: The incidence of CIS and tumour on FS during radical cystectomy for UC is low. The costs associated with FS are substantial. Frozen section analysis should only be performed in select patients undergoing radical cystectomy.

Touma, Naji; Izawa, Jonathan I.; Abdelhady, Mazen; Moussa, Madeleine; Chin, Joseph L.



Management of impacted proximal ureteral stone: Extracorporeal shock wave lithotripsy versus ureteroscopy with holmium: YAG laser lithotripsy  

PubMed Central

Objective: Prospective evaluation of the efficacy and safety of the extracorporeal shock wave lithotripsy (SWL) and ureteroscopy with Holmium: YAG laser lithotripsy (URSL) as a primary treatment for impacted stone in the proximal ureter. Patients and Methods: A total of 82 patients with a single impacted stone in the proximal ureter were included in the study. Patients were allocated into two groups according to patient preference for either procedure. The first group included 37 patients who were treated by SWL and the second group included 45 patients treated by URSL. The preoperative data and treatment outcomes of both procedures were compared and analyzed. Results: There was no difference as regards to patient and stone characters between the two groups. There was significantly higher mean session number and re-treatment rate in the SWL group in comparison to URSL group (1.5 ± 0.8 vs. 1.02 ± 0.15 session, and 43.2% vs. 2.2%, respectively). At one month, the stone-free rate of the URSL group was statistically significantly higher than that of the SWL group (80% vs. 67.6%, respectively). The stone-free rate at three months was still higher in the URSL group, but without statistically significant difference (80.2% vs. 78.4%, respectively). There was no statistically significant difference in the rate of complications between the SWL and URSL (24.3% vs. 15.6%, respectively). Conclusion: Both procedures can be used effectively and safely as a primary treatment for impacted stone in the proximal ureter; however, the URSL has a significantly higher initial stone-free rate and lower re-treatment rate.

Khalil, Mostafa



Endoscopic spray cryotherapy for genitourinary malignancies: safety and efficacy in a porcine model  

PubMed Central

Objective: To examine the effects and safety of using endoscopic spray cryotherapy (ESC) on bladder, ureteral, and renal pelvis urothelium in a live porcine model. Subjects and methods: ESC treatments were systematically applied to urothelial sites in the bladder, ureter, and renal pelvis of eight female Yorkshire swine in a prospective trial. Freeze–thaw cycles ranged from 5 to 60 s/cycle for one to six cycles using a 7 French cryotherapy catheter. Tissue was evaluated histologically for treatment-related effects. Acute physiologic effects were evaluated with pulse oximetry, Doppler sonography, and postmortem findings. Results: In bladder, treatment depth was inconsistent regardless of dose, demonstrating urothelial necrosis in one, muscularis propria depth necrosis in two, and full thickness necrosis in all remaining samples. In ureter, full thickness necrosis was seen in all samples, even with the shortest spray duration (5 s/cycle for six cycles or 30 s/cycle for one cycle). Treatment to the renal pelvis was complicated by adiabatic gas expansion of liquid nitrogen to its gaseous state, resulting in high intraluminal pressures requiring venting to avoid organ perforation, even at the lowest treatment settings. At a planned dose of 5 s/cycle for six cycles of the first renal pelvis animal, treatment was interrupted by sudden and unrecoverable cardiopulmonary failure after three cycles. Repeated studies replicated this event. Ultrasound and immediate necropsy confirmed the creation of a large gaseous embolism and reproducible cardiopulmonary effects. Conclusion: ESC in a porcine urothelial treatment model results in full-thickness tissue necrosis in bladder, ureter, and renal pelvis at a minimal treatment settings of 5 s/cycle for six cycles. Adiabatic gas expansion may result in fatal pyelovenous gas embolism and collateral organ injury, as seen in both animals receiving treatment to the renal pelvis in this study. These results raise safety concerns for use of ESC as a treatment modality in urothelial tissues with current device settings.

Power, Nicholas E.; Silberstein, Jonathan L.; Tarin, Tatum; Au, Joyce; Thorner, Daniel; Ezell, Paula; Monette, Sebastien; Fong, Yuman; Rusch, Valerie; Finley, David



Multiaxial mechanical behaviour of the passive ureteral wall: experimental study and mathematical characterisation.  


There is a scarcity of data regarding the mechanical properties of the ureter, although this would facilitate our understanding of its physiology and pathophysiology, and the development of suitable biomaterials for replacement. There is hence an urgent need for multiaxial experimental data and methodical constitutive formulations, which we aim at presenting through this report. The zero-stress state of wall tissue, serving as the starting geometry for biomechanical analyses, was accordingly determined and the 3D passive behaviour of ureteral specimens, isolated from healthy rabbits, was studied under a physiologic range of finite inflation and longitudinal extension. Two most-commonly employed descriptors of soft tissue behaviour were chosen to fit the material response: the Fung-type strain-energy function (SEF) and its combination with a quadratic function. Both SEFs were tested in the thick-walled setting, with incompressibility enforced explicitly or via a Lagrange multiplier. The deformational response of the ureter exhibited an exponential and not the sigmoidal dependency on pressure that requests implementation of two-term SEFs. Indeed, the four-parameter Fung-type SEF resulted in reasonable fit of both the external radius and longitudinal force vs. lumen pressure data, and fitting accuracy was not improved when attempting the seven-parameter Fung-type or biphasic SEFs. There were also serious over-parameterisation problems with those models, favouring the implementation of the SEF with the smallest number of parameters. The material parameters optimised revealed significant mechanical anisotropy, with longitudinal properties being stiffer than circumferential ones under equibiaxial stress states. We conclude that ureter displays a nonlinear anisotropic mechanical response that is well-characterised by the four-parameter Fung-type SEF. PMID:21660781

Sokolis, Dimitrios P



[Vesicoureteral reflux in adults].  


Vesicoureteral reflux (VUR) may be congenital or acquired. The most frequent form of congenital VUR is primary VUR. Its prevalence in adults is not exactly known, but it is higher in women, whose greater propensity for urinary tract infections increases the likelihood of an instrumental examination leading to the diagnosis of less severe cases. In men, even severe VUR may go undiagnosed for a long time. Primary VUR is due to a defect in the valve mechanism of the ureterovesical junction. In physiological conditions, the terminal ureter enters the bladder wall obliquely and bladder contraction leads to compression of this intravesical portion. Abnormal length of the intravesical portion of the ureter due to a genetic mutation (whose location is yet to be established) leads to VUR. In its less severe forms VUR may be asymptomatic, but in 50-70% of cases it manifests with recurrent cystitis or pyelonephritis. The manifestations leading to a diagnosis of VUR in adults, besides urinary tract infections, are proteinuria, renal failure and hypertension. The gold-standard diagnostic examination is a micturating cystourethrogram. Reflux nephropathy develops as a result of a pathogenetic mechanism unrelated to high cavity pressure or urinary tract infections but due to reduced formation of the normal renal parenchyma (hypoplasia or dysplasia). Abnormal renal parenchyma development is attributable to the same genes that control the development of the ureters and ureterovesical junction. VUR is considered only a marker of this abnormal development, playing no role in scar formation. There is no conclusive evidence regarding the indications for VUR correction. However, the risk that VUR leads to recurrent pyelonephritis and reflux nephropathy must be kept in mind. VUR certainly has to be corrected in women who contemplate pregnancy. PMID:22167611

Rollino, Cristiana; D'Urso, Leonardo; Beltrame, Giulietta; Ferro, Michela; Quattrocchio, Giacomo; Quarello, Francesco


Ureteral ectopia inserting into ipsilateral epididymis resulting in inflammatory paratesticular tumor.  


An 8-year-old male with a history of VACTERL association was found to have a paratesticular mass. The patient was treated successfully with a radical orchiectomy and found to have ureteral ectopia inserting into the ipsilateral epididymis, resulting in this paratesticular mass caused by inflammation of the epididymis. This is the only reported case in the English literature of an ectopic ureter inserting into the epididymis and presenting as a paratesticular tumor. In unclear cases of paratesticular, inflammatory appearing masses, inguinal exploration is warranted. PMID:22673544

Mally, Abhijith D; Fox, Janelle A; Reyes-Múgica, Miguel; Cannon, Glenn C



Routine use of the psoas hitch in ureteral reimplantation.  


Previously, the psoas hitch had been advocated only for difficult cases of ureteral implantation, especially when there had been inadequate ureteral length. However, during the last 10 years the paoas hitch in association with a modified Paquin technique has been used routinely at this institution for ureteral reimplantation. The technique has been used in all unilateral cases and in most bilateral reimplants. Results have been excellent. The psoas hitch allows for a long submucosal tunnel, with a fixed relationship between the ureter and posterolateral bladder wall. Intermittent hydronephrosis is not seen with this method of reimplantation and there have been no voiding disturbances. PMID:7359636

Middleton, R G



[Incidence of upper urothelial tumor in the Autonomous Community of La Rioja in 1976-1991].  


Study of the incidence rate of upper urothelium tumours between 1976 and 1991 among the population of the autonomous community La Rioja. A study by age, sex and time intervals, totalling 32 cases, is conducted. A greater incidence in males, and between 1987-1991 in terms of time, is observed. With regard to location of the upper urothelium tumour, a significant difference is found between right and left ureters and right and left renal pelvis. In 14 cases, an associated vesical carcinoma was noted (RR = 5338.9 with 95% CI from 2668.5 to 10681.4). PMID:8191941

Fernández Fernández, A; López Bonilla, A; Vazquez Medrano, A; Otero Mauricio, G



Ureteral metastasis from an appendiceal carcinoma and diagnosis by endoscopic ultrasound-guided fine-needle aspiration.  


Endoscopic ultrasound (EUS) is a standard tool for imaging the gastrointestinal tract and adjacent structures. EUS-guided fine-needle aspiration (FNA) allows the endosonographer easy access to these structures for both diagnostic and therapeutic purposes. We describe a case of metastatic lesion, adherent to a stented right ureter, which was imaged with transrectal EUS, with successful cytologic identification after EUS-guided FNA. EUS and EUS-guided FNA can be valuable tools in the evaluation of some soft-tissue abnormalities of the pelvis. PMID:15100956

Schmulewitz, N; Hawes, R



Transperitoneal robot-assisted laparoscopic pyeloplasty.  


Minimally invasive pyeloplasty has achieved success that has approached open pyeloplasty. Key principles such as removal of fibrosis, extensive mobilization of the ureteropelvic junction and crossing vessels, and creation of a tension-free, widely spatulated anastamosis are important in successful repair. In this review, we discuss the preparation and operative steps in performing a robotic pyeloplasty. Patient selection and diagnostic approach is discussed in the preoperative setting. Important surgical steps described include port placement, management of crossing vessels, division and spatulation of the ureter, and reanastamosis. Finally, management of more difficult cases is discussed. PMID:21241193

Lucas, Steven M; Sundaram, Chandru P



HIPEC for Peritoneal Carcinomatosis: Does an Associated Urologic Procedure Increase Morbidity?  

Microsoft Academic Search

Purpose  To report the incidence of urinary tract procedures performed during complete cytoreductive surgery (CCRS) plus intraperitoneal\\u000a chemotherapy, and to report the types of procedure, specific morbidity, risk factors, and treatment.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Data were extracted from a prospective database of patients with malignant peritoneal disease treated with CCRS plus intraperitoneal\\u000a chemotherapy who had undergone a resection or suture of the bladder, ureter,

C. Honore ´; A. Souadka; D. Goéré; F. Deschamps; D. Elias


Pelvic Nephroureterectomy for Renal Cell Carcinoma in an Ectopic Kidney  

PubMed Central

We present a case of an ectopic renal tumor in a 61-year-old morbidly obese man with a pelvic kidney found after presenting with hematuria and irritative voiding symptoms. The mass, along with the ectopic kidney and ureter, was radically resected through an open operation that involved removing both them and the renal vessels from the underlying iliac vessels. Pathological analysis demonstrated an 8.3?cm papillary renal cell carcinoma (RCC) with oncocytic features, Fuhrman nuclear grade 3, with angiolymphatic invasion and negative margins. The patient has been recurrence-free for over four years since tumor resection.

Baldie, Kevin G.; Al-Qassab, Usama A.; Ritenour, Chad W.; Issa, Muta M.; Osunkoya, Adeboye O.; Petros, John A.



?-Fetoprotein-Producing Non-Germ Cell Tumors of the Urological System  

PubMed Central

Elevated serum levels of ?-fetoprotein (AFP), a fetal serum protein, occur mainly in the development of hepatocellular carcinoma (HCC) or germ cell tumors, mainly yolk sac tumor. Rarely, other tumors of the urological system produce AFP. This article reviews the AFP-producing non-germ cell tumors of the urological tract reported to date. These include different types of tumors of the adrenal glands, kidney, ureter, urinary bladder, and testis. It is important for pathologists, urologists, and oncologists to be aware of such cases as the diagnosis affects the management plan for the patient.

El-Bahrawy, Mona



Specific body mass index cut-off value in relation to survival of patients with upper urinary tract urothelial carcinomas  

Microsoft Academic Search

Purpose  We studied the prognostic value of body mass index (BMI) in patients with upper tract urothelial carcinoma (UTUC) of the kidney\\u000a and ureter.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  We evaluated 153 patients who underwent surgery for UTUC (any T stage, N0–1, M0) between 1996 and 2009 at our institution.\\u000a Of the 153 patients screened for the study, 103 patients were found to have comprehensive clinical

Teruo Inamoto; Kazumasa Komura; Toshikazu Watsuji; Haruhito Azuma


[Left renal atrophy and ureteral abouchement in seminal vesicle. Laparoscopic surgical treatment].  


Renal atrophy with an ectopic drainage of the ureter is an uncommon malformation. Zinder described in 1914 a cystic dilation of the seminal vesicle in association with an ipsilateral renal agenesis. Usually, these patients present lower urinary tract symptoms with perineal discomfort and fever. The most accurate diagnosis is given by the MRI, while CT and ultrasonography are less precise. We present a case of a patient who goes into hospital because of left lumbar pain and urinary sepsis data, whose CT detects an ectopic drainage of the left uereter in the seminal vesicle. He underwent a successful laparoscopic surgical treatment. PMID:19462731

Janeiro Pais, José M; López García, Daniel; Ruibal Moldes, Manuel A; Casas Agudo, Vicente Pastor; Fernández Suárez, Paula; González Martín, Marcelino



Pathological and therapeutic significance of cellular invasion by Proteus mirabilis in an enterocystoplasty infection stone model  

Microsoft Academic Search

Proteus mirabilis infection often leads to stone formation. We evaluated\\u000a how bacterium-mucin adhesion, invasion, and intracellular crystal\\u000a formation are related to antibiotic sensitivity and may cause frequent\\u000a stone formation in enterocystoplasties. Five intestinal (Caco-2, HT29,\\u000a HT29-18N2, HT29-FU, and HT29-MTX) and one ureter cell line (SV-HUC-1) were\\u000a incubated in artificial urine with five Proteus mirabilis strains.\\u000a Fluorescence-activated cell sorting (FACS), laser

Rejiv B. Mathoera; Dik J. Kok; Cees M. Verduin; J. M. Nijman



Pathology Case Study: Bladder Mass in a 73-Year-Old Male  

NSDL National Science Digital Library

This case study, from the University of Pittsburgh School of Medicine's Department of Pathology, presents information about a 73-year-old male patient. According to the patient's history, he has a "history of invasive papillary transitional cell carcinoma with excessive muscular invasion and angiolymphatic invasion." Both gross and microscopic images of the prostate, bladder, pelvic lymph nodes, and the right and left pelvic ureter are provided in this case. Using these images and the provided patient history, students can test their knowledge of pathology and compare their diagnostic findings with the official findings in the "Final Diagnosis" section.

Hakam, Ardeshir



UPJ Obstruction in the Adult Population: Are Crossing Vessels Significant?  

PubMed Central

Ureteropelvic junction (UPJ) obstruction describes various causes of impaired drainage at the UPJ. Regardless of the cause, the end result is the same: impedance in the normal flow of urine from the renal pelvis into the proximal ureter, resulting in caliectasis and hydronephrosis. This may lead to progressive deterioration of renal function and, thus, often requires intervention to relieve the obstruction and restore the normal flow of urine. Defining the pertinent anatomy, the degree of obstruction, and differential renal function is key to determining whether and when intervention is necessary.

Grasso, Michael; Caruso, Robert P; Phillips, Courtney K



[Computer modeling in surgical treatment of rectum cancer].  


154 patients with rectal cancer were divided into the main group and the control group. All of them were investigated using endorectal and intraoperative sonography, spiral computer tomography and magnetic resonance tomography. Basing on the data of radial diagnostics pelvis model with tumour projection into rectum, bladder, ureters, prostate, uterus and vagina was recieved in all patients from the main group using Power SHAPE programm. Application of modern radial techniques and 3D modeling in diagnostics of rectal cancer contributes to adequate extent of surgical treatment adjacent with increased amount of radical operations (from 50% to 81,5%) and improvement of prognosis and survival rate in postoperative period. PMID:22408802

Glishkov, N I; Mucukaev, Kh M; Pavelets, K V; Lebedev, A K; Chernykh, D A



Absence of the ductus venosus with direct connection between the umbilical vein and right atrium.  


Abnormalities of the ductus venosus are rare. We present the case of a dichorionic, diamniotic twin pregnancy in which complete absence of the ductus venosus, with direct communication between the umbilical vein and right atrium, was detected in one infant on antenatal ultrasonography. Autopsy confirmed the aberrant course of the umbilical vein, which also had an abnormal histological structure. Associated congenital anomalies included an ostium secundum type atrial septal defect, absent inferior vena cava, single left pulmonary vein, stenosed right pulmonary artery, proliferation of the hepatic arterioles with reduction of portal venules, and a duplex ureter. The literature is reviewed and pathogenesis relevant to this case is discussed. PMID:11370268

Langman, G; Wainwright, H; Matthews, L


Problems with double-J stents and nephrostomy tubes.  


Double-J stents and nephrostomy tubes are used both to temporize prior to definitive treatment and for long-term relief of ureteral obstruction. Nephrostomy tubes that are correctly placed guarantee relief of obstruction and facilitate intrarenal manipulations but have a number of disadvantages, not least of which is the need for an external collecting bag. Double-J stents obviate the external bag but do not ensure relief of obstruction and have adverse functional and histopathologic effects on the ureter. Despite improvements in materials, no stent is totally resistant to encrustation, and frequent changes are required. PMID:9440851

Watson, G



Management of ureteral obstruction.  


The most common cause of ureteral obstruction in dogs and cats is ureteral calculi. Common clinical signs associated with ureteral obstruction include abnormalities in urination, persistent urinary tract infection, abdominal pain, vomiting, anorexia, weight loss,and depression or lethargy. Medical management of ureteral obstruction includes fluid diuresis, muscle relaxants, and treatment of azotemia using nephrostomy tubes or hemodialysis. Surgical techniques used to restore patency to the ureter include ureterotomy,partial ureterectomy and ureteroneocystostomy, and ureteral resection and anastomosis. Lithotripsy has been used in dogs to remove ureteral calculi. Renal function can be preserved if complete ureteral obstruction is relieved within several days of onset. PMID:15223212

Hardie, Elizabeth M; Kyles, Andrew E



Management of a malignant urinary fistula by ureteral embolization with coils.  


We report the case of a 42-year-old man with a synovial sarcoma of the prostate, metastatic at presentation, who after aggressive chemotherapy followed by extensive surgery developed a complex pelvic fistula involving the lower ureter, bladder, and enteral structures. The patient was a poor candidate for surgery because of his short life expectancy and poor health status. Conservative management with bilateral nephrostomy tubes did not allow sufficient fistulous output for symptomatic relief. Using the percutaneous access already in place, we performed bilateral ureteral embolization with coils. Complete ureteral occlusion was obtained with a minimally invasive procedure and allowed total symptomatic relief. PMID:16904469

Amsellem-Ouazana, Delphine; Cornud, François; Conquy, Sophie; Beuzeboc, Philippe; Massault, Pierre Philippe; Vieillefond, Annick; Flam, Thierry; Zerbib, Marc; Debré, Bernard



Identification of the cells underlying pacemaker activity in the guinea-pig upper urinary tract  

PubMed Central

The varying profile of cell types along the muscle wall of the guinea-pig upper urinary tract was examined electrophysiologically, using intracellular microelectrodes, and morphologically, using both electron and confocal microscopy. Simple ‘pacemaker’ oscillations (frequency of 8 min?1) of the membrane potential were recorded in both the pelvi-calyceal junction (83 % of cells) and the proximal renal pelvis (15 % of cells), but never in the distal renal pelvis or ureter. When filled with the cell marker, neurobiotin, ‘pacemaker’ cells were spindle shaped and ?160 ?m in length. In most cells of the ureter (100 %) and in both the proximal (75 %) and distal (89 %) renal pelvis, spontaneous action potentials (frequency of 3-5 min?1) consisted of an initial spike, followed by a number of potential oscillations superimposed on a plateau phase. When filled with neurobiotin, cells firing these ‘driven’ action potentials, were spindle shaped and > 250 ?m in length. Greater than 80 % of smooth muscle cells in the pelvi-calyceal junction were ‘atypical’, having < 40 % of their sectional areas occupied by loosely packed contractile filaments. Most of the smooth muscle cells in the ureter (99.7 %) and both the proximal (83 %) and distal (97.5 %) renal pelvis were of ‘typical’ appearance in that they contained cytoskeletal and contractile elements occupying > 60 % of cross-sectional area. A third type of spontaneously discharging cell fired ‘intermediate’ action potentials (3-4 min?1), consisting of a single spike followed by a quiescent plateau and an abrupt repolarization. These cells were morphologically similar to interstitial cells of Cajal (ICC). However, these ‘ICC-like’ cells were not immuno-reactive for c-Kit, the proto-oncogene for tyrosine kinase. In summary, ‘atypical’ smooth muscle cells were predominant in the pelvi-calyceal junction and fired ‘pacemaker’ potentials at a frequency significantly higher than ‘driven’ action potentials recorded in ‘typical’ smooth muscle cells throughout the renal pelvis and ureter. ‘Intermediate’ action potentials were recorded in ‘ICC-like’ cells in both the pelvi-calyceal junction and renal pelvis. We suggest that these ‘ICC-like’ cells act as a preferential pathway, conducting and amplifying pacemaker signals to initiate action potential discharge in the driven areas of the upper urinary tract.

Klemm, Megan F; Exintaris, Betty; Lang, R J



Mimicry of physiological urinary FDG excretion: squamous cell carcinoma of esophagus metastasizing to psoas muscle.  


Skeletal muscle metastases are rare and usually occur with various malignancies at more advanced stages. FDG PET/CT has been known as a useful tool to detect these lesions because of the character of whole-body scanning and superior contrast between malignant and normal tissues, except in areas with abundant physiological FDG radioactivity, such as the urinary system. We present a patient with esophageal squamous cell carcinoma and an incidental, rare finding of psoas muscle metastasis that was initially omitted because of the similarity of its distribution to physiological urinary FDG excretion in the ureter. PMID:21157206

Hsieh, Te-Chun; Sun, Shung-Shung; Wu, Yu-Chin; Yen, Kuo-Yang; Kao, Chia-Hung



Spontaneous pelvic rupture as a result of renal colic in a patient with klinefelter syndrome.  


We present the case of a young man with Klinefelter syndrome, who was admitted to our clinic with renal colic. Shortly after admittance, spontaneous decrease in pain has occurred. Ultrasound and intravenous contrast computed tomography were performed, which showed the evidence of urine extravasation at the level of left renal pelvis and a 4?mm stone in the lower third of the left ureter. The management with a double-J ureteric stent for three weeks was successful. Then, the stent was removed and computed tomography confirmed the absence of urine extravasation. We also analyze the literature related to this case and discuss the main mechanisms of collecting system rupture. PMID:23585981

Reva, Sergey; Tolkach, Yuri



Efficiency of percutaneous nephrolithotomy in pediatric patients using adult-type instruments  

Microsoft Academic Search

To evaluate the efficiency of percutaneous nephrolithotomy using adult-type instruments in children with kidney stones. Between\\u000a September 2004 and October 2009, 18 children (19 renal units) underwent percutaneous nephrolithotomy using adult-type instruments.\\u000a Following percutaneous access under fluoroscopy, 20–30F tract dilatation was performed (1,92,427F), and lithotripters were\\u000a used. Postoperatively, kidney–ureter–bladder X-ray and antegrade pyelography were performed to evaluate residual stones and

Bayram Dogan; Ali Fuat Atmaca; Abdullah Erdem Canda; Abidin Egemen Isgoren; Ziya Akbulut; Mevlana Derya Balbay


Ureteric and pulmonary endometriosis.  


Pulmonary lesions and ureter involvement are rare complications of endometriosis. We describe the first case with an involvement of both sites in this condition. The radiographs showed "pulmonary metastases" together with clinical findings of a hydronephrosis, mimicing a malignant metastatic gynecologic tumor of unknown primary. A laparoscopy showed severe endometriotic lesions; therefore the findings were most likely related to the condition of endometriosis. The patient was treated with gosereline acetate for six months (Zoladex). Control radiographs showed complete regression of the pulmonary lesions and the patient is symptom free at 36 months after diagnosis. PMID:11561747

Ludwig, M; Bauer, O; Wiedemann, G J; Diedrich, K



Primary Obstructive Megaureter with Giant Ureteral Stone: A Case Report  

PubMed Central

A 19-year-old male patient was admitted with flank pain, which had lasted intermittently for four years. In X-ray, there was a radiopacity with a dimension of 6?×?4?cm on the left pelvic bone. Intravenous pyelography revealed a huge left megaureter with a stone in the lower end and grade V hydronephrosis. A left ureterolithotomy, left nipple ureteroneocystostomy, and psoas hitch operation was performed. A voiding cystourethrogram taken three months after the operation showed no reflux, and in IVP there was reduced dilatation of the collecting system when compared to the ureter before the operation.

Demirtas, Abdullah; Sahin, Nurettin; Ak?nsal, Emre Can; Ekmekcioglu, Oguz; Tatl?sen, Atila



Primary obstructive megaureter with giant ureteral stone: a case report.  


A 19-year-old male patient was admitted with flank pain, which had lasted intermittently for four years. In X-ray, there was a radiopacity with a dimension of 6?×?4?cm on the left pelvic bone. Intravenous pyelography revealed a huge left megaureter with a stone in the lower end and grade V hydronephrosis. A left ureterolithotomy, left nipple ureteroneocystostomy, and psoas hitch operation was performed. A voiding cystourethrogram taken three months after the operation showed no reflux, and in IVP there was reduced dilatation of the collecting system when compared to the ureter before the operation. PMID:23533926

Demirta?, Abdullah; Sahin, Nurettin; Ak?nsal, Emre Can; Ekmekçio?lu, Oguz; Tatl??en, Atila



Can the CT planning image determine whether a kidney stone is radiopaque on a plain KUB?  


Almost all kidney stones are CT positive. Before a CT scan can be done a CT planning image (CTI) is generated in order to select the exact scanning area. The CTI looks approximately like a normal kidney-ureter-bladder abdominal radiography (KUB) but with reduced quality. It has been used as a guide, assuming that if the kidney stone could be seen on the CTI the kidney stone also would be visible on a conventional plain KUB (radiopaque). From the perspective of diagnosis and treatment as well as follow-up it is of importance to know whether a kidney stone is radiopaque or not. The aim of this study was to evaluate whether the CTI actually can predict radiopacity. CT scans and corresponding KUB's were analysed in 76 consecutive kidney stone patients. The CT scan and the KUB were performed on the same day. All patients were examined with the same CT scanner (64 slice GE light speed VCT). Three radiologists evaluated the images in plenum. The following was recorded regarding the kidney stones: X-ray positive (radiopaque on KUB), CTI positive (radiopaque on CTI), location (a kidney, b upper two-thirds of ureter and c lower one-thirds of ureter including the bladder), size and Hounsfield units (HU). We also measured the patient's 'anterior-posterior depth' (APD) at the kidney stone level in axial plane, and whether the stone was homogeneous/inhomogeneous. 54 of the 76 patients (71%) had radiopaque stones on KUB. 43 (57%) of these also could be seen on the CTI, resulting in a positive predicting value (PPV) of 100% and a negative predictive value (NPV) of 67%. In the 54 KUB positive kidney stones the mean kidney stone diameter was 7 mm (2-30 mm), mean HU's 1,007 (294-1,782 HU), location: a:32, b:9 and c:13 patients. APD was mean 23.6 cm (13-39 cm). In the KUB positive and CTI negative kidney stones (11 patients) mean kidney stone diameter was 4 mm (2-9 mm), mean HU's 742 (294-1,253 HU), location: a:32, b:9 and c:13 patients. APD in this group was mean 26.1 cm (13-37 cm). If the kidney stone can be seen on the CTI it is also visible on a plain KUB (PPV 100%). The CTI do, however, underestimate the radiopacity of a stone on a plain KUB (NPV 67%). Kidney stone HU > 742, stone location in the kidney and proximal ureter and APD < 26 cm independently predict agreement between CTI and KUB with regard to radiopacity. PMID:21850409

Graumann, Ole; Osther, Susanne S; Spasojevic, Diana; Osther, Palle J S



SOX9 controls epithelial branching by activating RET effector genes during kidney development.  


Congenital abnormalities of the kidney and urinary tract are some of the most common defects detected in the unborn child. Kidney growth is controlled by the GDNF/RET signalling pathway, but the molecular events required for the activation of RET downstream targets are still poorly understood. Here we show that SOX9, a gene involved in campomelic dysplasia (CD) in humans, together with its close homologue SOX8, plays an essential role in RET signalling. Expression of SOX9 can be found from the earliest stages of renal development within the ureteric tip, the ureter mesenchyme and in a segment-specific manner during nephrogenesis. Using a tissue-specific knockout approach, we show that, in the ureteric tip, SOX8 and SOX9 are required for ureter branching, and double-knockout mutants exhibit severe kidney defects ranging from hypoplastic kidneys to renal agenesis. Further genetic analysis shows that SOX8/9 are required downstream of GDNF signalling for the activation of RET effector genes such as Sprouty1 and Etv5. At later stages of development, SOX9 is required to maintain ureteric tip identity and SOX9 ablation induces ectopic nephron formation. Taken together, our study shows that SOX9 acts at multiple steps during kidney organogenesis and identifies SOX8 and SOX9 as key factors within the RET signalling pathway. Our results also explain the aetiology of kidney hypoplasia found in a proportion of CD patients. PMID:21212101

Reginensi, Antoine; Clarkson, Michael; Neirijnck, Yasmine; Lu, Benson; Ohyama, Takahiro; Groves, Andrew K; Sock, Elisabeth; Wegner, Michael; Costantini, Frank; Chaboissier, Marie-Christine; Schedl, Andreas



Bystander-induced apoptosis and premature differentiation in primary urothelial explants after charged particle microbeam irradiation.  


The ureter primary explant technique was developed to study bystander effects under in vivo like conditions where stem and differentiated cells are present. Irradiation was performed with a 3He2+ charged particle microbeam available at the Gray Cancer Institute, with high (approximately 2 microns) precision. Tissue sections from porcine ureters were pre-irradiated with the microbeam at a single location with 10 3He2+ particles (5 MeV; LET 70 keV.micron-1). After irradiation, the tissue section was incubated for 7 days, thus allowing the explant outgrowth to form. Total cellular damage (total fraction of micronucleated and apoptotic cells) was measured according to morphological criteria. Apoptosis was also assessed using a 3'-OH DNA end-labelling technique. Premature differentiation was estimated using antibodies to uroplakin III, a specific marker of terminal urothelial differentiation. Results of our experiments demonstrated a significant bystander-induced differentiation and a less significant increase in apoptotic and micronucleated cells. A hypothesis based on the protective nature of the bystander effect is proposed. PMID:12194297

Belyakov, O V; Folkard, M; Mothersill, C; Prise, K M; Michael, B D



Ureteral duplication and its complications.  


