Metallic ureteral stents in malignant ureteral obstruction: clinical factors predicting stent failure.

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Chow, Po-Ming; Hsu, Jui-Shan; Huang, Chao-Yuan; Wang, Shuo-Meng; Lee, Yuan-Ju; Huang, Kuo-How; Yu, Hong-Jheng; Pu, Yeong-Shiau; Liang, Po-Chin

2014-06-01

To provide clinical outcomes of the Resonance metallic ureteral stent in patients with malignant ureteral obstruction, as well as clinical factors predicting stent failure. Cancer patients who have received Resonance stents from July 2009 to March 2012 for ureteral obstruction were included for chart review. Stent failure was detected by clinical symptoms, image studies, and renal function tests. Survival analysis for stent duration was used to estimate patency rate and factors predicting stent failure. A total of 117 stents were inserted successfully into 94 ureteral units in 79 patients. There were no major complications. These stents underwent survival analysis and proportional hazard regression. The median duration for the stents was 5.77 months. In multivariate analysis, age (P=0.043), preoperative serum creatinine level (P=0.0174), and cancer type (P=0.0494) were significant factors associated with stent failure. Cancer treatment before and after stent insertion had no effect on stent duration. Resonance stents are effective and safe in relieving malignant ureteral obstructions. Old age and high serum creatinine level are predictors for stent failure. Stents in patients with lower gastrointestinal cancers have longer functional duration.

Retrograde placement of double-J ureteral stent with interventional therapy for the treatment of ureteral stricture

International Nuclear Information System (INIS)

Kong Jian; Xu Linfeng; Liang Huimin; Zheng Chuansheng; Zheng Jinlong; Feng Gansheng

2000-01-01

Objective: To evaluate the retrograde placement of Double-J ureteral stent with interventional therapy for the treatment of ureteral stricture. Methods: Twenty patients with ureteral stricture of various causes were treated with retrograde placing Double-J ureteral stent by interventional therapy. Results: The Double-J stent was successfully performed in all twenty patients. The successful rate of placing stent was 100%. The cure rate was 90% (18/20). The complications such as urinary leakage, wound infection, and bleeding were markedly decreased. The indication, duration of indwelling and complication of the indwelling stent were discussed. Conclusion: Retrograde placing Double-J stent with interventional therapy is simple and less invasive. It is believed to be a safe and effective method for the treatment of ureteral stricture

Image-guided ureteral reconstruction using rendezvous technique for complex ureteric transection after gunshot injuries.

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Arabi, Mohammad; Mat'hami, Abdulaziz; Said, Mohammad T; Bulbul, Muhammad; Haddad, Maurice; Al-Kutoubi, Aghiad

2016-01-01

Management of complex ureteric transection poses a significant clinical challenge, particularly after gunshot injuries due to marked distortion of anatomy and associated tissue loss. We report two cases of total ureteric transection due to gunshot injury successfully repaired using fluoroscopy-guided rendezvous procedure and double J stent placement. This minimally invasive approach may offer a safe and effective technique to repair complete ureteral transection and obviate the need for complex surgical procedures.

Analysis of ureteral length in adult cadavers

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Hugo F. F. Novaes

2013-04-01

Full Text Available Introduction In some occasions, correlations between human structures can help planning surgical intra-abdominal interventions. The previous determination of ureteral length helps pre-operatory planning of surgeries, reduces costs of auxiliary exams, the correct choice of double-J catheter with low morbidity and fewer symptoms, and an adequate adhesion to treatment. Objective To evaluate ureteral length in adult cadavers and to analyze its correlation with anthropometric measures. Materials and Methods: From April 2009 to January 2012 we determined ureteral length of adult cadavers submitted to necropsy and obtained the following measures: height, distance from shoulder to wrist, elbow-wrist, xiphoid appendix-umbilicus, umbilicus-pubis, xiphoid appendix-pubis and between iliac spines. We analyzed the correlations between ureteral length and those anthropometric measures. Results We dissected 115 ureters from 115 adult corpses from April 2009 to January 2012. Median ureteral length didn't vary between sexes or according to height. It was observed no correlation among ureteral length and all considered anthropometric measures in all analyzed subgroups and in general population. There were no significant differences between right and left ureteral measures. Conclusions There is no difference of ureteral length in relation to height or gender (male or female. There is no significant correlation among ureteral length and the considered anthropometric measures.

Penetrating ureteral trauma

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Gustavo P. Fraga

2007-04-01

Full Text Available OBJECTIVE: The purpose of this series is to report our experience in managing ureteral trauma, focusing on the importance of early diagnosis, correct treatment, and the impact of associated injuries on the management and morbid-mortality. MATERIALS AND METHODS: From January 1994 to December 2002, 1487 laparotomies for abdominal trauma were performed and 20 patients with ureteral lesions were identified, all of them secondary to penetrating injury. Medical charts were analyzed as well as information about trauma mechanisms, diagnostic routine, treatment and outcome. RESULTS: All patients were men. Mean age was 27 years. The mechanisms of injury were gunshot wounds in 18 cases (90% and stab wounds in two (10%. All penetrating abdominal injuries had primary indication of laparotomy, and neither excretory urography nor computed tomography were used in any case before surgery. The diagnosis of ureteric injury was made intra-operatively in 17 cases (85%. Two ureteral injuries (10% were initially missed. All patients had associated injuries. The treatment was dictated by the location, extension and time necessary to identify the injury. The overall incidence of complications was 55%. The presence of shock on admission, delayed diagnosis, Abdominal Trauma Index > 25, Injury Severity Score > 25 and colon injuries were associated to a high complication rate, however, there was no statistically significant difference. There were no mortalities in this group. CONCLUSIONS: A high index of suspicion is required for diagnosis of ureteral injuries. A thorough exploration of all retroperitoneal hematoma after penetrating trauma should be an accurate method of diagnosis; even though it failed in 10% of our cases.

Percutaneous Management of Ureteral Injuries that are Diagnosed Late After Cesarean Section

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Ustunsoz, Bahri; Ugurel, Sahin; Duru, Namik Kemal; Ozgok, Yasar; Ustunsoz, Ayfer [GATA Medical Faculty, Ankara (Turkmenistan)

2008-08-15

We wanted to present the results of percutaneous management of ureteral injuries that were diagnosed late after cesarean sections (CS). Twenty-two cases with 24 ureteral injuries that were diagnosed late after CS underwent percutaneous nephrostomy (PN), antegrade double J (DJ) catheter placement and balloon dilatation or a combination of these. The time for making the diagnosis was 21 +- 50.1 days. The injury site was the distal ureter in all cases (the left ureter: 13, the right ureter: 7 and bilateral: 2). Fifteen complete ureteral obstructions were detected in 13 cases. Ureteral leakage due to partial (n = 4) or complete (n = 3) rupture was noted in seven cases. Two cases had ureterovaginal fistula. All the cases were initially confirmed with antegrade pyelography and afterwards they underwent percutaneous nephrostomy. Balloon dilatation was needed in three cases. Antegrade DJ stents were placed in 10 cases, including the three cases with balloon dilatation. Repetititon of percutaneous nephrostomy with balloon dilatation and DJ stent placement was needed in one case with complete obstruction. All the cases were followed-up with US in their first week and then monthly thereafter for up to two years. Eighteen ureters (75%) were managed by percutaneous procedures alone. A total of six ureter injuries had to undergo surgery (25%). Percutaneous management is a good alternative for the treatment of post-CS ureteral injuries that are diagnosed late after CS. Percutaneous management is at least preparatory for a quarter of the cases where surgery is unavoidable

21 CFR 876.4620 - Ureteral stent.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ureteral stent. 876.4620 Section 876.4620 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4620 Ureteral stent. (a) Identification. A ureteral stent...

Chronically Elevated Levels of Short-Chain Fatty Acids Induce T Cell-Mediated Ureteritis and Hydronephrosis.

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Park, Jeongho; Goergen, Craig J; HogenEsch, Harm; Kim, Chang H

2016-03-01

Short-chain fatty acids (SCFAs) are major products of gut microbial fermentation and profoundly affect host health and disease. SCFAs generate IL-10(+) regulatory T cells, which may promote immune tolerance. However, SCFAs can also induce Th1 and Th17 cells upon immunological challenges and, therefore, also have the potential to induce inflammatory responses. Because of the seemingly paradoxical SCFA activities in regulating T cells, we investigated, in depth, the impact of elevated SCFA levels on T cells and tissue inflammation in mice. Orally administered SCFAs induced effector (Th1 and Th17) and regulatory T cells in ureter and kidney tissues, and they induced T cell-mediated ureteritis, leading to kidney hydronephrosis (hereafter called acetate-induced renal disease, or C2RD). Kidney hydronephrosis in C2RD was caused by ureteral obstruction, which was, in turn, induced by SCFA-induced inflammation in the ureteropelvic junction and proximal ureter. Oral administration of all major SCFAs, such as acetate, propionate, and butyrate, induced the disease. We found that C2RD development is dependent on mammalian target of rapamycin activation, T cell-derived inflammatory cytokines such as IFN-γ and IL-17, and gut microbiota. Young or male animals were more susceptible than old or female animals, respectively. However, SCFA receptor (GPR41 or GPR43) deficiency did not affect C2RD development. Thus, SCFAs, when systemically administered at levels higher than physiological levels, cause dysregulated T cell responses and tissue inflammation in the renal system. The results provide insights into the immunological and pathological effects of chronically elevated SCFAs. Copyright © 2016 by The American Association of Immunologists, Inc.

Helical CT of ureteral disease

International Nuclear Information System (INIS)

Cikman, Pablo; Bengio, Ruben; Bulacio, Javier; Zirulnik, Esteban; Garimaldi, Jorge

2000-01-01

Among the new applications of helical CT is the study of the ureteral pathology. The objective of this paper was to evaluate patients with suspected pathology of this organ and the repercussion in the therapeutic plans. We studied 23 patients with a helical CT protocol, without IV contrast injection and performed multiplanar reconstruction (MPR). We called this procedure Pielo CT. Thirteen ureteral stones were detected, 6 calculi, 2 urinary tract tumors, dilatation of the system in a patient with neo-bladder. In 2 patients, in whom ureteral pathology was ruled out, we found other alterations that explained the symptoms, (gallbladder stones, disk protrusion). The Pielo CT let decide a therapeutical approach in 20 or 21 patients with ureteral pathology. (author)

[Ureteral realignment with the rendezvous procedure in complex ureteral injuries - aspects of technique and our experience].

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Brandt, Alexander Sascha; von Rundstedt, F-C; Lazica, D A; Roth, S

2010-07-01

The rendezvous procedure for re-establishing ureteral continuity after complex ureteral injuries is introduced and we present our experience with this technique. Aspects of the technique are described in a detailed step-by-step instruction using intraoperative radiographs. We evaluated our patient data from 1998 until 2009 for cases in which the rendezvous procedure was attempted. The rendezvous procedure was used in a total of 11 patients. Realignment was successful in 10 cases (90.9 %) and the initial nephrostomy could be removed. In 3 of 7 cases postoperative removal of the JJ ureteric stent was successful. In 7 patients the final surgical ureter reconstruction was performed after a medium period of 7 months. 5 cases of ureteroneocystostomy and 2 cases of reconstruction of the ureter either with colon or ileum segments were accomplished. In 1 patient a permanent maintenance of the DJ ureteral stent was necessary. Ureteral realignment with the rendezvous procedure enables disposition of the ureteral stent in many cases, exclusively antegrade or retrograde procedures failed. By this means nephrostomy could be spared as a temporary or permanent solution and a better chance of restitutio ad integrum could be realised. Georg Thieme Verlag KG Stuttgart * New York.

Outcome of retrograde ureteric stenting as a urinary drainage procedure in ureteric obstruction related to malignant lesions.

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Wijayarathna, S; Suvendran, S; Ishak, M; Weligamage, A; Epa, A; Munasinghe, S; Abeygunaskera, A M

2014-12-01

We investigated the outcome of endoscopic retrograde ureteric stenting (RUS) in patients with ureteric obstruction related to malignant lesions. Data were prospectively collected from patients with ureteric obstruction related to malignant lesions treated at a single urology unit from 1 January 2011 to 30 April 2014. All patients had radiologically significant hydronephrosis by ultrasonography and CT scanning. First choice of urinary drainage was placing a retrograde ureteric stent cystoscopically. Outcome of patients who had stenting were recorded after following them until death or removal of stents. Eighty two patients with ureteric obstruction related to malignant lesions had complete data. In 33 (25%) patients, retrograde ureteric stenting was possible. Fifteen of them had recurrent tumour in the pelvis at the time of stenting and 13 (87%) were dead within 3 months of stenting. Four of the five patients who did not have pelvic tumour recurrence were alive at the end of the study. All eight patients who underwent stenting before surgery as a prophylactic measure and three of the five patients who had retroperitoneal tumour mass and underwent RUS were alive. Stenting was not possible in 42 patients. Thirty eight of them had pelvic tumour recurrences and two were having retroperitoneal tumour masses. Only one did not have tumour in the pelvis.CT evidence of tumour recurrence in the pelvis (OR 12.7; 95% CI 1.3-117.6; p=0.026) and high serum creatinine (OR 4.3; 95% CI 1.6-11.7; p=0.004) were associated with failure to ureteric stenting. Chances of successful RUS were low in patients with ureteric obstruction in the presence of tumour recurrences or elevated serum creatinine. Even if ureteric stenting was successful, their life expectancy was short.

Percutaneous Management of Ureteral Injuries that are Diagnosed Late After Cesarean Section

International Nuclear Information System (INIS)

Ustunsoz, Bahri; Ugurel, Sahin; Duru, Namik Kemal; Ozgok, Yasar; Ustunsoz, Ayfer

2008-01-01

We wanted to present the results of percutaneous management of ureteral injuries that were diagnosed late after cesarean sections (CS). Twenty-two cases with 24 ureteral injuries that were diagnosed late after CS underwent percutaneous nephrostomy (PN), antegrade double J (DJ) catheter placement and balloon dilatation or a combination of these. The time for making the diagnosis was 21 ± 50.1 days. The injury site was the distal ureter in all cases (the left ureter: 13, the right ureter: 7 and bilateral: 2). Fifteen complete ureteral obstructions were detected in 13 cases. Ureteral leakage due to partial (n = 4) or complete (n = 3) rupture was noted in seven cases. Two cases had ureterovaginal fistula. All the cases were initially confirmed with antegrade pyelography and afterwards they underwent percutaneous nephrostomy. Balloon dilatation was needed in three cases. Antegrade DJ stents were placed in 10 cases, including the three cases with balloon dilatation. Repetititon of percutaneous nephrostomy with balloon dilatation and DJ stent placement was needed in one case with complete obstruction. All the cases were followed-up with US in their first week and then monthly thereafter for up to two years. Eighteen ureters (75%) were managed by percutaneous procedures alone. A total of six ureter injuries had to undergo surgery (25%). Percutaneous management is a good alternative for the treatment of post-CS ureteral injuries that are diagnosed late after CS. Percutaneous management is at least preparatory for a quarter of the cases where surgery is unavoidable

Management of ureteric stone in pediatric patients

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Eugene Minevich

2010-01-01

Full Text Available The management of ureteral stones in children is becoming more similar to that in adults. A number of factors must be taken into account when selecting one′s choice of therapy for ureteral stone in children such as the size of the stone, its location, its composition, and urinary tract anatomy. Endoscopic lithotripsy in children has gradually become a major technique for the treatment of ureteral stones. The stone-free rate following urteroscopic lithotripsy for ureteral stones has been reported in as high as 98.5-100%. The safety and efficacy of Holmium:YAG laser lithotripsy make it the intracorporeal lithotriptor of choice. Given its minimally invasive features, extracorporeal shock wave lithotripsy (ESWL has become a primary mode of treatment for the pediatric patients with reno-ureteral stones. Stone-free rates have been reported from 59% to 91% although some patients will require more than one treatment session for stone clearance. It appears that the first-line of therapy in the child with distal and mid-ureteral stones should be ureteroscopic lithotripsy. While ESWL is still widely considered the first-line therapy for proximal ureteral calculi, there is an increasing body of evidence that shows that endoscopic or ESWL are equally safe and efficacious in those clinical scenarios. Familiarity with the full spectrum of endourological techniques facilitates a minimally invasive approach to pediatric ureteral stones.

Lumbar Ureteral Stenosis due to Endometriosis: Our Experience and Review of the Literature

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Salvatore Butticè

2013-01-01

Full Text Available Endometriosis is a chronic gynaecological disorder characterized by the presence of endometrial tissue outside the uterus. The disease most often affects the ovaries, uterine ligaments, fallopian tubes, and cervical-vaginal region. Urinary tract involvement is rare, accounting for around 1%-2% of all cases, of which 84% are in the bladder. We report a case of isolated lumbar ureteral stenosis due to endometriosis in a 37-year-old patient. The patient came to our observation complaining from lumbar back pain and presented with severe fever. The urological examination found monolateral left positive sign of Giordano. Blood tests evidenced marked lymphocytosis and increased valued of C-reactive protein. Urologic ultrasound showed hydronephrosis of first degree in the left kidney and absence of images related to stones bilaterally. Uro-CT scan evidenced ureteral stenosis at the transition between the iliac and pelvic tracts. We addressed the patient to surgery, and performed laparoscopic excision of the paraureteral bulk, endoscopic mechanical ureteral dilation, and stenting. The histological examination evidenced glandular structures lined by simple epithelium and surrounded by stroma. Immunohistochemical test of the glandular epithelium showed positivity for estrogen and progesterone receptors and moreover stromal cells were positive for CD10. The finding suggested a very rare diagnosis of isolated lumbar ureteral endometriosis.

Ureteral valve masquerading as obstructive megaureter

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Sushmita Bhatnagar

2017-05-01

Full Text Available Primary obstructed megaureter is a common urological condition in the pediatric age group. It is one of the differentials for congenital anomalies of the kidney and urinary tract that include a myriad of structural anomalies of the urinary tract. The obstructive conditions are usually managed conservatively unless there is deterioration in renal function, repeated urinary tract infection, or any other symptom such as abdominal pain on ipsilateral side and hypertension. Presented here is a case of left lower ureteral valve that was diagnosed as primary obstructed megaureter with pain in abdomen and reduced ipsilateral renal function wherein ureteral valve was detected incidentally intraoperatively. Excision of the valve with end to end uretero-ureteral anastomoses over a D-J stent, without resorting to ureteric reimplantation was successful in relieving the obstruction and hydronephrosis

Evaluation of ureteral lesions in ureterorenoscopy

DEFF Research Database (Denmark)

Lildal, Søren Kissow; Andreassen, Kim Hovgaard; Jung, Helene

2018-01-01

(PULS) classification system. RESULTS: The use of 10/12 Fr UASs resulted in less severe lesions than reported previously with larger diameter UASs. There was a higher risk of superficial lesions in the UAS group, with a calculated crude odds ratio (OR) of 1.84 [95% confidence interval (CI) 1...... with an endoscope alone, but when adjusting for age and gender the incidence of ureteral lesions was comparable between RIRS with and without the use of a 10/12 Fr UAS.......OBJECTIVE: The aim of this study was to evaluate the incidence of ureteral lesions in retrograde intrarenal surgery (RIRS) with and without the use of a 10/12 Fr ureteral access sheath (UAS). A further objective was to search for preoperative factors that could influence the risk of ureteral damage...

[The Predictive Factors of Stent Failure in the Treatment of Malignant Extrinsc Ureteral Obstruction Using Internal Ureteral Stents].

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Matsuura, Hiroshi; Arase, Shigeki; Hori, Yasuhide; Tochigi, Hiromi

2017-12-01

In this study, we retrospectively reviewed the experiences at our single institute in the treatment of malignant extrinsic ureteral obstruction (MUO) using ureteral stents to investigate the clinical outcomes and the predictive factors of stent failure. In 52 ureters of 38 patients who had radiologically significant hydronephrosis due to MUO, internal ureteral stents (The BARD(R) INLAY(TM) ureteral stent set) were inserted. The median follow-up interval after the initial stent insertion was 124.5 days (4-1,120). Stent failure occurred in 8 ureters (15.4%) of the 7 patients. The median interval from the first stent insertion to stent failure was 88 days (1-468). A Cox regression multivariate analysis showed that the significant predictors of stent failure were bladder invasion. Based on the possibility of stent failure, the adaptation of the internal ureteral stent placement should be considered especially in a patient with MUO combined with bladder invasion.

Outcome of ureteral stent placement for treatment of benign ureteral obstruction in dogs: 44 cases (2010-2013).

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Pavia, Philippa R; Berent, Allyson C; Weisse, Chick W; Neiman, Dana; Lamb, Kenneth; Bagley, Demetrius

2018-03-15

OBJECTIVE To describe the technique and short- and long-term outcomes for dogs undergoing double-pigtail ureteral stent placement for treatment of benign ureteral obstruction. DESIGN Retrospective case series. ANIMALS 44 dogs (57 ureters). PROCEDURES Medical records of dogs that underwent ureteral stenting for treatment of benign ureteral obstruction between 2010 and 2013 were reviewed. Signal-ment, history, pertinent diagnostic imaging results, endourologic and post-procedural details, duration of hospitalization, complications, and outcome (short term, 7 to 30 days; long term, > 30 days) were recorded. Ureteral stent placement was performed endoscopically, surgically, or both, with fluoroscopic guidance. RESULTS 57 ureters (44 dogs) underwent stenting because of obstructive ureterolithiasis (n = 48 [84%]), stricture (5 [9%]), or both (4 [7%]). Endoscopic or surgical techniques were successful for stent placement in 45 of 55 and 12 of 12 ureters (34/42 and 10/10 dogs), respectively. Median hospitalization time was 1 day. Median creatinine concentration was 2 mg/dL prior to stenting and 1.3 mg/dL 3 months after the procedure. Urinary tract infections were present in 26 of 44 (59%) dogs prior to stenting and in 11 of 43 dogs (26%) after stenting. One of the 44 (2%) dogs died after undergoing stenting, but the cause of death was not related to the procedure. Median follow-up time was 1,158 days (range, 3 to > 1,555 days), with 30 of 44 dogs alive at the time of last follow-up. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that ureteral stenting may be a viable option for first-line treatment of dogs with benign ureteral obstruction. However, patients should be monitored for urinary tract infection following stenting.

Mast Cells and MCPT4 Chymase Promote Renal Impairment after Partial Ureteral Obstruction

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Maguelonne Pons

2017-05-01

Full Text Available Obstructive nephropathy constitutes a major cause of pediatric renal progressive disease. The mechanisms leading to disease progression are still poorly understood. Kidney fibrotic lesions are reproduced using a model of partial unilateral ureteral obstruction (pUUO in newborn mice. Based on data showing significant mast cell (MC infiltration in patients, we investigated the role of MC and murine MCPT4, a MC-released chymase, in pUUO using MC- (Wsh/sh, MCPT4-deficient (Mcpt4−/−, and wild-type (WT mice. Measurement of kidney length and volume by magnetic resonance imaging (MRI as well as postmortem kidney weight revealed hypotrophy of operated right kidneys (RKs and compensatory hypertrophy of left kidneys. Differences between kidneys were major for WT, minimal for Wsh/sh, and intermediate for Mcpt4−/− mice. Fibrosis development was focal and increased only in WT-obstructed kidneys. No differences were noticed for local inflammatory responses, but serum CCL2 was significantly higher in WT versus Mcpt4−/− and Wsh/sh mice. Alpha-smooth muscle actin (αSMA expression, a marker of epithelial–mesenchymal transition (EMT, was high in WT, minimal for Wsh/sh, and intermediate for Mcpt4−/− RK. Supernatants of activated MC induced αSMA in co-culture experiments with proximal tubular epithelial cells. Our results support a role of MC in EMT and parenchyma lesions after pUUO involving, at least partly, MCPT4 chymase. They confirm the importance of morphologic impairment evaluation by MRI in pUUO.

Emergency management of ureteral stones: Recent advances

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Luis Osorio

2008-01-01

Full Text Available Most ureteral stones can be observed with reasonable expectation of uneventful stone passage. When an active ureteral stone treatment is warranted, the best procedure to choose is dependent on several factors, besides stone size and location, including operators′ experience, patients′ preference, available equipment and related costs. Placement of double-J stent or nephrostomy tube represents the classical procedures performed in a renal colic due to acute ureteral obstruction when the conservative drug therapy does not resolve the symptoms. These maneuvers are usually followed by ureteroscopy or extracorporeal shockwave lithotripsy, which currently represent the mainstay of treatment for ureteral stones. In this review paper a literature search was performed to identify reports dealing with emergency management of renal colic due to ureteral stones. The main aspects related to this debated issue are analyzed and the advantages and disadvantages of each treatment option are carefully discussed.

Emergency management of ureteral stones: Recent advances.

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Osorio, Luis; Lima, Estêvão; Autorino, Riccardo; Marcelo, Filinto

2008-10-01

Most ureteral stones can be observed with reasonable expectation of uneventful stone passage. When an active ureteral stone treatment is warranted, the best procedure to choose is dependent on several factors, besides stone size and location, including operators' experience, patients' preference, available equipment and related costs. Placement of double-J stent or nephrostomy tube represents the classical procedures performed in a renal colic due to acute ureteral obstruction when the conservative drug therapy does not resolve the symptoms. These maneuvers are usually followed by ureteroscopy or extracorporeal shockwave lithotripsy, which currently represent the mainstay of treatment for ureteral stones. In this review paper a literature search was performed to identify reports dealing with emergency management of renal colic due to ureteral stones. The main aspects related to this debated issue are analyzed and the advantages and disadvantages of each treatment option are carefully discussed.

Increased renal adrenomedullin expression in rats with ureteral obstruction

DEFF Research Database (Denmark)

Nørregaard, Rikke; Bødker, Tina; Jensen, Boye L

2009-01-01

Ureteral obstruction is characterized by decreased renal blood flow that is associated with hypoxia within the kidney. Adrenomedullin (AM) is a peptide hormone with tissue-protective capacity that is stimulated through hypoxia. We tested the hypothesis that ureteral obstruction stimulates...... increases in response to ureteral obstruction in agreement with expected oxygen gradients. Hypoxia acting through HIF-1alpha accumulation may be an important pathway for the renal response to ureteral obstruction....

Laparoscopic ureteral reimplantation with Boari flap for the management of long- segment ureteral defect: A case series with review of the literature.

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Bansal, Ankur; Sinha, Rahul Janak; Jhanwar, Ankur; Prakash, Gaurav; Purkait, Bimalesh; Singh, Vishwajeet

2017-09-01

The incidence of ureteral stricture is showing a rising trend due to increased use of laparoscopic and upper urinary tract endoscopic procedures. Boari flap is the preferred method of repairing long- segment ureteral defects of 8-12 cm. The procedure has undergone change from classical open (transperitoneal and retroperitoneal) method to laparoscopic surgery and recently robotic surgery. Laparoscopic approach is cosmetically appealing, less morbid and with shorter hospital stay. In this case series, we report our experience of performing laparoscopic ureteral reimplantation with Boari flap in 3 patients. This prospective study was conducted between January 2011 December 2014. The patients with a long- segment ureteral defect who had undergone laparoscopic Boari flap reconstruction were included in the study. Outcome of laparoscopic ureteral reimplantation with Boari flap for the manangement of long segment ureteral defect was evaluated. The procedure was performed on 3 patients, and male to female ratio was 1:2. One patient had bilateral and other two patient had left ureteral stricture. The mean length of ureteral stricture was 8.6 cm (range 8.2-9.2 cm). The mean operative time was 206 min (190 to 220 min). The average estimated blood loss was 100 mL (range 90-110 mL) and mean hospital stay was 6 days (range 5 to 7 days). The mean follow up was 19 months (range 17-22 months). None of the patients experienced any complication related to the procedure in perioperative period. Laparoscopic ureteral reimplantation with Boari flap is safe, feasible and has excellent long term results. However, the procedure is technically challenging, requires extensive experience of intracorporeal suturing.

Ureteritis cystica: A rare benign lesion

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F. Ibrahim

2014-09-01

Full Text Available Ureteritis cystica is an uncommon benign pathology of the ureter. The etiology is unclear but the diagnosis has become much easier to make with the routine use of ureteroscopy for diagnosis of ureteric lesions. We present a case of a 63 year old Sudanese woman with a history of repeated attacks of right loin pain in whom magnetic resonance urography (MRU showed multiple filling defects in the right ureter. These were initially thought to be malignant urothelial lesions. Ureteroscopy revealed cystic smooth walled masses which discharged tiny turbid fluid on biopsy. An intraoperative diagnosis of ureteritis cystica was confirmed. The patient was managed conservatively.

A comprehensive review of nephroblastoma with ureteric involvement

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Singh S

2017-12-01

Full Text Available Ureteric involvement is described rarely in nephroblastoma, the most common pediatric renal tumor. This clinicopathological, descriptive retrospective study was conducted to elucidate the prevalence and histomorphological features of ureteric involvement by nephroblastoma. Of 454 nephroblastomas diagnosed in the 25-year study period, 32 displayed ureteric involvement; 21 and 11 demonstrated prolapse and invasion, respectively. The patient cohort had a mean age of 47.3 months and mainly advanced stage disease. Pre-operative radiological and intra-operative assessments identified ureteric involvement in 4 and 13 patients, respectively, but distinction between ureteric prolapse and invasion was not possible. Histopathological assessment of the primary renal tumor demonstrated exclusive triphasichistomorphology in all 32 nephroblastomas. Favorable histology, diffuse anaplasia and nephroblastomatosis were present in 28, 4 and 7 tumors, respectively. Re-appraisal of 17 post-treated tumors were classified by SIOP criteria as mixed(6, stromal(4, anaplastic(4 and regressive(3 types. The ureteric component displayed triphasic(11, biphasic(5 and monophasic(1histomorphology. The staging profile of patients with ureteric prolapse was stages I(3, II(5, III(6, IV(6 and V(1. The staging profile of patients with ureteric invasion was stages I(0, II(2, III(3, IV(4 and V(2. Distant metastases were present in 10/32 patients. Follow-up of 32 patients confirmed 21 that were tumor-free, 7 with recurrent disease and 4 fatalities; of those that remained tumor-free, 11 had advanced disease. Even in advanced tumor stages, complete excision of the urinary tract tumor and optimal treatment of disseminated malignancy are pivotal to overall patient management and outcome.

Ureteral stenting can be a negative predictor for successful outcome following shock wave lithotripsy in patients with ureteral stones

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Dong Hyuk Kang

2016-11-01

Full Text Available Purpose: To evaluate ureteral stenting as a negative predictive factor influencing ureteral stone clearance and to estimate the probability of one-session success in shock wave lithotripsy (SWL patients with a ureteral stone. Materials and Methods: We retrospectively reviewed the medical records of 1,651 patients who underwent their first SWL. Among these patients, 680 had a ureteral stone measuring 4–20 mm and were thus eligible for our study. The 57 patients who underwent ureteral stenting during SWL were identified. Maximal stone length (MSL, mean stone density (MSD, skin-to-stone distance (SSD, and stone heterogeneity index (SHI were determined by pre-SWL noncontrast computed tomography. Results: After propensity score matching, 399 patients were extracted from the total patient cohort. There were no significant differences between stenting and stentless groups after matching, except for a higher one-session success rate in the stentless group (78.6% vs. 49.1%, p=0.026. In multivariate analysis, shorter MSL, lower MSD, higher SHI, and absence of a stent were positive predictors for one-session success in patients who underwent SWL. Using cutoff values of MSL and MSD obtained from receiver operator curve analysis, in patients with a lower MSD (≤784 HU, the success rate was lower in those with a stent (61.1% than in those without (83.5% (p=0.001. However, in patients with a higher MSL (>10 mm, the success rate was lower in those with a stent (23.6% than in those without (52.2% (p=0.002. Conclusions: Ureteral stenting during SWL was a negative predictor of one-session success in patients with a ureteral stone.

Anionic and cationic drug secretion in the isolated perfused rat kidney after neonatal surgical induction of ureteric obstruction.

NARCIS (Netherlands)

Gier, R.P.E. de; Feitz, W.F.J.; Masereeuw, R.; Wouterse, A.C.; Smits, D.; Russel, F.G.M.

2003-01-01

OBJECTIVE: To study the pathophysiological changes of renal tubular drug transport mechanisms in congenital renal obstruction, by developing a model for perfusing the isolated kidney (IPK) after neonatal surgical induction of partial ureteric obstruction in Hanover Wistar rats. MATERIAL AND METHODS:

Patterns of ureteral motion: Data compression and statistics

International Nuclear Information System (INIS)

Mueller-Schauenburg, W.

1981-01-01

Images of ureteral peristaltics (ureteral kinetography) have been recorded at Tuebingen University Hospital since 1978. These images give a synoptical picture of ureteral motion in highly compressed form. Possibilities of data compression are discussed on the basis of functional path-time images, the ROI series, the in the path-time matrix, and the background subtraction. Particular attention is paid to problems of urethral activity statistics. (WU) [de

The Effect of Ureteral Stent Placement Before Radical Prostatectomy on the Safety of Ureteral Dissection and the Surgeon’s Comfort

OpenAIRE

Fatih Akdemir; Emrah Okulu; Önder Kayıgil

2017-01-01

Objective: This study investigated the role of preoperative ureteral stent placement in reducing the risk of ureteral injury, an intraoperative complication of radical retropubic prostatectomy (RRP), and its contribution to the surgeon’s comfort. Materials and Methods: Open RRP was performed in 66 patients diagnosed with localized prostate cancer in our clinic between 2010 and 2015. The patients were divided into two groups; group 1 (n=34) underwent surgery without ureteral stent placement...

[Experimental work: reconstruction of the pelvi-ureteric junction and ureter using testicular tunica vaginalis autograft].

Science.gov (United States)

Usupbaev, A Ch; Kurbanaliev, R M; Chernetsova, G S; Kolesnichenko, I V; Sultanov, B M; Myrzakanov, N M; Zolotukhin, A O; Vagner, N A

2017-12-01

To evaluate the results of surgical reconstruction of the upper urinary tract using an autograft of testicular tunica vaginalis in experimental animals. The article presents the results of partial replacement of the renal pelvis and ureter with an autograft in 25 male dogs. The grafts were harvested by resection of the parietal layer of the testicular tunica vaginalis, which was transplanted into the region of the pelvi-ureteric junction and the proximal ureter. The upper urinary tract was drained using a ureteral stent catheter. The results were evaluated at week 1 and months 1, 3 and six after the operation. The functional state of the kidneys and ureters was analyzed using excretory urography and ultrasound; the autograft biopsy specimens were examined histologically. In all cases, the viability of the autograft was completely preserved, there were no signs of secondary infection, necrosis and impaired patency in the anastomosis zone. Histological examination revealed signs of epithelialization, connective tissue substitution and neovasculogenesis in the implantation zone. The proposed surgical modality is an alternative method to restore normal urine flow in the upper urinary tract in obstructive urological diseases. The group of obstructive urological diseases was studied using the model of the strictures of the pelvi-ureteric junction in the intrarenal pelvis and ureteral strictures measuring up to 3-4 cm in length.

Combined antegrade and retrograde ureteral stenting: the rendezvous technique

International Nuclear Information System (INIS)

Macri, A.; Magno, C.; Certo, A.; Basile, A.; Scuderi, G.; Crescenti, F.; Famulari, C.

2005-01-01

Ureteral stenting is a routine procedure in endourology. To increase the success rate in difficult cases, it may be helpful to use the rendezvous technique, a combined antegrade and retrograde approach. We performed 16 urological rendezvous in 11 patients with ureteral strictures or urologic lesions. The combined approach was successful in all patients, without morbidity or mortality. In our experience the rendezvous technique increased the success rate of antegrade ureteral stenting from 78.6 to 88.09% (p>0.05). This procedure is a valid option in case of failure of conventional ureteral stenting

Ureteral sciatic hernia: a case report

Energy Technology Data Exchange (ETDEWEB)

Choi, So Young; Han, Hyun Young; Park, Suk Jin; Choe, Hyoung Shim; Kim, Eun Tak [Eulji University Hospital, Daejeon (Korea, Republic of)

2008-09-15

A ureteral hernia that occurs through the sciatic foramen is very rare. We present a case of a ureteral sciatic hernia with hydronephrosis. Intravenous urography (IVU) showed the presence of a curved, laterally displaced ureter, and computed tomography (CT) clearly depicted the herniated ureter through the sciatic foramen. The patient was treated transiently with a double J catheter.

A case of ureteral tumor diagnosed by computed tomography

International Nuclear Information System (INIS)

Hirakawa, Shinji; Adachi, Botaro; Hamamoto, Ryuichi; Nishimoto, Kazuhiko; Goto, Hajime

1980-01-01

A 66-year-old woman, visited Tottori University Hospital with the chief complaint of asymptomatic macrohematuria on Oct. 4, 1979. RP showed right hydroureteronephrosis due to right lower ureteral stenosis. Computed tomography (CT) was employed to investigate the right lower ureter, which showed a tumor in the right lower ureter, confined within the ureteral wall. Diagnosis of the right ureteral tumor with right hydroureteronephrosis was made and under general anesthesia right complete nephroureterectomy was performed on Oct. 26, 1979. So, the accuracy of the preoperative diagnosis was confirmed by the operation. CT has been supposed to be disadvantageous in the diagnosis of ureteral lesions, since ureter is thin, and the ureteral wall is also thin. However as was demonstrated in this case, a sizeable tumor of ureter could be diagnosed accurately by CT. (author)

Cost analysis of prophylactic intraoperative cystoscopic ureteral stents in gynecologic surgery.

Science.gov (United States)

Fanning, James; Fenton, Bradford; Jean, Geraldine Marie; Chae, Clara

2011-12-01

Prophylactic intraoperative ureteral stent placement is performed to decrease operative ureteric injury, though few data are available on the effectiveness of this procedure, and no data are available on its cost. To analyze the cost of prophylactic intraoperative cystoscopic ureteral stents in gynecologic surgery. All cases of prophylactic ureteral stent placement performed in gynecologic surgery during a 1-year period were identified and retrospectively reviewed through the electronic medical records database of Summa Health System. Costs were obtained through the Healthcare Cost Accounting System. The principles of cost-effective analysis were used (ie, explicit and detailed descriptions of costs and cost-effectiveness statistics). Importantly, we evaluated cost and not charges or financial model estimates. In addition, we obtained the contribution margins (ie, the hospital's net profit or loss) for prophylactic ureteral stent placement. Other gynecologic procedures were also analyzed. Among 792 major inpatient gynecologic procedures, 18 cases of prophylactic intraoperative ureteral stents were identified. Median costs were as follows: additional cost of prophylactic intraoperative ureteral stenting, $1580; additional cost of surgical resources, $770; cost of ureteral catheters, $427; cost of surgeons, $383. The contribution margins per case for various gynecologic surgical procedures were as follows: oophorectomy, $2804 profit; abdominal hysterectomy, $2649 profit; laparoscopically assisted vaginal hysterectomy (LAVH), $1760 profit. When intraoperative ureteral stenting was added, the contribution margins changed to the following: oophorectomy, $782 profit; abdominal hysterectomy, $627 profit; LAVH, $262 loss. Overall, the contribution margin profit was decreased by about 85%, from $2400 to $380. Prophylactic intraoperative ureteral stenting in gynecologic surgery decreases a hospital's contribution margin. Because of the expense of this procedure, as well as

Prevention strategies for ureteral stricture following ureteroscopic lithotripsy

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Hao Dong

2018-04-01

Full Text Available Ureteral stricture formation after ureteroscopic lithotripsy is a late complication that can lead to hydronephrosis and a subsequent risk of renal deterioration. The specific incidence is unknown, and the mechanism of stricture formation has not been completely explained. In this review, we summarize the current evidence regarding the incidence of this condition and discuss its pathogenesis. We then list preventive strategies to reduce the morbidity of ureteral strictures. Keywords: Ureteroscopy, Ureteral stricture, Lithotripsy, Complications

Metallic ureteral stents in malignant ureteral obstruction: short-term results and radiological features predicting stent failure in patients with non-urological malignancies.

Science.gov (United States)

Chow, Po-Ming; Hsu, Jui-Shan; Wang, Shuo-Meng; Yu, Hong-Jheng; Pu, Yeong-Shiau; Liu, Kao-Lang

2014-06-01

To provide short-term result of the metallic ureteral stent in patients with malignant ureteral obstruction and identify radiological findings predicting stent failure. The records of all patients with non-urological malignant diseases who have received metallic ureteral stents from July 2009 to March 2012 for ureteral obstruction were reviewed. Stent failure was detected by clinical symptoms and imaging studies. Survival analysis was used to estimate patency rates and factors predicting stent failure. A total of 74 patients with 130 attempts of stent insertion were included. A total of 113 (86.9 %) stents were inserted successfully and 103 (91.2 %) achieved primary patency. After excluding cases without sufficient imaging data, 94 stents were included in the survival analysis. The median functional duration of the 94 stents was 6.2 months (range 3-476 days). Obstruction in abdominal ureter (p = 0.0279) and lymphatic metastasis around ureter (p = 0.0398) were risk factors for stent failure. The median functional durations of the stents for abdominal and pelvic obstructions were 4.5 months (range 3-263 days) and 6.5 months (range 4-476 days), respectively. The median durations of the stents with and without lymphatic metastasis were 5.3 months (range 4-398 days) and 7.8 months (range 31-476 days), respectively. Metallic ureteral stents are effective and safe in relieving ureteral obstructions resulting from non-urological malignancies, and abdominal ureteral obstruction and lymphatic metastasis around ureter were associated with shorter functional duration.

Normal ureteral diameter in infancy and childhood

International Nuclear Information System (INIS)

Hellstroem, M.; Hjaelmaas, K.; Jacobsson, B.; Jodal, U.; Oden, A.; Oestra Sjukhuset, Goeteborg; Oestra Sjukhuset, Goeteborg; Goeteborg Univ.

1985-01-01

Ureteral diameters were estimated on films from intravenous urography in 194 children (100 boys and 94 girls) aged 0-16 years. Children with signs of urinary tract infection, calculi, obstruction, duplication or malformation were excluded. Films obtained without abdominal compression were used for measurements, including only ureters visualized over 50 per cent of their lengths. A good correlation was demonstrated between ureteral diameter and age and between ureteral diameter and the length of a segment of the lumbar spine. The widest part of the ureter was most often located just above the crossing of the iliac vessels. The right ureter was slightly wider than the left one. No difference between boys and girls was noted. The results are in good agreement with those of others obtained at autopsy. Bearing in mind the possible physiologic variations, it would seem that measuring the ureteral diameter can be of value for a more objective differentiation between dilated and non-dilated ureters. (orig.)

The forgotten ureteric JJ stent and its prevention: a prospective audit of the value of a ureteric stent logbook.

Science.gov (United States)

Thomas, A Z; Casey, R G; Grainger, R; McDermott, T; Flynn, R; Thornhill, J A

2007-01-01

Temporary ureteric stent insertion is an integral part of modern endo-urological practice. Delayed stent removal or forgotten stents are associated with increased patient morbidity and complications which are often difficult to manage. We prospectively audited our ureteric stent insertion and removal logbook system to determine the value and effectiveness of our stent follow-up. Over a 1-year period, 210 ureteric stents were inserted in our urological unit. Of these, 47 (22.4%) patients were unaccounted as having their stents removed within the stent logbooks. One patient was lost to follow-up and re-presented with stent encrustation 10 months later. Our results in this audit suggest that our system of ureteric stent follow-up is not effective. We have now introduced a new system that we feel is a safer and a satisfactory alternative to the stent logbooks. This includes a patient education leaflet and removal date scheduling prior to discharge from hospital.

Histopathological correlations to ureteral lesions visualized during ureteroscopy

DEFF Research Database (Denmark)

Lildal, Søren Kissow; Sørensen, Flemming Brandt; Andreassen, Kim Hovgaard

2017-01-01

PURPOSE: To correlate ureteral lesions visualized during ureteroscopy with histopathological findings.MATERIALS AND METHODS: Ureteral access sheaths (UAS) sized 13/15 Fr. were inserted bilaterally in 22 laboratory pigs. During retraction of the UAS with a semirigid ureteroscope inside, ureteral......) stained. Histopathological scoring of ureteral wall lesions was subsequently performed according to PULS.RESULTS: In 72.1% of ureters, the highest histopathological score was at least 1 grade higher than the highest endoscopic PULS score. For 12 (27.9%) lesions, the difference was 2 scores higher......, and for 1 (2.3%), it was 3 scores higher. The histopathological PULS grade was higher than the endoscopical PULS grade at all minimum, quartile, and maximum scores. There was a significant difference in the distribution of highest lesional scores between the endoscopic and histopathological PULS (p = 0...

Ureteral Metastasis Secondary to Prostate Cancer: A Case Report

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I. Morales

2016-03-01

Full Text Available Prostate cancer is very frequent, but secondary ureteral metastasis are extremely rare. We present a 55 year old man with a 2 month history of right flank pain and lower urinary tract symptoms. Prostatic specific antigen of 11.3 ng/mL. Computed tomography showed right hydroureteronephrosis, a developing urinoma and right iliac adenopathies. He underwent right ureteronephrectomy, iliac lymphadenectomy and prostate biopsy. Pathology revealed prostatic carcinoma infiltrating the ureteral muscularis propria, without mucosal involvement. There are 46 reported cases of prostate cancer with ureteral metastases. Ureteral metastasis are a rare cause of renal colic and need of a high index of suspicion.

Appendix vermiformis as a left pyelo-ureteral substitute in a 6-month ...

African Journals Online (AJOL)

Extensive ureteral loss in early childhood is a rare but dramatic event. We present the case of a 6-monthold girl with a iatrogenic extensive pyelo-ureteral loss and solitary kidney. She successfully underwent left ureteral substitution using the appendix vermiformis. Left ureteral reconstruction using the appendix vermiformis ...

Can ureteral stones cause pain without causing hydronephrosis?

Science.gov (United States)

Song, Yan; Hernandez, Natalia; Gee, Michael S; Noble, Vicki E; Eisner, Brian H

2016-09-01

While computerized tomography (CT) is the gold standard for diagnosis of ureterolithiasis, ultrasound is a less costly and radiation-free alternative which is commonly used to evaluate patients with ureteral colic. The purpose of this study was to evaluate the frequency with which patients with ureteral stones and renal colic demonstrate hydronephrosis in order to better understand the evaluation of these patients. Two hundred and forty-eight consecutive patients presenting with ureteral colic and diagnosed with a single unilateral ureteral stone on CT scan in an urban tertiary care emergency department were retrospectively reviewed. Radiology reports were reviewed for stone size, diagnosis, and degree of hydronephrosis. Of the 248 patients evaluated for suspected ureteral stone, 221 (89.1 %) demonstrated any hydronephrosis, while 27 (10.9 %) did not. Hydronephrosis grade, available in 194 patients, was as follows: mild-70.6 %, moderate-27.8 %, and severe-1.5 %. Mean patient age was 47.0 years (SD 15.5), gender distribution was 35.9 % female and 64.1 % male, and mean stone axial diameter was 4.1 mm (SD 2.4). Stone location was as follows: ureteropelvic junction-4.1 %, proximal ureter-21 %, distal ureter-24.9 %, and ureterovesical junction-47.1 %. Axial stone diameter and coronal length (craniocaudal) were both significant predictors of degree of hydronephrosis (ANOVA, p hydronephrosis. In patients with ureteral stones and colic, nearly 11 % do not demonstrate any hydronephrosis and a majority (nearly 71 %) will demonstrate only mild hydronephrosis. Stone diameter appears to be related to degree of hydronephrosis, whereas age, gender, and stone location are not. The lower incidence of hydronephrosis for small stones causing renal colic may explain the lower diagnostic accuracy of ultrasound when compared to CT for detecting ureteral stones.

Radionuclide imaging of ureteric peristalsis

Energy Technology Data Exchange (ETDEWEB)

Lewis, C.A.; Coptcoat, M.J.; Carter, S.StC.; Hilson, A.W.J.; Wickham, J.E.A.; Shah, P.J.F. (Inst. of Urology and St. Peter' s Hospitals, London (UK))

1989-02-01

Dynamic renal scintigraphy is a successful and minimally invasive technique for evaluating renal function. An extension to the basic technique involving fast-frame acquisition and a modified analysis is described which enables ureteric function to be examined. Ureteric peristalsis was assessed in 32 patients using this technique. The results from 5 representative studies are described in detail. Normally functioning ureters exhibit peristaltic contractions at a frequency of up to 3/min. Hyperperistalsis that exceeds 4 contractions/min is associated with obstruction. Peristaltic behaviour in 9 patients examined before and after ESWL was not altered. (author).

Radionuclide imaging of ureteric peristalsis

International Nuclear Information System (INIS)

Lewis, C.A.; Coptcoat, M.J.; Carter, S.StC.; Hilson, A.W.J.; Wickham, J.E.A.; Shah, P.J.F.

1989-01-01

Dynamic renal scintigraphy is a successful and minimally invasive technique for evaluating renal function. An extension to the basic technique involving fast-frame acquisition and a modified analysis is described which enables ureteric function to be examined. Ureteric peristalsis was assessed in 32 patients using this technique. The results from 5 representative studies are described in detail. Normally functioning ureters exhibit peristaltic contractions at a frequency of up to 3/min. Hyperperistalsis that exceeds 4 contractions/min is associated with obstruction. Peristaltic behaviour in 9 patients examined before and after ESWL was not altered. (author)

The Role of Pharmacology in Ureteral Physiology and Expulsive Therapy

Science.gov (United States)

Jerde, Travis J.; Nakada, Stephen Y.

2007-04-01

Research in the field of ureteral physiology and pharmacology has traditionally been directed toward relaxation of ureteral spasm as a mechanism of analgesia during painful ureteral obstruction, most often stone-induced episodes. However, interest in this field has expanded greatly in recent years with the expanded use of alpha-blocker therapy for inducing stone passage, a usage now termed "medical expulsive therapy". While most clinical reports involving expulsive therapy have focused on alpha receptor or calcium channel blockade, there are diverse studies investigating pharmacological ureteral relaxation with novel agents including cyclooxygenase inhibitors, small molecule beta receptor agonists, neurokinin antagonists, and phosphodiesterase inhibitors. In addition, cutting edge molecular biology research is revealing promising potential therapeutic targets aimed at specific molecular changes that occur during the acute obstruction that accompanies stone disease. The purpose of this report is to review the use of pharmacological agents as ureteral smooth muscle relaxants clinically, and to look into the future of expulsive therapy by reviewing the available literature of ureteral physiology and pharmacology research.

Yang-Monti Principle in Bridging Long Ureteral Defects: Cases Report and A Systemic Review.

Science.gov (United States)

Bao, Jun Sheng; He, Qiqi; Li, Yuzhuo; Shi, Wei; Wu, Gongjin; Yue, Zhongjin

2017-07-02

Ureteric substitution using the Yang-Monti principle was reported as a modification of simple ileal ureter replacement. During April 2013 to June in 2015, 2 patients underwent ileal ureteral substitution using a reconfigured ileal segment of Yang Monti principle in our clinical center. Some slight modifications were made and then follow-up were carried out up to 12 months. For these 2 cases, no significant intra/post-operative complications occurred. In 1 year follow up, serum creatinine (Scr) and blood urea nitrogen (BUN) of both patients decreased to normal.Glomerular filtration rate (GFR), renogram and pyelogram showed a stable split renal function. To better understand the Yang-Monti principle and potential risks and complications, we conduct an systemic review by searching PubMed, Google Scholar and the Cochrane Library database from January 1996 through June 2016. 10 out of 644 publications were identified, which included 269 patients from cohort studies. The most usual indications for Yang-monti therapy were iatrogenic stricture and retroperitoneal fibrosis. Infection and ileus were indicated as themain short time postoperative complications while the fistula and re- strictures happened in long-term. In general,we believe Yang-Monti Principle is a safer and efficient technique for clinical partial and complete ureteral defects if patients and potential risks could be well prepared.