Duplication of the ureters is a common anomaly and is frequently encountered by radiologists. Duplication may be either complete or incomplete and is often accompanied by various complications. Incomplete duplication is most often associated with ureteroureteral reflux or ureteropelvic junction obstruction of the lower pole of the kidney. Complete duplication is most often associated with vesicoureteral reflux, ectopic ureterocele, or ectopic ureteral insertion, all of which are more common in girls than in boys. Vesicoureteral reflux affects the lower pole and can be outgrown, as in nonduplicated systems. Ectopic ureterocele and ectopic ureteral insertion affect the upper pole. The ectopic ureterocele produces a filling defect of variable size in the bladder; it can be identified with contrast material studies or ultrasound. Ectopic ureters may function poorly, be difficult to detect, and cause enuresis in girls. A fourth complication, ureteropelvic junction obstruction, occurs only in the lower pole and is seen in more boys than girls. Anatomic variants or anomalies as well as suboptimal imaging techniques can either simulate or obscure duplication, making diagnosis difficult. However, familiarity with the embryology of duplication and an awareness of the potential pitfalls of excretory urography and voiding cystourethrography will foster an understanding of the varied appearances and associated complications of both incomplete and complete duplication. PMID:9017803

Fernbach, S K; Feinstein, K A; Spencer, K; Lindstrom, C A


Part III - Treatment of Ureterovesical Reflux  

PubMed Central

Of 134 girls with demonstrable ureterovesical reflux, 61 (105 ureters) had the reflux surgically corrected with an overall surgical cure rate of 97 percent. In the remaining 73 children (112 ureters), the reflux was treated conservatively with medical management alone. During the follow-up period no significant differences were demonstrated in the overall incidence of urinary tract infection; two years following corrective operation or medical treatment more than 50 percent of both medically and surgically treated children were still experiencing infections. A pronounced decrease, however, occurred in the incidence of clinical pyelonephritis among the surgically treated group. Following correction of reflux, the incidence of pyelonephritis was similar in both medically and surgically treated cases and was approximately the same as that found in a comparable group of children without reflux. In approximately two-thirds of refluxing renal units in which there was evidence of clubbing and scarring before medical or surgical therapy, deterioration progressed during the follow-up period. In most of these cases infection control was felt to be inadequate with episodes of clinical pyelonephritis occurring during the period of medical management, or, in the surgically treated group, occurring just before corrective operation and the scar appearing within two years after operation. The majority of renal units in which calyceal clubbing and parenchymal scarring was present had the most severe grades of reflux.

Govan, Duncan E.; Fair, William R.; Friedland, Gerald W.; Filly, Roy A.



[Urologic complications of gynecologic surgery and their treatment in our clinical data].  


In 19 women (aged 27-66 years, mean 44.6 years) a retrospective analysis of the urological complications suffered during gynecological surgery was performed. 14 (73.6%) patients had ureteral injuries with concomitant bladder lesions in two. In the remaining 4 (21%) bladder injury only was present including a woman with a simultaneous urethral lesion. In the postoperative period 3 ureteric, 5 vesicovaginal, and one vesicouterine fistula developed. Intraoperative diagnosis followed by immediate surgical repair of the ureteric and bladder lesions was performed in 2 (10.5%) patients only. Except one case ureteral injury was unilateral, and predominantly right-sided (10:5). One patient suffered injury of one of the ureters in a complete ureteral duplication. The most frequent side of ureteral injury was at the level of the uterine artery with complete ligature of the ureter in 10 (71.4%), and partial in 4 (28.6%) patients. Percutaneous nephrostomy as a temporary diversion was performed in 8 (57.1%) patients. Definitive treatment involved simple Paquin ureteral reimplantation in 5 patients, Boari's procedure in 3, and psoas hitch technique once. Ureteral lysis only was sufficient in 3 patients. The surgical treatment including repair of vesical fistulas was in all cases successful. PMID:9750378

Nagy, V; Valanský, L; Milichovský, I



Noncancer disease incidence in atomic bomb survivors, 1958-1998.  


We examined the relationships between the incidence of noncancer diseases and atomic bomb radiation dose using the longitudinal data for about 10,000 Adult Health Study (AHS) participants during 1958-1998. The current report updates the analysis we presented in 1993 with 12 additional years of follow-up. In addition to the statistically significant positive linear dose-response relationships detected previously for the incidence of thyroid disease (P < 0.0001), chronic liver disease and cirrhosis (P = 0.001), and uterine myoma (P < 0.00001), we also found a significant positive dose response for cataract (P = 0.026), a negative linear dose-response relationship for glaucoma (P = 0.025), and significant quadratic dose-response relationships for hypertension (P = 0.028) and for myocardial infarction among survivors exposed at less than 40 years of age (P = 0.049). Significant radiation effects for calculus of the kidney and ureter were evident for men but not for women (test of heterogeneity by sex: P = 0.007). Accounting for smoking and drinking did not alter the results. Radiation effects for cataract, glaucoma, hypertension, and calculus of the kidney and ureter in men are new findings. These results attest to the need for continued follow-up of the aging A-bomb survivors to fully elucidate the effects of radiation exposure on the occurrence of noncancer diseases. PMID:15161358

Yamada, Michiko; Wong, F Lennie; Fujiwara, Saeko; Akahoshi, Masazumi; Suzuki, Gen



Advances in the percutaneous management of the ureteropelvic junction and other obstructions of the urinary tract in children.  


In conclusion, endopyelotomy has been developed over the past several decades on the basis of sound laboratory and clinical research. The success rates have been similar to those of the standard open pyeloplasty, and the procedure is not associated with undue complications. Endopyelotomy has several distinct advantages over open surgery, including the decreased morbidity and associated expense of an open operation, minimal interference with the blood supply of the ureter, and avoidance of removal of the ureter from its natural sheath, preventing the tendency to adhere to adjacent structures and thus kink. As the instrumentation available for percutaneous renal surgery has improved and been miniaturized, the techniques developed in adults have been progressively applied to younger and smaller children. There seems to be little doubt that a comparison of morbidity and socioeconomic factors associated with a successful endopyelotomy versus an open pyeloplasty in adults heavily favors the percutaneous procedures, and judicious application to children would seem warranted. However, the changing presentation of ureteropelvic junction obstruction in children that has resulted from the widespread use of prenatal ultrasonography may make the question moot. Open infant pyeloplasty is a highly successful procedure, accompanied by minimal morbidity and accomplished in a 2- to 3-day hospital stay. The socioeconomic factors are obviated in the infant, who already requires constant maternal care. However, endopyelotomy deserves consideration in the older child, especially if the obstruction is secondary in nature after a previous open procedure. PMID:2336748

Douenias, R; Smith, A D; Brock, W A



Robotic-assisted laparoscopic pyeloplasty and nephropexy for ureteropelvic junction obstruction and nephroptosis.  


A 22-year-old female was referred with right flank pain and recurrent urinary infections. Flank pain was persistent while standing and relieved upon supine position. Intravenous urography demonstrated change of position with descent approximately 6-7 cm as the patient moved from the supine to the erect position. Diuretic renography corroborated the finding of right ureteropelvic junction obstruction (UPJO). A robotic-assisted laparoscopic dismembered pyeloplasty with simultaneous nephropexy was performed. The proximal ureter appeared to course posterior to the renal vein and then anterior to the lower pole renal artery. There was a significant "nutcracker effect" to the proximal ureter, which was causing the patient's UPJO, and the concomitant nephroptosis contributed to increase the degree of obstruction. The robotic-assisted laparoscopic pyeloplasty and nephropexy offer advantages for patients and surgeons and can be used in challenging cases with an efficacy similar to that of open repair. The robotic-assisted laparoscopic pyeloplasty is the evolving standard for UPJO, especially in the presence of crossing vessels. PMID:19216694

Boylu, Ugur; Lee, Benjamin R; Thomas, Raju



Pediatric renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusion.  


Renal cell carcinoma (RCC) in children and young adults is rare and pathologically problematic. RCC can be either hereditary or sporadic and has a guarded prognosis because appropriate management has not been established. A case of RCC in an 11-year-old is reported. The clinical presentation was a right abdominal mass, hematuria, urinary tract infection, and wasting. Radio-logically, the mass was found within the right kidney with calcification and paraaortic lymphadenopathy. The postsurgical diagnosis was Wilms' tumor stage T4N2M0. On gross inspection, the tumor was ill defined, extending across Gerota's fascia and into the ureter lumina. Microscopically, the tumor consisted of malignant epithelial cells with clear and eosinophilic cytoplasm in nested, papillary, and alveolar configuration. Hyaline nodules, psammoma bodies, vascular invasion, capsular invasion, and extension into the ureter were also found. Immunohistochemically, the cells showed strong nuclear immunoreactivity for TFE3. We concluded that this case was an RCC associated with Xp11.2 translocation/TFE3 fusion, Fuhrman grade 3, stage IV. PMID:18203790

Winarti, Ni Wayan; Argani, Pedram; De Marzo, Angelo M; Hicks, Jessica; Mulyadi, Ketut



Current Status of Gil-Vernet Trigonoplasty Technique  

PubMed Central

Significant controversy exists regarding vesicoureteral reflux (VUR) management, due to lack of sufficient prospective studies. The rationale for surgical management is that VUR can cause recurrent episodes of pyelonephritis and long-term renal damage. Several surgical techniques have been introduced during the past decades. Open anti-reflux operations have high success rate, exceeding 95%, and long durability. The goal of this article is to review the Gil-Vernet trigonoplasty technique, which is a simple and highly successful technique but has not gained the attention it deserves. The mainstay of this technique is approximation of medial aspects of ureteral orifices to midline by one mattress suture. A unique advantage of Gil-Vernet trigonoplasty is its bilateral nature, which results in prevention from contralateral new reflux. Regarding not altering the normal course of the ureter in Gil-Vernet procedure, later catheterization of and retrograde access to the ureter can be performed normally. There is no report of ureterovesical junction obstruction following Gil-Vernet procedure. Gil-Vernet trigonoplasty can be performed without inserting a bladder catheter and drain on an outpatient setting. Several exclusive advantages of Gil-Vernet trigonoplasty make it necessary to reconsider the technique role in VUR management.

Simforoosh, Nasser; Radfar, Mohammad H.



Escherichia coli–Mediated Impairment of Ureteric Contractility Is Uropathogenic E. coli Specific  

PubMed Central

Background.?Ureters are fundamental for keeping kidneys free from uropathogenic Escherichia coli (UPEC), but we have shown that 2 strains (J96 and 536) can subvert this role and reduce ureteric contractility. To determine whether this is (1) a widespread feature of UPEC, (2) exhibited only by UPEC, and (3) dependent upon type 1 fimbriae, we analyzed strains representing epidemiologically important multilocus sequence types ST131, ST73, and ST95 and non-UPEC E. coli. Methods.?Contractility and calcium transients in intact rat ureters were compared between strains. Mannose and fim mutants were used to investigate the role of type 1 fimbriae. Results.?Non-UPEC had no significant effect on contractility, with a mean decrease after 8 hours of 8.8%, compared with 8.8% in controls. UPEC effects on contractility were strain specific, with decreases from 9.47% to 96.7%. Mannose inhibited the effects of the most potent strains (CFT073 and UTI89) but had variable effects among other UPEC strains. Mutation and complementation studies showed that the effects of the UTI89 cystitis isolate were fimH dependent. Conclusions.?We find that (1) non-UPEC do not affect ureteric contractility, (2) impairment of contractility is a common feature of UPEC, and (3) the mechanism varies between strains, but for the most potent UPEC type 1 fimbriae are involved.

Floyd, Rachel V.; Upton, Mathew; Hultgren, Scott J.; Wray, Susan; Burdyga, Theodor V.; Winstanley, Craig



Anodized 20 nm diameter nanotubular titanium for improved bladder stent applications  

PubMed Central

Materials currently used for bladder applications often suffer from incomplete coverage by urothelial cells (cells that line the interior of the bladder and ureter) which leads to the continuous exposure of the underlying materials aggravating an immune response. In particular, a ureteral (or sometimes called an ureteric or bladder) stent is a thin tube inserted into the ureter to prevent or treat obstruction of urine flow from the kidney. The main complications with ureteral stents are infection and blockage by encrustation, which can be avoided by promoting the formation of a monolayer of urothelial cells on the surface of the stent. Nanotechnology (or the use of nanomaterials) may aid in urothelialization of bladder stents since nanomaterials have been shown to have unique surface energetics to promote the adsorption of proteins important for urothelial cell adhesion and proliferation. Since many bladder stents are composed of titanium, this study investigated the attachment and spreading of human urothelial cells on different nanotextured titanium surfaces. An inexpensive and effective scaled up anodization process was used to create equally distributed nanotubular surfaces of different diameter sizes from 20–80 nm on titanium with lengths approximately 500 nm. Results showed that compared to untreated titanium stents and 80 nm diameter nanotubular titanium, 20 nm diameter nanotubular titanium stents enhanced human urothelial cell adhesion and growth up to 3 days in culture. In this manner, this study suggests that titanium anodized to possess nanotubular surface features should be further explored for bladder stent applications.

Alpaslan, Ece; Ercan, Batur; Webster, Thomas J



Long-Term Urinary Bladder Function Following Unilateral Refluxing Low Loop Cutaneous Ureterostomy  

PubMed Central

Purpose Unilateral low loop cutaneous ureterostomy (LLCU) has been offered as the preferred method of temporary urinary diversion in cases of massively dilated and refluxing ureters. We sought to explore whether LLCU is effective in preserving urinary bladder function in the long term. Materials and Methods The charts of all patients who had undergone temporary unilateral LLCU as newborns in the presence of massive vesico-ureteric reflux were retrospectively reviewed. Demographic data, follow-up length, and presence of incontinence were recorded. Patients were interviewed regarding lower urinary tract symptoms (LUTS), and their urination patterns were recorded by using uroflow and post-void residual (PVR) measurements. Results Between 1972 and 2003, a total of 24 patients underwent unilateral LLCU in the presence of massively refluxing ureters. Eight patients were included in the final analysis. The median age at diversion was 12 days, the median time to closure was 22.5 months, and the median follow-up was 12.5 years. Urinary bladders showed normal contour, normal capacities, and minimal PVRs in most cases. None of the patients required augmentation cystoplasty. One patient suffered from urinary leakage and few demonstrated minimal LUTS. Conclusions Unilateral refluxing LLCU is an effective method of urinary diversion that preserves urinary bladder function for the long term. Larger studies are required to confirm this finding.

Golomb, Jacob; Kitrey, Noam D; Inbar, Yael; Heyman, Zehava; Kleinnbaum, Yeruham; Mor, Yoram



Selective growth of normal adult human urothelial cells in serum-free medium.  


A serum-free medium (HMRI-2) has been developed for the outgrowth and subculture of epithelial cells from normal adult human ureter and bladder. Medium HMRI-2 consists of Ham's MCDB 152 with double the amounts of the essential amino acids in Stock 1, low Ca2+ (0.06 mM) and is supplemented with epithelial growth factor, 5 ng/ml; transferrin, 5 micrograms/ml; insulin, 5 micrograms/ml; ethanolamine and phosphoethanolamine, 0.1 mM each; hydrocortisone, 2.8 X 10(-6) M; and bovine pituitary extract, 126 micrograms protein/ml. The cultured cells showed ultrastructural markers of epithelial cells (prekeratin fibers, tonofilaments, surface microvilli with glycocalyx), exhibited ABO antigens, and had a normal human diploid karyotype. Primary cultures could be subcultured and also cryopreserved in HMRI-2 in liquid nitrogen. Cells in mass cultures showed a population doubling time of 40.5 +/- 4.5 h and had a maximum in vitro life span of 20 to 25 population doublings. It was observed that primary outgrowths, secondary cultures, and even cryopreserved cells all retained the capacity to respond to high Ca2+ and serum by differentiation and desquamation. This study has resulted in the availability of easily obtainable serum-free epithelial cultures from normal adult human ureter and bladder. The useful in vitro life span of these cultures may be important in future studies of carcinogenesis. PMID:4008432

Kirk, D; Kagawa, S; Vener, G; Narayan, K S; Ohnuki, Y; Jones, L W



[Heterotopic urine derivation in females with urinary bladder extrophy].  


Fifteen females aged from 17 to 31 years with bladder extrophy (the condition after ureterosygmostomy) have undergone heterotopic urine derivation with creation of a cutaneous urine-retention catheter mechanism. Surgery was indicated in progressive decline of renal function in the presence of renal reflux, total urine incontinence in the failure of pelvic floor muscles and rectal sphyncter apparatus. Creation of cutaneous urine-retention catheter mechanism was made by the following techniques: heterotopic plastic repair from the ileocecal angle by Mainz pouch I (11 patients, 73.4%); heterotopic W ileocystoplasty by Abol-Enein (4 patients, 26.8%). Implantation of both ureters was conducted by Wallace technique in 4 (26.7%) cases. In 7 (46.6%) patients ureteral implantation was performed with antireflux defense by the method of cross dublicate creation. Four (26.7%) patients with small intestinal derivation have undergone extramural implantation of the ureters according to Abol-Enein. The results show that conversion of ureterosygmostomy in heterotopic urine derivation with one-stage genital reconstructive interventions decreases the number of potential complications, improves surgical outcomes and provides much better medico-social rehabilitation. Heterotopic intestinal continent derivation of urine is an operation of choice in women with urinary malformations. In such patients orthotopic urine derivation is impossible. PMID:17471989

Darenkov, S P; Adamian, L V; Adamian, A A; Kovalev, V A; Ochchardzhiev, S B; Chernyshev, I V; Dzitiev, V K; Samsonov, Iu V


A review of ureteral injuries after external trauma  

PubMed Central

Introduction Ureteral trauma is rare, accounting for less than 1% of all urologic traumas. However, a missed ureteral injury can result in significant morbidity and mortality. The purpose of this article is to review the literature since 1961 with the primary objective to present the largest medical literature review, to date, regarding ureteral trauma. Several anatomic and physiologic considerations are paramount regarding ureteral injuries management. Literature review Eighty-one articles pertaining to traumatic ureteral injuries were reviewed. Data from these studies were compiled and analyzed. The majority of the study population was young males. The proximal ureter was the most frequently injured portion. Associated injuries were present in 90.4% of patients. Admission urinalysis demonstrated hematuria in only 44.4% patients. Intravenous ureterogram (IVU) failed to diagnose ureteral injuries either upon admission or in the operating room in 42.8% of cases. Ureteroureterostomy, with or without indwelling stent, was the surgical procedure of choice for both trauma surgeons and urologists (59%). Complications occurred in 36.2% of cases. The mortality rate was 17%. Conclusion The mechanism for ureteral injuries in adults is more commonly penetrating than blunt. The upper third of the ureter is more often injured than the middle and lower thirds. Associated injuries are frequently present. CT scan and retrograde pyelography accurately identify ureteral injuries when performed together. Ureteroureterostomy, with or without indwelling stent, is the surgical procedure of choice of both trauma surgeons and urologists alike. Delay in diagnosis is correlated with a poor prognosis.



Effect of microvibration on activity of ureteral and portal smooth muscles.  


Spontaneous contractions were elicited by microvibrations (1--80 Hz, 50--400 micron) imposed upon quiescent ureter and portal venous smooth muscles of dogs. The microvibrations increased the rate of spontaneous contractions. A microvibration of larger amplitude gave rise to a more profound increase at each frequency. The acceleration was often accompanied by a reduction in contractile force. The positive chronotropic effect was enhanced by increases in frequency from 20 to 40 Hz and not affected by administration of autonomic blocking agents and tetrodotoxin, but disappeared in a Ca-free environment and reappeared on addition of Ba2+. the simulating action of microvibration was almost proportional to external Ca2+ concentrations ranging from 2.2 to 6.2 mM. The microvibrations were able to elicit spontaneous activity in the preparation, which had been made quiescent by administration of Mn2+. These findings suggested that the positive chronotropic effect may be closely related to an increased Ca2+ influx through the membrane of smooth muscle. Active tension in the ureter in a state of contracture was depressed by imposed microvibrations. PMID:443363

Ohhashi, T; Azuma, T; Sakaguchi, M



Options in the management of tuberculous ureteric stricture  

PubMed Central

Ureteric stricture is a feared manifestation of genitourinary tuberculosis (TB) with the commonest site being the lower ureter. The purpose of this review is to discuss the management options for this condition. Literature search was done using PubMed and all articles on TB and ureteric stricture were reviewed published between 1990 till September 2007. The exact site and length of stricture must be defined with radioimaging (intravenous urography, retrograde, or antegrade pyelography) and renal function be quantified. The treatment of stricture mostly requires some kind of intervention after a brief period of antituberculous medicines with or without steroids. For uncomplicated/simple strictures (short segment, passable, with renal function >25%, good bladder capacity) endourologic option should be used which usually means double-J stenting with or without balloon dilatation. For complicated/complex strictures (long segment, dense fibrosis, with renal function <20%, small bladder capacity) regular surgical options should be considered which usually means ureteroureterostomy or ureteropyelostomy for upper ureteric strictures, intubated ureterostomy, or transureteroureterostomy for midureteric strictures, psoas hitch/Boari flap for lower ureteric strictures or ileal ureter/autotransplantation for whole length/multiple strictures.

Goel, Apul; Dalela, D.



Medical Management of Retroperitoneal Fibrosis  

PubMed Central

Background: Small series and case reports suggest that a combination of mycophenolate mofetil and prednisone is an efficatious and safe treatment for patients with retroperitoneal fibrosis. Objective: To describe the outcomes of patients with retroperitoneal fibrosis treated with a combination of prednisone and mycophenolate mofetil. Design: Prospective, case series. Patients: 31 patients with retroperitoneal fibrosis. Setting: Single-center tertiary care facility. Intervention: Prednisone 40 mg administered daily and tapered over 6 months and mycophenolate mofetil 1,000 mg given twice daily. Measurement: Clinical course, laboratory assessment, measurement of periaortic mass. Results: Systemic symptoms resolved in all patients. Eighty-nine percent of patients had a 25 % or greater reduction in periaortic mass. Eighteen patients had 32 obstructed ureters. Thirty of these ureters were free of obstruction after an average of 513 days of therapy. Laboratory abnormalities of elevated erythrocyte sedimentation rate and serum creatinine and decreased hemoglobin levels normalized in all patients. Recurrent disease occurred in 2 of 28 patients. Conclusion: Combined prednisone and mycophenolate mofetil appears to be an effective therapeutic option for patients with retroperitoneal fibrosis.

Scheel, Paul J.; Sozio, Stephen M.; Feeley, Nancy



Current status of genitourinary fistula.  


From 1970-1985, 303 women with genitourinary fistulas were seen at the Mayo Clinic. The fistula formed after treatment for benign conditions in 74% of the patients and malignant conditions in 14%; in 12%, we were unable to establish the nature of the condition. Gynecologic surgery was responsible for 82% of the fistulas, obstetric procedures for 8%, various forms of irradiation for 6%, and trauma or fulguration for 4%. In the nonirradiated patient, the ideal time for operative repair was eight to 12 weeks after fistula formation or failed repair. With ureterovaginal fistulas, the patient's general condition and the degree of obstruction of the ureter influenced the time and method of repair. We used a vaginal approach for urethral fistulas and an abdominal one for ureteral repairs. Because of difficulty with adequate exposure and the proximity of the ureter, an abdominal approach was used in 20% of the patients with vesicovaginal fistulas; the remaining 80% were approached vaginally, regardless of size, number, or history of previous repairs. Ninety-two percent of the urethrovaginal fistulas were corrected on the first attempt; the four failures were managed successfully at the second attempt. Ninety-eight percent of the vesicovaginal fistulas were corrected on the first attempt when approached vaginally, and all were managed successfully when approached abdominally, regardless of the number, size, or previous operative attempts. PMID:3043287

Lee, R A; Symmonds, R E; Williams, T J



Interaction between FGF and BMP signaling pathways regulates development of metanephric mesenchyme  

PubMed Central

Nephrogenesis in the mouse kidney begins at embryonic day 11 and ends ?10 days postpartum. During this period, new nephrons are continually being generated from a stem-cell population—the nephrogenic mesenchyme—in response to signals emanating from the tips of the branching ureter. Relatively little is known about the mechanism by which the nephrogenic mesenchyme cell population is maintained at the tips of the ureter in the presence of signals promoting tubulogenesis. Previous studies have shown that a loss of Bmp7 function leads to kidney defects that are a likely result of progressive loss of nephrogenic mesenchyme by apoptosis. The studies presented here demonstrate that BMP7 signaling can prevent apoptosis in explants of metanephric mesenchyme. The surviving mesenchyme cell population, however, is not competent to respond to signals promoting tubulogenesis. In conjunction with FGF2, BMP7 promotes growth and maintains competence of the mesenchyme in vitro. In addition, FGF2 and BMP7 signaling, both independently and in combination, inhibit tubulogenesis. Interestingly, FGF2 and BMP7 also promote expansion of the stromal progenitor cell population in whole kidney culture. Because BMP7 is not produced by stromal progenitor cells, these data suggest a novel interaction between the nephrogenic mesenchyme and stromal progenitor cell populations. A model for the regulation of nephrogenesis by FGF and BMP signaling is presented.

Dudley, Andrew T.; Godin, Robert E.; Robertson, Elizabeth J.



p53 Regulates Metanephric Development  

PubMed Central

p53 is best known as a tumor suppressor that regulates cell-cycle, differentiation, and apoptosis pathways, but its potential role in embryonic development and organogenesis remains controversial. Here, p53?/? embryos bred on C57Bl6 background exhibited a spectrum of congenital abnormalities of the kidney and urinary tract, including ureteric bud (UB) ectopia, double ureters/collecting systems, delayed primary branching of the UB, and hypoplastic metanephroi. We observed ectopic UB outgrowth from the Wolffian duct (WD) in one third of p53?/? embryos. The prevalence of duplex was higher in embryos than in neonates, and ex vivo organ culture suggested that ectopic ureters can regress over time, leaving behind a dysplastic pole (“segmental dysgenesis”). Transgenic expression of dominant negative p53 or conditional inactivation of p53 in the UB but not in the metanephric mesenchyme lineage recapitulated the duplex phenotype. Mechanistically, p53 inactivation in the WD associated with enhanced sensitivity to glial cell line–derived neurotrophic factor (GDNF)-induced ectopic budding and potentiated phosphatidylinositol-3 kinase activation by GDNF in UB cells. Unlike several other models of UB ectopia, hypersensitivity of p53?/? WD to GDNF is not accompanied by reduced Sprouty-1 or anterior expansion of the GDNF domain. In summary, our data lend support for a restrictive role for p53 activity in UB outgrowth from the WD.

Dipp, Susana; Stefkova, Jana; Yao, Xiao; Lookabaugh, Sarah; El-Dahr, Samir S.



[Fragmentation of urinary calculi using the Lithoclast EMS. Technique and results].  


The Lithoclast is an endoscopic lithotriptor which uses the ballistic energy produced by a small hand-held apparatus, by the movement of a small metal part (the projectile) driven by a jet of compressed air. The energy is transmitted to a metal rod whose diameter is selected according to the application: 0.8 or 1 mm in the ureter; 2 mm in the bladder and kidney. We have used this apparatus to treat 40 stones in 39 patients (25 ureteric stones, 11 renal stones, 4 bladder stones). Satisfactory fragmentation was obtained for 39 of the 40 stones (97.5%). The apparatus is very easy to use in the kidney and bladder (the risk of urinary tract perforation is very low at this level). The risk of perforation of the ureteric wall by 0.8 mm or 1 mm rods is considerable (12% of cases), but these punctate lesions heal rapidly over a double J stent. Special techniques should be used in the ureter to limit the risk of pushing the stone towards the renal pelvis. PMID:8305936

Abbar, M; Sousa Castello, A; Gelet, A; Martin, X; Marechal, J M; Dubernard, J M



Mechanism of flavoxate antispasmodic activity comparative in vitro studies.  


In order to clarify the pharmacological activity of flavoxate, its effect on the tone and spontaneous activity of the guinea-pig isolated ureter and of the muscle strip from rat urinary bladder were studied. Flavoxate, as well as papaverine, reduced all three parameters considered on the guinea-pig isolated ureter, namely: peristaltic motility, endoluminal pressure and longitudinal muscle contractility. In the same test, verapamil (a calcium antagonist), emepronium and atropine (both anticholinergic drugs) were used for comparison. Using strips of rat urinary bladder depolarized by KCl, flavoxate, papaverine and verapamil displayed a relaxant activity, while anticholinergic compounds such as atropine, hyoscine and emepronium failed to relax this tissue. In another series of experiments the effects of flavoxate and anticholinergic drugs on the contraction elicited by vagal electrical stimulation of the guinea-pig isolated stomach in toto were assayed. The results obtained suggest that the action of flavoxate is due to direct smooth muscle relaxation and does not involve anticholinergic activity. PMID:4026456

Cazzulani, P; Panzarasa, R; De Stefani, C; Graziani, G



Anatomy of Complications workshop: an educational strategy to improve performance in obstetricians and gynaecologists.  


Many specialist obstetricians and gynaecologists feel inadequately trained to deal with certain situations such as injury to bowel, bladder, ureter and major vessels, and value further training to prevent and manage these problems. We present the structure, objectives and rationale for a surgical skills workshop, which is an intensive practical learning experience aimed to improve the performance of obstetricians and gynaecologists. The overall objective of the workshop is improvement in the prevention and management of complications in obstetric and gynaecological surgery. Over 100 participants have completed the workshop so far. Pre-workshop preparation includes anatomical illustrations to guide reading and a training video describing surgical skills, ewe anatomy and hysterectomy in the ewe. There are four modules: anatomy includes an interactive lecture, cadaveric dissection and examination of prosections with specific learning tasks. Surgical skills involves the demonstration, practice and learning of techniques needed to deal with unexpected operative injury to bowel, bladder, ureter and major blood vessels. Live animal surgery on a ewe allows further supervised practice of the previously learned skills plus the repair of serious vascular injury. Case presentations allow each participant to present a complicated case in a facilitated group session with discussion and feedback from their peers. This session is controlled, non-threatening and a valuable interactive learning experience. Participant feedback suggests that this workshop format is useful and appears to improve the confidence, competence and performance of the participants. This workshop is presented as a template on which other educational activities can be developed. PMID:14712964

Hammond, Ian; Taylor, John; McMenamin, Paul



The role of renal scintigraphy and unenhanced helical computerized tomography in patients with ureterolithiasis.  


Unenhanced helical computerized tomography (UHCT) has recently evolved as an accurate imaging modality for determination of the presence or absence of ureterolithiasis in patients with acute flank pain. Functional renal scintigraphy is considered the gold standard for urinary tract obstruction. The objective of this study was to correlate the secondary signs of urinary obstruction on UHCT with findings of functional renal scintigraphy. UHCT was performed in 30 patients admitted to the emergency room with acute flank pain. All patients had a calcified urinary stone identified on UHCT. The location of each urinary stone was classified as ureteral or in the ureterovesical junction. The presence of secondary CT signs of ureteral obstruction was determined for each patient. After oral or intravenous hydration, a technetium-99m diethylene triamine penta-acetic acid renal scan was performed in all patients within 12 h of the CT scan. Follow-up delayed scintigraphic images were obtained at 2 h and 24 h in patients with evidence of ureteral obstruction. The sensitivity, specificity and predictive values of each possible combination of CT findings were determined by comparison with the scintigraphic results. The distal ureter was the most common location for a calculus on UHCT, followed in frequency by the ureterovesical junction, proximal ureter and mid-ureter. The renograms showed high-grade, unilateral obstruction in 12 patients, indeterminate scans in five patients and normal renograms in 13 patients. The sensitivities and specificities of individual CT findings ranged from 50% to 75% and from 8% to 69%, respectively. Perinephric stranding gave the highest positive predictive value (PPV) for obstruction (69% including indeterminate renograms). None of the individual CT findings showed a statistically significant correlation with scintigraphic findings. A combination of one or two positive CT findings had a PPV of only 25% for obstruction. A combination of three or four positive CT findings gave a PPV of 70% for obstruction. Our preliminary study shows that secondary CT signs of ureterolithiasis correlate poorly with the scintigraphic findings and that they do not permit evaluation of the functional status of obstructed kidneys. Even a combination of the most frequent CT findings has a low predictive value, i.e. does not allow a decision to be made as to the most suitable treatment. Therefore, renal scintigraphy should be performed in conjunction with UHCT in all patients with ureteral calculi. PMID:10805118

Lorberboym, M; Kapustin, Z; Elias, S; Nikolov, G; Katz, R



Urological applications of single-site laparoscopic surgery  

PubMed Central

Single-port, single-incision laparoscopy is part of the natural development of minimally invasive surgery. Refinement and modification of laparoscopic instrumentation has resulted in a substantial increase in the use of laparoendoscopic single-site surgery (LESS) in urology over the past 2 years. Since the initial report of single-port nephrectomy in 2007, the majority of laparoscopic procedures in urology have been described with a single-site approach. This includes surgery on the adrenal, ureter, bladder, prostate, and testis, for both benign and malignant conditions. In this review, we describe the current clinical applications and results of LESS in Urological Surgery. To date this evidence comes from small case series in centres of excellence, with good results. Further well-designed prospective trials are awaited to validate these findings.