Double-blind ureteral duplication: report of two cases

International Nuclear Information System (INIS)

Choi, Ja-Young; Kim, Seung Hyup; Kim, Sun Ho

2002-01-01

Blind ending of ureteral duplication is one of the most rare anomalies of the upper urinary tract. We report two cases of ureteral duplication with a blind ending both superiorly and inferiorly, and with no definite communication with the urinary tract. (orig.)

Ureteric diverticulum: A diagnostic challenge

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Rahul Kumar Gupta

2017-11-01

Full Text Available Ureteric diverticulum is a rare urological condition with only 47 cases described in the literature till 2013. A full term female infant presented with a huge cystic lump occupying almost the entire right side of the abdomen at 1 month of age. Ultrasonography and Magnetic Resonance Urography (MRU revealed right sided gross hydronephrosis with pelvis appeared folded onto itself along with left sided mild hydronephrosis. On EC scan, differential function of right sided kidney was 0.9%. With working diagnosis of right sided giant hydronephrosis secondary to pelviureteric junction obstruction, the child was posted for Anderson - Hynes pyeloplasty through right flank incision. On exploration we were surprised to find ureteric diverticula. Excision of ureteric diverticulum with proximal ureterostomy was done. Distal part of ureter was transfixed. Histopathological examination of diverticulum showed presence of fibromuscular wall suggestive of true diverticulum. Since ureterostomy was draining only few drops of clear fluid and on repeat EC scan there was no improvement in function of right kidney, right nephroureterectomy was done after 6 months.

A Case of Polyarteritis Nodosa with Bilateral Ureteral Obstruction

Science.gov (United States)

Yoo, Bin; Kim, Hong Kyu; Choi, Seung Won; Moon, Hee Bom

1996-01-01

We report a case of bilateral ureteral obstruction most likely caused by polyarteritis nodosa. The diagnosis was based upon muscle biopsy which showed typical necrotizing vasculitis in medium size artery in conjunction with microaneurysms in renal angiography. Ureteral obstruction is a rare manifestation of polyarteritis nodosa. This condition is thought to result from vasculitis of periureteral vessels. The patient was managed with prednisolone alone, which resulted in complete resolution of ureteral obstruction on both sides. PMID:8854655

The impact of ureteral Double-J stent insertion following ureterorenoscopy in patients with ureteral stones accompanied by perirenal fat stranding

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Ercan Ogreden

2018-03-01

Full Text Available Objective: To evaluate the impact of ureteral stent insertion following semirigid ureterorenoscopy (URS in patients with perirenal fat stranding (PFS due to ureteral stones. Material and methods: Data of 600 patients who underwent URS were analyzed retrospectively. Seventy-two patients detected to have PFS accompanying ureteral stone were included. Patients who did not undergo double J (DJ stent insertion following semirigid URS were classified as Group I (n: 52, while those who underwent stent insertion were classified as Group II (n: 20. Side distribution; localization of the stones, stone size, presence of fever, urinary tract infection (UTIs and urosepsis rates were compared in the two groups. Results: The average age of the patients was 44.4 (20-71 years. Male/female ratio and side of the stone location showed similar distribution in both groups (p > 0.05. Fever occurred in 23 cases (44.2% in Group I and in 15 cases (75% in Group II (p = 0.038. UTIs occurred in 15 cases (28.9% in Group I and in 12 cases (60% in Group II (p = 0.03. Urosepsis presented in 3 (5.8% and 5 (25% of the patients in Group I and II, respectively (p = 0.033. Conclusions: According to our results, ureteral DJ stent insertion following URS in patients with PFS due to ureteral stone caused an increase on postoperative infection related complications.

Ureteral stent retrieval using the crochet hook technique in females.

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Takashi Kawahara

Full Text Available INTRODUCTION: We developed a method for ureteral stent removal in female patients that requires no cystoscopy or fluoroscopic guidance using a crochet hook. In addition, we also investigated the success rate, complications and pain associated with this procedure. METHODS: A total of 40 female patients (56 stents underwent the removal of ureteral stents. All procedures were carried out with the patients either under anesthesia, conscious sedation, or analgesic suppositories as deemed appropriate for each procedure including Shock Wave Lithotripsy (SWL, Ureteroscopy (URS, Percutaneous Nephrolithotomy (PCNL, and ureteral stent removal. At the time of these procedures, fluoroscopy and/or cystoscopy were prepared, but they were not used unless we failed to successfully remove the ureteral stent using the crochet hook. In addition, matched controls (comprising 50 stents which were removed by standard ureteral stent removal using cystoscopy were used for comparison purposes. RESULTS: A total of 47 of the 56 stents (83.9% were successfully removed. In addition, 47 of 52 (90.4% were successfully removed except for two migrated stents and two heavily encrusted stents which could not be removed using cystoscopy. Ureteral stent removal using the crochet hook technique was unsuccessful in nine patients, including two encrustations and two migrations. Concerning pain, ureteral stent removal using the crochet hook technique showed a lower visual analogue pain scale (VAPS score than for the standard technique using cystoscopy. CONCLUSIONS: Ureteral stent removal using a crochet hook is considered to be easy, safe, and cost effective. This technique is also easy to learn and is therefore considered to be suitable for use on an outpatient basis.

Clinical and radiographic characteristics of ureteral polyps in children

International Nuclear Information System (INIS)

Niu Zhibing; Wang Changlin; Yang Qi; Hou Ying

2007-01-01

Objective: To analyze the clinical and radiographic characterstics of ureteral polyps with hydronephrosis in children. Methods: Thirteen patients with ureteral polyps and hydronephrosis were studied retrospectively. All patients underwent abdominal plain film, intravenous pyelogram (IVP) and ultrasound (US) examinations,contrast-enhanced CT scan was performed in 10 cases. Results: Intermittent or recurrent abdominal pain with painless hematuria was presented in most cases. Hydronephrosis was demonstrated in radiographic images. IVP delineated the dilatation of the ureter and filling defects within the ureteral lumen in 5 cases. Computed tomography (CT) showed all abnormal changes of ureter and irregular intraluminal soft tissue masses in 6 cases. Moderate and low echoic structures were showed in ureters by US in 2 cases. Conclusion: US and CT, as an important imaging modalities, can improve the diagnostic accuracy for ureteral polyps. (authors)

Acute bilateral ureteral obstruction following Dextranomer/hyaluronic acid polymer injection: A case report

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Arnon Lavi

2017-05-01

Full Text Available Ureteral obstruction following bulking agent injection for treatment of vesicoureteral reflux is rare. Herein we report a case of acute bilateral ureteral obstruction following bilateral Dextranomer/hyaluronic acid polymer injection. The obstruction which manifested hours following the injection, was treated with prompt insertion of bilateral ureteral stents. The stents were removed 4 weeks later with complete resolution of the obstruction. We believe that ureteral stenting is an excellent solution for acute ureteral obstruction following Dextranomer/hyaluronic acid polymer injection

Ureteric injuries following laparoscopic hysterectomy: A report of ...

African Journals Online (AJOL)

The incidence of ureteric injuries following hysterectomy varies. Raut et al in 1991 documented 12 ureteric injuries (1.34%) following 892 gynaecological procedures (2) while Nawaz et al reported a rate of 0.6% following gynaecological procedures over a 20 year period at the Aga Khan University Hospital,. Karachi (2).

Spontaneous calyceal rupture caused by a ureteral calculus

African Journals Online (AJOL)

A. Chaabouni

Ureteral calculus;. CT;. Ureterel stent. Abstract. Rupture of the urinary collecting system with perirenal and retroperitoneal extravasation of the urine is an unusual condition that is typically caused by ureteral-obstructing calculi. We report a case of calyceal rupture with urinoma formation, due to a stone in the distal ureter.

Detection of Vesico-Ureteric Reflux Using Voiding Hippuran Ureterograms

Energy Technology Data Exchange (ETDEWEB)

Sutherland, J. B.; Palser, R. [Section of Nuclear Medicine, Manitoba Cancer Treatment and Research Foundation, Winnipeg General Hospital, Winnipeg (Canada); Macpherson, R. I. [Children' s Hospital of Winnipeg, Winnipeg (Canada)

1971-02-15

Initial results of a technique for the demonstration of vesico-ureteric reflux in children are described. Hippuran-{sup 131}I (15 {mu}Ci) (ortho-iodohippurate) is injected intravenously. A standard renogram is obtained. Additional collimation is added to the recording probes and they are positioned to record the radioactivity from the mid-ureteric region. Recordings of normal and abnormal peristaltic activity during per-ora hydration of the patient are thus obtained. When the child is willing to void, he is placed upright on a bed pan, the probes positioned to record over the lower ureteric region and recordings are made while the child voids. All data are recorded on a 512-channel analyser operated in the multi-scaler node. Data are punched out on paper tape and, after an 11 point computer smoothing program, are displayed graphically. These recordings show different patterns in normal children and those with vesico-ureteric reflux. There are several advantages to this technique over the standard radiological and other radionuclide voiding cystoureterograms. The results are compared with contrast voiding cystourethrograms in both normal children and those with vesico-ureteric reflux. (author)

Post appendectomy acalculus bilateral ureteric obstruction: A rare entity in children

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Vipul Gupta

2013-01-01

Full Text Available Bilateral acalculus ureteric obstruction is described as rare sequelae of acute appendicitis in two paediatric patients aged 6 and 11 years presented with features of anuria. Imaging and endoscopic evaluation confirmed bilateral ureteric obstruction secondary to bladder wall oedema as an inflammatory reaction to appendix. Both cases recovered following bilateral ureteric stenting and are doing well.

Percutaneous dilatation of benign ureteral stricture -a case report-

Energy Technology Data Exchange (ETDEWEB)

Sung, Kyu Bo; Ahn, Jung Sook; Ham, So Hie; Woo, Won Hyung [Koryo General Hospital, Seoul (Korea, Republic of)

1987-06-15

Percutaneous ureteral dilatation was done with balloon catheter and ureteral stent. A 40 year old woman had a pelvic surgery due to inflammatory cyst and this surgery was complicated by incidental cutting of right ureter and ureteroureteral anastomosis was done. After 1 month, she was suffered from severe right flank pain, nausea and vomiting, and showed delayed visualization of pelvocalyceal system with dilatation in intravenous pyelography. Percutaneous nephrostomy was done and complete obstruction at lower ureter was seen in antegrade pyelography. 4 mm balloon catheter was introduced through the nephrostomy tract and dilatation was done with a pressure of 5 atm for 1 minute duration for 4 times and no. 7 double J ureteral stent was left across the lesion for prevention of restenosis. Ureteral stent was removed after 2 months, and successful dilatation was seen and no evidence of restenosis in 5 weeks follow up.

Clinical presentation and outcome of cats with circumcaval ureters associated with a ureteral obstruction.

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Steinhaus, J; Berent, A C; Weisse, C; Eatroff, A; Donovan, T; Haddad, J; Bagley, D

2015-01-01

Circumcaval ureters (CU) are a rare embryological malformation resulting in ventral displacement of the caudal vena cava, which crosses the ureter, potentially causing a ureteral stricture. To evaluate cats with obstructed CU(s) and report the presenting signs, diagnostics, treatment(s), and outcomes. Cats with obstructed CU(s) were compared to ureterally obstructed cats without CU(s). 193 cats; 22 circumcaval obstructed (Group 1); 106 non-circumcaval obstructed (Group 2); 65 non-obstructed necropsy cases (Group 3). Retrospective study, review of medical records for cats treated for benign ureteral obstructions from AMC and University of Pennsylvania between 2009 and 2013. surgical treatment of benign ureteral obstruction, complete medical record including radiographic, ultrasonographic, biochemistry, and surgical findings. Seventeen percent (22/128) of obstructed cats had a CU (80% right-sided) compared to 14% (9/65) non-obstructed necropsy cats (89% right-sided). Clinical presentation, radiographic findings, and creatinine were not statistically different between Groups 1 and 2. Strictures were a statistically more common (40%) cause of ureteral obstruction in Group 1 compared to Group 2 (17%) (P = .01). The MST for Groups 1 and 2 after ureteral decompression was 923 and 762 days, respectively (P = .62), with the MST for death secondary to kidney disease in both groups being >1,442 days. Re-obstruction was the most common complication in Group 1 (24%) occurring more commonly in ureters of cats treated with a ureteral stent(s) (44%) compared to the subcutaneous ureteral bypass (SUB) device (8%) (P = .01). Ureteral obstructions in cats with a CU(s) have a similar outcome to those cats with a ureteral obstruction and normal ureteral anatomy. Long-term prognosis is good for benign ureteral obstructions treated with a double pigtail stent or a SUB device. The SUB device re-obstructed less commonly than the ureteral stent, especially when a ureteral stricture was

Impaction and Prediction: Does Ureteral Wall Thickness Affect the Success of Medical Expulsive Therapy in Pediatric Ureteral Stones?

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Tuerxun, Aierken; Batuer, Abudukahaer; Erturhan, Sakip; Eryildirim, Bilal; Camur, Emre; Sarica, Kemal

2017-01-01

The study aimed to evaluate the predictive value of ureteral wall thickness (UWT) and stone-related parameters for medical expulsive therapy (MET) success with an alpha blocker in pediatric upper ureteral stones. A total of 35 children receiving MET ureteral stones (Hounsfield unit), degree of hydronephrosis, and UWT were evaluated with patient demographics and recorded. The possible predictive value of these parameters in success rates and time to stone expulsion were evaluated in a comparative manner between the 2 groups. The overall mean patient age and stone size values were 5.40 ± 0.51 years and 6.24 ± 0.28 mm, respectively. Regarding the predictive values of these parameters for the success of MET, while stone size and UWT were found to be highly predictive for MET success, patients age, body mass index, stone density, and degree of hydronephrosis had no predictive value on this aspect. Our findings indicated that some stone and anatomical factors may be used to predict the success of MET in pediatric ureteral stones in an effective manner. With this approach, unnecessary use of these drugs that may cause a delay in removing the stone will be avoided, and the possible adverse effects of obstruction as well as stone-related clinical symptoms could be minimized. © 2017 S. Karger AG, Basel.

Lymphovascular invasion, ureteral reimplantation and prior history of urothelial carcinoma are associated with poor prognosis after partial cystectomy for muscle-invasive bladder cancer with negative pelvic lymph nodes.

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Ma, B; Li, H; Zhang, C; Yang, K; Qiao, B; Zhang, Z; Xu, Y

2013-10-01

To identify predictive factors underlying recurrence and survival after partial cystectomy for pelvic lymph node-negative muscle-invasive bladder cancer (MIBC) (urothelial carcinoma) and to report the results of partial cystectomy among select patients. We retrospectively reviewed 101 cases that received partial cystectomy for MIBC (pT2-3N0M0) between 2000 and 2010. The log-rank test and a Cox regression analyses were performed to identify factors that were predictive of recurrence and survival. With a median follow-up of 53.0 months (range 9-120), the 5-year overall survival (OS), cancer-specific survival (CSS) and recurrence-free survival (RFS) rates were 58%, 65% and 50%, respectively. A total of 33 patients died of bladder cancer and 52 patients survived with intact bladder. Of the 101 patients included, 55 had no recurrence, 12 had non-muscle-invasive recurrence in the bladder that was treated successfully, and 34 had recurrence with advanced disease. The multivariate analysis showed that prior history of urothelial carcinoma (PH.UC) was associated with both CSS and RFS and weakly associated with OS; lymphovascular invasion (LVI) and ureteral reimplantation (UR) were associated with OS, CSS and RFS. Among patients with pelvic lymph node-negative MIBC, PH.UC and UR should be considered as contraindications for partial cystectomy, and LVI is predictive of poor outcomes after partial cystectomy. Highly selective partial cystectomy is a rational alternative to radical cystectomy for the treatment of MIBC with negative pelvic lymph nodes. Copyright © 2013 Elsevier Ltd. All rights reserved.

Anti-fibrotic effect of natural toxin bee venom on animal model of unilateral ureteral obstruction.

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An, Hyun Jin; Kim, Kyung Hyun; Lee, Woo Ram; Kim, Jung Yeon; Lee, Sun Jae; Pak, Sok Cheon; Han, Sang Mi; Park, Kwan Kyu

2015-05-29

Progressive renal fibrosis is the final common pathway for all kidney diseases leading to chronic renal failure. Bee venom (BV) has been widely used as a traditional medicine for various diseases. However, the precise mechanism of BV in ameliorating the renal fibrosis is not fully understood. To investigate the therapeutic effects of BV against unilateral ureteral obstruction (UUO)-induced renal fibrosis, BV was given intraperitoneally after ureteral ligation. At seven days after UUO surgery, the kidney tissues were collected for protein analysis and histologic examination. Histological observation revealed that UUO induced a considerable increase in the number of infiltrated inflammatory cells. However, BV treatment markedly reduced these reactions compared with untreated UUO mice. The expression levels of TNF-α and IL-1β were significantly reduced in BV treated mice compared with UUO mice. In addition, treatment with BV significantly inhibited TGF-β1 and fibronectin expression in UUO mice. Moreover, the expression of α-SMA was markedly withdrawn after treatment with BV. These findings suggest that BV attenuates renal fibrosis and reduces inflammatory responses by suppression of multiple growth factor-mediated pro-fibrotic genes. In conclusion, BV may be a useful therapeutic agent for the prevention of fibrosis that characterizes progression of chronic kidney disease.

Anti-Fibrotic Effect of Natural Toxin Bee Venom on Animal Model of Unilateral Ureteral Obstruction

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Hyun Jin An

2015-05-01

Full Text Available Progressive renal fibrosis is the final common pathway for all kidney diseases leading to chronic renal failure. Bee venom (BV has been widely used as a traditional medicine for various diseases. However, the precise mechanism of BV in ameliorating the renal fibrosis is not fully understood. To investigate the therapeutic effects of BV against unilateral ureteral obstruction (UUO-induced renal fibrosis, BV was given intraperitoneally after ureteral ligation. At seven days after UUO surgery, the kidney tissues were collected for protein analysis and histologic examination. Histological observation revealed that UUO induced a considerable increase in the number of infiltrated inflammatory cells. However, BV treatment markedly reduced these reactions compared with untreated UUO mice. The expression levels of TNF-α and IL-1β were significantly reduced in BV treated mice compared with UUO mice. In addition, treatment with BV significantly inhibited TGF-β1 and fibronectin expression in UUO mice. Moreover, the expression of α-SMA was markedly withdrawn after treatment with BV. These findings suggest that BV attenuates renal fibrosis and reduces inflammatory responses by suppression of multiple growth factor-mediated pro-fibrotic genes. In conclusion, BV may be a useful therapeutic agent for the prevention of fibrosis that characterizes progression of chronic kidney disease.

Ultrasonographic diagnosis of ureteral stones: Accuracy and factors influencing on diagnostic sensitivity

Energy Technology Data Exchange (ETDEWEB)

Park, Young Mi; Han, Sang Seok; Chang, Seung Kuk; Joo, Sang Hoo; Lee, Jeong Sik; Eun, Choong Ki [Pusan Paik Hospital, Inje University College of Medicine, Pusan (Korea, Republic of)

1999-12-15

To determine the accuracy of ultrasonographic diagnosis in patients with clinically suspected ureteral stones and to evaluate the factors influencing on the diagnostic sensitivity for the detection of ureteral stone. The patients (115 cases) with proven presence or absence of ureteral stones were included in the study. At first, both sided kidney and proximal ureters were examined on each decubitus position and then middle ureters were done if proximal ureters were visualized. On the supine view, distal ureters and UVJ were scanned through the acoustic window of the filled bladder. KUB (20 cases), IVU (62 cases), AGP (7 cases), RGP (3 cases), ESWL (9 cases), CT (9 cases), and patients' history of spontaneous passage of stones (5 cases) were included as confirmation methods. The sensitivity, specificity, and accuracy of the ultrasonographic diagnosis of ureteral stones were calculated and the factors influencing on the sensitivity on the focus of the position and size of ureteral stone, visibility of ureter, the presence or absence of renal stone and hydronephrosis were analyzed. Of 82 cases with proven ureteral stone, 72 cases were revealed on ultrasonography and there was one false positive examination among 33 cases with proven absence of ureteral stone. The overall diagnostic accuracy was 90%. The ultrasonographic detection rates of ureteral stones as correlated with their locations were 83% (24/29), 100% (11/11), 80% (16/20), and 100% (21/21) of each group of proximal, middle, distal ureter, and UVJ stones. Of 61 stones, those as correlated with their sizes, were 82% (37/45) and 94% (15/16) of each group less than 10 mm and more than 11 mm. Those as correlated with the presence or absence of ureteral visualization on ultrasonography were 92% (69/75) and 43% (3/7) of each group. Those as correlated with presence of absence of renal stones were 85% (41/48) and 91% (31/34) of each group. Those as correlated with presence or absence of hydronephrosis were 89

Percutaneous balloon dilatation for transplant ureteral strictures

Energy Technology Data Exchange (ETDEWEB)

Kim, Jong Chul [Chungnam National University School of Medicine, Taechun (Korea, Republic of); Banner, Marc P [University of Pennsylvania School of Medicine, Philadelphia (United States)

1993-09-15

We report 10 kidney allografted patients treated for 11 ureteral strictures with standard endourlogic balloon catheter dilatation and internal stenting between August 1979 and December 1991. They have been followed until 2 to 140 months (mean 42). We compared and analyzed the 6 successful strictures (54%) and 5 unsuccessful strictures. There was no statistically significant difference of demographic, clinical and radiologic interventional techniques between two groups. But there was slightly higher success rate in abruptly narrowed shorter fibrotic strictures in ureteroneocystomy sites than smoothly taped longer ones in other sites of the ureter. Longterm stenting by the transplantation team with cystoscopic removal of internal ureteral stents by urologists resulted in 3 cases of stent occlusion, encrustation or fracture. Exact early diagnosis of ureteral stricture with continued close follow up and proper radiologic interventional procedure with optimal stenting period may increase the success rate and still provide an alternative to surgery.

The ureteric bud epithelium: morphogenesis and roles in metanephric kidney patterning.

Science.gov (United States)

Nagalakshmi, Vidya K; Yu, Jing

2015-03-01

The mammalian metanephric kidney is composed of two epithelial components, the collecting duct system and the nephron epithelium, that differentiate from two different tissues -the ureteric bud epithelium and the nephron progenitors, respectively-of intermediate mesoderm origin. The collecting duct system is generated through reiterative ureteric bud branching morphogenesis, whereas the nephron epithelium is formed in a process termed nephrogenesis, which is initiated with the mesenchymal-epithelial transition of the nephron progenitors. Ureteric bud branching morphogenesis is regulated by nephron progenitors, and in return, the ureteric bud epithelium regulates nephrogenesis. The metanephric kidney is physiologically divided along the corticomedullary axis into subcompartments that are enriched with specific segments of these two epithelial structures. Here, we provide an overview of the major molecular and cellular processes underlying the morphogenesis and patterning of the ureteric bud epithelium and its roles in the cortico-medullary patterning of the metanephric kidney. © 2015 Wiley Periodicals, Inc.

Antegrade Ureteral Stenting is a Good Alternative for the Retrograde Approach.

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van der Meer, Rutger W; Weltings, Saskia; van Erkel, Arian R; Roshani, Hossain; Elzevier, Henk W; van Dijk, Lukas C; van Overhagen, Hans

2017-07-01

Double J (JJ) stents for treating obstructive ureteral pathology are generally inserted through a retrograde route with cystoscopic guidance. Antegrade percutaneous insertion using fluoroscopy can be performed alternatively but is less known. Indications, success rate and complications of antegrade ureteral stenting were evaluated. Data of consecutive patients in which antegrade ureteral stenting was performed were retrospectively analysed using the radiology information system and patient records. Patient characteristics, details of the antegrade JJ stent insertion procedure and registered complications were collected. Furthermore, it was investigated if prior to the antegrade procedure a retrograde attempt for JJ stent insertion was performed. Total 130 attempts for antegrade JJ stent insertion were performed in 100 patients. A percutaneous nephrostomy catheter had already been placed in the majority of kidneys (n = 109) for initial treatment of hydronephrosis. Most prevelant indication for a JJ stent was obstructive ureteral pathology due to malignancy (n = 63). A JJ stent was successfully inserted in 125 of 130 procedures. In 21 cases, previous retrograde ureteral stenting had failed but, subsequent antegrade ureteral stenting was successful. There were 8 procedure related complications; 6 infections, 1 false tract and 1 malposition. Antegrade percutaneous insertion of a JJ stent is a good alternative for retrograde insertion.

paediatric ureteric calculi: in-situ extracorporeal shock wave lithotripsy

African Journals Online (AJOL)

Objective To evaluate prospectively the efficacy of in-situ extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteric calculi in the paediatric age group. Patients and Methods Twenty children (aged 2.2 16 years) with 22 ureteric stones were evaluated and treated with in-situ ESWL using the Dornier S lithotripter ...

Results of radiotherapy on ureteric obstruction in muscle-invasive bladder cancer

DEFF Research Database (Denmark)

Honnens De Lichtenberg, Mette; Miskowiak, J; Rolff, H

1995-01-01

To evaluate the effect of radiotherapy on ureteric obstruction due to muscle-invasive bladder cancer.......To evaluate the effect of radiotherapy on ureteric obstruction due to muscle-invasive bladder cancer....

Fluoroscopic guidance of retrograde exchange of ureteral stents in women.

Science.gov (United States)

Chang, Ruey-Sheng; Liang, Huei-Lung; Huang, Jer-Shyung; Wang, Po-Chin; Chen, Matt Chiung-Yu; Lai, Ping-Hong; Pan, Huay-Ben

2008-06-01

The purpose of this study was to review our experience with fluoroscopically guided retrograde exchange of ureteral stents in women. During a 48-month period, 28 women (age range, 38-76 years) were referred to our department for retrograde exchange of a ureteral stent. The causes of urinary obstruction were tumor compression in 26 patients and benign fibrotic stricture in two patients. A large-diameter snare catheter (25-mm single loop or 18- to 35-mm triple loop) or a foreign body retrieval forceps (opening width, 11.3 mm) was used to grasp the bladder end of the stent under fluoroscopic guidance. The technique entailed replacement of a patent or occluded ureteral stent with a 0.035- or 0.018-inch guidewire with or without the aid of advancement of an angiographic sheath. A total of 54 ureteral stents were exchanged with a snare catheter in 42 cases or a forceps in 12 cases. One stent misplaced too far up the ureter was replaced successfully through antegrade percutaneous nephrostomy. Ten occluded stents, including one single-J stent, were managed with a 0.018-inch guidewire in three cases, advancement of an angiographic sheath over the occluded stent into the ureter in five cases, and recannulation of the ureteral orifice with a guidewire in two cases. No complications of massive hemorrhage, ureter perforation, or infection were encountered. With proper selection of a snare or forceps catheter, retrograde exchange of ureteral stents in women can be easily performed under fluoroscopic guidance with high technical success and a low complication rate.

Retroperitoneal fibrosis: A rare cause of both ureteral and small bowel obstruction

Institute of Scientific and Technical Information of China (English)

Faisal Aziz; Srinivasulu Conjeevaram; Than Phan

2006-01-01

Retroperitoneal fibrosis (RPF) is a rare condition of unclear etiology. It can cause ureteral obstruction. We present the unique case of a 54 years old female, who initially presented with spontaneous perforation of the cecum. Upon exploring the abdomen, the classical glistening white, unyielding retroperitoneal fibrosis was encountered. A right hemicolectomy was performed.Subsequently, the patient presented with bilateral ureteral obstruction, and later on with small bowel obstruction. Ureteral obstruction was treated with stents,and small bowel obstruction was treated with bypass.To our knowledge no case of idiopathic RPF presenting with features of both bilateral ureteral and small bowel obstruction has been reported in the literature.

Laparoscopic surgery to treat ureterosciatic herniation after ureteral stent failure

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Yi-Sheng Tai

2014-03-01

Full Text Available We report on a patient who presented with left flank pain for 6 months. Computed tomography and intravenous urography revealed left ureterosciatic herniation with severe hydronephrosis. Antegrade placement of the ureteral double-J stent was performed and her symptoms subsequently subsided. These symptoms recurred after the removal of the stent 1 year later with persistent hydronephrosis and herniation. We performed laparoscopic ureterolysis, ureteral fixation to psoas muscle, and sciatic hernia repair with hyaluronan-containing mesh. The result was encouraging and the follow-up image at 6 months showed no hydronephrosis and no ureteral herniation.

Balloon dilatation of ureteric strictures.

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Punekar S

2000-01-01

Full Text Available AIMS: Evaluation of dilatation as a minimally invasive technique for the treatment of ureteric strictures. MATERIAL AND METHODS: We evaluated this technique in 16 patients with ureteric and secondary pelviureteric junction strictures from June 1998. Of these, 7 were men and 9 were women. The age range was from 14 to 40 years. RESULTS: Balloon dilatation was successful in 69% of patients. Strictures secondary to previous surgery had nearly 100% success. Of the 8 cases diagnosed as genitourinary tuberculosis, success rate was 50%. CONCLUSIONS: Factors affecting success of balloon dilatation are: a age of the stricture b length of the stricture and c etiology of the stricture. In a select group of patients with fresh post-operative or post-inflammatory strictures, balloon dilatation may be an attractive alternative to surgery.

Cystoscopic temporary ureteral catheterization during radical vaginal and abdominal trachelectomy.

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Abu-Rustum, Nadeem R; Sonoda, Yukio; Black, Destin; Chi, Dennis S; Barakat, Richard R

2006-11-01

To describe the role of temporary retrograde ureteral catheterization at the time of fertility-sparing radical vaginal or abdominal trachelectomy in women with early-stage cervical cancer. We analyzed a prospectively maintained database of all patients with cervical cancer who were explored for radical vaginal or abdominal trachelectomy at our institution. Cystourethroscopy and ureteral catheterization were performed prior to the vaginal or abdominal operation in all patients, except two pediatric ones. Temporary bilateral retrograde ureteral catheters were planned for all patients as part of our routine procedure to facilitate identification of the distal ureters. 5Fr whistle-tip or open-ended catheters were used and usually advanced to approximately 20 cm. Catheters were removed at the end of the operation in all cases. All catheters were inserted by a gynecologic oncology fellow or attending. Between 11/01 and 12/05, 40 patients were taken to the operating room for planned fertility-sparing radical vaginal or abdominal trachelectomy. We previously reported on two pediatric patients; they are excluded from this report. The median age for adult patients was 32 years (mean, 31.6; range, 23-40). International Federation of Gynecology and Obstetrics (FIGO) stage included IB1 (26), IA2 (6), and IA1 with lymphovascular invasion (6). Thirty-four patients underwent radical vaginal trachelectomy and four underwent a radical abdominal trachelectomy. Two (5%) of 38 patients required immediate completion radical hysterectomy due to extensive endocervical disease (one in the vaginal group and one in the abdominal group). Bilateral ureteral catheters were inserted successfully in 37 (97%) of 38 patients and facilitated identification of the distal ureter during the dissection. In one case, the right ureteral orifice could not be successfully catheterized, and the case was completed with unilateral catheterization. The estimated time to perform this part of the operation was

Distal Ureteral Diameter Ratio is Predictive of Breakthrough Febrile Urinary Tract Infection.

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Arlen, Angela M; Leong, Traci; Guidos, P Joseph; Alexander, Siobhan E; Cooper, Christopher S

2017-12-01

Distal ureteral diameter ratio is an objective measure that is prognostic of spontaneous resolution of vesicoureteral reflux. Along with likelihood of resolution, improved identification of children at risk for recurrent febrile urinary tract infections may impact management decisions. We evaluated the usefulness of ureteral diameter ratio as a predictive factor for breakthrough febrile urinary tract infections. Children with primary vesicoureteral reflux and detailed voiding cystourethrogram were identified. Ureteral diameter ratio was computed by measuring largest ureteral diameter within the pelvis and dividing by the distance between L1 and L3 vertebral bodies. Demographics, vesicoureteral reflux grade, laterality, presence/absence of bladder-bowel dysfunction, and ureteral diameter ratio were tested in univariate and multivariable analyses. Primary outcome was breakthrough febrile urinary tract infections. We analyzed 112 girls and 28 boys with a mean ± SD age of 2.5 ± 2.3 years at diagnosis. Vesicoureteral reflux was grade 1 to 2 in 64 patients (45.7%), grade 3 in 50 (35.7%), grade 4 in 16 (11.4%) and grade 5 in 10 (7.2%). Mean ± SD followup was 3.2 ± 2.7 years. A total of 40 children (28.6%) experienced breakthrough febrile urinary tract infections. Ureteral diameter ratio was significantly greater in children with (0.36) vs without (0.25) breakthrough febrile infections (p = 0.004). Controlling for vesicoureteral reflux grade, every 0.1 U increase in ureteral diameter ratio resulted in 1.7 times increased odds of breakthrough infection (95% CI 1.24 to 2.26, p urinary tract infections independent of reflux grade. Ureteral diameter ratio provides valuable prognostic information about risk of recurrent pyelonephritis and may assist with clinical decision-making. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Endometriosis on the uterosacral ligament: a marker of ureteral involvement.

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Lima, Raquel; Abdalla-Ribeiro, Helizabet; Nicola, Ana Luisa; Eras, Aline; Lobao, Anna; Ribeiro, Paulo Ayroza

2017-06-01

To evaluate the association between ultrasound measurements of endometriosis nodules on the uterosacral ligament (USL) and the risk of ureteral involvement, as well as to assess whether associations with other ultrasound variables increase the sensitivity and specificity of the diagnosis of ureteral endometriosis. Cross-sectional, observational study. University hospital. Four hundred sixty-three women with deep infiltrating endometriosis (DIE). Patients diagnosed with DIE underwent transvaginal ultrasound endometriosis mapping before laparoscopic surgery for full excision of endometriotic lesions. Preoperative ultrasound evaluation, intra- and postoperative assessment, and anatomopathologic confirmation. Of the 463 patients who participated in the study, 111 (23.97%) presented with endometriosis nodules with USL involvement on ultrasound examination conducted by a single radiologist. Receiver operating characteristic curve analysis showed that the size of the USL nodule had a statistically significant association with ipsilateral ureteral involvement. After multivariate logistic regression, the variables reduction in ovarian mobility, ureteral changes on the right side, size of the USL nodule, and presence of endometrioma on the left side were significantly associated with a ureteral endometriosis nodule. However, the combined result for the variables cited was worse than the diagnostic analysis using only the size of the USL nodule. Uterosacral ligament nodules with ultrasound measurements of 1.75 cm and 1.95 cm on the right and left sides, respectively, significantly increase the risk of ureteral involvement. Even with the association of other ultrasound variables, there was no improvement in sensitivity. Therefore, USL nodule size is a key measure for therapeutic planning and consent of the patient. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Laparoscopic Management of Ureteral Endometriosis and Hydronephrosis Associated With Endometriosis.

Science.gov (United States)

Alves, João; Puga, Marco; Fernandes, Rodrigo; Pinton, Anne; Miranda, Ignacio; Kovoor, Elias; Wattiez, Arnaud

STUDY OBJECTIVE: To evaluate if laparoscopic treatment of ureteral endometriosis is feasible, safe, and effective and to determine if ureteral dilatation and/or the number of incisions increases complications. An institutional review board-approved retrospective cohort study of consecutive patients who underwent surgery for deep infiltrating endometriosis involving the ureter with hydronephrosis (Canadian Task Force classification III). A university hospital. Of 658 patients who had surgery for deep infiltrating endometriosis between November 2004 and December 2013, 198 of the 658 patients had ureteral endometriosis and required ureterolysis, and 28 of the 198 patients were identified with ureteral dilatation and hydronephrosis associated with endometriosis. Of these 28 cases, 15 ureterolyses, 12 reanastomoses, and 1 reimplantation were performed. Medical, operative, and pathological data on the evolution of pain, urinary complaints, fertility, complications, and recurrences were collected from clinical records. Additionally, telephone interviews were performed for the follow-up of long-term outcomes. All 28 patients had concomitant surgical procedures because of endometriosis elsewhere in the pelvis or abdomen; 12 (42.9%) underwent surgery of the bowel, whereas 5 (17.9%) had bladder surgery. The evolution of pain after surgery showed a positive response (mean dysmenorrhea evaluation measured by the Numeric Pain Rating Scale from 0-10 preoperatively at the short-term follow-up and the long-term follow-up: 7.25-1.73 and 0.25, respectively). Three complications were noted in the group of 28 patients with ureterohydronephrosis; 1 required surgical reintervention. Logistic regression analyses found vaginal incision (odds ratio = 2.08; 95% CI 0.92-4.73), bladder incision (odds ratio = 8.77; 95% CI 3.25-23.63), number of incisions (odds ratio = 2.12; 95% CI 1.29-3.47), and number of previous surgeries (odds ratio = 1.26; 95% CI 0.93-1.71) as independent risk

Effect of ipsilateral ureteric obstruction on contralateral kidney and role of renin angiotensin system blockade on renal recovery in experimentally induced unilateral ureteric obstruction

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Shasanka S Panda

2013-01-01

Full Text Available Aims: To study, the effects of ipsilateral ureteric obstruction on contralateral kidney and the role of renin angiotensin system (RAS blockade on renal recovery in experimentally induced unilateral ureteric obstruction. Materials and Methods: Unilateral upper ureteric obstruction was created in 96 adult Wistar rats that were reversed after pre-determined intervals. Losartan and Enalapril were given to different subgroups of rats following relief of obstruction. Results: The severity of dilatation on the contralateral kidney varied with duration of ipsilateral obstruction longer the duration more severe the dilatation. There is direct correlation between renal parenchymal damage, pelvi-ureteric junction (PUJ fibrosis, inflammation and severity of pelvi-calyceal system dilatation of contralateral kidney with duration of ipsilateral PUJ obstruction. Conclusions: Considerable injury is also inflicted to the contralateral normal kidney while ipsilateral kidney remains obstructed. Use of RAS blocking drugs has been found to significantly improve renal recovery on the contralateral kidney. It can, thus, be postulated that contralateral renal parenchymal injury was mediated through activation of RAS.

Results of radiotherapy for ureteric obstruction in muscle-invasive bladder cancer

International Nuclear Information System (INIS)

Holm, M.; Miskowiak, J.; Rolff, H.

1996-01-01

Retrospective evaluation of the records of 574 patients with muscle-invasive bladder cancer revealed 90 patients (16%) with ureteric obstruction; the obstruction was bilateral in 24%. The effect of radiotherapy was assessed in 55 patients with 68 obstructed kidneys. Six patients with eight obstructed kidneys required percutaneous nephrostomy or ureteric catheters in addition to radiotherapy. Drainage improved in only 20% of kidneys and the diverting catheter could be withdrawn permanently in only one (17%) of the diverted patients. The median survival was 11 months. Irradiation was followed by significant complications in 37 patients (67%). This raises doubts about the assumed beneficial effect of irradiation on ureteric obstruction due to muscle invasive bladder cancer. The short median survival of 11 months confirms that ureteric obstruction is a poor prognostic factor in muscle invasive bladder cancer. (au) 10 refs

Is the Routine Check Nephrostogram Following Percutaneous Antegrade Ureteric Stent Placement Necessary?

International Nuclear Information System (INIS)

Soh, Keng Chuan; Tay, Kiang Hiong; Tan, Bien Soo; MM Htoo, Austin; HG Lo, Richard; Lin, Shueh En

2008-01-01

Our aim was to review our experience with percutaneous antegrade ureteric stent (PAUS) placement and to determine if the routinely conducted check nephrostogram on the day following ureteric stent placement was necessary. Retrospective review of patients who had undergone PAUS placement between January 2004 and December 2005 was performed. There were 83 subjects (36 males, 47 females), with a mean age of 59.9 years (range, 22-94 years). Average follow-up duration was 7.1 months (range, 1-24 months). The most common indications for PAUS placement were ureteric obstruction due to metastatic disease (n = 56) and urinary calculi (n = 34). Technical success was 93.2% (96/103 attempts), with no major immediate procedure-related complications or mortalities. The Bard 7Fr Urosoft DJ Stent was used in more than 95% of the cases. Eighty-one of 89 (91.0%) check nephrostograms demonstrated a patent ureteric stent with resultant safety catheter removal. Three check nephrostograms revealed distal stent migration requiring repositioning by a goose-snare, while five others showed stent occlusion necessitating permanent external drainage by nephrostomy drainage catheter reinsertion. Following PAUS placement, the serum creatinine level improved or stabilized in 82% of patients. The serum creatinine outcome difference between the groups with benign and malignant indications for PAUS placement was not statistically significant (p = 0.145) but resolution of hydronephrosis was significantly better (p = 0.008) in patients with benign indications. Percutaneous antegrade ureteric stent placement is a safe and effective means of relief for ureteric obstruction. The check nephrostogram following ureteric stent placement was unnecessary in the majority of patients

The efficacy of tamsulosin in lower ureteral calculi

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Griwan M

2010-01-01

Full Text Available Context: There has been a paradigm shift in the management of ureteral calculi in the last decade with the introduction of new less invasive methods, such as ureterorenoscopy and extracorporeal shock wave lithotripsy (ESWL. Aims: Recent studies have reported excellent results with medical expulsive therapy (MET for distal ureteral calculi, both in terms of stone expulsion and control of ureteral colic pain. Settings and Design: We conducted a comparative study in between watchful waiting and MET with tamsulosin. Materials and Methods: We conducted a comparative study in between watchful waiting (Group I and MET with tamsulosin (Group II in 60 patients, with a follow up of 28 days. Statistical Analysis: Independent ′t′ test and chi-square test. Results: Group II showed a statistically significant advantage in terms of the stone expulsion rate. The mean number of episodes of pain, mean days to stone expulsion and mean amount of analgesic dosage used were statistically significantly lower in Group II (P value is 0.007, 0.01 and 0.007, respectively as compared to Group I. Conclusions: It is concluded that MET should be considered for uncomplicated distal ureteral calculi before ureteroscopy or extracorporeal lithotripsy. Tamsulosin has been found to increase and hasten stone expulsion rates, decrease acute attacks by acting as a spasmolytic, reduces mean days to stone expulsion and decreases analgesic dose usage.

Diagnosis and surgical management of obstructive ureteral calculi in cats: 11 cases (1993-1996)

International Nuclear Information System (INIS)

Kyles, A.E.; Stone, E.A.; Gookin, J.; Spaulding, K.; Clary, E.M.; Wylie, K.; Spodnick, G.

1998-01-01

To evaluate diagnostic methods, surgical treatment, perioperative management, and renal function of cats with obstructive calcium oxalate ureteroliths. Retrospective case series. 11 cats that underwent surgery for removal of calcium oxalate ureteroliths. Medical records were reviewed, and the following information was recorded: signalment; results of physical examination, clinicopathologic analyses, and abdominal imaging; surgical procedure; postoperative management; and results of ureterolith quantitative analysis. Ureteroliths in the proximal portion of the ureter were removed from 5 cats (pyelotomy, 1 cat; unilateral ureterotomy, 2 cats; bilateral ureterotomies, 2 cats). Calculi in the middle and distal part of the ureter were removed by partial ureterectomy and ureteroneocystostomy (6 cats). Ten cats recovered from surgery and were discharged from the hospital. One cat died from unknown causes 4 months after surgery, and 1 cat had a nephrectomy elsewhere 5 weeks after ureterolith removal. Eight cats were evaluated 12 to 20 months after surgery. Of these, 2 cats that were markedly azotemic before surgery improved after surgery, and 2 cats developed nephroliths after surgery. Also, of 5 cats that had nephroliths that were not removed at the time of surgery, 4 still had visible nephroliths. One cat had recurrent ureteral obstruction from a ureterolith and persistent urinary tract infection. Ureteroliths or ultrasonographic evidence of ureteral obstruction were not detected in other cats. A combination of microsurgical techniques and intensive postoperative care is necessary to minimize morbidity of cats after removal of a ureterolith. Renal function may improve or stabilize after removal of the ureteral obstruction

Robotic Ureteroplasty with Buccal Mucosa Graft for the Management of Complex Ureteral Strictures.

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Lee, Ziho; Waldorf, Benjamin T; Cho, Eric Y; Liu, Jeffrey C; Metro, Michael J; Eun, Daniel D

2017-12-01

Surgical management of proximal and mid ureteral strictures that are not amenable to primary excision and anastomosis is challenging. Although a buccal mucosa graft is commonly used during substitution urethroplasty, its use in substitution ureteroplasty is limited. We describe our technique of robotic ureteroplasty with a buccal mucosa graft to manage complex ureteral strictures and we report our outcomes. We retrospectively reviewed the records of 12 patients who underwent robotic ureteroplasty with a buccal mucosa graft between September 2014 and June 2016. The indication for the procedure was a proximal or mid ureteral stricture not amenable to primary excision and anastomosis. The primary outcomes were clinical success, absent symptoms on ureteral pathology and radiological success, defined as absent ureteral obstruction on retrograde pyelography, renal scan and/or computerized tomography. Four of the 12 patients (33.3%) had a ureteropelvic junction stricture, 4 (33.3%) had a proximal stricture and 4 (33.3%) had a mid ureteral stricture. Eight of the 12 patients (66.7%) had previously undergone failed ureteral reconstruction. Median stricture length was 3 cm (range 2 to 5). Median operative time was 217 minutes (range 136 to 344) and mean estimated blood loss was 100 ml (range 50 to 200). Median length of stay was 1 day (range 1 to 6). At a median followup of 13 months (range 4 to 30) 10 of the 12 cases (83.3%) were clinically and radiologically successful. Robotic ureteroplasty with a buccal mucosa graft is associated with low inherent morbidity. It is an effective way to manage complex proximal and mid ureteral strictures. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Management of ureteral endometriosis with hydronephrosis: Experience from a tertiary medical center.

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Huang, Jing-Zhi; Guo, Hong-Ling; Li, Jin-Bo; Chen, Shu-Qin

2017-10-01

We report the clinical characteristics and experience of the surgical management of ureteral endometriosis in our institution. We retrospectively reviewed the data of patients with hydronephrosis resulting from ureteral endometriosis. Forty-six patients with different degrees of hydronephrosis were included in the study; 35% had urinary tract symptoms. Concomitant involvement of the ipsilateral ovary occurred in more than two-thirds of the patients. Four patients had nephrectomy, one of which involved ureterolysis because of hydronephrosis recurrence six months later. Hydronephrosis may be caused by uncommon reasons, such as ureteral endometriosis, which can even cause silent loss of renal function. Routine ultrasound scanning of the upper urinary tract for severe stages of endometriosis is very important in order to detect any potential ureteral lesions. Ureterolysis should be considered as the first surgical step, not only to avoid iatrogenic ureteral injuries but also to better evaluate ureter involvement for further procedures. To warrant tension-free and lesion-free anastomosis, it is wise to perform ureteroneocystostomy for long-term sound results. © 2017 Japan Society of Obstetrics and Gynecology.

Effect of Diuretics on Ureteral Stone Therapy with Extracorporeal Shock Wave Lithotripsy

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Zomorrodi A

2008-01-01

Full Text Available To evaluate the effect of diuretics on ureteral stone fragmentation and clearance during therapy with extra corporeal shock wave lithotripsy (ESWL, we studied 87 patients with ureteral stone at different levels and treated with ESWL. The patients were randomized into two groups treated by standard ESWL; the treatment protocol included 3500 shock wave per patient in each session, energy of the shock in two groups was 13 to 9 kv per patient, and the number of sessions was 3 per patient. The first group included 43 patients who received only ESWL, while the second group of 44 patients received as well 40 mg of furosemide. Stone fragmentation rate was 81% and 93.1% and stone clearance rate was 68.2% and 88.4% for the first and the second groups, respectively. With diuretics, fragmentation was18.8% more in the middle ureteral stones, 16.9% more in the upper tract stones, and 5.4% more in the distal stones. Moreover, clearance of fragmented stones was 38%, 28%, 15.4% more at middle and upper and distal ureteral stone, respectively. We conclude that the stone fragmentation and clearance were higher with ESWL and diuretics than without diuresis. Diuresis is safe and has some advantage at increasing the effect of ESWL on ureteral stones especially the middle ureteral calculi.

Primary antegrade ureteric stenting: Prospective experience and cost-effectiveness analysis in 50 ureters

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Watson, Gillian M.T.; Patel, Uday

2001-07-01

AIM: To evaluate the success rate and cost efficiency of primary antegrade ureteric stenting (antegrade ureteric stent insertion as a single procedure without preliminary drainage). MATERIALS AND METHODS: A policy of primary stenting was tested in 38 patients (50 ureters) with obstructive hydronephrosis, of acute or chronic onset and of benign or malignant origin. Patients with suspected pyonephrosis were excluded. Patients successfully primarily stented (group 1) were compared to a group stented as a traditional two-stage procedure (group 2). End point assessments were screening time, equipment used, procedure-related costs, bed occupancy and technical and clinical success rate. Using these cost and outcome measures, a cost-efficiency analysis was performed comparing the two strategies. RESULTS: 40/50 (80%) ureters were considered primary stent successes. The average procedure-related bed occupancy was 2 days (range 1-2 days). Simple equipment alone was successful in 16 cases. Van Andel dilatation catheters and peel-away sheaths were frequently used (23 ureters). Expensive equipment was rarely necessary (four cases) and average extra equipment cost was small (46 pounds/case). The mean screening time was similar for the two groups (13.5 min vs 15.3 min;P {>=} 0.05). There was a minimum saving of 800 pounds per successful primary stent. The cost-effectiveness of a primary antegrade stenting strategy was 1229 pounds vs 2093 pounds for secondary stenting. CONCLUSION: In carefully selected patients, the majority of obstructed ureters can be primarily stented using simple equipment. The reduced hospital stay and overall success rate significantly improves the cost competitiveness of antegrade ureteric stenting. Watson, G.M.T. and Patel, U. (2001)

[The effiectiveness of extracorporeal shock wave lithotripsy in treating proxima ureteral stones].

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Kogan, M I; Belousov, I I; Yassine, A M

2017-10-01

Extracorporeal shock wave lithotripsy (ESWL) has proven efficacy in the treatment of proximal ureteral stones. The research to date has not been able to establish real time to spontaneous stone clearance after ESWL and the appropriateness and effectiveness of -blockers in stimulating residual stone clearance after ESWL. To conduct a comprehensive assessment of the effectiveness of ESWL in treating proximal ureteral stones and determine the appropriateness of using -blockers to stimulate residual stone clearance. ESWL was performed in 40 patients with X-ray positive proximal ureteral stones. Before ESWL and at 3 months after the treatment all patients underwent multispiral computed tomography. ESWL was considered successful if there was a complete clearance of the stones with no residual fragments on the control MSCT. If a residual ureteral stone was found at 3 months after ESWL, a 2-week course of silodosin was administered. Complete stone clearance was achieved in 37.5% of patients. Silodosin therapy for residual stones resulted in stone clearance in 68.4% of cases. Taken together, ESWL monotherapy and additional 3 months of lithokinetic therapy resulted in stone clearance in 70.0% of patients. The remaining patients underwent contact ureteral lithotripsy. Spontaneous stone passage after ESWL for proximal ureteral stones occurs not in all patients. Most commonly it occurred during the first three weeks after ESWL, and thereafter stone passage was not observed. In half of the patients with residual stones they were asymptomatic. The effectiveness of ESWL as a monotherapy for ureteral stones greater than 15 mm is incomplete. Adding silodosin during the long-term post ESWL period improves the passage of asymptomatic residual stones in 2/3 of patients, which makes its use promising.

Medical impulsive therapy (MIT): the impact of 1 week of preoperative tamsulosin on deployment of 16-French ureteral access sheaths without preoperative ureteral stent placement.