Symes, Andrew; Rane, Abhay



Urological applications of single-site laparoscopic surgery.  


Single-port, single-incision laparoscopy is part of the natural development of minimally invasive surgery. Refinement and modification of laparoscopic instrumentation has resulted in a substantial increase in the use of laparoendoscopic single-site surgery (LESS) in urology over the past 2 years. Since the initial report of single-port nephrectomy in 2007, the majority of laparoscopic procedures in urology have been described with a single-site approach. This includes surgery on the adrenal, ureter, bladder, prostate, and testis, for both benign and malignant conditions. In this review, we describe the current clinical applications and results of LESS in Urological Surgery. To date this evidence comes from small case series in centres of excellence, with good results. Further well-designed prospective trials are awaited to validate these findings. PMID:21197251

Symes, Andrew; Rane, Abhay



Laparoscopic management of a small bowel herniation from an ileal conduit: report of a case and review of the literature.  


Bladder carcinoma can be treated with cystectomy and urinary diversion. Ileal conduit is a popular technique, originally performed with closure of all mesenteric and peritoneal defects to minimize internal herniation. Recent advances in laparoscopic and robotic techniques often leave these defects open. We present a case of a 75-year-old gentleman with a small bowel entrapment underneath an intraperitoneal ileal conduit and ureter causing obstruction. This internal hernia occurred 2 months after undergoing a DaVinci robotic-assisted laparoscopic cystoprostatectomy with an ileal conduit. Bowel obstruction is an important complication associated with the need for reoperation and patient mortality. Historical review shows a precedent for closure of the mesenteric defect, obliterating the peritoneal defect in the right lumbar gutter, and suturing the ileal conduit to the posterior peritoneum to prevent potential internal hernias. The literature involving ileal conduits is examined for consensus on the preferred method of treating these potential spaces. PMID:23579536

Coughlin, Lisa M; Orr, Dennis P



Abnormalities of the bladder in children: imaging findings.  


Radiologic evaluation of the genitourinary tract in infants and children frequently focuses on the kidneys. The bladder may be imaged in a cursory or perfunctory manner or not at all. Unfortunately, this practice contributes to errors in diagnosis of renal abnormalities both prenatally and throughout childhood. For example, a "renal cyst" diagnosed prenatally really might be the obstructed upper pole of a duplex kidney; scanning the bladder is necessary to detect the dilated distal ureter or ureterocele below. Similarly, the bladder might have a congenital anomaly when the kidneys are normal. The appearance of many common and a few uncommon bladder anomalies in children are described in this article. Some normal variants and acquired problems, such as tumors and neurogenic bladder, are discussed and illustrated because these can cause problems in diagnosis. Changes in the appearance of the bladder produced by surgery to correct vesicoureteral reflux are also presented. PMID:8166000

Fernbach, S K; Feinstein, K A



Targeting the visceral purinergic system for pain control.  


Experimental evidence is presented to support the hypothesis that purinergic mechanosensory transduction can initiate visceral pain in urinary bladder, ureter, gut and uterus. In general, physiological reflexes are mediated via P2X3 and P2X2/3 receptors on low threshold sensory fibres, while these receptors on high threshold sensory fibres mediate pain. Potential therapeutic strategies are considered for the treatment of visceral pain in such conditions as renal colic, interstitial cystitis and inflammatory bowel disease by purinergic agents, including P2X3 and P2X2/3 receptor antagonists that are orally bioavailable and stable in vivo and agents that modulate ATP release and breakdown. PMID:22036885

Burnstock, G



Purinergic signalling in the lower urinary tract.  


The aim of this review is to describe the conceptual steps contributing to our current knowledge of purinergic signalling and to consider its involvement in the physiology and pathophysiology of the lower urinary tract. The voiding reflex involves ATP released as a cotransmitter with acetylcholine from parasympathetic nerves supplying the bladder and ATP released from urothelial cells during bladder distension to initiate the voiding reflex via P2X3 receptors on suburothelial low threshold sensory nerve fibres. This mechanosensory transduction pathway also participates, via high threshold sensory nerve fibres, in the initiation of pain in bladder and ureter. Treatment of prostate and bladder cancer with ATP is effective against the primary tumours in animal models and human cell lines, via P2X5 and P2X7 receptors, and also improves the systemic symptoms associated with advanced malignancy. Acupuncture is widely used for the treatment of urinary disorders, and a purinergic hypothesis is discussed for the underlying mechanism. PMID:23176070

Burnstock, G



Canine distemper virus infection in fennec fox (Vulpes zerda).  


Fifteen 8-month-old fennec foxes imported from Sudan showed fever, mucopurulent ocular discharge, diarrhea, severe emaciation, seizures, and generalized ataxia, and died. Three of the 15 animals were presented for diagnostic investigation. Severe dehydration, brain congestion, and gastric ulcers were observed in all animals. In one animal, the lungs had failed to collapse and were multifocally dark red in appearance. Histopathologically, there were lymphohistiocytic meningoencephalitis with malacia, mild interstitial pneumonia, lymphoid depletion of lymphoid tissues and organs, and intestinal villous atrophy with intralesional coccidia. There were many intracytoplasmic and/or intranuclear inclusion bodies in the epithelial cells of the medullary velum, lungs, liver, kidneys, trachea, pancreas, stomach, gall bladder, urinary bladder, and ureters, and in macrophages of malacia foci and lymphocytes and macrophages of lymphoid organs. Additionally, intestinal coccidia were confirmed to be Isospora species by a fecal test. To our knowledge, this is the first report of canine distemper with intestinal coccidiosis in fennec fox. PMID:20299771

Woo, Gye-Hyeong; Jho, Yeon-Sook; Bak, Eun-Jung



Staged endourologic and endovascular repair of an infrarenal inflammatory abdominal aortic aneurysm presenting with forniceal rupture.  


We present the case of a 79-year-old female who presented with severe left flank pain and a pulsatile abdominal mass. She was diagnosed with left peripelvic urinary extravasation and forniceal rupture secondary to an intact infrarenal inflammatory abdominal aortic aneurysm with extensive periaortic fibrosis. Successful operative repair was performed with staged ureteral and endovascular stenting with subsequent resolution of periaortic inflammation and ureteral obstruction, and shrinkage of the aneurysm sac. Inflammatory abdominal aortic aneurysms (IAAAs) represent 5% to 10% of all abdominal aortic aneurysms. The distinguishing features of inflammatory aneurysms include thickening of aneurysm wall, retroperitoneal fibrosis, and adhesions to adjacent retroperitoneal structures. The most commonly involved adjacent structures are the duodenum, left renal vein, and ureter. Adhesions to the urinary system can cause hydronephrosis or hydroureter and result in obstructive uropathy. An unusual case of IAAA presenting with forniceal rupture is presented, with successful endovascular and endourologic repair. PMID:18971042

Edmonds, Rebecca D; Tomaszewski, Jeffrey J; Jackman, Stephen V; Chaer, Rabih A



[Relations of regulatory polypeptide and syndrome differentiation of traditional Chinese medicine of angina pectoris patients].  


Ninety cases of angina pectoris patients with the Deficiency of Heart Qi Syndrome (DHQS), Deficiency of Heart-Yin Syndrome (DHYS) and blood stasis in Heart vessels Syndrome (BSHVS) were studied. The number of patients were 30 for each group. Their regulatory polypeptides:atrial natri-uretic polypeptide (ANP), beta-Endorphine (beta-EP), Endothelin (ET), Angiotensin (A-II) were tested. Results showed that in comparing with normal level, P < 0.05 or < 0.01, ANP and beta-EP of them: DHQS > BSHVS > normal group > DHYS. ET and A-II of them: DHYS > BSHVS > normal group > DHQS. And the comparison between groups revealed that P < 0.05 or < 0.01. So ANP, beta-EP, ET and A-II were the principal material basis, and they could be the specific objective parameters of the Syndrome Differentiation. PMID:9387748

Huang, H Y; Zhu, W F; Li, B X



[Primary megaureter].  


A primary megaureter is an anomaly with a prevesical or overall dilated ureter of more than 6 mm in diameter. It is important to distinguish between cases of primary non-refluxing and primary obstructive-refluxing megaureters, as the treatment of both is completely different. The basic diagnostic work-up includes ultrasonography and voiding cystourethrography. Diuretic renography is used to detect split renal function and the degree of upper urinary tract obstruction. In most cases of primary non-refluxing megaureter surgical treatment is unnecessary due to the high remission rate, whereas obstructive refluxing megaureters commonly only need to be corrected. Antibiotic prophylaxis may be indicated in infants with a primary obstructive megaureter during the first 6 months of life due to a higher risk of complications due to pyelonephritis especially in this age group. PMID:23340725

Anheuser, P; Kranz, J; Steffens, J; Beetz, R



[Outcome of pregnancy in patient with cloacal dysgenesis].  


The cloacal dysgenesis or persistent cloaca is an anomaly included in urogenital tract malformations (UGM) and, in particular, in anomalies due to a missed development of the urogenital septum. The UGM occur during 6-11th weeks of gestation owing to a stop and/or alteration of the normal development and subdivision process of the cloaca, the embryonic structure from which gives origin to the ano-rectal segment of midgut, bladder, ureters, vagina and uterus. The case of a patient submitted to many surgical treatments for urogenital tract congenital malformations is described; when pregnant, she carried other pregnancy until the 34th week of gestation, giving birth a newborn by cesarean section. The patient was checked constantly for her general conditions and, in particular, her renal functions by an active collaboration between internist, nephrologist and gynecologist. PMID:15258547

Maruotti, G; Del Bianco, A; D'Apolito, A; Lombardi, L; Pietropaolo, F



Nonleukemic ureteral granulocytic sarcoma presenting with unilateral urinary obstruction and hematuria.  


Granulocytic sarcoma is an extramedullary tumor which is composed of myeloblasts and immature myeloid cells. It usually occurs in association with acute myeloid leukemia and most commonly involves skin, soft tissue, lymph nodes, bone, and periosteum. We report a case of isolated ureteral granulocytic sarcoma without hematologic manifestations. Our patient presented with bloody urine and left-sided lumbar pain. Preoperative clinical and radiologic features raised the suspicion of an upper urinary tract transitional cell carcinoma, and he was scheduled for nephroureterectomy. However, perioperative pathologic feedback and the unusual endoscopic appearance of the tumor altered our surgical strategy towards segmental ureterectomy and ureteroneocystostomy. Eventual pathologic diagnosis was granulocytic sarcoma of the ureter. Postoperative workup failed to demonstrate any sign of an accompanying hematologic disorder. He started receiving the chemotherapy protocol of acute myeloblastic leukemia. To our knowledge, this is the first documented case of nonleukemic ureteral granulocytic sarcoma which came to attention due to urologic complaints. PMID:24024067

Acar, Omer; Esen, Tar?k; Tecimer, Tülay; Cetiner, Mustafa; Peker, Onder; Musao?lu, Ahmet



Ureteral Interventions  

PubMed Central

The pelvic course of the ureter with its close proximity to the iliac artery, pelvic viscera, and other structures predispose to fistula formation. Surgical management of lower urinary tract fistulas is difficult and often ineffective. Nonvascular lower urinary tract fistulas can be managed by urinary diversion with percutaneous nephrostomy to allow for fistula healing. If this fails, ureteral embolization can be very effective; however, this should be preceded by careful evaluation and discussion with the patient as this intervention results in irreversible ureteral occlusion necessitating a diverting nephrostomy catheter indefinitely. A ureteroarterial fistula is a distinct entity compared with nonvascular fistulas with a different approach to management; it can be managed by exclusion of the fistula by endovascular placement of a stent graft across the arterial component of the fistula.

Popuri, Radha; Zuckerman, Darryl A.



First temporal and spatial quantification of single-shot electrohydraulic lithotripsy in vitro.  


Single electrohydraulic lithotripsy (EHL) discharges from a human ureter were analyzed with a mechanical high-speed motion analysis camera. We found a cavitation bubble, at 650 mJ, 4-11 mm in size, with a lifetime of 400-500 microseconds. Varying sizes and lifetimes were found using single-shot analysis, as well as in different shot-sequences. This supports similar observations by recent investigations of cavitation bubble size with high-shutter-speed videofilm, which have depicted events at shutter speeds of 4000/s, i.e., an approximate exposure time of 250 microseconds. Due to the occurrence of high-voltage interference from the EHL high-voltage generator, no other technical electronic event timing equipment has so far been available capable of mechanical high-speed film motion analysis, while at the same time avoiding high-voltage interference. PMID:8839484

Corleis, R; Vorreuther, R; Engelmann, U; Schaarschmidt, U; Morgenstern, B



Combined laparoscopic and vaginal approach for nephrectomy, ureterectomy, and removal of a large rectovaginal endometriotic nodule causing loss of renal function.  


A late consequence of ureteral endometriosis is the silent loss of renal function caused by progressive "enclosure" of the lower part of the ureter by the endometriosis. In our experience, in cases of severe loss of renal function with cortical atrophy and residual kidney function (evaluated by Tc99 DMSA scintigraphy) of less than 15%, removal of the endometriosis combined with ureterolysis does not allow recovery of renal function. A nonfunctioning kidney associated with hydronephrosis is a risk factor for vascular hypertension, recurrent pyelonephritis, or kidney stones and therefore an indication for nephrectomy. By means of a case report, this paper describes the combination of laparoscopic nephrectomy, ureterectomy, removal of the rectovaginal endometriotic nodule, and extraction of the kidney through the vagina. PMID:17368268

Jadoul, Pascale; Feyaerts, Axel; Squifflet, Jean; Donnez, Jacques


[Primary ureteral carcinoma composed of both transitional cell carcinoma and mucinous carcinoma: a case report].  


We present a case of primary ureteral carcinoma composed of both transitional cell carcinoma and mucinous carcinoma. A 79-year-old woman visited her home doctor with the chief complaint of right lower abdominal pain. Abdominal computed tomographic scan (CT) disclosed a tumor measuring about 5 cm in diameter at the right lower quadrant of the abdomen. Percutaneous nephrostomy was performed for hydronephrosis and pyonephrosis. The urinary cytology revealed class V, transitional cell carcinoma. Re-abdominal CT showed further enlargement of tumor diameter, but the primary site of the tumor was not identified. Her general condition worsened, and she died 42 days after her initial complaint. Pathologic examinations upon autopsy revealed both mucinous carcinoma and transitional cell carcinoma in the right ureter. Pathogenesis and management of this rare condition are discussed. PMID:18203527

Suzuki, Takahisa; Kurita, Yutaka; Nagata, Masao; Otsuka, Atsushi; Shinbo, Hitoshi; Furuse, Hiroshi; Terada, Hiroshi; Mugiya, Soichi; Ushiyama, Tomomi; Ozono, Seiichiro; Kawasaki, Hideya



Creation of the digital three-dimensional model of the prostate and its adjacent structures based on Chinese visible human.  


We managed to provide three-dimensional digitized visible model of the prostate and its adjacent structures and to provide morphological data for imaging diagnosis and male urological surgery. With 3D-DOCTOR software, the contour line of prostate and its adjacent structures including rectum, bladder, male urethra, ureter, seminal vesicle, ductus deferens, ejaculatory ducts, obturator internus, levator ani, coccygeus, male pelvis, femur, prostatic nervous and venous plexus, internal and external iliac arteries were segmented from the Chinese visible human (CVH)-1 data set and the three-dimensional surfaces of intrapelvic visceras were successfully and accurately reconstructed via surface rendering, which can also be manipulated individually and interactively. Combined with AMIRA software, surface rendering reconstructed model of male urological organs and its adjacent structures via volume rendering reconstruction can be displayed together clearly and actually. It provides a learning tool of practicing virtual anatomy and virtual urological surgery for medical students and younger surgeons. PMID:20397017

Wu, Yi; Zhang, Shao-Xiang; Luo, Na; Qiu, Ming-Guo; Tan, Li-Wen; Li, Qi-Yu; Liu, Guang-Jiu; Li, Kai



Comparison of the pulsed dye and holmium lasers for stone fragmentation: in-vitro studies and clinical experience  

NASA Astrophysics Data System (ADS)

The pulsed dye laser used with a 1 microsecond pulse duration at 504 nm delivered via a 320 micron core fiber is designed specifically for ureteric calculi. The threshold for stone fragmentation is in the region of 40 to 50 mJ for the majority of stones. Fragmentation is efficient in the 60 to 70 mJ range but for some stones 100 mJ is required. The Candela MDL 2000 (Candela Corporation) is capable of delivering 140 mJ. This laser has minimal effect on tissue. The holmium laser delivers 300 microsecond pulses of 2.1 microns wavelength (Sunrise Technologies and Coherent Ltd). A maximum of 1 J per pulse at 5 Hz is usually recommended because of the significant action on tissue. Even using this regimen significant damage can be inflicted on the ureter. In this paper the action of these two laser regimens on stones is contrasted.

Watson, Graham M.; Smith, Neil



From mininvasive to maxinvasive surgery in colorectal cancer: modem evolution of oncologic specialized units.  


In the last years a wide range of new technique offers the possibility to have R0 resection in colorectal cancer. We report our experience about Single Port Laparoscopic Surgery (SPL) for not advanced right colon cancer and about pelvectomy with cilindric Abdominal Perineal Resection (APR) for advanced rectal cancer. SPL offer mainly cosmetic advantages but also quicker recovery. No touch technique with adequate surgical margin and lymphectomy were respected. Operative time of SPL was 85-115 minutes, the incision was 5 cm long. There were no complications. Length of hospital stay was 4-6 days. With advanced pelvic cancer, pelvic exenteration with en-bloc resection is indicated. Then we propose a case of a 55 years old woman with a pelvic recurrence from a metastatic rectal cancer involving the right obturator fossa, the vaginal stump, the right ureter. Modern surgical technique give us the chance to offer the most appropriate oncologic surgical treatment. PMID:21066988

Romano, G; Bianco, F; Delrio, P; Cremona, F; Ruffolo, F; Pace, U; Sassaroli, C; Scala, D; De Franciscis, S; Cardone, E; Atelli, P F



Bladder Neck Rupture Following Perineal Bull Horn Injury: A Surgical Challenge  

PubMed Central

Pelvic-abdominal injuries caused by goring are serious lesions which require rapid diagnosis and urgent treatment in the context of a polytraumatized patient. The simultaneous rupture of both the bladder and the prostatic-membranous urethra occurs in 10%–29% of males with pelvic fractures but bladder neck injuries in adults are rarer. Unstable pelvic fractures, bilateral fractures of the ischiopubic branches (also referred to as fractures from falling astride) and the diastasis of the pubic symphysis are those that have the greatest likelihood of injuring both the posterior urethra and the bladder. We present a case of perineal bull horn injury with muscle laceration, bone fractures, scrotal avulsion and rupture of the bladder neck involving the right ureter which required two operations to be repaired.

Padilla-Fernandez, B.; Diaz-Alferez, F.J.; Garcia-Garcia, M.A.; Herrero-Polo, M.; Velasquez-Saldarriaga, J.F.; Lorenzo-Gomez, M.F.





Foetus-in-foetu is a rare malformation in which a monozygotic diamniotic parasitic twin is incorporated into the body of its fellow twin and grows inside it. Less than 100 cases have been reported in literature. One day old newborn male was admitted with antenatal diagnosis of abdominal mass. It was cystic/solid in nature with pressure effects on left ureter and urinary bladder, most likely to be a germ cell tumour. Birth history was uneventful. Exploratory laparotomy was performed and the mass was excised. Physical examination confirmed the diagnosis of foetus-in-foetu. Although it is a rare condition, imaging may play an important role in the correct prospective diagnosis of foetus-in-foetu. Surgical excision is the recommended treatment. PMID:22125997

Ali, Syed Rehan; Qadir, Maqbool; Ahmed, Shakeel; Kumar, Prem



Intestinal type villous adenoma of the renal pelvis.  


Intestinal type villous adenomas are uncommon in the genitourinary tract. Most reported cases have been located in the urinary bladder or urachus. Villous adenoma arising in the renal pelvis or ureter is very rare. We present a case of an 81-year-old female who presented with difficulty voiding and mucosuria. A computed tomography scan identified right-sided hydronephrosis, renal parenchymal atrophy, nonobstructing calculi and a lower pole renal mass. She underwent open right nephrectomy. Histopathologic examination of the kidney revealed an intestinal type villous adenoma of the renal pelvis with high-grade dysplasia and focal areas suspicious for invasive adenocarcinoma. We review the four previously reported cases of intestinal type villous adenoma in the renal pelvis and discuss diagnosis and management of this unusual neoplasm. PMID:23671505

Hudson, Jill; Arnason, Thomas; Merrimen, Jennifer L O; Lawen, Joseph


[A case of urachal abscess accompanied by a stone].  


A 64-year-old woman presented to our hospital with the chief complaints of abdominal pain and appetite loss, and she was admitted to the internal medicine department. Kidney, ureter and bladder X-ray revealed intrapelvic calcification near the bladder, and so, the patient consulted our department. Computed tomography and magnetic resonance imaging revealed an urachal abscess accompanied by a stone. Open surgery was performed under general anesthesia. The mass adhered tightly to the intestine and bladder. The urachal abscess ruptured during the operation, and pus leaked into the intraabdominal cavity. Partial cystectomy was performed to remove the mass completely. The stone existed in the urachal abscess, and its constituents were CaOxa (51%) and CaP (49%). The pathological diagnosis was urachal abscess without malignancy. PMID:23633634

Okumura, Akiou; Tsuritani, Shinji; Kiriyama, Masato; Arai, Kazunori; Takagawa, Kiyoshi; Fuse, Hideki



Morphology and SSU rDNA sequences of Ortholinea orientalis (Shul'man and Shul'man-Albova, 1953) (Myxozoa, Ortholineidae) from Clupea harengus and Sprattus sprattus (Clupeidae) from Denmark.  


Ortholinea orientalis (Shul'man and Shul'man-Albova 1953) Shul'man 1956 is redescribed from Clupea harengus L. and Sprattus sprattus (L.) (Teleostei, Clupeidae) from the northern Øresund, Denmark. S. sprattus is a new host record. Polysporic plasmodia and most myxospores were found in the ureters of both hosts. The myxospores have external valvular ridges, which were not observed in the original description. The presence of this character causes us to consider Ortholinea clupeidae Aseeva 2000 as a likely synonym of O. orientalis. Ortholinea antipae Moshu and Trombitsky, 2006 from a Black Sea clupeid is also similar and represent a possible synonym. Sequence comparisons and phylogenetic analysis of partial SSU rDNA sequences of O. orientalis reveal closest affinity (82-86% identity) to members of the 'Freshwater Urinary Bladder Clade' sensu Fiala (2006), a clade among the Platysporina containing members of the myxosporean genera Myxobilatus, Hoferellus, Myxidium, Zschokkella and Chloromyxum from freshwater fishes. PMID:21301876

Karlsbakk, Egil; Køie, Marianne



Microvibration: capable of inducing spontaneous contractions in smooth muscles.  


Spontaneous contractions were elicited by the vibration of small amplitude (microvibration) imposed upon the quiescent strips prepared from the ureter and portal vein of dogs. An acceleration of the existing rhythm in the spontaneously contracting strips was also brought about by microvibration. Frequencies and amplitudes of microvibration ranged from 1 to 90 Hz and from 50 to 150 mum, respectively. Imposed cyclic strains were less than 1% at their maximum. Up to the amplitude of 150 mum, the greater the amplitude, the faster the induced rhythm. Stepwise increase of the frequencies up to 30 Hz brought about a gradual acceleration of rhythmicity. At frequencies of above 30 Hz, no appreciable frequency-dependent differences were observable among the responses induced. Local adrenergic mechanism proved to have nothing to do with these effects. PMID:1257247

Azuma, T; Ohhashi, T; Sakaguchi, M



Acardiac amorphous twin with prune belly sequence in the co-twin.  


We describe a twin with acardia acephalus or "Twin Reversed Arterial Perfusion Sequence" and prune belly sequence in the co-twin. In a former quite similar case a prune belly appearance of the co-twin of an acardiac fetus was found to be secondary to the ascites caused by cardiac failure. In the present case, we are dealing with the prune belly sequence as a separate condition, given the fact there were no signs of ascites or cardiac failure. We also found associated anomalies: agenesis of the left ureter and kidney, dysplastic right kidney and anal atresia. Urinary tract obstruction has never been described in the co-twin of an acardiac amorphous fetus. PMID:1877624

Buntinx, I M; Bourgeois, N; Buytaert, P M; Dumon, J E



Weight of uterus in bangladeshi cadaver.  


This cross sectional descriptive study was done to see the weight of uterus in Bangladeshi cadavers to increase the knowledge regarding variational anatomy in our country. Sixty post mortem specimens containing uterus, uterine tube, ureter and surrounding structures were collected by non random or purposive sampling technique from cadavers of different groups and fixed in 10% formol-saline solution. This study was carried out in the Department of Anatomy of Mymensingh Medical College, Mymensingh from July 2006 to June 2007. Gross and fine dissection was carried out to study the weight of uterus. In this study our findings were compared with those of the references. Maximum weight of the uterus was found in age group B (13 to 45 years). It is about 51.35 ± 17.95 gm. PMID:23134908

Ara, Z G; Zaman, K S; Ahmed, M S; Rahman, M M; Sultana, S Z; Mannan, S



An Unusual Extremely Distant Noncommunicating Uterine Horn with Myoma and Adenomyosis Treated with Laparoscopic Hemihysterectomy  

PubMed Central

A 41-year-old woman referred to us with dysmenorrhea and severe pelvic pain although she was previously submitted to right laparotomic adnexectomy for ovarian endometrioma and to a subsequent operative laparoscopy for pelvic adhesions. After ultrasound examination, the patient underwent diagnostic hysteroscopy and operative laparoscopy which confirmed the clinic suspect of an unicornuate uterus. However, it was very unusual to see an extremely distanced right horn, without communication with uterus, without adnexa, and with a small myoma belonging to it. Moreover, omentum and bowel were attached to fundus of right horn and thick adhesions fixed it to rectum and right pelvic wall. Therefore, identification of anatomical structures was difficult, as it was extremely arduous to isolate the ureter, which was involved inside the adhesions surrounding the right uterine horn. Nevertheless, laparoscopic right hemihysterectomy was successfully performed and right horn was sent to our pathologist who recognized hypotrophic endometrium and adenomyosis.

Morelli, Michele; Mocciaro, Rita; Lico, Daniela; Zullo, Fulvio



In vitro binding of type 1-fimbriated Escherichia coli to uroplakins Ia and Ib: relation to urinary tract infections.  

PubMed Central

Urinary tract infections, caused mainly by Escherichia coli, are among the most common infectious diseases. Most isolates of the uropathogenic E.coli can express type 1 and P fimbriae containing adhesins that recognize cell receptors. While P fimbriae recognize kidney glycolipid receptors and are involved in peyelonephritis, the urothelial for type 1 fimbriae were not identified. We show that type 1-fimbriated E. coli recognize uroplakins Ia and Ib, two major glycoproteins of urothelial apical plaques. Anchorage of E. coli to urothelial surface via type 1 fimbriae-uroplakin I interactions may play a role in its bladder colonization and eventual ascent through the ureters, against urine flow, to invade the kidneys. Images Fig. 5

Wu, X R; Sun, T T; Medina, J J



Avulsion of the left renal artery following blunt abdominal trauma in a dog.  


A two-year-old, male, crossbreed dog was presented three days after being involved in a motor vehicle accident. Survey radiographs showed multiple pelvic fractures and poor intraperitoneal and retroperitoneal contrast. Ultrasound indicated the left kidney to be hypoperfused, and a thrombus was visible at the origin of the left renal artery. Ultrasound-guided fine needle aspiration confirmed that free fluid visible in the retroperitoneal and peritoneal spaces was blood. No improvement was seen in the renal perfusion over a 43 hour period, and the intestinal hypomotility worsened over this time. The haemoperitoneum and the haemoretroperitoneum both resolved ultrasonographically within this 43 hour period. Surgery confirmed an avulsion of the left renal artery approximately 10 mm from its origin on the aorta and an avulsion of the left ureter at the ureteropelvic junction. An ureteronephrectomy was performed on the left kidney and the dog recovered uneventfully. PMID:19037893

Millward, I R



Radionuclide studies of chronic schistosomal uropathy  

SciTech Connect

Fifty patients with chronic urinary tract schistosomiasis were studied with /sup 99m/Tc-DTPA. All had a flow study, sequential analog imaging, and digital imaging for 25-35 minutes (20-sec. frames). Time-activity curves (DTPA renograms) were extracted; 12 patients had /sup 131/I-Hippuran probe renograms as well. Renal changes included diminished perfusion and structural abnormalities ranging from minor calyceal dilatation to overt hydronephrosis. Ureteral changes included dilatation, tortuosity, and kinking. Marked distortion of the ureterovesical tunction was seen in some patients due to periureteral and perivesicular fibrosis, which is a major factor in upper urinary tract damage. Renograms showed varying obstruction and parenchymal damage. Nuclear medicine complements excretory urography and is sometimes preferable for visualization of the ureters. After the initial urogram, sequential DTPA scanning and renography are sufficient for follow-up.

Lamki, L.M.; Lamki, N.



Radionuclide studies of chronic schistosomal uropathy. [/sup 99m/Tc-DTPA; /sup 131/I-hippuran  

SciTech Connect

Fifty patients with chronic urinary tract schistosomiasis were studied with /sup 99m/Tc-DTPA. All had a flow study, sequential analog imaging, and digital imaging for 25 to 35 min (20-sec frames). Time-activity curves (DTPA renograms) were extracted; 12 patients had /sup 131/I-Hippuran probe renograms as well. Renal changes included diminished perfusion and structural abnormalities ranging from minor calyceal dilatation to overt hydronephrosis. Ureteral changes included dilatation, tortuosity, and kinking. Marked distortion of the ureterovesical junction was seen in some patients due to periureteral and perivesicular fibrosis, which is a major factor in upper urinary tract damage. Renograms showed varying obstruction and parenchymal damage. Nuclear medicine complements excretory urography and is sometimes preferable for visualization of the ureters. After the initial urogram, sequential DTPA scanning and renography are sufficient for follow-up.

Lamki, L.M.; Lamki, N.



Antibodies directed against renal collecting ducts in sera of human renal allograft recipients.  

PubMed Central

Anatibodies directed against the plasma membrane of renal collecting ducts were found in the sera of two out of 101 renal allograft recipients. The sera also reacted with the epithelium of the renal pelvis, the ureter, the ductus deferens, the skin, the oesophagus, the trachea and the bile ducts of random individuals, indicating that the antibodies were directed against a widespread epithelial antigen. The antibody activity against these structures was removed by absorption of the sera with homogenized renal medullary tissue; absorption with plasma proteins, erythrocytes, spleen leucocytes or platelets did not influence the antibody titers. In the two patients with circulating antibodies, the graft function was unremarkable eight and fifteen months after transplantation, respectively. From this study we conclude that circulating epithelial antibodies directed against the collecting ducts of the graft are of little or no clinical importance. Images FIG. 2

Paul, L C; Van Es, L A; Kalff, M W; Fleuren, G J



Important surgical measures and techniques at cesarean hysterectomy for placenta previa accreta.  


For cesarean hysterectomy with placenta previa accreta, "universally achievable" measures are required. We propose eight measures: (i) placement of intra-iliac arterial occlusion balloon catheters; (ii) placement of ureter stents; (iii) "holding the cervix" to identify the site to be transected; (iv) uterine fundal incision; (v) avoidance of uterotonics; (vi) "M cross double ligation" for ligating the ovarian ligament; (vii) "filling the bladder" to identify the bladder separation site and "opening the bladder" for placenta previa accreta with bladder invasion; and (viii) to continue to clamp the medial side of the parametrium or the cervix or employment of the "double edge pick-up" to ligate it. These eight measures are simple, easy, effective, and thus "universally achievable". PMID:23323568

Matsubara, Shigeki; Kuwata, Tomoyuki; Usui, Rie; Watanabe, Takashi; Izumi, Akio; Ohkuchi, Akihide; Suzuki, Mitsuaki; Nakata, Manabu



Trans-urethral ultrasound (TUUS) imaging for visualization and analysis of the prostate and associated tissues  

NASA Astrophysics Data System (ADS)

Accurate assessment of pathological conditions in the prostate is difficult. Screening methods include palpation if the prostate gland, blood chemical testing, and diagnostic imaging. Trans-rectal Ultrasound (TRUS) is commonly used for the assessment of pathological conditions, however, TRUS is severely constrained by the relative distal location of the imaging probe. Trans-urethral Ultrasound (TUUS) may overcome some limitations of TRUS. A TUUS catheter was used to image the prostate, rectum, bladder, ureter, neuro-vascular bundles, arteries, and surrounding tissue. In addition, 360 degrees rotational scans were recorded for reconstruction into 3D volumes. Segmentation was challenging, however, new techniques such as active contour methods show potential. 3D visualizations, including both volume and surface rendering, were provided to clinicians off-line. On-line 3D visualization techniques are currently being developed. Potential applications of TUUS include: prostate cancer diagnosis and staging as well as image guided biopsy and therapy.