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Kaler, Kamaljot S; Safiullah, Shoaib; Lama, Daniel J; Parkhomenko, Egor; Okhunov, Zhamshid; Ko, Young H; Huynh, Linda; Patel, Roshan M; Landman, Jaime; Clayman, Ralph V

2018-05-25

Medical expulsive therapy is based on pharmacologic ureteral relaxation. We hypothesized this concept may facilitate the deployment of the large 16 French (F) ureteral access sheath (UAS) when patients are intentionally pre-treated with oral tamsulosin, i.e., medical impulsive therapy. We retrospectively analyzed our experience with UAS deployment during endoscopic-guided percutaneous nephrolithotomy in prone position in patients pre-treated for 1 week with oral tamsulosin with a contemporary untreated cohort. Between January 2015 and September 2016, seventy-seven patients without a pre-existing ureteral stent met inclusion criteria. Demographic data, tamsulosin usage, UAS size, deployment failure, ureteral injuries, stone-free rates, and complications were recorded. Univariate and multivariate analysis was conducted to assess the impact of tamsulosin on deployment of the 16F UAS. There was no statistical difference between the tamsulosin (n = 40) group and non-tamsulosin (n = 37) group in regard to demographic data. The tamsulosin group had a significantly higher percentage of 16F UAS deployment, 87 vs. 43% (p < 0.001), and no significant difference in ureteral injuries (p = 0.228). Univariate and multivariate analysis revealed that tamsulosin significantly increased the odds ratio (9.3 and 19.4, respectively) for successful passage of a 16F UAS. Despite a larger stone volume, there was no significant difference in computed tomography scan complete stone-free rates (29 vs. 42%; p = 0.277) at median post-operative time of only 3 days. In this retrospective study, 1 week of preoperative tamsulosin was associated with an increase in the deployment of a 16F UAS in patients without preoperative ureteral stent placement.

Antegrade deligation of iatrogenic distal ureteric obstruction utilising a high pressure balloon dilatation technique.

LENUS (Irish Health Repository)

Rajendran, Simon

2012-02-01

BACKGROUND: Iatrogenic trauma is the leading cause of ureteric injury with an incidence in abdominal and pelvic surgery varying between 0.4 and 2.5%. CASE: We report a case of ureteric obstruction caused by a haemostatic clip. There was associated rupture of the ureter proximal to the clip with intra-peritoneal leakage of urine. The patient was unfit for surgery and was managed by a novel procedure of endoluminal balloon deligation. CONCLUSION: Ureteric injuries are rare but potentially serious complications. They require prompt diagnosis and management depends on the patients\\' clinical condition, extent of injury and interval from injury to diagnosis. We have successfully demonstrated a new technique to treat ureteric obstruction caused by a haemostatic clip with associated ureteral rupture in a patient unfit for surgery.

Better recovery of kidney function in patients with de novo chronic kidney disease after partial nephrectomy compared with those with pre-existing chronic kidney disease.

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Takagi, Toshio; Kondo, Tsunenori; Iizuka, Junpei; Omae, Kenji; Kobayashi, Hirohito; Hashimoto, Yasunobu; Yoshida, Kazuhiko; Tanabe, Kazunari

2014-06-01

We compared kidney functional recovery between patients with pre-existing chronic kidney disease, those with de novo chronic kidney disease and those with normal kidney function, after partial nephrectomy. A total of 311 patients who underwent partial nephrectomy at Tokyo Women's Medical University Hospital, Tokyo, Japan, between January 2004 and July 2011 with sufficient kidney functional data participated in the study. Patients with pre-existing chronic kidney disease (group1: 78 patients) were defined as those with estimated glomerular filtration rate under 60 mL/min/m(2) before partial nephrectomy. Patients with de novo chronic kidney disease (group 2: 49) were defined as those with estimated glomerular filtration rate over 60 mL/min/m(2) before surgery and who developed estimated glomerular filtration rate under 60 mL/min/m(2) 3 months after partial nephrectomy. Normal patients (group 3: 184) were defined as those with estimated glomerular filtration rate over 60 mL/min/m(2) both before and after partial nephrectomy. Group 1 was associated with older age and higher comorbidity, including hypertension and diabetes mellitus, compared with other groups. R.E.N.A.L. score was not significantly different between the groups. Although the percent change of estimated glomerular filtration rate between the preoperative period and 3 months after partial nephrectomy in group 2 was significantly decreased compared with that in other groups (group 1: -6.8%, group 2: -18%, group 3: -7.3%), the renal functional recovery between 3 and 12 months after partial nephrectomy in group 2 was better than that in other groups (group 1: -0.5%, group 2: 5.6%, group 3: -0.4%). Patients with de novo chronic kidney disease had better kidney functional recovery than the other two groups, which might suggest that they were surgically assaulted and developed chronic kidney disease in the early postoperative period, and were essentially different from those with pre-existing chronic kidney

Distal ureteral calculi: the usefulness of transrectal ultrasound and comparison with intravenous urography

International Nuclear Information System (INIS)

Choi, Moon Hae; Yoon, Dae Young; Shim, Joo Eun; Kim, Ho Chul; Yi, Jeong Geun; Choi, Chul Sun; Bae, Sang Hoon; Kim, Ha Young

1996-01-01

To determine the usefulness of transrectal ultrasound (TRUS) and to compare TRUS with intravenous urography (IVU) in the evaluation of distal ureteral calculi. TRUS and IVU were performed in 24 patients with distal ureteral calculi. Using TRUS, we evaluated the presence and size of calculus, type of ureteral jet at the affected site and diameter of ureter proximal to calculus, and using IVU evaluated the presence and size of calculus, degree of ureteral obstruction, and degree of hydroureter. TRUS and IVU findings, were compared. In each patient, TRUS detected calculus of the distal ureter;in only 18 cases (75%), were the calculi demonstrated with IVU. In 18 cases where calculi were detected by both modalities, average calculus size was 4.5x3.0mm (longest and shortest dimensions) by IVU, and 6.1x3.7mm by TRUS. Between TRUS and IVU(p 0.05). TRUS appears to be a useful adjunctive method for the evaluation of distal ureteral calculus

Ureteral diameter in low-risk vesicoureteral reflux in infancy and childhood

International Nuclear Information System (INIS)

Hellstroem, M.; Hjaelmaas, K.; Jacobsson, B.; Jodal, U.; Oestra Sjukhuset, Goeteborg; Oestra Sjukhuset, Goeteborg

1986-01-01

In order to improve the accuracy of the grading of vesicoureteral reflux (VUR), reference values for ureteral diameter at micturition cystourethrography (MCUG) were established in infants and children with low-risk VUR. Low-risk VUR was defined as VUR not associated with infection, obstruction, calculi, duplication, malformations (except for hypospadia) or neurogenic bladder disturbances. Forty-six children (age 1 day - 14 years) were selected by examining the records of 12000 MCUG:s performed 1960-1983. Ureteral diameter was measured at the widest point of the ureter on the films from MCUG:s and urographies. Ureteral diameter was slightly larger at MCUG than at urography in the same individuals but the difference was not significant. The ureteral diameter at MCUG also correlated closely to normal values at urography in a previous study. It is proposed that the reference values obtained at MCUG in the present investigation can be used for the differentiation between dilatation and no dilatation in the grading of VUR. (orig.)

Endoscopic rendezvous procedure for ureteral iatrogenic detachment: report of a case series with long-term outcomes.

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Pastore, Antonio Luigi; Palleschi, Giovanni; Silvestri, Luigi; Leto, Antonino; Autieri, Domenico; Ripoli, Andrea; Maggioni, Cristina; Al Salhi, Yazan; Carbone, Antonio

2015-04-01

Injury to the ureter is the most common urologic complication of pelvic surgery, with an incidence that ranges from 1% to 10%. Most cases of ureteral injuries are related to gynecologic procedures. The ureter is particularly vulnerable to detachment or ligation during hysterectomy because of its position from the lateral edge of the cervix. We report a case series of female patients who underwent the ureteral rendezvous procedure for ureteral detachment. Between January 2009 and April 2013, 18 ureteral rendezvous procedures were performed for patients with complete detachment. We assessed the operative and clinical outcomes of these patients over a mean follow-up duration of 26.5 months and describe the three most representative cases. The endoscopic rendezvous technique was performed in all cases to manage ureteral detachment. CT urography at discharge and 6 and 12 months after discharge confirmed the restoration of ureteral integrity without any leakage in 66% (12/18) patients, indicated ureteral stenosis in 22% (4/18) patients, and indicated ureteral leakage in 12% (2/18) patients. The overall long-term success rate for all 18 patients was 78% (14/18) at a mean follow-up of 26.5 months. The endoscopic rendezvous procedure reduces the need for invasive open surgical repair and represents the optimal initial option in patients with iatrogenic ureteral lesions before invasive procedures with higher morbidity are attempted.

Experimental evaluation of furosemide renography in unobstructed and partially obstructed upper urinary tracts in pigs

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Harving, N.; Christiansen, P.; Taagehoj-Jensen, F.; Frokjaer, J.; Djurhuus, J.C.; Mortensen, J. (Institute of Experimental Clinical Research, University of Aarhus (Denmark))

1991-06-01

To evaluate the reliability and the constancy of the furosemide renography an experimental evaluation of the test has been performed. A standardized unilateral partial proximal ureteral obstruction was applied to 11 pigs. Preoperatively and again weekly in the three weeks following obstruction a furosemide renogram (FR) was done. The furosemide renography was a very constant parameter in the unobstructed kidney (85%) and in the partly obstructed kidney (85%). A type I FR pattern (O'Reilly classification) was an exact indicator of an unobstructed pelvis. After partial ureteral obstruction, an immediate change in the FR pattern was seen either into type II or type IIIa renography. In this experimental study furosemide renography was found to be a reliable tool in the differentiation between the unobstructed normal renal pelves and the partly obstructed dilated renal pelves.

Ureterolithotripsy for a Ureteral Calculus at the Ureteroureterostomy of a Renal-transplant Recipient.

Science.gov (United States)

Mitsui, Yosuke; Wada, Koichiro; Araki, Motoo; Yoshioka, Takashi; Ariyoshi, Yuichi; Nishimura, Shingo; Kobayashi, Yasuyuki; Sasaki, Katsumi; Watanabe, Toyohiko; Nasu, Yasutomo

2017-10-01

We describe a 40-year-old living-donor renal-transplant recipient who underwent successful ureterolithotripsy. He had been on hemodialysis for >15 years pre-transplant and underwent ureteroureterostomy along with the surgery. One year post-transplant, ultrasound examination demonstrated hydronephrosis, and CT showed a 6-mm ureteral calculus at the ureteroureterostomy site. No pain and no elevated serum creatinine were present. As the ureter was easily accessed, we performed a ureterolithotripsy, which would confirm whether a suture caused the calculus. Despite ureteral tortuosity, laser stone fragmentation succeeded. The calculus was completely removed with an antegrade guidewire. Mild postoperative ureteral stenosis resolved with a temporary ureteral stent without balloon dilation. Ureterolithotripsy is effective even in renal transplant recipients with ureteroureterostomy.

Sonography as an initial study in patients with suspected ureteral stone

International Nuclear Information System (INIS)

Lee, Jae Gue; Lim, Joo Won; Ko, Young Tae; Lee, Dong Ho; Lee, Hye Won; Oh, Joo Hyeong; Yoon, Yup; Lee, Sun Ju

1999-01-01

To evaluate the usefulness of sonography as an initial study in patients with suspected ureteral stone. We have undertaken a prospective study for 106 patients with suspected ureteral stone during 15 months. All the patients subsequently underwent urography at a mean interval of 1.8 days after the abdominopelvic sonography. We had only a clinical impression at the sonography and didn't refer to the other study such as KUB. We observed the degree of hydronephrosis using a grading system by Ellenbogen et aland location and size of stone. Seventy four patients had ureteral stone disease. The sonographic findings of these 74 patients showed a stone with hydronephrosis in 61 patients, a stone without hydronephrosis in 9, only hydronephrosis without stone in 2, and unremarkable finding in 2. In 3 of the remaining 32 patients, sonography showed hydronephrosis without stone. Locations of stone were 9 patients of ureteropelvic junction(UPJ), 19 of proximal ureter, 30 of distal ureter, and 16 of ureterovesical junction(UVJ). The sensitivity of sonography for stone was 95% and the specificity was 100%. When a ureteral stone was present, ipsilateral hydronephrosis was detected in 85% of cases on sonography. When only hydronephrosis without stone was detected on sonography, a ureteral stone was diagnosed in 2(40%) of 5 patients. Mean discrepancy of stone size between sonography and KUB was 3.1mm and stone size on sonography was larger. Grade of hydronephrosis between sonography and urography was the same in 32(59%) of 54 patients, whose stones were not expelled until urography after sonography. Sonography could be used as an initial study in patients with suspected ureteral stone.

CT urograms in pediatric patients with ureteral calculi: do adult criteria work?

International Nuclear Information System (INIS)

Smergel, E.; Greenberg, S.B.; Crisci, K.L.; Salwen, J.K.

2001-01-01

Background: Secondary signs of urinary obstruction associated with ureteral calculi are useful adjuncts to diagnosis in adults with renal colic evaluated by unenhanced helical CT. Objective: Our purpose was to evaluate the frequency of secondary signs of obstruction in children with renal colic undergoing unenhanced helical CT. Materials and methods: Ureteral calculi were identified in 20 of 61 children with acute flank pain examined by unenhanced helical CT. Each imaging study was evaluated for the presence of secondary signs of urinary obstruction. The frequencies of individual signs were compared with each other by means of the McNemar test. Results: Six children had no secondary sign identified. In the remaining 14 children, proximal ureteral dilatation was seen in 10, renal enlargement in 10, hydronephrosis in 9, tissue rim sign in 6, decreased kidney attenuation in 5, and perinephric stranding in 1. Comparison of the frequencies strongly suggested that perinephric stranding occurs less frequently than proximal ureteral dilatation (P = 0.004), hydronephrosis (P = 0.008), or renal enlargement (P = 0.012). Conclusion: Perinephric stranding, a common secondary sign in adults with ureteral calculi, occurs less frequently in children than other reported secondary signs. (orig.)

CT urograms in pediatric patients with ureteral calculi: do adult criteria work?

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Smergel, E.; Greenberg, S.B.; Crisci, K.L.; Salwen, J.K. [Dept. of Radiology, St. Christopher' s Hospital for Children, Philadelphia, PA (United States)

2001-10-01

Background: Secondary signs of urinary obstruction associated with ureteral calculi are useful adjuncts to diagnosis in adults with renal colic evaluated by unenhanced helical CT. Objective: Our purpose was to evaluate the frequency of secondary signs of obstruction in children with renal colic undergoing unenhanced helical CT. Materials and methods: Ureteral calculi were identified in 20 of 61 children with acute flank pain examined by unenhanced helical CT. Each imaging study was evaluated for the presence of secondary signs of urinary obstruction. The frequencies of individual signs were compared with each other by means of the McNemar test. Results: Six children had no secondary sign identified. In the remaining 14 children, proximal ureteral dilatation was seen in 10, renal enlargement in 10, hydronephrosis in 9, tissue rim sign in 6, decreased kidney attenuation in 5, and perinephric stranding in 1. Comparison of the frequencies strongly suggested that perinephric stranding occurs less frequently than proximal ureteral dilatation (P = 0.004), hydronephrosis (P = 0.008), or renal enlargement (P = 0.012). Conclusion: Perinephric stranding, a common secondary sign in adults with ureteral calculi, occurs less frequently in children than other reported secondary signs. (orig.)

Incidental diagnosis of diseases on un-enhanced helical computed tomography performed for ureteric colic

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Ather M Hammad

2003-03-01

Full Text Available Abstract Background Patients presenting in the emergency room with flank pain suggestive of acute ureteric colic may have alternative underlying conditions mimicking ureteric stones. An early diagnosis and appropriate treatment for other causes of flank pain is important. The majority of centers around the world are increasingly using un-enhanced helical CT (UHCT for evaluation of ureteric colic. This study was conducted to determine the incidence and spectrum of significant incidental diagnoses established or suggested on UHCT performed for suspected renal/ureteric colic. Methods Urologist and radiologist reviewed 233 consecutive UHCT, performed for suspected renal/ureteral colic along with assessment of the medical records. Radiological diagnoses of clinical entities not suspected otherwise were analyzed. All other relevant radiological, biochemical and serological investigations and per-operative findings were also noted. Results Ureteral calculi were identified in 148 examinations (64%, findings of recent passage of calculi in 10 (4% and no calculus in 75 examinations (32%. Overall the incidental findings (additional or alternative diagnosis were found in 28 (12% CT scans. Twenty (71% of these diagnoses were confirmed by per-operative findings, biopsy, and other radiological and biochemical investigations or on clinical follow up. Conclusion A wide spectrum of significant incidental diagnoses can be identified on UHCT performed for suspected renal/ureteral colic. In the present series of 233 consecutive CT examinations, the incidence of incidental diagnosis was 12%.

Abdominal colic due to ureteric diverticulum with stone formation

International Nuclear Information System (INIS)

Roodhooft, A.M.; Boven, K.; Acker, K.J. van; Gentens, P.

1987-01-01

In a 15-year-old boy right lower abdominal colicky pain was caused by intermittent obstruction of the ureter by stones which had accumulated in a ureteric diverticulum. As was shown by repeated X-rays, each of these stones had moved to the ureter and back to the diverticulum. Ureteric diverticulum mostly remains asymptomatic in children: stone formation and obstruction of the ureter by the stones is one of the instances which may cause symptoms. (orig.)

The Cost-Effectiveness of Treatment Modalities for Ureteral Stones

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Justin Ji-Yuen Siu MD

2016-10-01

Full Text Available Additional intervention and medical treatment of complications may follow the primary treatment of a ureteral stone. We investigated the cost of the treatment of ureteral stone(s within 45 days after initial intervention by means of retrospective analysis of the National Health Insurance Research Database of Taiwan. All patients of ages ≥20 years diagnosed with ureteral stone(s( International Classification of Diseases, Ninth Revision, Clinical Modification/ICD-9-CM: 592.1 from January 2001 to December 2011 were enrolled. We included a comorbidity code only if the diagnosis appeared in at least 2 separate claims in a patient’s record. Treatment modalities (code included extracorporeal shock-wave lithotripsy (SWL; 98.51, ureteroscopic lithotripsy (URSL; 56.31, percutaneous nephrolithotripsy (PNL; 55.04, (open ureterolithotomy (56.20, and laparoscopy (ie, laparoscopic ureterolithotomy; 54.21. There were 28 513 patients with ureteral stones (13 848 men and 14 665 women in the randomized sample of 1 million patients. The mean cost was 526.4 ± 724.1 United States Dollar (USD. The costs of treatment were significantly increased in patients with comorbidities. The costs of treatment among each primary treatment modalities were 1212.2 ± 627.3, 1146.7 ± 816.8, 2507.4 ± 1333.5, 1533.3 ± 1137.1, 2566.4 ± 2594.3, and 209.8 ± 473.2 USD in the SWL, URSL, PNL, (open ureterolithotomy, laparoscopy (laparoscopic ureterolithotomy, and conservative treatment group, respectively. In conclusion, URSL was more cost-effective than SWL and PNL as a primary treatment modality for ureteral stone(s when the possible additional costs within 45 days after the initial operation were included in the calculation.

Tamsulosin and spontaneous passage of ureteral stones in children: a multi-institutional cohort study.

Science.gov (United States)

Tasian, Gregory E; Cost, Nicholas G; Granberg, Candace F; Pulido, Jose E; Rivera, Marcelino; Schwen, Zeyad; Schulte, Marion; Fox, Janelle A

2014-08-01

Tamsulosin is associated with increased passage of ureteral stones in adults but its effectiveness in children is uncertain. We determined the association between tamsulosin and the spontaneous passage of ureteral stones in children. We performed a multi-institutional retrospective cohort study of patients 18 years or younger who presented between 2007 and 2012 with ureteral stones up to 10 mm and who were treated with tamsulosin or oral analgesics alone. The outcome was spontaneous stone passage, defined as radiographic clearance and/or patient report of passage. Subjects prescribed tamsulosin were matched with subjects prescribed analgesics alone, using nearest neighbor propensity score matching to adjust for treatment selection. Conditional logistic regression models were used to estimate the association between tamsulosin and spontaneous passage of ureteral stones, adjusting for stone size and location. Of 449 children with ureteral stones 334 were eligible for inclusion, and complete data were available for 274 patients from 4 institutions (99 receiving tamsulosin, 175 receiving analgesics alone). Following case matching, there were no differences in age, gender, weight, height, stone size or stone location between the 99 subjects prescribed tamsulosin and the 99 propensity score matched subjects prescribed analgesics alone. In the tamsulosin cohort 55% of ureteral stones passed, compared to 44% in the analgesics alone cohort (p=0.03). In multivariate analysis adjusting for stone size and location tamsulosin was associated with spontaneous passage of ureteral stones (OR 3.31, 95% CI 1.49-7.34). The odds of spontaneous passage of ureteral stones were greater in children prescribed tamsulosin vs analgesics alone. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Ureteric complications in live related donor renal transplantation - impact on graft and patient survival

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A Srivastava

2004-01-01

Full Text Available Objective : The study was performed with an aim to determine the incidence of ureteric complications in live related donor renal transplantation, and to study the effect of ureteric complications on long term graft and patient survival. Patients And Methods: Records of 1200 consecutive live related renal transplants done from 1989-2002 were reviewed. Twenty-six ureteric complications were noted to occur and treatment modalities employed were documented. In the non complication group sufficient data for evaluation was available in 867 patients. Survival analysis were performed using Kaplan-Meier techniques. Results: The overall incidence of urological complications is 2.9%. Complications occurred at a mean interval of 31.9 days after renal transplantation. Ureteric complications occurred in 2% patients with stented and 7.7% patients with non stented anastomosis (p=0.001. Mean follow up following renal transplantation was 37.4 months. Survival analysis showed that ureteric complications did not increase the risk of graft fai lu re or patient death. Conclusions: Ureteric complications in live related donor renal transplantation occurred in 2.9 % patients and did not impair graft and patient survival.

Intraureteral metallic endoprosthesis in the treatment of ureteral strictures

Energy Technology Data Exchange (ETDEWEB)

Daskalopoulos, George; Hatzidakis, Adam; Triantafyllou, Theodosis; Delakas, Dimitrios; Anezinis, Ploutarchos; Metaxari, Maria; Cranidis, Angelos

2001-09-01

Objective: We report our experience on intraureteral metallic stents placement for the treatment of malignant and benign ureteral strictures. Methods: Eight patients (six men and two women) with inoperable malignant or benign ureteral strictures, underwent insertion of metallic stents through percutaneous tracts. Six lesions (three malignant, three benign) involved ureterointestinal anastomoses after cystectomy for bladder cancer and ureteroileal urinary diversion or bladder substitution, and two malignant lesions involved the midureter. Self-expandable stents were used in seven cases and a balloon-expandable stent in the remaining one case. One stent was sufficient in seven ureters, and in one ureter, two overlapping stents were placed. Results: Metallic stents were inserted without technical difficulties in all obstructed ureters and patency was achieved in all patients. Ultrasonography revealed resolution of pre-existing hydronephrosis. The duration of follow-up was 6-17 months (mean, 9 months). One ureter was occluded 8 months after stent placement because of ingrowth of tumor and granulation tissue. The other ureters showed no signs of obstruction during follow-up. No major complications directly attributable to the metallic stent occurred. Conclusions: Our results suggest that insertion of a metallic stent in the ureter is feasible and safe for the treatment of benign or malignant ureteral strictures. However, more work needs to be done to establish the use of these stents for the treatment of ureteral obstruction.

Percutaneous antegrade ureteric stent removal using a rigid alligator forceps.

LENUS (Irish Health Repository)

Given, M F

2008-12-01

To evaluate the safety and efficacy of percutaneous antegrade ureteric stent removal using a rigid alligator forceps. Twenty patients were included in our study. Indications for ureteric stent insertion included stone disease (n = 7), malignancy (n = 8) and transplant anastomotic strictures (n = 5). Stent retrieval was carried out for proximal stent placement\\/migration in seven patients and encrustation in the remaining 13. Twenty-two stents were successfully retrieved in 20 patients. There was one technical failure (5%). There were no major complications. We had four minor complications, which included nephrostomy site pain (n = 2), periprocedural sepsis (n = 1) and a small urinoma (n = 1). All patients settled with conservative management. Percutaneous radiologically guided antegrade ureteric stent removal with an alligator forceps is safe and effective, particularly when initial surgical removal has failed.

Comparison of ESWL and ureteroscopic holmium laser lithotripsy in management of ureteral stones.

Science.gov (United States)

Cui, Yon; Cao, Wenzhou; Shen, Hua; Xie, Jianjun; Adams, Tamara S; Zhang, Yuanyuan; Shao, Qiang

2014-01-01

There are many options for urologists to treat ureteral stones that range from 8 mm to 15 mm, including ESWL and ureteroscopic holmium laser lithotripsy. While both ESWL and ureteroscopy are effective and minimally invasive procedures, there is still controversy over which one is more suitable for ureteral stones. To perform a retrospective study to compare the efficiency, safety and complications using ESWL vs. ureteroscopic holmium laser lithotripsy in management of ureteral stones. Between October 2010 and October 2012, 160 patients who underwent ESWL or ureteroscopic holmium laser lithotripsy at Suzhou municipal hospital for a single radiopaque ureteral stone (the size 8-15 mm) were evaluated. All patients were followed up with ultrasonography for six months. Stone clearance rate, costs and complications were compared. Similarity in stone clearance rate and treatment time between the two procedures; overall procedural time, analgesia requirement and total cost were significantly different. Renal colic and gross hematuria were more frequent with ESWL while voiding symptoms were more frequent with ureteroscopy. Both procedures used for ureteral stones ranging from 8 to 15 mm were safe and minimally invasive. ESWL remains first line therapy for proximal ureteral stones while ureteroscopic holmium laser lithotripsy costs more. To determining which one is preferable depends on not only stone characteristics but also patient acceptance and cost-effectiveness ratio.

Comparison of ESWL and ureteroscopic holmium laser lithotripsy in management of ureteral stones.

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Yon Cui

Full Text Available BACKGROUND: There are many options for urologists to treat ureteral stones that range from 8 mm to 15 mm, including ESWL and ureteroscopic holmium laser lithotripsy. While both ESWL and ureteroscopy are effective and minimally invasive procedures, there is still controversy over which one is more suitable for ureteral stones. OBJECTIVE: To perform a retrospective study to compare the efficiency, safety and complications using ESWL vs. ureteroscopic holmium laser lithotripsy in management of ureteral stones. METHODS: Between October 2010 and October 2012, 160 patients who underwent ESWL or ureteroscopic holmium laser lithotripsy at Suzhou municipal hospital for a single radiopaque ureteral stone (the size 8-15 mm were evaluated. All patients were followed up with ultrasonography for six months. Stone clearance rate, costs and complications were compared. RESULTS: Similarity in stone clearance rate and treatment time between the two procedures; overall procedural time, analgesia requirement and total cost were significantly different. Renal colic and gross hematuria were more frequent with ESWL while voiding symptoms were more frequent with ureteroscopy. Both procedures used for ureteral stones ranging from 8 to 15 mm were safe and minimally invasive. CONCLUSION: ESWL remains first line therapy for proximal ureteral stones while ureteroscopic holmium laser lithotripsy costs more. To determining which one is preferable depends on not only stone characteristics but also patient acceptance and cost-effectiveness ratio.

An unusual case: right proximal ureteral compression by the ovarian vein and distal ureteral compression by the external iliac vein

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Halil Ibrahim Serin

2015-12-01

Full Text Available A 32-years old woman presented to the emergency room of Bozok University Research Hospital with right renal colic. Multidetector computed tomography (MDCT showed compression of the proximal ureter by the right ovarian vein and compression of the right distal ureter by the right external iliac vein. To the best of our knowledge, right proximal ureteral compression by the ovarian vein together with distal ureteral compression by the external iliac vein have not been reported in the literature. Ovarian vein and external iliac vein compression should be considered in patients presenting to the emergency room with renal colic or low back pain and a dilated collecting system.

Ureteral stents increase risk of postoperative acute kidney injury following colorectal surgery.

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Hassinger, Taryn E; Mehaffey, J Hunter; Mullen, Matthew G; Michaels, Alex D; Elwood, Nathan R; Levi, Shoshana T; Hedrick, Traci L; Friel, Charles M

2018-07-01

Ureteral stents are commonly placed before colorectal resection to assist in identification of ureters and prevent injury. Acute kidney injury (AKI) is a common cause of morbidity and increased cost following colorectal surgery. Although previously associated with reflex anuria, prophylactic stents have not been found to increase AKI. We sought to determine the impact of ureteral stents on the incidence of AKI following colorectal surgery. All patients undergoing colon or rectal resection at a single institution between 2005 and 2015 were reviewed using American College of Surgeons National Surgical Quality Improvement Program dataset. AKI was defined as a rise in serum creatinine to ≥ 1.5 times the preoperative value. Univariate and multivariate regression analyses were performed to identify independent predictors of AKI. 2910 patients underwent colorectal resection. Prophylactic ureteral stents were placed in 129 patients (4.6%). Postoperative AKI occurred in 335 (11.5%) patients during their hospitalization. The stent group demonstrated increased AKI incidence (32.6% vs. 10.5%; p colorectal surgery including age, procedure duration, and ureteral stent placement. Prophylactic ureteral stents independently increased AKI risk when placed prior to colorectal surgery. These data demonstrate increased morbidity and hospital costs related to usage of stents in colorectal surgery, indicating that placement should be limited to patients with highest potential benefit.

Evaluation of symptoms and patients' comfort for JJ-ureteral stents with and without antireflux-membrane valve.

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Ecke, Thorsten H; Bartel, Peter; Hallmann, Steffen; Ruttloff, Jürgen

2010-01-01

To evaluate safety and patients' comfort by using the ureteral stent symptom questionnaire. Ureteral stents are used to provide upper urinary-tract drainage. A total of 133 JJ-ureteral stents with and without antireflux-membrane valve as consecutive referrals for therapy of hydronephrosis have been inserted. Four weeks after insertion of the ureteral stent, the patients were asked about pain while urination, flank pain due to reflux, and the comparison with former stents. Ultrasound of the kidney for hydronephrosis grade and creatinine value as follow-up have been documented. Statistical analysis included chi(2) test after Pearson correlation computed and performed by SPSS software. We found a high correlation between the JJ-ureteral stent used and the detection of a hydronephrosis (P = .004). More patients who had a JJ-ureteral stent without valve complained of flank pain (P JJ-ureteral stent with valve found this one to be worse than what they had before. JJ-stent related symptoms are a major problem for these patients. New stent designs and materials will be developed in the future to reduce stent-related morbidity and improve patient comfort. JJ-ureteral stents with an antireflux-membrane valve have a lower complication rate and provide a higher patient comfort compared with stents without valve. Crown Copyright 2010. Published by Elsevier Inc. All rights reserved.

Robot-assisted pyeloplasty for pelvi-ureteric junction obstruction of lower moiety in partial duplex system: A technical challenge

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Girdhar S Bora

2016-01-01

Full Text Available Management of pelvi-ureteric junction obstruction (PUJO in a duplex system is technically challenging as dissection at the pelvis may jeopardize the vascularity of the normal moiety ureter. Anastomosing the pelvis to the one single ureter will have a risk of future development of stricture which then will risk both the moieties. Robotic assistance enables appropriate tissue dissection; minimal handling of normal ureter and precision in suturing, overcoming the potential challenges involved in the minimally invasive management of such complex cases. We report the feasibility and efficacy of robot-assisted laparoscopic pyeloplasty in such case.

Tamsulosin and the spontaneous passage of ureteral stones in children: A multi-institutional cohort study

Science.gov (United States)

Tasian, Gregory E.; Cost, Nicholas G.; Granberg, Candace F.; Pulido, Jose E.; Rivera, Marcelino; Schwen, Zeyad; Schulte, Marion; Fox, Janelle A.

2014-01-01

Purpose Tamsulosin is associated with increased passage of ureteral stones in adults, but its effectiveness in children is uncertain. We determined the association between tamsulosin and the spontaneous passage of ureteral stones in children. Methods We performed a multi-institutional retrospective cohort study of children ≤ 18 years who presented between 2007 and 2012 with a ureteral stone ≤ 10 mm and were managed with tamsulosin or oral analgesics alone. The outcome was spontaneous stone passage defined as radiographic clearance and/or patient report of passage. Subjects prescribed tamsulosin were matched with subjects prescribed analgesics alone using nearest neighbor propensity score matching to adjust for treatment selection. Conditional logistic regression models were used to estimate the association between tamsulosin and spontaneous passage of ureteral stones, adjusting for stone size and location. Results Of 449 children with ureteral stones, 334 were eligible for inclusion, and complete data were available for 274 children from 4 institutions (99 tamsulosin; 175 analgesics alone). Following case matching, there were no differences in patient age, gender, weight, height, stone size, or stone location between the 99 subjects prescribed tamsulosin and the 99 propensity-score matched subjects prescribed analgesics alone. In the tamsulosin cohort, 55% of ureteral stones passed versus 44% in the analgesics alone cohort (p = 0.03). In multivariate analysis adjusting for stone size and location, tamsulosin was associated with spontaneous passage of ureteral stones (OR 3.31; 95% CI 1.49–7.34). Conclusions The odds of spontaneous passage of ureteral stones were higher in children prescribed tamsulosin versus analgesics alone. PMID:24518765

Ureteral quintuplication with renal atrophy in an infant after the 1986 Chernobyl nuclear disaster.

Science.gov (United States)

Jurkiewicz, Beata; Ząbkowski, Tomasz; Shevchuk, Dmitrij

2014-01-01

Ureteral duplication is a comparatively frequent urinary tract anomaly. Ureteral triplication is rare, but quadruplication is extremely rare. In this study, we describe a case of ureteral quintuplication, the first such report in the English-language literature. A newborn female baby was diagnosed with left ureteral quintuplication. The left ureter was divided into 5 ureters with 5 renal pelvises within approximately 3 cm of the urinary bladder, and trace parenchyma of the kidney was noted. The patient was born within 60 km of the epicenter of the 1986 Chernobyl disaster, 24 years after the catastrophic nuclear accident, and is currently aged 3 years. Copyright © 2014 Elsevier Inc. All rights reserved.

Transperitoneal laparoscopic ureteric reimplantation for lower ...

African Journals Online (AJOL)

V. Singh

2016-07-21

Jul 21, 2016 ... in Table 1. All the patients had an initial failed retrograde JJ stent .... we found only a single case of recurrence of the stricture or stenosis in the follow up ... scopic ureteral reconstruction for benign stricture disease. Urology.

Doppler visualization of ureteric jets in unilateral hydronephrosis in children and adolescents

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Cvitkovic Kuzmic, Andrea E-mail: andreack@workmail.com; Brkljacic, Boris; Rados, Marko; Galesic, Kresimir

2001-09-01

Objective: to evaluate Doppler visualization of ureteric jets in the assessment of unilateral kidney collecting system dilatation in children and adolescents. Methods and patients: color Doppler ultrasonography was performed in 27 patients with hydronephrosis (11 female, 16 male, age range 3-21 years, mean age 10.5{+-}4.4). Nine had acute obstruction due to ureteral calculus, seven had obstructive hydronephrosis due to uretero-pelvic junction (UPJ) stenosis, and 11 had non-obstructive hydronephrosis. Doppler was also performed in 32 healthy children (15 boys and 17 girls, age 2-17 years, mean age 7.8{+-}3.9), who represented the control group. Results: in the control group jets were visible in 57 out of 64 ureteric units (89%). The mean frequency of jets in healthy children was 4.1 jets per min. In all children with hydronephrosis, jets were visible in 25 out of 27 normal ureteric units (92.6%), and their mean frequency was 4.5 jets per min. In children with acute unilateral colic, ureteric jets were completely absent in eight of nine patients (89%). In children with obstructive hydronephrosis, due to UPJ stenosis, jets were absent in five out of seven patients (71.4%), and in children with non-obstructive hydronephrosis jets were absent in three out of eleven patients (27.3%). When jets are visible, their frequencies are much lower on the obstructed side as compared with normal side, while in cases of nonobstructive dilatation frequency of jets is similar on both sides. Conclusion: absence of jets in patients with acute obstruction due to ureteral calculus, strongly correlates with high-grade obstruction. In children with UPJ stenosis, presence of ureteric jet does not exclude significant obstruction, but the frequency of jets on the obstructed side is much lower as compared with the unaffected side. When there is absence of jet from the dilated side or significant asymmetry in jet frequency, hydronephrosis is likely to be obstructive.

Doppler visualization of ureteric jets in unilateral hydronephrosis in children and adolescents

International Nuclear Information System (INIS)

Cvitkovic Kuzmic, Andrea; Brkljacic, Boris; Rados, Marko; Galesic, Kresimir

2001-01-01

Objective: to evaluate Doppler visualization of ureteric jets in the assessment of unilateral kidney collecting system dilatation in children and adolescents. Methods and patients: color Doppler ultrasonography was performed in 27 patients with hydronephrosis (11 female, 16 male, age range 3-21 years, mean age 10.5±4.4). Nine had acute obstruction due to ureteral calculus, seven had obstructive hydronephrosis due to uretero-pelvic junction (UPJ) stenosis, and 11 had non-obstructive hydronephrosis. Doppler was also performed in 32 healthy children (15 boys and 17 girls, age 2-17 years, mean age 7.8±3.9), who represented the control group. Results: in the control group jets were visible in 57 out of 64 ureteric units (89%). The mean frequency of jets in healthy children was 4.1 jets per min. In all children with hydronephrosis, jets were visible in 25 out of 27 normal ureteric units (92.6%), and their mean frequency was 4.5 jets per min. In children with acute unilateral colic, ureteric jets were completely absent in eight of nine patients (89%). In children with obstructive hydronephrosis, due to UPJ stenosis, jets were absent in five out of seven patients (71.4%), and in children with non-obstructive hydronephrosis jets were absent in three out of eleven patients (27.3%). When jets are visible, their frequencies are much lower on the obstructed side as compared with normal side, while in cases of nonobstructive dilatation frequency of jets is similar on both sides. Conclusion: absence of jets in patients with acute obstruction due to ureteral calculus, strongly correlates with high-grade obstruction. In children with UPJ stenosis, presence of ureteric jet does not exclude significant obstruction, but the frequency of jets on the obstructed side is much lower as compared with the unaffected side. When there is absence of jet from the dilated side or significant asymmetry in jet frequency, hydronephrosis is likely to be obstructive

Shock Wave Lithotripsy in Ureteral Stones: Evaluation of Patient and Stone Related Predictive Factors

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Ozgur Yazici

2015-08-01

Full Text Available ABSTRACTPurpose:To evaluate the patient and stone related factors which may influence the final outcome of SWL in the management of ureteral stones.Materials and Methods:Between October 2011 and October 2013, a total of 204 adult patients undergoing SWL for single ureteral stone sizing 5 to 15 mm were included into the study program. The impact of both patient (age, sex, BMI, and stone related factors (laterality, location, longest diameter and density as CT HU along with BUN and lastly SSD (skin to stone distance on fragmentation were analysed by univariate and multivariate analyses. Results: Stone free rates for proximal and distal ureteral stones were 68.8% and 72.7%, respectively with no statistically significant difference between two groups (p=0.7. According to univariate and multivariate analyses, while higher BMI (mean: 26.8 and 28.1, p=0.048 and stone density values (mean: 702 HU and 930 HU, p<0.0001 were detected as statistically significant independent predictors of treatment failure for proximal ureteral stones, the only statistically significant predicting parameter for the success rates of SWL in distal ureteral stones was the higher SSD value (median: 114 and 90, p=0.012.Conclusions:Our findings have clearly shown that while higher BMI and increased stone attenuation values detected by NCCT were significant factors influencing the final outcome of SWL treatment in proximal ureteral stones; opposite to the literature, high SSD was the only independent predictor of success for the SWL treatment of distal ureteral stones.

Robot-assisted ureteral reconstruction – current status and future directions

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Paurush Babbar

2018-01-01

Full Text Available Robotic surgery in the treatment in certain urological diseases has become a mainstay. With the increasing use of the robotic platform, some surgeries which were historically performed open have transitioned to a minimally invasive technique. Recently, the robotic approach has become more utilized for ureteral reconstruction. In this article, the authors review the surgical techniques for a number of major ureteral reconstuctive surgeries and briefly discuss the outcomes reported in the literature.

Primary ureteral carcinoma: MRI diagnosis and comparison with other diagnostic imaging facilities

International Nuclear Information System (INIS)

An Ningyu; Jiang Bo; Cai Youquan; Liang Yan

2004-01-01

Objective: To investigate MRI examination methods and imaging manifestations of primary ureteral carcinoma, and to evaluate its clinical values when comparing with other diagnostic imaging facilities. Methods: Eighty-seven cases of primary ureteral carcinoma who were operated within recent 8 years came into the study, among which, 35 cases had MRI examinations. For MRI examination, coronal heavy T 2 WI (water imaging) was performed to show the dilated ureter, then axial T 2 WI and T 1 WI were scanned at the obstruction level. 11 cases underwent additional Gd-DTPA dynamic contrast enhanced scans. The original pre-operative diagnostic reports of various imaging facilities were analyzed comparing with the results of operation and pathology. Results: MRI showed ureteral dilatation in 33 of 35 cases, no abnormal appearance in 1 case, and only primary kidney atrophy post renal transplantation in 1 case. Among the 33 cases with ureteral obstruction, soft mass at the obstruction level was detected on axial scans in 32 cases. The lesions showed gradual and homogeneous mild to moderate enhancement on contrast MRI. The overall employment rate of imaging facilities was as follows: ultrasound (94.3%), IVU (59.8%), CT (52.9%), MRI (40.2%), and RUP (35.6%). The accurate diagnostic rate was as follows :MRI (91.4%), RUP (80.6%), CT (63.0%), ultrasound (47.6%), and IVU (11.5%). Conclusion: Combination of MR water imaging and conventional sequences can demonstrate most primary ureteral carcinoma lesions and has a highest diagnostic accuracy among the current diagnostic imaging facilities. It should be taken as the first diagnostic imaging method of choice when primary ureteral carcinoma is suspected after ultrasound screening

Ureteropelvic junction obstruction and ureteral strictures treated by simple high-pressure balloon dilation

DEFF Research Database (Denmark)

Osther, P J; Geertsen, U; Nielsen, H V

1998-01-01

The long-term results of simple high-pressure balloon dilation in the treatment of ureteropelvic junction obstruction (UPJO) and ureteral strictures were evaluated. A total of 77 consecutive patients were treated: 40 had UPJO and 37 ureteral strictures. The etiology of the obstruction included...... years, success was achieved in only 25% of cases. There were no major complications. It was concluded that simple high-pressure balloon dilation is a safe and reasonably effective technique for the management of most ureteral strictures and congenital UPJO with symptom debut in adult life. Balloon...

Ureteral catheters for colorectal surgery: Influence on operative times and complication outcomes: An observational study

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Julio T. Chong

2018-03-01

Full Text Available Purpose: Placement of pre-operative ureteral catheters for colorectal surgery can aid in the identification of ureteral injuries. This study investigates whether simultaneous ureteral catheterization with surgery skin preparation can minimize operating room times without increasing post-operative complications. Materials and Methods: Patients undergoing simultaneous colorectal surgery skin preparation and placement of pre-operative ureteral catheters (n=21 were compared to those who underwent these events sequentially (n=28. Operative time-points of anesthesia ready (AR, surgery procedure start (PS, dorsal lithotomy and catheter insertion (CI times were compared to assess for differences between groups. Complications were compared between groups. Results: There were no differences in age, gender, body mass index (BMI, American Society of Anesthesiologists (ASA, comorbidities, current procedure terminology (CPT or International Classification of Diseases, 9th revision (ICD-9 codes between groups. Simultaneous catheterization saved 11.82 minutes of operative time between CI to PS (p=0.005, t-test. There was a significant difference in mean time between CI to PS (11.82 minutes, p=0.008 between simultaneous and sequential ureteral catheterization groups in a linear regression multivariate analysis controlling for age, BMI, CPT and ICD-9 codes. There were 4 complications in the simultaneous (19% and 3 in the sequential group (11% (p=0.68. Conclusions: Ureteral catheterization and colorectal surgery skin preparation in a simultaneous fashion decreases the time between CI and PS without significant increase in complications. Mean time saved with simultaneous ureteral catheterization was 11.82 minutes per case. Simultaneous ureteral catheterization may be an option in colorectal surgery and may result in cost savings without additional complications.

Stone Formation and Fragmentation in Forgotten Ureteral Double J Stent

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Okan Bas

2014-02-01

Full Text Available Aim: Nowadays, ureteral stents play an essential role in various endourological and open surgical procedures and common procedures performed in daily urological practice. However, stents can cause significant complications such as migration, infection, fragmentation, stone formation and encrustation, especially when forgotten for a long period. Objectives: We present our experience in endoscopic management of forgotten ureteral stents with a brief review of current literature. Case presentation: A total of 2 patients with forgotten ureteral stents were treated with endourological approaches in our department. Indwelling durations were 18 months and 36 months. After treatment both patients were stone and stent free. Conclusion: An endourological approach is effective for stent and stone removal after a single anesthesia session with minimal morbidity and short hospital stay. However, therapeutic strategy is also determined by the technology available. The best treatment would be the prevention of this complication by providing detailed patient education.

BILATERAL SINGLE SESSION URETEROSCOPY FOR URETERAL ...

African Journals Online (AJOL)

Objectives: To determine the feasibility, safety and success rate of bilateral single session rigid retrograde ureteroscopy (URS) for bilateral ureteral calculi. Patients and Methods: Thirty-five patients underwent bilateral single session ureteroscopic calculus removal. Results: Out of 70 renal units in 35 patients treated, ...

Oculomotor impairment during chronic partial sleep deprivation.

Science.gov (United States)

Russo, M; Thomas, M; Thorne, D; Sing, H; Redmond, D; Rowland, L; Johnson, D; Hall, S; Krichmar, J; Balkin, T

2003-04-01

The effects of chronic partial sleep (sleep deprivation) and extended sleep (sleep augmentation) followed by recovery sleep on oculomotor function were evaluated in normal subjects to explore the usefulness of oculomotor assessment for alertness monitoring in fitness-for-duty testing. Sixty-six commercial drivers (24-62 years, 50m/16f) participated in a 15 day study composed of 3 training days with 8h time in bed per night, 7 experimental days with subjects randomly assigned to either 3, 5, 7, or 9h time in bed, and 3 recovery nights with 8h time in bed. Data from 57 subjects were used. Saccadic velocity (SV), initial pupil diameter (IPD), latency to pupil constriction (CL), and amplitude of pupil constriction (CA) were assessed and correlated with the sleep latency test (SLT), the Stanford sleepiness scale (SSS), and simulated driving performance. Regression analyses showed that SV slowed significantly in the 3 and 5h groups, IPD decreased significantly in the 9h group, and CL increased significantly in the 3h group. SLT and SSS significantly correlated with SV, IPD, CL, and driving accidents for the 3h group, and with CL for the 5h group. Analyses also showed a significant negative correlation between decreasing SV and increasing driving accidents in the 3h group and a significant negative correlation between IPD and driving accidents for the 7h group. The results demonstrate a sensitivity primarily of SV to sleepiness, and a correlation of SV and IPD to impaired simulated driving performance, providing evidence for the potential utility of oculomotor indicators in the detection of excessive sleepiness and deterioration of complex motor performance with chronic partial sleep restriction. This paper shows a relationship between sleep deprivation and oculomotor measures, and suggests a potential utility for oculometrics in assessing operational performance readiness under sleep restricted conditions.

Comparison of Two Types of Double-J Ureteral Stents that Differ in Diameter and the Existence of Multiple Side Holes along the Straight Portion in Malignant Ureteral Strictures.

Science.gov (United States)

Song, Myung Gyu; Seo, Tae-Seok; Lee, Chang Hee; Kim, Kyeong Ah; Kim, Jun Suk; Oh, Sang Cheul; Lee, Jae-Kwan

2015-06-01

This study was decided to evaluate the impact of diameter and the existences of multiple side holes along the straight portion of double-J ureteral stents (DJUS) on early dysfunction of stents placed for malignant ureteral strictures. Between April 2007 and December 2011, 141 DJUSs were placed via a percutaneous nephrostomy (PCN) tract in 110 consecutive patients with malignant ureteral strictures. 7F DJUSs with multiple side holes in the straight portion were placed in 58 ureters of 43 patients (Group 1). 8F DJUSs with three side holes in the proximal 2-cm of the straight portion were placed in 83 ureters of 67 patients (Group 2). The incidence of early DJUS dysfunction was compared between the two groups, and nephrostographic findings were evaluated in the cases of early dysfunction. Early dysfunction of the DJUS was noted in 14 of 58 patients (24.1 %) in Group 1, which was significantly higher (p = 0.001) than in Group 2 in which only 1 of 83 patients (1.2 %) had early dysfunction of the DJUS. Nephrostographic findings of early dysfunction included dilatation of the pelvicalyceal system, filling defects in the ureteral stent, and no passage of contrast media into the urinary bladder. In malignant ureteral strictures, multiple side holes in the straight portion of the 7-F DJUS seem to cause early dysfunction. The 8F DJUSs with three side holes in the proximal 2-cm of the straight portion may be superior at preventing early dysfunction.

Diagnosis and management of ureteral complications following renal transplantation

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Brian D. Duty

2015-10-01

Full Text Available When compared with maintenance dialysis, renal transplantation affords patients with end-stage renal disease better long-term survival and a better quality of life. Approximately 9% of patients will develop a major urologic complication following kidney transplantation. Ureteral complications are most common and include obstruction (intrinsic and extrinsic, urine leak and vesicoureteral reflux. Ureterovesical anastomotic strictures result from technical error or ureteral ischemia. Balloon dilation or endoureterotomy may be considered for short, low-grade strictures, but open reconstruction is associated with higher success rates. Urine leak usually occurs in the early postoperative period. Nearly 60% of patients can be successfully managed with a pelvic drain and urinary decompression (nephrostomy tube, ureteral stent, and indwelling bladder catheter. Proximal, large-volume, or leaks that persist despite urinary diversion, require open repair. Vesicoureteral reflux is common following transplantation. Patients with recurrent pyelonephritis despite antimicrobial prophylaxis require surgical treatment. Deflux injection may be considered in recipients with low-grade disease. Grade IV and V reflux are best managed with open reconstruction.

A partial hearing animal model for chronic electro-acoustic stimulation

Science.gov (United States)

Irving, S.; Wise, A. K.; Millard, R. E.; Shepherd, R. K.; Fallon, J. B.

2014-08-01

Objective. Cochlear implants (CIs) have provided some auditory function to hundreds of thousands of people around the world. Although traditionally carried out only in profoundly deaf patients, the eligibility criteria for implantation have recently been relaxed to include many partially-deaf patients with useful levels of hearing. These patients receive both electrical stimulation from their implant and acoustic stimulation via their residual hearing (electro-acoustic stimulation; EAS) and perform very well. It is unclear how EAS improves speech perception over electrical stimulation alone, and little evidence exists about the nature of the interactions between electric and acoustic stimuli. Furthermore, clinical results suggest that some patients that undergo cochlear implantation lose some, if not all, of their residual hearing, reducing the advantages of EAS over electrical stimulation alone. A reliable animal model with clinically-relevant partial deafness combined with clinical CIs is important to enable these issues to be studied. This paper outlines such a model that has been successfully used in our laboratory. Approach. This paper outlines a battery of techniques used in our laboratory to generate, validate and examine an animal model of partial deafness and chronic CI use. Main results. Ototoxic deafening produced bilaterally symmetrical hearing thresholds in neonatal and adult animals. Electrical activation of the auditory system was confirmed, and all animals were chronically stimulated via adapted clinical CIs. Acoustic compound action potentials (CAPs) were obtained from partially-hearing cochleae, using the CI amplifier. Immunohistochemical analysis allows the effects of deafness and electrical stimulation on cell survival to be studied. Significance. This animal model has applications in EAS research, including investigating the functional interactions between electric and acoustic stimulation, and the development of techniques to maintain residual

[Construction of a capsular tissue-engineered ureteral stent seeded with autologous urothelial cells].

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Tan, Haisong; Fu, Weijun; Li, Jianqiang; Wang, Zhongxin; Li, Gang; Ma, Xin; Dong, Jun; Gao, Jiangping; Wang, Xiaoxiong; Zhang, Xu

2013-01-01

To investigate the feasibility of constructing a capsular poly L-lactic acid (PLLA) ureteral stent seeded with autologous urothelial cells using tissue engineering methods. The capsular ureteral stent was constructed by subcutaneously embedding PLLA ureteral stent in the back of beagles for 3 weeks to induce the formation of connective tissue on the surfaces. After decellularization of the stent, the expanded autologous urothelial cells were seeded on the stent. The surface structure and cell adhesion of the stent were observed using HE staining, scanning electron microscope (SEM) and immunocytochemical staining. MTT assay was used to evaluate urothelial cell proliferation on the capsular PLLA ureteral stent and on circumferential small intestinal submucosa graft. HE staining and VIII factor immunohistochemistry revealed numerous capillaries in the connective tissue encapsulating the stent without obvious local inflammatory response. The results of SEM and immunocytochemical staining showed that the capsule contained rich collagenic fibers forming three-dimensional structures, and the seeded autologous urothelial cells could adhere and well aligned on the surface. MTT assay showed normal growth of the cells on the stent as compared with the cells grown on circumferential small intestinal submucosa graft. The capsular PLLA ureteral stent allows adhesion and proliferation of autologous urothelial cells and shows a potential in applications of constructing tissue-engineered ureter.

Endoscopic placement of double-J ureteric stents in children as a treatment for primary obstructive megaureter

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Carroll Daniel

2010-01-01

Full Text Available Aim: To determine the efficacy and potential complications of double-J ureteric stents in the treatment of persistent or progressive primary obstructive megaureter in pediatric patients within our institution. Materials and Methods: A retrospective case-note review of all patients with double-J ureteric stents, between 1997 and 2004, was performed. In all, 38 stents were inserted in 31 patients aged between 2 months and 15 years of age. Complications and results of follow-up investigations and the need for follow-up investigations were recorded. Patients were followed up clinically and radiologically for a minimum of 2 years following stent insertion. Results: Endoscopic placement of double-J ureteric stents in childhood is straightforward and complications are uncommon (8/38 insertions. In non-resolving or progressive primary non-refluxing megaureter, double-J ureteric stenting alone is effective with resolution of primary non-refluxing megaureter in 66% of cases (25/38 insertions. Conclusions: Ureteric stenting provides an alternative to early surgery in patients with primary non-refluxing megaureter. The youngest patient in our series was 2 months old at the time of endoscopic ureteric double-J stent insertion. Endoscopic placement of ureteric double-J stents should be considered as a first-line treatment in the management of persistent or progressive non-refluxing megaureter leading to progressive hydronephrosis or pyonephrosis.

US demonstration of pyelitis and ureteritis in children

International Nuclear Information System (INIS)

Avni, E.F.; Gansbeke, D. van; Matos, C.; Thoua, Y.; Schulman, C.C.

1988-01-01

The authors report a new ultrasonic sign of urinary tract infection in children: thickening of the renal pelvis and/or ureteral wall. This thickening as encountered in 10 children, (10 months to 12 years) all with urinary tract infection, appears to result from inflammatory changes and to correspond to a sonographic sign of pyelitis and ureteritis. These alterations of the walls are similar to striations and folds described in this pathology on intravenous pyelograms. The thickening was the only sign of abnormality of the urinary tract in two cases; it was observed without reflux in four cases. The demonstration of this pattern should lead to further uroradiological investigations and to appropriate treatment. (orig.)

Early release of neonatal ureteral obstruction preserves renal function

DEFF Research Database (Denmark)

Shi, Yimin; Pedersen, Michael; Li, Chunling

2004-01-01

was left in place or released after 1 or 4 wk. Renal blood flow (RBF) and kidney size were measured sequentially over 24 wk using MRI. In rats in which the obstruction was left in place, RBF of the obstructed kidney was progressively reduced to 0.92 ± 0.17 vs. 1.79 ± 0.12 ml·min−1·100 g body wt−1 (P ...The incidence of congenital hydronephrosis is ∼1% and is often associated with renal insufficiency. It is unknown whether early release is essential to prevent deterioration of renal function. Rats were subjected to partial unilateral ureteral obstruction (PUUO) on postnatal day 2. The obstruction...... downregulation of Na-K-ATPase to 62 ± 7%, aquaporin-1 to 53 ± 3%, and aquaporin-3 to 53 ± 7% of sham levels. Release after 1 wk completely prevented development of hydronephrosis, reduction in RBF and glomerular filtration rate, and downregulation of renal transport proteins, whereas release after 4 wk had...

Extragenitourinary retroperitoneal primary hydatid cyst: a rare cause of bilateral lower ureteric obstruction and unilateral limb edema

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Amit Goel

2013-01-01

Full Text Available Hydatid cyst is an endemic disease in our country. Most commonly, it occurs in the liver and lungs. Bilateral hydroureteronephrosis is one of the rare presentations of hydatid disease. Herein, we are reporting an unusual case of hydatid disease where the primary mode of presentation was external iliac vein compression with chronic renal failure because of bilateral ureteric involvement. The patient was treated with bilateral double-J stenting to improve the renal function and operated later for removal of hydatid cyst under albendazole drug treatment.

INSITU extracorporeal shock- wave lithotripsy as a primary treatment for ureteral stones

International Nuclear Information System (INIS)

Maghraby, Hisham

2003-01-01

The aim of the sudy was to evaluate the results ofextracorporeal shock-wave lithotripsy (ESWL) as a primary treatment for ureteral calculi at different levels. We treated 166 consecutive patients with solitary ureteral stones (73 at the upper, 4 at the middle and 89 at the lower ureter) by primary in situ ESWL on an outpatient basis. A maximum of three treatments were given individually before adopting ureteroscopy as an alternative treatment. The success rate was calculated on the basis of complete stone clearance and resolution of any associated obstruction. Re-treatment rates ,complications and time to complete stone clearence were recorded. Complete stone clearance was received in 152 patients (91.6%) after an average of 10.2 days ( range1-28). The average treatment rate was 1.3 sessions per patient. As whole groups, lower ureteral stones required more treatment sessions than those in the upper ureter , and the difference was statistically significant.However, differences in the final success rate and time to stone clearence were statistically nonsignificant. When stratified according to size, the success rate was lowest for lower ureteral stones >1 cm in diameter. We believe ESWL is a safe and simple non-invasive option of choice for most ureteral calculi at different levels. Ureteroscopy represents an alternative choice in case of ESWL failure, or in cases of larger stones in the lower ureter when it might be the first option. (author)

50% dextrose versus normal saline as distension media during cystoscopy for assessment of ureteric patency.

Science.gov (United States)

Narasimhulu, Deepa Maheswari; Prabakar, Cheruba; Tang, Nancy; Bral, Pedram

2016-04-01

To compare the visualization of ureteric jets when using 50% dextrose (D50) as opposed to normal saline (NS) as distension media during cystoscopy. Cross sectional study. Two patients each had two cystoscopy videos recorded at the time of a ureteric jet; one using NS and the other using D50 resulting in two sets of paired videos (four videos). A fifth cystoscopy video was recorded, as a control, at a time when there was no ureteric-jet. Fifty participants including attending physicians, residents and medical students were recruited at an academic-affiliated community hospital. Participants were blinded to the medium used and viewed each of the five videos. Participants assessed each video for presence of a ureteric-jet, ease of interpretation, and compared the paired D50 and NS videos for clarity of ureteric-jets. Participant's assessment of clarity of the ureteric jets when D50 was used as compared to when NS was used in the paired videos. All 100 observations of the two D50 videos with jets identified the presence of a jet; for the NS videos, 96/100 observations identified a jet, 2/100 did not identify a jet and 2/100 were unsure. 48/50 observations of the video with no jet were correct, while 2/50 were unsure. Participants rated the ureteric-jets to be clearer in videos with D50 (86% vs 14%, Pdextrose was used as the distension medium during cystoscopy as compared to normal saline. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Laparoscopic transperitoneal ureterolithotomy for large ureteric stones

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Ahmed Al-Sayyad

2012-01-01

Conclusion: Laparoscopic transperitoneal ureterolithotomy is a safe and effective approach for selected patients with large proximal ureteric stones with reduced postoperative pain and short hospital stay, and should be considered as a treatment option for such stones.

Extracorporeal shock wave lithotripsy in the treatment of ureteric stones: Experience from Twam Hospital, United Arab Emirates

International Nuclear Information System (INIS)

Ghafoor, M.; Halim, A.

2002-01-01

The optimal treatment of ureteric stones, especially the lower ureteric stone, remains controversial. The purpose of this study was to evaluate the role of extracorporeal shock wave lithotripsy (ESWL) in the management of ureteric stones. A total of 99 patients with ureteric stones at different levels were treated with ESWL from 1994 through 1998 at our hospital. All patients were treated using Siemen Lithostar-II Plus Lithotripter. Of 99 patients, 22 were excluded from the study because they had no follow-up records of their stone-free status. The clearance rates for ureteric stones of the other 79 patients treated were stratified according to the site, size and the number of treatment sessions required per stone. The stone size was determined by the widest diameters. Based on stone size, the patients were divided into two groups: A ( 1 0 mm) and B (11-20 mm). The overall all clearance rate for ureteric stones treated with ESWL, irrespective of its site and size, was 78.5%. The overall clearance rate for size A (<-10 mm) stone was 82% and size B (11-20 mm) was 58% regardless of the site of the stone in the ureter. A total of 17 upper ureteric stones were treated with ESWL. The overall clearance rate for upper ureteric stones was 94%. Thirteen patients with mid-ureteric stones were treated with ESWL. The overall clearance rate for the lower ureteric stones was 69.3%. ESWL is safe, effective, noninvasive and a convenient way of treatment for all ureteric stones. The clearance rate for stones in the upper and mid-ureter is above 90%. ESWL being an outpatient procedure without ant need for anesthesia or any pretreatment intervention. It should be considered as the first line of treatment for all stones in the upper and mid-ureter. The clearance for small stones (<1 mm) in the lower third of ureter was 73.8% in our study and for these, ESWL may be considered as a primary therapy. For stones larger than 10 mm in the distal third of ureter, the clearance rate was low

Retrograde or antegrade double-pigtail stent placement for malignant ureteric obstruction?

International Nuclear Information System (INIS)

Uthappa, M.C.; Cowan, N.C.

2005-01-01

AIM: To determine the optimum approach for double-pigtail stent placement in malignant ureteric obstruction. PATIENTS AND METHODS: Retrograde stent placement was attempted in a consecutive series of patients presenting with malignant ureteric obstruction. If retrograde stent placement was unsuccessful, percutaneous nephrostomy was performed immediately followed by elective antegrade stent placement. Identical digital C-arm fluoroscopy for image-guidance and conditions for anaesthesia and analgesia were employed for both retrograde and antegrade procedures. Identical 8 Fr (20-26 cm) double-pigtail hydrophilic coated stents were used for each approach. RESULTS: Retrograde placement was attempted in 50 ureters in 30 patients {19 male, 11 female, average age 61.4 yr (range 29-90 yr)} over a 24-month period. The success rate for retrograde ureteric stent placement was 50% (n=25/50). Technical failures were due to failure to identify the ureteric orifice (n=22), failure to cross the stricture (n=1), failure to pass the stent (n=1) and failure to pass a 4 Fr catheter (n=1). Antegrade placement was attempted in 25 ureters with a success rate of 96% (n=24/25). Failure in the one case was due to inability to cross an upper third stricture secondary to pyeloureteritis cystica. CONCLUSION: It is suggested that retrograde route should be the initial approach if imaging shows no involvement of ureteric orifice (UO), when nephrostomy is technically very difficult or in cases of solitary kidney. The antegrade route is preferred if imaging shows tumour occlusion of the UO or if there is a tight stricture very close to the uretero-vesical junction (UVJ) making purchase within the ureter difficult for crossing the stricture

The treatment of ureteric calculi before and after the introduction of extracorporeal shockwave lithotripsy

DEFF Research Database (Denmark)

Gade, J; Holtveg, H; Nielsen, O S

1995-01-01

Indications and treatment results of ureteric calculi one year before and one year after the introduction of ESWL were analysed in 169 consecutive patients. Sex, age, former stone operation, stone localisation and stone size were not significantly different in the two groups. Before ESW1 47...... with ESWL, but not significantly. Judged from the length of the hospital stay there was no major economic benefit from ESWL. In conclusion, ESWL with a second generation lithotriptor is suitable for in situ treatment of ureteric calculi. It should be first choice for ureteric calculi....

Comparison of Two Types of Double-J Ureteral Stents that Differ in Diameter and the Existence of Multiple Side Holes along the Straight Portion in Malignant Ureteral Strictures

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Song, Myung Gyu, E-mail: acube808@naver.com; Seo, Tae-Seok, E-mail: g1q1papa@korea.ac.kr; Lee, Chang Hee, E-mail: chlee86@korea.ac.kr; Kim, Kyeong Ah, E-mail: kahkim@korea.ac.kr [Korea University College of Medicine, Department of Radiology, Korea University Guro Hospital (Korea, Republic of); Kim, Jun Suk, E-mail: kjs6651@kumc.or.kr; Oh, Sang Cheul, E-mail: sachoh@korea.ac.kr [Korea University College of Medicine, Department of Oncology, Korea University Guro Hospital (Korea, Republic of); Lee, Jae-Kwan, E-mail: jklee38@korea.ac.kr [Korea University College of Medicine, Department of Gynecology, Korea University Guro Hospital (Korea, Republic of)

2015-06-15

PurposeThis study was decided to evaluate the impact of diameter and the existences of multiple side holes along the straight portion of double-J ureteral stents (DJUS) on early dysfunction of stents placed for malignant ureteral strictures.MethodsBetween April 2007 and December 2011, 141 DJUSs were placed via a percutaneous nephrostomy (PCN) tract in 110 consecutive patients with malignant ureteral strictures. 7F DJUSs with multiple side holes in the straight portion were placed in 58 ureters of 43 patients (Group 1). 8F DJUSs with three side holes in the proximal 2-cm of the straight portion were placed in 83 ureters of 67 patients (Group 2). The incidence of early DJUS dysfunction was compared between the two groups, and nephrostographic findings were evaluated in the cases of early dysfunction.ResultsEarly dysfunction of the DJUS was noted in 14 of 58 patients (24.1 %) in Group 1, which was significantly higher (p = 0.001) than in Group 2 in which only 1 of 83 patients (1.2 %) had early dysfunction of the DJUS. Nephrostographic findings of early dysfunction included dilatation of the pelvicalyceal system, filling defects in the ureteral stent, and no passage of contrast media into the urinary bladder.ConclusionsIn malignant ureteral strictures, multiple side holes in the straight portion of the 7-F DJUS seem to cause early dysfunction. The 8F DJUSs with three side holes in the proximal 2-cm of the straight portion may be superior at preventing early dysfunction.

Tamsulosin hydrochloride vs placebo for management of distal ureteral stones: a multicentric, randomized, double-blind trial.

Science.gov (United States)

Vincendeau, Sébastien; Bellissant, Eric; Houlgatte, Alain; Doré, Bertrand; Bruyère, Franck; Renault, Alain; Mouchel, Catherine; Bensalah, Karim; Guillé, François

2010-12-13

α-Blockers induce selective relaxation of ureteral smooth muscle with subsequent inhibition of ureteral spasms and dilatation of the ureteral lumen. The aim of the study was to evaluate the efficacy and safety of the α-blocker tamsulosin hydrochloride in patients with ureteral colic owing to a distal ureteral stone. This was a multicenter, placebo-controlled, randomized, double-blind study. Patients with emergency admission for ureteral colic with a 2- to 7-mm-diameter radio-opaque distal ureteral stone were included in the study. They received tamsulosin (0.4 mg/d) or matching placebo until stone expulsion or day 42, whichever came first. The main end point was time to stone expulsion between inclusion and day 42. Sequential statistical analysis was performed using the triangular test. A total of 129 patients with acute renal colic were recruited from emergency wards between February 1, 2002, and December 8, 2006, in 6 French hospitals. Of these 129 randomized patients (placebo, 63; tamsulosin, 66), 7 were excluded from analyses: 5 for major deviations from inclusion criteria, 1 for stone expulsion before the first treatment administration, and 1 for consent withdrawal. At inclusion, mean (SD) stone diameters were 3.2 (1.2) and 2.9 (1.0) mm in the placebo and tamsulosin groups, respectively (P = .23). Expulsion delay distributions during 42 days did not show any difference (P = .30). The numbers of patients who spontaneously expelled their stone within 42 days were 43 of 61 (70.5%) and 47 of 61 (77.0%) in the placebo and tamsulosin groups, respectively (P = .41). Corresponding delays were 10.1 (10.0) and 9.6 (9.8) days (P = .82). Other secondary end points and tolerance were not different between groups. Although well tolerated, a daily administration of 0.4 mg of tamsulosin did not accelerate the expulsion of distal ureteral stones in patients with ureteral colic. clinicaltrials.gov Identifier: NCT00151567.

Radionuclide determination of individual kidney function in the treatment of chronic renal obstruction

International Nuclear Information System (INIS)

Belis, J.A.; Belis, T.E.; Lai, J.C.; Goodwin, C.A.; Gabriele, O.F.

1982-01-01

Differential radionuclide renal scans can be useful in the management of patients with chronic partial obstruction of 1 kidney. The /sup 99m/Tc diethylenetriaminepentaacetic acid perfusion scan can be used to assess glomerular blood flow. The 131 I orthoiodohippurate renal scan provides qualitative functional information from scintigrams and quantitative evaluation of effective renal plasma flow to each kidney, as well as a total excretory index. Sequential /sup 99m/Tc diethylenetriaminepentaacetic acid and 131 I orthoiodohippurate renal scans were used to assess individual renal function before and after surgical correction of unilateral chronic renal obstruction in 31 patients. The preservation of cortical perfusion on /supb 99m/Tc diethylenetriaminepentaacetic acid scans indicated that potential existed for partial recovery of renal function. Effective renal plasma flow and excretory index determined in conjunction with the 131 I orthoiodohippurate scans provided a quantitative assessment of preoperative renal function, an evaluation of the effect of surgery and a sensitive method for long-term evaluation of differential renal function. Correction of ureteropelvic junction obstruction usually resulted in improvement in unilateral renal function. Neither nephrolithotomy nor extended pyelolithotomy diminished renal function in the kidney subjected to an operation and often improved it. Patients with long-standing distal ureteral obstruction had the least improvement in renal function postoperatively

Simultaneous Bilateral Ureteral Calculi: A New Paradigm for Management.

Science.gov (United States)

Scotland, Kymora B; Hubosky, Scott G; Tanimoto, Ryuta; Cooper, Robert; Healy, Kelly A; Bagley, Demetrius H

2018-05-21

To define the need for emergent intervention between patients with simultaneous bilateral ureteral calculi (SBUC) compared to unilateral ureteral calculi (UUC). Patients with SBUC represent a potential urological emergency due to possible anuria or electrolyte imbalance. While conventional practice mandates immediate intervention in these patients, little data exist to define the rate of these events. Records of all patients with ureteral stones treated ureteroscopically over an 11-year period were reviewed to identify those with SBUC. Patient presenting characteristics, time from diagnosis to intervention, and postoperative outcomes were noted. To determine the need for emergent intervention, we compared metabolic and infectious parameters between SBUC patients and age- and sex-matched patients with UUC. A total of 3800 patients presented with ureteral calculi including 42 (1.1%) with SBUC. Two-thirds of patients with SBUC had an established diagnosis of nephrolithiasis. Among the 42 patients with SBUC, 11 (26.2%) were considered emergent due to metabolic (5 of 11, 45.5%), infectious (1 of 11, 9.1%), or both metabolic and infectious indications (5 of 11, 45.5%). No patients required acute dialysis before surgical intervention. Compared to patients with UUC, those with SBUC were significantly more likely to require emergent management (P = .03, odds ratio 2.3). Univariate and multivariate analyses showed this to be due to anuria (P = .001) and acidosis (P = .003). SBUC is an uncommon condition and, in this series, only the minority of patients presented emergently. Therefore, patients with SBUC can often be managed electively if counseled on clinical signs warranting emergent medical attention. Appropriately selected patients have excellent outcomes following single stage bilateral ureteroscopy. Copyright © 2018. Published by Elsevier Inc.

Fluids and diuretics for acute ureteric colic.

Science.gov (United States)

Worster, Andrew S; Bhanich Supapol, Wendy

2012-02-15

Acute ureteric colic is commonly associated with severe and debilitating pain. Theoretically, increasing fluid flow through the affected kidney might expedite stone passage, thereby improving symptoms more quickly. The efficacy and safety of interventions such as high volume intravenous (IV) or oral fluids and diuretics aimed at expediting ureteric stone passage is, however, uncertain. To look at the benefits and harms of diuretics and high volume (above maintenance) IV or oral fluid therapy for treating adult patients presenting with uncomplicated acute ureteric colic. We searched the Cochrane Renal Group's specialised register (3 January 2012). Previously we searched the Cochrane Central Register of Controlled Trials (CENTRAL The Cochrane Library), MEDLINE (from 1966), EMBASE (from 1980) and handsearched reference lists of nephrology and urology textbooks, review articles, relevant studies, and abstracts from nephrology scientific meetings. All randomised controlled trials (RCTs) and quasi-RCTs (including the first period of randomised cross-over studies) looking at diuretics or high volume IV or oral fluids for treating uncomplicated acute ureteric colic in adult patients presenting to the emergency department for the first time during that episode were included. Two authors independently assessed study quality and extracted data. Statistical analyses were performed using the random-effects model for multiple studies of the same outcomes, otherwise the fixed-effect model was used. Results were expressed as risk ratios (RR) for dichotomous outcomes or as mean differences (MD) for continuous data with 95% confidence intervals (CI). Two studies (enrolling 118 participants) examined the association between intense hydration and ureteric colic outcomes. There was no significant difference in pain at six hours (1 study, 60 participants: RR 1.06, 95% CI 0.71 to 1.57), surgical stone removal (1 study, 60 participants: RR 1.20, 95% CI 0.41 to 3.51) or manipulation by

[Questions of terminology, systematization and grading of complications of contact ureteral lithotripsy].

Science.gov (United States)

Dutov, V V; Bazaev, V V; Mamedov, E A; Urenkov, S B; Podoinitsyn, A A

2017-07-01

To investigate the advantages and disadvantages of the current variants of systematization and grading of complications of contact ureteral lithotripsy (CULT) and develop a working classification of CULT complications. The study analyzed results of 545 fluoroscopy-guided endoscopic procedures performed at the MRRCI Clinic of Urology from 2008 to 2015 in 506 patients with ureterolithiasis. The proposed and implemented classification and terminology of CULT complications unifies the diagnostic and management algorithm. This tool is more systematic and structured than the classical classification and universal methods of systematization and grading of CULT complications (classifying CULT complications in "major" and "minor", PULS scale, Satava and Clavien-Dindo grading systems). Given the lack of clear grading of ureteral rupture, it was divided into amputation (two-level rupture) and avulsion (one-level rupture). Using such term as extravasation of the contrast media and/or migration of the stone outside of the ureter is groundless because these complications occur only after the perforation of the ureteral wall. Therefore, these conditions are complications not of CULT, but of the ureteral wall perforation. The ureteral perforation was classified into macro- and micro-perforation. The existing terminology, classification and grading of the CULT complications should undergo a more detailed analysis. None of the existing classifications of CULT complications afford them to be fully staged and systematized. The working classification of complications of CULT developed at the M.F. Vladimirsky MRRCI Clinic of Urology warrants a multi-center prospective study to validate it and investigate its effectiveness.

Extraction Strings for Ureteric Stents: Is There an Increased Risk for Urinary Tract Infections?

Science.gov (United States)

Fröhlich, Maryna; Fehr, Jan; Sulser, Tullio; Eberli, Daniel; Mortezavi, Ashkan

To evaluate urinary tract infections associated with placement of ureteric stents, we performed a retrospective study and compared rates between patients with and patients without an extraction string attached to the ureteric stent. Indwelling ureteric stents are routinely removed by cystoscopy. If an extraction string has been connected to the stent at the time of placement, however, the removal can be performed without an invasive procedure. Concerns exist regarding the risk for an unintentional dislocation, increased stent-related discomfort, or an increase of the post-operative urinary tract infection rate. All elective transurethral ureteric stent placements performed between November 2011 and December 2012 in our department were included for this investigation. Urinary tract infection was defined according to the Centers for Disease Control and Prevention (CDC)/National Healthcare Safety Network (NHSN) surveillance definition of health-care-associated infections. Patients with an existing urinary tract infection at the time of admission were excluded from the analysis. A total of 342 patients receiving ureteric stents were evaluated regarding post-operative urinary tract infections. Of these patients, 127 (37.1%) had an extraction string and 215 (62.9%) a stent without a string. The total urinary tract infection rate was 6.4% with no significant difference between the two groups (7.9% vs. 5.6%, p = 0.49). In the present study, we did not observe an increased rate of post-operative urinary tract infections in patients with an extraction string attached to the ureteral stent. Extraction string is a good option for patients to avoid cystoscopic stent removal.

Can tamsulosin facilitate expulsion of ureteral stones? A meta-analysis of randomized controlled trials.

Science.gov (United States)

Fan, Bo; Yang, Deyong; Wang, Jianbo; Che, Xiangyu; Li, Xiancheng; Wang, Lina; Chen, Feng; Wang, Tiezheng; Song, Xishuang

2013-08-01

To determine the efficacy and safety of the adrenergic alpha-antagonist tamsulosin in facilitating ureteral stones expulsion. A literature search was carried out using the PubMed database, Medline via Ovid, Embase and the Cochrane Library database to identify randomized controlled trials evaluating the efficiency of tamsulosin in the treatment of ureteral stones. Meta-analysis and forest plots were carried out by use of Review Manager version 5.1 software (Cochrane Collaboration). Compared with the control group, the tamsulosin group had an increase in expulsion rate of 51% and a decrease in expulsion time of 2.63 days. Furthermore, tamsulosin was found to reduce the risk of ureteral colic during treatment by 40% and also the risk of requirement of auxiliary procedures during follow up by 60%. In terms of safety, the tamsulosin group had a 117% increase in the incidence of side-effects compared with the control group, especially for incidence of dizziness. Tamsulosin facilitates the expulsion of ureteral calculi by providing a higher expulsion rate, a shorter expulsion time, a lower incidence of ureteral colic during treatment and a lower requirement of auxiliary procedures. However, the incidence of dizziness occurring during tamsulosin treatment is significantly higher in this setting. © 2012 The Japanese Urological Association.

Laparoscopic partial cystectomy for urachal and bladder cancer

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Jose R. Colombo Jr.

2008-01-01

Full Text Available PURPOSE: To report our initial experiences with laparoscopic partial cystectomy for urachal and bladder malignancy. MATERIALS AND METHODS: Between March 2002 and October 2004, laparoscopic partial cystectomy was performed in 6 cases at 3 institutions; 3 cases were urachal adenocarcinomas and the remaining 3 cases were bladder transitional cell carcinomas. All patients were male, with a median age of 55 years (45-72 years. Gross hematuria was the presenting symptom in all patients, and diagnosis was established with trans-urethral resection bladder tumor in 2 patients and by means of cystoscopic biopsy in the remaining 4 patients. Laparoscopic partial cystectomy was performed using the transperitoneal approach under cystoscopic guidance. In each case, the surgical specimen was removed intact entrapped in an impermeable bag. One patient with para-ureteral diverticulum transitional cell carcinoma required concomitant ureteral reimplantation. RESULTS: All six procedures were completed laparoscopically without open conversion. The median operating time was 110 minutes (90-220 with a median estimated blood loss of 70 mL (50-100. Frozen section evaluations of bladder margins were routinely obtained and were negative for cancer in all cases. The median hospital stay was 2.5 days (2-4 and the duration of catheterization was 7 days. There were no intraoperative or postoperative complications. Final histopathology confirmed urachal adenocarcinoma in 3 cases and bladder transitional cell carcinoma in 3 cases. At a median follow-up of 28.5 months (range: 26 to 44 months, there was no evidence of recurrent disease as evidenced by radiologic or cystoscopic evaluation. CONCLUSIONS: Laparoscopic partial cystectomy in carefully selected patients with urachal and bladder cancer is feasible and safe, offering a promising and minimally invasive alternative for these patients.

Ureteric transection secondary to penetrating handlebar injury

Directory of Open Access Journals (Sweden)

K.P. Debbink

2017-08-01

Full Text Available Ureteric trauma is rare, occurring in <1% of all traumas. We present a unique case of a 13 year old female who sustained a penetrating abdominal injury from a bicycle handlebar. Upon initial examination there was herniation of bowel through the abdominal wound, so exploratory laparotomy was performed. A serosal injury of the colon and bleeding mesenteric veins were encountered; the retroperitoneum was not explored at that time. Postoperative course was remarkable for a doubling of the serum creatinine, increasing abdominal distention and pain. Computed tomography on postoperative day five demonstrated a large amount of intra-abdominal fluid. The patient was taken for re-exploration. The left ureter was found to be completely transected. It was repaired over a double-J stent. This case demonstrates the need for a high index of suspicion in the diagnosis of ureteric injury. Keywords: Ureter, Bicycle, Handlebar, Penetrating

ureteric perforation following laparoscopic assisted vaginal

African Journals Online (AJOL)

2011-03-03

Mar 3, 2011 ... Ureteric injury is one of the most common complications of hysterectomy, both in open and laparoscopic and is a source of serious morbidity. Laparoscopy carries a higher risk because of increased use of electro-surgery close to the ureter when securing the uterine artery and it is more likely to be ...

Severity of hydronephrosis correlates with tumour invasiveness and urinary bladder recurrence of ureteric cancer.

Science.gov (United States)

Luo, Hao Lun; Kang, Chih Hsiung; Chen, Yen Ta; Chuang, Yao Chi; Lee, Wei Ching; Cheng, Yuan Tso; Chiang, Po Hui

2013-08-01

To explore the prognostic role of hydronephrosis grade in patients with pure ureteric cancer. The study included 162 patients with pure ureteric cancer who were treated between January 2005 and December 2010 at a single tertiary referral centre. The association between hydronephrosis grade with pathological findings and oncological outcomes was assessed using multivariate Cox regression analysis. Hydronephrosis grade >2 was independently associated with non-organ-confined ureteric cancer (P = 0.003). Hydronephrosis grade Hydronephrosis grade >2 and bladder cancer history independently predict bladder cancer recurrence (P = 0.021 and P = 0.002, respectively) Hydronephrosis of grade >2 was found to be associated with local and distant recurrence only in univariate analysis; non-organ-confined pathology independently predicted local and distant oncological failure (P ≤ 0.001 and P = 0.002, respectively). Hydronephrosis grade >2 is associated with non-organ-confined ureteric cancer and with bladder cancer recurrence. Non-organ-confined pathology is still the most important predictor for local and distant oncological failure. © 2013 BJU International.

Numerical analysis of urine flow through the side holes of a double J stent in a ureteral stenosis.

Science.gov (United States)

Kim, Hyoung-Ho; Choi, Young Ho; Lee, Seung Bae; Baba, Yasutaka; Kim, Kyung-Wuk; Suh, Sang-Ho

2017-07-20

Ureteral stenosis presents with a narrowing in the ureter, due to an intrinsic or extrinsic ureteral disease, such as ureter cancer or retroperitoneal fibrosis. The placement of a double J stent in the upper urinary system is one of the most common treatments of ureteral stenosis, along with the insertion of a percutaneous nephrostomy tube into the renal pelvis. The effect that the side holes in a double J stent have on urine flow has been evaluated in a few studies using straight ureter models. In this study, urine flow through a double J stent's side holes was analyzed in curved ureter models, which were based on human anatomy. In ureteral stenosis, especially in severe ureteral stenosis, a stent with side holes had a positive effect on the luminal and total flow rates, compared with the rates for a stent without side holes. The more side holes a stent has, the greater the luminal and total flow rates. However, the angular positions of the side holes did not affect flow rate. In conclusion, the side holes in a double J stent had a positive effect on ureteral stenosis, and the effect became greater as the ureteral stenosis became more severe.

Outcomes of Percutaneous Management of Anastomotic Ureteral Strictures in Renal Transplantation: Chronic Nephroureteral Stent Placement with and without Balloon Dilatation

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Uflacker, A., E-mail: andreuflacker@gmail.com; Sheeran, D., E-mail: dsheeran9@gmail.com; Khaja, M., E-mail: mkhaja@mac.com [University of Virginia/Interventional Radiology (United States); Patrie, J., E-mail: jp4h@virginia.edu [UVA Health System/Radiology (United States); Elias, G., E-mail: gae2y@virginia.edu [VCU Medical Center/Radiology (United States); Saad, W., E-mail: wspikes@yahoo.com [University of Michigan Health System (United States)

2015-06-15

PurposeThis study was designed o evaluate outcomes of percutaneous management of anastomotic ureteral strictures in renal transplants using nephroureteral stents with or without balloon dilatation.MethodsA retrospective audit of 1,029 consecutive renal transplants was performed. Anastomotic ureteral strictures were divided into two groups: nephroureteral stent only (NUS) and NUS+PTA (nephroureteral stent plus percutaneous transluminal angioplasty), with each cohort subdivided into early versus late presentation (obstructive uropathy occurring <90 day or >90 days from transplant, respectively). Overall and 6-month technical success were defined as removal of NUS any time with <30 % residual stenosis (any time lapse less or more than 6 months) and at >6 months, respectively. Patency was evaluated from NUS removal to last follow-up for both groups and compared.ResultsSixty-seven transplant patients with 70 ureteric anastomotic strictures (6.8 %, n = 70/1,029) underwent 72 percutaneous treatments. 34 % were late (>90 days, n = 24/70), and 66 % were early (<90 days, n = 46/70). Overall technical success was 82 % (n = 59/72) and 6-month success was 58 % (n = 42/72). Major and minor complications were 2.8 % (n = 2/72), and 12.5 % (n = 9/72). NUS+PTA did not improve graft survival (p = 0.354) or patency (p = 0.9) compared with NUS alone. There was no difference in graft survival between treated and nontreated groups (p = 0.74).ConclusionsThere is no advantage to PTA in addition to placement of NUS, although PTA did not negatively impact graft survival or long-term patency and both interventions were safe and effective. Neither the late or early groups benefited from PTA in addition to NUS. Earlier obstructions showed greater improvement in serum creatinine than later obstructions.

Treatment of pyonephrosis with a subcutaneous ureteral bypass device in four cats.

Science.gov (United States)

Cray, Megan; Berent, Allyson C; Weisse, Chick W; Bagley, Demetrius

2018-03-15

CASE DESCRIPTION 4 cats were examined because of ureteral obstruction. CLINICAL FINDINGS Clinical and clinicopathologic abnormalities were nonspecific and included anorexia, lethargy, weight loss, anemia, leukocytosis, neutrophilia, lymphopenia, and azotemia. A diagnosis of pyonephrosis was made in all cats. The presence of bacteriuria was confirmed by means of urinalysis in 2 cats, bacterial culture of a urine sample obtained by means of preoperative cystocentesis in 2 cats, and bacterial culture of samples obtained from the renal pelvis intraoperatively in 3 cats. Ureteral obstruction was caused by a urolith in 3 cats; ureteral stricture associated with a circumcaval ureter was identified in 1 cat. TREATMENT AND OUTCOME All 4 cats underwent renal pelvis lavage and placement of a subcutaneous ureteral bypass (SUB) device for treatment of obstructive pyonephrosis. Postoperatively, the cystostomy tube became occluded with purulent material in 1 cat, requiring exchange. The procedure was successful in relieving the obstruction and pyonephrosis in all cats. Three of 4 cats had documented resolution of urinary tract infection. One cat had persistent bacteriuria without clinical signs 1 month after SUB device placement. CLINICAL RELEVANCE Results of this small series suggested that renal pelvis lavage with placement of an SUB device may be a treatment option for cats with obstructive pyonephrosis.

Ureteral obstructions treatment with percutaneous translumbar insertion of double J endoprostheses. First remote results

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Gandini, G; Asnaghi, R; Righi, D and others

1987-01-01

Percutaneous insertion of ureteral stents is a widely accepted method for ureteral obstructions treatment. from 1981 to February 1986, we introduced 78 endoprostheses in 60 patients. Fifty-six with malignant tumours and 4 with benign stenoses. In 48 of those 60 patients follow-up is complete. In the patients with malignant obstructions the mean time of survival was 198 days. Twelve patients were still alive in February 1986, with a mean time of survival over 300 days. In 12 patients (25%) the stent became obstructed in a mean time of 96.8 days. The placement of ureteral stents offers an alternative treatment to the palliative urologic surgery. 27 refs.

Forgotten ureteral stents: Risk factors, complications and management

African Journals Online (AJOL)

A.Y. Abdelaziz

2018-02-07

Feb 7, 2018 ... Preoperative non-contrast spiral CT abdomen and pelvis showed encrustations on the stent in 23.5% of patients ... Despite their advantages, ureteral stents are not without possible morbidity. ..... A model to quantify encrusta-.

Pelvi-ureteric junction obstruction related to crossing vessels: vascular anatomic variations and implication for surgical approaches.

Science.gov (United States)

Panthier, Frédéric; Lareyre, Fabien; Audouin, Marie; Raffort, Juliette

2018-03-01

Pelvi-ureteric junction obstruction corresponds to an impairment of urinary transport that can lead to renal dysfunction if not treated. Several mechanisms can cause the obstruction of the ureter including intrinsic factors or extrinsic factors such as the presence of crossing vessels. The treatment of the disease relies on surgical approaches, pyeloplasty being the standard reference. The technique consists in removing the pathologic ureteric segment and renal pelvis and transposing associated crossing vessels if present. The vascular anatomy of the pelvi-ureteric junction is complex and varies among individuals, and this can impact on the disease development and its surgical treatment. In this review, we summarize current knowledge on vascular anatomic variations in the pelvi-ureteric junction. Based on anatomic characteristics, we discuss implications for surgical approaches during pyeloplasty and vessel transposition.

Acute kidney injury secondary to iatrogenic bilateral ureteric ligation ...

African Journals Online (AJOL)

Acute kidney injury secondary to iatrogenic bilateral ureteric ligation following emergency abdominal hysterectomy. Oluseyi A. Adejumo, Olurotimi S. Ogundiniyi, Ayodeji A. Akinbodewa, Lawrence A. Adesunloro, Oladimeji J. Olafisoye ...

Bilateral complete ureteral duplication with calculi obstructing both limbs of left double ureter.

Science.gov (United States)

Aiken, William D; Johnson, Peter B; Mayhew, Richard G

2015-01-01

A woman with bilateral complete ureteral duplication with stones simultaneously obstructing both limbs of the left double ureter is presented. A search of the English medical literature suggests that this is the first reported case. Based on the initial difficulty accessing the stones via ureteroscopy we make recommendations regarding how this rare problem should be approached if encountered. A 37-year old woman with left-sided flank pain was discovered on CT scan to have bilateral complete ureteral duplication and three stones obstructing both limbs of the left double ureter. Ureteroscopy was initially unsuccessful due to the very small calibre and unyielding nature of the ureters and both ureteral limbs were stented. Repeat ureteroscopy was easily achieved after pre-stenting and the impacted stones were completely cleared with intracorporeal laser lithotripsy. The smaller calibre of both double ureters and their presence in a common adventitial sheath distally, made initial attempts at ureteroscopy difficult. Stenting both limbs increased ureteral compliance, passively dilated both ureters and allowed for improved manoeuvrability and retrograde passage of the ureteroscope. Based on the experience with this first reported case it is recommended that pre-stenting should be routinely performed prior to any attempt at ureteroscopy in cases of stones complicating completely duplicated ureters. We report the first recorded case of bilateral complete ureteral duplication with stones simultaneously obstructing both limbs of the double ureter and recommend that routine pre-stenting be done prior to ureteroscopy to allow easy uncomplicated retrograde passage of the ureteroscope. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Intra-urinoma Rendezvous Using a Transconduit Approach to Re-establish Ureteric Integrity

International Nuclear Information System (INIS)

Anderson, Hugh; Alyas, Faisal; Edwin, Patrick Joseph

2005-01-01

Ureteric discontinuity following injury has been traditionally treated surgically. With the advent of improved interventional instrumentation it is possible to stent these lesions percutaneously, retrogradely or failing that using a combined (rendezvous) technique. We describe an intra-urinoma rendezvous procedure combining a percutaneous antegrade-transconduit retrograde technique of stent insertion to successfully re-establish ureteric integrity that was used following the failure of a percutaneous retrograde approach. We illustrate its usefulness as an alternative to surgery

Assessment of readability, quality and popularity of online information on ureteral stents.

Science.gov (United States)

Mozafarpour, Sarah; Norris, Briony; Borin, James; Eisner, Brian H

2018-02-12

To evaluate the quality and readability of online information on ureteral stents. Google.com was queried using the search terms "ureteric stent", "ureteral stent", "double J stent" and, "Kidney stent" derived from Google AdWords. Website popularity was determined using Google Rank and the Alexa tool. Website quality assessment was performed using the following criteria: Journal of the American Medical Association (JAMA) benchmarks, Health on the Net (HON) criteria, and a customized DISCERN questionnaire. The customized DISCERN questionnaire was developed by combining the short validated DISCERN questionnaire with additional stent-specific items including definition, placement, complications, limitations, removal and "when to seek help". Scores related to stent items were considered as the "stent score" (SS). Readability was evaluated using five readability tests. Thirty-two websites were included. The mean customized DISCERN score and "stent score" were 27.1 ± 7.1 (maximum possible score = 59) and 14.6 ± 3.8 (maximum possible score = 24), respectively. A minority of websites adequately addressed "stent removal" and "when to seek medical attention". Only two websites (6.3%) had HON certification (drugs.com, radiologyinfo.org) and only one website (3.3%) met all JAMA criteria (bradyurology.blogspot.com). Readability level was higher than the American Medical Association recommendation of sixth-grade level for more than 75% of the websites. There was no correlation between Google rank, Alexa rank, and the quality scores (P > 0.05). Among the 32 most popular websites on the topic of ureteral stents, online information was highly variable. The readability of many of the websites was far higher than standard recommendations and the online information was questionable in many cases. These findings suggest a need for improved online resources in order to better educate patients about ureteral stents and also should inform physicians that popular websites may

The Effect of Tamsulosin in the Medical Treatment of Distal Ureteral Stones

Science.gov (United States)

Alizadeh, M.; Magsudi, M.

2014-01-01

Introduction: Renal stones are common disorders that affect approximately 5% to 10% of the population and the incidence of renal stones is rising. Treatment of ureteral stones is an important part of urologists and minimally invasive procedures such as ESWL and ureteroscopy effectiveness has been proven in various studies. However, these methods are not completely safe and are expensive and can be complicated. Purpose of this study is to evaluate the effectiveness of tamsulosin in the medical treatment of distal ureteral stones. Patients and methods: A total of 96 patients with distal ureteral stones or UVj are randomly divided into two study group (50 patients) and control group (46 patients). Patients in the control group allowed to freely consuming fluids (hydration) and indomethacin 100 mg PRN. Study group in addition to indomethacin and daily analgesic 0.4 mg tamsulosin was administered. All subjects in terms of analgesic dose, duration of expulsion and expulsion were studied. Results: Spontaneous expulsion of stone was occurred in 62.5% (30 patients out of 46) of control group patients and 82% (41 patients out of 50) that there was no significant difference (P>0.05). Average time to fix the stone in control group 4.7±8.03 days (range 2 to 28 days) and in the study group, 3.7±5.70 days (range 1 to 23 days) is significantly different (P>0.05). The average amount of analgesic consumption in the control group was 2.3±4.31and in the study group was 1.48±2.15 that showed significant differences (Ptamsulosin to conservative treatment of distal ureteral stones in the distal ureteral stone expulsion showed no significant difference between the two groups, but the reduction in the duration of expulsion, reduce pain and reduce the need for analgesic has been beneficial. PMID:25363178

Extra-corporeal shock wave lithotripsy (ESWL) versus ureteroscopic management for ureteric calculi.

Science.gov (United States)

Nabi, G; Downey, P; Keeley, F; Watson, G; McClinton, S

2007-01-24

Ureteral stones frequently cause renal colic and if left untreated can cause obstructive uropathy. Extracorporeal Shock Wave Lithotripsy (ESWL) and ureteroscopy, with or without intracorporeal lithotripsy, are the two most commonly offered interventional procedures in these patients. ESWL treatment is less invasive but has some limitations such as a high retreatment rate and lack of availability in many centres. Advances in ureteroscopy over the past decade have increased the success rate and reduced complication rates. To examine evidence from randomised controlled trials (RCTs) on the outcomes of ESWL or ureteroscopy in the treatment of ureteric calculi. We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library Issue 2, 2006), MEDLINE (1966 - March 2006), EMBASE (1980 - March 2006), reference lists of articles and abstracts from conference proceedings without language restriction. RCTs comparing ESWL with ureteroscopic retrieval of ureteric stones were included. Participants were adults with ureteric stones requiring intervention. Published and unpublished sources were considered. Two authors independently assessed trial quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) for dichotomous outcomes or weighted mean difference (MD) for continuous data with 95% confidence intervals (CI). Six RCTs (833 patients) were included. The stone-free rates were lower in the ESWL group (RR 0.84 95% CI 0.73 to 0.96). The retreatment rates were lower but not significant in the ureteroscopy group (RR 3.34 95% CI 0.82 to 13.62). The rate of complications was lower in the ESWL group (RR 0.48 95% CI 0.26 to 0.91). Length of hospital stay was less for ESWL treatment (MD -2.10 95% CI -2.55 to -1.64). Ureteroscopic removal of ureteral stones achieves a higher stone-free state but with a higher complication rate and a longer hospital stay.

Differences in Ureteroscopic Stone Treatment and Outcomes for Distal, Mid-, Proximal, or Multiple Ureteral Locations

DEFF Research Database (Denmark)

Perez Castro, Enrique; Osther, Palle J S; Jinga, Viorel

2014-01-01

Ureteroscopy has traditionally been the preferred approach for treatment of distal and midureteral stones, with shock wave lithotripsy used for proximal ureteral stones.......Ureteroscopy has traditionally been the preferred approach for treatment of distal and midureteral stones, with shock wave lithotripsy used for proximal ureteral stones....

Prediction of vesico-ureteral reflux in children from intravenous urography films

International Nuclear Information System (INIS)

Lanning, P.; Seppaenen, U.; Huttunen, N.P.; Uhari, M.

1979-01-01

Intravenous urography and voiding urethrocystography were performed on 255 children with urinary tract infection. Eighty-six (34%) of these children has some kind of abnormality of the urinary tract. Vesico-ureteral reflux was observed to 96 ureters (19%) in 69 children (27%). The prediction of vesic-ureteral reflux by two radiologists from urography films only gave 46 (48%) and 51 (53%) false negative results respectively. In cases of clinically important reflux (III to V 0 ), however, the rate of false negative prediction was 0/18 and 1/18 (6%) respectively. The rate for false positive predictions were 45/413 (11%) for both radiologist. In view of the number of pathological findings in this series i.v. urography is recommended as a routine in children undergoing urological work-up after their first urinary tract infection. As the clinically important vesico-ureteral reflux seems to be predictable from urography films alone, voiding urethrocystography seems not to be justified in children with negative i.v. urography, and can be postponed and carried out later if the urinary tract infection recurs. (author)

Outcomes of outpatient ureteral stenting without fluoroscopy at ...

African Journals Online (AJOL)

for several years, resource limitations in the form of hospital bed ... ureteric stone complicated by non-resolving pain, failure of medical ... The overall success rate for the procedures was 85.4%, independent of gender (p=0.87), age (p=0.13), ...

Medical expulsive therapy for distal ureteric stones: tamsulosin versus silodosin

Directory of Open Access Journals (Sweden)

Vittorio Imperatore

2014-06-01

Full Text Available Objectives: To compare the efficacy and safety of tamsulosin and silodosin in the context of medical expulsive therapy (MET of distal ureteric stones. Patients and methods: Observational data were collected retrospectively from patients who received silodosin (N = 50 or tamsulosin (N = 50 as MET from January 2012 to January 2013. Inclusion criteria were: patients aged ≥ 18 years with a single, unilateral, symptomatic, radiopaque ureteric stone of 10 mm or smaller in the largest dimension located between the lower border of the sacroiliac joint and the vesico-ureteric junction. Stone expulsion rate, stone expulsion time, number of pain episodes, need for analgesics use, incidence of side effects were compared. Results: Stone-expulsion rate in the silodosin and in the tamsulosin groups were 88% and 82%, respectively (p not significant. Mean expulsion times were 6.7 and 6.5 days in the silodosin and tamsulosin group, respectively (p not significant. Mean number of pain episodes were 1.6 and 1.7 in the silodosin and tamsulosin group, respectively (p not significant. The mean number of analgesic requirement was 0.84 and 0.9 for the silodosin and tamsulosin group, respectively (p not significant. Overall, incidence of side effects was similar in both groups. Patients taking silodosin experienced an higher incidence of retrograde ejaculation but a lower incidence of side effects related to peripheral vasodilation when compared to patients taking tamsulosin. Subgroup analysis demonstrated significantly lower mean expulsion times and pain episodes in patients with stones ≤ 5 mm in both groups. Conclusions: Tamsulosin and silodosin are equally effective as MET for distal ureteric stones sized 10 mm or smaller. MET with silodosin is associatd with a lower incidence of side effects related to peripheral vasodilation but an higher incidence of retrograde ejaculation when compared to tamsulosin.

Medical expulsive therapy for distal ureteric stones: tamsulosin versus silodosin.

Science.gov (United States)

Imperatore, Vittorio; Fusco, Ferdinando; Creta, Massimiliano; Di Meo, Sergio; Buonopane, Roberto; Longo, Nicola; Imbimbo, Ciro; Mirone, Vincenzo

2014-06-30

To compare the efficacy and safety of tamsulosin and silodosin in the context of medical expulsive therapy (MET) of distal ureteric stones. Observational data were collected retrospectively from patients who received silodosin (N = 50) or tamsulosin (N = 50) as MET from January 2012 to January 2013. Inclusion criteria were: patients aged ≥ 18 years with a single, unilateral, symptomatic, radiopaque ureteric stone of 10 mm or smaller in the largest dimension located between the lower border of the sacroiliac joint and the vesico-ureteric junction. Stone expulsion rate, stone expulsion time, number of pain episodes, need for analgesics use, incidence of side effects were compared. Stone-expulsion rate in the silodosin and in the tamsulosin groups were 88% and 82%, respectively (p not significant). Mean expulsion times were 6.7 and 6.5 days in the silodosin and tamsulosin group, respectively (p not significant). Mean number of pain episodes were 1.6 and 1.7 in the silodosin and tamsulosin group, respectively (p not significant). The mean number of analgesic requirement was 0.84 and 0.9 for the silodosin and tamsulosin group, respectively (p not significant). Overall, incidence of side effects was similar in both groups. Patients taking silodosin experienced an higher incidence of retrograde ejaculation but a lower incidence of side effects related to peripheral vasodilation when compared to patients taking tamsulosin. Subgroup analysis demonstrated significantly lower mean expulsion times and pain episodes in patients with stones ≤ 5 mm in both groups. Tamsulosin and silodosin are equally effective as MET for distal ureteric stones sized 10 mm or smaller. MET with silodosin is associatd with a lower incidence of side effects related to peripheral vasodilation but an higher incidence of retrograde ejaculation when compared to tamsulosin.