Holmes, David R.; Robb, Richard A.



Diagnosis and management of urinary incontinence and functional fecal incontinence (encopresis) in children.  


The ability to maintain normal continence for urine and stools is not achievable in all children by a certain age. Gaining control of urinary and fecal continence is a complex process, and not all steps and factors involved are fully understood. While normal development of anatomy and physiology are prerequisites to becoming fully continent, anatomic abnormalities, such as bladder exstrophy, epispadias, ectopic ureters, and neurogenic disturbances that can usually be recognized at birth and cause incontinence, will require specialist treatment, not only to restore continence but also to preserve renal function. Most forms of urinary incontinence are not caused by an anatomic or physiologic abnormality and, hence, are more difficult to diagnose and their management requires a sound knowledge of bladder and bowel function. PMID:18794006

Nijman, Rien J M



[Endoscopic methods for the correction of ureteral strictures].  


The comprehensive examination and treatment of 80 patients aged 19 to 63 years with strictures of the ureteropelvic junction (UPJ) and ureter obstruction was performed. 23 patients underwent probing with ureteral stenting, 30 patients underwent balloon dilation of strictures under fluoroscopic guidance, 18 patients--endoureteropielotomy with "cold" knife, 9 patients underwent endoureteropielotomy using holmium laser. Correction of ureteral stricture with the removal of the stone was performed in 6 patients. It was found that efficiency of the methods increases in the following order: balloon dilatation (73.3%), dissection using "cold" knife (77.8%), probing with ureteral stenting (82.6%), and laser endoureteropielotomy (100%). In general, endoscopic correction of ureteral contractions is a minimally invasive treatment option for restoring its continuity, without perfoming traumatic surgery in 80% of patients with UPJ and ureteral strictures, including complicated by stone formation. PMID:23987051

Zuban', O N; Skorniakov, S N; Borodin, É P; Novikov, B I; Madvinski?, I D; Arkanov, L V; Bobykin, E N; Verbetski?, A F; Zhilinski?, D G


Percutaneous sequential bacillus Calmette-Guèrin and mitomycin C for panurothelial carcinomatosis.  


A 59 year old male presented with a 4 month history of lower urinary tract symptoms. Exhaustive urological investigations revealed papillary tumors and carcinoma in situ extending from the prostatic urethra, throughout the bladder, up both ureters and into the renal pelves. Tumors were resected where possible and then bacillus Calmette-Guèrin (BCG) and mitomycin C (MMC) were infused sequentially through bilateral nephrostomy tubes for a total of six BCG and three MMC instillations. Follow up 1 month post treatment demonstrated a complete response which persisted for 2 years. Then there appeared a solitary papillomatous recurrence in the bladder which was successfully resected. Side effects were the occasional fever and BCG induced granulomatous prostatitis which slowly resolved. In conclusion, sequential BCG/MMC instillations were effective treatment for widespread panurothelial carcinomatosis. PMID:16401376

Di Stasi, Savino M; Giannantoni, Antonella; Stephen, Robert L; Storti, Luigi; Attisani, Francesco; Sansalone, Salvatore; Virgili, Guido



Arginine vasotocin: locus of action along the nephron of the ornate dragon lizard, Ctenophorus ornatus.  


The first measurements of AVT-sensitive adenylate cyclase activity in specific segments of the nephron of the Australian arid-zone agamid lizard, Ctenophorus (=Amphibolurus) ornatus, are reported. All sections of the collecting-duct system of this lizard were found to be sensitive to AVT at a concentration of 1 x 10(-6) M. In addition, receptors to AVT were located in the thin-intermediate segment linking proximal and distal convoluted tubules. No significant response to AVT was detected in the glomeruli, in either proximal or distal convoluted tubules, or in the ureter. The physiological significance of these particular segments is discussed in terms of the action of AVT in stimulating water and salt reabsorption in the lizard kidney. PMID:8812398

Bradshaw, F J; Bradshaw, S D



Peristaltic pumping of solid particles immersed in a viscoelastic fluid  

NASA Astrophysics Data System (ADS)

Peristaltic pumping of fluid is a fundamental method of transport in many biological processes. In some instances, particles of appreciable size are transported along with the fluid, such as ovum transport in the oviduct or kidney stones in the ureter. In some of these biological settings, the fluid may be viscoelastic. In such a case, a nonlinear constitutive equation to describe the evolution of the viscoelastic contribution to the stress tensor must be included in the governing equations. Here we use an immersed boundary framework to study peristaltic transport of a macroscopic solid particle in a viscoelastic fluid governed by a Navier-Stokes/Oldroyd-B model. Numerical simulations of peristaltic pumping as a function of Weissenberg number are presented. We examine the spatial and temporal evolution of the polymer stress field, and also find that the viscoelasticity of the fluid does hamper the overall transport of the particle in the direction of the wave.

Chrispell, John; Fauci, Lisa



Neonatal Bartter syndrome and unilateral ectopic renal cyst as new renal causes of hydrops fetalis: two case reports and review of the literature.  


Non-immune hydrops fetalis (NIHF) is a challenging entity as it represents the end stage of several different disorders. Renal and genitourinary causes of NIHF are rare and include congenital renal malformations, tumors and ureter-urethra disorders. Herein, two NIHF cases with different renal causes were presented. The first case that had antenatal NIHF was diagnosed neonatal Bartter syndrome. The second case of NIHF with antenatal large cyst in the surrenal gland area required surgery and ectopic renal cyst was diagnosed. To our best of knowledge, these are the first reports of NIHF associated with neonatal Bartter syndrome and ectopic renal cyst in neonates. Although it may be coincidental, these cases suggest that both neonatal Bartter syndrome and unilateral ectopic renal cyst may cause NIHF development in neonates by several different mechanisms. Therefore, these two rare entities should be suspected in cases of NIHF with similar findings. PMID:23484775

Çetinkaya, Merih; Durmaz, Oguzhan; Büyükkale, Gökhan; Ozbek, Sibel; Acar, Deniz; Kilicaslan, Isin; Kavuncuoglu, Sultan



Bilateral botryoid nephroblastoma: a rare cause of renal failure.  


The authors describe the case of a 16-month-old girl who presented with bilateral hydronephrosis and renal failure secondary to bilateral renal pelvic botryoid Wilms' tumour (nephroblastoma). The term 'botryoid' describes an intrapelvic polypoid renal Wilms tumour, either extending from the renal parenchyma or primarily pelvis-based tumour. Both tumours filled the renal pelvis and extended down the proximal ureter, with no intraparenchymal tumour seen. Bilateral intralobar nephrogenic rests were present. Histological examination demonstrated triphasic nephroblastoma, with focal rhabdomyomatous differentiation of the stromal element bilaterally. Postchemotherapy, the patient underwent bilateral nephrectomy. Post complete resection of her bilateral disease, this patient has had an excellent outcome. This is only the third reported case of bilateral botryoid Wilms' tumour. While the condition is extremely rare, it should be included in the differential diagnosis of a young child with bilateral renal pelvic masses. PMID:22962373

Conlon, Niamh; Teoh, Chia Wei; Pears, Jane; O'Sullivan, Maureen



Ret-dependent cell rearrangements in the Wolffian duct epithelium initiate ureteric bud morphogenesis  

PubMed Central

SUMMARY While the genetic control of renal branching morphogenesis has been extensively described, the cellular basis of this process remains obscure. GDNF/Ret signaling is required for ureter and kidney development, and cells lacking Ret are excluded from the tips of the branching ureteric bud in chimeric kidneys. Here, we find that this exclusion results from earlier, Ret-dependent cell rearrangements in the caudal Wolffian duct, which generate a specialized epithelial domain that later emerges as the tip of the primary ureteric bud. By juxtaposing cells with elevated or reduced Ret activity, we find that Wolffian duct cells compete, based on Ret signaling levels, to contribute to this domain. At the same time, the caudal Wolffian duct transiently converts from a simple to a pseudostratified epithelium, a process that does not require Ret. Thus, both Ret-dependent cell movements and Ret-independent changes in the Wolffian duct epithelium contribute to ureteric bud formation.

Chi, Xuan; Michos, Odysse; Shakya, Reena; Riccio, Paul; Enomoto, Hideki; Licht, Jonathan D.; Asai, Naoya; Takahashi, Masahide; Ohgami, Nobutaka; Kato, Masashi; Mendelsohn, Cathy; Costantini, Frank



Percutaneous Radiofrequency Ablation for Treatment of Recurrent Retroperitoneal Liposarcoma  

SciTech Connect

Percutaneous CT-guided radiofrequency ablation (RFA) is becoming more and more established in the treatment of various neoplasms, including retroperitoneal tumors of the kidneys and the adrenal glands. We report the case of RFA in a patient suffering from the third relapse of a retroperitoneal liposarcoma in the left psoas muscle. After repeated surgical resection and supportive radiation therapy of a primary retroperitoneal liposarcoma and two surgically treated recurrences, including replacement of the ureter by a fraction of the ileum, there was no option for further surgery. Thus, we considered RFA as the most suitable treatment option. Monopolar RFA was performed in a single session with a 2-cm umbrella-shaped LeVeen probe. During a 27-month follow-up period the patient remained free of tumor.

Keil, Sebastian, E-mail:; Bruners, Philipp [RWTH Aachen University, Department of Diagnostic Radiology, University Hospital (Germany); Brehmer, Bernhard [RWTH Aachen University, Department of Urology, University Hospital (Germany); Mahnken, Andreas Horst [RWTH Aachen University, Department of Diagnostic Radiology, University Hospital (Germany)



Uretero-vesico-cervical fistula following a caesarean section: a unique case report.  


A unique combined fistula involving simultaneously the bladder, ureter, and cervix following cesarean section is described. Evaluation, management, and review of the literature regarding this rare and challenging case are reported. This unique case report emphasizes the potential complexity of iatrogenic genitourinary fistulae, suggesting that these might have unexpected morphology and present with multiple fistulous components. It has been demonstrated that concomitant ureteral involvement is estimated to complicate at least 10 % of vesico-vaginal fistulae. Thus, increased awareness of the possibility of complex iatrogenic fistulae and precise evaluation of the upper urinary tract are necessary to accurately define the extent of all fistulous tracts during the initial evaluation. This in turn may enable tailored management of these challenging cases. Moreover, in the case of surgical treatment, an accurate initial definition of fistula morphology may enable a single-stage reconstructive procedure sparing additional interventions and avoiding any potential complications. PMID:22527547

Tsivian, Maria; Tsivian, Matvey; Sidi, A Ami; Tsivian, Alexander



A huge bladder calculus causing acute renal failure.  


We present a 39-year-old man with repeated urinary tract infection and lower abdominal pain. Kidney-ureter-bladder (KUB) and IVU film showed a huge 450-g elliptical pelvic calculus that was surgically removed with excellent results. Surgical intervention by cystolithotomy or endoscopic cystolithotripsy can achieve satisfactory results. Bladder outlet obstruction should be treated simultaneously. Bladder stone is a common disease, but it is rare for such a calculus to be so large as to cause bilateral hydronephrosis. Close follow-up, however, is mandatory because the recurrence of urolithiasis is high in those patients with voiding problems and recurrent urinary infection. To the best of our knowledge, this is the largest bladder stone in a human male. PMID:20033143

Wei, Wuran; Wang, Jia



Reflex anuria following acute cardiac event  

PubMed Central

Background Reflex anuria is an uncommon cause for acute renal failure, which occurs almost always after manipulation or irritation to kidneys, ureter, bladder or other pelvic organs. Case presentation Here we describe a case of acute renal failure due to reflex anuria following acute cardiac event. This patient had background history of urolithiasis. In the absence of other pre renal, renal or post- renal causes for acute kidney injury, we believe reflex anuria is the causative entity for acute renal failure in our patient. Conclusion Acute renal failure due to reflex anuria is related to a reflex mechanism involving arteriolar vasoconstriction and urethral spasm. Patients with reflex anuria can be successfully managed with medical or surgical interventions. Our case suggests that reflex anuria should be considered as one of the differential diagnosis of acute renal failure following acute cardiac event, especially in patients with background urological problem.



Lumbar Pseudomeningocele Causing Hydronephrosis  

PubMed Central

Background/Objective: Pseudomeningocele is most commonly the result of a rent in the meninges during spine surgery. Noniatrogenic causes exist but are rare. Pseudomeningoceles may heal spontaneously, but they may also slowly enlarge. They rarely present as a mass within the abdomen. The objective of this study was to present the first case report of hydronephrosis secondary to lumbar pseudomeningocele. Design: Single case report and literature review. Methods: Single case report. Results: This man had undergone extensive lumbar spine surgery for pain and spondylolisthesis. He subsequently developed a pseudomeningocele that caused hydronephrosis of the left kidney. He was treated with surgical intervention and had resolution of his hydronephrosis and his flank and groin pain. He also had improvement of his back pain. Conclusions: This report shows an unusual cause of hydronephrosis—a pseudomeningocele presenting as an abdominal mass that compressed the ureter.

Hamilton, Rita G; Brown, Steven W; Goetz, Lance L; Miner, Michael



Botryoid Wilms' tumor: a case report and review of the literature  

PubMed Central

Here, we report a new case of botryoid Wilms’ tumor, a 4-year-old boy, who was referred to us with a chief complaint of dysuria and gross hematuria. The computed tomography and radical nephroureterectomy showed that a botryoid sarcoma-like appearance occupied the right renal pelvis and extended into the bladder. Histologic examination further confirmed this case was a mixed type of Wilms’ tumor. In a word, we demonstrated a rare case of botryoid Wilms’ tumor, which extended from the renal pelvis into the ureter and bladder, then some degenerative and necrotic tissue with calcification discharged from urethra. Postoperative adjuvant chemotherapy was executed. At 24-month follow-up, there was no evidence of recurrence.



Retreatment of a patient who presented with synchronous multiple primary colorectal carcinoma: report of a case  

PubMed Central

It is well known that one-stage resection of synchronous multiple primary colorectal carcinoma is an ideal choice if the patient’s physical condition is not bad. Detailed examination of the whole intestinal tract is very important for patients with colorectal cancer, which could prevent patients from receiving repeat treatment to a great extent. We present a case report of a patient with synchronous primary colorectal cancer. Because pre- or intra-operative examination is not sufficient at his first consultation, the patient had undergone multiple operations after receiving chemotherapy, radiotherapy and intestinal stent insertion, which results in peritoneal adhesions formation. The preoperative placement of prophylactic ureteral catheters facilitated recognition of ureters in operation that assure the prevention of ureteral injuries. If not aware of the importance of detailed preoperative examination and standardized treatment can lead to wrong treatment as in this case. Prophylactic ureteral catheters might assist in their immediate recognition.

Jiang, Zheng; Muhammad, Shan



[Retroperitoneal neoformation: case study].  


Retroperitoneal sarcoma represents approximately 12-15% of all sarcomas and between 0.2 and 0.5% of all neoplasia. They very rarely metastasize, and the main cause of death is local recurrence. Radiotherapy and chemotherapy still do not represent valid therapeutic alternatives, therefore radical surgery remains the only valid option. We would like to present the following case of a 48-year-old male patient. After episodes of right-side renal colic, a 19x16x19 cm mass was found, which was palpable in the right quadrants, englobed the right ureter and caused ipsilateral hydroureteronephrosis of medium grade. Surgery allowed total excision of this neoplasm (which was tenaciously attached to various organs), with the sacrifice of the right kidney. The final histological examination on a sample taken during surgery confirmed that the neoplasm was a spindle-cell sarcoma at an intermediate grade of malignancy. One year after surgery the patient is disease free. PMID:21948137

Pettenò, Alberto; Dotti, Paolo; Tralce, Luigi


Laser induced shock wave lithotripsy--biologic effects of nanosecond pulses  

SciTech Connect

Laser energy of a Nd-YAG laser (1064 nm. wave length, 8 nsec pulse duration) was directed against various tissue cultures and the urothelium of the ureter, bladder and kidney parenchyma in pigs. Single pulse energy was 50 to 120 mJ with a repetition rate of 20 Hz. Urothelium and kidney parenchyma were irradiated in seven pigs. Tissue samples were examined histologically and electron microscopically directly, two, four, eight and 12 days after irradiation. No macroscopic lesion could be found. Maximum energy caused a small rupture cone of 40 micron. depth. No thermic effects or necrosis resulted, so that no harm is to be expected with unintentional irradiation during laser stone disintegration.

Hofmann, R.; Hartung, R.; Geissdoerfer, K.A.; Ascherl, R.; Erhardt, W.; Schmidt-Kloiber, H.; Reichel, E.



The role of percutaneous nephrostomy in the management of obstructing candidiasis of the urinary tract in infants.  


We report on 5 neonates with obstructive urinary tract candidiasis in whom percutaneous nephrostomy had a major role in management. The advantages of percutaneous nephrostomy in this setting include prompt drainage of the obstructed renal pelvis or ureter, direct access to obtain specimens from the renal pelvis to confirm the diagnosis, direct irrigation of the fungus balls with amphotericin B and an access route for fragmentation of fungus balls by guide wire manipulation. In 3 cases percutaneous placement of the nephrostomy tube was successful in obtaining and maintaining access to the renal pelvis, while in 2 surgical intervention was required because of problems maintaining placement of the percutaneous catheters. Percutaneous nephrostomy with antegrade amphotericin B irrigation, coupled with systemic antifungal therapy, is the mainstay of treatment. The usefulness of ultrasonography in the early diagnosis of renal candidiasis also is emphasized. PMID:3398131

Bartone, F F; Hurwitz, R S; Rojas, E L; Steinberg, E; Franceschini, R



An epizootic among knots (Calidris canutus) in Florida. I. Disease syndrome, histology and transmission studies.  


About 150 knots found sick or dead had distention of serosal blood vessels, and small, raised hemorrhagic foci on the serosal surface of the jejunum and ileum. The principal finding was endaortitis with large intimal multinucleated cysts that contained a protozoan parasite within a cytoplasmic vacuole. There was endarteritis of mesenteric arteries and muscular arteries of the external layers of the intestinal tract. Single or multiple schizont-like stages containing zoites were in the wall of the small intestine and close to affected muscular arteries. The more usual intestinal lesion was an aneurysm of the inflamed muscular artery. It was concluded that endarteritis led to colonic infarction. Schizonts in medullary renal tubular cells were smaller than stages in the intestine. There was necrosis of epithelial cells of themedullary collecting ducts and inflammatory and regenerative changes. Schizonts and zoites were free in collecting ducts and ureters. PMID:883096

Woodard, J C; Forrester, D J; White, F H; Gaskin, J M; Thompson, N P



Bioresorbable microspheres by spinning disk atomization as injectable cell carrier: from preparation to in vitro evaluation.  


Vesico-ureteral reflux, a common pathology in children, can be treated cystoscopically by injection of a bulking material underneath the most distal, intramural ureter, which forces the latter to do a detour, increasing its submucosal path. This increase of the length of the submucosal path of the ureter within the bladder is directly responsible for the anti-reflux effect. So far Teflon and collagen paste have been commonly used as bulking materials. We suggest replacing these materials by living tissue consisting of bladder smooth muscle, normally present at this location. The aim of this work is to provide a long-term effective treatment by producing bioresorbable microspheres which can act as a support matrix and an entrapment substance for bladder smooth muscle cells, with the goal of an in vivo transfer of the in vitro cultured cells with a minimal surgical procedure. By the use of Spinning Disk Atomization, which has specifically been developed for this purpose, we have shown two methods for the preparation of porous poly(lactic acid) microspheres with tunable sizes from 160 to 320 microm. The controlled solvent burst method has shown the advantage over the crystal leaching method in the direct creation of microspheres with large closed pores, by atomizing the polymer solution in controlled temperature conditions. Microspheres with various closed pore structures have thus been prepared. The innovation of this work is in the direct and rapid formation of porous microspheres with a pore morphology which is designed to create cavities suitable for adherence and growth of cells by adapting the temperature conditions of atomization. Injection tests have shown promising results in using these cell-loaded microspheres for future non-invasive tissue engineering. PMID:10817266

Senuma, Y; Franceschin, S; Hilborn, J G; Tissières, P; Bisson, I; Frey, P



Tolerance of retroperitoneal structures to intraoperative radiation  

SciTech Connect

In conjunction with the clinical development of intraoperative radiotherapy, a study was undertaken in dogs to define the tolerance of normal anatomic structures in the retroperitoneum to radiation delivered during operation. Twenty adult dogs were subjected to laparotomy and intraoperative 11 MeV electron irradiation in single doses ranging from 5000 rad. Animals were followed regularly with clinical observation, blood count, serum chemistries, pyelography, and angiography. Animals were sacrificed and autopsied at regular intervals up to 12 months following treatment to assess radiation-induced complications or tissue damage. Irradiation field in all dogs consisted of a 4 X 15 cm rectangle extending in the retroperitoneum from the level of the renal vessels to the bifurcation of aorta and vena cava. The field included aorta, vena cava, inferior portion of left kidney, and distal portion of left ureter. No complications or histologic changes occurred in any animal given doses of 2000 rad, with a follow-up in excess of 18 months. A dose of 3000 rad was well tolerated, except for left ureteral occlusion in one animal. Mild vascular fibrosis was present inthe aorta and vena cava, and significant ureteral fibrosis developed by six months after doses of 4000 or 5000 rad. All animals that received 5000 rad died of radiation-related complications, including ureteral obstruction and rectal perforation. It was concluded that major vessels tolerate intraoperative irradiation well up to and including 3000 rad and that no clinically significant vascular problems develop after 4000 and 5000 rad, although some fibrosis does occur. The ureter and kidney appear to be the most radiosensitive structures inthe retroperitoneum, showing progressive changes at 300 rad or greater and showing the potential for serious complications after doses of 4000 rad or more.

Sindelar, W.F.; Tepper, J.; Travis, E.L.; Terrill, R.



Human Alpha Defensin 5 Expression in the Human Kidney and Urinary Tract  

PubMed Central

Background The mechanisms that maintain sterility in the urinary tract are incompletely understood. Recent studies have implicated the importance of antimicrobial peptides (AMP) in protecting the urinary tract from infection. Here, we characterize the expression and relevance of the AMP human alpha-defensin 5 (HD5) in the human kidney and urinary tract in normal and infected subjects. Methodology/Principal Findings Using RNA isolated from human kidney, ureter, and bladder tissue, we performed quantitative real-time PCR to show that DEFA5, the gene encoding HD5, is constitutively expressed throughout the urinary tract. With pyelonephritis, DEFA5 expression significantly increased in the kidney. Using immunoblot analysis, HD5 production also increased with pyelonephritis. Immunostaining localized HD5 to the urothelium of the bladder and ureter. In the kidney, HD5 was primarily produced in the distal nephron and collecting tubules. Using immunoblot and ELISA assays, HD5 was not routinely detected in non-infected human urine samples while mean urinary HD5 production increased with E.coli urinary tract infection. Conclusions/Significance DEFA5 is expressed throughout the urinary tract in non-infected subjects. Specifically, HD5 is expressed throughout the urothelium of the lower urinary tract and in the collecting tubules of the kidney. With infection, HD5 expression increases in the kidney and levels become detectable in the urine. To our knowledge, our findings represent the first to quantitate HD5 expression and production in the human kidney. Moreover, this is the first report to detect the presence of HD5 in infected urine samples. Our results suggest that HD5 may have an important role in maintaining urinary tract sterility.

Porter, Edith; Bevins, Charles L.; DiRosario, Julianne; Becknell, Brian; Wang, Huanyu



The 'buoy' stent: evaluation of a prototype indwelling ureteric stent in a porcine model.  


OBJECTIVE To assess a prototype ureteric 'buoy' stent with a 10 F upper body tapering to a 3F tail, developed to potentially reduce stent-related irritative symptoms while providing an adequate mould for healing after endopyelotomy. MATERIALS AND METHODS Eighteen Yucatan minipigs had the stent placed either into the intact ureter (phase I) or after Acucise proximal endoureterotomy (phase II). Buoy stents were compared to 10/7 F endopyelotomy stents and to standard 7 F stents in phases I and II, respectively. The pigs were assessed for vesico-ureteric reflux, hydronephrosis and infection, before stent insertion and at harvest. Stents were weighed before and after placement and the removal force was measured. Pressure/flow studies, antegrade nephrostograms and specimens for histopathology from the renal pelvis, ureter and vesico-ureteric junction (VUJ) were obtained at harvest. RESULTS Thirteen minipigs survived the entire study. Ureteric flow with the stents in situ was better for buoy stents than for 10/7 F stents (P < 0.005). Ureteric flow after endoureterotomy and subsequent stent removal was similar for buoy stents and standard 7 F stents. None of the stents refluxed. There was no difference between stents in removal force, weight change or incidence of hydronephrosis. At 1 and 12 weeks, buoy stents tended to produce lower histopathological alteration scores than control stents, especially at the VUJ (phase I, 2.0 vs 3.9, P = 0.092; phase II, 0.6 vs 1.7, P = 0.18). CONCLUSIONS The novel buoy stents are easily placed and removed via the urethra. They can cause less VUJ inflammation than standard stents while allowing for adequate ureteric flow and healing after proximal endoureterotomy. PMID:19154469

Krebs, Alfred; Deane, Leslie A; Borin, James F; Edwards, Robert A; Sala, Leandro G; Khan, Farhan; Abdelshehid, Corollos; McDougall, Elspeth M; Clayman, Ralph V



Naftopidil and tolterodine in the medical expulsive therapy for intramural ureteral stones: a prospective randomized study.  


We performed a randomized, prospective study to assess the possible role of combined naftopidil and tolterodine for facilitating the spontaneous expulsion of intramural ureteral stones. A total of 76 patients with intramural ureter stones were included in the study from December 2007 to February 2011. Patients were randomized to one of three treatment groups. Group A patients received naftopidil 25 mg/day, group B patients received naftopidil 25 mg/day plus tolterodine 2 mg (twice a day), and group C patients received tolterodine 2 mg (twice a day). Both groups were followed up for 2 weeks. The stone expulsion rate and time and the number of pain episodes were obtained. Subjects rated the urgency associated with each micturition using the Urinary Sensation Scale (USS). Pain descriptions were recorded by the patients using the visual analog scale (VAS). A significant difference was shown for the expulsion rate between the group C and the other two groups (P < 0.001 by log rank test). In groups A, B and C, the mean number of pain episodes was 2.25 ± 0.90, 1.38 ± 1.37 and 1.54 ± 1.18, respectively. The USS score for groups A, B and C at 3 days was 2.32 ± 0.55, 1.4 ± 0.58 and 1.34 ± 0.49, respectively. It was 1.75 ± 0.44, 1.2 ± 0.41 and 1.22 ± 0.42, respectively, at 7 days. On the other hand, a statistically significant difference was found between groups A and B, and groups A and C in relation to the visual analog scale score on days 3 and 7, respectively. Treatment with naftopidil and tolterodine appears to be beneficial in intramural ureteral stones clearance, particularly in the intramural ureter with symptoms of vesical irritability. PMID:22926289

Lu, Jian Lin; Tang, Qing Lai; De Liu, Fa; Hui, Ju Hong



Insufficient joint forces of first-generation articulating instruments for laparoendoscopic single-site surgery.  


Background. The current articulating instruments used in laparoendoscopic single-site surgery do not appear to provide the joint forces required. Thus, we measured the joint forces of first-generation articulating laparoscopic instruments. To compare these forces with those necessary in the surgical context, we evaluated the forces sufficient to produce secure surgical ties in an animal model. Methods. The articulating instruments tested were Laparo-Angle (Cambridge Endoscopic Devices Inc, Framingham, MA), RealHand (Novare Surgical Systems Inc, Cupertino, CA), and Roticulator (Covidien Inc, Mansfield, MA). For each, we measured the angle between the end-effector and the shaft in proportion to the articulating force using a push-pull gauge. Two fixed-position configurations of the instruments were predetermined: the neutral and the fully articulated positions. The forces required to secure surgical ties for the ureter, renal artery, and renal vein were evaluated using kidneys harvested from a female pig. Results. The bending forces required to bend from the neutral position to 30° were 5.6 ± 1.2 and 4.7 ± 1.0 N with the Laparo-Angle and RealHand, respectively. Furthermore, the slippage forces in the fully articulated state were 1.8 ± 0.3, 1.6 ± 0.2, and 1.5 ± 0.2 N in the above order. In contrast, the mean forces to produce surgical ties of the ureter, renal artery, and renal vein were 14.5 ± 2.3, 11.5 ± 0.8, and 10.3 ± 2.3 N, respectively. Conclusion. The joint forces of first-generation articulating instruments for laparoendoscopic single-site surgery are not sufficient to meet the usual operative needs. Improved articulating instruments with greater articulating forces should be developed. PMID:23242516

Jeong, Chang Wook; Kim, Sung Hoon; Kim, Hyung Tae; Jeong, Seong Jin; Hong, Sung Kyu; Byun, Seok-Soo; Lee, Sang Eun



Kidney Development in the Absence of Gdnf and Spry1 Requires Fgf10  

PubMed Central

GDNF signaling through the Ret receptor tyrosine kinase (RTK) is required for ureteric bud (UB) branching morphogenesis during kidney development in mice and humans. Furthermore, many other mutant genes that cause renal agenesis exert their effects via the GDNF/RET pathway. Therefore, RET signaling is believed to play a central role in renal organogenesis. Here, we re-examine the extent to which the functions of Gdnf and Ret are unique, by seeking conditions in which a kidney can develop in their absence. We find that in the absence of the negative regulator Spry1, Gdnf, and Ret are no longer required for extensive kidney development. Gdnf?/?;Spry1?/? or Ret?/?;Spry1?/? double mutants develop large kidneys with normal ureters, highly branched collecting ducts, extensive nephrogenesis, and normal histoarchitecture. However, despite extensive branching, the UB displays alterations in branch spacing, angle, and frequency. UB branching in the absence of Gdnf and Spry1 requires Fgf10 (which normally plays a minor role), as removal of even one copy of Fgf10 in Gdnf?/?;Spry1?/? mutants causes a complete failure of ureter and kidney development. In contrast to Gdnf or Ret mutations, renal agenesis caused by concomitant lack of the transcription factors ETV4 and ETV5 is not rescued by removing Spry1, consistent with their role downstream of both RET and FGFRs. This shows that, for many aspects of renal development, the balance between positive signaling by RTKs and negative regulation of this signaling by SPRY1 is more critical than the specific role of GDNF. Other signals, including FGF10, can perform many of the functions of GDNF, when SPRY1 is absent. But GDNF/RET signaling has an apparently unique function in determining normal branching pattern. In contrast to GDNF or FGF10, Etv4 and Etv5 represent a critical node in the RTK signaling network that cannot by bypassed by reducing the negative regulation of upstream signals.

Michos, Odysse; Cebrian, Cristina; Hyink, Deborah; Grieshammer, Uta; Williams, Linda; D'Agati, Vivette; Licht, Jonathan D.; Martin, Gail R.; Costantini, Frank



Effects of cadmium on the renal and skeletal muscle microcirculation in rats  

SciTech Connect

The effects of cadmium on the arteriolar diameters of the kidney and skeletal muscle were quantified, because of the hypertensive effect of cacmium. The effect of cacmium on the constrictor response of the renal arterioles to angiotensin II (Ang II) were also assessed. In vivo preparations of the rat hydronephrotic kidney and cremaster muscle were used for direct visualization of the microvessels with intravital television microscopy. Hydronephrosis was induced in twenty-seven male Wistar-Kyoto rats (150-180 g) by unilateral ureter ligation. The hydronephrotic kidney, with intact cortical circulation and innervation, was exteriorized in a specially designed bath for microcirculation observation 6-8 weeks following the ureter ligation. The cremaster muscle experiments were conducted in another thirty-seven male WKY rats (120-180 g). Disparate effects of cadmium were observed in these two microcirculation beds. Topical cadmium (1.35 [mu]M-0.45 mM) increased the diameters of the pre- and postglomerular vessels in the hydronephrotic kidney maximally by 15-26%. Cadmium (0.27 mM) inhibited the Ang II response of the arterioles non-competitively. However, intraperitoneally injected cadmium (2 mg/kg), which significantly increased the mean arterial pressure, did not dilate the arterioles nor alter the Ang II response. On the other hand, cadmium (13.5 [mu]M-0.72 mM) constricted the larger arterioles in the cremaster muscle (60-160 [mu]m) concentration-dependently, but not small arterioles (15-30 [mu]m). In summary, topical cadmium dilates renal arterioles and decreases their reactivity to Ang II, but constricts the larger cremaster arterioles. The disparate effects of cadmium suggest different Ca[sup 2+] utilization mechanisms in different vascular beds. The construction of the cremaster arterioles may contribute to cadmium-induced hypertension by increasing peripheral resistance.

Zhang Chong.



Echocontrast cystosonography versus micturating cystourethrography in the detection of vesicoureteric reflux  

PubMed Central

Purpose: To compare echocontrast cystosonography (ECS) using in-vivo agitated saline with fluoroscopic micturating cystourethrography (MCU) in the detection and grading of vesicoureteric reflux (VUR). Materials and methods: This was a prospective study of 25 children, who had MCU between 2007 and 2009. ECS was performed and findings documented prior to MCU. Baseline renal and bladder sonograms were obtained. The bladder was filled with normal saline followed by introduction of 10–20 mls of air to generate microbubbles. Detection of VUR was based on two sonographic criteria: (1) presence of microbubbles in the pelvicaliceal system (PCS), and (2) increase in dilatation of the PCS. VUR was graded as (1) Grade I: microbubbles seen in ureter only; (2) Grade II: microbubbles seen in non-dilated PCS; and (3) Grade III-V: microbubbles seen in dilated PCS. The ECS findings were compared using MCU as the gold standard. Results: Of the 50 kidney-ureter (K-U) units studied, ECS detected 9 of 10 K-U units with VUR on MCU. ECS did not detect a Grade II VUR. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value for criterion 1 was 90%, 87.5%, 88%, 64.3% and 97%, respectively, compared to criterion 2 which was 70%, 90%, 86%, 64% and 92%, respectively. The grading of VUR was similar on both ECS and MCU except for one case. Conclusion: ECS using agitated saline was a sensitive technique for the detection of VUR. ECS grading was comparable with MCU grading of VUR.

Faizah, MZ; Kanaheswari, Y; Thambidorai, CR; Zulfiqar, MA



Regional differences in practice patterns and associated outcomes for upper tract urothelial carcinoma in Canada  

PubMed Central

Introduction: We delineated Canadian regional differences in practice patterns in the management of upper tract urothelial carcinoma (UTUC) after nephroureterectomy and relate these to patient outcomes. Methods: A database was created with 1029 patients undergoing radical nephroureterectomy for UTUC between 1994 and 2009 at 10 Canadian centres. Demographic, clinical and pathological variables were collected from chart review. Practice pattern variables were defined as: open versus laparoscopic nephroureterectomy, management strategy for the distal ureter, performance of lymphadenectomy and administration of chemotherapy and/or radiation therapy. The outcome measures were overall (OS), disease-specific (DSS) and recurrence-free survival (RFS). The centres were divided into three regions (West, Central, East). Cox proportional multivariable linear regression analysis was used to determine the association between regional differences in practice patterns and clinical outcomes. Results: There was a significant difference in practice patterns between regions within Canada for: time from diagnosis to surgery (p = 0.001), type of surgery (open vs. laparoscopic, p < 0.01) and method of management of the distal ureter (p = 0.001). As well, there were significant differences in survival between regions across Canada: 5-year OS (West 70%, Central 81% and East 62%, p < 0.0001) and DSS (West=79%, Central=85%, East=75%, p = 0.007) were significantly different, but there was no difference in RFS (West 47%, Central 48%, East 46%, p = 0.88). Multivariable linear regression analysis demonstrated that the differences in survival were independent of region OS (p = 0.78), DSS (p = 0.30) or RFS (p = 0.43). Conclusion: There is significant disparity in practice patterns between regions within Canada, but these do not appear to have an effect on survival. We believe that the variability in practice is a reflection of the lack of standardized treatments for UTUC and underlines the need for multi-institutional studies in this disease.

Metcalfe, Michael; Kassouf, Wassim; Rendon, Ricardo; Bell, David; Izawa, Jonathan; Chin, Joseph; Kapoor, Anil; Matsumoto, Edward; Lattouf, Jean-Baptiste; Saad, Fred; Lacombe, Louis; Fradet, Yves; Fairey, Adrian; Jacobson, Niels-Eric; Drachenberg, Darryl; Cagiannos, Ilias; So, Alan; Black, Peter



A biomechanical simulation of ureteral flow during peristalsis using intraluminal morphometric data.  


Reflux nephropathy and vesicoureteral reflux are two of the most important abnormalities in the upper urinary system in which toxins and bacteria from the bladder infect the ureter and the kidney and initiate renal scar formation. A quantitative analysis that characterizes urine flow will further help our understanding of the ureter and also assist in the design of flow aided devices such as valves and stents to correct reflux situations. Here, A numerical simulation with fluid-structure interactions (FSI) using arbitrary Lagrangian-Eulerian (ALE) formulation and adaptive mesh procedure was introduced and solved to perform ureteral flow analysis. Incompressible Navier-Stokes equations were utilized as the governing equations of fluid domain. Ureteral in-vivo morphometric data during peristalsis were used to construct the presented model. A nonlinear material model was used to exhibit ureteral wall mechanical properties. Direct coupling method was used to solve the solid, fluid and interface equations simultaneously. Results showed that recirculation regions formed against the jet flow, neighboring the bolus peak. Through wave propagation, separation occurred behind the moving bolus on the wall and ureteropelvic reflux began from that location and extended upstream to the ureteral inlet. The maximum luminal pressure consistently occurred behind the urine bolus during peristalsis. The measured magnitude of maximum volumetric flow rate resulted from isolated bolus transportation was 0.92 ml/min. In conclusion; due to presence of fluid inertial forces during peristalsis, the function of ureteropelvic junction in prevention of reflux is significant, especially at the beginning of peristaltic wave propagation. Moreover, modeling of ureteral function using imaging data will be valuable and it may help physicians to diagnose and cure the abnormalities. PMID:22214750

Vahidi, Bahman; Fatouraee, Nasser



[Symptomatic reflux and stenosis of ureteroenteric anastomosis. Diagnostics and therapy].  


Stenosis of the ureteroenterostomy and symptomatic reflux are among the most dangerous complications of all forms of urinary diversion. Variations in ureter implantation techniques and different surgical expertises are responsible for the heterogeneity of the available prevalence data. Antirefluxive implantation techniques seem to be more vulnerable to stenosis and obstruction than refluxive techniques, although no difference in kidney function deterioration over time was shown according to the presence or absence of reflux protection. Despite frequent controls, approximately one quarter of all obstructed renal units show a complete loss of function. The reimplantation rate of stenotic ureters exceeds 30%.The development of an implantation stenosis may be silent and subtle. The loss of renal function often remains unnoticed if sonography and creatinine measurements are the only follow-up tools employed. Neither of these tests is reliable in estimating kidney function and may mislead both doctor and patient. DMSA scintigraphy and retrograde contrast studies (conduitogram, pouchogram) are the most sensitive tools available to evaluate a symptomatic reflux, whereas MAG-3 renal scans and antegrade function tests (nephrostogram, renal pelvic pressure measurement) are recommended for investigating ureteric obstruction. Stenosis of the ureteroenterostomy usually occurs within 2 years after urinary diversion; delayed occurrence of ureteric obstruction is indicative of malignant local recurrence or compressive metastases.There are various minimally invasive treatment options such as balloon dilatation, internal ureterotomy, stenting and nephrostomy placement. However, the technical challenge of a ureteroenterostomy should not be a deterrent. In fact, if surgically possible, the patient should be offered open revision, since this is the only way to durably cure the underlying pathology and re-establish the already impaired quality of life of patients with urinary diversion as much as possible. PMID:22419010

Hampel, C; Thomas, C; Thüroff, J W; Roos, F



Acoustic performance and clinical use of a fibreoptic hydrophone.  


Initial clinical experience with the use of an optical fibre hydrophone for in vivo ultrasound dosimetry is reported. The hydrophone, originally described by Beard and Mills (1997), operates as an extrinsic, low-finesse Fabry-Perot optical sensor where acoustically-induced thickness changes in a polymer film modulate the phase difference between light beams reflected from the two surfaces of the film. The pressure waveforms from the sensor are compared with those from a calibrated piezoelectric polymer membrane hydrophone. The sensor is found to have a frequency resonance at around 12 MHz, corresponding to the thickness mode of the 50-micron polymer film. The directional responses at 0.16 MHz, 1.0 MHz and 5.0 MHz are found to be similar to those predicted for a plane piston receiver with the same diameter as that of the polymer film (400 microns). The performance of the sensor as a broad-band hydrophone is degraded by the relatively low acoustical impedance of the adhesive used in the fibre-film bond. The hydrophone was used in the clinic for measurement of acoustic pressures within the ureter of 4 patients undergoing clinical extracorporeal shock-wave lithotripsy on a Dornier HM3 lithotripter. Pressures in the range 0.5 to 5.0 MPa were recorded in the ureter at positions over 10 cm from the renal pelvis. Problems related to the clinical use of the sensor, including instability in the sensitivity of the sensor following handling and its mechanical strength in high-amplitude acoustic fields, are discussed. PMID:9483782

Coleman, A J; Draguioti, E; Tiptaf, R; Shotri, N; Saunders, J E



Does tamsulosin change the management of proximally located ureteral stones?  


The objective of this study is to assess the efficacy of an alpha-1 adrenergic receptor blocking agent on the spontaneous passage of proximal ureteral calculi < or =10 mm. 92 patients having single radio-opaque proximal ureteral stone < or =10 mm were randomized into two groups. Group 1 patients (n = 50) were followed with classical conservative approach and patients in Group 2 (n = 42) additionally received tamsulosin, 0.4 mg/day during 4 weeks follow-up. The stone passage rates, stone expulsion time, VAS score, change in colic episodes, and hospital re-admission rates for colicky pain were compared. The patients were furthermore stratified according to stone diameters <5 and 5-10 mm. The data of these subgroups were also compared. Stone expulsion rates showed statistically significant difference between tamsulosin receivers and non-receivers (35.7 vs 30%, p = 0.04). Time to stone expulsion period was also shortened in those receiving tamsulosin (8.4 +/- 3.3 vs 11.6 +/- 4.1 days, p = 0.015). Likewise, the mean VAS score and renal colic episodes during follow-up period were significantly diminished in Group 2 patients (4.5 +/- 2.3 vs 8.8 +/- 2.9, p < 0.01 and 66.6 vs 36%, p = 0.001, respectively). Among the stones <5 mm, tamsulosin receiving patients had higher spontaneous passage rate (71.4 vs 50%, p < 0.001). The prominent effect of tamsulosin on the 5-10 mm stones was the relocation of the stones to a more distal part of ureter (39.3 vs 18.7%, p = 0.001). Administration of tamsulosin in the medical management of proximal ureteral calculi can facilitate the spontaneous passage rate in the stone <5 mm and the relocation of the stones between 5 and 10 mm to more distal part of the ureter. PMID:20182703

Yencilek, Faruk; Erturhan, Sakip; Canguven, Onder; Koyuncu, Hakan; Erol, Bulent; Sarica, Kemal



Vesicoureteral reflux and elimination disorders.  


Two kinds of elimination disorders can be associated with Vesico Ureteral Reflux (VUR): pure bladder elimination disorders or combination of bladder and bowel elimination disorders. An elimination disorder is always a factor which worsens the prognosis of VUR, as it increases the risk of infectious complications and thus presents a threat for the upper urinary tract. Regarding pure bladder elimination disorders, a chronic urine residue is observed in four clinical situations: the syndrome megacystis-mega ureter; the mega bladder without mega ureter, but with VUR; high grade massive VUR without a mega bladder; organic obstructions of the urethra (such as posterior urethral valves.). VUR associated with urine and fecal elimination disorders cover functional pelvi perineal dyscoordination, bladder sphincter dysynergia, disturbances of visceral motricity and anal sphincter function. The most characteristic type is represented by the neuropathic detrusor-sphincter dysfunction; also enter in this category neurogenic non-neurogenic bladders (Hinman's syndrome); However the vast majority of urine and fecal elimination disorders is represented by non neuropathic perineal dyscoordination associating at various degrees: voiding postponement, lack of sphincter relaxation during micturation, interrupted voiding, and constipation. The diagnosis of elimination disorders associated with VUR is based on non invasive investigations such as anamnesis and drinking/voiding chart in children and adolescents, and "four observation test" in infants. Ultrasound and uroflowmetry are also useful tools. Invasive investigations include mainly voiding cystourethrography and urodynamics, ideally combined in video urodynamic studies. The management of urinary and intestinal elimination disorders is based on the prevention of infections, the suppression of the post voiding residual urine and the treatment of an associated constipation. If surgical treatment of VUR is needed, it must be associated to the management of elimination disorders in the peri operative period. In many instances, an appropriate treatment of elimination disorders often leads to the VUR resolution. PMID:18491738

Alova, I; Lottmann, H B



Clinical effectiveness of the PolyScope(TM) endoscope system combined with holmium laser lithotripsy in the treatment of upper urinary calculi with a diameter of less than 2 cm  

PubMed Central

The aim of this study was to evaluate the clinical value of the PolyScope™ endoscope system in the treatment of upper urinary calculi with a diameter of <2 cm. A total of 86 patients hospitalized with upper urinary tract calculi were included. The patients were placed under general or spinal anesthesia and in a lithotomy position. Following the dilation of the ureter, a guide wire was inserted under the direct vision of an F8/9.8 rigid ureteroscope, and an F12/14 flexible ureteral access sheath was positioned along the guide wire. Holmium laser lithotripsy was subsequently performed, using an F8.0 ‘PolyScope’ modular flexible ureteroscope. Plain film of the kidney-ureter-bladder (KUB) was performed 1 day subsequent to the surgery, in order to determine the result of the lithotripsy and the position of the double-J stent which was inserted after after holmium laser lithotripsy. In addition, in certain patients, KUB radiography was performed 2–4 weeks subsequent to the surgery, and extracorporeal shockwave lithotripsy (ESWL) was performed if the diameter of the residual stones was >6 mm. Lithotripsy was successful in 77 patients and the duration of the surgery ranged between 25 and 80 min (mean duration, 42 min). Little bleeding was observed. Three patients presented with a slight fever following the surgery; however, no ureteral perforation, high fever or septicemia was observed among the patients following anti-inflammatory treatment. The stone-free rate (SFR) of the single-pass lithotripsy was 89.5% (77/86) and the SFR with ESWL was 96.5% (83/86). The study demonstrated that the F8 modular flexible ureteroscope was safe, convenient and effective for the lithotripsy of upper-tract calculi.




Absence of Canonical Smad Signaling in Ureteral and Bladder Mesenchyme Causes Ureteropelvic Junction Obstruction  

PubMed Central

Obstruction of the ureteropelvic junction (UPJ) is a common congenital anomaly frequently associated with ureteral defects. To study the molecular mechanisms that modulate ureteral development, we inactivated Smad4, the common Smad critical for transcriptional responses to TGF-? and Bmp signaling, in the ureteral and bladder mesenchyme during embryogenesis. Loss of canonical Smad signaling in these tissues caused bilateral UPJ obstruction and severe hydronephrosis beginning at embryonic day 17.5. Despite a reduction in quantity of ureteral smooth muscle, differentiation proceeded without Smad4, producing a less severe phenotype than Bmp4 mutants; this finding suggests that at least some Bmp4 functions in ureteral smooth muscle may be Smad-independent. The absence of canonical Smad signaling in the ureteral mesenchyme, but not in the urothelium itself, led to urothelial disorganization, highlighting the importance of mesenchymal support for epithelial development. Transcript profiling revealed altered expression in known Bmp targets, smooth muscle-specific genes, and extracellular matrix-related genes in mutant ureters before the onset of hydronephrosis. Expression of the Bmp target Id2 was significantly lower in Smad4 mutants, consistent with the observation that Id2 mutants develop UPJ obstruction. In summary, Smad4 deficiency reduces the number and contractility of ureteral smooth muscle cells, leading to abnormal pyeloureteral peristalsis and functional obstruction. The subsequent bending and luminal constriction of the ureter at the UPJ marks the transition from a functional obstruction to a more intractable physical obstruction, suggesting that early intervention for this disease may prevent more irreversible damage to the urinary tract.

Tripathi, Piyush; Wang, Yinqiu; Casey, Adam M.



Treatment of ureteral stones: A prospective randomized controlled trial on comparison of Ho:YAG laser and pneumatic lithotripsy  

PubMed Central

Objectives: To study the treatment of ureteric stones by HO:YAG laser lithotripsy and pneumatic lithotripsy and to evaluate the results of the two treatment modalities to assess effectiveness and complications. Materials and Methods: Over 1-year period, a total of 79 patients with 82 ureteral stones were randomized into two groups. In group 1 (39 cases with 41 ureteral stones) ureteroscopic HO:YAG laser lithotripsy was performed using a rigid 8 Fr-ureteroscope (LL group). In group 2 (40 cases with 41 ureteral stones) pneumatic lithotripsy was performed in like manner. Efficacy safety and complications in both groups were analyzed. Results: A total of 79 patients with 82 calculi were treated. Two cases in LL group and one in PL group had bilateral ureteral stones. Mean stone size was 12.07 mm in LL group and 10.2 mm in PL group. Stones located in lower ureter in 30 cases on LL group and 29 cases in PL group. Proximal migration of stone occurred in 1 case on LL group and in 3 cases on PL group. Successful fragmentation occurred in 37 cases on LL group and in 30 cases on PL group. Stone-free rate after 1 month in the base of Kidney Ureter Bladder (KUB) and sonography was 95% in LL group and 80.5% in PL group. Ureteral perforation, urinoma, and urosepsis were not seen in both groups. Conclusion: HO:YAG laser has advantages over PL in high efficacy of stone fragmentation and a low-retrograde migration of ureteral stone treatment. Other complication of ureteral stone treatment with LL and PL are the same and very rare.

Maghsoudi, Robab; Amjadi, Mohsen; Norizadeh, Davood; Hassanzadeh, Hassan



Ureteroscopic Management of Chronic Unilateral Hematuria: A Single-Center Experience over 22 Years  

PubMed Central

Objective To analyze the short and long term safety and efficacy of ureteroscopic evaluation and management of chronic unilateral hematuria. Methods We retrospectively reviewed patients with chronic unilateral hematuria from 1987 to 2008. The distal to middle ureter was evaluated with a semi-rigid ureteroscope without a guidewire. Subsequently, the flexible ureteroscope was advanced into the upper ureter to the renal pelvis using a low-pressure automated irrigant system (Uromat™). Lesions identified ureteroscopically were treated with diathermy fulguration. Results One hundred and four (56 male, 48 female) patients were identified, with a median age of 37 (14–80) years and median follow-up of 139 (34–277) months. The median preoperative duration of gross hematuria was 5 (1–144) months. Endoscopic findings included 61 (56%) minute venous rupture (MVR; a venous bleeding without clear abnormalities), 21 (20%) hemangioma (vascular tumor-like structure), 3 (3%) varix (tortuous vein), 1 (1%) calculus and 18 (17%) no lesions. The incidence of “no lesions” was less in the recent 12 years (9%) than the first 10 years (27%), while the incidence of MVR increased from 40 to 66% (p<0.05). All patients were treated endoscopically. Immediate success rate was 96% (100% in the recent 12 years). Long-term recurrent gross hematuria rate was 7%. Six resolved spontaneously and only 1 required ureteroscopy, revealing a different bleeding site. Conclusion Ureteroscopy and diathermy fulguration is highly useful for evaluation and treatment of chronic unilateral hematuria. Sophisticated technique and improved instrumentation contributes to a better outcome.

Araki, Motoo; Uehara, Shinya; Sasaki, Katsumi; Monden, Koichi; Tsugawa, Masaya; Watanabe, Toyohiko; Monga, Manoji; Nasu, Yasutomo; Kumon, Hiromi



Ureteral blockade sensitizes to the generalized Shwartzman reaction.  

PubMed Central

Renal cortical necrosis (RCN) has been reported in the normal kidney of patients with a contralateral ureteral occlusion (UO). So far, studies have examined the mechanisms protecting the affected kidney from glomerular thrombosis and cortical necrosis; but to the authors' knowledge, none has ever investigated the potential role of UO on the occurrence of the associated disseminated intravascular coagulation (DIC) episode leading to RCN. Female rats with a ligature of the right or left ureter were given injections, at different times after surgery, of 400 micrograms Salmonella typhosa 0901 endotoxin. Other experimental groups included normal and sham-operation rats and animals with a unilateral nephrectomy or with one kidney rendered ischemic by complete ligature of the renal vessels and of the ureter. All the animals were sacrificed 4 hours after endotoxin, and kidney sections stained with PTAH were examined for the presence of fibrin thrombi. Glomerular thrombosis was never observed in any hydronephrotic kidney, but occurred with a low incidence (16%) in the contralateral organ in the group given endotoxin the second day after UO. The incidence and severity of glomerular capillary thrombosis gradually increased in the normal kidney as the delay between surgery and endotoxin was prolonged; the incidences (P less than 0.01) were 45% and 83%, respectively, after 6 and 10 days. Endotoxin failed totally to initiate the lesion 1 day after UO as well as in normal, sham-operation and unilaterally nephrectomized rats, and in animals with combined UO and ligature of the renal circulation. We conclude that the perfused hydronephrotic kidney liberates a factor(s) that sensitizes to DIC and glomerular thrombosis, typical of the generalized Shwartzman reaction. Images Figure 1

Latour, J. G.; Leger-Gauthier, C.



How Safe is High-Power Ultrasonic Dissection?  

PubMed Central

Objective To evaluate the safety of ultrasonic dissection. Summary Background Data High-power ultrasonic dissection is in widespread use for both open and laparoscopic operations and is generally perceived to carry a low risk of collateral damage, but there is no published evidence for this. Methods Under controlled experimental conditions, ultrasonic dissections were performed in pigs using Ultracision (Ethicon) or Autosonix (Tyco/USSC) at the three power settings (3, 4, and 5) in random fashion to mobilize the cardia and fundus, bile duct, hepatic artery, portal vein, aorta from the inferior vena cava, renal vessels, colon, and ureters. The dissections (open and laparoscopic) were carried out on pigs at each power setting with each device. Thermal mapping of the tissues during dissection was performed with an infrared thermal camera and associated software. The animals were killed at the end of each experiment and specimens were harvested for quantitative histology. Results Extreme and equivalent temperature gradients were generated by ultrasonic dissection with both systems. Heat production was directly proportional to the power setting and the activation time. The core body temperature of the animals after completion of the laparoscopic dissections rose by an average of 2.3°C. The zone around the jaws that exceeded 60°C with continuous ultrasonic dissection for 10 to 15 seconds at level 5 measured 25.3 and 25.7 mm for Ultracision and Autosonix, respectively. At this power setting and an activation time of 15 seconds, the temperature 1.0 cm away from the tips of the instrument exceeded 140°C. Although there was no discernible macroscopic damage, these thermal changes were accompanied by significant histologic injury that extended to the media of large vessels and caused partial- to full-thickness mural damage of the cardia, ureter, and bile duct. Collateral damage was absent or insignificant after dissections at power level 3 with both systems and an activation time not exceeding 5 seconds. Conclusions High-power ultrasonic dissections at level 5 and to a lesser extent level 4 result in considerable heat production that causes proximity collateral damage to adjacent tissues when the continuous activation time exceeds 10 seconds. Ultrasonic dissections near important structures should be conducted at level 3. At power levels of 4 and 5, the ultrasonic energy bursts to the tissue should not exceed 5 seconds at any one time.

Emam, Tarek A.; Cuschieri, Alfred



Risks of Primary Extracolonic Cancers Following Colorectal Cancer in Lynch Syndrome  

PubMed Central

Background Lynch syndrome is a highly penetrant cancer predisposition syndrome caused by germline mutations in DNA mismatch repair (MMR) genes. We estimated the risks of primary cancers other than colorectal cancer following a diagnosis of colorectal cancer in mutation carriers. Methods We obtained data from the Colon Cancer Family Registry for 764 carriers of an MMR gene mutation (316 MLH1, 357 MSH2, 49 MSH6, and 42 PMS2), who had a previous diagnosis of colorectal cancer. The Kaplan–Meier method was used to estimate their cumulative risk of cancers 10 and 20 years after colorectal cancer. We estimated the age-, sex-, country- and calendar period–specific standardized incidence ratios (SIRs) of cancers following colorectal cancer, compared with the general population. Results Following colorectal cancer, carriers of MMR gene mutations had the following 10-year risk of cancers in other organs: kidney, renal pelvis, ureter, and bladder (2%, 95% confidence interval [CI] = 1% to 3%); small intestine, stomach, and hepatobiliary tract (1%, 95% CI = 0.2% to 2%); prostate (3%, 95% CI = 1% to 5%); endometrium (12%, 95% CI = 8% to 17%); breast (2%, 95% CI = 1% to 4%); and ovary (1%, 95% CI = 0% to 2%). They were at elevated risk compared with the general population: cancers of the kidney, renal pelvis, and ureter (SIR = 12.54, 95% CI = 7.97 to 17.94), urinary bladder (SIR = 7.22, 95% CI = 4.08 to 10.99), small intestine (SIR = 72.68, 95% CI = 39.95 to 111.29), stomach (SIR = 5.65, 95% CI = 2.32 to 9.69), and hepatobiliary tract (SIR = 5.94, 95% CI = 1.81 to 10.94) for both sexes; cancer of the prostate (SIR = 2.05, 95% CI = 1.23 to 3.01), endometrium (SIR = 40.23, 95% CI = 27.91 to 56.06), breast (SIR = 1.76, 95% CI = 1.07 to 2.59), and ovary (SIR = 4.19, 95% CI = 1.28 to 7.97). Conclusion Carriers of MMR gene mutations who have already had a colorectal cancer are at increased risk of a greater range of cancers than the recognized spectrum of Lynch syndrome cancers, including breast and prostate cancers.



Lessons we learn from review of urological procedures performed during three decades in a spinal cord injury patient: a case report  

PubMed Central

Background We review urological procedures performed on a spinal cord injury patient during three decades. Case presentation A 23-year-old male patient sustained T-12 paraplegia in 1971. In 1972, intravenous urography showed both kidneys functioning well; division of external urethral sphincter was performed. In 1976, reimplantation of left ureter (Lich-Gregoir) was carried out for vesicoureteric reflux. As reflux persisted, left ureter was reimplanted by psoas hitch-Boari flap technique in 1978. This patient suffered from severe pain in legs; intrathecal injection of phenol was performed twice in 1979. The segment bearing the scarred spinal cord was removed in September 1982. This patient required continuous catheter drainage. Deep median sphincterotomy was performed in 1984. As the left kidney showed little function, left nephroureterectomy was performed in 1986. In an attempt to obviate the need for an indwelling catheter, bladder neck resection and tri-radiate sphincterotomy were carried out in 1989; but these procedures proved futile. UroLume prosthesis was inserted and splinted the urethra from prostatic apex to bulb in October 1990. As mucosa was apposing distal to stent, in November 1990, second UroLume stent was hitched inside distal end of first. In March 1991, urethroscopy showed the distal end of the distal stent had fragmented; loose wires were removed. In April 1991, this patient developed sweating, shivering and haematuria. Urine showed Pseudomonas. Suprapubic cystostomy was performed. Suprapubic cystostomy was done again the next day, as the catheter was pulled out accidentally during night. Subsequently, a 16 Fr Silastic catheter was passed per urethra and suprapubic catheter was removed. In July 1993, Urocoil stent was put inside UroLume stent with distal end of Urocoil stent lying free in urethra. In September 1993, this patient was struggling to pass urine. Urocoil stent had migrated to bladder; therefore, Urocoil stent was removed and a Memotherm stent was deployed. This patient continued to experience trouble with micturition; therefore, Memotherm stent was removed. Currently, wires of UroLume stent protrude in to urethra, which tend to puncture the balloon of urethral Foley catheter, especially when the patient performs manual evacuation of bowels. Conclusion We failed to implement intermittent catheterisation along with anti-cholinergic therapy. Instead, we performed several urological procedures with unsatisfactory outcome; the patient lost his left kidney. We believe that honest review of clinical practice will help towards learning from past mistakes.



Hydrodissection using an iodinated contrast medium during percutaneous renal cryoablation.  


We describe our experience using an iodinated contrast solution to hydrodissect adjacent structures before percutaneous renal cryoablation. Hydrodissection was performed before cryoablation with placement of a 20-gauge, 15-cm introducer needle into the retroperitoneum under CT or ultrasonographic guidance followed by infusion of 5% dextrose in water and 2% iodinated contrast between the kidney and the adjacent organ. Ten patients underwent hydrodissection with an iodinated contrast solution at our institution. The mean tumor size was 3.1 ± 1.2 cm. The organs displaced included colon (n=7), small bowel (n=1), pancreas (n=1), and in one case, both the colon and ureter were displaced. The average displacement of all organs from the kidney was 2.8 cm (range 2.2-3.5 cm). There were no complications and no injuries to any adjacent structures. The injection of iodinated contrast allows for safe mobilization and differentiation of adjacent structures from the renal tumor and parenchyma leading to potentially safer cryoablation. PMID:22332600

Patel, Sutchin R; Hinshaw, J Louis; Lubner, Meghan G; Lubne, Meghan G; Lee, Fred T; Nakada, Stephen Y; Hedican, Sean P



Urothelial signaling.  


The urothelium, which lines the inner surface of the renal pelvis, the ureters, and the urinary bladder, not only forms a high-resistance barrier to ion, solute and water flux, and pathogens, but also functions as an integral part of a sensory web which receives, amplifies, and transmits information about its external milieu. Urothelial cells have the ability to sense changes in their extracellular environment, and respond to chemical, mechanical and thermal stimuli by releasing various factors such as ATP, nitric oxide, and acetylcholine. They express a variety of receptors and ion channels, including P2X3 purinergic receptors, nicotinic and muscarinic receptors, and TRP channels, which all have been implicated in urothelial-neuronal interactions, and involved in signals that via components in the underlying lamina propria, such as interstitial cells, can be amplified and conveyed to nerves, detrusor muscle cells, and ultimately the central nervous system. The specialized anatomy of the urothelium and underlying structures, and the possible communication mechanisms from urothelial cells to various cell types within the bladder wall are described. Changes in the urothelium/lamina propria ("mucosa") produced by different bladder disorders are discussed, as well as the mucosa as a target for therapeutic interventions. PMID:23589830

Birder, Lori; Andersson, Karl-Erik



Renal scarring and vesicoureteric reflux.  

PubMed Central

A review of 105 children with urinary tract infection showed an increasing prevalence of grades II-III vesicoureteric reflux with diminishing age. During infancy reflux was almost always severe, and affected boys as often as girls. Radiologically scarred kidneys were drained by refluxing ureters in 98% of cases. The prevalence of scars also rose significantly with increasinglyly severe reflux. Deterioration of existing scars or new scar formation was seen in 15 children; 18 out of 20 affected kidneys (90%) were associated with grade III vesicoureteric reflux. 2 out of 5 children who developed new scars did so after 5 years of age. Because severe reflux may occasionally be seen in the presence of a normal intravenous urogram, and since the finding of grades II-III vesicoureteric reflux is an indication for chemoprophylaxis, we consider cystourethrography essential in children of all ages with recurrent urinary tract infection. In children under 5 years the increased prevalence of both severe reflux and renal scarring are arguments for regarding cystourethrography as a necessary initial investigation. Images Fig. 1 p213-a Fig. 2 Fig. 3 Fig. 4 p216-b

Shah, K J; Robins, D G; White, R H



Embryology and anatomy of the vesicoureteric junction with special reference to the etiology of vesicoureteral reflux  

PubMed Central

Concerning the ureterovesical junction – the region most important for the anti-reflux mechanism – there is still a lot of misunderstanding and misinterpretation with regard to normal fetal development. Data are scarce on possible causes of primary vesicoureteral reflux and on involved mechanisms of the so-called maturation process of refluxing ureteral endings. The ratio of the intravesical ureteral length to the ureteral diameter is obviously lower than assumed so far, as clearly revealed by some studies. Therefore it can be doubted that the length and course of the intravesical ureter is of sole importance in the prevention of reflux. Additionally refluxing intravesical ureteral endings present with dysplasia, atrophy, and architectural derangement of smooth muscle fibers. Besides, a pathologically increased matrix remodeling combined with deprivation of the intramural nerve supply has been confirmed. Consequently, symmetrical narrowing of the very distal ureteral smooth muscle coat creating the active valve mechanism to defend reflux is not achievable. It is apparent that primary congenital vesicoureteral reflux seems to be the result of an abnormality within the ureterovesical junction with an insufficient muscular wrap. Nature is believed to establish much more sophisticated mechanisms than the so-called passive anti-reflux mechanism. Remodeling processes within the ureterovesical junction of refluxing ureteral endings support that maturation itself is nothing else than wound or defect healing and not a restitution of a morphological normal ureterovesical junction. Lacking the nerve supply a restoration of any muscular structure can not be achieved.