Holmium laser lithotripsy (HoLL) of ureteral calculi

Science.gov (United States)

Kuntz, Rainer M.; Lehrich, Karin; Fayad, Amr

2001-05-01

The effectiveness and side effects of ureteroscopic HoLL of ureteral stones should be evaluated. In 63 patients (17 female, 46 males) a total of 75 stones of 3-20 mm diameter were treated with ureteroscopic HoLL. 18.7 percent of stones were located in the proximal third, 24.0 percent in the middle third and 57.3 percent in the distal third of the ureter. HoLL was performed with small diameter semirigid and flexible ureteroscopes, 220 or 365 nm flexible laser fibers and a holmium:YAG laser at a power of 5-15 W (0.5-1.0 J, 10- 15 Hz). 47 of 63 patients (74.6 percent) were immediately free of stones, and 8 others (12.6 percent) lost their residual fragments spontaneously within two weeks. Another 2 patients received additional chmolitholysis for uric acid stone fragments, i.e. 90.5 percent of patients were stone free by one sitting of ureterscopic HoLL. Of the remaining 6 patients (9.5 percent) who still had residual calculi 4 weeks after HoLL, 2 asymptomatic patients refused any additional treatment, 2 patients preferred treatment with ESWL, and 2 patients had a successful second HoLL, thereby raising the success rate of ureteroscopic HoLL to 93.7 percent. 2 patients showed contrast medium extravasation on retrograde ureterograms, due to guide wire perforation. No ureteral stricture occurred. In conclusion, transurethral ureteroscopic HoLL proved to be a safe and successful minimal invasive treatment of ureteral calculi.

Extracorporeal shock wave lithotripsy (ESWL) versus ureteroscopic management for ureteric calculi.

Science.gov (United States)

Aboumarzouk, Omar M; Kata, Slawomir G; Keeley, Francis X; McClinton, Samuel; Nabi, Ghulam

2012-05-16

Ureteral stones frequently cause renal colic, and if left untreated, can lead to obstructive uropathy. Extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy, with or without intracorporeal lithotripsy, are the most common interventions used to treat ureteral stones. ESWL treatment is less invasive than ureteroscopy, but has some limitations such as a high retreatment rate, and is not available in all centres. Recent advances in ureteroscopy have increased success rates and reduced complication rates. To examine evidence from randomised controlled trials (RCTs) on the outcomes of ESWL or ureteroscopy in the treatment of ureteric calculi. We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library Issue 2, 2011), MEDLINE (1966 to March 2011), EMBASE (1980 to March 2011), CINAHL, Clinicaltrials.gov, Google Scholar, reference lists of articles and abstracts from conference proceedings, all without language restriction. RCTs that compared ESWL with ureteroscopic retrieval of ureteric stones were included in this review. Study participants were adults with ureteric stones requiring intervention. Published and unpublished sources were considered for inclusion. Three authors independently assessed study quality, risk of bias, and extracted data. Statistical analyses were performed using the random-effects model. Results were expressed as risk ratios (RR) for dichotomous outcomes or mean differences (MD) for continuous data, both with 95% confidence intervals (CI). Seven RCTs (1205 patients) were included in the review. Stone-free rates were lower in patients who underwent ESWL (7 studies, 1205 participants: RR 0.84, 95% CI 0.73 to 0.96) but re-treatment rates were lower in ureteroscopy patients (6 studies, 1049 participants: RR 6.18, 95% CI 3.68 to 10.38. ESWL-treated patients had less need for auxiliary treatment (5 studies, 751 participants: RR 0.43, 95% CI 0.25 to 0.74; fewer complications (7 studies, 1205 participants: RR 0

Ureteric catheterization via an ileal conduit: technique and retrieval of a JJ stent.

Science.gov (United States)

Wah, T M; Kellett, M J

2004-11-01

Retrograde ureteric catheterization of a patient with an ileal conduit is difficult, because guide wires and catheters coil in the conduit. A modified loopogram, using a Foley catheter as a fulcrum through which catheters can be advanced to the ureteric anastomosis, is described. This technique was used to remove a JJ stent, which had been inserted previously across a stricture in one ureter, the stent crossing from one kidney to the other.

Dextranomer/hyaluronic acid copolymer (Deflux) implants mimicking distal ureteral calculi on CT

Energy Technology Data Exchange (ETDEWEB)

Nelson, Caleb P. [Children' s Hospital Boston, Department of Urology, Boston, MA (United States); Chow, Jeanne S. [Children' s Hospital Boston, Department of Radiology, Boston, MA (United States)

2008-01-15

Periureteral or subtrigonal injection of dextranomer/hyaluronic acid (Dx/HA) copolymer (Deflux, Q-Med, Uppsala, Sweden) is an increasingly common endoscopic treatment for vesicoureteral reflux. We report a confusing radiographic finding of bilateral calcified Dx/HA injections initially thought to represent bilateral distal ureteral stones in a boy who presented with intermittent periumbilical pain. Urologists, radiologists, and emergency room physicians should be aware of the potential for calcification of ureteral implants of Dx/HA, and of the potentially confusing radiographic images that may result. (orig.)

Dextranomer/hyaluronic acid copolymer (Deflux) implants mimicking distal ureteral calculi on CT

International Nuclear Information System (INIS)

Nelson, Caleb P.; Chow, Jeanne S.

2008-01-01

Periureteral or subtrigonal injection of dextranomer/hyaluronic acid (Dx/HA) copolymer (Deflux, Q-Med, Uppsala, Sweden) is an increasingly common endoscopic treatment for vesicoureteral reflux. We report a confusing radiographic finding of bilateral calcified Dx/HA injections initially thought to represent bilateral distal ureteral stones in a boy who presented with intermittent periumbilical pain. Urologists, radiologists, and emergency room physicians should be aware of the potential for calcification of ureteral implants of Dx/HA, and of the potentially confusing radiographic images that may result. (orig.)

Emergency extracorporeal shock wave lithotripsy (ESWL) for obstructing ureteral stones.

Science.gov (United States)

Tligui, M; El Khadime, M R; Tchala, K; Haab, F; Traxer, O; Gattegno, B; Thibault, P

2003-05-01

To evaluate emergency treatment of obstructing ureteral stones by in situ extracorporeal shock wave lithotripsy (ESWL) during acute renal colic. From January 1994 to February 2000, 200 patients (mean age: 42 years) were treated by ESWL (EDAP LT-02) for obstructing ureteral stones causing acute renal colic refractory to medical treatment or recurring within 24hours of such treatment. Stones were visualised by fluoroscopic imaging and/or ultrasound. Follow-up included radiological and/or ultrasound examinations and lasted three months. Mean stone size was 7mm (3-20mm). At three months, 164/200 (82%) patients were stone-free. This rate ranged from 79% to 83% according to the location of the stone, and from 75% to 86% according to the size of the stone. These differences in rate were not significant. Two or three ESWL sessions were required in 79 patients. ESWL was well tolerated in 90% of patients. The only complication was a case of pyelonephritis requiring the placement of a JJ stent, administration of antibiotics, and distant ureteroscopy. The 36 patients, in whom ESWL failed, underwent ureteroscopy (n=23) or lithotripsy with a Dornier machine (n=13). Non-deferred ESWL for acute renal colic secondary to obstructing ureteral stones has a satisfactory success rate and very low morbidity.

Deep infiltrating ureteral endometriosis with catamenial hydroureteronephrosis: a case report.

Science.gov (United States)

Lee, Hyun Jung; Lee, Yoon Soon

2017-12-13

This aim of this case report is to raise awareness of ureteral endometriosis in women of reproductive age with hydronephrosis in the absence of urolithiasis to enable early diagnosis and prevent loss of renal function. A 44-year-old Asian woman presented with a 4-year history of cyclic right flank pain and right hydronephrosis during menstruation. Despite several evaluations by physicians, including gynecologists, the cause of her symptoms was not diagnosed. On transvaginal ultrasonography, the uterus was observed deviated to the right, with a nodular lesion at the right uterosacral ligament, and the right ovary was attached to the uterus with no apparent cystic lesion. Magnetic resonance imaging showed a mass in the right uterine wall and mild wall thickening with delayed enhancement of the right distal ureter. Right ureteral endometriosis was suspected. Diagnostic laparoscopy revealed narrowing of the distal right ureter between the right uterosacral ligament and the right ovary with adhesions caused by deep infiltrating endometriosis. The adhesion bands and infiltrating endometriosis around the right ureter were dissected. The nonspecific symptoms of ureteral endometriosis can result in incorrect diagnosis, with renal damage as a result of prolonged hydronephrosis. A high index of suspicion and use of imaging modalities enable earlier diagnosis and preservation of renal function.

Pattern of Ureteric Pathology Presenting to a Fistula Centre in Western Kenya

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Anthony Wanjala

2018-01-01

Full Text Available Background. Ureteric pathology arises from surgical misadventures, trauma, and congenital anomalies. Early detection and treatment is of the essence. Objectives. To determine the types/etiology and outcome of ureteric pathology presenting to Gynocare Fistula Centre, Eldoret, Kenya. Methods. Descriptive retrospective study that evaluated patients presenting with ureteric pathology at Gynocare between 1st January 2012 and 31st December 2016. We pulled out patient charts and extracted and analyzed relevant data using STATA 13E statistical software. Results. We analyzed 33 charts, and their age ranged from 10 to 58 years. Annual proportion for 2012, 2013, 2014, 2015, and 2016 was 2.5%, 2.8%, 1.2%, 1.4%, and 3.0% respectively among all the fistula patients treated in the hospital. All the patients presented with urinary incontinence, and 7 (21.2% had flank pain. Iatrogenic injuries contributed 84.8% (28, and 3 (9.1% were congenital while trauma and infection had 1 each. Of those resulting from surgical misadventures, 17 (60.7% were from obstetric while 11 (39.2% were from gynecological surgery. All the injuries were in the distal third of the ureter; 5 were bilateral; and 11 were left sided while 17 were right-sided. Repair and/or reimplantation was successful in 31 (93.93% of the patients. Conclusion. Highest proportion of ureteric pathologies was accounted for by iatrogenic causes and surgical repair and/or reimplantation has a high success rate.

Do stone size and impaction influence therapeutic approach to proximal ureteral stones?

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Radulović Slobodan

2009-01-01

Full Text Available Background/Aim. Primary therapeutic approach to lumbar ureteral stones is still contraversial. The aim of the study was to investigate the influence of stone impaction and size on the effectiveness of proximal ureteral stone lithotripsy. Methods. A total of 123 patients with proximal ureteral stones were investigated in this prospective study performed in a 10- month period. The patients were divided into the group I - 86 patients treated with extracorporeal shock wave lithotripsy (ESWL and the group II - 37 patients treated with 'Swiss' Lithoclast. In the group I, 49 stones (57% were classified as impacted, while 20 stones (23.3% were larger than 100 mm2. In the group II, 26 stones (70.3% were impacted, and 11 stones (29.7% were larger than 100 mm2. Stones were defined as impacted by the radiographic, echosonographic as well as endoscopic findings in the group II of patients. Stone size was presented in mm2. Chemical composition of stones were almost the same in both groups of the patients. Results. Generally, there was no statistically significant difference in the treatment success between the groups. However, stones larger than 100 mm2 were statistically more successfully treated endoscopically, while there was no statistical difference in the treatment success of impacted stones between these two groups. Conclusion. ESWL can by considered as primary first therapeutic approach in treatment of all proximal ureteral stones except for stones larger than 100 mm2 that should primarily be treated endoscopically.

Effects of PDE5 Inhibitors and sGC Stimulators in a Rat Model of Artificial Ureteral Calculosis.

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Peter Sandner

Full Text Available Urinary colics from calculosis are frequent and intense forms of pain whose current pharmacological treatment remains unsatisfactory. New and more effective drugs are needed to control symptoms and improve stone expulsion. Recent evidence suggested that the Nitric Oxide (NO / cyclic guanosine monophosphate (cGMP/phosphodiesterase type 5 (PDE5 system may contribute to ureteral motility influencing stone expulsion. We investigated if PDE5 inhibitors and sGC stimulators influence ureteral contractility, pain behaviour and stone expulsion in a rat model of ureteral calculosis. We investigated: a the sex-specific PDE5 distribution in the rat ureter; b the functional in vitro effects of vardenafil and sildenafil (PDE5 inhibitors and BAY41-2272 (sGC stimulator on induced ureteral contractility in rats and c the in vivo effectiveness of vardenafil and BAY41-2272, alone and combined with ketoprofen, vs hyoscine-N-butylbromide alone or combined with ketoprofen, on behavioural pain indicators and stone expulsion in rats with artificial calculosis in one ureter. PDE5 was abundantly expressed in male and female rats' ureter. In vitro, both vardenafil and BAY41-2272 significantly relaxed pre-contracted ureteral strips. In vivo, all compounds significantly reduced number and global duration of "ureteral crises" and post-stone lumbar muscle hyperalgesia in calculosis rats. The highest level of reduction of the pain behaviour was observed with BAY41-2272 among all spasmolytics administered alone, and with the combination of ketoprofen with BAY41-2272. The percentage of stone expulsion was maximal in the ketoprofen+BAY41-2272 group. The NO/cGMP/PDE5 pathway is involved in the regulation of ureteral contractility and pain behaviour in urinary calculosis. PDE5 inhibitors and sGC stimulators could become a potent new option for treatment of urinary colic pain.

A Giant Ureteral Stone without Underlying Anatomic or Metabolic Abnormalities: A Case Report

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Selcuk Sarikaya

2013-01-01

Full Text Available A 28-year old man presented with left flank pain and dysuria. Plain abdominal film and computed tomography showed a left giant ureteral stone measuring 11.5 cm causing ureteral obstruction and other stones 2.5 cm in size in the lower pole of ipsilateral kidney and 7 mm in size in distal part of right ureter. A left ureterolithotomy was performed and then a double J stent was inserted into the ureter. The patient was discharged from the hospital 4 days postoperatively with no complications. Stone analysis was consistent with magnesium ammonium phosphate and calcium oxalate. Underlying anatomic or metabolic abnormalities were not detected. One month after surgery, right ureteral stone passed spontaneously, left renal stone moved to distal ureter, and it was removed by ureterolithotomy. Control intravenous urography and cystography demonstrated unobstructed bilateral ureter and the absence of vesicoureteral reflux.

Experience of extracorporeal shock wave lithotripsy for kidney and upper ureteric stones by electromagnetic lithotripter

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Wazir, B.G.; Haq, M.I.H.; Faheem-ul-Haq; Nawaz, A.; Nawaz, A.; Ikramullah; Jamil, M.

2010-01-01

Background: Extracorporeal Shock Wave Lithotripsy (ESWL) is a non-invasive treatment of urinary stones which breaks them, by using externally applied, focused, high intensity acoustic pulse, into smaller pieces so that they can pass easily through ureter. Shock wave generation, focusing, coupling and stone localisation by fluoroscope or ultrasound are the basic components of ESWL. ESWL has some complications and is contraindicated in certain situations. The aim of this study was to evaluate the effectiveness and safety of ESWL in kidney and upper ureteric stones by Electromagnetic Lithotriptor. Methods: All adult patients with renal and upper ureteric stones having a diameter of up to 1 Cm were included in the study. Basic evaluation such as history, examination, ultrasound and excretory urography were performed. Electromagnetic lithotripsy was done and data were collected on a printed proforma from January 1, 2008 to March 30, 2009 in Institute of Kidney Diseases, Peshawar. Results: Out of a total of 625 patients 463 were male and 162 were female; 67.36% of patients were having renal stones, 23.84% upper ureteric and 8.8% both renal and ureteric stones. Complications noted were renal colic in 9.76%, haematuria in 3.2%, stein strasse in 2.72%, and fever in 1.12% of patients. The stone free rate was 89% and 7% of patients were having stone fragments <4 mm. ESWL failed in 4% of patients. Conclusion: ESWL is a safe and effective way of treating kidney and upper ureteric stones. (author)

Usefulness of Early Extracorporeal Shock Wave Lithotripsy in Colic Patients with Ureteral Stones

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Choi, Hyeung Joon; Jung, Jin-Hee; Bae, Jungbum; Cho, Min Chul; Lee, Hae Won; Lee, Kwang Soo

2012-01-01

Purpose To compare efficacy and safety between early extracorporeal shock wave lithotripsy (eESWL) and deferred ESWL (dESWL) in colic patients with ureteral stones and to investigate whether eESWL can play a critical role in improving treatment outcomes. Materials and Methods A total of 279 patients who underwent ESWL for single radio-opaque ureteral stones of 5 to 20 mm in size were included in this retrospective study. The patients were categorized into two groups according to the time betw...

Combined retrograde flexible ureteroscopic lithotripsy with holmium YAG laser for renal calculi associated with ipsilateral ureteral stones.

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Cocuzza, Marcello; Colombo, Jose R; Ganpule, Arvind; Turna, Burak; Cocuzza, Antonio; Dhawan, Divyar; Santos, Bruno; Mazzucchi, Eduardo; Srougi, Miguel; Desai, Mahesh; Desai, Mihir

2009-02-01

The purpose of this study was to evaluate the effectiveness of combined ureteroscopic holmium YAG lithotripsy for renal calculi associated with ipsilateral ureteral stones. Between August 2002 and March 2007, retrograde flexible ureteroscopic stone treatment was attempted in 351 cases. Indication for treatment was concurrent symptomatic ureteral stones in 63 patients (group I). Additional operative time and perioperative complication rates were compared to a group of 39 patients submitted to ureteroscopic treatment for ureteral calculi exclusively (group II). Mean ureteral stone size was 8.0 +/- 2.6 mm and 8.1 +/- 3.4 mm for groups I and II, respectively. Mean operative time for group I was 67.9 +/- 29.5 minutes and for group 2 was 49.3 +/- 13.2 minutes (p stone size was 10.7 +/- 6.4 mm, overall stone free rate in group I was 81%. However, considering only patients with renal stones smaller than 15 mm, the stone free rate was 88%. Successful treatment occurred in 81% of patients presenting lower pole stones, but only 76% of patients with multiple renal stones became stone free. As expected, stone free rate showed a significant negative correlation with renal stone size (p = 0.03; r = -0.36). Logistic regression model indicated an independent association of renal stones smaller than 15 mm and stone free rate (OR = 13.5; p = 0.01). Combined ureteroscopic treatment for ureteral and ipsilateral renal calculi is a safe and attractive option for patients presenting for symptomatic ureteral stone and ipsilateral renal calculi smaller than 15 mm.

Outcome of ureteroscopy for the management of distal ureteric ...

African Journals Online (AJOL)

M. El-Qadhi

Minimal invasive techniques for management of ureteric cal- culi include extracorporeal shockwave lithotripsy (ESWL), ureteroscopy (URS), and laparoscopic ureterolithotomy. The choice of the procedure depends on location and characteristics of the stone, patient's preference, as well as associated costs. According to.

Usefulness of Early Extracorporeal Shock Wave Lithotripsy in Colic Patients with Ureteral Stones

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Choi, Hyeung Joon; Jung, Jin-Hee; Bae, Jungbum; Cho, Min Chul; Lee, Hae Won

2012-01-01

Purpose To compare efficacy and safety between early extracorporeal shock wave lithotripsy (eESWL) and deferred ESWL (dESWL) in colic patients with ureteral stones and to investigate whether eESWL can play a critical role in improving treatment outcomes. Materials and Methods A total of 279 patients who underwent ESWL for single radio-opaque ureteral stones of 5 to 20 mm in size were included in this retrospective study. The patients were categorized into two groups according to the time between the onset of colic and ESWL: eESWL (ESWL sessions and less time to achieve stone-free status than did the dESWL group. For 241 patients with stones ESWL complication rates were comparable between the two groups. In the multivariate analysis, smaller stone size and a time to ESWL of <48 hours were independent predictors of success. Conclusions Our data suggest that eESWL in colic patients with ureteral stones is an effective and safe treatment with accelerated stone clearance. PMID:23301130

Spontaneous calyceal rupture caused by a ureteral calculus ...

African Journals Online (AJOL)

Rupture of the urinary collecting system with perirenal and retroperitoneal extravasation of the urine is an unusual condition that is typically caused by ureteral-obstructing calculi. We report a case of calyceal rupture with urinoma formation, due to a stone in the distal ureter. The diagnosis was confirmed by computed ...

Renal vein doppler sonography in rabbits with acute ureteral obstruction: usefulness of impedance index of renal vein

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Sohn, Kyung Myung; Chung, Su Kyo; Lee, Sung Yong

2004-01-01

To evaluate the usefulness of the impedance index of the renal vein for the diagnosis of acute obstructive uropathy in rabbits. Ligation of the left ureter was done in 12 rabbits. Doppler sonography of the interlobar veins in both kidneys was checked before and 30 minutes, 1, 3, 6, 9 and 24 hours after ureteral ligation. The venous impedance index [(peak flow signal-least flow signal)/peak flow signal] was compared between the obstructed and non-obstructed kidneys for all periods. The change in the impedance index after ureteral ligation was also compared between the obstructed and non-obstructed kidneys. A decrease in the impedance index of the intrarenal vein was observed starting from 30 mins atter ureteral ligation, and the index remained low up to 24 hours after ureteral ligation. The obstructed kidneys had a significantly lower impedance index than the contralateral kidneys for all six of the postligation measurements (p< 0.05). There were significant differences in the change of impedance index after ureteral ligation between the obstructed and non-obstructed kidneys (p< 0.05). The impedance index of the intrarenal vein was significantly decreased in the obstructed kidneys. The measurement of the impedance index of the intrarenal vein using Doppler sonography could provide a useful method of diagnosing obstructive uropathy

Self-organisation after embryonic kidney dissociation is driven via selective adhesion of ureteric epithelial cells.

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Lefevre, James G; Chiu, Han S; Combes, Alexander N; Vanslambrouck, Jessica M; Ju, Ali; Hamilton, Nicholas A; Little, Melissa H

2017-03-15

Human pluripotent stem cells, after directed differentiation in vitro , can spontaneously generate complex tissues via self-organisation of the component cells. Self-organisation can also reform embryonic organ structure after tissue disruption. It has previously been demonstrated that dissociated embryonic kidneys can recreate component epithelial and mesenchymal relationships sufficient to allow continued kidney morphogenesis. Here, we investigate the timing and underlying mechanisms driving self-organisation after dissociation of the embryonic kidney using time-lapse imaging, high-resolution confocal analyses and mathematical modelling. Organotypic self-organisation sufficient for nephron initiation was observed within a 24 h period. This involved cell movement, with structure emerging after the clustering of ureteric epithelial cells, a process consistent with models of random cell movement with preferential cell adhesion. Ureteric epithelialisation rapidly followed the formation of ureteric cell clusters with the reformation of nephron-forming niches representing a later event. Disruption of P-cadherin interactions was seen to impair this ureteric epithelial cell clustering without affecting epithelial maturation. This understanding could facilitate improved regulation of patterning within organoids and facilitate kidney engineering approaches guided by cell-cell self-organisation. © 2017. Published by The Company of Biologists Ltd.

Chronic ethanol or nicotine treatment results in partial cross-tolerance between these agents.

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Burch, J B; de Fiebre, C M; Marks, M J; Collins, A C

1988-01-01

Female DBA/2Ibg mice were treated chronically (21 days) with ethanol- or dextrin-containing liquid diets or infused chronically with nicotine (8 mg/kg/h) or saline for 10 days. The responses of these animals to challenge doses of ethanol (2.5 g/kg) or nicotine (1 or 2 mg/kg) were measured using a test battery consisting of respiration rate, acoustic startle response, Y-maze crosses and rears, heart rate and body temperature. Chronic ethanol-treated animals were tolerant to the effects elicited by a challenge dose of ethanol on four of the six measures and were cross-tolerant to nicotine's effects on the acoustic startle test. Chronic nicotine-treated animals were tolerant to nicotine's effects on five of the six measures and cross-tolerant to ethanol's effects on heart rate and body temperature. Thus, partial cross-tolerance between ethanol and nicotine exists. Chronic nicotine treatment resulted in significant increases in L-[3H]-nicotine binding in six of seven brain regions and in alpha-[125I]-bungarotoxin binding in three of seven brain regions. Chronic ethanol treatment failed to alter the binding of either ligand. Therefore, the cross-tolerance that develops between ethanol and nicotine is not totally dependent on alterations in the number of brain nicotinic receptors.

Retroperitoneal laparoscopy management for ureteral fibroepithelial polyps causing hydronephrosis in children: a report of five cases.

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Dai, L N; Chen, C D; Lin, X K; Wang, Y B; Xia, L G; Liu, P; Chen, X M; Li, Z R

2015-10-01

Hydronephrosis is a common disease in children and may be caused by ureteral fibroepithelial polyps (UFP). Ureteral fibroepithelial polyps are rare in children and are difficult to precisely diagnose before surgery. Surgical treatment for symptomatic UFP is recommended. At the present institution, retroperitoneal laparoscopy has been used to treat five boys with UFP since 2006. To highlight the significance of UFP as an etiological factor of hydronephrosis in children and evaluate the applicative value of retroperitoneal laparoscopy in the treatment of children with UFP. Between 2006 and 2013 five boys underwent retroperitoneal laparoscopy at the present institution. They were identified with UFP by review of the clinical database. Detailed data were collected, including: radiographic studies, gross anatomical pathology, and pathology and radiology reports. All boys had been followed up at least every 6 months. All of the boys were aged between 7 and 16 years (mean 9.8 years). The main symptoms were flank pain (all five) and hematuria (three). Radiographic examination showed that all of the boys presented with incomplete ureteral obstruction and hydronephrosis. The ureteral fibroepithelial polyps were located near the left UPJ or the left proximal ureter. All of the boys had the UFP removed: three underwent retroperitoneal laparoscopic dismembered Anderson-Hynes pyeloplasty and polypectomy, and two had retroperitoneal laparoscopic ureteral anastomosis. These polyps were all on the left side and between 15 and 35 mm in length (mean 22 mm) (Figure). All of the boys recovered well and were discharged from hospital. The postoperative histological report confirmed that the specimens were UFP. Hydronephrosis was periodically assessed by ultrasonography (using the same method as pre-surgical ultrasonography) after surgery. Mean follow-up was 33 months (range 6-58 months) and no complications were found afterwards. Ureteral fibroepithelial polyps are rare but rather

Efficacy of extracorporeal shockwave lithotripsy using Dornier SII in different levels of ureteral stones

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Elkholy, Mohamed M.; Ismail, Hassan; Abdelkhalek, Mohamed A.; Badr, Mohamad M.; Elfeky, Mohamed M.

2014-01-01

Objective: The objective of this study was to evaluate the efficacy and safety of the Dornier lithotripter S II system in the treatment of ureteral calculi. Patients and Methods: A total of 97 cases which consists of 54 males and 43 females with ureteral stones were treated by extracorporeal shock wave lithotripsy (ESWL). Mean age was 42.6 years. Inclusion criteria were solitary radiopaque ureteral stones of radiological stone size of ≤1 cm. The stones were not impacted, with normal kidney functions. Procedure time, number of shocks, energy used, number of sessions and complications were reported. The outcome of ESWL was also recorded. Results: Stones were in the abdominal (upper ureter) in 50% of patients, in pelvic (middle ureter) in 47% of patients. All patients had unilateral stones and the mean stone size in maximum length was) 10 mm). Good dye excretion passing the stone was noted in all patients. Mild hydronephrosis was found in 85% of cases. A total of 49 cases were treated by a single session, while in 35% of cases two sessions were enough and 16% received three sessions. The average number of shocks per session was 3125. The average number of shocks per patient was 5962.5 shocks and average energy was 204.3 Joules. The overall stone-free rate 3 months after lithotripsy was 94%. After a single session of lithotripsy, 49 patients (49%) became stone-free. Stone free rates after ESWL for upper, middle ureteral stones were 94%, 95.7% respectively. Additional procedures were needed in only 6 cases (6%) to render patients stone-free after lithotripsy. No serious complications occurred. Conclusion: The Dornier lithotripter S II is very effective in the treatment of ureteral calculi with no major complications. PMID:25371614

Cutting-balloon angioplasty of resistant ureteral stenosis as bridge to stent insertion

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Iezzi, R., E-mail: iezzir@virgilio.it [Department of Bioimaging and Radiological Sciences, Institute of Radiology, ' A. Gemelli' Hospital - Catholic University, L.go A Gemelli 8, 00168 Rome (Italy); Di Stasi, C.; Simeone, A.; Bonomo, L. [Department of Bioimaging and Radiological Sciences, Institute of Radiology, ' A. Gemelli' Hospital - Catholic University, L.go A Gemelli 8, 00168 Rome (Italy)

2011-07-15

Ureteral stenting is a routine, minimally invasive procedure performed for relief of benign or malignant obstruction. In case of ureteral stenosis, to allow a correct insertion of the stent, a predilatation of the ureter stenosis with a conventional balloon catheter can be necessary. In exceptional cases, it can be difficult to advance an 7-8 Fr JJ-catheter over a tight resistant ureter stenosis following unsuccessful high-pressure balloon dilatation. In the present report, we describe two cases of resistant ureter stenosis successfully dilated by a cutting-balloon following the failure of high-pressure balloon dilatation, allowing a correct and uncomplicated antegrade stent insertion.

Cutting-balloon angioplasty of resistant ureteral stenosis as bridge to stent insertion

International Nuclear Information System (INIS)

Iezzi, R.; Di Stasi, C.; Simeone, A.; Bonomo, L.

2011-01-01

Ureteral stenting is a routine, minimally invasive procedure performed for relief of benign or malignant obstruction. In case of ureteral stenosis, to allow a correct insertion of the stent, a predilatation of the ureter stenosis with a conventional balloon catheter can be necessary. In exceptional cases, it can be difficult to advance an 7-8 Fr JJ-catheter over a tight resistant ureter stenosis following unsuccessful high-pressure balloon dilatation. In the present report, we describe two cases of resistant ureter stenosis successfully dilated by a cutting-balloon following the failure of high-pressure balloon dilatation, allowing a correct and uncomplicated antegrade stent insertion.

Use of 50% Dextrose as the Distension Medium During Cystoscopy for Visualization of Ureteric Jets.

Science.gov (United States)

Narasimhulu, Deepa M; Prabakar, Cheruba; Tang, Nancy; Bral, Pedram

2016-01-01

Indigotindisulfonate sodium has been used to color the urine and thereby improve the visualization of ureteric jets during intraoperative cystoscopy. After indigotindisulfonate sodium became unavailable, there has been an ongoing search for an alternate agent to improve visualization of the jets. We used 50% dextrose, which is more viscous than urine, as the distension medium during cystoscopy so that the ureteric efflux is seen as a jet of contrasting viscosity. We instilled 100 mL of 50% dextrose into the bladder through an indwelling catheter, which is then removed and cystoscopy is performed as usual. We observed jets of contrasting viscosity in every patient in whom 50% dextrose was used as compared with coloring agents in which the jet is not always colored at the time of cystoscopy. Visualization of the other structures in the bladder and the bladder wall itself is not altered by 50% dextrose, although the volume of 50% dextrose that we typically use may not provide adequate distension for a complete assessment of the bladder. If additional distension is necessary, normal saline may be used in addition to the 50% dextrose once the ureteric jets have been assessed. Fifty percent dextrose is an effective alternative to indigotindisulfonate sodium for visualization of ureteric jets during cystoscopy.

[Tamsulosin, oxybutynin or their combination in the treatment of ureteral stent-related symptoms].

Science.gov (United States)

Maldonado-Alcaraz, Efraín; Moreno-Palacios, Jorge; López-Sámano, Virgilio A; Landa-Salas, Jason D; Torres-Mercado, León O; García-Cruz, Carlos

2017-01-01

The aim of this paper is to compare the efficacy of tamsulosin, oxybutynin or their combination for the treatment of symptoms related to double J stent (DJS). Randomized clinical non-blinded trial with three arms (tamsulosin, oxybutynin or combination) to assess the improvement of ureteral related symptoms with DJS with the questionnaire of Ureteral Stent Symptom Questionnaire (USSQ) and the adverse effects of treatment. Evaluations were made at 7 and 21 days after the placement of DJS. The maneuvers were compared using Chi squared test, Kruskall-Wallis, ANOVA and Wilcoxon considering a statistically significant p ≤ 0.05. 170 patients with CJJ were evaluated. A perprotocol analysis was performed in 142 patients, 53 received tamsulosin (37.4%), 42 oxybutynin (29.6%) and 47 the combination of both (33%). At 7 and 21 days the improvement was similar in all three arms. Men with tamsulosin and women with oxybutynin had less general symptoms. Tamsulosin, oxybutynin or its combination similarly improve ureteral stent related symptoms and this improvement becomes more noticeable over time. Men are less symptomatic with tamsulosin and women with oxybutynin.

Original article Role of Tamsulosin in Improving Double-J Ureteric ...

African Journals Online (AJOL)

2011-10-04

related symptoms and quality of life (QoL) in patients with double-J (DJ) ureteric stents. Subjects and Methods: A total of 136 patients were prospectively evaluated and distributed randomly in two groups. Group 1 was 69 ...

Useful technique for long-term urinary drainage by inlying ureteral stent. Six-year experience.

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Kearney, G P; Mahoney, E M; Brown, H P

1979-08-01

Endoscopically placed inlying ureteral stents have proved useful in the conservative management of patients with ureteral obstruction, urinary fistula, and malignancy and have obviated the need for operative intervention. In high-risk symptomatic patients with widespread malignancy, internal urinary diversion offers the opportunity for an improved quality of life without the surgical risk or potential morbidity of supravesical diversion. Potential candidates for this simple, safe, and effective technique include: those with postsurgical obstruction and/or fistula, retroperitoneal fibrosis, metastatic carcinoma, congenital ureteropelvic junction obstruction, as well as those with reversible obstruction from lymphoma and carcinoma of the prostate who are undergoing radiotherapy and/or chemotherapy. The focus of this report is on the technique we have found successful in providing us with stents that fit our individual patients. Readily available fabricated graduated ureteral catheter can be cut and shaped to particular measurements unlike prefabricated catheters. Minimal preparation time is demanded, and there is no need for extensive stocking of various catheter sizes.

Anterior vitrectomy and partial capsulectomy via anterior approach to treat chronic postoperative endophthalmitis

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Mete Güler

2013-02-01

Full Text Available AIM:To describe the results of vitrectomy and partial capsulectomy via anterior approach surgical technique in treatment of chronic postoperative endophthalmitis (CPE.METHODS:Clinical records of 9 patients treated for CPE between 2006 and 2010 were reviewed retrospectively. All of these patients were treated with vitrectomy and partial capsulectomy via anterior approach.RESULTS:Six of 9 patients were male. The average patients’ age was (60±8.1 years. The average period between cataract extraction and onset of signs and symptoms was (3.6±1.3 weeks. The average presenting visual acuity was 0.3±0.1 and the average final post operative visual acuity was 0.7±0.2. The mean follow-up period was (28.1±8.9 weeks. In all patients, the inflammation subsided after surgery.CONCLUSION:Our results suggest that anterior vitrectomy and partial capsulectomy via anterior approach may be considered as potentially useful and relatively less invasive technique to treat CPE.

Body mass index and buttock circumference are independent predictors of disintegration failure in extracorporeal shock wave lithotripsy for ureteral calculi

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Teng-Kai Yang

2013-07-01

Conclusion: Stone burden is the main predictor of ESWL failure for all patients with ureteral calculi. BC and BMI are independent predictors for ESWL failure for middle/lower and upper ureteral calculi, respectively.

Spontaneous ureteral rupture in a patient with systemic lupus erythematosus

International Nuclear Information System (INIS)

Benson, C.H.; Pennebaker, J.B.; Harisdangkul, V.; Songcharoen, S.

1983-01-01

A patient with known systemic lupus erythematosus had fever and symptoms of a lower urinary tract infection. Bone scintigraphy showed left ureteral perforation and necrosis with no demonstrable nephrolithiasis. It is speculated that this episode was due to lupus vasculitis

Usefulness of unenhanced helical CT in patients with suspected ureteral colic

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Kim, Bong Soo; Nam Kung, Sook; Kim, Heung Cheol; Hwang, Woo Chul; Lee, In Sun; Hwang, Im Kyung; Kim, Ho Chul; Bae, Sang Hoon; Lee, Sang Kon; Lee, Seong Ho [College of Medicine, Hallym Univ., Chunchon (Korea, Republic of)

2002-07-01

To determine the usefulness of unenhanced helical CT in patients with suspected renal colic. One hundred and fourteen patients with suspected ureteral colic, referred by physicians, underwent unenhanced helical CT. Two radiologists prospectively interpreted the results, determining the presence or absence of ureter stone and other diseases the arise outside the urinary tract. In cases of ureteral stone, we retrospectively sought secondary signs of hydronephrosis, perinephric fat stranding, thickening of renal fascia, renal enlargement, and the tissue rim sign. Among the 114 patients, 57 were confirmed as having ureter stones. Unenhanced helical CT depicted 57 of 58 stones in 57 patients, producing one false-negative and one false-positive result. Overall, the results showed 98% sensitivity, 95% specificity, 98% positive predictive value, 95% negative predictive value, and 97% accuracy. The frequencies of secondary signs were as follows: hydronephrosis, 95%(54/57); perinephric fat stranding, 81% (46/57); thickening of renal fascia, 77% (44/57); renal enlargement , 65%(37/57); and the tissure rim sign 72%(21/29). In 20 patients, the diagnoses were not related to stone disease and included one false-negative diagnosis of pyonephrosis. Unenhanced helical CT provides information which is valuable in the accurate diagnosis of ureteral stone as well as other diseases that arise outside the urinary tract in patients with suspected renal colic.

Treatment of Ureteroarterial Fistulae with Covered Vascular Endoprostheses and Ureteral Occlusion

International Nuclear Information System (INIS)

Bilbao, Jose I.; Cosin, Octavio; Bastarrika, Gorka; Rosell, David; Zudaire, Javier; Martinez-Cuesta, Antonio

2005-01-01

Background. Ureteroarterial fistulae (UAFs) are a rare entity, often difficult to identify, and associated with a high mortality rate. This fact has been attributed to a delay in diagnosis and treatment. Five conditions that can predispose to the development of this uncommon entity have been described: prior pelvic surgery, prolonged ureteral stenting, radiation therapy, previous vascular surgery and vascular pathology. Methods. We present 4 patients with UAFs and at least three of the above-mentioned conditions. Ureteral ischemia and subsequent necrosis promote the formation of these fistulae. The constant pulsation of the iliac artery is transmitted to an already compromised ureter containing a stiff intraluminal foreign body, resulting in pressure necrosis, most likely where the ureter crosses the iliac artery. Results and Conclusion. Cases were managed percutaneously with a combination of the deployment of a covered prosthesis and, when needed, with mechanical occlusion of the ureter. Hematuria stopped in all the patients with no evidence of immediate rebleeding. One patient presented a new episode of vaginal bleeding 13 months after endograft placement and ureteral embolization. Arteriography showed the presence of a hypogastric artery pseudoaneurysm that was occluded using coils. No new bleeding has occurred in this patient 12 months after the second embolization. At present all 4 patients are alive with follow-up periods of 5, 9, 11 and 25 months since the first procedure

A case report of ureteral cast stone and giant urethral stone, respectively

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Song, Ho Yung; Rhee, Song Joo; Choi, Ki Chul [School of Medicine, Jeongbug National University, Jeonju (Korea, Republic of)

1980-12-15

Urinary lithiasis is one of the most common disease of the urinary tract. It occurs more frequently in men than in women but rare in children and in blacks; a familial predisposition is often encountered. Ureteral stones originate in the kidney. Gravity and peristalis contribute to spontaneous passage into and down the ureter. Ureterovesical junction is the most frequent lodging site of stone. In our hospital one case of ureteral cast stone and giant urethral stone were found respectively and they were confirmed by radiological examination and surgery on Aug. 1978 and Jan. 1979. Ureteral cast stone which had been introduced and named first by Kiyonobu Tari and Kikjiro So in 1972 was very giant unusually. It may be the only one till now. Our patient was 36 years old female who has been suffered from intermittent right flank pain for 10 years. On KUB giant cylindrical radiopaque shadow was shown on RLQ extended to right minor pelvis and this was confirmed as a stone by retrograde ureteral catheterization. A stone measured 13cm x 1.5cm was found above the ureterovesical junction during operation. Follow up excretory urogram one year after operation showed no functional improvement of right kidney. Urethral stone is also unusual urinary lithiasis. This 60 years old male patient was been suffered from non-tender palpable hard mass on scrotal area and intermittent urinary retention. When urinary retention was occurred it was relieved by manipulation of the mass by himself. On plain film oval shaped giant radiopaque shadow was shown on cavernous urethral region. On urethrocystogram anterior urethra was opacified, but posterior urethra and bladder were not opacified and multiple fistulous leakage was identified. A stone measured 6.5cm x 3.5cm was found in cavernous urethra during operation.

A case report of ureteral cast stone and giant urethral stone, respectively

International Nuclear Information System (INIS)

Song, Ho Yung; Rhee, Song Joo; Choi, Ki Chul

1980-01-01

Urinary lithiasis is one of the most common disease of the urinary tract. It occurs more frequently in men than in women but rare in children and in blacks; a familial predisposition is often encountered. Ureteral stones originate in the kidney. Gravity and peristalis contribute to spontaneous passage into and down the ureter. Ureterovesical junction is the most frequent lodging site of stone. In our hospital one case of ureteral cast stone and giant urethral stone were found respectively and they were confirmed by radiological examination and surgery on Aug. 1978 and Jan. 1979. Ureteral cast stone which had been introduced and named first by Kiyonobu Tari and Kikjiro So in 1972 was very giant unusually. It may be the only one till now. Our patient was 36 years old female who has been suffered from intermittent right flank pain for 10 years. On KUB giant cylindrical radiopaque shadow was shown on RLQ extended to right minor pelvis and this was confirmed as a stone by retrograde ureteral catheterization. A stone measured 13cm x 1.5cm was found above the ureterovesical junction during operation. Follow up excretory urogram one year after operation showed no functional improvement of right kidney. Urethral stone is also unusual urinary lithiasis. This 60 years old male patient was been suffered from non-tender palpable hard mass on scrotal area and intermittent urinary retention. When urinary retention was occurred it was relieved by manipulation of the mass by himself. On plain film oval shaped giant radiopaque shadow was shown on cavernous urethral region. On urethrocystogram anterior urethra was opacified, but posterior urethra and bladder were not opacified and multiple fistulous leakage was identified. A stone measured 6.5cm x 3.5cm was found in cavernous urethra during operation

Clinical implications and applications of the twinkling sign in ureteral calculus: a preliminary study.

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Sharma, Gyanendra; Sharma, Anshu

2013-06-01

Twinkling is an artifact seen on color Doppler ultrasound as a rapidly changing mixture of red and blue behind a stationary echogenic structure. We studied the presence or absence of this artifact in ureteral calculi detected on ultrasound and correlated it with clinical parameters. We evaluated 284 ureteral calculi seen on color Doppler ultrasound. The twinkling artifact was graded as 0 to 2 and correlated with the presence or absence of pain, symptom duration, degree of hydronephrosis and passage of a Glidewire® guidewire across the ureteral calculus during ureterorenoscopy. The presence or absence of twinkling was not associated with the degree of hydronephrosis. Twinkling was absent in 92% of patients with significant pain and grade 2 twinkling was seen in 69.5% without significant pain. Twinkling was dominantly absent in patients with a recent colic episode, while 77% who presented 2 to 15 days after a colic episode had grade 2 twinkling. The guidewire was difficult to pass in cases with absent twinkling compared to those with grade 2 twinkling, in which the guidewire and ureteral catheter crossed the calculus easily. Absent twinkling is associated with significant pain, a recent colic episode and difficult guidewire passage across the calculus. These findings suggest that absent twinkling implies significant obstruction, while its presence indicates no significant obstruction. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Thrombospondin-1 plays a profibrotic and pro-inflammatory role during ureteric obstruction.

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Bige, Naïke; Shweke, Nasim; Benhassine, Safa; Jouanneau, Chantal; Vandermeersch, Sophie; Dussaule, Jean-Claude; Chatziantoniou, Christos; Ronco, Pierre; Boffa, Jean-Jacques

2012-06-01

Thrombospondin-1 (TSP-1) is an endogenous activator of transforming growth factor-β (TGF-β), and an anti-angiogenic factor, which may prevent kidney repair. Here we investigated whether TSP-1 is involved in the development of chronic kidney disease using rats with unilateral ureteral obstruction, a well-known model to study renal fibrosis. Obstruction of 10 days duration induced inflammation, tubular cell atrophy, dilation, apoptosis, and proliferation, leading to interstitial fibrosis. TSP-1 expression was increased in parallel to that of collagen III and TGF-β. Relief of the obstruction at day 10 produced a gradual improvement in renal structure and function, the reappearance of peritubular capillaries, and restoration of renal VEGF content over a 7- to 15-day post-relief period. TSP-1 expression decreased in parallel with that of TGF-β1 and collagen III. Mice in which the TSP-1 gene was knocked out displayed less inflammation and had better preservation of renal tissue and the peritubular capillary network compared to wild-type mice. Additional studies showed that the inflammatory effect of TSP-1 was mediated, at least in part, by monocyte chemoattractant protein-1 and activation of the Th17 pathway. Thus, TSP-1 is an important profibrotic and inflammatory mediator of renal disease. Blockade of its action may be a treatment against the development of chronic kidney disease.

A clinical nomogram to predict the successful shock wave lithotripsy of renal and ureteral calculi.

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Wiesenthal, Joshua D; Ghiculete, Daniela; Ray, A Andrew; Honey, R John D'A; Pace, Kenneth T

2011-08-01

Although shock wave lithotripsy is dependent on patient and stone related factors, there are few reliable algorithms predictive of its success. In this study we develop a comprehensive nomogram to predict renal and ureteral stone shock wave lithotripsy outcomes. During a 5-year period data from patients treated at our lithotripsy unit were reviewed. Analysis was restricted to patients with a solitary renal or ureteral calculus 20 mm or less. Demographic, stone, patient, treatment and 3-month followup data were collected from a prospective database. All patients were treated using the Philips Lithotron® lithotripter. A total of 422 patients (69.7% male) were analyzed. Mean stone size was 52.3±39.3 mm2 for ureteral stones and 78.9±77.3 mm2 for renal stones, with 95 (43.6%) of the renal stones located in the lower pole. The single treatment success rates for ureteral and renal stones were 60.3% and 70.2%, respectively. On univariate analysis predictors of shock wave lithotripsy success, regardless of stone location, were age (p=0.01), body mass index (p=0.01), stone size (pstone density (pstone distance (pstone area and skin to stone distance were significant predictors with an AUC of 0.75. For ureteral calculi predictive factors included body mass index and stone size (AUC 0.70). Patient and stone parameters have been identified to create a nomogram that predicts shock wave lithotripsy outcomes using the Lithotron lithotripter, which can facilitate optimal treatment based decisions and provide patients with more accurate single treatment success rates for shock wave lithotripsy tailored to patient specific situations. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Endoscopic placement of double-J ureteric stents in children as a treatment for primary hydronephrosis.

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Pogorelić, Zenon; Brković, Tomislava; Budimir, Dražen; Todorić, Jakov; Košuljandić, Đurđica; Jerončić, Ana; Biočić, Mihovil; Saraga, Marijan

2017-06-01

The aim of this study was to determine the efficacy and potential complications of double-J ureteric stents in the treatment of primary hydronephrosis in pediatric patients. A retrospective case-records review of 133 patients (45 girls and 88 boys) treated because of primary hydronephrosis with double-J ureteric stents, in Department of Pediatric Surgery, Split University Hospital, between December 1997 and December 2014, was performed. Success of treatment, results of follow up investigations and complications were recorded. Patients were followed up clinically and radiologically for a minimum of 2 years following stent insertion. In all, 133 endoscopic double-J ureteric stents insertions were performed. Of the total number of patients, left-sided hydronephrosis was found in 82 patients, right-sided in 38, and bilateral in 13 patients. The median age of children was 2 years (range 0-17 years). Mean hospital stay was 2 days (range 1-10 days). In primary hydronephrosis, double-J ureteric stenting alone was effective with resolution of hydronephrosis in 73% of cases (97/133 insertions). Regarding the age of the patients the highest success of 83.5% was achieved in age group 0-4 years. Success in groups 5-9 years; 10-14 years and 15-17 years were 47%; 33.5% and 0%, respectively. Several complications have been recorded: symptomatic infections, migration in the renal pelvis and bladder, progression of hydronephrosis, spontaneously prolapse of prosthesis, bleeding and perforation of the renal pelvis. A significant, decreasing trend in success rates by age of participants was observed (p hydronephrosis. Endoscopic placement of ureteric double-J stents should be considered as a first-line treatment in the management of primary hydronephrosis especially in children till 4 years of age, with success rate of 83.5% and without the need for conventional surgery. In a case of failure we are time-consuming to definitive surgery.

The treatment of the reno-ureteral calculi by extracorporeal shockwave lithotripsy (ESWL).

Science.gov (United States)

Ceban, E

2012-06-12

Urolithiasis has an important role in the structure of urological pathology, due to its high incidence, frequency of recurrence and complications it might cause. There are many methods of treatment for kidney stones described in the scientific literature as conservative, surgical, laparoscopic, endoscopic, and ESWL. In this study, we have analyzed the ESWL method of treatment of reno-ureteral stones.There are still many controversies about the effectiveness of different models of lithotripters but the lithotripter type Modulith SLK Storz Medical (Germany) used in our clinic has proved to be very effective. ESWL is currently the first-line treatment for the majority of kidney and ureteral stones, which are up to 20 mm in diameter.

Evaluation with Decision Trees of Efficacy and Safety of Semirigid Ureteroscopy in the Treatment of Proximal Ureteral Calculi.

Science.gov (United States)

Sancak, Eyup Burak; Kılınç, Muhammet Fatih; Yücebaş, Sait Can

2017-01-01

The decision on the choice of proximal ureteral stone therapy depends on many factors, and sometimes urologists have difficulty in choosing the treatment option. This study is aimed at evaluating the factors affecting the success of semirigid ureterorenoscopy (URS) using the "decision tree" method. From January 2005 to November 2015, the data of consecutive patients treated for proximal ureteral stone were retrospectively analyzed. A total of 920 patients with proximal ureteral stone treated with semirigid URS were included in the study. All statistically significant attributes were tested using the decision tree method. The model created using decision tree had a sensitivity of 0.993 and an accuracy of 0.857. While URS treatment was successful in 752 patients (81.7%), it was unsuccessful in 168 patients (18.3%). According to the decision tree method, the most important factor affecting the success of URS is whether the stone is impacted to the ureteral wall. The second most important factor affecting treatment was intramural stricture requiring dilatation if the stone is impacted, and the size of the stone if not impacted. Our study suggests that the impacted stone, intramural stricture requiring dilatation and stone size may have a significant effect on the success rate of semirigid URS for proximal ureteral stone. Further studies with population-based and longitudinal design should be conducted to confirm this finding. © 2017 S. Karger AG, Basel.

Use of Self-Expanding Metallic Ureteral Stents in the Secondary Treatment of Ureteral Stenosis Following Kidney Transplantation.