Radmayr, Christian; Schwentner, Christian; Lunacek, Andreas; Karatzas, Anastasios; Oswald, Josef



Reoperative ureteroneocystostomy: review of 69 patients.  


Reoperative ureteroneocystostomy in 69 patients with primary vesicoureteral reflux was reviewed. Of the renal units 49 were obstructed and 48 had reflux. Postoperative obstruction was caused by mechanical factors in 61 per cent of the renal units, distal ureteral scarring in 31 per cent and a previously unrecognized functionally neurogenic bladder (without a neurological lesion) in 8 per cent. Persistent postoperative reflux was secondary to a short submucosal tunnel in 94 per cent of the renal units and occult neurogenic bladder in 6 per cent. Reoperative ureteroneocystostomy was successful in 79 per cent of the renal units, with a mean followup of 33 months. The modified Paquin technique (omitting the ureteral cuff) yielded consistently superior results in children undergoing reoperation for ureterovesical junction obstruction. In patients with postoperative vesicoureteral reflux a variety of techniques produced similar and gratifying results. That 52 per cent of our patients had no symptoms indicates clearly the absolute necessity of careful followup after ureteral reimplantation. Furthermore, 20 per cent of our patients had late failure (4 to 10 years after initial ureteroneocystostomy), which suggests the need for careful monitoring of the reimplanted ureter past puberty. PMID:3973988

Mesrobian, H G; Kramer, S A; Kelalis, P P



Low contrast dose voiding urosonography in children with phase inversion imaging.  


Voiding urosonography (VUS) using a microbubble contrast agent has been introduced as an alternative technique in the diagnosis of vesicoureteral reflux (VUR). This study was undertaken to assess if phase inversion ultrasound (PIUS), a recent microbubble specific imaging technique, has advantages over fundamental in VUS and if it allows a reduction of contrast agent dose. Forty-three children with suspected VUR (aged 3 days-12 years, average of 3.9 years) with 92 kidney-ureter units (KUU) were included. Everyone obtained a baseline US scan that was followed by VUS using Levovist as the contrast agent. Constant switching between fundamental and PIUS performed the enhanced part for comparison. Every child underwent VCUG immediately afterwards. Contrast enhancement was stronger and longer lasting on PIUS than on fundamental US in all 43 cases. Reflux was detected in a total of 21 KUU, out of 92 KUU (23%). PIUS revealed VUR in 18; fundamental in 14 KUU and VCUG depicted 16 cases of reflux (p> or =0.29). The mean volume of Levovist dose administered to the bladder was 7.4+/-3.4% of the bladder volume. VUS using PI mode provided considerably stronger and longer enhancement and slightly improved the detection of VUR. It allowed a reduction of contrast dose and cost by approximately 35% over current dose recommendations for fundamental US. PMID:15232711

Kopitzko, Andrea; Cornely, Daniel; Reither, Klaus; Wolf, Karl-Jürgen; Albrecht, Thomas



Renin-angiotensin system in ureteric bud branching morphogenesis: insights into the mechanisms.  


Branching morphogenesis of the ureteric bud (UB) is a key developmental process that controls organogenesis of the entire metanephros. Notably, aberrant UB branching may result in a spectrum of congenital anomalies of the kidney and urinary tract (CAKUT). Genetic, biochemical and physiological studies have demonstrated that the renin-angiotensin system (RAS), a key regulator of the blood pressure and fluid/electrolyte homeostasis, also plays a critical role in kidney development. All the components of the RAS are expressed in the metanephros. Moreover, mutations in the genes encoding components of the RAS in mice or humans cause diverse types of CAKUT which include renal papillary hypoplasia, hydronephrosis, duplicated collecting system, renal tubular dysgenesis, renal vascular abnormalities, abnormal glomerulogenesis and urinary concentrating defect. Despite widely accepted role of the RAS in metanephric kidney and renal collecting system (ureter, pelvis, calyces and collecting ducts) development, the mechanisms by which an intact RAS exerts its morphogenetic actions are incompletely defined. Emerging evidence indicates that defects in UB branching morphogenesis may be causally linked to the pathogenesis of renal collecting system anomalies observed under conditions of aberrant RAS signaling. This review describes the role of the RAS in UB branching morphogenesis and highlights emerging insights into the cellular and molecular mechanisms whereby RAS regulates this critical morphogenetic process. PMID:21359618

Yosypiv, Ihor V



[Neisseria gonorrhoeae culture: development of an easy method].  


An easy and cheap method for culturing Neisseria is developed. The medium for gonococci is prepared as proposed by the producer (BBL, Oxoid, Hoechst). About 8 ml of the medium are poured in sterile air-tight stool tubes of 25 ml volume. Materials to be examined for gonococci are taken from the cervix, ureter or anus and are inoculated on the medium. A small piece (20-30 mg) of the GasPak tablet (BBL) is then deposited in the tube and closed immediately. The GasPak tablet consists of sodium bicarbonate and citric acid which, if they come in contact with humidity, produce CO2 gas. The inoculated tube is then put in an incubator at 37 degrees C for 14-24 h. This method gives a good microbiological result. With the aid of the oxidase reaction the colonies take a brown-black color. For further differentiation of the species the sugar fermentation method is necessary. PMID:405261

Itani, Z S



Do New Vessel Sealing Devices and Harmonic Ace Increase Ureteric Injury in Total Laparoscopic Hysterectomy?  

PubMed Central

Objectives: To compare the risk of ureteric injury in total laparoscopic hysterectomy (TLH) using new vessel sealing devices (VSDs) and harmonic scalpel with simple scissors, bipolar and suturing. This was an evaluation of 1209 cases, carried out from May 1999 to April 2010. Design and Setting: A retrospective comparative study was carried out at a tertiary gynecological endoscopic unit. Materials and Methods: Out of 1209 patients, who had hysterectomies for various indications, TLH was done in 892 patients, 273 had vaginal hysterectomy and 44 had abdominal hysterectomy. We evaluated the incidence of ureteric injury in these cases. Results: There was no mortality. In the group of vaginal and abdominal hysterectomy, there were no ureteric injuries. In the TLH group, we had 390 cases with simple scissors, bipolar and suturing with no ureteric injury. In 502 cases, new VSDs, e.g., plasma kinetic gyrus, Martin Maxim with Robi grasper, with or without harmonic 5 mm scalpel/ace were used. There were five ureteric injuries, all on the right side (one double ureter): first case was with Martin Maxim and Robi grasper, two with plasma kinetic gyrus 10 mm trissector, one with harmonic scalpel and the last one with scissors. We evaluated the reasons for such ureteric injuries, with experienced laparoscopic surgeons and the best possible set up. There were seven conversions to open surgery out of 892 cases of TLH, more due to poor case selection.

Trivedi, Prakash; D'Costa, Sylvia; Shirkande, Preeti; Wahi, Meenu; Kumar, Shilpi



Laparoscopic trocar port site endometriosis: a case report and brief literature review.  


Endometriosis is defined as the presence of ectopic endometrial tissue outside the lining of the uterine cavity. It occurs most commonly in pelvic sites such as ovaries, cul-de-sac, and fallopian tubes but also can be found associated with the lungs, bowel, ureter, brain, and abdominal wall. Abdominal wall endometriosis, also known as scar endometriosis, is extremely rare and mainly occurs at surgical scar sites. Although many cases of scar endometriosis have been reported after a cesarean section, some cases of scar endometriosis have been reported after an episiotomy, hysterectomy, appendectomy, and laparoscopic trocar port tracts. To our knowledge, 14 case reports related to trocar site endometriosis have been published in the English language literature to date. Herein, we present the case of a 20-year-old woman (who had been previously operated on for left ovarian endometrioma 1.5 years ago by laparoscopy) with the complaint of a painful mass at the periumbilical trocar site with cyclic pattern. Consequently, although rare, if a painful mass in the surgical scar, such as the trocar site, is found in women of reproductive age with a history of pelvic or obstetric surgery, the physician should consider endometriosis. PMID:23102079

Emre, Arif; Akbulut, Sami; Yilmaz, Mehmet; Bozdag, Zehra


Appendicolithiasis causing diagnostic dilemma: a rare cause of acute appendicitis (report of a case).  


Appendicolithiasis is a condition characterized by a concretion in the vermiform appendix. Appendicoliths are found in 10% of patients with acute appendicitis, but they are seen more frequently in perforated appendicitis and in abscess formation. We herein report a case of acute appendicitis due to appendicolithiasis, which mimics acute disorders of the genitourinary tract and causes diagnostic confusion. A38- year-old man presented to our emergency department with a history of intense, acute, recurrent, crampy right lower quadrant pain radiating to the right groin region, accompanied by nausea. Physical examination revealed muscular defense and rebound tenderness in the right lower quadrant, tenderness in the line of the right ureter and right costovertebral angle tenderness. On X-ray examination, a right kidney stone was identified as was an incidental 3-cm density in the right lower quadrant. The patient underwent appendectomy. The diagnosis was made by operation and also X-ray examination of the appendectomy material showing appendicolithiasis. Acute appendicitis may manifest as a variety of genitourinary disorders. The possibility of an appendicolith with or without acute appendicitis must always be considered in the differential diagnosis of acute lower abdominal and pelvic disorders, and in the consideration of common acute urological disorders. PMID:18988058

Teke, Zafer; Kabay, Burhan; Erbi?, Halil; Tuncay, Omer Levent



Radiation-induced endometriosis in Macaca mulatta  

SciTech Connect

Female rhesus monkeys received whole-body doses of ionizing radiation in the form of single-energy protons, mixed-energy protons, X rays, and electrons. Endometriosis developed in 53% of the monkeys during a 17-year period after exposure. Incidence rates for endometriosis related to radiation type were: single-energy protons, 54%; mixed-energy protons, 73%; X rays, 71%; and electrons, 57%. The incidence of endometriosis in nonirradiated control monkeys was 26%. Monkeys exposed to single-energy protons, mixed-energy protons, and X rays developed endometriosis at a significantly higher rate than control monkeys (chi 2, P less than 0.05). Severity of endometriosis was staged as massive, moderate, and minimal. The incidence of these stages were 65, 16, and 19%, respectively. Observations of clinical disease included weight loss in 43% of the monkeys, anorexia in 35%, space-occupying masses detected by abdominal palpation in 55%, abnormal ovarian/uterine anatomy on rectal examination in 89%, and radiographic evidence of abdominal masses in 38%. Pathological lesions were endometrial cyst formation in 69% of the monkeys, adhesions of the colon in 66%, urinary bladder in 50%, ovaries in 86%, and ureters in 44%, focal nodules of endometrial tissue throughout the omentum in 59%, and metastasis in 9%. Clinical management of endometriosis consisted of debulking surgery and bilateral salpingo-oophorectomy combined in some cases with total abdominal hysterectomy. Postoperative survival rates at 1 and 5 years for monkeys recovering from surgery were 48 and 36%, respectively.

Fanton, J.W.; Golden, J.G. (USAF School of Aerospace Medicine, Brooks AFB, TX (USA))



Diagnostic accuracy of magnetic resonance voiding cystourethrography for detecting vesico-ureteral reflux in children and adolescents  

PubMed Central

Background: The purpose of the present study is to determine the accuracy of magnetic resonance voiding cystourethrography (MRVCUG) for diagnosis of vesicoureteral reflux (VUR) in children and adolescents with recurrent urinary tract infection (UTI). Materials and Methods: During the cross-sectional study from May 2009 to June 2011, 30 patients’ (60 kidney-ureter units) MRVCUG findings by 1.5 T magnetic resonance imaging (MRI) were compared with voiding cystourethrography (VCUG) findings in patients with urinary tract infection. The sensitivity, specificity, positive and negative predictive values for MRVCUG were calculated. Findings: The sensitivity, specificity, positive and negative predictive values and accuracy for MRVCUG for detecting VUR were respectively 92.68% (95% CI: 80.57-97.48%), 68.42% (95% CI: 46.01-84.64%), 86.36% (95% CI: 71.95-94.33%), 81.25% (95% CI: 53.69-95.02%), and 85% (95% CI: 80.40-89.60%. The level of agreement between MRVCUG and VCUG findings for diagnosis VUR was very good (P < 0.001, according to Cohen's kappa value = 0.638). Studying correlation of low grade VUR (grade I and II) and high grade VUR (grade III-V) showed a very good agreement between MRVCUG and VCUG findings (P < 0.001, Cohen's kappa value = 0.754). Conclusion: MRVCUG could accurately reveal the presence and severity of VUR, especially in cases with high-grade (grade III-V) VUR in both children and adolescents.

Hekmatnia, Ali; Merrikhi, Alireza; Farghadani, Maryam; Barikbin, Roozbeh; Hekmatnia, Farzaneh; Nezami, Nariman



Toxicity and exposure of an adenovirus containing human interferon alpha-2b following intracystic administration in cynomolgus monkeys.  


The safety and toxicokinetics of SCH 721015, an adenovirus encoding the human interferon alpha-2b gene, and Syn3 (SCH 209702), a novel excipient, were assessed in cynomolgus monkeys administered intravesical doses of 2.5 × 10E11 or 1.25 × 10E13 particles SCH 721015 in 25 mg Syn3 or 25 mg Syn3 alone on study days 1 and 91. There was no systemic toxicity. Monkeys dosed with SCH 721015 in Syn3 were positive for SCH 721015-specific DNA in the urine for 2 to 3 days following each dose and had interferon alpha-2b protein in the urine for 1-3 days after a single dose and in fewer animals after a second dose. Intracystic administration was associated with inflammation and focal/multifocal ulceration in the urinary bladder and irritation in the ureters and urethra at necropsy. The physical trauma from catheterization and filling/emptying of the bladder was likely a contributing factor and Syn3 exacerbated the trauma. There was nearly complete resolution of these findings 2 months after the last dose. The trauma to the bladder likely contributed to low, transient systemic exposure to Syn3, SCH 721015 and human interferon protein. The results of this study support the clinical investigation of SCH 721015 in Syn3. PMID:21900961

Veneziale, R W; Kishnani, N S; Nelson, J; Resendez, J C; Frank, D W; Cai, X-Y; Xie, L; Cullen, C; Frugone, C A; Rosenfeld, C; Hubbell, J; Maxwell, S E; Sugarman, B J; Hutchins, B; Maneval, D; Treinen, K A



Primary diffuse large B-cell lymphoma of the uterus complicated with hydronephrosis.  


Malignant lymphoma sometimes originates from extranodal sites; however, the uterus has rarely been reported as the site of the primary lesion. We present a patient with malignant lymphoma of the uterus complicating bilateral hydronephrosis. A 67-year-old previously healthy woman was seen at a clinic because of massive genital bleeding. She was referred to our hospital for further examination of a uterine tumor. Computed tomography scans revealed a pelvic tumor invading to the retroperitoneal region, which caused bilateral obstruction of the ureters and hydronephrosis. No lymph node swelling was detected. Magnetic resonance imaging showed a bulky uterine tumor that was homogenously low on T1-weighted imaging and isointense on T2-weighted imaging, while the endometrium was intact. A pathological examination of the biopsy specimen from the uterine cervix revealed diffuse infiltration of CD20-positive atypical large lymphoid cells, which was compatible with diffuse large B-cell lymphoma (DLBCL). Since the tumor expanded from the uterus and no other abnormal lesion was observed in imaging studies including gallium scintigraphy, a diagnosis of DLBCL of the uterus, clinical stage IE was made. The patient received six cycles of rituximab plus CHOP chemotherapy followed by involved field irradiation. She achieved complete remission and has been alive for more than two years without relapse. PMID:23666223

Isosaka, Mai; Hayashi, Toshiaki; Mitsuhashi, Kei; Tanaka, Michihiro; Adachi, Takeya; Kondo, Yoshihiro; Suzuki, Takashi; Shinomura, Yasuhisa



[Two cases of malignant tumors of the inferior vena cava].  


The malignant tumors of the inferior vena cava are rare. Their prognosis is bad. We report two cases of a 17-year-old and 46-year-old woman presenting the one an intimal sarcoma of the inferior vena cava and the other a metastatic of adenocarcinoma whose primary tumor was not identified. The aortic wall was invaded in both patients. The ureter repulsed in first case, was invaded in second case. The treatment consisted on resection of the tumor including the aortic wall with vein closure in both patients, with right nephrectomy in second patient. In the two cases, a prosthetic reconstruction of the arterial integrity was attempted with aortobiiliac bypass. The two patients died after relapse tumorous to the 6th month in first patient and by multisystem organ failure 5th day post-operative in second. Through these two personal cases, we try to point out the difficult problem of diagnosis that put these tumors and their bad prognosis despite an improvement of treatment. PMID:15182080

El Mahi, O; Bouarhroum, A; Alaoui, M; Sefiani, Y; Lekehal, B; Mahassini, N; El Mesnaoui, A; Benjelloun, A; Ammar, F; Bensaid, Y



The Prune Belly Syndrome in a Female Foetus with Urorectal Septum Malformation Sequence: A Case Report on a Rare Entity with an Unusual Association  

PubMed Central

The prune belly syndrome is a rare congenital anomaly which is characterized by the triad of an absent or a deficient development of the abdominal muscle, bilateral cryptorchidism and an anomalous urinary tract. In its full form, this condition occurs only in males. However, a similar condition occurs in females in the absence of cryptorchidism. On the other hand, the urorectal septum malformation sequence is a lethal congenital malformation which is characterized by the development of a phallus like structure, a smooth perineum and the absence of urethral, vaginal and anal openings. We are reporting a case of a female foetus with the prune belly syndrome, which was associated with a urorectal septum malformation sequence. A dead foetus with a protruded abdomen and ambiguous genitalia, was born at 32 weeks of pregnancy. On autopsy, it was found to have female internal genital organs. The left kidney, the urinary bladder and the rectum were absent. The sigmoid colon, the ureters and the fallopian tubes opened into a common cloacal sac. The histopathological examination of the ovary showed the presence of Leydig’s cells. The occurrence of the female counterpart of the prune belly syndrome is extremely rare and only few of such cases were found to be discussed in the details in the indexed English literature so far. Hence, we hope that this case report will contribute to the existing knowledge on the prune belly syndrome.

Goswami, Dibyajyoti; Kusre, Giriraj; Dutta, Hemonta Kumar; Sarma, Adity



The prune belly syndrome in a female foetus with urorectal septum malformation sequence: a case report on a rare entity with an unusual association.  


The prune belly syndrome is a rare congenital anomaly which is characterized by the triad of an absent or a deficient development of the abdominal muscle, bilateral cryptorchidism and an anomalous urinary tract. In its full form, this condition occurs only in males. However, a similar condition occurs in females in the absence of cryptorchidism. On the other hand, the urorectal septum malformation sequence is a lethal congenital malformation which is characterized by the development of a phallus like structure, a smooth perineum and the absence of urethral, vaginal and anal openings. We are reporting a case of a female foetus with the prune belly syndrome, which was associated with a urorectal septum malformation sequence. A dead foetus with a protruded abdomen and ambiguous genitalia, was born at 32 weeks of pregnancy. On autopsy, it was found to have female internal genital organs. The left kidney, the urinary bladder and the rectum were absent. The sigmoid colon, the ureters and the fallopian tubes opened into a common cloacal sac. The histopathological examination of the ovary showed the presence of Leydig's cells. The occurrence of the female counterpart of the prune belly syndrome is extremely rare and only few of such cases were found to be discussed in the details in the indexed English literature so far. Hence, we hope that this case report will contribute to the existing knowledge on the prune belly syndrome. PMID:24086893

Goswami, Dibyajyoti; Kusre, Giriraj; Dutta, Hemonta Kumar; Sarma, Adity



Alpha 1 adrenergic receptors in canine lower genitourinary tissues: insight into development and function  

SciTech Connect

Radioligand receptor binding methods were used to characterize the alpha 1-adrenergic receptor in the bladder body, bladder base, prostate and urethra of the male dog. Saturation experiments were performed in tissue homogenates using (/sup 125/iodine)-Heat, an alpha 1-adrenergic antagonist of high specific activity (2,200 Ci. per mmol.). The equilibrium dissociation constant Kd for (/sup 125/iodine)-Heat binding in the bladder body (0.56 pM.), bladder base (0.81 +/- 0.11 pM.), prostate (0.86 +/- 0.19 pM.) and urethra (0.55 pM.) was similar, suggesting homogeneity of alpha 1-adrenergic binding sites in lower genitourinary tissues. The receptor density in the bladder body, bladder base, prostate and urethra, expressed as fmol. per mg. wet weight, was 0.22 +/- 0.02, 0.82 +/- 0.09, 0.55 +/- 0.06 and 0.27 +/- 0.06, respectively (mean +/- standard error of mean). Competitive binding experiments with (/sup 125/iodine)-Heat and unlabeled prazosin and clonidine confirmed the selectivity of Heat for alpha 1-adrenergic binding sites. Anatomical dissections have revealed that a major component of the smooth muscle of the bladder base and prostate originates from the ureter, whereas a major component of the smooth muscle of the urethra originates from the bladder. The measured alpha 1-adrenergic receptor densities support these developmental theories.

Shapiro, E.; Lepor, H.



Alpha-fetoprotein-producing carcinoma of the renal pelvis exhibiting hepatoid and urothelial differentiation.  


Neoplasms commonly associated with alpha-fetoprotein (AFP) production are hepatocellular carcinomas and some germ cell tumors, typically yolk sac tumor. Rare tumors of visceral origin may also be associated with AFP production and those exhibiting a distinctive morphology are now known as hepatoid adenocarcinomas. To date, eight such tumors have been reported from the bladder and a further four from the renal pelvis. We report a unique case of a mixed hepatoid adenocarcinoma and urothelial carcinoma of the renal pelvis and ureter, in which both components were found to express AFP. An 84-year-old woman with a serum AFP level of 701 ng/ml was found to have advanced high-grade renal pelvi-calyceal and ureteral urothelial carcinoma exhibiting focal hepatoid adenocarcinoma differentiation. Both components displayed strong immunostaining for AFP. The patient was treated by radical nephro-uretectomy and postoperatively the serum AFP level declined to normal at a rate commensurate with its biological half-life. The presence of AFP expression in both the urothelial and hepatoid components of the tumor suggest that the molecular pathway changes associated with AFP production precede the hepatoid differentiation of tumor cells. PMID:23155269

Samaratunga, Hemamali; Samaratunga, Dinithi; Dunglison, Nigel; Perry-Keene, Joanna; Nicklin, James; Delahunt, Brett



Blind hemibladder, ectopic ureterocele, or Gartner's duct cyst in a woman with Müllerian malformation and supposed unilateral renal agenesis: a case report.  


Genital anomalies associated with unilateral renal agenesis are generally due to agenesis or hypoplasia of the entire urogenital ridge or distal mesonephric aberrations. However, renal adysplasia could also occur in association with anomalies of the ventral urogenital sinus. The patient presented didelphys uterus in the superior uterine segment, a septate cervix, and a simple vagina. After transvaginal puncture and injection of a contrast agent into the bulge observed in the right vaginal wall, a filled sac or cavity was detected, possibly a hemibladder. This structure continued upward with a possible dilated tortuous ureter that filled retrogradely. Magnetic resonance imaging also showed the presence of the right blind paravaginal sac. Right hemitrigone and ureteral orifice were absent in the cystourethroscopy. No right kidney was found, despite the use of multiple imaging techniques. Blind hemibladder, ectopic ureterocele, and Gartner's duct cyst seem to be a possible diagnosis associated to Müllerian malformations and supposed unilateral renal agenesis. Therefore, Müllerian anomalies without combined mesonephric alteration could be associated with conditions of the ventral urogenital sinus, including blind hemibladder or ectopic ureterocele with secondary renal dysplasia. PMID:19597716

Acién, Pedro; Acién, Maribel; Romero-Maroto, Jesús



Minimally invasive surgical management of ureteropelvic junction obstruction: laparoscopic and robot-assisted laparoscopic pyeloplasty.  


Ureteropelvic junction (UPJ) obstruction is characterized by a functionally significant impairment of urinary transport caused by an intrinsic or extrinsic obstruction in the area where the ureter joins the renal pelvis. The majority of cases are congenital in origin; however, acquired conditions at the level of the ureteropelvic junction may also present with symptoms and signs of obstruction. Until recently, open pyeloplasty and endoscopic techniques have been the main surgical options, with the intent of complete excision or incision of the obstruction. The introduction of laparoscopy and robot-assisted applications has allowed for minimally invasive reconstructive surgery that mirrors open surgical techniques. These techniques offer substantial benefits to patients by reducing morbidity, hastening postoperative recovery, and improving cosmetic outcome. During the last decade, laparoscopic pyeloplasty has garnered much interest. However, because of the technically challenging nature of this procedure, it is performed only at select medical centers by surgeons with advanced laparoscopic training. The recent introduction of robotics to the field of minimally invasive surgery may facilitate this procedure and allow for more widespread implementation by surgeons of varying skill levels. This review is limited primarily to the treatment of congenital or acquired UPJ obstruction via laparoscopic and robot-assisted laparoscopic pyeloplasty. Herein, we report the early results, ongoing evolution, and potential future role for these novel surgical procedures. PMID:14649575

Munver, Ravi; Del Pizzo, Joseph J; Sosa, R Ernest; Poppas, Dix P



[Technical aspects of laparoscopic robot-assisted pyeloplasty].  


From 2000, the robot-assisted laparoscopic approach has been developed for the management of ureteropelvic junction obstruction (UJO) with equivalent outcomes to conventional laparoscopic access regarding functional results. This system has simplified the suturing and has improved the precision of operative technique. The main surgical steps of the transperitoneal laparoscopic robot-assisted pyeloplasty are as follows: four or five port arrangement; initial dissection and early identification of the ureteropelvic junction; renal pelvis section; transection of the ureter and preparation of a spatula; continuous posterior suture; confection of a handle racket suture; placement of a double J stent; ending of the anastomosis. Outcomes after robotic and pure laparoscopic pyeloplasties are equivalent nowadays. Despite the financial cost, it seems easier and technically feasible and accessible for surgeons accustomed to the laparoscopic techniques and even beginners to learn the robotic technique if the system is available in their institution with success rate (radiologic and clinical) almost similar with those obtain with open techniques. PMID:19800549

Ferhi, K; Rouprêt, M; Rode, J; Misraï, V; Lebeau, T; Richard, F; Vaessen, C



Robot assisted laparoscopic pyeloplasty in patients of ureteropelvic junction obstruction with previously failed open surgical repair.  


To review our experience of robotic redo pyeloplasty as a salvage procedure in previously failed repair of ureteropelvic junction (UPJ) obstruction. In one year, robot-assisted laparoscopic pyeloplasty was performed in nine patients for previously failed open pyeloplasty. Four of these patients had undergone additional retrograde endopyelotomy following failed repair, prior to being referred to us. The mean age was 16.4 years. All patients presented with persistent flank pain and an obstructive pattern on diuretic renogram. Robotic redo pyeloplasty could be performed successfully in all patients without any technical problems. Intraoperative findings for cause of UPJ obstruction were peri-ureteral fibrosis, narrow ureter, anterior crossing vessels, and redundant pelvis. The mean hospital stay was 3.4 days (2-5 days). All patients had improvement in symptoms and the nuclear scan showed non-obstructive drainage. Robot assisted redo pyeloplasty enables complex repair in patients with previous failed cases of UPJ obstruction repair. Three-dimensional magnified vision, and a dynamic articulated endowrist, allows fine dissection in the fibrosed area and precise suturing in an ergonomic fashion with a success equivalent to open surgery. PMID:18786197

Hemal, Ashok K; Mishra, Saurabh; Mukharjee, Satydip; Suryavanshi, Manav



Percutaneous Nephroscopic Surgery  

PubMed Central

With the development of techniques for percutaneous access and equipment to disintegrate calculi, percutaneous nephroscopic surgery is currently used by many urologists and is the procedure of choice for the removal of large renal calculi and the management of diverticula, intrarenal strictures, and urothelial cancer. Although it is more invasive than shock wave lithotripsy and retrograde ureteroscopic surgery, percutaneous nephroscopic surgery has been successfully performed with high efficiency and low morbidity in difficult renal anatomies and patient conditions. These advantages of minimal invasiveness were rapidly perceived and applied to the management of ureteropelvic junction obstruction, calyceal diverticulum, infundibular stenosis, and urothelial cancer. The basic principle of endopyelotomy is a full-thickness incision of the narrow segment followed by prolonged stenting and drainage to allow regeneration of an adequate caliber ureter. The preferred technique for a calyceal diverticulum continues to be debated. Excellent long-term success has been reported with percutaneous, ureteroscopic, and laparoscopic techniques. Each approach is based on the location and size of the diverticulum. So far, percutaneous ablation of the calyceal diverticulum is the most established minimally invasive technique. Infundibular stenosis is an acquired condition usually associated with inflammation or stones. Reported series of percutaneously treated infundibular stenosis are few. In contrast with a calyceal diverticulum, infundibular stenosis is a more difficult entity to treat with only a 50-76% success rate by percutaneous techniques. Currently, percutaneous nephroscopic resection of transitional cell carcinoma in the renal calyx can be applied in indicated cases.



Small bowel obstruction secondary to strangulation through a defect in the falciform ligament after blunt abdominal trauma in a pediatric patient.  


Obstruction caused by strangulation internal hernia secondary to incarceration within the falciform ligament, although rare, has been previously reported in the literature. These cases, however, were unrelated to trauma. We report on the first case in the pediatric literature of a strangulated internal hernia secondary to incarceration in the falciform ligament precipitated by blunt abdominal trauma. A 12-year-old girl presented to the emergency room less than 24 hours after sustaining a kick to the right upper quadrant. She described sharp, nonradiating, right-upper-quadrant abdominal pain, which was associated with nausea and vomiting. A KUB (kidney, ureter, bladder) view showed a paucity of bowel in the right upper quadrant with distended adjacent bowel. An ultrasound showed a small amount of abdominal ascites and a prominent liver. Computed tomography scan revealed a linear hypodensity at the tip of the right lobe of the liver, suggestive of a laceration. Moderate abdominal and pelvic ascites and multiple collapsed small-bowel loops with diffuse wall thickening and poor enhancement were seen in the right upper quadrant. Significantly, pneumatosis was noted, raising the question of obstruction/volvulus and/or bowel ischemia. An exploratory laparotomy revealed incarcerated small bowel herniated into a defect in the falciform ligament, which was resected. The defect was repaired. Seemingly trivial trauma may play a precipitating role in strangulation in a patient who already has a defect in the falciform ligament. PMID:20531130

Sykes, Joseph A; Norton, Karen I; Bhattacharya, Nishith; Stombaugh, Lauretta



An atypical case of nephrolithiasis with transient remission of symptoms following spinal manipulation  

PubMed Central

Objective Nephrolithiasis is a common condition with symptoms similar to common mechanical lesions of the lumbar spine and pelvis. The purpose of this report is to outline a case of nephrolithiasis that closely mimicked sacroiliac joint syndrome in subjective report, objective findings, and reduction of symptoms with spinal manipulation. Clinical Features A 41-year-old obese male patient with mild pain over the left posterior sacroiliac joint, penile paresthesia, and the penile sensation of urinary urgency presented for chiropractic care. Subjective history and objective evaluation suggested sacroiliac joint syndrome. Intervention and Outcome A trial of conservative management including spinal manipulation was initiated. Following each treatment, the patient reported temporary relief of all symptoms (4 hours to 2 days). After unsuccessful permanent resolution of symptoms, a urinalysis was performed; and a follow-up computerized tomography scan revealed a large renal calculus obstructing the left ureter. Laser lithotripsy produced obliteration of the stone and complete resolution of symptoms. Conclusions This report outlines the potential overlap of symptoms of visceral and somatic lesions in both presentation and response to care. In this case, a favorable response to spinal manipulation masked the most likely underlying symptom generator. This encounter demonstrates the potential need for further clinical examination in the instance of the unresponsive mechanical lesion. This report also supports the need for future research into spinal manipulation as a possible adjunct for visceral pain management.