Science.gov (United States)

Xu, Guibin; Li, Xun; He, Yongzhong; Zhao, Haibo; Yang, Weiqing; Xie, Qingling

2015-10-01

To evaluate the safety and efficacy of self-expanding metal stents in the treatment of ureteral stenosis following kidney transplantation. Seven patients who developed benign stenosis after kidney transplantation were treated by a self-expanding metallic stent implantation from June 2007 to March 2014. All patients had undergone at least one open surgical procedure and one endourologic procedure for treatment of the stenosis. The extent of stenosis varied from 1.2 to 3.7 cm. Ultrasonography, urography, diuretic renography, and urine culture were performed every 3 months after stent insertion. Ureteroscopic examination was performed when needed. Stent placement was technically effective in all cases. The mean operative time was 37 minutes (range, 26-59 minutes). Lower urinary-tract symptoms and the ipsilateral flank pain were common early-stage complications and were greatly relieved after an average of 3 months. The mean follow-up duration was 38 months (range, 13-86 months), and no stent migration or fragmentation was observed. Urothelial hyperplasia occurred in only one patient and was effectively managed with a Double-J stent. Five patients had normal stable renal function; the remaining two had impaired renal function, including one patient with a preoperative renal failure who required dialysis at the end of the follow-up period (36 months). As an alternative to open surgery, implantation of a self-expanding metal stent is a safe and effective treatment for ureteral stenosis in patients who have undergone kidney transplantation.

Repair of a common bile duct defect with a decellularized ureteral graft

Science.gov (United States)

Cheng, Yao; Xiong, Xian-Ze; Zhou, Rong-Xing; Deng, Yi-Lei; Jin, Yan-Wen; Lu, Jiong; Li, Fu-Yu; Cheng, Nan-Sheng

2016-01-01

AIM To evaluate the feasibility of repairing a common bile duct defect with a decellularized ureteral graft in a porcine model. METHODS Eighteen pigs were randomly divided into three groups. An approximately 1 cm segment of the common bile duct was excised from all the pigs. The defect was repaired using a 2 cm long decellularized ureteral graft over a T-tube (T-tube group, n = 6) or a silicone stent (stent group, n = 6). Six pigs underwent bile duct reconstruction with a graft alone (stentless group). The surviving animals were euthanized at 3 mo. Specimens of the common bile ducts were obtained for histological analysis. RESULTS The animals in the T-tube and stent groups survived until sacrifice. The blood test results were normal in both groups. The histology results showed a biliary epithelial layer covering the neo-bile duct. In contrast, all the animals in the stentless group died due to biliary peritonitis and cholangitis within two months post-surgery. Neither biliary epithelial cells nor accessory glands were observed at the graft sites in the stentless group. CONCLUSION Repair of a common bile duct defect with a decellularized ureteral graft appears to be feasible. A T-tube or intraluminal stent was necessary to reduce postoperative complications. PMID:28082809

Body mass index and buttock circumference are independent predictors of disintegration failure in extracorporeal shock wave lithotripsy for ureteral calculi.

Science.gov (United States)

Yang, Teng-Kai; Yang, Hung-Ju; Lee, Liang-Min; Liao, Chun-Hou

2013-07-01

Effective stone disintegration by extracorporeal shockwave lithotripsy (ESWL) may depend on patient- and stone-related factors. We investigated predictors of disintegration failure in ESWL for a solitary ureteral calculus. From July 2008 to May 2010, 203 patients who underwent ESWL for a solitary ureteral calculus were enrolled. Clinical and radiologic data were collected, and factors related to ESWL failure were analyzed. Fifty-two patients (25.6%) showed ESWL failure, with a mean follow-up of 41 days. Forty patients (19.7%) required retreatment, including 12 who underwent repeat ESWL and 28 who underwent curative ureteroscopy. Patients with ESWL failure had significantly higher body weight, body mass index (BMI), and buttock circumference (BC) than patients for whom ESWL was successful. Univariate analysis showed that stone burden (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.03-1.06) and BC (OR, 1.06; 95% CI, 1.01-1.11) were predictors of ESWL failure, while BMI was a potential predictor with borderline significance (OR, 1.09; 95% CI, 0.99-1.20). Multivariate analysis showed that stone burden (OR, 1.04; 95% CI, 1.03-1.06) was a significant predictor for all patients. On stratifying patients according to the level of ureteral calculi, BC was found to be an independent predictor (OR, 1.35; 95% CI, 1.02-1.80) for ESWL failure for middle/lower ureteral calculi and BMI (OR, 1.47; 95% CI, 1.13-1.91) for upper ureteral calculi. Stone burden is the main predictor of ESWL failure for all patients with ureteral calculi. BC and BMI are independent predictors for ESWL failure for middle/lower and upper ureteral calculi, respectively. Copyright © 2012. Published by Elsevier B.V.

[The thermoformable spiral metallic stents in the treatment of localized ureteral stenosis: an alternative to JJ stent? Prospective multicenter study].

Science.gov (United States)

Bonniol, R; Meria, P; Safsaf, A; Albouy, B; Sibert, L

2011-06-01

Evaluation of the effectiveness and tolerance of thermoformable metallic spiral stents Memokath(®) 051 (Bard, Pnn Medical) in the treatment of localized ureteral stenosis in non-operable patients who have JJ ureteral stents. Prospective, descriptive and multicenter study of patients with ureteral strictures treated with metallic ureteral stents Memokath(®) 051. Assessment criteria (recurrent stenotic, permeability, tolerance) were measured by clinical, biological and radiological examination at 1 month, and then every 3 months. Fifteen stents (average length: 9.15 cm, range 6-15 cm) were implanted in 14 patients (mean age: 55 years, range: 38-72 years) with secondary suspended ureteral stenosis during 2 years in two centers. The median follow-up was 11 months (range 6 to 24 months). Technical difficulty was observed with two patients. Stents are still up in four patients. The stenosis recurred in four patients with spontaneous progression of stenosis but without endoprosthetics tissue invasion. Two and three migration were observed with spontaneous expulsions. Two lower urinary infections and one high occurred, resolved on antibiotic therapy, no inlay or hematuria, no pain (mean VAS score=3/10) or urinary disorders of the lower unit have been identified. Stents Memokath(®) 051 are well tolered and seem to position themselves as an interesting alternative to JJ ureteral stent in some frails patients. The refinement of contraindication should help to improve the stent's efficacity and to reduce the risk of migration and expulsion. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

[Sciatic hernia as a cause of chronic pelvic pain].

Science.gov (United States)

De los Ríos, José F; Calle, Gustavo; Castañeda, Juan D; Serna, Eduardo A; Vásquez, Ricardo A; Arango, Adriana M; López, Claudia C

2013-04-01

Sciatic hernia constitutes the scarcest group of hernias of pelvic floor; however, they should be considered in the origin of chronic pelvic pain. The proper diagnosis of sciatic hernias has allowed to surgeons treating successfully patients with acute or chronic pelvic pain, with intestinal or ureteral obstruction and with urinary or gluteus sepsis. It has to be considered as differential diagnosis before the finding of a congenital or acquired gluteus mass. Laparoscopist gynecologist should know the existence of this defect, to be familiar with its aspect in laparoscopic view and to know the laparoscopic treatment of this disease.

Insertion of a single double-J stent for bilateral open ureteral reimplantation: introducing a novel technique and assessment of feasibility.

Science.gov (United States)

Nabavizadeh, Behnam; Keihani, Sorena; Hosseini Sharifi, Seyed Hossein; Kajbafzadeh, Abdol-Mohammad

2016-07-01

To propose a novel technique for bilateral placement of a single double-J stent during bilateral open ureteral reimplantation in order to reduce the intravesical length of stent and potentially minimize the irritative symptoms. A retrospective chart review was performed to find patients who underwent bilateral open ureteral reimplantation. According to the patient's age, an appropriate single double-J stent is used for stenting both ureters after open reimplantation using the Politano-Leadbetter technique. The stent is fixed to the bladder wall with a 4-0 chromic absorbable suture in the midline, superior to the intertrigonal ridge. A non-absorbable suture is also fixed to the stent in the midline as an extraction string. From June 2009 to July 2013, 20 patients underwent bilateral ureteric surgery. Twelve (60 %) were female. Patients' age ranged from 3 months to 2 years. Double-J stents were successfully removed within 2 weeks postoperatively in all patients. This technique might reduce the stent-related symptoms after open bladder surgery for bilateral ureteral surgery. Using this technique will reduce the redundant mass of ureteral stents in bladder and potentially minimize the trigonal irritation and subsequent pain and discomfort.

Revisiting the tethered ureteral stents in children: a novel modification.

Science.gov (United States)

Kajbafzadeh, Abdol-Mohammad; Nabavizadeh, Behnam; Keihani, Sorena; Hosseini Sharifi, Seyed Hossein

2015-06-01

To propose a simple noninvasive method for ureteral stent retrieval using an extraction string sutured to the skin in children. A retrospective chart review was performed to gather relevant data from December 2005 to February 2013. After the surgeries, if indicated, a tethered double-J stent was placed in the ureter. A 5-0 non-absorbable Prolene stitch was used as an extraction string passing through the urethra and was sutured to subcoronal skin in boys or inner surface of labia majora in girls. For stent removal, a small amount of 2 % lidocaine jelly was pushed into the urethra 5 min before the procedure. The string was then pulled by continuous and gentle force until the entire stent was out. The suture was then cut to release the stent. No sedation or anesthesia was needed. A total of 378 double-J stents with extraction strings were inserted for a total of 325 patients (61.2 % male). Of the 53 patients with bilateral ureteral stents, one male patient (1.88 %) experienced early stent protrusion from urethral meatus. Two of 272 patients (0.73 %) with unilateral ureteral stent (one male and one female) encountered the same problem. All other stents were extracted successfully using the extraction string without any complications. No upward stent migration or suture site reaction was encountered. This method is a safe, easy-to-use, feasible and noninvasive alternative for cystoscopic stent removal with high success rate and minimal complications. This can lead to considerable saving in time and costs for patients, families and healthcare system.

Molecular Pathology of Murine Ureteritis Causing Obstructive Uropathy with Hydronephrosis

Science.gov (United States)

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

2011-01-01

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. PMID:22114694

Role of ureteric stents in relieving obstruction in patients with obstructive uropathy

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M Shehab

2013-01-01

Conclusion: The predictors of renal recoverability revealed that ureteral stents alone can help in regaining renal function and significant improvement of clinical condition in patients with obstructive uropathy.

Extracorporeal shockwave lithotripsy versus ureteroscopy for distal ureteric calculi: efficacy and patient satisfaction

Directory of Open Access Journals (Sweden)

Ibrahim F. Ghalayini

2006-12-01

Full Text Available OBJECTIVE: We compared the efficacy of extracorporeal shock wave lithotripsy (ESWL and ureteroscopy (URS for the treatment of distal ureteral calculi with respect to patient satisfaction. MATERIALS AND MHETODS: This is a prospective study where a total of 212 patients with solitary, radiopaque distal ureteral calculi were treated with ESWL (n = 92 using Dornier lithotriptor S (MedTech Europe GmbH or URS (n = 120. Patient and stone characteristics, treatment parameters, clinical outcomes, and patient satisfaction were assessed for each group. RESULTS: The 2 groups were comparable in regard to patient age, sex, stone size, and side of treatment. The stone-free status for ESWL and URS at 3 months was 81.5% and 97.5%, respectively (p < 0.0001. In addition, 88% of patients who underwent ESWL versus 20% who underwent URS were discharged home the day of procedure. Minor complications occurred in 3.3% and 8.3% of the ESWL and URS groups, respectively (p = 0.127. No ureteral perforation or stricture occurred in the URS group. Postoperative flank pain and dysuria were more severe in the URS than ESWL group, although the differences were not statistically significant (p = 0.16. Patient satisfaction was high for both groups, including 94% for URS and 80% for ESWL (p = 0.002. CONCLUSIONS: URS is more effective than ESWL for the treatment of distal ureteral calculi. ESWL was more often performed on an outpatient basis, and showed a trend towards less flank pain and dysuria, fewer complications and quicker convalescence. Patient satisfaction was significantly higher for URS according to the questionnaire used in this study.

Size matters. The width and location of a ureteral stone accurately predict the chance of spontaneous passage

Energy Technology Data Exchange (ETDEWEB)

Jendeberg, Johan; Geijer, Haakan; Alshamari, Muhammed; Liden, Mats [Oerebro University Hospital, Department of Radiology, Faculty of Medicine and Health, Oerebro (Sweden); Cierzniak, Bartosz [Oerebro University, Department of Surgery, Faculty of Medicine and Health, Oerebro (Sweden)

2017-11-15

To determine how to most accurately predict the chance of spontaneous passage of a ureteral stone using information in the diagnostic non-enhanced computed tomography (NECT) and to create predictive models with smaller stone size intervals than previously possible. Retrospectively 392 consecutive patients with ureteric stone on NECT were included. Three radiologists independently measured the stone size. Stone location, side, hydronephrosis, CRP, medical expulsion therapy (MET) and all follow-up radiology until stone expulsion or 26 weeks were recorded. Logistic regressions were performed with spontaneous stone passage in 4 weeks and 20 weeks as the dependent variable. The spontaneous passage rate in 20 weeks was 312 out of 392 stones, 98% in 0-2 mm, 98% in 3 mm, 81% in 4 mm, 65% in 5 mm, 33% in 6 mm and 9% in ≥6.5 mm wide stones. The stone size and location predicted spontaneous ureteric stone passage. The side and the grade of hydronephrosis only predicted stone passage in specific subgroups. Spontaneous passage of a ureteral stone can be predicted with high accuracy with the information available in the NECT. We present a prediction method based on stone size and location. (orig.)

Medical expulsive treatment of distal ureteral stone using tamsulosin

International Nuclear Information System (INIS)

Ahmad, H.; Azim, W.; Akmal, M.; Murtaza, B.

2015-01-01

Many minimally invasive interventional techniques as well as expectant treatments exist for the management of lower ureteric calculi. This study was conducted to evaluate the efficacy of tamsulosin as an expulsive pharmacologic therapy for the treatment of distal ureteral stone. Methods: This randomized control trial included 100 patients over 18 years of age with stone Size = 8mm in distal 1/3 of ureter. Patients were randomly assigned into two groups (A and B). Group A Patients were given Capsule Tamsulosin 0.4 mg, 1 daily up to 4 weeks while group B patients were given placebo, 1 Capsule daily up to 4 weeks. The primary endpoint was expulsion rate. A written informed consent was taken from all the patients. Expulsion time, need for analgesics, need for hospitalization and drug side effects were secondary endpoints. Results: A total of 49 patients in group A and 48 patients in group B reported back, therefore 97 out of 100 patients were evaluated. Mean age of the patients was 36.34 years (range 18-57 years). Mean stone size was 5.78 mm (range 4-8 mm) in greatest dimension. A stone expulsion rate of 85.71% (42 patients) was noted in group A and 54.20% (26 patients) in group B. Group A revealed a statistically significant advantage in term of stone expulsion rate (p=0.032). Considering expulsion time in days group A showed statistically significant advantage (p=0.015). Regarding age, sex, stone size and stone lateralization (right/left), there was no significant difference between the group A and B. No drug side effects were noted in both the groups. Conclusion: By using tamsulosin a higher stone expulsion rates can be achieved in a shorter time. More randomized control trials are required to establish tamsulosin as a standard medical expulsive treatment for small distal ureteric calculus. (author)

Diagnosis of acute flank pain caused by ureteral stones: value of combined direct and indirect signs on IVU and unenhanced helical CT

International Nuclear Information System (INIS)

Wang, Li-Jen; Wong, Yon-Cheong; Ng, Chip-Jin; Chen, Jih-Chang; Chiu, Te-Fa

2004-01-01

The aim of this study was to assess the usefulness of combined direct and indirect signs on intravenous urography (IVU) and unenhanced helical computed tomography (UHCT) for the diagnosis of ureteral stones in emergency patients with acute flank pain. During an 8-month period, 82 emergency patients with acute flank pain undergoing IVU and UHCT with sufficient clinical follow-up formed the study group. The presence or absence of direct sign (visualization of ureteral stones) and indirect signs on IVU and UHCT was recorded. The diagnostic accuracy of each direct/indirect sign and their combination for the diagnosis of ureteral stones on IVU and UHCT were analyzed and compared. Of the 82 patients, 66 had ureteral stones, four had passed urinary stones prior to imaging and 12 had other diseases. The diagnostic accuracies of direct signs on IVU and UHCT for the diagnosis of ureteral stones were 79.3 and 98.8%, respectively, which was more accurate than that of any single indirect sign on IVU and UHCT. However, the diagnostic accuracy of ureteral stones by IVU increased to 90.2% when using diagnostic criteria requiring the presence of a direct sign or at least three indirect signs, and by UHCT, it increased to 100% when using diagnostic criteria requiring the presence of a direct sign with at least one indirect sign. Therefore, for emergency patients with acute flank pain, the use of the above combinations of direct/indirect signs is useful as the diagnostic criterion for ureteral stones. (orig.)

In Vivo and In Vitro Elution of Analgesics from Multilayered Poly(D,L-lactide-co-glycolide Nanofibers Incorporated Ureteral Stents

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Yi-Chia Lin

2018-01-01

Full Text Available We develop novel analgesic-eluting nanofiber-incorporated ureteral stents that offer sustained release of lidocaine and ketorolac for local drug delivery. Lidocaine and poly(D,L-lactide-co-glycolide (PLGA were dissolved in hexafluoroisopropanol and were electrospun into nonwoven nanofibers onto the surface of ureteral stents. This was followed by electrospinning of another layer of PLGA nanofibers containing ketorolac. Electrospun drug-loaded nanofibers were then characterized using scanning electron microscopy, Fourier transform infrared spectroscopy, and water contact angle analysis. In addition, the elution behavior characteristics of the analgesics, both in vivo and in vitro, from the nanofiber-incorporated stents were evaluated. Experimental results indicate that the analgesic-eluting ureteral stents could liberate high strengths of analgesics in vitro and in vivo for at least 50 and 30 days, respectively. The analgesic-eluting nanofiber-incorporated ureteral stents are potentially applicable for alleviating the discomfort associated with stent implant.

A randomized controlled trial comparing alpha blocker (tamsulosin) and anticholinergic (solifenacin) in treatment of ureteral stent-related symptoms.

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El-Nahas, Ahmed R; Tharwat, Mohamed; Elsaadany, Mohamed; Mosbah, Ahmed; Gaballah, Mohamed A

2016-07-01

To compare the effectiveness of tamsulosin and solifenacin in relieving ureteral stents related symptoms. A randomized controlled trial was conducted between January 2013 and July 2014. Inclusion criteria were patients aged 20-50 years who underwent temporary unilateral ureteral stent for drainage of calcular upper tract obstruction or after ureteroscopic lithotripsy. Patients with history of lower urinary tract symptoms before stent placement, stents that were fixed after open or laparoscopic procedures, and those who developed complications related to the primary procedure were not included. Eligible patients were randomly assigned to 1 of 3 groups using computer-generated random tables. Patients in group 1 received placebo, patients in group 2 received tamsulosin 0.4 mg once daily, and those in group 3 received solifenacin 5 mg once daily. Ureteral Stent Symptom Questionnaire (USSQ) was answered by all patients 1-2 weeks after stent placement. The primary outcome was the comparison of total score of USSQ between all groups. The study included 131 patients. All baseline characteristics (age, sex, side, indication, length, and duration of stent) were comparable for all groups. Total USSQ score was 61 in solifenacin group, 76 in tamsulosin group, and 83 in control group (P tamsulosin group (P tamsulosin alone or solifenacin alone in patients with ureteral stents can improve the quality of life by decreasing ureteral stent-related symptoms. Solifenacin was better than tamsulosin. CLINICALTRIAL. NCT01880619.

A rare complication of acute appendicitis: complete bilateral distal ureteral obstruction

NARCIS (Netherlands)

Aronson, D. C.; Moorman-Voestermans, C. G.; Tiel-van Buul, M. M.; Vos, A.

1994-01-01

Three children treated for appendicitis developed anuria and acute renal insufficiency several days after appendicectomy. Associated hydronephrosis or hydroureters were present in two. At cystoscopy, marked swelling of the trigonum and ureteric orifices was seen. One patient developed unilateral

The effect and influence of lumen holmium laser lithotripsy on serum oxidative stress proteins and inflammatory factors of ureteral calculi patients

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Fan Zhang

2016-09-01

Full Text Available Objective: To investigate the effect and influence of lumen holmium laser lithotripsy on treating serum oxidative stress proteins and inflammatory factors of patients with ureteral calculi. Methods: A total of 120 cases of patients with ureteral calculi treated in our hospital from May 2010 to Nov 2014 were enrolled in this research for an analysis study. The effect and influence on serum oxidative stress proteins and inflammatory factors of lumen holmium laser lithotripsy on ureteral calculi patients were assayed. Then 120 cases of healthy subjects in our hospital at the same period were taken as control. Results: Among the 120 cases of ureteral calculi patients, 113 cases of patients showed successful operation, with a success rate of 94.2%. The average calculi-discharged time was (28.4 ± 11.2 d and the average operation time was (58.9 ± 10.7 min, while the postoperative hospital stay is (3.8 ± 1.2 d. The results also showed that the levels of NOX1. NOX3, NOX4 and NOX5, and levels of interleukin-2 (IL-2, IL-6, IL-10 and TNF-α of patients with ureteral calculi were significantly higher, compared with the control group, and these parameters were normalized greatly after operation with that the levels of them were significantly different from those before operation. Conclusion: Lumen holmium laser lithotripsy exerts a significant effect on ureteral calculi patients and the oxidative stress parameters and inflammatory factor were normalized greatly.

Incidence of Deflux® calcification masquerading as distal ureteric calculi on ultrasound.

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Yankovic, Francisca; Swartz, Robert; Cuckow, Peter; Hiorns, Melanie; Marks, Stephen D; Cherian, Abraham; Mushtaq, Imran; Duffy, Patrick; Smeulders, Naima

2013-12-01

Dextranomer-hyaluronic acid (Deflux(®)), the most widely used compound in the endoscopic treatment of vesico-ureteric reflux (VUR) today, is believed to provoke only minimal inflammation. Reports of calcification of Deflux(®) are increasing. We ascertain the incidence of Deflux(®) calcification appearing as distal ureteric calculi on ultrasound. Three cases (2 external patients) of ureteroscopy for calcified submucosal Deflux(®) prompted a retrospective review of the notes and imaging of all children treated with Deflux(®) for VUR between December 2000 and January 2011 at Great Ormond Street Hospital. 232 children (M:F = 5:3) received Deflux(®) for VUR at median age 2 years (range 2 months-12 years). Follow-up annual ultrasound, performed in all, identified calcification in 2. The interval between Deflux(®) injection and presentation of its calcification was 4 years. 104 of the 232 children had been followed up for 4-10 years. Considering the observed lag-period, after 4 years the incidence of calcification of Deflux(®) on ultrasound was 2% (2/104). Patients should be warned that calcification of Deflux(®) can occur. Misinterpretation as ureteric stones is common and may lead to unnecessary ureteroscopy. In this series, the incidence of calcification of Deflux(®) on ultrasound after 4 years was 2%. Copyright © 2012 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Treatment of lower ureteric stones by ESWL and ICPL: a comparative study.

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Islam, M S; Shameem, I A; Alam, A K M K; Kibria, S A M G

2005-12-01

This study was carried-out to find-out better and effective treatment option for Lower Ureteric Stones (LUS) by comparing Extracorporeal Shock Wave Lithotripsy (ESWL) with ureterorenoscopic (URS) Intracorporeal Pneumatic Lithotripsy (ICPL). A total of 60 patients attending the outpatient department of Bangabandhu Sheikh Mujib Medical University (BSMMU) with lower ureteric stones were divided into two groups, 30 in group-I (URS + ICPL) and the remaining 30 in group-II (ESWL). In group-I, 60% were male with mean age of 32.76 years and in group-II, 40% were male with mean age of 36.23 years. The ratio of involvement of right to left ureter was 1.7:1. The mean stone size was 10.7 + 2.69 mm (SD) in group-I and 9.9 + 1.97 mm (SD) in group-II. The differences in age, sex and side of involvement of ureter were not significant (p > 0.05) between the two groups. Among the groups 24 (80%) in group-I and 26 (86.61%) of patients in group-II were found stone free. The post procedure loin pain, fever and haematuria were more common in group-I than in group-II. The LUTS and loin pain were significantly more in group-I than in group-II (p ESWL was found effective method than URS + ICPL for the treatment of lower ureteric stones.

Suture-free technique for canine ureteral resection-anastomosis using a microvascular anastomotic system: a cadaveric study.

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Wavreille, Vincent; Adin, Christopher A; Arango, Johnattan; Ham, Kathleen L; Byron, Julie K; McLoughlin, Mary A

2015-01-01

To describe a suture-free technique for canine ureteral resection-anastomosis using a microvascular anastomotic system (MAS) and to compare surgical time and burst pressure of hand-sewn (HS) ureteral end-to-end anastomosis with the MAS technique. Experimental ex vivo study. Canine cadavers (n = 8). For each cadaver, 1 ureter was randomly assigned to undergo HS anastomosis and the contralateral ureter had MAS anastomosis. The first 3 cadavers (6 ureters) were used to refine the MAS technique. In the other 5 dogs, surgical time and ureteral burst pressure were compared between groups (n = 5 ureters/group). Preliminary procedures showed that selective impaling of the mucosa and submucosa (without muscularis and adventitia) is necessary to allow complete mechanical interlock of the anastomotic rings for the MAS technique. Median anastomotic time was significantly shorter for MAS (7.6 min) than HS (16.6 min; p = .029) and burst pressure higher for MAS (393 cm H2 O) than HS (180 cm H2 O; p = .012). This study demonstrated the feasibility of a suture-free technique of canine ureteral resection-anastomosis using a commercially available MAS. The MAS anastomosis was faster and had higher burst strength compared with the HS anastomosis. © Copyright 2014 by The American College of Veterinary Surgeons.

Effect of Flos carthami Extract and α1-Adrenergic Antagonists on the Porcine Proximal Ureteral Peristalsis

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San-Yuan Wu

2014-01-01

Full Text Available Traditional Chinese medicine (TCM has been proposed to prevent urolithiasis. In China, Flos carthami (FC, also known as Carthamus tinctorius (Safflower; Chinese name: Hong Hua/紅花 has been used to treat urological diseases for centuries. We previously performed a screening and confirmed the in vivo antilithic effect of FC extract. Here, ex vivo organ bath experiment was further performed to study the effect of FC extract on the inhibition of phenylepinephrine (PE (10−4 and 10−3 M ureteral peristalsis of porcine ureters with several α1-adrenergic antagonists (doxazosin, tamsulosin, and terazosin as experimental controls. The results showed that doxazosin, tamsulosin, and terazosin dose (approximately 4.5 × 10−6 − 4.5 × 10−1 μg/mL dependently inhibited both 10−4 and 10−3 M PE-induced ureteral peristalsis. FC extract achieved 6.2% ± 10.1%, 21.8% ± 6.8%, and 24.0% ± 5.6% inhibitions of 10−4 M PE-induced peristalsis at doses of 5 × 103, 1 × 104, and 2 × 104 μg/mL, respectively, since FC extract was unable to completely inhibit PE-induced ureteral peristalsis, suggesting the antilithic effect of FC extract is related to mechanisms other than modulation of ureteral peristalsis.

Robotic versus open pediatric ureteral reimplantation: Costs and complications from a nationwide sample.

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Kurtz, Michael P; Leow, Jeffrey J; Varda, Briony K; Logvinenko, Tanya; Yu, Richard N; Nelson, Caleb P; Chung, Benjamin I; Chang, Steven L

2016-12-01

We sought to compare complications and direct costs for open ureteral reimplantation (OUR) versus robot-assisted laparoscopic ureteral reimplantation (RALUR) in a sample of hospitals performing both procedures. Anecdotal reports suggest that use of RALUR is increasing, but little is known of the outcomes and costs nationwide. The aim was to determine the costs and 90-day complications (of any Clavien grade) in a nationwide cohort of pediatric patients undergoing OUR or RALUR. Using the Premier Hospital Database we identified pediatric patients (age robotic experience, and that outcomes for these procedures should be carefully and systematically tracked. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Histochemical Analysis of Renal Dysplasia with Ureteral Atresia

International Nuclear Information System (INIS)

Kawate, Toyoko; Kawamura, Ryuki; Uchida, Takenori; Takahashi, Kyosuke; Hasegawa, Tomohiro; Futamata, Haruo; Katoh, Ryohei; Takeda, Sen

2009-01-01

Unilateral small kidney with ureteral obstruction was discovered in a 74-year-old female cadaver during an anatomical dissection course. In order to elucidate the histogenesis of renal dysplasia, we carried out histochemical and immunohistochemical analyses. On macroscopic view, the kidney was approximately 3 cm in length, 2 cm in width and weighed only 9 g. Although the ureter ran from the renal hilus to the bladder, its width was under 2 mm. The renal parenchyma was extremely thin and there was a large congested vein in the renal sinus. On microscopic examination of the kidney, we observed that numerous developing renal tubules had cytokeratin-positive epithelia, most of which were surrounded by concentric fibrosis. However, we could not detect any structures resembling the collecting duct, renal tubules, renal pelvis, or glomeruli. The concentric mesencymal fibrous tissue surrounding the immature renal tubules contained the smooth muscles that were positive for h-caldesmon. Serial sections of the ureter revealed several small and discontinuous lacunae lined by cuboidal and transitional epithelium, which did not constitute a patent lumen through the bladder. This case is a rare case of renal dysplasia with defect in recanalization of the ureteral bud during the early developmental stage

Metallic stent in the treatment of ureteral obstruction: Experience of single institute

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Chien-Chang Li

2011-10-01

Conclusion: Patients with ureteral obstructions can be treated sufficiently with the Resonance® metallic stent. Patients who had gynecological malignancies and received radiotherapy had a higher failure rate after Resonance® metallic stent insertion.

Ureteral in situ biocompatibility of L-lactide-glycolic acid copolymer 80:20 stent

International Nuclear Information System (INIS)

Hou Yuchuan; Wang Chunxi; Zhang Baogang; Chen Xuesi

2006-01-01

Objective: To evaluate the in situ biocompatibility of a new biodegradable ureteral stent made of L-lactide-glycolic acid copolymer 80:20 (PLGA 80:20). Methods: 16 dogs served as experimental animals. Ureteral stents of PLGA 80:20 were inserted in situ into the left ureter after transection at the mid level, then the ureters were routinely anastomosed. Ureters surrounding the stent were taken out 2, 4, 8 and 12 weeks postoperatively. The ureters were dissected to find changes of stents and local ureters. Histological analysis was performed to investigate tissue reactions to the stent and evaluate the biocompatibility. Rods of UROVISION stent served as controls. Results: The PLGA stent was degraded completely within 12 weeks post implantation. In the early stage (2-4 weeks), both stents induced epithelial hyperplasia and inflammatory cell reaction at local ureter (P>0.05). In the later stage (8-12 weeks), the tissue reaction nearly subsided in PLGA stented ureters after degradation of the device. Whereas, the tissue reaction induced by UROVISION stent had lasted throughout the observation period, even deteriorated with time going (P<0.05). Conclusion: The tissue reaction induced by PLGA stent is retrievable. PLGA is regarded highly compatible and can serve as an ideal material for biodegradable ureteral stent. (authors)

Safety and efficacy of silodosin and tadalafil in ease of negotiation of large ureteroscope in the management of ureteral stone: A prosective randomized trial.

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Bhattar, Rohit; Jain, Vipin; Tomar, Vinay; Yadav, Sher Singh

2017-12-01

To evaluate the safety and efficacy of silodosin and tadalafil in ease of negotiation of large size ureteroscope (8/9.8 Fr) in the management of ureteral stone. Between June 2015 and May 2016, 86 patients presented with ureteral stone of size 6-15 mm were on consent randomly assigned to 1 of 3 outpatient treatment arms: silodosin (Group A), tadalafil (Group B), and placebo (Group C). After two weeks of therapy 67 patients underwent ureteroscopy, and ureteral orifice configuration, ureteroscopic negotiation, ureteral dilatation, operating time, procedural complication and drug related side effects were noted in each group. Ureteral negotiation was significantly better in Groups A (73.9%) and B (69.6%) as compared to Group C (38.1%) (p<0.01). Statistically significant difference was noted in the requirement for dilatation in Group C (71.4%) as compared to Groups A (26.1%) and B (39.1%) (p<0.01). Ureteral orifice was found to be more dilated in Groups A (69.6%) and B (60.9%) as compared to Group C (28.6%). Mean operating time was statistically lower in Groups A (35.2 min) and B (34.91 min) as compared to Group C (41.14 min) (p<0.01). Both silodosin and tadalafil not only relax ureteral smooth muscle but also help in forward propagation of large size ureteroscope (8/9.8 Fr) without any significant risk of adverse events.

Inferior vena cava filter penetration following Whipple surgical procedure causing ureteral injury.

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Abdel-Aal, Ahmed Kamel; Ezzeldin, Islam B; Moustafa, Amr Soliman; Ertel, Nathan; Oser, Rachel

2015-12-01

We report a case of an indwelling inferior vena cava filter that penetrated the IVC wall after Whipple's pancreatico-duodenectomy procedure performed in a patient with ampullary carcinoma, resulting in right ureteral injury and obstruction with subsequent hydroureter and hydronephrosis. This was incidentally discovered on a computed tomography scan performed as routine follow up to evaluate the results of the surgery. We retrieved the inferior vena cava filter and placed a nephrostomy catheter to relieve the ureteral obstruction. Our case highlights the importance of careful inferior vena cava manipulation during abdominal surgery in the presence of an inferior vena cava filter, and the option of temporary removal of the filter to be placed again after surgery in order to avoid this complication, unless protection is required against clot migration during the surgical procedure.

The clinical implications of hydronephrosis and the level of ureteral obstruction in stage IIIB cervical cancer

International Nuclear Information System (INIS)

Chao, K.S. Clifford; Leung, W.-M.; Grigsby, Perry W.; Mutch, David G.; Herzog, Thomas; Perez, Carlos A.

1998-01-01

Purpose: There are two criteria for the diagnosis of Stage IIIB cervical cancer in the FIGO staging system: tumor fixation to the pelvic side wall and/or the presence of hydronephrosis due to tumor. However, we often encounter hydronephrosis without tumor fixed to the pelvic side wall or the level of ureteral obstruction not corresponding to the main tumor mass in the pelvis. The clinical implication of these phenomena remains unclear. We investigated the Stage IIIB population treated at the Mallinckrodt Institute of Radiology and hypothesized that, if hydronephrosis presents without tumor fixation to the pelvic side wall or if the level of ureteral obstruction is above the main pelvic tumor mass, it most likely resulted from external compression of ureter(s) by enlarged lymph nodes and, consequently, a worse outcome is expected. Methods and Materials: From 1959 to 1989, there were 297 patients with Stage IIIB cervical cancer who received definitive radiation therapy at the Mallinckrodt Institute of Radiology and were assessable for the presence of hydronephrosis and the level of ureteral obstruction. There were 281 patients who presented with tumor fixed to the pelvic side wall, and 62 of them were associated with concurrent hydronephrosis. An additional 16 patients presented with hydronephrosis without tumor fixation to the pelvic side wall. Among these 78 documented cases of hydronephrosis, the level of ureteral obstruction was above the true pelvis in 39 patients, and below the true pelvis in the other 39. Radiation therapy was individualized according to tumor extension and configuration; para-aortic lymph nodes were not routinely treated except in patients with clinical evidence of nodal metastasis. Results: The progression-free survival (PFS) at 5 years was 35% in 62 patients with hydronephrosis and tumor fixed to the pelvic side wall vs. 43% in 213 patients with tumor fixed to the pelvic side wall only (p 0.12). However, PFS at 5 years decreased to 23% in

Ureteric stricture secondary to unusual extension of prostatic adenocarcinoma.

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Chalasani, Venu; Macek, Petr; O'Neill, Gordon F; Barret, Wade

2010-02-01

This article describes an unusual finding in a patient who presented with an adenocarcinoma of the prostate and right hydronephrosis. A 68-year-old male presented with right hydronephrosis and a PSA of 96. DRE was consistent with cT3 carcinoma. Cystoscopy showed an exophytic superficial transitional cell carcinoma (TCC) of the bladder and a transrectal biopsy of the prostate confirmed adenocarcinoma Gleason score 4+3. Staging investigations (CT pelvis and bone scan) were negative; androgen deprivation therapy was therefore initiated for the prostatic adenocarcinoma. Upper tract imaging showed multiple filling defects in the proximal ureter. Ureteroscopy showed a stricture at the level of the iliac vessels. With a working diagnosis of upper tract TCC, right open nephroureterectomy was performed. Final histology showed prostatic adenocarcinoma infiltrating the adventitia of the entire ureter up to the level of the renal pelvis. A rare cause of ureteric stricture, contiguous spread of prostatic adenocarcinoma, should be considered in the differential diagnosis of patients presenting with upper tract obstruction and a known history of prostatic adenocarcinoma. Androgen deprivation therapy for several months did not seem to cause resolution of the tumor in the periureteric, ureteric and perihilar tissues.

Chronic renal failure due to unilateral renal agenesis and total renal dysplasia (=aplasia)

International Nuclear Information System (INIS)

Kroepelin, T.; Ziupa, J.; Wimmer, B.

1983-01-01

Three adult patients with unilateral renal agenesis/total dysplasia (= aplasia) and with an early chronic renal failure are presented. One patient had renal agenesis without ureter bud and ureteric ostium on one side, and reflux pyelonephritis on the other; one had small compact total renal dysplasia (= aplasia) on one side, while chronic uric acid nephropathy (chronic renal disease as a cause of gout) was diagnosed on the other; the third patient had a total large multicystic dysplasia on one side, and on the other a segmental large multicystic dysplasia. Radiological steps and radiodiagnostic criteria are discussed and the combination of urogenital and extraurogenital anomalies is referred to. (orig.)

Role of Tamsulosin in Improving Double-J Ureteric Stent-Related ...

African Journals Online (AJOL)

Objective: To evaluate the efficacy of tamsulosin in improving stent- related symptoms and quality of life (QoL) in patients with double-J (DJ) ureteric stents. Subjects and Methods: A total of 136 patients were prospectively evaluated and distributed randomly in two groups. Group 1 was 69 patients with mean age 35 years ...

Is pre-operative imaging essential prior to ureteric stone surgery?

Science.gov (United States)

Youssef, F R; Wilkinson, B A; Hastie, K J; Hall, J

2012-09-01

The aim of this study was to identify patients not requiring ureteric stone surgery based on pre-operative imaging (within 24 hours) prior to embarking on semirigid ureteroscopy (R-URS) for urolithiasis. The imaging of all consecutive patients on whom R-URS for urolithiasis was performed over a 12-month period was reviewed. All patients had undergone a plain x-ray of the kidney, ureters and bladder (KUB), abdominal non-contrast computed tomography (NCCT-KUB) or both on the day of surgery. A total of 96 patients were identified for the study. Stone sizes ranged from 3 mm to 20 mm. Thirteen patients (14%) were cancelled as no stone(s) were identified on pre-operative imaging. Of the patients cancelled, 8 (62%) required NCCT-KUB to confirm spontaneous stone passage. One in seven patients were stone free on the day of surgery. This negates the need for unnecessary anaesthetic and instrumentation of the urinary tract, with the associated morbidity. Up-to-date imaging prior to embarking on elective ureteric stone surgery is highly recommended.

Human Health Countermeasures - Partial-Gravity Analogs Workshop

Science.gov (United States)

Barr, Yael; Clement, Gilles; Norsk, Peter

2016-01-01

The experimental conditions that were deemed the most interesting by the HHC Element lead scientists are those permitting studies of the long-term effects of exposure to (a) chronic rotation when supine or in head down tilt (ground-based); and (b) long-radius centrifugation (space based). It is interesting to note that chronic ground based slow rotation room studies have not been performed since the 1960's, when the USA and USSR were investigating the potential use of AG for long-duration space missions. On the other hand, the other partial gravity analogs, i.e., parabolic flight, HUT, suspension, and short-radius centrifugation, have been regularly used in the last three decades (see review in Clément et al. 2015). Based on the workshop evaluations and the scores by the HHC scientific disciplines indicated in tables 3 and 4, simulation of partial G between 0 and 1 should be prioritized as follows: Priority 1. Chronic space-based partial-G analogs: a. Chronic space-based long-radius centrifugation. The ideal scenario would be chronic long-radius centrifugation of cells, animals and humans in a translational research approach - ideally beyond low earth orbit under deep space environmental effects and at various rotations - to obtain different G-effects. In this scenario, all physiological systems could be evaluated and the relationship between physiological response and G level established. This would be the most integrative way of defining, for the first time ever, G-thresholds for each physiological system. b. Chronic space-based centrifugation of animals. Chronic centrifugation of rodents at various G levels in space would allow for determination of AG thresholds of protection for each physiological system. In this case, all physiological systems will be of interest. Intermittent centrifugation will be of secondary interest. c. Chronic space-based centrifugation of cell cultures (RWV). Bioreactor studies of cells and cell cultures of various tissues at various G

Efficacy of tamsulosin hydrochloride in relieving "double-J ureteral stent-related morbidity": a randomized placebo controlled clinical study.

Science.gov (United States)

Singh, Iqbal; Tripathy, Sambit; Agrawal, Vivek

2014-12-01

To evaluate the efficacy of tamsulosin therapy in reducing ureteral double-J stent morbidity by evaluating USSQ, IPSS, QOL and VAS (primary objective) and to evaluate the morbidity and or complication(s) associated with indwelling double-J ureteral stent(s) and to evaluate the safety of tamsulosin therapy for "morbidity associated with double-J stents" by evaluating its tolerability, side effects and adverse events if any (secondary objective) as per protocol. After institutional review board approval, 60 consecutive patients with a double-J ureteral stent inserted after percutaneous nephrolithotomy or ureteroscopic stone treatment were randomly assigned to receive tamsulosin 0.4 mg, or a placebo for 4 weeks. The validated USSQ, VAS and IPSS were completed before stent insertion, at 3 days and 4 weeks after stent insertion and at 2 weeks after stent removal. Data were statistically analyzed for efficacy and tolerability of one drug over the other using Wilcoxon signed-rank test, Mann-Whitney test and Student's t test. Patients receiving tamsulosin compared with the placebo showed significant decrease in urinary index score, pain index score, work performance score, VAS score at loin area, VAS score at flank, VAS score at suprapubic area, average VAS score, need for antibiotics, number of hospital visits (P tamsulosin but, however, the decrease was not significant. No patients discontinued medication because of side effects. We conclude that ureteral stenting using double-J stents with concomitant tamsulosin therapy was generally well tolerated, safe, effective and significantly beneficial in reducing stent morbidity in the majority of our patients. We advocate the routine use of concomitant tamsulosin therapy in eligible patients undergoing ureteral stenting in order to minimize stent morbidity.

Comparative Study of Ureteral Stents Following Endoureterotomy in the Porcine Model: 3 vs 6 Weeks and 7F vs 14F

International Nuclear Information System (INIS)

Soria, Federico; Sanchez, Francisco M.; Sun, Fei; Ezquerra, Javier; Duran, Esther; Uson, Jesus

2005-01-01

The aim of the study was to determine the optimal stent size and stenting duration following retrograde endoureterotomy of experimental ureteral strictures. Twenty healthy Large White female pigs were randomly divided into four groups, depending on stent size (7F vs 14F) and stenting duration (3 weeks vs 6 weeks). Three additional pigs were used as the control group. The internal ureteral diameter was measured 2 cm below the lower pole of the right kidney. Histopathological changes of the urinary tract, ultrasonographic and fluoroscopic studies, urine culture, and serum urea and creatine levels were analyzed during the different phases of the study. The study was divided into three phases. Phase I included premodel documentation of the normal urinary tract and laparoscopic ureteral stricture creation. During the second phase 1 month later, the diagnosis and endourologic treatment of strictures were performed. Phase III began 4 weeks after stent removal; follow-up imaging studies and postmortem evaluation of all animals were performed. Ureteral strictures developed in all animals 4 weeks after model creation. Results from ureteral diameter measurements and pathological studies revealed no statistically significant intergroup differences. However, prevalence of urinary infection proved to be directly related to stent size (14F) and permanence (6 weeks). The chi square results suggest a statistically significant relationship between the urinary tract infection and recurrent strictures (α = 0.046). We recommend the use of 7F stents for a period of 3 weeks or less, as these are more easily positioned and result in the reduction of secondary side effects (lower infection rate, less intramural ureteral lesions). A significant relationship between urinary tract infection and stricture recurrence was found in this experimental study

Early Experience Of Pneumatic Lithoclast For The Management Of Ureteric Stones At Peshawar.

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Nawaz, Ahmad; Wazir, Bakhtawar Gul; Orakzai, Akhtar Nawaz

2016-01-01

Pakistan lies in the Afro-Asia stone belt. Ureteric calculi are common occurrence and a major burden on health care facilities in Pakistan. The objective of this study was to assess the efficacy and safety of pneumatic lithoclast in the management of ureteric calculi. Case series study Department of Urology at Institute of Kidney Diseases Hayatabad Peshawar, from 1st Oct 2010 to 1st Oct 2011. One-hundred adult patients with ureteric calculi ≥ 0.7 cm were evaluated by history, physical examination, routine blood and urine examination after taking their written informed consent and approval of ethical committee. Ultrasound and X-ray KUB were done with IVU if required. All patients underwent ureteroscopy within intracorporeal lithotripsy and JJ stenting. Patients were followed up with post-op X-ray KUB at 24 hours and then weekly intervals till they became stone free. Following parameters were assessed: stone size, site, laterality, degree of fragmentation, success rate, stone migration and complications. Inability to reach the calculus with URS, proximal migration of stone or requirement of another/auxiliary procedure was considered failure. One hundred and ten patients were enrolled with a mean age of 38±10 years. There were 72 males and 28 females. Fifty-eight calculi were on right and 42 on left side. 24, 24 and 52 stones were in upper, middle and lower ureter respectively. Forty stones measured 7-10 mm, 52 measured 11-15 mm and 8 measured 16-20 mm in size. 98 stones were broken while 2 calculi migrated proximally. Overall success rate was 90% (Efficiency Quotient =78.95). Success rate in upper, middle and lower ureter was 83.3%, 83.3% and 96.1% respectively. 10 and 2 patients required ESWL and open ureterolithotomy, respectively, as additional treatment. Mean operative time was 33.5 minutes. There were no major complications.. Pneumatic lithoclast with URS is effective and safe in the management of the ureteric calculi with some limitations in the upper ureter.

The effect of diclofenac (Voltarol) and pethidine on ureteric peristalsis and the isotope renogram

International Nuclear Information System (INIS)

Brough, R.J.; Lancashire, M.J.R.; Prince, J.R.; Rose, M.R.; Prescott, M.C.; Testa, H.J.; Payne, S.R.

1998-01-01

Diclofenac (a non-steroidal anti-inflammatory drug) and pethidine (a synthetic opiate) are the two analgesics most commonly used to relieve the pain of ureteric colic. Fast frame renography is a non-invasive means of imaging ureteric peristalsis and renal drainage. The aim of this study was to determine the effects of each of these drugs on the drainage pattern of the upper tracts. Twelve normal male volunteers were studied. All underwent a standard fast frame renogram using 75 MBq of technetium-99m-mercaptoacetyltriglycine, and were then administered either 100 mg pethidine or 75 mg diclofenac by intramuscular injection. Fast frame renography was then repeated. Peristalsis was determined from the condensed image of each ureter and the renogram curves were analysed to obtain standard parameters and deconvolution analysis. Diclofenac caused a profound disruption to both ureteric peristalsis and the renogram curve. This effect was not seen after the administration of pethidine. Deconvolution analysis suggests the effects of diclofenac are mediated via a direct effect on drainage rather than by any alteration of blood flow to the kidney. This study suggests that pethidine is the analgesic of choice prior to renography and that inferences about alterations of drainage in the presence of diclofenac should be interpreted with care. (orig.)

Efficacy and Safety of Tamsulosin in Medical Expulsive Therapy for Distal Ureteral Stones with Renal Colic: A Multicenter, Randomized, Double-blind, Placebo-controlled Trial.

Science.gov (United States)

Ye, Zhangqun; Zeng, Guohua; Yang, Huan; Tang, Kun; Zhang, Xiaochun; Li, Hong; Li, Weibing; Wu, Zhong; Chen, Lingwu; Chen, Xingfa; Liu, Xiankui; Deng, Yaoliang; Pan, Tiejun; Xing, Jinchun; Wang, Shusheng; Cheng, Yue; Gu, Xiaojian; Gao, Wenxi; Yang, Jianggen; Zhang, Yonghai; Mi, Qiwu; Qi, Lin; Li, Jiongming; Hu, Weilie; Liang, Peiyu; Sun, Zhaolin; Xu, Changbao; Long, Yongfu; Liao, Yongbin; Liu, Siping; Liu, Guoqing; Xu, Xun; He, Wei; Chen, Zhiqiang; Xu, Hua

2017-11-12

Recent large high-quality trials have questioned the clinical effectiveness of medical expulsive therapy using tamsulosin for ureteral stones. To evaluate the efficacy and safety of tamsulosin for distal ureteral stones compared with placebo. We conducted a double-blind, placebo-controlled study of 3296 patients with distal ureteral stones, across 30 centers, to evaluate the efficacy and safety of tamsulosin. Participants were randomly assigned (1:1) into tamsulosin (0.4mg) or placebo groups for 4 wk. The primary end point of analysis was the overall stone expulsion rate, defined as stone expulsion, confirmed by negative findings on computed tomography, over a 28-d surveillance period. Secondary end points included time to stone expulsion, use of analgesics, and incidence of adverse events. Among 3450 patients randomized between September 1, 2011, and August 31, 2013, 3296 (96%) were included in the primary analysis. Tamsulosin benefits from a higher stone expulsion rate than the placebo (86% vs 79%; ptamsulosin for the treatment of large distal ureteral stones (>5mm). Considering the secondary end points, tamsulosin-treated patients reported a shorter time to expulsion (ptamsulosin use benefits distal ureteral stones in facilitating stone passage and relieving renal colic. Subgroup analyses find that tamsulosin provides a superior expulsion rate for stones >5mm, but no effect for stones ≤5mm. In this report, we looked at the efficacy and safety of tamsulosin for the treatment of distal ureteral stones. We find that tamsulosin significantly facilitates the passage of distal ureteral stones and relieves renal colic. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Computer aided detection of ureteral stones in thin slice computed tomography volumes using Convolutional Neural Networks.

Science.gov (United States)

Längkvist, Martin; Jendeberg, Johan; Thunberg, Per; Loutfi, Amy; Lidén, Mats

2018-06-01

Computed tomography (CT) is the method of choice for diagnosing ureteral stones - kidney stones that obstruct the ureter. The purpose of this study is to develop a computer aided detection (CAD) algorithm for identifying a ureteral stone in thin slice CT volumes. The challenge in CAD for urinary stones lies in the similarity in shape and intensity of stones with non-stone structures and how to efficiently deal with large high-resolution CT volumes. We address these challenges by using a Convolutional Neural Network (CNN) that works directly on the high resolution CT volumes. The method is evaluated on a large data base of 465 clinically acquired high-resolution CT volumes of the urinary tract with labeling of ureteral stones performed by a radiologist. The best model using 2.5D input data and anatomical information achieved a sensitivity of 100% and an average of 2.68 false-positives per patient on a test set of 88 scans. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Robot-assisted laparoscopic versus open partial nephrectomy in patients with chronic kidney disease: A propensity score-matched comparative analysis of surgical outcomes.

Science.gov (United States)

Takagi, Toshio; Kondo, Tsunenori; Tachibana, Hidekazu; Iizuka, Junpei; Omae, Kenji; Kobayashi, Hirohito; Yoshida, Kazuhiko; Tanabe, Kazunari

2017-07-01

To compare surgical outcomes between robot-assisted laparoscopic partial nephrectomy and open partial nephrectomy in patients with chronic kidney disease. Of 550 patients who underwent partial nephrectomy between 2012 and 2015, 163 patients with T1-2 renal tumors who had an estimated glomerular filtration rate between 30 and 60 mL/min/1.73 m 2 , and underwent robot-assisted laparoscopic partial nephrectomy or open partial nephrectomy were retrospectively analyzed. To minimize selection bias between the two surgical methods, patient variables were adjusted by 1:1 propensity score matching. The present study included 75 patients undergoing robot-assisted laparoscopic partial nephrectomy and 88 undergoing open partial nephrectomy. After propensity score matching, 40 patients were included in each operative group. The mean preoperative estimated glomerular filtration rate was 49 mL/min/1.73 m 2 . The mean ischemia time was 21 min in robot-assisted laparoscopic partial nephrectomy (warm ischemia) and 35 min in open partial nephrectomy (cold ischemia). Preservation of the estimated glomerular filtration rate 3-6 months postoperatively was not significantly different between robot-assisted laparoscopic partial nephrectomy and open partial nephrectomy (92% vs 91%, P = 0.9348). Estimated blood loss was significantly lower in the robot-assisted laparoscopic partial nephrectomy group than in the open partial nephrectomy group (104 vs 185 mL, P = 0.0025). The postoperative length of hospital stay was shorter in the robot-assisted laparoscopic partial nephrectomy group than in the open partial nephrectomy group (P negative surgical margin status were not significantly different between the two groups. In our experience, robot-assisted laparoscopic partial nephrectomy and open partial nephrectomy provide similar outcomes in terms of functional preservation and perioperative complications among patients with chronic kidney disease. However, a lower estimated blood loss and

Efficacy and Safety of Alfuzosin as Medical Expulsive Therapy for Ureteral Stones: A Systematic Review and Meta-Analysis.

Directory of Open Access Journals (Sweden)

Chenli Liu

Full Text Available Alfuzosin has been widely used to treat benign prostatic hyperplasia and prostatitis, and is claimed to be a selective agent for the lower urinary tract with low incidence of adverse side-effects and hypotensive changes. Recently, several randomized controlled trials have reported using Alfuzosin as an expulsive therapy of ureteral stones. Tamsulosin, another alpha blocker, has also been used as an agent for the expulsive therapy for ureteral stones. It is unclear whether alfuzosin has similar efficacy as Tamsulosin in the management of ureteral stones.To perform a systematic review and analysis of literatures comparing Alfuzosin with Tamsulosin or standard conservative therapy for the treatment of ureteral stones less than 10 mm in diameter.A systematic literature review was performed in December 2014 using Pubmed, Embase, and the Cochrane library databases to identify relevant studies. All randomized and controlled trials were included. A subgroup analysis was performed comparing Alfuzosin with control therapy on the management of distal ureteral stones.Alfuzosin provided a significantly higher stone-free rate than the control treatments (RR: 1.85; 95% confidence interval [CI], 1.35-2.55; p<0.001, and a shorter stone expulsion time (Weighted mean difference [WMD]: -4.20 d, 95%CI, -6.19 to -2.21; p<0.001, but it has a higher complication rate (RR: 2.02; 95% CI, 1.30-3.15; p<0.01. When Alfuzosin was compared to Tamsulosin, there was no significant difference in terms of stone-free rate (RR: 0.90; 95% CI, 0.79-1.02; p = 0.09 as well as the stone expulsion time (WMD: 0.52 d, 95%CI, -1.61 to 2.64; p = 0.63. The adverse effects of Alfuzosin were similar to those of Tamsulosin (RR: 0.88; 95% CI, 0.61-1.26; p = 0.47.Alfuzosin is a safe and effective agent for the expulsive therapy of ureteral stones smaller than 10 mm in size. It is more effective than therapeutic regiment without alpha blocker. It is equivalent to Tamsulosin in its effectiveness and

Bedside Ultrasound in the Emergency Department to Detect Hydronephrosis for the Evaluation of Suspected Ureteric Colic.

Science.gov (United States)

Shrestha, R; Shakya, R M; Khan A, A

2016-01-01

Background Renal colic is a common emergency department presentation. Hydronephrosis is indirect sign of urinary obstruction which may be due to obstructing ureteric calculus and can be detected easily by bedside ultrasound with minimal training. Objective To compare the accuracy of detection of hydronephrosis performed by the emergency physician with that of radiologist's in suspected renal colic cases. Method This was a prospective observational study performed over a period of 6 months. Patients >8 years with provisional diagnosis of renal colic with both the bedside ultrasound and the formal ultrasound performed were included. Presence of hydronephrosis in both ultrasounds and size and location of ureteric stone if present in formal ultrasound was recorded. The accuracy of the emergency physician detection of hydronephrosis was determined using the scan reported by the radiologists as the "gold standard" as computed tomography was unavailable. Statistical analysis was executed using SPSS 17.0. Result Among the 111 included patients, 56.7% had ureteric stone detected in formal ultrasound. The overall sensitivity, specificity, positive predictive value and negative predictive value of bedside ultrasound performed by emergency physician for detection of hydronephrosis with that of formal ultrasound performed by radiologist was 90.8%., 78.3%, 85.5% and 85.7% respectively. Bedside ultrasound and formal ultrasound both detected hydronephrosis more often in patients with larger stones and the difference was statistically significant (p=.000). Conclusion Bedside ultrasound can be potentially used as an important tool in detecting clinically significant hydronephrosis in emergency to evaluate suspected ureteric colic. Focused training in ultrasound could greatly improve the emergency management of these patients.

Tamsulosin versus tadalafil as a medical expulsive therapy for distal ureteral stones: A prospective randomized study.

Science.gov (United States)

Kc, Hari Bahadur; Shrestha, Anil; Acharya, Ganesh Bhakta; Basnet, Robin Bahadur; Shah, Arvind Kumar; Shrestha, Parash Mani

2016-09-01

This study aimed to compare the safety and efficacy of tamsulosin and tadalafil as medical expulsive therapy for distal ureteral stones. This prospective randomized study was conducted at the Department of Urology of Bir Hospital over a period of 12 months in patients with distal ureteral stones sized 5 to 10 mm. Patients were randomly divided into 2 groups: group A received tamsulosin 0.4 mg and group B received tadalafil 10 mg at bedtime for 2 weeks. Stone expulsion rate, number of ureteric colic episodes and pain score, analgesic requirements, and adverse drug effects were noted in both groups. Statistical analyses were performed by using Student t-test and chi-square test. Altogether 85 patients, 41 in group A and 44 in group B, were enrolled in the study. The patients' average age was 31.72±12.63 years, and the male-to-female ratio was 1.5:1. Demographic profiles, stone size, and baseline investigations were comparable between the 2 groups. The stone expulsion rate was significantly higher in the tadalafil group than in the tamsulosin group (84.1% vs. 61.0%, p=0.017). Although the occurrence of side effects was higher with tadalafil, this difference was not significant (p=0.099). There were no serious adverse effects. Tadalafil has a significantly higher stone expulsion rate than tamsulosin when used as a medical expulsive therapy for distal ureteral stones sized 5-10 mm. Both drugs are safe, effective, and well tolerated with minor side effects.

Editorial comment on: “Ureteritis cystica: A rare benign lesion”

African Journals Online (AJOL)

E.O. Kehinde

This is an interesting rare case of filling defects in the ureter of a. Sudanese lady, proved to be due to ureteritis cystica. The correct diagnosis was made by the finding of filling defects in the ureter on. CT urography and MRU films and at ureteroscopy and biopsy. Nat- urally as clinicians, we think of neoplasms first in such ...

Fibroepithelial ureteral polyps presenting as ureteropelvic obstruction

Science.gov (United States)

Cusano, Antonio; Abarzua-Cabezas, Fernando; Kesler, Stuart

2014-01-01

A 57-year-old woman presented with bilateral abdominal pain and flank discomfort. Imaging studies, consisting of CT scan, diethylene triamine pentaacetic acid renal scan with Lasix and a retrograde pyelogram, indicated an obstruction at the uteropelvic junction (UPJ), possibly due to fibroepithelial polyps within the ureter. A robotic pyeloplasty revealed a ureteral diverticulum and a thin, still-attached fibroepithelial polyp of approximately 2 cm in length. The patient tolerated the procedure well and was discharged one day postpyeloplasty with no reported complications. This rare clinical scenario should be considered when formulating a diagnosis for a UPJ obstruction. PMID:24759168

Endoluminal release of ureteral ligature after hysterectomy

Directory of Open Access Journals (Sweden)

Chih-Jen Wang

2016-01-01

Full Text Available Iatrogenic ureteral injury is a well-recognized complication of abdominal total hysterectomy. We report a case of a 57-year-old female who underwent abdominal total hysterectomy for a uterine myoma and experienced severe right flank pain postoperatively. The imaging study displayed an obstruction of the right distal ureter. Under ureteroscopy, an extraluminal ligature was released with a holmium:yttrium–aluminum–garnet laser. The stenotic segment was immediately relieved. Two months later, the intravenous urogram illustrated patency of the distal ureter with regression of right hydronephrosis. There was no recurrent hydronephrosis during 1 year of follow-up.

Tamsulosin versus tamsulosin plus tadalafil as medical expulsive therapy for lower ureteric stones: a randomized controlled trial.

Science.gov (United States)

Jayant, Kumar; Agrawal, Rajendra; Agrawal, Swati

2014-10-01

To compare the efficacy of tamsulosin versus tamsulosin plus tadalafil as medical expulsive therapy for lower ureteric stones. Between January 2013 and December 2013, 244 patients presenting with distal ureteric stones (size 5-10 mm) were randomized equally to tamsulosin (group A) or tamsulosin plus tadalafil (group B). Therapy was given for a maximum of 4 weeks. Stone expulsion rate, time to stone expulsion, analgesic use, number of hospital visits for pain, follow up, endoscopic treatment and adverse effects of drugs were recorded. Statistical analyses were carried out using Student's t-test and the χ(2) -test. There was a statistically significant higher expulsion rate in group B compared with group A (83.6% vs 65.5%; P-value = 0.031) and a shorter time to expulsion (14.9 ± 4.4 days vs 16.7 ± 4.8 days; P-value = 0.003). Statistically significant differences were noted in terms of the number of hospital visits and analgesic requirement in favor of group B. There was no serious adverse event. An improvement in erectile function was noted in patients of group B compared with those of group A. Medical expulsive therapy for distal ureteric stones using tamsulosin plus tadalafil is safe, effective and well tolerated. Furthermore, tadalafil provides the additional advantage of improving erectile dysfunction when this condition coexists with a lower ureteric stone. © 2014 The Japanese Urological Association.

Percutaneous Balloon Dilatation for the Treatment of Early and Late Ureteral Strictures After Renal Transplantation: Long-Term Follow-Up

International Nuclear Information System (INIS)

Bachar, Gil N.; Mor, E.; Bartal, G.; Atar, Eli; Goldberg, N.; Belenky, A.

2004-01-01

We report our experience with percutaneous balloon dilatation (PBD) for the treatment of ureteral strictures in patients with renal allografts. Of the 422 consecutive patients after renal transplantation in our center 10 patients had ureteral strictures. An additional 11 patients were referred from other centers. The 21 patients included 15 men and 6 women aged 16 to 67 years. Strictures were confirmed by sonography and scintigraphy in all cases. Patients underwent 2 to 4 PBDs at 7-10-day intervals. Clinical success was defined as resolution of the stenosis and hydronephrosis on sequential ultrasound and normalization of creatinine levels. Patients were divided into two groups: those who underwent transplantation more than 3 months previously and those who underwent transplantation less than 3 months previously. PBD was successful in 13 of the 21 patients (62%). There was no statistically significant difference in success rate between the patients with early (n 12) and those with late (n = 9) obstruction: 58.4% and 66%, respectively. No major complications were documented. PBD is a safe and simple tool for treating ureteral strictures and procedure-related morbidity is low. It can serve as an initial treatment in patients with early or late ureteral strictures after renal transplantation

Outcome analysis of holmium laser and pneumatic lithotripsy in the endoscopic management of lower ureteric calculus in pediatric patients: a prospective study

Directory of Open Access Journals (Sweden)

Ankur Jhanwar

Full Text Available ABSTRACT Objective: To analyse outcomes of holmium laser and pneumatic lithotripsy in treatment of lower ureteric calculus in pediatric patients. Materials and methods: Prospective study conducted between August 2013 and July 2015. Inclusion criteria were lower ureteric calculus with stone size ≤1.5cms. Exclusion criteria were other than lower ureteric calculus, stone size ≥1.5cms, congenital renal anomalies, previous ureteral stone surgery. Patients were divided into two groups. Group A underwent pneumatic and group B underwent laser lithotripsy procedure. Patient's baseline demographic and peri-operative data were recorded and analysed. Post operatively X-ray/ultrasound KUB (Kidney, ureter and bladder was performed to assess stone free status. Results: A total of 76 patients who met the inclusion criteria to ureteroscopic intracorporeal lithotripsy were included. Group A and B included 38 patients in each. Mean age was 12.5±2.49 in Group A and 11.97±2.74 years in Group B respectively (p=0.38. Overall success rate was 94.73% in Group A and 100% in Group B, respectively (p=0.87. Conclusion: Holmium Laser lithotripsy is as efficacious as pneumatic lithotripsy and can be used safely for the endoscopic management of lower ureteric calculus in pediatric patients. However, holmium laser requires more expertise and it is a costly alternative.

Vesico-ureteral reflux in children with prenatally detected hydronephrosis: a systematic review

NARCIS (Netherlands)

van Eerde, A. M.; Meutgeert, M. H.; de Jong, T. P. V. M.; Giltay, J. C.

2007-01-01

To investigate the value of prenatally detected hydronephrosis (PNH) as a prognostic factor for vesico-ureteral reflux (VUR). The MEDLINE database was searched for articles on PNH and VUR published between 1980 and 2004. A total of 18 studies were identified and reviewed for various aspects. Results

The effect of diclofenac (Voltarol) and pethidine on ureteric peristalsis and the isotope renogram

Energy Technology Data Exchange (ETDEWEB)

Brough, R.J. [Department of Urology, Withington Hospital, Manchester (United Kingdom); Lancashire, M.J.R. [Department of Virology, The Alexandra Hospital, Redditch (United Kingdom); Prince, J.R. [Department of Medical Physics, Christie Hospital, Manchester (United Kingdom); Rose, M.R.; Prescott, M.C.; Testa, H.J. [Department of Nuclear Medicine, Manchester Royal Infirmary, Manchester (United Kingdom); Payne, S.R. [Department of Urology, Manchester Royal Infirmary, Manchester (United Kingdom)

1998-11-01

Diclofenac (a non-steroidal anti-inflammatory drug) and pethidine (a synthetic opiate) are the two analgesics most commonly used to relieve the pain of ureteric colic. Fast frame renography is a non-invasive means of imaging ureteric peristalsis and renal drainage. The aim of this study was to determine the effects of each of these drugs on the drainage pattern of the upper tracts. Twelve normal male volunteers were studied. All underwent a standard fast frame renogram using 75 MBq of technetium-99m-mercaptoacetyltriglycine, and were then administered either 100 mg pethidine or 75 mg diclofenac by intramuscular injection. Fast frame renography was then repeated. Peristalsis was determined from the condensed image of each ureter and the renogram curves were analysed to obtain standard parameters and deconvolution analysis. Diclofenac caused a profound disruption to both ureteric peristalsis and the renogram curve. This effect was not seen after the administration of pethidine. Deconvolution analysis suggests the effects of diclofenac are mediated via a direct effect on drainage rather than by any alteration of blood flow to the kidney. This study suggests that pethidine is the analgesic of choice prior to renography and that inferences about alterations of drainage in the presence of diclofenac should be interpreted with care. (orig.) With 5 figs., 2 tabs., 15 refs.

[Comparison of the efficacy of ESWL and ureteroscopy in the treatment of lower ureteric stone].

Science.gov (United States)

Petrík, A

2007-01-01

The efficacy of ESWL and ureteroscopy in the treatment of lower ureteric stone is still discussed. The aim of the study is to compare efficacy and safeness of both methods. A retrospective study comparing the treatment results of distal ureteric stones was performed. The inclusion criteria were: distal ureteric stones with no previous treatment and an accomplished three months follow-up after the treatment. There were 395 cases (390 patients) included in the ESWL group and 509 cases (501 patients) in the ureteroscopy group. Higher efficacy of ureteroscopy as opposed to ESWL therapy was marked. There is no significant difference in stone free rate in three months after the treatment (97.72% vs. 98.40%, p = 0.4675), but there is a significant difference in EQ according to Rassweiler (43.52 vs. 89.60, p ESWL treatment is accompanied by a higher re-treatment rate (51% vs. 2%, p ESWL. The main advantage of ureteroscopy is the immediate effect, low re-treatment rate and low incidence of auxiliary procedures, except the need of removing the J-J stent. The disadvantage of ureteroscopy is the requirement of general anaesthesia and a higher incidence of complications after the treatment, though only minor ones in most of the cases.

In Vivo and In Vitro Elution of Analgesics from Multilayered Poly(D,L)-lactide-co-glycolide Nanofibers Incorporated Ureteral Stents

OpenAIRE

Lin, Yi-Chia; Liu, Kuo-Sheng; Lee, Demei; Li, Min-Jhan; Liu, Shih-Jung; Ito, Hiroshi

2018-01-01

We develop novel analgesic-eluting nanofiber-incorporated ureteral stents that offer sustained release of lidocaine and ketorolac for local drug delivery. Lidocaine and poly(D,L)-lactide-co-glycolide (PLGA) were dissolved in hexafluoroisopropanol and were electrospun into nonwoven nanofibers onto the surface of ureteral stents. This was followed by electrospinning of another layer of PLGA nanofibers containing ketorolac. Electrospun drug-loaded nanofibers were then characterized using scannin...

Medical expulsive therapy for ureteral stones: where do we go from here?

NARCIS (Netherlands)

Somani, Bhaskar K.; Aboumarzouk, Omar; Traxer, Olivier; Baard, Joyce; Kamphuis, Guido; de la Rosette, Jean

2016-01-01

Despite two decades of clinical use, the effectiveness of medical expulsive therapy (MET) for the noninvasive management of patients with ureteral stones has, in the past year, been called into in question. The primary aim of MET is to expedite stone passage, although it has also shown effectiveness

Effect of ureteral reimplantation on prevention of urinary tract infection and renal growth in infants with primary vesicoureteral reflux

International Nuclear Information System (INIS)

Matsumoto, Fumi; Tohda, Akira; Shimada, Kenji

2004-01-01

We retrospectively reviewed the results of ureteral reimplantation in infants with primary vesicoureteral reflux (VUR) to evaluate the effect on prevention of urinary tract infection (UTI) and renal growth. From July 1991 to December 2001, a total of 205 infants (180 boys and 25 girls) with primary VUR underwent ureteral reimplantation at the Department of Urology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan. Indications for surgery were high-grade reflux (grade IV-V), breakthrough UTI and non-compliance of medical treatment. Age at surgery raged from 1 to 11 months (mean, 6.4 months). Ureteral reimplantation was performed according to Cohen's method. Only two of 336 refluxing ureters required ureteral tailoring. Follow-up ranged from 12 to 110 months (mean, 64 months). Surgical outcome, frequency of UTI and individual renal growth measured by 99m Tc-dimercaptosuccinic acid (DMSA) scintigraphy was evaluated. Postoperative ultrasound and voiding cystourethrography showed neither residual reflux nor ureterovesical obstruction. Contralateral low grade reflux occurred in six of 74 patients (8.1%) who had unilateral reflux preoperatively. After reimplantation, 10 patients documented 13 febrile UTI. Eleven of the 13 episodes occurred early in the postoperative period (<6 months). Frequency of febrile UTI reduced from 0.23538 before surgery to 0.00894 and 0.00081 per patient per month at 6 and 12 months after surgery, respectively. No development of renal scarring was seen in postoperative DMSA scan. Changes of differential renal function was <0.05 in all patients. The present results show ureteral reimplantation in infants is safe and very effective for the prevention of UTI. After surgical treatment in infancy, individual renal growth of children with primary VUR is stable. (authors)

Outcomes of complex robot-assisted extravesical ureteral reimplantation in the pediatric population.

Science.gov (United States)

Arlen, Angela M; Broderick, Kristin M; Travers, Curtis; Smith, Edwin A; Elmore, James M; Kirsch, Andrew J

2016-06-01

While open ureteral reimplantation remains the gold standard for surgical treatment of vesicoureteral reflux (VUR), minimally invasive approaches offer potential benefits. This study evaluated the outcomes of children undergoing complex robot-assisted laparoscopic ureteral reimplantation (RALUR) for failed previous anti-reflux surgery, complex anatomy, or ureterovesical junction obstruction (UVJO), and compared them with patients undergoing open extravesical repair. Children undergoing complex RALUR or open extravesical ureteral reimplantation (OUR) were identified. Reimplantation was classified as complex if ureters: 1) had previous anti-reflux surgery, 2) required tapering and/or dismembering, or 3) had associated duplication or diverticulum. Seventeen children underwent complex RALUR during a 24-month period, compared with 41 OUR. The mean follow-up was 16.6 ± 6.5 months. The RALUR children were significantly older (9.3 ± 3.7 years) than the OUR patients (3.1 ± 2.7 years; P urinary tract infection compared with a single child (5.9%) undergoing RALUR (P = 1.00). There was no significant difference in complication rate between the two groups (12.2% OUR versus 11.8% RALUR; P = 1.00). A postoperative cystogram was performed in the majority of RALUR patients, with no persistent VUR detected, and one child (6.7%) was diagnosed with contralateral reflux. Reported VUR resolution rates following robot-assisted ureteral reimplantation are varied. In the present series, children undergoing RALUR following failed previous anti-reflux surgery, with complex anatomy, or UVJO experienced a shorter length of stay but had similar analgesic requirements to those undergoing open repair. Radiographic, clinical success rates and complication risk were comparable. This study had several limitations, aside from lack of randomization. Analgesic use was limited to an inpatient setting, and pain scores were not assessed. Not all children underwent a postoperative VCUG, so

Normal differential renal function does not indicate a normal kidney after partial ureteropelvic obstruction and subsequent relief in 2-week-old piglets

Energy Technology Data Exchange (ETDEWEB)

Dissing, Thomas H.; Mikkelsen, Mette Marie; Pedersen, Michael; Froekiaer, Joergen; Djurhuus, Jens Christian [University of Aarhus, Institute of Clinical Medicine, Aarhus (Denmark); Eskild-Jensen, Anni [Aarhus University Hospital, Department of Nuclear Medicine, Aarhus Sygehus, Aarhus (Denmark); Gordon, Isky [University College London, Institute of Child Health, London (United Kingdom); University College London, Radiology and Physics Unit, Institute of Child Health, London (United Kingdom)

2008-09-15

We investigated the functional consequences of relieving ureteric obstruction in young pigs with experimental hydronephrosis (HN) induced by partial unilateral ureteropelvic obstruction. Three groups of animals were followed from the age of 2 weeks to the age of 14 weeks: Eight animals had severe or grades 3-4 HN throughout the study. Six animals had relief of the obstruction after 4 weeks. Six animals received sham operations at both ages. Morphological and functional examinations were performed at age 6 weeks and again at age 14 weeks and consisted of magnetic resonance imaging (MRI), technetium-diethylenetriaminepentaaceticacid ({sup 99m}Tc-DTPA) renography, renal technetium-dimercaptosuccinicacid ({sup 99m}Tc-DMSA) scintigraphy, and glomerular filtration rate (GFR) measurement. After relief of the partial obstruction, there was reduction of the pelvic diameter and improvement of urinary drainage. Global and relative kidney function was not significantly affected by either obstruction or its relief. Renal {sup 99m}Tc-DMSA scintigraphy showed a change in both the appearance of the kidney and a change in the distribution within kidneys even after relief of obstruction. This study shows that partial ureteric obstruction in young pigs may be associated with little effect on global and differential kidney function. However, even after relief of HN, the distribution of {sup 99m}Tc-DMSA in the kidney remains abnormal suggesting that a normal differential renal function may not represent a normal kidney. (orig.)

Chronic ethanol intake induces partial microglial activation that is not reversed by long-term ethanol withdrawal in the rat hippocampal formation.

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Cruz, Catarina; Meireles, Manuela; Silva, Susana M

2017-05-01

Neuroinflammation has been implicated in the pathogenesis of several disorders. Activation of microglia leads to the release of pro-inflammatory mediators and microglial-mediated neuroinflammation has been proposed as one of the alcohol-induced neuropathological mechanisms. The present study aimed to examine the effect of chronic ethanol exposure and long-term withdrawal on microglial activation and neuroinflammation in the hippocampal formation. Male rats were submitted to 6 months of ethanol treatment followed by a 2-month withdrawal period. Stereological methods were applied to estimate the total number of microglia and activated microglia detected by CD11b immunohistochemistry in the hippocampal formation. The expression levels of the pro-inflammatory cytokines TNF-α, COX-2 and IL-15 were measured by qRT-PCR. Alcohol consumption was associated with an increase in the total number of activated microglia but morphological assessment indicated that microglia did not exhibit a full activation phenotype. These data were supported by functional evidence since chronic alcohol consumption produced no changes in the expression of TNF-α or COX-2. The levels of IL-15 a cytokine whose expression is increased upon activation of both astrocytes and microglia, was induced by chronic alcohol treatment. Importantly, the partial activation of microglia induced by ethanol was not reversed by long-term withdrawal. This study suggests that chronic alcohol exposure induces a microglial phenotype consistent with partial activation without significant increase in classical cytokine markers of neuroinflammation in the hippocampal formation. Furthermore, long-term cessation of alcohol intake is not sufficient to alter the microglial partial activation phenotype induced by ethanol. Copyright © 2017 Elsevier B.V. All rights reserved.

Treatment of distal ureteric stones-comparative efficacy of transureteral pneumatic lithotripsy and extracorporeal shock wave lithotripsy

International Nuclear Information System (INIS)

Wazir, B.G.; Nawaz, A.; Orakzai, A.N.

2015-01-01

Ureteric stones greater than 6mm require intervention. Extracorporeal shockwave lithotripsy (ESWL) and ureteroscopy (URS) with intra-corporeal lithotripsy (ICL) are two least invasive therapies. Both show acceptable stone clearance. What should be the first line of treatment in distal ureteric stones. We conducted this study to compare the efficacy of ESWL and pneumatic ICL in order to develop clear cut treatment guidelines. Methods: This randomized control trial was conducted at Institute of Kidney Diseases, Peshawar from June 2011 to June 2012. Two hundred and twenty-four patients with distal ureteric stones 6-12 mm in size were included. Patients were randomized into two groups. Group-A patients were treated with URS plus ICL and Group-B with ESWL. Patients were evaluated for stone clearance after 2 weeks, with X-ray KUB and ultrasound. All the data were recorded in a proforma and analysed in SPSS 10. Fisher's exact test was applied to compare the efficacy and a p-value of 0.05 was considered significant. Results: Out of 112 patients in Group-A, 75 (67%) were males and 37 (33%) were females while in Group-B 79 (70.5%) were males and 33 (29.5%) were females. The mean age in Group-A was, 48.73 ± 16.23 years whereas it was 6 ± 14.58 years in Group-B. Overall, mean age was 47.36 ± 15.4 years. Mean stone size was 9.18 ± 1.6 mm. At follow up (2 weeks post-operative) URS with ICL was successful in 101 (90.2%) patients while ESWL was successful in 75 (67%) patients (p-value=0.0001). Conclusion: Extracorporeal shockwave lithotripsy shows acceptable stone clearance but ureteroscopy with intra-corporeal lithotripsy shows superior results in distal ureteric stones. (author)

Comparison of Pneumatic and Laser Lithotripsy in the Endoscopic Treatment of Upper Ureteral Stones

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Ozer Guzel

2016-04-01

Full Text Available Aim: We aimed to compare the success rate of the use of a pneumatic and a holmium laser lithotripter for endoscopic treatment of upper ureteral calculi with semirigid uretero-renoscopy (URS. Material and Method: A total of 74 patients were included in this study. The patients were divided into two groups; a ballistic lithotripter was used for group 1 containing 33 and a Holmium-YAG laser lithotripter for the remaining 41 patients in group 2. Both groups were compared in terms of stone size the duration of the operation, postoperative hospitalization time, stone-free rate and complications. Results: The mean age of the patients was 47.6. The mean stone size in groups 1 and 2 were 16.4mm and 11.0mm, respectively (p=0.043. The mean stone-free rate groups 1 and 2 were 78.7% and 80.5% respectively at the approximately 1 month follow-up (p=0.391. In group 1 two patients and in group 2 two patients had a minor complication (ClavienI-II. In group 1 three patients had major complications due to ureteral perforation (Clavien 3a and 3b. No major complications (Clavien III-V occurred in Group 2. Discussion: Based on these findings laser lithotripsy can be regarded as safer. If laser lithotripter is available in medical centers, we argue that it should be the first choice for the treatment of upper ureteral stones.

Gunshot Injury of Pelvi-Ureteric Junction: Management by the Rendezvous Technique.

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Sekhon, Virender; Suryavanshi, Manav

2017-01-01

Background: Gunshot injury of ureter is common, but isolated injury of pelvi-ureteric junction (PUJ) has not been reported. Moreover, its management is evolving from the traditional urinary diversion, stenting followed later by definitive surgical repair to a more upfront minimally invasive endourologic approach. Case Presentation: An adolescent boy presented with gunshot laceration injury of left PUJ with associated small intestinal injury. Radiological investigations confirmed a contained urinary leak. Retrograde stenting was not effective. The same guidewire was retained into the urinoma and an antegrade percutaneous access was obtained. A snare was used to retrieve the guidewire and obtain a through and through access. A ureteropelvic drainage catheter was inserted over this guidewire and secured in the upper ureter, bypassing the region of injury. Three weeks later, the drainage tube was removed and the same tract was used for antegrade stenting. A retrograde pyelogram done 3 months later during stent removal demonstrated no leak. The patient is asymptomatic for urinary symptoms on 6 months of follow-up. Conclusion: Rendezvous technique is a feasible alternative to open repair of gunshot pelvi-ureteric junction injury. Long-term follow-up is awaited.

Complications of Percutaneous Nephrostomy, Percutaneous Insertion of Ureteral Endoprosthesis, and Replacement Procedures

International Nuclear Information System (INIS)

Kaskarelis, Ioannis S.; Papadaki, Marina G.; Malliaraki, Niki E.; Robotis, Epaminondas D.; Malagari, Katerina S.; Piperopoulos, Ploutarchos N.

2001-01-01

Purpose: The aim of the present study was to record and identify the frequency of complications following percutaneous nephrostomy, replacement of nephrostomy drains and percutaneous insertion of ureteral endoprostheses.Methods: During a 10-year period 341 patients were referred to our department with indications for percutaneous nephrostomy and/or percutaneous insertion of a ureteral endoprosthesis, and a total of 1036 interventional procedures were performed (nephrostomy, catheter change, stenting).Results: There were three major complications (0.29%): two patients died during the first 30 days after the procedure, due to aggravation of their condition caused by the procedure, and one patient had retroperitoneal bleeding requiring surgery. There were 76 complications of intermediate severity (7.33%): catheter or stent displacement (n = 37, 3.57%) catheter occlusion (n = 18, 1.73%), hematuria (n = 12, 1.16%), and urinary tract infection (n = 9, 0.87%). The 55 minor complications (5.3%) comprised inflammation of the skin at the site of insertion of the percutaneous catheter.Conclusion: The small number of complications observed during acts of interventional uroradiology prove transcutaneous manipulations to be safe medical procedures

Reconstruction after ureteral resection during HIPEC surgery: Re-implantation with uretero-neocystostomy seems safer than end-to-end anastomosis.

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Pinar, U; Tremblay, J-F; Passot, G; Dazza, M; Glehen, O; Tuech, J-J; Pocard, M

2017-09-01

Resection of the pelvic ureter may be necessary in cytoreductive surgery for peritoneal carcinomatosis in combination with hyperthermic intraperitoneal chemotherapy (HIPEC). As the morbidity for cytoreductive surgery with HIPEC has decreased, expert teams have begun to perform increasingly complex surgical procedures associated with HIPEC, including pelvic reconstructions. After ureteral resection, two types of reconstruction are possible: uretero-ureteral end-to-end anastomosis and uretero-vesical re-implantation or uretero-neocystostomy (the so-called psoas hitch technique). By compiling the experience of three surgical teams that perform HIPEC surgeries, we have tried to compare the effectiveness of these two techniques. A retrospective comparative case-matched multicenter study was conducted for patients undergoing operation between 2005 and 2014. Patients included had undergone resection of the pelvic ureter during cytoreductive surgery with HIPEC for peritoneal carcinomatomosis; ureteral reconstruction was by either end-to-end anastomosis (EEA group) or re-implantation uretero-neocystostomy (RUC group). The primary endpoint was the occurrence of urinary fistula in postoperative follow-up. There were 14 patients in the EEA group and 14 in the RUC group. The groups were comparable for age, extent of carcinomatosis (PCI index) and operative duration. Four urinary fistulas occurred in the EEA group (28.5%) versus zero fistulas in the RUC group (0%) (P=0.0308). Re-implantation with uretero-neocystostomy during cytoreductive surgery with HIPEC is the preferred technique for reconstruction after ureteral resection in case of renal conservation. Copyright © 2017. Published by Elsevier Masson SAS.

As in Real Estate, Location Is What Matters: A Case Report of Transplant Ureteral Obstruction Due to an Inguinal Hernia.

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Bugeja, Ann; Clark, Edward G; Sood, Manish M; Ali, Sohrab N

2018-01-01

Kidney allograft dysfunction is common and often reversible but can lead to allograft loss if not promptly evaluated. Transplant ureteral obstruction in an inguinal hernia is a rare cause of allograft dysfunction, but early recognition may prevent allograft loss. We present a case of a man with acute kidney allograft dysfunction who received a deceased donor kidney transplant 6 years earlier for end-stage kidney disease secondary to polycystic kidney disease. Abdominal ultrasounds revealed hydronephrosis without full visualization of the transplant ureter. Abdominal computed tomography revealed moderate hydronephrosis of the transplant kidney due to obstructed herniation of the transplant ureter in a right inguinal hernia. A stent was inserted into the transplant ureter to prevent further allograft dysfunction and facilitate hernia repair. Transplant ureteral obstruction is a rare cause of acute kidney allograft dysfunction, and its detection can be challenging. The recognition of transplant ureteral obstruction is vital to timely management for preventing allograft loss.

Abdominal fat distribution on computed tomography predicts ureteric calculus fragmentation by shock wave lithotripsy.

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Juan, Hsu-Cheng; Lin, Hung-Yu; Chou, Yii-Her; Yang, Yi-Hsin; Shih, Paul Ming-Chen; Chuang, Shu-Mien; Shen, Jung-Tsung; Juan, Yung-Shun

2012-08-01

To assess the effects of abdominal fat on shock wave lithotripsy (SWL). We used pre-SWL unenhanced computed tomography (CT) to evaluate the impact of abdominal fat distribution and calculus characteristics on the outcome of SWL. One hundred and eighty-five patients with a solitary ureteric calculus treated with SWL were retrospectively reviewed. Each patient underwent unenhanced CT within 1 month before SWL treatment. Treatment outcomes were evaluated 1 month later. Unenhanced CT parameters, including calculus surface area, Hounsfield unit (HU) density, abdominal fat area and skin to calculus distance (SSD) were analysed. One hundred and twenty-eight of the 185 patients were found to be calculus-free following treatment. HU density, total fat area, visceral fat area and SSD were identified as significant variables on multivariate logistic regression analysis. The receiver-operating characteristic analyses showed that total fat area, para/perirenal fat area and visceral fat area were sensitive predictors of SWL outcomes. This study revealed that higher quantities of abdominal fat, especially visceral fat, are associated with a lower calculus-free rate following SWL treatment. Unenhanced CT is a convenient technique for diagnosing the presence of a calculus, assessing the intra-abdominal fat distribution and thereby helping to predict the outcome of SWL. • Unenhanced CT is now widely used to assess ureteric calculi. • The same CT protocol can provide measurements of abdominal fat distribution. • Ureteric calculi are usually treated by shock wave lithotripsy (SWL). • Greater intra-abdominal fat stores are generally associated with poorer SWL results.

Evaluating the importance of mean stone density and skin-to-stone distance in predicting successful shock wave lithotripsy of renal and ureteric calculi.

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Wiesenthal, Joshua D; Ghiculete, Daniela; D'A Honey, R John; Pace, Kenneth T

2010-08-01

Shock wave lithotripsy (SWL) is considered the first line treatment for the majority of patients with renal and ureteric calculi, with success rates from contemporary series varying from 60 to 90%. Success is dependent on many patient and stone-related factors. We conducted a retrospective analysis of mean stone CT density (MSD) and skin-to-stone distance (SSD) to determine their influence on the success of SWL of renal and ureteric calculi. Data from all patients treated at the St. Michael's Hospital Lithotripsy Unit from May 2004 to June 2009 were reviewed. Analysis was restricted to those patients with a pre-treatment non-contrast CT scan conducted at our center demonstrating a solitary renal or ureteric calculus 900 HU (OR = 0.49, CI: 0.32-0.75) and SSD >110 mm (OR = 0.49, CI: 0.31-0.78) were both significant predictors of outcome. We have identified in a large series of renal and ureteric calculi that both MSD and SSD can reliably predict SWL outcomes. This data can be used in combination with other patient and stone-related factors to facilitate optimal treatment-based decisions and provide patients with more accurate single-treatment success rates for SWL.

Clinical protocol levels are required in laboratory animal surgery when using medical devices: experiences with ureteral replacement surgery in goats

OpenAIRE

de Jonge, Paul K. J. D.; Sloff, Marije; Janke, Heinz P.; Kortmann, Barbara B. M.; de Gier, Robert P. E.; Geutjes, Paul J.; Oosterwijk, Egbert; Feitz, Wout F. J.

2017-01-01

It is common to test medical devices in large animal studies that are or could also be used in humans. In this short report we describe the use of a ureteral J-stent for the evaluation of biodegradable tubular constructs for tissue reconstruction, and the regeneration of ureters in Saanen goats. Similarly to a previous study in pigs, the ureteral J-stent was blindly inserted until some resistance was met. During evaluation of the goats after three months, perforation of the renal cortex by th...

Extracorporeal shock waves lithotripsy versus retrograde ureteroscopy: is radiation exposure a criterion when we choose which modern treatment to apply for ureteric stones?

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Catalin Pricop

2014-10-01

Full Text Available The aim of this study is to compare two major urological procedures in terms of patient exposure to radiation. We evaluated 175 patients, that were subjected to retrograde ureteroscopy (URS and extracorporeal shock waves lithotripsy (ESWL for lumbar or pelvic ureteral lithiasis, at two urological departments. The C-arm Siemens (produced in 2010 by Siemens AG, Germany was used for ureteroscopy. The radiological devices of the lithotripters used in this study in the two clinical centers had similar characteristics. We evaluated patient exposure to ionizing radiation by using a relevant parameter, the air kerma-area product (PKA; all values in cGy cm2, calculated from the radiation dose values recorded by the fluoroscopy device. PKA depends on technical parameters that change due to anatomical characteristics of each case examined, such as body mass index (BMI, waist circumference, and stone location. For the patients subjected to ESWL for lumbar ureteral lithiasis the mean of PKA (cGy cm2 was 509 (SD=180, while for those treated for pelvic ureteral lithiasis the mean of PKA was 342 (SD=201. In the URS group for lumbar ureteral lithiasis, the mean of PKA (cGy cm2 was 892 (SD=436, while for patients with pelvic ureteral lithiasis, the mean of PKA was 601 (SD=429. The patients treated by URS had higher exposure to ionizing radiation dose than patients treated by ESWL. The risk factors of higher radiation doses were obesity, exposure time, and localization of the stones.

Renal autotransplantation--a possibility in the treatment of complex renal vascular diseases and ureteric injuries.

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Hau, Hans Michael; Bartels, Michael; Tautenhahn, Hans-Michael; Morgul, Mehmet Haluk; Fellmer, Peter; Ho-Thi, Phuc; Benckert, Christoph; Uhlmann, Dirk; Moche, Michael; Thelen, Armin; Schmelzle, Moritz; Jonas, Sven

2012-12-31

We report our contemporary experiences with renal autotransplantation in patients with complicated renal vascular diseases and/or complex ureteral injuries. Since its first performance, renal autotransplantation has been steadily improved and become a safe and effective procedure. Between 1998 and 2006, 6 renal autotransplantations in 6 patients were performed at the University Medical Center of Leipzig. After nephrectomy and renal perfusion ex vivo, the kidney was implanted standardized in the fossa iliaca. The vessels were anastomized to the iliac vessels, the ureter was reimplanted in an extravesical tunneled ureteroneocystostomy technique according to Lich-Gregoir. Demographic, clinical, and laboratory data of the patients were collected and analyzed for pre-, intra-, and postoperative period. Indications for renal autotransplantation were complex renovascular diseases in 2 patients (1 with fibromuscular dysplasia and 1 with Takayasu's arteritis) and in 4 patients with complex ureteral injuries. The median duration of follow-up was 9.7 years (range: 5.6-13.3). The laboratory values of our 6 patients showed improvements of creatinine, urea and blood pressure levels in comparison to the preoperative status at the end of follow-up period. The present study reports excellent results of renal autotransplantation in patients with renovascular disease or complex ureteric injuries. After a median follow-up of 9.7 years all 6 patients present with stable renal function as well as normal blood pressure values. Postoperative complications were observed with a rate comparable to other studies.

Application of the chronic constriction injury of the partial sciatic nerve model to assess acupuncture analgesia

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Zhi MJ

2017-09-01

Full Text Available Mu-Jun Zhi,1,2,* Kun Liu,1,* Zhou-Li Zheng,1,3 Xun He,1 Tie Li,2 Guang Sun,1,2 Meng Zhang,4 Fu-Chun Wang,2 Xin-Yan Gao,1 Bing Zhu1 1Department of Physiology, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China; 2College of Acupuncture and Moxibustion, Changchun University of Chinese Medicine, Changchun, People’s Republic of China; 3College of Acupuncture and Moxibution, Shaanxi University of Chinese Medicine, People’s Republic of China; 4Department of Chinese Medicine, Dongli Hospital of Traditional Chinese Medicine, Tianjin, People’s Republic of China *These authors contributed equally to this work Purpose: To validate and explore the application of a rat model of chronic constriction injury to the partial sciatic nerve in investigation of acupuncture analgesia.Methods: Chronic constriction injury of the sciatic nerve (CCI and chronic constriction injury of the partial sciatic nerve (CCIp models were generated by ligating either the sciatic nerve trunk or its branches in rats. Both models were evaluated via paw mechanical withdrawal latency (PMWL, paw mechanical withdrawal threshold (PMWT, nociceptive reflex-induced electromyogram (C-fiber reflex EMG, and dorsal root ganglion immunohistochemistry. Electroacupuncture (EA was performed at GB30 to study the analgesic effects on neuropathic pain and the underlying mechanisms.Results: Following ligation of the common peroneal and tibial nerves, CCIp rats exhibited hindlimb dysfunction, hind paw shrinkage and lameness, mirroring those of CCI rats (generated by ligating the sciatic nerve trunk. Compared to presurgery measurements, CCIp and CCI modeling significantly decreased the PMWL and PMWT. EA at GB30 increased the PMWL and PMWT in both CCI and CCIp rats. Calcitonin gene-related polypeptide and substance P expressions were apparently increased in both CCI and CCIp groups, but were not different from each other. The C

Suspected ureteral colic: plain film and sonography vs unenhanced helical CT. A prospective study in 66 patients

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Ripolles, Tomas; Agramunt, Marcos; Errando, Jose; Martinez, Maria Jesus [Department of Radiology, Hospital Universitario Dr. Peset, 90 Gaspar Aguilar Avenue, 46017, Valencia (Spain); Coronel, Belen [Department of Urology, Hospital Universitario Dr. Peset, 90 Gaspar Aguilar Avenue, 46017, Valencia (Spain); Morales, Maria [Research Unit, Hospital Universitario Dr. Peset, 90 Gaspar Aguilar Avenue, 46017, Valencia (Spain)

2004-01-01

The aim of this study was to compare the sensitivity and specificity of plain abdominal films plus ultrasound, vs nonenhanced CT for the diagnosis of ureteral colic in patients with acute flank pain. During a 4-month period, 66 patients (mean age 48 years) with acute flank pain were prospectively studied by means of plain abdominal film, US, and unenhanced CT. The presence of lithiasis and of obstructive uropathy signs were determined. The plain film was only used as a guide for the US exam. Clinical follow-up of all patients was obtained. Ureteral lithiasis was confirmed in 56 patients. The CT had a greater sensitivity (93 vs 79%) and negative predictive value (71 vs 46%) for the detection of lithiasis. The combination of lithiasis plus obstructive signs showed a sensitivity and a specificity of 100% for CT and of 100 and 90%, respectively, for US. The 11 lithiasis not detected by US were passed spontaneously (10 were <5 mm). Both techniques showed similar extraurinary pathology. Computed tomography is the most accurate technique for the detection of ureteral lithiasis; however, the combination of plain film and US is an alternative to nonenhanced CT with a lower sensitivity and radiation dose that has a good practical value. (orig.)

Pyelo-cystic Reflux in F-18 FDG PET Scan Due to Ureteral Obstruction

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Reyhan, Mehmet [Baskent Univ., Adana (Turkmenistan)

2013-09-15

A 72-year-old woman with a history of cervical cancer was treated with brachytherapy and chemotherapy. Combined F-18 FDG PET/CT performed for restaging demonstrated increased FDG uptake in a hypodense cystic lesion at the posterior part of the right renal cortex and a hypermetabolic soft tissue mass at the right parailiac region suggestive of a metastatic lymph node causing ureteral obstruction. There had been no FDG uptake in the cystic lesion on the FDG PET/CT study performed 1 year before. These findings suggest that the increased FDG uptake in the cystic lesion was caused by pyelocystic reflux due to ureteral obstruction secondary to parailiac lymph node metastasis (Figs. 1 and 2). Several renal lesions may have increased metabolism, such as renal cell carcinoma, lymphoma, oncocytoma, adult Wilms' tumor, angiomyolipoma, metastatic lesions, xanthogranulo-matous pyelonephritis and infected cyst. Most of these lesions are solid. Some infected renal cysts may be FDG avid, but in this situation increased FDG uptake is observed on the wall of the cyst. In our case, FDG uptake was seen in the entire cystic lesion. The patient had no symptoms or laboratory findings related to infection. Cysts are the most common space-occupying lesions of the kidney. The vast majority of these are simple cysts that are usually unilateral and solitary. Simple cysts are asymptomatic, except when complications exist such as hemorrhage, infection or rupture. There have been a few reports on spontaneous communications between renal cysts and the pyelocaliceal system, in most cases involving ruptures of the cysts into the pyelocaliceal system due to increased intracystic pressure caused by bleeding or infection of the cyst. In the present case, the cause of the connection between the cystic cavity and the pyelocaliceal system is the increased pressure in the renal pelvic cavity due to the ureteral obstruction secondary to parailiac lymph node metastasis.

Intracorporal Alexandrite-laser lithotripsy in the treatment of ureteral calculi

Science.gov (United States)

Zumbe, Juergen; Fischer, Hermann; Kimont, Hans-Georg; Kierfeld, Gerd

1994-02-01

Extracorporal shock wave lithotripsy (ESWL) is the standard therapy in the treatment of urinary calculi. the high rate of fragmentation and simultaneous stone selectivity makes laser lithotripsy an alternative method in the treatment of obstructing ureteral calculi. In comparison to the success rate of ESWL, laser lithotripsy as a minimally invasive endoscopic procedure seems to be superior in disintegrating calculi in the distal ureter. Together with the advance of miniaturized semiflexible endoscopes, intracorporal laser lithotripsy presents a new aspect in the treatment of urinary calculi.

Current practices in the management of patients with ureteral calculi in the emergency room of a university hospital

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Oliver Rojas Claros

2012-01-01

Full Text Available OBJECTIVE: Urinary lithiasis is a common disease. The aim of the present study is to assess the knowledge regarding the diagnosis, treatment and recommendations given to patients with ureteral colic by professionals of an academic hospital. MATERIALS AND METHODS: Sixty-five physicians were interviewed about previous experience with guidelines regarding ureteral colic and how they manage patients with ureteral colic in regards to diagnosis, treatment and the information provided to the patients. RESULTS: Thirty-six percent of the interviewed physicians were surgeons, and 64% were clinicians. Forty-one percent of the physicians reported experience with ureterolithiasis guidelines. Seventy-two percent indicated that they use noncontrast CT scans for the diagnosis of lithiasis. All of the respondents prescribe hydration, primarily for the improvement of stone elimination (39.3%. The average number of drugs used was 3.5. The combination of nonsteroidal anti-inflammatory drugs and opioids was reported by 54% of the physicians (i.e., 59% of surgeons and 25.6% of clinicians used this combination of drugs (p = 0.014. Only 21.3% prescribe alpha blockers. CONCLUSION: Reported experience with guidelines had little impact on several habitual practices. For example, only 21.3% of the respondents indicated that they prescribed alpha blockers; however, alpha blockers may increase stone elimination by up to 54%. Furthermore, although a meta-analysis demonstrated that hydration had no effect on the transit time of the stone or on the pain, the majority of the physicians reported that they prescribed more than 500 ml of fluid. Dipyrone, hyoscine, nonsteroidal anti-inflammatory drugs, and opioids were identified as the most frequently prescribed drug combination. The information regarding the time for the passage of urinary stones was inconsistent. The development of continuing education programs regarding ureteral colic in the emergency room is necessary.

PERCUTANEOUS NEPHROSTOMY AND DOUBLE PIGTAIL (JJ URETERAL STENTS AS TEMPORARY METHODS IN SOLVING SUPRAVESICAL OBSTRUCTION CAUSED BY STONE

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Ljubomir Dinić

2015-08-01

Full Text Available Percutaneous nephrostomy and ureteral stenting are temporary treatments for the upper urinary tract obstruction. The aim of this study was to evaluate the efficacy of these two methods by comparing complications, placement success, urinary symptoms, urine culture analyses prior to derivation placement and derivation removal and success of stone elimination after extracorporeal shock wave lithotripsy (ESWL. This prospective study included 157 patients with supravesical obstruction caused by ureteral stones. Eighty-one patients underwent percutaneus nephrostomy, and JJ stent was inserted in seventy-six (76 patients. After resolving the obstruction, ESWL was performed in all patients. There were no statistically significant differences in success of the urinary derivation placement, the urine culture results before and after placement and success of ESWL treatment between the two studied groups (p>0.05. Urinary symptoms (dysuria, hematuria, urinary urgency, frequent urination during the day were significantly more present in patients with a JJ stent and this difference was statistically significant for each symptom (p<0.001. Major complications were verified in 2 (2.46% patients with PCN catheter, and in 7 (9.2% patients in the group with the JJ stent. Minor complications were significantly more frequent in the group with the JJ stent compared to the group with PCN catheter (28.39% vs 60.52%, p<0.001. Percutaneous nephrostomy and JJ stenting are optimal methods for temporary treatment of supravesical obstruction caused by ureteral stones, with similar incidence of the following complications, except for the pain, which dominates in patients with the JJ stent. Urinary symptoms and asymptomatic bacteriuria are more common in patients with the JJ stent. If the ESWL treatment of ureteral stone is performed after urinary derivation placement, we can expect greater success in patients with the JJ stent.

L-Endoglin Overexpression Increases Renal Fibrosis after Unilateral Ureteral Obstruction

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Arévalo, Miguel; Núñez-Gómez, Elena; Pérez-Roque, Lucía; Pericacho, Miguel; González-Núñez, María; Langa, Carmen; Martínez-Salgado, Carlos; Perez-Barriocanal, Fernando; Bernabeu, Carmelo; Lopez-Novoa, José M.