Wolcott, Christopher C.



Kidney Stones  

PubMed Central

The prevalence of kidney stones has steadily risen during this century; passage of a calculus and a positive family history increase the probability of recurrence. Findings from recent studies on the cause of renal calculi have stressed crystallization and crystal aggregation of stone minerals from supersaturated urine, rather than excessive organic matrix. Absence of normal urine inhibitors of calcium salts is also stressed. Formation of calcium oxalate stones is the major problem. Therapy with decreased calcium and oxalate intake, thiazides, phosphate salts and allopurinol in various combinations has substantially decreased the prevalence of recurrent stones. The rationale for the use of allopurinol is that uric acid salts enhance the tendency for calcium oxalate to crystallize from supersaturated urine. The hypercalciuria seen in 30 percent to 40 percent of patients with oxalate stones is usually caused by intestinal hyperabsorption of calcium. Although patients with uric acid calculi constitute only a small fraction of those in whom stones form, they represent a group in whom good medical therapy, based on sound physiologic principles, has proved extremely successful. Renal tubular syndromes lead to nephrocalcinosis and lithiasis through hypercalciuria, alkaline urine and hypocitraturia, the latter an inhibitor of calcium salt precipitation. Recent advances in surgical techniques are discussed, including the rationale for removing staghorn calculi. The ileal ureter and coagulum pyelolithotomy deserve special emphasis. ImagesFigure 2.Figure 4.Figure 5.Figure 7.

Kleeman, Charles R.; Coburn, Jack W.; Brickman, Arnold S.; Lee, David B. N.; Narins, Robert G.; Ehrlich, Richard M.



Vascular Remodeling and Arterial Calcification Are Directly Mediated by S100A12 (EN-RAGE) in Chronic Kidney Disease  

PubMed Central

Background The proinflammatory cytokine S100A12 (also known as EN-RAGE) is associated with cardiovascular morbidity and mortality in hemodialysis patients. In the cur- rent study, we tested the hypothesis that S100A12 expressed in vascular smooth muscle in nonatherosclerosis-prone C57BL/6J mice on normal rodent chow diet, but exposed to the metabolic changes of chronic kidney disease (CKD), would develop vascular disease resembling that observed in patients with CKD. Methods CKD was induced in S100A12 transgenic mice and wild-type littermate mice not expressing human S100A12 by surgical ligation of the ureters. The aorta was analyzed after 7 weeks of elevated BUN (blood urea nitrogen), and cultured aortic smooth muscle cells were studied. Results We found enhanced vascular medial calcification in S100A12tg mice subjected to CKD. Vascular calcification was mediated, at least in part, by activation of the receptor for S100A12, RAGE (receptor for advanced glycation endproducts), and by enhanced oxidative stress, since inhibition of NADPH-oxidase Nox1 and limited access of S100A12 to RAGE attenuated the calcification and gene expression of osteoblastic genes in cultured vascular smooth muscle cells. Conclusion S100A12 augments CKD-triggered osteogenesis in murine vasculature, reminiscent of features associated with enhanced vascular calcification in patients with chronic and end-stage kidney disease.

Gawdzik, Joseph; Mathew, Liby; Kim, Gene; Puri, Tipu S.; Hofmann Bowman, Marion A.



Functional analysis of BMP4 mutations identified in pediatric CAKUT patients.  


Human congenital anomalies of the kidney and urinary tract (CAKUT) represent the major causes of chronic renal failure (CRF) in children. This set of disorders comprises renal agenesis, hypoplasia, dysplastic or double kidneys, and/or malformations of the ureter. It has recently been shown that mutations in several genes, among them BMP4, are associated with hereditary renal developmental diseases. In BMP4, we formerly identified three missense mutations (S91C, T116S, N150K) in five pediatric CAKUT patients. These BMP4 mutations were subsequently studied in a cellular expression system, and here we present functional data demonstrating a lower level of messenger RNA (mRNA) abundance in Bmp4 mutants that indicates a possible negative feedback of the mutants on their own mRNA expression and/or stability. Furthermore, we describe the formation of alternative protein complexes induced by the S91C-BMP4 mutation, which results in perinuclear endoplasmic reticulum (ER) accumulation and enhanced lysosomal degradation of Bmp4. This work further supports the role of mutations in BMP4 for abnormalities of human kidney development. PMID:19685083

Tabatabaeifar, Mansoureh; Schlingmann, Karl-Peter; Litwin, Mieczyslaw; Emre, Sevinc; Bakkaloglu, Aysin; Mehls, Otto; Antignac, Corinne; Schaefer, Franz; Weber, Stefanie



Hydronephrosis and renal failure following inadequate management of neuropathic bladder in a patient with spinal cord injury: Case report of a preventable complication  

PubMed Central

Background Condom catheters are indicated in spinal cord injury patients in whom intravesical pressures during storage and voiding are safe. Unmonitored use of penile sheath drainage can lead to serious complications. Case report A 32-year old, male person, sustained complete paraplegia at T-11 level in 1985. He had been using condom catheter. Eleven years after sustaining spinal injury, intravenous urography showed no radio-opaque calculus, normal appearances of kidneys, ureters and bladder. Blood urea and Creatinine were within reference range. A year later, urodynamics revealed detrusor pressure of 100?cm water when detrusor contraction was initiated by suprapubic tapping. This patient was advised intermittent catheterisation and take anti-cholinergic drug orally; but, he wished to continue penile sheath drainage. Nine years later, this patient developed bilateral hydronephrosis and renal failure. Indwelling urethral catheter drainage was established. Five months later, ultrasound examination of urinary tract revealed normal kidneys with no evidence of hydronephrosis. Conclusion Spinal cord injury patients with high intravesical pressure should not have penile sheath drainage as these patients are at risk for developing hydronephrosis and renal failure. Intermittent catheterisation along with antimuscarinic drug should be the preferred option for managing neuropathic bladder.



Constitutive TL1A Expression under Colitogenic Conditions Modulates the Severity and Location of Gut Mucosal Inflammation and Induces Fibrostenosis  

PubMed Central

Intestinal fibrostenosis is a hallmark of severe Crohn's disease and can lead to multiple surgeries. Patients with certain TNFSF15 variants overexpress TL1A. The aim of this study was to determine the effect of TL1A overexpression on intestinal inflammation and the development of fibrostenosis. We assessed the in vivo consequences of constitutive TL1A expression on gut mucosal inflammation and fibrostenosis using two murine models of chronic colitis. In the dextran sodium sulfate (DSS) and adoptive T-cell transfer models, there was proximal migration of colonic inflammation, worsened patchy intestinal inflammation, and long gross intestinal strictures in Tl1a transgenic compared to wild-type littermates. In the DSS model, myeloid- and T-cell–expressing Tl1a transgenic mice had increased T-cell activation markers and interleukin-17 expression compared to wild-type mice. In the T-cell transfer model, Rag1?/? mice receiving Tl1a transgenic T cells had increased interferon-? expression but reduced T-helper 17 cells and IL-17 production. Narrowed ureters with hydronephrosis were found only in the Tl1a transgenic mice in all chronic colitis models. In human translational studies, Crohn's disease patients with higher peripheral TL1A expression also exhibited intestinal fibrostenosis and worsened ileocecal inflammation with relative sparing of rectosigmoid inflammation. These data show that TL1A is an important cytokine that not only modulates the location and severity of mucosal inflammation, but also induces fibrostenosis.

Barrett, Robert; Zhang, Xiaolan; Koon, Hon Wai; Vu, Michelle; Chang, Jyh-Yau; Yeager, Nicole; Nguyen, Mary Ann; Michelsen, Kathrin S.; Berel, Dror; Pothoulakis, Charalabos; Targan, Stephan R.; Shih, David Q.



Primary paraganglioma of seminal vesicle?  

PubMed Central

INTRODUCTION Paragangliomas are rare tumors arising from neural crest tissue located outside the adrenal gland. Primary seminal vesicle paraganglioma is extremely rare entity. PRESENTATION OF CASE A 26-year-old male patient presented with symptoms and signs of acute appendicitis where a CT of abdomen and pelvis showed an inflamed appendix and incidental finding of left seminal vesicle mass. The patient underwent uneventful laparoscopic appendectomy followed by transrectal ultrasound (TRUS) guided seminal vesicle biopsies. Histopathology revealed a neuroendocrine neoplasm consistent with paraganglioma. Surgical excision of the left seminal vesicle was carried out. DISCUSSION Paraganglioma of genitourinary tract is rare. The urinary bladder is the most common site, followed by the urethra, pelvis and ureter. Seminal vesicle paragangliomas were reported in association with other genitourinary organ involvement such as bladder and prostate. Isolated seminal vesicle paraganglioma is extremely rare and surgical excision remains the standard treatment for localized paraganglioma. CONCLUSION Primary tumors of seminal vesicle are rare and represent a diagnostic challenge. Differential diagnosis includes a list of benign and malignant tumors. Primary seminal vesicle paraganglioma is a rare but important diagnosis to be included in the differential diagnosis.

Alharbi, Badr; Al-Ghamdi, Abdullah



[Pharmacologic modification of ureteral activity].  


The renal pelvis and the ureter represent a functional system with myogenic excitation generation and conduction. The activity of this system is modulated by the autonomic nervous system: alpha-adrenergic and cholinergic substances stimulate, beta-adrenergic drugs inhibit the pyeloureteral activity. Besides the sympathetic nervous system with adrenergic postganglionic excitation conduction and the parasympathetic nervous system with cholinergic transmission, non-adrenergic, non-cholinergic systems appear to exist. Vasoactive intestinal peptide (VIP), e.g., markably decreases the frequency and amplitude of the ureteral activity. Calcium antagonists (e.g. nifedipin) lead to a direct inhibition of the ureteral activity: the quick phasic contractions are selectively oppressed without any influence on the tonic activity of the pyeloureter. A direct therapeutic modulation of the ureteral activity, however, e.g. to treat a colic or to accelerate the spontaneous discharge of stones, seems to be only rarely possible: Glucagone shows a markable decrease of ureteral peristalsis in animal experiments. Antagonists of prostaglandine proved to have not only an antiinflammatory and central analgetic effect but they also influence the pyeloureter directly by relaxing the muscular layer. PMID:3787887

Hannappel, J; Rohrmann, D; Lutzeyer, W



Sigmoido-gluteal fistula--a rare complication in clinically asymptomatic chronic diverticulitis.  


Chronic colonic diverticulitis may be associated with typical complications such as local abscesses, stenosis, bleeding, intraperitoneal bowel perforations or fistulas to other organs. Most commonly, fistulas exist between the colon and the bladder; nevertheless, they may also extend to the small intestine, other areas of the colon, ureter, uterus, salpinx, vagina, abdominal wall, portal- and mesenterial venous system, pleura, urachus, biliary system and the hip. We report on a patient with chronic colonic diverticulitis having an unusual sigmoido-gluteal fistula along the sacrum, the piriformis muscle and sciatic nerve. The patient presented with sciatic nerve symptoms and recurrent gluteal abscess formation, but no other clinical symptoms leading to an abdominal pathology. Initially, that fact caused an unsuccessful local treatment under the differential diagnosis of a local gluteal abscess for about a year. Finally, a sigmoid colon resection with end-to-end anastomosis and a proximal diverting stoma was performed. The colostomy was closed electively five months later without any complication. PMID:21954740

Fehmer, T; Citak, M; Schildhauer, T A


Ureteral Reimplantation with Psoas Bladder Hitch in Adults: A Contemporary Series with Long-Term Followup  

PubMed Central

We retrospectively evaluated our experience with ureteral reimplantation and psoas bladder hitch to restore urinary tract continuity in patients with lower ureteral defects, since long-term data on the outcomes of this procedure have been relatively scarce in the last two decades. The procedure was performed in 24 patients (7 male, 17 female) with a mean age of 54.6 years. The mean ureteral defect length was 4.8?cm (range 3–10), the ureterovesical anastomosis was performed with simplified split-cuff technique in 18 patients, submucosal tunnel in 2, and direct anastomosis without antireflux technique in 2. Mean followup was 53 months (range 12–125), and there were no reinterventions. Postoperative renal imaging was normal in 22 cases (91.6%) and revealed decreased kidney size in 2, 3 patients presented intermittent flank pain, and 5 had sporadic episodes of lower tract UTI but no one pyelonephritis. Psoas hitch ureteral reimplantation can be successfully used for bridging defects of the lower ureter up to 10?cm in length in difficult clinical situations. It is relatively simple to perform, compared to other procedures of ureteral reconstruction, and it provides adequate protection of the upper urinary tract.

Manassero, Francesca; Mogorovich, Andrea; Fiorini, Girolamo; Di Paola, Giuseppe; De Maria, Maurizio; Selli, Cesare



Apolipoprotein J expression at fluid-tissue interfaces: potential role in barrier cytoprotection.  

PubMed Central

Apolipoprotein J (apoJ) is a sulfated secreted glycoprotein that exhibits ubiquitous expression, evolutionary conservation, and diverse tissue inducibility. It has been proposed to have roles in programmed cell death, sperm maturation, complement regulation, and lipid transport. To identify cell types that synthesize apoJ and to aid evaluation of its function, we screened mouse and human tissues by in situ hybridization. ApoJ was expressed at high levels in an array of specialized cell types of adult and fetal mouse tissues and in similar cell types of human tissues. Most of these cell types are highly secretory and form the cellular interfaces of many fluid compartments. This group includes epithelial boundary cells of the esophagus, biliary ducts, gallbladder, urinary bladder, ureter, kidney distal convoluted tubules, gastric glands, Brunner's glands, choroid plexus, ependyma, ocular ciliary body, endometrium, cervix, vagina, testis, epididymus, and visceral yolk sac. Several nonepithelial secretory cell types that express high levels of apoJ also line fluid compartments, such as synovial lining cells and ovarian granulosa cells. In the context of its known biochemical properties, this expression pattern suggests that localized synthesis of apoJ serves to protect a variety of secretory, mucosal, and other barrier cells from surface-active components of the extracellular environment. Images

Aronow, B J; Lund, S D; Brown, T L; Harmony, J A; Witte, D P



The C5a receptor is expressed by human renal proximal tubular epithelial cells  

PubMed Central

The C5a receptor is expressed by a variety of cell types. These studies demonstrate by immunohistochemistry that the receptor is present on the surface of proximal and distal tubular epithelial cells from normal kidney. In addition, the receptor was detected on transitional epithelial cells of the ureter and bladder. Primary proximal tubular cultures and a proximal tubular cell line both also expressed the C5a receptor, as demonstrated by immunofluorescence and by FACS analysis. The presence of mRNA encoding the receptor was confirmed by reverse transcriptase-polymerase chain reaction analysis. As opposed to its effect on glomerular mesangial cells, the receptor did not mediate a proliferative response by the proximal tubular cells. C5a also did not enhance the synthesis/secretion of transforming growth factor-beta 1, monocyte chemoattractant protein-1, platelet-derived growth factor-AB or tumour necrosis factor-alpha by cultured proximal tubular cells. Therefore, although the C5a receptor clearly is expressed by proximal tubular cells, clarification of its functional relevance on this cell type awaits further studies.

Zahedi, R; Braun, M; Wetsel, R A; Ault, B H; Khan, A; Welch, T R; Frenzke, M; Davis, A E



Model of human transitional cell carcinoma: tumor xenografts in upper urinary tract of nude rat.  


An in vivo model for the study of human transitional cell carcinoma (TCC) in the urinary tract is desirable. Orthotopic xenografts are useful in order to approximate better the behavior of human tumor cells in situ. Prior models have been described in the urinary bladder of the nude mouse and rat. We have developed the first model of implantation of human TCC in the upper urinary tract of an experimental animal. The kidneys of homozygous nude rats 4 weeks of age were inoculated with 1-5 x 10(6) cells of the RT4 well-differentiated papillary human TCC line through bilateral flank incisions, with transparenchymal injection of tumor cells into either the collecting system (renal pelvis) or the parenchyma. The overall implantation rate was 92% (54/59 kidneys). However, implantation into the collecting system occurred in only 45% (18/45) of the group. Ligation of the ureter prior to inoculation to produce urine stasis improved the mucosal implantation rate. Despite suspect urine cytology findings in the renal pelvis injection group, no distal seeding of the urinary tract was seen. Intraparenchymal tumor growth was less differentiated and had a higher fraction of mitotic cells than mucosal tumors. Vascular and lymphatic invasion were commonly seen; however, distant metastasis was not observed. This model will prove useful in determining the role of seeding in recurrent disease and in developing less invasive modalities for the treatment of upper tract TCC. PMID:7780425

Jarrett, T W; Chen, Y; Anderson, A E; Oshinsky, G; Smith, A D; Weiss, G H



Tubular adenoma of the urinary tract: a newly described entity.  


Tubular adenomas in the urinary tract with the same appearance as those in the gastrointestinal tract have not yet been described in the literature. We herein report 4 cases of tubular adenomas in the urinary tract encountered within our consult practice. This lesion was defined by the presence of a collection of small round tubular glands with intestinal-type epithelium showing moderate dysplasia, identical to the histology of tubular adenomas in the intestinal tract. Patients ranged in age from 37 to 63 years (mean, 45 years), with 3 of the 4 being male (male-to-female ratio, 3:1). The locations were urinary bladder, prostatic urethra and ureter with hematuria, polyps, and obstructive mass as their presentations, respectively. One lesion was large measuring 1.4 cm associated with pseudoinvasion as well as invasive adenocarcinoma. Immunohistochemically, the tubular adenomas stained positive for CDX2 and CK20, while negative for GATA3 and CK7. One case showed positive nuclear ?-catenin staining. Tubular adenoma of the urinary tract is a rare lesion, and recognition of this entity will encourage further reports and help to better understand the relation of tubular adenoma to concurrent and subsequent urinary tract malignancies. PMID:23664485

Kao, Chia-Sui; Epstein, Jonathan I



ARA290, a non-erythropoietic EPO derivative, attenuates renal ischemia/reperfusion injury  

PubMed Central

Background In contrast with various pre-clinical studies, recent clinical trials suggest that high dose erythropoietin (EPO) treatment following kidney transplantation does not improve short-term outcome and that it even increases the risk of thrombotic events. ARA290 is a non-erythropoietic EPO derivative and does not increase the risk of cardiovascular events, but potentially has cytoprotective capacities in prevention of renal ischemia/reperfusion injury. Methods Eight female Dutch Landrace pigs were exposed to unilateral renal ischemia for 45 minutes with simultaneous cannulation of the ureter of the ischemic kidney. ARA290 or saline was administered by an intravenous injection at 0, 2, 4 and 6 hours post-reperfusion. The animals were sacrificed seven days post-reperfusion. Results ARA290 increased glomerular filtration rate during the observation period of seven days. Furthermore, ARA290 tended to reduce MCP-1 and IL-6 expression 15 minutes post-reperfusion. Seven days post-reperfusion ARA290 reduced interstitial fibrosis. Conclusions The improvement in renal function following renal ischemia/reperfusion and reduced structural damage observed in this study by ARA290 warrants further investigation towards clinical application.




PubMed Central

1. In four animals with a bile duct-ureter anastomosis and without disturbance due to obstruction or absorption, the total quantity of bile pigment output during a day under normal conditions varied from 0.0618 to 0.0678 gm. These figures are practically identical with those of Stadelmann (9, 10) but lower than those given by Hooper and Whipple (7), who find that the average bile pigment excretion amounts to about 1 mg. per pound of body weight per 6 hours. 2. In all the experiments there is definite evidence of a decrease in bile pigment elimination after splenectomy. This is true not only of the elimination when no hemolytic agent is administered but also when excessive blood destruction is caused. Under the latter circumstances the amount of bile pigment is greatly increased but never reaches the high level of blood destruction before splenectomy. 3. These observations appear to show conclusively that the absence of the spleen influences the formation of bile pigment. To what extent the influence is mechanical, i.e., change in the course of the blood to the liver, and to what extent due to anemia, cannot be stated at present.

Goto, Kingo



Upper urinary tract urothelial carcinoma: what have we learned in the last 4 years?  

PubMed Central

In the last 4 years many studies have been published on the topic of upper urinary tract urothelial carcinoma (UTUC). This is a recent review of the available literature of the last 3 years. A systematic Medline/PubMed search on UTUC including limits for clinical trials and randomized, controlled trials was performed for English-language articles using the keywords ‘upper urinary tract carcinoma’, ‘nephroureterectomy’, ‘laparoscopic’, ‘ureteroscopy’, ‘percutaneous’, ‘renal pelvis’, ‘ureter’ and their combinations from January 2008 to December 2010. Additional selected reports from 2007 were included. Case reports and non-English literature were excluded. Publications were mostly retrospective, including some large, multicentre studies from the Upper Tract Urothelial Carcinoma Collaboration (UTUCC). The authors of this article are members of the UTUCC. Altogether, 92 original articles dealing with UTUC were identified and summarized. The vast majority of the available literature has a low level of evidence (level IV), although many multicentre studies tried to overcome the problem of low numbers by pooling data. It was concluded that in the last 3 years our knowledge regarding UTUC has increased dramatically, although new study concepts allowing us to increase the level of evidence are needed.

Remzi, Mesut; Shariat, Shahrokh; Huebner, Wilhelm; Fajkovic, Harun; Seitz, Christian



Diagnosis, treatment and follow-up of 25 patients with melamine-induced kidney stones complicated by acute obstructive renal failure in Beijing Children's Hospital.  


A total of 25 Chinese patients aged 6 to 36 months hospitalised at Beijing Children's Hospital due to melamine-induced kidney stones complicated by acute obstructive renal failure in 2008 were included in a study in order to diagnose and treat these special cases more effectively. Feeding history, clinical presentation, ultrasound findings, treatments and effects were summarised. Twelve to seventeen months follow-up was reported also. Ultrasound examination showed that calculi were located at the kidney and ureters. Stones were composed of both uric acid and melamine in a molar ratio of 1.2:1 to 2.1:1. Treatments providing liquid plus alkalisation of urine proved to be effective in helping the patients pass the stones. Surgical intervention was needed in severe cases. Renal function returned to normal in all 25 patients after various durations of therapy. Sixty-eight percent of the patients expelled all of the calculi within 3 months, 90% in 6 months and 95% in 9 months, without sequelae till now. Melamine-contaminated milk formula can cause kidney stones in infants, which should be diagnosed by feeding history, clinical symptoms and ultrasound examination. Composition of the stones was not only of melamine but also uric acid. Providing liquid orally or intravenously plus alkalisation of urine proved to promote the removal of the stones. Follow-up of 12 to 17 months after discharge showed no sequelae. PMID:19841939

Sun, Qiang; Shen, Ying; Sun, Ning; Zhang, Gui Ju; Chen, Zhi; Fan, Jian Feng; Jia, Li Qun; Xiao, Hong Zhan; Li, Xu Ran; Puschner, Birgit



A New Technique for Laparoscopic Anterior Resection for Rectal Endometriosis  

PubMed Central

Background: Anterior rectal resection is sometimes necessary to treat deeply infiltrating rectovaginal endometriosis. We describe a completely laparoscopic approach as a new way of excising rectal endometriosis that can be used without opening any part of the rectum. This avoids opening the abdomen or any risk of fecal spillage. Methods: The patient received preoperative oral bowel preparation. Ureteric stents (6 F) were inserted cystoscopically. The peritoneum in the ovarian fossae was opened lateral to any disease and the rectum reflected off the back of the cervix, leaving any endometriosis on the front of the rectum. The pelvic peritoneum was reflected medially, below the level of the ureters. The mesorectum was then dissected off a 6-cm length of rectum by using a Harmonic scalpel. A circular end-to-end anastomosis instrument was passed anally until the outline of the anvil was visible, inside the colon, above the diseased rectum. The anvil was detached and held by a soft grasper before the rectum was then divided above and below the disease using a laparoscopic stapling device. The tip of the anvil was pushed through the proximal end of the colon allowing reanastomosis of the rectal stump. Conclusion: The patient was discharged after 5 days without complications.

English, James; Miles, W. F. Anthony; Giannopoulos, Theo



[Ureteral lithotripsy with rigid ureteroscopy and pulsed dye laser].  


Pulsed dye laser lithotripsy represents nowadays a new approach to ureteral stones. 27 patients were treated with a pulsed dye laser unit (Pulsolith TM) at our department from november 1989 to january 1990. 21 had a single stone and the remaining a multiple ureteral lithiasis. The pulsed dye laser operated at a wave length of 504 nm, energy ranged between 90 and 160 mj with pulse of 1,5 ms. A 320 theta diameter quartz fiber with Helium Neon red laser (to visualize the top of the fiber) introduced in a rigid 9.5 ureteroscope (Wolf) was used during the procedure. Spinal, peridural or general anesthesia was done in all patients and the time of the procedure ranged between 8-150 minutes. Fiber was inserted in a 4 Ch ureteral catheter which provided easier manipulation of the fiber. Complete fragmentation was achieved in 88.9% of the patients, and combined manoeuvres were requested in another 3.7%. Failures were 7.4%. Minimal lesions of the ureter, due to ureteroscope advancement subsided spontaneously after placement of double F catheter. Pulsed dye laser lithotripsy seems to be a safe and useful procedure for treatment of impacted ureteral calculi and seems to offer low morbidity in respect of ultrasonic or electrohydraulic procedures especially when the stone location does not permit an ESWL approach. PMID:1677489

Scarpa, R M; Migliari, R; De Lisa, A; Campus, G; Usai, M; Usai, E



Remote control of renal physiology by the intestinal neuropeptide pigment-dispersing factor in Drosophila.  


The role of the central neuropeptide pigment-dispersing factor (PDF) in circadian timekeeping in Drosophila is remarkably similar to that of vasoactive intestinal peptide (VIP) in mammals. Like VIP, PDF is expressed outside the circadian network by neurons innervating the gut, but the function and mode of action of this PDF have not been characterized. Here we investigate the visceral roles of PDF by adapting cellular and physiological methods to the study of visceral responses to PDF signaling in wild-type and mutant genetic backgrounds. We find that intestinal PDF acts at a distance on the renal system, where it regulates ureter contractions. We show that PdfR, PDF's established receptor, is expressed by the muscles of the excretory system, and present evidence that PdfR-induced cAMP increases underlie the myotropic effects of PDF. These findings extend the similarities between PDF and VIP beyond their shared central role as circadian regulators, and uncover an unexpected endocrine mode of myotropic action for an intestinal neuropeptide on the renal system. PMID:22778427

Talsma, Aaron D; Christov, Christo P; Terriente-Felix, Ana; Linneweber, Gerit A; Perea, Daniel; Wayland, Matthew; Shafer, Orie T; Miguel-Aliaga, Irene



Reproductive assessment of male elephants (Loxodonta africana and Elephas maximus) by ultrasonography.  


Transrectal ultrasonography was performed on five wild and two captive male African elephants (Loxodonta africana) and four captive male Asian elephants (Elephas maximus) to develop standards for assessment of reproductive health and status. The entire internal urogenital tract was visualized ultrasonographically by using a 3.5 MHz or a 7.5-MHz transducer in combination with a probe extension adapted for elephant anatomy. The findings were verified by postmortem ex situ ultrasound examinations in several individuals of each species. Each part of the internal urogenital tract was sonographically detectable except for the bulbourethral glands and the cranial portion of the ureters and ductus deferentes, which were only observed in situ in the neonate. Each structure visualized was measured and described. The size and morphology of the urogenital structures, especially the accessory glands, were indicative of breeding status, if known. There was a notable difference between African and Asian males in the size and morphology of the prostate gland and a slight difference in the shape of the ampullae. No other structure showed significant species differences. The detection of the location and description of the testes may provide information for modifying present castration procedures. Furthermore, ultrasound examination of the male accessory glands may aid in the identification of potential semen donors for assisted reproduction programs in captive elephants. PMID:9732024

Hildebrandt, T B; Göritz, F; Pratt, N C; Schmitt, D L; Quandt, S; Raath, J; Hofmann, R R



Human placenta: de visu demonstration of interstitial Cajal-like cells.  


Traditional interstitial cells of Cajal (ICC) are present in the digestive tube and are supposed to act as pacemakers and neuromodulators. However, interstitial Cajal-like cells (ICLCs) were found outside the gastrointestinal tract, in various organs (e.g. ureter, bladder, fallopian tube, uterus, pancreas, mammary gland, myocardium etc.) and looking for such ICLC is a priority in our laboratories. We report here unequivocal visual evidence that ICLCs are present in the mesenchymal tissue of the villi from human term placenta. The following methods were used: a. vital staining with methylene blue (cryosections); b. silver impregnation (paraffin sections); c. Epon-embedded sections (approximately 1 microm) of glutaraldehyde/osmium fixed tissue, stained with toluidine blue; d. primary cell cultures (or second-passage cells) to reveal the characteristic, very long, moniliform cell processes and mitochondrial localization at dilations (molecular fluorescence probe: Mito Tracker Green); e. immunofluorescence for c-kit/CD117 marker or other characteristic proteins; f. transmission electron microscopy to establish the identity of ICLC. PMID:17635651

Suciu, Laura; Popescu, L M; Gherghiceanu, Mihaela


Penile Duplication and Two Anal Openings; Report of a Very Rare Case  

PubMed Central

Background Penile duplication (diphallus) is an extremely rare disorder. It is almost always associated with other malformations like double bladder, exstrophy of the cloacae, imperforate anus, duplication of the rectosigmoid and vertebral deformities. Meanwhile anal canal duplication, the most distal and least common duplication of the digestive tube and is a very rare congenital malformation. Case Presentation A 21 days old Egyptian neonate is reported with complete penile duplication and two scrotums with each one carrying two palpable testes. Both penises have normal shaft with normally located meatus. Clear urine voids from both meati spontaneously. The child had also a fold of redundant skin about 4×5 cm at the anal region in which two separate anal openings are present. In rectal examination we found two normal anuses passing stool spontaneously. Ascending (voiding) cystourethrography revealed two penises with two separate meatuses and one bladder from which the two urethras go out separately. Intravenous pyelogram (IVP) revealed two normal kidneys and ureters. Barium study revealed duplication of rectum and colon, otherwise normal GIT. Conclusion In our review of the literature, we did not come across any other case of this variety of the penile duplication and congenital presence of two anuses. Unfortunately the patient expired before any surgical correction.

Bakheet, Mohamed Abdel Al M.; Refaei, Mohammad



MONTI as continent catheterized stoma using serosal-lined trough "Ghoneim Abolenin" technique in ileocystoplasty  

PubMed Central

It is a great challenge to select and perform continent mechanism in a stoma for urinary reservoir. A new technique by combining MONTI ileal conduit with the serosal lined trough in order to achieve continent catheterizable stoma to the umbilicus as a part of augmentation ileocystoplasty. We applied serosal-lined trough as a continent mechanism with MONTI ileal tube in 12 years smart girl underwent ileocystoplasty for neuropathic bladder due to meylomeningocele in whom continence failed to be achieved by using Mitrofanoff with submucosal tunnel of the bladder as continent mechanism before, also the previous operation included left to right transuretero-ureterostomy, ureterocystoplasty and reimplantation of the right ureter. The patient became completely continent; she was able to do self-catheterization easily through the umbilical stoma using 16-French catheter and was able to wash the mucous easily. The capacity of the augmented bladder was 300ccs. She became independent from her mother and stopped using diapers, anticholinergic and antibiotics. Combining MONTI conduit with serosal-lined extramural valve trough (The Ghoneim technique) is an effective continent technique and gives wider channel for catheterization and washing out the mucous.

Sammour, Mohammed T.; Ajjaj, Abdulbari Bin



Maximal Points of Head's Zone in Fixed Drug Eruption  

PubMed Central

The principles determining the primary localization of lesions in fixed drug eruption (FDE) are still unknown. Studies investigating the predilection areas in FDE have indicated drug-related, trauma-related, or inflammation-related specific site involvement, as well as visceracutaneous reflex-related specific site involvement. The importance of viscerocutaneous reflexes for the location of dermatoses was first recognized in the 1960s. Head's zones are viscerocutaneous reflex projection fields on the skin that extend over certain dermatomes and possess a reflex-associated maximal point. Recently, in a Turkish collective of patients, three women with the primary location of FDE lesions on the maximal points of Head's zones were presented. We also experienced 3 cases with FDE where the lesions were located at specific sites (buttocks), the so-called maximal points of Head's zones, which are known to be the most active dermatomal areas of an underlying visceral pathology. An underlying internal disturbance (ureter stone, pyelonephritis and chronic pelvic inflammatory disease) was found in all 3 patients, corresponding to the organ-related maximal point of Head's zones in each case. In conclusion, the primary location of FDE lesions on the maximal points of Head's zones revealed relevant organ disorders with corresponding projection fields.

Lee, Sang Sin; Hong, Dong Kyun; Im, Myung; Lee, Young; Seo, Young Joon



Effects of renal pelvic high-pressure perfusion on nephrons in a porcine pyonephrosis model  

PubMed Central

The aim of this study was to investigate the effects of various renal pelvic pressure gradients on nephrons with purulent infection. Five miniature test pigs were selected. One side of the kidney was used to prepare the pyonephrosis model and the other side was used as the healthy control. A piezometer and a water fill tube were inserted into the renal pelvis through the ureter. Prior to perfusion, punctures were made on the healthy and purulent sides of the kidneys to obtain tissues (as controls). Subsequently, a puncture biopsy was conducted on the kidneys at five pressure levels: 10, 20, 30, 40 and 50 mmHg. Once the renal pelvic pressure had increased, the healthy and injured kidneys presented pathological changes, including dilation of the renal tubule and capsule and compression of the renal glomerulus. When the renal pelvic pressure exceeded 20 mmHg, the injured kidney presented more damage. Electron microscopy revealed that the increase in pressure resulted in the following: the podocyte gap widened, the epithelial cells of the renal capsule separated from the basement membrane, the basement membrane thickness became uneven, the continuity of the basement membrane was interrupted at multiple positions and the renal tubule microvillus arrangement became disorganised. The manifestations in the pyonephrosis model were more distinct compared with those in the healthy kidney. As the renal pelvic pressure exceeds 20 mmHg under a renal purulent infection status, the nephrons become damaged. The extent of the damage is aggravated as the pressure is increased.




Remote control of renal physiology by the intestinal neuropeptide pigment-dispersing factor in Drosophila  

PubMed Central

The role of the central neuropeptide pigment-dispersing factor (PDF) in circadian timekeeping in Drosophila is remarkably similar to that of vasoactive intestinal peptide (VIP) in mammals. Like VIP, PDF is expressed outside the circadian network by neurons innervating the gut, but the function and mode of action of this PDF have not been characterized. Here we investigate the visceral roles of PDF by adapting cellular and physiological methods to the study of visceral responses to PDF signaling in wild-type and mutant genetic backgrounds. We find that intestinal PDF acts at a distance on the renal system, where it regulates ureter contractions. We show that PdfR, PDF's established receptor, is expressed by the muscles of the excretory system, and present evidence that PdfR-induced cAMP increases underlie the myotropic effects of PDF. These findings extend the similarities between PDF and VIP beyond their shared central role as circadian regulators, and uncover an unexpected endocrine mode of myotropic action for an intestinal neuropeptide on the renal system.

Talsma, Aaron D.; Christov, Christo P.; Terriente-Felix, Ana; Linneweber, Gerit A.; Perea, Daniel; Wayland, Matthew; Shafer, Orie T.; Miguel-Aliaga, Irene



Laparoscopic Trocar Port Site Endometriosis: A Case Report and Brief Literature Review  

PubMed Central

Endometriosis is defined as the presence of ectopic endometrial tissue outside the lining of the uterine cavity. It occurs most commonly in pelvic sites such as ovaries, cul-de-sac, and fallopian tubes but also can be found associated with the lungs, bowel, ureter, brain, and abdominal wall. Abdominal wall endometriosis, also known as scar endometriosis, is extremely rare and mainly occurs at surgical scar sites. Although many cases of scar endometriosis have been reported after a cesarean section, some cases of scar endometriosis have been reported after an episiotomy, hysterectomy, appendectomy, and laparoscopic trocar port tracts. To our knowledge, 14 case reports related to trocar site endometriosis have been published in the English language literature to date. Herein, we present the case of a 20-year-old woman (who had been previously operated on for left ovarian endometrioma 1.5 years ago by laparoscopy) with the complaint of a painful mass at the periumbilical trocar site with cyclic pattern. Consequently, although rare, if a painful mass in the surgical scar, such as the trocar site, is found in women of reproductive age with a history of pelvic or obstetric surgery, the physician should consider endometriosis.

Emre, Arif; Akbulut, Sami; Yilmaz, Mehmet; Bozdag, Zehra



The renal scan in pregnant renal transplant patients  

SciTech Connect

With the greater frequency of renal transplant surgery, more female pts are becoming pregnant and carrying to term. In the renal allograft blood vessels and ureter may be compressed resulting in impaired renal function and/or, hypertension. Toxemia of pregnancy is seen more frequently than normal. Radionuclide renal scan monitoring may be of significant value in this high risk obstetrical pt. After being maintained during the pregnancy, renal function may also deteriorate in the post partum period. 5 pregnant renal transplant pts who delivered live babies had renal studies with Tc-99m DTPA to assess allograft perfusion and function. No transplanted kidney was lost during or after pregnancy as a result of pregnancy. No congenital anomalies were associated with transplant management. 7 studies were performed on these 5 pts. The 7 scans all showed the uterus/placenta. The bladder was always distorted. The transplanted kidney was rotated to a more vertical position in 3 pts. The radiation dose to the fetus is calculated at 0.024 rad/mCi administered. This study demonstrates the anatomic and physiologic alterations expected in the transplanted kidney during pregnancy when evaluated by renal scan and that the radiation burden may be acceptable in management of these pts.

Goldstein, H.A.; Ziessman, H.A.; Fahey, F.H.; Collea, J.V.; Alijani, M.R.; Helfrich, G.B.



CT urography for hematuria.  


Hematuria can signify serious disease such as bladder cancer, upper urinary tract urothelial cell carcinoma (UUT-UCC), renal cell cancer or urinary tract stones. CT urography is a rapidly evolving technique made possible by recent advances in CT technology. CT urography is defined as CT examination of the kidneys, ureters and bladder with at least one series of images acquired during the excretory phase after intravenous contrast administration. The reasoning for using CT urography to investigate hematuria is based on its high diagnostic accuracy for urothelial cell carcinoma (UCC) and favorable comparison with other imaging techniques. The optimum diagnostic imaging strategy for patients with hematuria at high-risk for UCC involves the use of CT urography as a replacement for other imaging tests (ultrasonography, intravenous urography, or retrograde ureteropyelography) and as a triage test for cystoscopy, resulting in earlier diagnosis and improved prognosis of bladder cancer, UUT-UCC, renal cell cancer and stones. Current problems with CT urography for investigating hematuria might be solved with a formative educational program simulating clinical reporting to reduce reader error, and a new technique for image-guided biopsy of UUT-UCC detected by CT urography for histopathological confirmation of diagnosis and elimination of false-positive results. CT urography is recommended as the initial imaging test for hematuria in patients at high-risk for UCC. PMID:22410682

Cowan, Nigel C



Shared Copy Number Variation in Simultaneous Nephroblastoma and Neuroblastoma due to Fanconi Anemia  

PubMed Central

Concurrent emergence of nephroblastoma (Wilms Tumor; WT) and neuroblastoma (NB) is rare and mostly observed in patients with severe subtypes of Fanconi anemia (FA) with or without VACTER-L association (VL). We investigated the hypothesis that early consequences of genomic instability result in shared regions with copy number variation in different precursor cells that originate distinct embryonal tumors. We observed a newborn girl with FA and VL (aplasia of the thumbs, cloacal atresia (urogenital sinus), tethered cord at L3/L4, muscular ventricular septum defect, and horseshoe-kidney with a single ureter) who simultaneously acquired an epithelial-type WT in the left portion of the kidney and a poorly differentiated adrenal NB in infancy. A novel homozygous germline frameshift mutation in PALB2 (c.1676_c1677delAAinsG) leading to protein truncation (pGln526ArgfsX1) inherited from consanguineous parents formed the genetic basis of FA-N. Spontaneous and induced chromosomal instability was detected in the majority of cells analyzed from peripheral lymphocytes, bone marrow, and cultured fibroblasts. Bone marrow cells also showed complex chromosome rearrangements consistent with the myelodysplastic syndrome at 11 months of age. Array-comparative genomic hybridization analyses of both WT and NB showed shared gains or amplifications within the chromosomal regions 11p15.5 and 17q21.31-q25.3, including genes that are reportedly implicated in tumor development such as IGF2, H19, WT2, BIRC5, and HRAS.

Serra, A.; Eirich, K.; Winkler, A.K.; Mrasek, K.; Gohring, G.; Barbi, G.; Cario, H.; Schlegelberger, B.; Pokora, B.; Liehr, T.; Leriche, C.; Henne-Bruns, D.; Barth, T.F.; Schindler, D.



Urologic surgical techniques.  


Surgery for incontinence, other than genuine stress incontinence, is a small part of the general gynecologist's practice. He or she must maintain a high index of suspicion for diverticula and fistulae. Included here are several good review articles that outline the state of the art and include classic references in the bibliography. Patients with cancer with a genitourinary fistula and incontinence may be managed in a variety of ways. Percutaneous nephrostomy and occlusion of the distal ureter may be an option in patients with incurable disease. Continent diversion, such as the Indiana pouch, offers a long-term remedy to the appropriate patient, even one who has been irradiated, as reported by Mannel. Iatrogenic incontinence is distressing to the patient and her doctor. Webster and Kreder offer keen insight into the evaluation of patients who have postoperative, obstructive, voiding dysfunction. They describe an operative correction, the obturation shelf repair, quite similar to the paravaginal defect repair, which restores "normal anatomy" and results in excellent relief of voiding dysfunction in approximately 90% of their patients. Postoperative bladder care is of concern to the doctor, patient, and nursing staff. Noble's article on the timing of catheter removal is innovative and practical. PMID:1908717

Shull, B L



[A 8-year-forgotten ureteral stent after kidney transplantation: treatment and long-term ?follow-up].  


Introduction: Forgotten indwelling ureteral stents can cause significant urological complications. Only few cases are reported after kindney transplantation.?Materials and methods: We present a case of a 39-year-old woman, transplanted in 1993 and referred to our Transplant Center 8 years later, because of a serious urinary tract infection with renal function impairment. Abdominal CT scan showed pyelonephritis and hydronephrosis in the transplanted kidney and the presence of a calcific ureteral stent, which had been forgotten in situ for 8 years. The stent was removed, but it was impossibile to replace it with a new stent both retrogradely and anterogradely, because of a tight obstruction of the mid ureter. So a uretero-ureteral anastomosis with up urinary tract was performed.?Results: No intra- or post-operative complications occurred. At 9 years' follow-up, the patient shows an optimal renal function, with no urinary tract infection.?Discussion: A forgotten ureteral stent in a trasplanted kidney can cause a lot of complications and can lead to graft loss. The prosthesis may cause an irreversibile ureteral damage, so, as in our experience, forgetting a ureteral stent can result in a complex surgery. PMID:23423682

Lasaponara, Fedele; Dalmasso, Ettore; Santià, Silvia; Sedigh, Omidreza; Bosio, Andrea; Pasquale, Giovanni; Segoloni, Giuseppe P; Fontana, Dario



Prolonged urinary leakage in the postoperative period of renal hydatic cyst treatment with oral desmopressin: a case report  

PubMed Central

Introduction Prolonged extravasation after renal and ureter surgeries is a bothersome situation for both the patient and the doctor. It is usually related to the suture line not being watertight. The contact between urine and the edges of the wound also delay healing of the wound. In this situation, the first thing to do is to break the contact between the wound and the urine by inserting an adequate stent. Sometimes, this process is not enough. We approached this problem with a different treatment method for a case involving prolonged drainage. Case presentation A 52-year-old Caucasian woman who presented at our clinic with right flank pain was operated on due to a renal hydatic cyst, and cyst removal was performed. On follow-up, prolonged urinary leakage was observed and a desmopressin treatment was started on the patient. Drainage was greatly reduced after desmopressin was started and there was no drainage on the fifth day. Conclusion Prolonged extravasation is a bothersome situation and there can be many reasons for this. Whenever traditional approaches are not enough, oral desmopressin therapy can be started reliably if there are no contraindications for the patient. Eventually, contact between urine and the suture site will cease and therefore the fever and healing time will be shortened.



Ureteric Injury due to the Use of LigaSure  

PubMed Central

Background. LigaSure is a bipolar clamping device used in open and laparoscopic surgeries for producing haemostasis in vascular pedicles up to 7?mm in diameter (“Covidien LigaSure technology: consistent, reliable, trusted vessel sealing,” 2012). The use of LigaSure has made securing haemostasis and tissue dissection relatively easy especially in laparoscopic surgery; however, if not used with care it can cause damage to the surrounding structures through lateral spread of energy. Case Report. This case report discusses the induction of a thermal ureteral injury associated with the use of LigaSure. An 80-year-old gentleman was operated for bowel cancer. LigaSure was used for securing haemostasis and tissue dissection. Postoperatively, he was found to have damage to the right ureter secondary to lateral spread of energy from the jaws of LigaSure with high abdominal drain output. Conclusion. Judicious and careful use of electrosurgical devices should be done to prevent inadvertent damage to the surrounding structures. Early recognition and involvement of a urologist can prevent long-term complications.

Gilkison, William



?-catenin is necessary to keep cells of ureteric bud/Wolffian duct epithelium in a precursor state  

PubMed Central

Differentiation is the process by which tissues/organs take on their final, physiologically functional form. This process is mediated in part by the silencing of embryonic genes and the activation of terminal, differentiation gene products. Mammalian kidney development is initiated when the Wolffian duct branches and invades the overlying metanephric mesenchyme. The newly formed epithelial bud, known as the ureteric bud, will continue to branch ultimately differentiating into the collecting duct system and ureter. Here, we show that Hoxb7-Cre mediated removal of ?-catenin from the mouse Wolffian duct epithelium leads to the premature expression of gene products normally associated with the differentiated kidney collecting duct system including the water channel protein, Aquaporin-3 and the tight junction protein isoform, ZO-1?+. Mutant cells fail to maintain expression of some genes associated with embryonic development, including several mediators of branching morphogenesis, which subsequently leads to kidney aplasia or hypoplasia. Reciprocally, expression of a stabilized form of ?-catenin appears to block differentiation of the collecting ducts. All of these defects occur in the absence of any effects on the adherens junctions. These data indicate a role for ?-catenin in maintaining cells of the Wolffian ducts and the duct derived ureteric bud/collecting duct system in an undifferentiated or precursor state.

Marose, Thomas D.; Merkel, Calli E.; McMahon, Andrew P.; Carroll, Thomas J.



Actin Depolymerizing Factors Cofilin1 and Destrin Are Required for Ureteric Bud Branching Morphogenesis  

PubMed Central

The actin depolymerizing factors (ADFs) play important roles in several cellular processes that require cytoskeletal rearrangements, such as cell migration, but little is known about the in vivo functions of ADFs in developmental events like branching morphogenesis. While the molecular control of ureteric bud (UB) branching during kidney development has been extensively studied, the detailed cellular events underlying this process remain poorly understood. To gain insight into the role of actin cytoskeletal dynamics during renal branching morphogenesis, we studied the functional requirements for the closely related ADFs cofilin1 (Cfl1) and destrin (Dstn) during mouse development. Either deletion of Cfl1 in UB epithelium or an inactivating mutation in Dstn has no effect on renal morphogenesis, but simultaneous lack of both genes arrests branching morphogenesis at an early stage, revealing considerable functional overlap between cofilin1 and destrin. Lack of Cfl1 and Dstn in the UB causes accumulation of filamentous actin, disruption of normal epithelial organization, and defects in cell migration. Animals with less severe combinations of mutant Cfl1 and Dstn alleles, which retain one wild-type Cfl1 or Dstn allele, display abnormalities including ureter duplication, renal hypoplasia, and abnormal kidney shape. The results indicate that ADF activity, provided by either cofilin1 or destrin, is essential in UB epithelial cells for normal growth and branching.

Kuure, Satu; Cebrian, Cristina; Machingo, Quentin; Lu, Benson C.; Chi, Xuan; Hyink, Deborah; D'Agati, Vivette; Gurniak, Christine; Witke, Walter; Costantini, Frank



Role of fibroblast growth factor receptor 2 in kidney mesenchyme  

PubMed Central

Conditional deletion of murine fibroblast growth factor receptors (Fgfrs) 1 and 2 in metanephric mesenchyme leads to renal agenesis with unbranched ureteric buds; however, there are occasionally 2 buds per nephric duct. Our goal was to determine whether conditional deletion of Fgfr1 or Fgfr2 alone resulted in multiple ureteric bud induction sites. While deletion of Fgfr1 alone results in no abnormalities, loss of Fgfr2 often leads to multiple ureteric buds and anomalies including renal aplasia, misshaped kidneys, partially duplicated kidneys, duplicated ureters, and obstructed hydroureter. Deletion of Fgfr2 did not change expression domains of glial cell line-derived neurotrophic factor (Gdnf), Robo2, bone morphogenetic protein 4, or Sprouty1, all of which regulate ureteric bud induction. Cultured Fgfr2 mutant nephric ducts were also not more sensitive to exogenous GDNF than controls. Whole mount in situ hybridization revealed that in mutant embryos, Fgfr2 was deleted from stromal cells around the nephric duct and ureteric bud base, which correlates well with the ureteric bud induction abnormalities. Thus, Fgfr2 is critical in ensuring that there is a single ureteric bud from the nephric duct. The plethora of later stage defects in Fgfr2 conditional knockouts is reminiscent of many human cases of genetic urogenital anomalies.

Hains, David; Sims-Lucas, Sunder; Kish, Kayle; Saha, Monalee; McHugh, Kirk; Bates, Carlton M.



[First clinical trials of a new endoscopic lithotriptor with ballistic energy (Waltz EL 25 Combilith)].  


The Waltz Combilith EL 25 is an endoscopic lithotriptor equipped with an electrohydraulic and ballistic function. The device which generates the ballistic energy is a hand-piece in which a projectile, driven by an electromagnet, strikes a metal rod which transmits the energy to the stone. The diameter and length of the rod are adapted to the site of the stone (bladder + kidney: 1.7 mm rod; ureter: 0.8 mm rod). 29 stones in 25 patients with a mean age of 43 years (range: 25-72) were treated using ballistic energy: 22 ureteric stones (mean dimensions: 9 x 6 mm), 2 renal stones (mean dimensions: 20 x 30 mm) and 5 bladder stones (mean dimensions: 15 mm). Satisfactory stone fragmentation was obtained for 26 of the 29 stones (89.6%) with a mean fragmentation time of 142 seconds. One minimal ureteric perforation was observed (cure without sequelae after drainage by a double J stent). The Combilith EL 25 presents an excellent efficacy/safety ratio and can be used throughout the urinary tract. PMID:8580978

Friaa, S; Gelet, A; Manzan, K; Dawahra, M; Martin, X; Marechal, J M; Dubernard, J M



Pharmacological studies on the mode of action of flavoxate.  


Previous studies on the mode of action of flavoxate have shown that the drug exerts a selective and direct muscle relaxant activity. In order to study the mode of action of flavoxate, the following activities were investigated: calcium blocking, inhibition of cyclic AMP phosphodiesterase (PDE), local anaesthetic activity, the effects on the synthesis and release of prostaglandins. In the K+-depolarized guinea-pig taenia coli, contracted by CaCl2, flavoxate and papaverine showed a moderate calcium antagonistic activity. Anticholinergic drugs, such as atropine and emepronium, did not exert a similar action. The antispasmodic activity of a drug can be correlated with inhibition of cyclic AMP phosphodiesterase, and since papaverine is a potent PDE inhibitor, we tested flavoxate for this activity. Flavoxate exerted a PDE inhibitory activity about three and five times greater than that of aminophylline in tissues homogenates of guinea-pig ureter and urinary bladder, respectively. It also showed the same local anaesthetic activity of lidocaine. Finally, the synthesis and release of prostaglandins by urinary bladder muscle in vitro have been investigated before and after treatment with flavoxate. Myolytic activity of papaverine and flavoxate do not involve inhibition of prostaglandins synthesis in rat urinary bladder in vitro. Therefore, the mode of action of flavoxate can be related to a superimposition of myotropic, calcium antagonistic and local anaesthetic activity. PMID:6329116

Cazzulani, P; Panzarasa, R; Luca, C; Oliva, D; Graziani, G



Single-session laparoscopic cystectomy and nephroureterectomy  

PubMed Central

Patients with high grade and/or muscle invasive bladder cancer and with concomitant diseases of the upper urinary tract, e.g. urothelial tumors (transitional cell carcinoma – TCC) or afunctional hydronephrotic kidneys, may be candidates for simultaneous cystectomy and nephroureterectomy. Although the progress in laparoscopic techniques made these procedures feasible and safe, they are still technically demanding so only experienced surgeons can perform them. The aim of the study is to report our experience with laparoscopic simultaneous en bloc resection of the urinary bladder together with unilateral or bilateral nephroureterectomy in patients with TCC. Our material consists of three cases operated on in three centers between 2002 and 2011. After having completed bilateral (1 case) or unilateral (2 cases) nephroureterectomy, we performed radical cystectomy with pelvic lymph node dissection. All the specimens, including the kidneys, ureters, bladder, and reproductive organs in the female, were collected in endobags and were retrieved en bloc using hypogastric incision in the male patient and the vaginal route in the female patients. The demographic and perioperative information was collected and analyzed. All procedures were completed laparoscopically without the need of conversion to open surgery. No major intra- or postoperative complications were observed. Only 1 patient suffered from prolonged lymphatic leakage. From our experience we can conclude that single-session laparoscopic cystectomy and nephroureterectomy are technically feasible and safe, and may be offered for the treatment of selected cases of TCC of the urinary tract.

Chlosta, Piotr; Myslak, Marek; Herlinger, Grzegorz; Dobronski, Piotr; Kryst, Piotr; Drewa, Tomasz



Retroperitoneal extraovarian fibrothecoma mimicking a malignant epithelial ovarian carcinoma.  


Background. Fibrothecomas are benign sex cord-stromal tumors which rarely originate outside of the ovary. To date, two such cases have been reported in the literature. We report the third case of an extraovarian fibrothecoma and the first presenting similarly to a metastatic epithelial ovarian cancer. Clinical History. We describe a 62-year-old woman with history, physical examination, and imaging suggestive of metastatic ovarian cancer. CA-125 was elevated at 1291?U/mL. Paracenteses were negative for malignant cells and core biopsy showed spindle cell proliferation. A primary debulking surgery for a presumed ovarian cancer was planned. Method and Results. At surgery, 6 liters of ascites were drained. The uterus, ovaries, peritoneum, and omentum were normal. An 18 × 11 × 7?cm retroperitoneal mass was found between the left ureter and the sigmoid mesocolon, wrapped with sigmoid colon. Fallopian tubes and ovaries were normal. The mass was resected en bloc with the sigmoid colon, uterus, ovaries, and omentum. Microscopically, there was spindle cell proliferation typical of fibrothecoma. No ovarian tissue was identified in association with the tumor. Conclusion. This third case of extraovarian fibrothecoma highlights the importance of obtaining histologic evidence of malignancy prior to initiating neoadjuvant chemotherapy for a presumed ovarian cancer. PMID:22928131

Roberts, Patrick; Nofech-Mozes, Sharon; Coburn, Natalie; Hamilton, Paul; Gien, Lilian T



Movement of acid equivalents across the mammalian smooth muscle cell membrane.  


Factors affecting intracellular pH (pHi) in the smooth muscle of guinea pig ureter have been investigated using pH-sensitive microelectrodes. Associated acids and bases appear to have free passage across the cell membrane but results suggest very low permeability to charged acid equivalents, thus implicating carrier-mediated movements in many of the observed pHi transients. Recovery from acidosis in the nominal absence of CO2 was inhibited by removal of Na+ and by the presence of amiloride, indicating that Na+/H+ exchange was responsible. The presence of CO2 resulted in a faster recovery from acidosis but, since intracellular buffering power was not increased, not a substantially faster effective extrusion of protons. Surprisingly, amiloride no longer caused discernable inhibition. Recovery from moderate acidosis remained Na+ dependent but was not inhibited by DIDS or acetazolamide or by the absence of Cl-, suggesting a dominant Na+-, and HCO3(-)-dependent mechanism unlike any hitherto described. Recovery from alkalosis was inhibited by DIDS and Cl(-)-free conditions, indicating that Cl-/HCO3- exchange was involved. Results suggest reversal of this mechanism on extreme acidosis. Experiments in vascular smooth muscle with fluorescent indicators confirm the presence of Na+/H+ exchange but provide conflicting evidence about the presence and properties of the HCO3(-)-dependent mechanism. PMID:2849529

Aickin, C C



A proliferation-dependent bystander effect in primary porcine and human urothelial explants in response to targeted irradiation.  


The aim of this study was to test whether radiation-induced bystander effects are involved in the response of multicellular systems to targeted irradiation. A primary explant technique was used that reconstructed the in vivo microarchitecture of normal urothelium with proliferating and differentiated cells present. Sections of human and porcine ureter were cultured as explants and irradiated on day 7 when the urothelial outgrowth formed a halo around the tissue fragment. The Gray Cancer Institute charge particle microbeam facility allowed the irradiation of individual cells within the explant outgrowth with a predetermined exact number of (3)He(2+) ions (which have very similar biological effectiveness to alpha-particles). A total of 10 individual cell nuclei were irradiated with 10 (3)He(2+) ions either on the periphery, where proliferating cells are located, or at the centre of the explant outgrowth, which consisted of terminally differentiated cells. Samples were fixed 3 days after irradiation, stained and scored. The fraction of apoptotic and micronucleated cells was measured and a significant bystander-induced damage was observed. Approximately 2000-6000 cells could be damaged by the irradiation of a few cells initially, suggesting a cascade mechanism of cell damage induction. However, the fraction of micronucleated and apoptotic cells did not exceed 1-2% of the total number of the cells within the explant outgrowth. It is concluded that the bystander-induced damage depends on the proliferation status of the cells and can be observed in an in vitro explant model. PMID:12618888

Belyakov, O V; Folkard, M; Mothersill, C; Prise, K M; Michael, B D



Recognition of the laminin E8 cell-binding site by an integrin possessing the alpha 6 subunit is essential for epithelial polarization in developing kidney tubules  

PubMed Central

It has been previously shown that A-chain and domain(E8)-specific antibodies to laminin that inhibit cell adhesion also interfere with the establishment of epithelial cell polarity during kidney tubule development (Klein, G., M. Langegger, R. Timpl, and P. Ekblom. 1988. Cell. 55:331-341). A monoclonal antibody specific for the integrin alpha 6 subunit, which selectively blocks cell binding to E8, was used to study the receptors involved. Immunofluorescence staining of embryonic kidneys and of organ cultures of metanephric mesenchyme demonstrated coappearance of the integrin alpha 6 subunit and the laminin A-chain in regions where nonpolarized mesenchymal cells convert into polarized epithelial cells. Both epitopes showed marked colocalization in basal areas of tubules, while an exclusive immunostaining for alpha 6 was observed in lateral and apical cell surfaces of the tubular epithelial cells. Organ culture studies demonstrated a consistent inhibition of kidney epithelium development by antibodies against the alpha 6 subunit. The data suggest that the recognition of E8 cell-binding site of laminin by a specific integrin is crucial for the formation of kidney tubule epithelium from undifferentiated mesenchymal stem cells. In some other cell types (endothelium, some ureter cells) an exclusive expression of alpha 6 with no apparent colocalization of laminin A-chain in the corresponding basement membrane was seen. Thus, in these cells, integrins possessing the alpha 6 subunit may bind to laminin isoforms that differ from those synthesized by developing tubules.



Bladder neck closure and suprapubic catheter placement as definitive management of neurogenic bladder  

PubMed Central

Objective Surgical management for neurogenic bladder may require abandonment of the native urethra due to intractable urinary incontinence, irreparable urethral erosion, severe scarring from previous transurethral procedures, or urethrocutaneous fistula. In these patients, bladder neck closure (BNC) excludes the native urethra and provides continence while preserving the antireflux mechanism of the native ureters. This procedure is commonly combined with ileovesicostomy or continent catheterizable stoma, with or without augmentation enterocystoplasty. Alternatively, BNC can be paired with suprapubic catheter diversion. This strategy does not require a bowel segment, resulting in shorter operative times and less opportunity for bowel-related morbidity. The study purpose is to examine preoperative characteristics, indications, complications, and long-term maintenance of renal function of BNC patients. Methods A retrospective review of medical records of 35 patients who underwent BNC with suprapubic catheter placement from 1998 to 2007 by a single surgeon (LKL) was completed. Results Neurogenic bladder was attributable to spinal cord injury in 71%, 23% had multiple sclerosis, and 9% had cerebrovascular accident. Indications for BNC included severe urethral erosion in 80%, decubitus ulcer exacerbated by urinary incontinence in 34%, urethrocutaneous fistula in 11%, and other indications in 9%. The overall complication rate was 17%. All but two patients were continent at follow-up. Forty-nine per cent of patients had imaging available for review, none of which showed deterioration of the upper tracts. Conclusions Our results suggest that BNC in conjunction with suprapubic catheter diversion provides an excellent chance at urethral continence with a reasonable complication rate.

Colli, Janet; Lloyd, L. Keith



A Systematic Molecular Pathology Study of a Laboratory Confirmed H5N1 Human Case  

PubMed Central

Autopsy studies have shown that human highly pathogenic avian influenza virus (H5N1) can infect multiple human organs other than just the lungs, and that possible causes of organ damage are either viral replication and/or dysregulation of cytokines and chemokines. Uncertainty still exists, partly because of the limited number of cases analysed. In this study, a full autopsy including 5 organ systems was conducted on a confirmed H5N1 human fatal case (male, 42 years old) within 18 hours of death. In addition to the respiratory system (lungs, bronchus and trachea), virus was isolated from cerebral cortex, cerebral medullary substance, cerebellum, brain stem, hippocampus ileum, colon, rectum, ureter, aortopulmonary vessel and lymph-node. Real time RT-PCR evidence showed that matrix and hemagglutinin genes were positive in liver and spleen in addition to positive tissues with virus isolation. Immunohistochemistry and in-situ hybridization stains showed accordant evidence of viral infection with real time RT-PCR except bronchus. Quantitative RT-PCR suggested that a high viral load was associated with increased host responses, though the viral load was significantly different in various organs. Cells of the immunologic system could also be a target for virus infection. Overall, the pathogenesis of HPAI H5N1 virus was associated both with virus replication and with immunopathologic lesions. In addition, immune cells cannot be excluded from playing a role in dissemination of the virus in vivo.

Gao, Rongbao; Dong, Libo; Dong, Jie; Wen, Leying; Zhang, Ye; Yu, Hongjie; Feng, Zijian; Chen, Minmei; Tan, Yi; Mo, Zhaojun; Liu, Haiyan; Fan, Yunyan; Li, Kunxiong; Li, Chris Ka-Fai; Li, Dexin; Yang, Weizhong; Shu, Yuelong



Optically triggered solid state driver for shock wave therapy  

NASA Astrophysics Data System (ADS)

Shock wave lithotripsy (SWL) represents one of several first-line therapies for the treatment of stones located in the kidneys and ureters. Additional applications for shock wave therapy are also under exploration, including non-urinary calculi, orthopedics, and neovascularization. Except for the elimination of a large water bath in which the treatment is performed, current procedures remain largely unchanged, with one of the original commercial devices (the Dornier HM3) still considered a gold standard for comparison. To accelerate research in this area, Coleman, et al. published an experimental electrohydraulic shock wave generator capable of simulating the acoustic field generated by the HM3. We propose a further update of this system, replacing the triggered spark gap with an optically triggered solid state switch. The new system has better reliability, a wider operating range, and reduced timing jitter allowing synchronization with additional acoustic sources under exploration for improving efficacy and reducing injury. Originally designed for exciting electrohydraulic spark electrodes, the system can also be adapted for driving piezoelectric and electromagnetic sources.

Duryea, Alexander P.; Roberts, William W.; Cain, Charles A.; Hall, Timothy L.