2014-01-01

Transforming growth factor-β (TGF-β) plays a pivotal role in renal fibrosis. Endoglin, a 180 KDa membrane glycoprotein, is a TGF-β co-receptor overexpressed in several models of chronic kidney disease, but its function in renal fibrosis remains uncertain. Two membrane isoforms generated by alternative splicing have been described, L-Endoglin (long) and S-Endoglin (short) that differ from each other in their cytoplasmic tails, being L-Endoglin the most abundant isoform. The aim of this study was to assess the effect of L-Endoglin overexpression in renal tubulo-interstitial fibrosis. For this purpose, a transgenic mouse which ubiquitously overexpresses human L-Endoglin (L-ENG+) was generated and unilateral ureteral obstruction (UUO) was performed in L-ENG+ mice and their wild type (WT) littermates. Obstructed kidneys from L-ENG+ mice showed higher amounts of type I collagen and fibronectin but similar levels of α-smooth muscle actin (α-SMA) than obstructed kidneys from WT mice. Smad1 and Smad3 phosphorylation were significantly higher in obstructed kidneys from L-ENG+ than in WT mice. Our results suggest that the higher increase of renal fibrosis observed in L-ENG+ mice is not due to a major abundance of myofibroblasts, as similar levels of α-SMA were observed in both L-ENG+ and WT mice, but to the higher collagen and fibronectin synthesis by these fibroblasts. Furthermore, in vivo L-Endoglin overexpression potentiates Smad1 and Smad3 pathways and this effect is associated with higher renal fibrosis development. PMID:25313562

Efficacy of α-blocker in improving ureteral stent-related symptoms: a meta-analysis of both direct and indirect comparison

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He F

2016-05-01

Full Text Available Feng He, Li-bo Man, Gui-zhong Li, Ning Liu Department of Urinary Surgery, Beijing Jishuitan Hospital, Beijing, People’s Republic of China Objective: To critically evaluate the efficacy of an α-blocker in improving ureteral-stent-related symptoms and preliminarily investigate the difference between different types of α-blockers. Methods: Relevant randomized controlled trials were identified through searching PubMed, the Cochrane Library, Embase, and other sources. After quality assessment and data abstraction, direct comparison based on the Ureteral Stent-related Symptom Questionnaire (USSQ between α-blockers and control was performed by RevMan 5.3. Indirect comparison between different types of α-blockers was performed by ITC 1.0. Sensitive and subgroup analyses were used to handle important clinical factors. Results: Sixteen randomized controlled trials containing 1,489 cases were included. Compared with control, α-blockers significantly reduced the overall urinary symptom, pain index, general health index, and scores related to sexual matters, while no significant difference was found in work performance and additional problem scores. Subgroup analysis showed that the duration of stent insertion, patient’s age, stent size, and the type of α-blocker had the potential to influence the outcomes. Through indirect comparison, we found alfuzosin and terazosin to be better than tamsulosin in pain relief and general health improvement. Conclusion: α-Blocker was effective in treating ureteral stent-related symptoms, as it improved the major indexes of USSQ post-insertion or post-removal. Alfuzosin and terazosin seemed to be better than tamsulosin, which needs further verification because of the lack of direct comparison currently. Keywords: α-blocker, tamsulosin, alfuzosin, terazosin, ureteral stent-related discomfort

Comparison of secondary signs as shown by unenhanced helical computed tomography in patients with uric acid or calcium ureteral stones

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Yii-Her Chou

2012-06-01

Full Text Available Unenhanced helical computed tomography (UHCT has evolved into a well-accepted diagnostic method in patients with suspected ureterolithiasis. UHCT not only shows stones within the lumen of the ureter, it also permits evaluation of the secondary signs associated with ureteral obstruction from stones. However, there we could find no data on how secondary signs might differ in relation to different compositions of ureteral stones. In this study, we compared the degree of secondary signs revealed by UHCT in uric acid stone formers and in patients forming calcium stones. We enrolled 117 patients with ureteral stones who underwent UHCT examination and Fourier transform infra-red analysis of stone samples. Clinical data were collected as follows: age, sex, estimated glomerular filtration rate (eGFR, urine pH, and radiological data on secondary signs apparent on UHCT. The uric acid stone formers had significantly lower urine pH and eGFR in comparison to calcium stone formers, and on UHCT they also had a higher percentage of the secondary signs, including rim sign (78.9% vs. 60.2%, hydroureter (94.7% vs. 89.8%, perirenal stranding (84.2% vs. 59.2% and kidney density difference (73.7% vs. 50.0%. The radiological difference was statistically significant for perirenal stranding (p=0.041. In conclusion, we found that UHCT scanning reveals secondary signs to be more frequent in patients with uric acid ureteral stones than in patients with calcium stones, a tendency that might result from an acidic urine environment.

Acute versus chronic partial sleep deprivation in middle-aged people: differential effect on performance and sleepiness.

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Philip, Pierre; Sagaspe, Patricia; Prague, Mélanie; Tassi, Patricia; Capelli, Aurore; Bioulac, Bernard; Commenges, Daniel; Taillard, Jacques

2012-07-01

To evaluate the effects of acute sleep deprivation and chronic sleep restriction on vigilance, performance, and self-perception of sleepiness. Habitual night followed by 1 night of total sleep loss (acute sleep deprivation) or 5 consecutive nights of 4 hr of sleep (chronic sleep restriction) and recovery night. Eighteen healthy middle-aged male participants (age [(± standard deviation] = 49.7 ± 2.6 yr, range 46-55 yr). Multiple sleep latency test trials, Karolinska Sleepiness Scale scores, simple reaction time test (lapses and 10% fastest reaction times), and nocturnal polysomnography data were recorded. Objective and subjective sleepiness increased immediately in response to sleep restriction. Sleep latencies after the second and third nights of sleep restriction reached levels equivalent to those observed after acute sleep deprivation, whereas Karolinska Sleepiness Scale scores did not reach these levels. Lapse occurrence increased after the second day of sleep restriction and reached levels equivalent to those observed after acute sleep deprivation. A statistical model revealed that sleepiness and lapses did not progressively worsen across days of sleep restriction. Ten percent fastest reaction times (i.e., optimal alertness) were not affected by acute or chronic sleep deprivation. Recovery to baseline levels of alertness and performance occurred after 8-hr recovery night. In middle-aged study participants, sleep restriction induced a high increase in sleep propensity but adaptation to chronic sleep restriction occurred beyond day 3 of restriction. This sleepiness attenuation was underestimated by the participants. One recovery night restores daytime sleepiness and cognitive performance deficits induced by acute or chronic sleep deprivation. Philip P; Sagaspe P; Prague M; Tassi P; Capelli A; Bioulac B; Commenges D; Taillard J. Acute versus chronic partial sleep deprivation in middle-aged people: differential effect on performance and sleepiness. SLEEP 2012;35(7):997-1002.

Notas clínicas: Un caso de transplantación ureteral

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Abelardo Arango A.

1933-11-01

Full Text Available Un caso de trasplantación ureteral. Jorge Cavalier / La nueva técnica de histeropexia. Jorge E. Helo / La última epidemia de sarampión en Bogotá. Gerardo Bonilla I. / Patología veminosa del Municipio de Girardota (Antioquia. Gabriel Vélez Vélez / La vacunoterapia en la fiebre tifoidea. Andrés Soriano Lleras / Aglutinaciones como aporte a la investigación de la fiebre ondulante en Colombia. Cupertino Patiño S.

Preoperative JJ stent placement in ureteric and renal stone treatment: results from the Clinical Research Office of Endourological Society (CROES) ureteroscopy (URS) Global Study.

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Assimos, Dean; Crisci, Alfonso; Culkin, Daniel; Xue, Wei; Roelofs, Anita; Duvdevani, Mordechai; Desai, Mahesh; de la Rosette, Jean

2016-04-01

To compare outcomes of ureteric and renal stone treatment with ureteroscopy (URS) in patients with or without the placement of a preoperative JJ stent. The Clinical Research Office of the Endourological Society (CROES) URS Global Study collected prospective data for 1 year on consecutive patients with ureteric or renal stones treated with URS at 114 centres around the world. Patients that had had preoperative JJ stent placement were compared with those that did not. Inverse-probability-weighted regression adjustment (IPWRA) was used to examine the effect of preoperative JJ stent placement on the stone-free rate (SFR), length of hospital stay (LOHS), operative duration, and complications (rate and severity). Of 8 189 patients with ureteric stones, there were 978 (11.9%) and 7 133 patients with and without a preoperative JJ stent, respectively. Of the 1 622 patients with renal stones, 590 (36.4%) had preoperative stenting and 1 002 did not. For renal stone treatment, preoperative stent placement increased the SFR and operative time, and there was a borderline significant decrease in intraoperative complications. For ureteric stone treatment, preoperative stent placement was associated with longer operative duration and decreased LOHS, but there was no difference in the SFR and complications. One major limitation of the study was that the reason for JJ stent placement was not identified preoperatively. The placement of a preoperative JJ stent increases SFRs and decreases complications in patients with renal stones but not in those with ureteric stones. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

Use of partial budgeting to determine the economic benefits of antibiotic treatment of chronic subclinical mastitis caused by Streptococcus uberis or Streptococcus dysgalactiae

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Swinkels, J.M.; Rooijendijk, J.G.A.; Zadoks, R.N.; Hogeveen, H.

2005-01-01

The economic effect of lactational antibiotic treatment of chronic subclinical intramammary infections due to Streptococcus uberis or Streptococcus dysgalactiae was explored by means of partial budgeting. Effects at cow level and herd level were modelled, including prevention of clinical mastitis

Comparative efficacy of tamsulosin versus nifedipine for distal ureteral calculi: a meta-analysis.

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Wang, Hai; Man, Li Bo; Huang, Guang Lin; Li, Gui Zhong; Wang, Jian Wei

2016-01-01

The aim of this study was to systematically compare the therapeutic effect and safety of tamsulosin with nifedipine in medical expulsive therapy for distal ureteral calculi. Databases, including PubMed, EMBASE, the Cochrane Library, and Clinical Trial Register Centers, were comprehensively searched. Relevant randomized controlled trials (RCTs) were selected, and quality assessment was performed according to the Cochrane Handbook. RevMan software was used to analyze the outcome measures, which consisted of expulsion rate, expulsion time, and complications. Twelve RCTs consisting of 4,961 patients were included (tamsulosin group, 2,489 cases; nifedipine group, 2,472 cases). Compared with nifedipine, tamsulosin significantly increased the expulsion rate (risk ratio =1.29, 95% CI [1.25, 1.33], Ptamsulosin was associated with fewer complications than nifedipine (risk ratio =0.45, 95% CI [0.28, 0.72], P=0.0008), and further subgroup analysis showed that tamsulosin was associated with a lower risk of both mild and moderate-to-severe complications. On the bias of current evidence, tamsulosin showed an overall superiority to nifedipine for distal ureteral calculi Tamsulosin was supposed to be the first drug to be recommended to patients willing to receive medical expulsive therapy.

Interkinetic nuclear migration in the mouse embryonic ureteric epithelium: Possible implication for congenital anomalies of the kidney and urinary tract.

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Motoya, Tomoyuki; Ogawa, Noriko; Nitta, Tetsuya; Rafiq, Ashiq Mahmood; Jahan, Esrat; Furuya, Motohide; Matsumoto, Akihiro; Udagawa, Jun; Otani, Hiroki

2016-05-01

Interkinetic nuclear migration (INM) is a phenomenon in which progenitor cell nuclei migrate along the apico-basal axis of the pseudostratified epithelium, which is characterized by the presence of apical primary cilia, in synchrony with the cell cycle in a manner of apical mitosis. INM is suggested to regulate not only stem/progenitor cell proliferation/differentiation but also organ size and shape. INM has been reported in epithelia of both ectoderm and endoderm origin. We examined whether INM exists in the mesoderm-derived ureteric epithelium. At embryonic day (E) 11.5, E12.5 and E13.5, C57BL/6J mouse dams were injected with 5-bromo-2'-deoxyuridine (BrdU) and embryos were killed 1, 2, 4, 6, 8, 10 and 12 h later. We immunostained transverse sections of the ureter for BrdU, and measured the position of BrdU (+) nuclei in the ureteric epithelia along the apico-basal axis at each time point. We analyzed the distribution patterns of BrdU (+) nuclei in histograms using the multidimensional scaling. Changes in the nucleus distribution patterns suggested nucleus movement characteristic of INM in the ureteric epithelia, and the mode of INM varied throughout the ureter development. While apical primary cilia are related with INM by providing a centrosome for the apical mitosis, congenital anomalies of the kidney and urinary tract (CAKUT) include syndromes linked to primary ciliary dysfunction affecting epithelial tubular organs such as kidney, ureter, and brain. The present study showed that INM exists in the ureteric epithelium and suggests that INM may be related with the CAKUT etiology via primary ciliary protein function. © 2015 Japanese Teratology Society.

Bilateral transrenal ureteral occlusion by means of n-butyl cyanoacrylate and AMPLATZER vascular plug

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Rosario F Grasso

2014-01-01

Full Text Available AMPLATZER vascular plug is a widely used embolic agent. In the present paper, we present a case of an 86-year-old female patient who underwent bilateral ureteral occlusion by means of AMPLATZER vascular plug II coupled to n-butyl cyanoacrylate (NBCA because of recurring pyelonephritis following cystectomy with subsequent bilateral ureterosigmoidostomy (sec. Mainz type II.

Ultrasonography-guided PNL in comparison with laparoscopic ureterolithotomy in the management of large proximal ureteral stone.

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Karami, Hossein; Mazloomfard, Mohammad Mohsen; Lotfi, Behzad; Alizadeh, Asghar; Javanmard, Babak

2013-01-01

The aim of study was to evaluate the clinical outcomes of PNL in comparison with laparoscopic ureterolithotomy (LUL) in proximal ureteral stones larger than 1 cm. A total of 80 patients who were candidates for treatment of large ureteral stones in our urology center were enrolled in the study between September 2004 and September 2008. By using patient randomization, they were assigned into two forty-patient groups (PNL and LUL). After evaluating the patients with laboratory tests and IVP, PNL was performed under sonography guidance in the prone position or the patients were submitted to classic laparoscopic ureterolithotomy (LUL) transperitoneally. All patients underwent postoperative assessments including KUB and ultrasonography. A hundred-percent success was achieved in both groups. The mean age of the patients were 39.4 (16-63) and 35.2 (18-57) years old in PNL and LUL groups, respectively. The mean stone size in PNL group was 14.2 (10-25) mm and in LUL group was 13.5 (10-28) mm. The duration of the operations were 54.35 (50-82) minutes, and 82.15 (73-180) minutes (P PNL and LUL, accordingly. The mean Hb decrease in PNL group was 0.9mg/dL and in LUL group was 0.4mg/dL (p = 0.001). No statistically significant differences in terms of blood transfusion, fever, ICU admission, and prolonged urinary leakage were detected in both groups. According to our study, percutaneous nephrolithotomy under ultrasonography guidance is comparable with the laparoscopic ureterolithotomy for the treatment of proximal ureteral stones larger than 1 cm.

Symptomatic small non-obstructing lower ureteric calculi: comparison of ureteroscopy and extra corporeal shock wave lithotripsy.

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Andankar M

2001-07-01

Full Text Available OBJECTIVE: To compare the success, efficacy and complications of ureteroscopy (URS and extra corporeal shock wave lithotripsy (ESWL for the treatment of symptomatic small non obstructing lower ureteric calculi. SUBJECTS AND METHODS: This prospective non-randomised study was conducted simultaneously at two urological referral centres, included 280 patients with symptomatic small (4-10 mm lower ureteric calculi (situated below the sacroiliac joint, with good renal function on intravenous urography. Patients were offered both the treatment options. One hundred and sixty patients chose ureteroscopy, whereas 120 patients were treated by ESWL. Standard techniques of ureteroscopy and ESWL were employed. Patients were followed-up to assess the success rates and complications of the two procedures. RESULTS: Ureteroscopy achieved complete stone clearance in one session in 95% of patients. In six patients ureteroscopy had failed initially and was later accomplished in second session improving the success rate to 98.7%. Two patients had a proximal migration of calculus that needed ESWL. Of the 120 patients treated by ESWL, 90% achieved stone free status at three months. Ureteroscopy was needed for twelve patients (10% where ESWL failed to achieve stone clearance. There were no significant ESWL related complications. ESWL was administered on outpatient basis, while patients needed hospitalisation and anaesthesia for ureteroscopy. CONCLUSION: ESWL can be the primary mode of treatment for symptomatic small non-obstructing lower ureteric calculi as it is minimally invasive and safe. Ureteroscopy can be offered to patients who demand immediate relief or when ESWL fails.

Impact of Hydronephrosis on Treatment Outcome of Solitary Proximal Ureteral Stone After Extracorporeal Shock Wave Lithotripsy

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Hsi-Lin Hsiao

2008-10-01

Full Text Available The purpose of this study was to investigate the impact of hydronephrosis on the treatment outcome of patients with a solitary proximal ureteral stone after extracorporeal shock wave lithotripsy (ESWL. A total of 182 consecutive patients who underwent ESWL for a solitary proximal ureteral stone of between 5 and 20 mm in size in our institution were included in this study. The degree of hydronephrosis was defined by renal ultrasonography. Patient data, stone size, shock wave numbers and shock wave energy were also recorded. Treatment outcome was evaluated 3 months after the first session of ESWL. In multivariate analysis, only the maximal stone length (odds ratio [OR], 0.15; 95% confidence interval [CI], 0.03–0.91; p = 0.04 and the degree of hydronephrosis (OR, 0.40; 95% CI, 0.16–0.98; p = 0.045 were significant predicting factors for stone-free status 3 months after ESWL. For stones ≤ 10 mm, the stone-free rate decreased from 80% in patients with mild hydronephrosis to 56.4% in those with moderate to severe hydro-nephrosis. For stones > 10 mm, the stone-free rate decreased further, from 65.2% in patients with mild hydronephrosis to 33.3% in those with moderate to severe hydronephrosis. In summary, patients with a solitary proximal ureteral stone and a stone > 10 mm, the treatment outcome after ESWL was not good if moderate to severe hydronephrosis was noted on ultrasonography. Alternative treatments, such as ureteroscopic lithotripsy, may be appropriate as initial treatment or after failure of one session of ESWL.

Lessons learned over a decade of pediatric robotic ureteral reimplantation

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Minki Baek

2017-01-01

Full Text Available The da Vinci robotic system has improved surgeon dexterity, ergonomics, and visualization to allow for a minimally invasive option for complex reconstructive procedures in children. Over the past decade, robot-assisted laparoscopic ureteral reimplantation (RALUR has become a viable minimally invasive surgical option for pediatric vesicoureteral reflux (VUR. However, higher-thanexpected complication rates and suboptimal reflux resolution rates at some centers have also been reported. The heterogeneity of surgical outcomes may arise from the inherent and underestimated complexity of the RALUR procedure that may justify its reclassification as a complex reconstructive procedure and especially for robotic surgeons early in their learning curve. Currently, no consensus exists on the role of RALUR for the surgical management of VUR. High success rates and low major complication rates are the expected norm for the current gold standard surgical option of open ureteral reimplantation. Similar to how robot-assisted laparoscopic surgery has gradually replaced open surgery as the most utilized option for prostatectomy in prostate cancer patients, RALUR may become a higher utilized surgical option in children with VUR if the adoption of standardized surgical techniques that have been associated with optimal outcomes can be adopted during the second decade of RALUR. A future standard of RALUR for children with VUR whose parents seek a minimally invasive surgical option can arise if widespread achievement of high success rates and low major complication rates can be obtained, similar to the replacement of open surgery with robot-assisted laparoscopic radical prostectomy as the new strandard for men with prostate cancer.

Non-Contrast Computed Tomography Scan Based Parameters of Ureteric Stones Affecting the Outcome of Extracorporeal Shock Wave Lithotripsy

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Ayaz Khan, Mohammad; Waqas Iqbal, Muhammad; Akbar, Mian Khalid; Saqib, Imad-ud-din; Akhter, Saeed

2017-01-01

Objective  To compare the non-contrast computed tomography (NCCT) scan-based parameters of ureteric stones affecting the outcome of extracorporeal shock wave lithotripsy (ESWL). Materials and methods We retrospectively evaluated the pre-procedure NCCT of 74 patients who had ESWL for solitary ureteric calculi of 5-20 mm in diameter. We assessed the age, sex, basal metabolic index (BMI), laterality, location, presence of double 'J' (DJ) stent, skin to stone distance (SSD), stone maximum diameter, Hounsfield unit (HU), Hounsfield density (HD), area, and volume. All those who had no stone on follow-up imaging within 30 days were declared successful while those who had residual stone were declared failures. Results The overall success rate was 78% (58/74). Sixty (81.1%) patients were male. The success of ESWL was correlated with lower SSD, Hounsfield units (HU) and Hounsfield density (HD). However, in multivariate analysis, SSD, Hounsfield unit, and stone area showed correlation with success of procedure but Hounsfield density failed to show correlation. The success rate in patients with stone HU 1000 were 93.9%, 69%, and 58.3%, respectively. Patients with lower BMI (30 kg/m2) and higher HD (>76 HU/mm). Conclusion BMI, SSD, stone Hounsfield units and Hounsfield unit density were strong predictors of outcome of ESWL for ureteric stone. PMID:28589076

Proximal Hamstring Tendinosis and Partial Ruptures.

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Startzman, Ashley N; Fowler, Oliver; Carreira, Dominic

2017-07-01

Proximal hamstring tendinosis and partial hamstring origin ruptures are painful conditions of the proximal thigh and hip that may occur in the acute, chronic, or acute on chronic setting. Few publications exist related to their diagnosis and management. This systematic review discusses the incidence, treatment, and prognosis of proximal hamstring tendinosis and partial hamstring ruptures. Conservative treatment measures include nonsteroidal anti-inflammatory drugs, physical therapy, rest, and ice. If these measures fail, platelet-rich plasma or shockwave therapy may be considered. When refractory to conservative management, these injuries may be treated with surgical debridement and hamstring reattachment. [Orthopedics. 2017; 40(4):e574-e582.]. Copyright 2017, SLACK Incorporated.

A novel ureteral stent material with antibacterial and reducing encrustation properties

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Zhao, Jing [Institute of Metal Research, Chinese Academy of Sciences, Shenyang 110016 (China); Cao, Zhiqiang [General Hospital of Shenyang Military Region, Shenyang 110840 (China); Ren, Ling; Chen, Shanshan; Zhang, Bingchun; Liu, Rui [Institute of Metal Research, Chinese Academy of Sciences, Shenyang 110016 (China); Yang, Ke, E-mail: kyang@imr.ac.cn [Institute of Metal Research, Chinese Academy of Sciences, Shenyang 110016 (China)

2016-11-01

Ureteral stents have been used to relieve ureterostenosis. Complications such as infection and encrustation occur in the long time of stent implantation, which is a clinical problem needs to be resolved. Indwelling ureteral stents have shown to develop microbial biofilm that may lead to recurrent infection and encrustation. This study was aiming to reduce those complications by using a novel material, Cu-bearing antibacterial stainless steel. The antibacterial performance, encrustation property, and biocompatibility were examined by SEM, image analysis, MTT and would healing. The in vitro immersion test showed that 316LCu-bearing stainless steel (316LCu-SS) not only inhibited proliferation of bacteria and formation of biofilm, but also had less encrustation deposition. Its antibacterial effectiveness against Escherichia coli reached to 92.7% in the artificial urine for 24 h and 90.3% in the human urine for 6 h. The encrustation surface coverage percentage was 30.2% by 12 weeks, which was nearly one half of NiTi alloy. The in vitro tests showed that 316LCu-SS had no toxicity, and promoted the migration of urethral epithelial cells. - Highlights: • 316LCu-SS exhibited strong antibacterial performance against E.coli in the urine. • 316LCu-SS had less crystals deposition on its surface compared to NiTi. • 316LCu-SS showed no toxicity and promoted migration of epithelial cells. • 316LCu-SS is prospective to be a new candidate material to relieve UTIs.

A novel ureteral stent material with antibacterial and reducing encrustation properties

International Nuclear Information System (INIS)

Zhao, Jing; Cao, Zhiqiang; Ren, Ling; Chen, Shanshan; Zhang, Bingchun; Liu, Rui; Yang, Ke

2016-01-01

Ureteral stents have been used to relieve ureterostenosis. Complications such as infection and encrustation occur in the long time of stent implantation, which is a clinical problem needs to be resolved. Indwelling ureteral stents have shown to develop microbial biofilm that may lead to recurrent infection and encrustation. This study was aiming to reduce those complications by using a novel material, Cu-bearing antibacterial stainless steel. The antibacterial performance, encrustation property, and biocompatibility were examined by SEM, image analysis, MTT and would healing. The in vitro immersion test showed that 316LCu-bearing stainless steel (316LCu-SS) not only inhibited proliferation of bacteria and formation of biofilm, but also had less encrustation deposition. Its antibacterial effectiveness against Escherichia coli reached to 92.7% in the artificial urine for 24 h and 90.3% in the human urine for 6 h. The encrustation surface coverage percentage was 30.2% by 12 weeks, which was nearly one half of NiTi alloy. The in vitro tests showed that 316LCu-SS had no toxicity, and promoted the migration of urethral epithelial cells. - Highlights: • 316LCu-SS exhibited strong antibacterial performance against E.coli in the urine. • 316LCu-SS had less crystals deposition on its surface compared to NiTi. • 316LCu-SS showed no toxicity and promoted migration of epithelial cells. • 316LCu-SS is prospective to be a new candidate material to relieve UTIs.

A case of ectopic ureteral orifice with hypoplastic kidney diagnosed by enhanced computed tomography

International Nuclear Information System (INIS)

Kishi, Mikio; Yoshimoto, Jun; Matsumura, Yosuke; Ohmori, Hiroyuki

1983-01-01

A case of ectopic ureteral orifice, 6 year old girl with urinary incontinece, is herein reported. Cystoscopy and excretory urogram showed absense of right half of trigone and non visualizing kidney. By enhanced computed tomography, right hypoplastic kidney was found and right nephrectomy was performed. We emphasize that enhanced computed tomography is very usefull for diagnosis of localization of hypoplastic kidney. (author)

TISU: Extracorporeal shockwave lithotripsy, as first treatment option, compared with direct progression to ureteroscopic treatment, for ureteric stones: study protocol for a randomised controlled trial.

Science.gov (United States)

McClinton, Samuel; Cameron, Sarah; Starr, Kathryn; Thomas, Ruth; MacLennan, Graeme; McDonald, Alison; Lam, Thomas; N'Dow, James; Kilonzo, Mary; Pickard, Robert; Anson, Ken; Keeley, Frank; Burgess, Neil; Clark, Charles Terry; MacLennan, Sara; Norrie, John

2018-05-22

Urinary stone disease is very common with an estimated prevalence among the general population of 2-3%. Ureteric stones are associated with severe pain as they pass through the urinary tract and have significant impact on patients' quality of life due to the detrimental effect on their ability to work and need for hospitalisation. Most ureteric stones can be expected to pass spontaneously with supportive care. However, between one-fifth and one-third of cases require an intervention. The two standard active intervention options are extracorporeal shockwave lithotripsy (ESWL) and ureteroscopic stone retrieval. ESWL and ureteroscopy are effective in terms of stone clearance; however, they differ in terms of invasiveness, anaesthetic requirement, treatment setting, complications, patient-reported outcomes (e.g. pain after intervention, time off work) and cost. There is uncertainty around which is the most clinically effective in terms of stone clearance and the true cost to the NHS and to society (in terms of impact on patient-reported health and economic burden). The aim of this trial is to determine whether, in adults with ureteric stones, judged to require active intervention, ESWL is not inferior and is more cost-effective compared to ureteroscopic treatment as the initial management option. The TISU study is a pragmatic multicentre non-inferiority randomised controlled trial of ESWL as the first treatment option compared with direct progression to ureteroscopic treatment for ureteric stones. Patients aged over 16 years with a ureteric stone confirmed by non-contrast computed tomography of the kidney, ureter and bladder (CTKUB) will be randomised to either ESWL or ureteroscopy. The primary clinical outcome is resolution of the stone episode (no further intervention required to facilitate stone clearance) up to six months from randomisation. The primary economic outcome is the incremental cost per quality-adjusted life years (QALYs) gained at six months from

A multi-centre cohort study evaluating the role of inflammatory markers in patient’s presenting with acute ureteric colic (MIMIC

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T.T. Shah

Full Text Available Background: Spontaneous Stone Passage (SSP rates in acute ureteric colic range from 47 to 75%. There is conflicting evidence on the role of raised inflammatory markers in acute ureteric colic. The use of an easily applicable biomarker that could predict SSP or need for intervention would improve the management of obstructing ureteric stones. Thus, there is a need to determine in an appropriately powered study, in patients who are initially managed conservatively, which factors at the time of acute admission can predict subsequent patient outcome such as SSP and the need for intervention. Particularly, establishing whether levels of white cell count (WBC at presentation are associated with likelihood of SSP or intervention may guide clinicians on the management of these patients’ stones. Design: Multi-center cohort study disseminated via the UK British Urology Researchers in Surgical Training (BURST and Australian Young Urology Researchers Organisation (YURO. Primary research question: What is the association between WBC and SSP in patients discharged from emergency department after initial conservative management? Patient population: Patients who have presented with acute renal colic with CT KUB evidence of a solitary ureteric stone. A minimum sample size of 720 patients across 15 centres will be needed. Hypothesis: A raised WBC is associated with decreased odds of spontaneous stone passage. Primary outcome: The occurrence of SSP within six months of presentation with acute ureteric colic (YES/NO. SSP was defined as absence of need for intervention to assist stone passage. Statistical analysis plan: A multivariable logistic regression model will be constructed, where the outcome of interest is SSP using data from patients who do not undergo intervention at presentation. A random effect will be used to account for clustering of patients within hospitals/institutions. The model will include adjustments for gender, age as control variables

Fluoroscopically guided pyeloureteral interventions using a retrograde perurethral approach

International Nuclear Information System (INIS)

Amendola, M.A.; Banner, M.P.; Pollack, H.M.; Gordon, R.L.; Van Arsdalen, K.N.

1987-01-01

Employing standard interventional equipment, fluoroscopy, and partially or completely inserted ureteral catheters for access, the authors performed 168 perurethral interventional procedures since 1985. Procedures have included insertion of double (n = 42) or single pigtail stents (n = 47), advancement of retrograde ureteral catheters with or without displacement of a ureteral stone to the renal pelvis (n = 42), urothelial biopsy (n = 30), balloon dilation of ureteral structures (n = 3), ureteral stone extraction (n = 1), and conversion of retrograde to antegrade catheters for balloon dilation of ureteropelvic junction strictures (n = 3). This retrograde approach often obviates the need for antegrade interventional procedures (including percutaneous nephrostomy and ureteral stenting), ureteroscopy, or surgery. Indications, techniques, pitfalls, and complications are illustrated

Extracorporeal shock wave lithotripsy (ESWL) vs. ureterorenoscopic (URS) manipulation in proximal ureteric stone.

Science.gov (United States)

Manzoor, Salman; Hashmi, Altaf Hussain; Sohail, Muhammad Ali; Mahar, Feroz; Bhatti, Shahid; Khuhro, Abdul Qayoom

2013-10-01

To compare the stone free rate at one week after extracorporeal shock wave lithotripsy (ESWL) and ureterorenoscopic (URS) manipulation for proximal ureteric stone (10 - 15 mm size). Randomized controlled trial. Sindh Institute of Urology and Transplantation (SIUT), Karachi, from August 2010 to February 2011. One hundred and ninety patients with 10 - 15 mm proximal urteric stone, in each group were treated with ESWL and ureterorenoscopic manipulation by using an 8.0 or 8.5 Fr semi rigid ureteroscope. Intracorporeal lithotripsy was performed by using pneumatic lithoclast. The stone free rate were compared between groups by considering size of stone at one week after procedure. The success rate, retreatment rate, auxiliary procedure and complication rate were compared in each group. Success rate was 49.2% for ESWL and 57.8% for URS (p = 0.008). The re-treatment rate was significantly higher in ESWL group than in URS group (40% vs. 11 and 18% in URS group). Although ESWL is regarded as the preferred choice of treatment for proximal ureteric stone, the present results suggest that ureterorenoscopic manipulation with intracorporeal lithotripsy is a safe alternative, with an advantage of obtaining an earlier or immediate stone-free status. Laparoscopic approaches are reasonable alternatives in cases, where ESWL and URS have failed.

Diuretic urography in the assessment of obstruction of the pelvi-ureteric junction

International Nuclear Information System (INIS)

Nilson, A.E.; Aurell, M.; Bratt, C.G.; Nilsson, S.

1980-01-01

Twenty adult patients with urographic evidence of unilateral, moderately wide renal pelves were examined by routine and diuretic urography. Planimetry of the corresponding calyx system of the two examinations was performed. An increase in size by more than 20 per cent following osmotic diuresis indicated an obstruction of the pelvi-ureteric junction in kidneys with moderately wide renal pelves. Diuretic urography may be useful to diagnose obstruction as a cause of moderately wide renal pelves and to assess operative results. (Auth.)

Laparoscopic bilateral nephroureterectomy and bladder cuff excision for native renal pelvic and ureteral transitional cell carcinoma after renal transplantation.

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Chen C

2003-01-01

Full Text Available A 37-years-old female who was suffering from end-stage renal disease for about 6 years received allograft renal transplantation 4 years ago. She has been receiving 50mg of Cyclosporin A orally daily for immuno-suppression since then. Gross haematuria was noted and computerised tomography showed native left renal pelvic and ureteral multi-focal transitional cell carcinoma with severe hydronephrosis. Laparoscopic bilateral nephroureterectomy and bladder cuff excision were performed. In the past, history of previous operation was considered a relative contraindication for laparoscopic surgery. To our knowledge, we present the first case of laparoscopic treatment for native renal pelvic and ureteral transitional cell carcinoma after renal allograft transplantation without a hand-assisted device. This case shows the feasibility of laparoscopic bilateral nephroureterectomy in patients with transplanted kidneys.

Hybrid laparoscopic and robotic ultrasound-guided radiofrequency ablation-assisted clampless partial nephrectomy.

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Nadler, Robert B; Perry, Kent T; Smith, Norm D

2009-07-01

To describe a clampless approach made possible by creating an avascular plane of tissue with radiofrequency ablation. Laparoscopic partial nephrectomy is slowly gaining acceptance as a method to treat small (generator. Typically, we used a power setting of 50 W but have found settings as low as 25 W necessary to provide hemostasis for larger vessels. The tumor was then sharply excised with a negative margin using robotic scissors and electrocautery to facilitate tissue cutting. Retrograde injection of methylthioninium chloride and saline through an externalized ureteral catheter allowed for precise sutured closure of the collecting system. FloSeal and BioGlue were then applied, making surgical bolsters or parenchymal sutures unnecessary. Intraoperative histologic evaluation of the surgical margin and repeat resection of the tumor bed was possible because the renal hilum was not clamped, and no warm ischemia was used. This technique, which combines the improving technologies of robotic surgery, intraoperative laparoscopic ultrasonography, and radiofrequency ablation, might make more surgeons comfortable with the intricacies of laparoscopic suturing and eliminate prolonged warm ischemia times. Overall, this method should result in more patients being able to undergo minimally invasive laparoscopic partial nephrectomy.

Effects of Qingshen Granules on the Oxidative Stress-NF/kB Signal Pathway in Unilateral Ureteral Obstruction Rats.

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Jin, Hua; Wang, Yiping; Wang, Dong; Zhang, Lei

2018-01-01

Background . The activation of NF-kappa B (NF/kB) signaling pathway plays an important role in the process of epithelial-mesenchymal transition (EMT) and renal interstitial fibrosis (RIF) in renal tubules. The process of oxidative stress reaction in kidney is via excessive reactive oxygen species (ROS) production to activate NF/kB signaling pathway. Qingshen Granule (QSG) is an effective Chinese formula utilized to treat chronic renal failure. Previous studies confirmed that QSG could inhibit RIF in unilateral ureteral obstruction (UUO) rats. In this study, we used UUO rats to investigate the effects of QSG on oxidative stress and the activation of NF/kB signaling. Seventy male Sprague-Dawley (SD) rats were randomly divided into a sham group, UUO model group, Qingshen Granules (QSG) high-dose, medium-dose, and low-dose groups, PDTC group, and candesartan group (10 rats in each group). Our study demonstrated that oxidative stress-NF/kB signal pathway contributed to the formation of UUO renal interstitial fibrosis. QSG may protect against RIF by inhibiting the oxidative stress-NF/kB signal pathway, reducing inflammation, and improving renal tubular EMT.

Ultrasonography-guided PNL in comparison with laparoscopic ureterolithotomy in the management of large proximal ureteral stone

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Hossein Karami

2013-01-01

Full Text Available Purpose: The aim of study was to evaluate the clinical outcomes of PNL in comparison with laparoscopic ureterolithotomy (LUL in proximal ureteral stones larger than 1 cm. Materials and Methods: A total of 80 patients who were candidates for treatment of large ureteral stones in our urology center were enrolled in the study between September 2004 and September 2008. By using patient randomization, they were assigned into two forty-patient groups (PNL and LUL. After evaluating the patients with laboratory tests and IVP, PNL was performed under sonography guidance in the prone position or the patients were submitted to classic laparoscopic ureterolithotomy (LUL transperitoneally. All patients underwent postoperative assessments including KUB and ultrasonography. Results: A hundred-percent success was achieved in both groups. The mean age of the patients were 39.4 (16-63 and 35.2 (18-57 years old in PNL and LUL groups, respectively. The mean stone size in PNL group was 14.2 (10-25 mm and in LUL group was 13.5 (10-28 mm. The duration of the operations were 54.35 (50-82 minutes, and 82.15 (73-180 minutes (P < 0.0001; and the average hospital stay days were 2.6 (2-5 and 3.5 (3-8 days (p = 0.011 in groups PNL and LUL, accordingly. The mean Hb decrease in PNL group was 0.9mg/dL and in LUL group was 0.4mg/dL (p = 0.001. No statistically significant differences in terms of blood transfusion, fever, ICU admission, and prolonged urinary leakage were detected in both groups. Conclusion: According to our study, percutaneous nephrolithotomy under ultrasonography guidance is comparable with the laparoscopic ureterolithotomy for the treatment of proximal ureteral stones larger than 1 cm.

Can stone density on plain radiography predict the outcome of extracorporeal shockwave lithotripsy for ureteral stones?

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Lim, Ki Hong; Jung, Jin-Hee; Kwon, Jae Hyun; Lee, Yong Seok; Bae, Jungbum; Cho, Min Chul; Lee, Kwang Soo

2015-01-01

Purpose The objective was to determine whether stone density on plain radiography (kidney-ureter-bladder, KUB) could predict the outcome of extracorporeal shockwave lithotripsy (ESWL) for ureteral stones. Materials and Methods A total of 223 patients treated by ESWL for radio-opaque ureteral stones of 5 to 20 mm were included in this retrospective study. All patients underwent routine blood and urine analyses, plain radiography (KUB), and noncontrast computed tomography (NCCT) before ESWL. Demographic, stone, and radiological characteristics on KUB and NCCT were analyzed. The patients were categorized into two groups: lower-density (LD) group (radiodensity less than or equal to that of the 12th rib, n=163) and higher-density (HD) group (radiodensity greater than that of the 12th rib, n=60). Stone-free status was assessed by KUB every week after ESWL. A successful outcome was defined as stone free within 1 month after ESWL. Results Mean stone size in the LD group was significantly smaller than that in the HD group (7.5±1.4 mm compared with 9.9±2.9 mm, p=0.002). The overall success rates in the LD and HD groups were 82.1% and 60.0%, respectively (p=0.007). The mean duration of stone-free status and average number of SWL sessions required for success in the two groups were 21.7 compared with 39.2 days and 1.8 compared with 2.3, respectively (pESWL since colic and radiodensity of the stone on KUB were independent predictors of successful ESWL. Conclusions Our data suggest that larger stone size, longer time to ESWL, and ureteral stones with a radiodensity greater than that of the 12th rib may be at a relatively higher risk of ESWL failure 1 month after the procedure. PMID:25598937

Treatment of forgotten ureteral stents: how much does it really cost? A cost-effectiveness study in 27 patients.

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Sancaktutar, Ahmet Ali; Söylemez, Haluk; Bozkurt, Yasar; Penbegül, Necmettin; Atar, Murat

2012-08-01

Aim of study was to present costs of forgotten ureteral stents extraction so as to distract attentions of the urologists on this issue. Medical files of 27 accessible patients who referred to our clinics between 2001 and 2010 because of forgotten ureteral stent were retrospectively analyzed. The indwelling time of double-j stents (DJS) was calculated from the time of its insertion. Costs related to radiological investigations, all invasive, and noninvasive interventions, duration of hospital stay, and medical treatments used were calculated. These estimations were based on 2010 prices determined by Turkey Ministry of Health. Mean age of the patients was 31.2 (8-86 years) years. Mean indwelling time of ureteral DJSs was 36.7 months (14-84 months). Seventy-one [extracorporeal shock wave lithotripsy (ESWL), n = 26; invasive/noninvasive interventions, n = 32] procedures were applied for 27 patients. In six patients without incrustation, after a single session of ESWL DJSs could be removed cystoscopically. A various combination of a multimodal therapy was used for other 21 patients. Total financial burden of 27 patients was US $ 34,300. Cost of treatment was estimated to be 6.9-fold (1.8- to 21-fold) higher than an average timely stent extraction. Financial burden of the treatments increased in parallel with the duration of the stent retention (p = 0.001). Management of forgotten DJS is time consuming, difficult, complicated, risky, and costly. Therefore; financial burden, increased labour loss, and impaired quality of life brought by the application of these modalities must not be forgotten.

Extracorporeal Shock Wave Lithotripsy (ESWL) vs. Ureterorenoscopic (URS) Manipulation in Proximal Ureteric Stone

International Nuclear Information System (INIS)

Manzoor, S.; Khuhro, A.Q.; Hashmi, A.H.; Sohail, M.A.; Mahar, F.; Bhatti, S.

2013-01-01

Objective: To compare the stone free rate at one week after extracorporeal shock wave lithotripsy (ESWL) and ureterorenoscopic (URS) manipulation for proximal ureteric stone (10 - 15 mm size). Study Design: Randomized controlled trial. Place and Duration of Study: Sindh Institute of Urology and Transplantation (SIUT), Karachi, from August 2010 to February 2011. Methodology: One hundred and ninety patients with 10 - 15 mm proximal urteric stone, in each group were treated with ESWL and ureterorenoscopic manipulation by using an 8.0 or 8.5 Fr semi rigid ureteroscope. Intracorporeal lithotripsy was performed by using pneumatic lithoclast. The stone free rate were compared between groups by considering size of stone at one week after procedure. The success rate, retreatment rate, auxiliary procedure and complication rate were compared in each group. Results: Success rate was 49.2% for ESWL and 57.8% for URS (p = 0.008). The re-treatment rate was significantly higher in ESWL group than in URS group (40% vs. 11 and 18% in URS group). Conclusion: Although ESWL is regarded as the preferred choice of treatment for proximal ureteric stone, the present results suggest that ureterorenoscopic manipulation with intracorporeal lithotripsy is a safe alternative, with an advantage of obtaining an earlier or immediate stone-free status. Laparoscopic approaches are reasonable alternatives in cases, where ESWL and URS have failed. (author)

Auxiliary partial liver transplantation

NARCIS (Netherlands)

C.B. Reuvers (Cornelis Bastiaan)

1986-01-01

textabstractIn this thesis studies on auxiliary partial liver transplantation in the dog and the pig are reported. The motive to perform this study was the fact that patients with acute hepatic failure or end-stage chronic liver disease are often considered to form too great a risk for successful

Negative pressure wound therapy via vacuum-assisted closure following partial foot amputation: what is the role of wound chronicity?

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Armstrong, David G; Lavery, Lawrence A; Boulton, Andrew J M

2007-03-01

Randomised clinical trials (RCTs) to evaluate diabetic foot wound therapies have systematically eliminated large acute wounds from evaluation, focusing only on smaller chronic wounds. The purpose of this study was to evaluate the proportion and rate of wound healing in acute and chronic wounds after partial foot amputation in individuals with diabetes treated with negative pressure wound therapy (NPWT) delivered by the vacuum-assisted closure (VAC) device or with standard wound therapy (SWT). This study constitutes a secondary analysis of patients enrolled in a 16-week RCT of NPWT: 162 open foot amputation wounds (mean wound size = 20.7 cm(2)) were included. Acute wounds were defined as the wounds less than 30 days after amputation, whereas chronic wounds as the wounds greater than 30 days. Inclusion criteria consisted of individuals older than 18 years, presence of a diabetic foot amputation wound up to the transmetatarsal level and adequate perfusion. Wound size and healing were confirmed by independent, blinded wound evaluators. Analyses were done on an intent-to-treat basis. There was a significantly higher proportion of acute wounds (SWT = 59; NPWT = 63) than chronic wounds (SWT = 26; NPWT = 14), evaluated in this clinical trial (P = 0.001). There was no significant difference in the proportion of acute and chronic wounds achieving complete wound closure in either treatment group. Despite this finding, the Kaplan-Meier curves demonstrated statistically significantly faster healing in the NPWT group in both acute (P = 0.030) and chronic wounds (P = 0.033). Among the patients treated with NPWT via the VAC, there was not a significant difference in healing as a function of chronicity. In both the acute and the chronic wound groups, results for patients treated with NPWT were superior to those for the patients treated with SWT. These results appear to indicate that wound duration should not deter the clinician from using this modality to treat complex wounds.

Large impacted upper ureteral calculi: A comparative study between retrograde ureterolithotripsy and percutaneous antegrade ureterolithotripsy in the modified lateral position

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Kamal Moufid

2013-01-01

Conclusions: In our series, Perc-URS is a safe and efficient treatment option for proximal ureteral stone, especially when the stone size is superior to 15 mm with the presence of moderate or severe hydronephrosis.

Terapia Expulsiva Medicamentosa na Litíase Ureteral: Revisão de Literatura/ Medicamental Expulsive Therapy in Ureteral Lithiasis: Literature Review

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Kenji Maeda Missima

2014-06-01

Full Text Available A terapia expulsiva medicamentosa na litíase ureteral tem ganhado importante espaço na prática clínica, visto que é um método não invasivo e de grande eficácia. Como se trata de uma afecção comum, de alta incidência e custo, a terapia expulsiva possibilita um manejo clínico menos dispendioso e invasivo, quando comparada a procedimentos intervencionistas. Há consenso na literatura que a terapia expulsiva medicamentosa é efetiva e deve ser utilizada em cálculos com cerca de 5 milímetros de diâmetro, visto que as drogas utilizadas aumentam a taxa e diminuem o tempo de expulsão, além de diminuir a dor e o número de internações. O tamanho e localização do cálculo são de extrema relevância para que se possa considerar o manejo conservador. As drogas que obtém as melhores taxas expulsivas são os bloqueadores dos receptores alfa-adrenérgicos e os bloqueadores dos canais de cálcio. Analgésicos também são utilizados para o alívio da dor e o uso de corticoides ainda é questionado. Medicamental expulsive therapy for ureteral stones has gained important place in clinical practice, because it is a noninvasive and highly effective method. As it is a common disorder with high incidence and cost, expulsive therapy provides a less costly and invasive clinical management when compared to interventional procedures. There is a consensus that the medicamental expulsive therapy is effective and should be used in calculations with about 5 millimeters in diameter, since the drugs used increase rate and decrease the time of expulsion, in addition to reducing the pain and the number of hospitalizations. The size and location of the calculi are very important for it to be considered conservative management. The drugs that get the best expulsive rates are alpha - adrenergic receptor blockers and calcium channel blockers. Analgesics are also used for pain relief and the use of corticosteroids is still questioned.

Ureteric stent dwelling time: a risk factor for post-ureteroscopy sepsis.

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Nevo, Amihay; Mano, Roy; Baniel, Jack; Lifshitz, David A

2017-07-01

To evaluate the association between stent dwelling time and sepsis after ureteroscopy, and identify risk factors for sepsis in this setting. The prospectively collected database of a single institution was queried for all patients who underwent ureteroscopy for stone extraction between 2010 and 2016. Demographic, clinical, preoperative and operative data were collected. The primary study endpoint was sepsis within 48 h of ureteroscopy. Logistic regressions were performed to identify predictors of post-ureteroscopy sepsis in the ureteroscopy cohort and specifically in patients with prior stent insertion. Between October 2010 and April 2016, 1 256 patients underwent ureteroscopy for stone extraction. Risk factors for sepsis included prior stent placement, female gender and Charlson comorbidity index. A total of 601 patients had a ureteric stent inserted before the operation and were included in the study cohort, in which the median age was 56 years, 90 patients were women (30%), and 97 patients were treated for positive preoperative urine cultures (16.1%). Postoperative sepsis, Sepsis rates after stent dwelling times of 1, 2, 3 and >3 months were 1, 4.9, 5.5 and 9.2%, respectively. On multivariate analysis, stent dwelling time, stent insertion because of sepsis, and female gender were significantly associated with post-ureteroscopy sepsis in patients with prior stent placement. Patients who undergo ureteroscopy after ureteric stent insertion have a higher risk of postoperative sepsis. Prolonged stent dwelling time, sepsis as an indication for stent insertion, and female gender are independent risk factors. Stent placement should be considered cautiously, and if inserted, ureteroscopy should be performed within 1 month. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

Prospective randomized comparison between fluoroscopy-guided ureteroscopy versus ureteroscopy with real-time ultrasonography for the management of ureteral stones

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Vishwajeet Singh

2016-01-01

Conclusions: Ultrasound-guided ureteroscopy is safe and effectively for ureteric stone. Fluoroscopy can be avoided during ureteroscopy for uncomplicated stone. No radiation ureteroscopy is feasible with good success and minimal complication. Larger sample size with multicentric trial needed for its greater applicability.

The incidence of ureteral obstruction secondary to aorto-femoral bypass surgery. A prospective study

DEFF Research Database (Denmark)

Henriksen, L O; Mejdahl, Steen; Petersen, F

1988-01-01

Hydronephrosis is reported to be an infrequent complication of aorto-femoral bypass operations. To define the true incidence of this complication, renography (131I-Hippuran) and renal scintigraphy (99 Technetium) were performed both pre- and postoperatively on 56 asymptomatic patients following...... successful aortic reconstruction. No patient developed signs of ureteral obstruction. It is concluded that hydronephrosis is a rare complication to aorto-femoral bypass surgery and postoperative control is only indicated in patients with symptoms from the urinary tract....

A case of retrocaval ureter diagnosed by CT scan combined with a ureteral catheter

International Nuclear Information System (INIS)

Matsumoto, Atsushi; Iio, Shozo; Toyama, Takashi; Mochizuki, Teruichi

1986-01-01

The patient was a 45-year-old male who was admitted for right flank pain, nausea and vomitting. IVP revealed right hydronephrosis and hydroureter with medial distortion at the level of the 3rd lumbar spine. The diagnosis of retrocaval ureter was made with CT scan combined with a ureteral catheter. End to end anastomosis after resection of the retrocaval segment was performed. IVP 21 days after the operation showed that the right hydroureteronephrosis had moderately improved. (author)

Drug treatment of bothersome lower urinary tract symptoms after ureteric JJ-stent insertion: A contemporary, comparative, prospective, randomised placebo-controlled study, single-centre experience.

Science.gov (United States)

Hekal, Ihab A

2016-12-01

To provide a guide for medication to alleviate bothersome lower urinary tract symptoms (LUTS) in patients after JJ ureteric stenting. Between June 2011 and June 2015, a prospective randomised placebo-controlled study was conducted on 200 consecutive cases of ureteric stones that required JJ stents. All patients had signed informed consent and JJ-stent placement confirmed by X-ray. The patients were randomised into five groups: A, solifenacin 5 mg; B, trospium chloride 20 mg; C, antispasmodic; and E, α-blocker; and a placebo group (D). A standard model was created to lessen patient selection bias. Eligible patients were enrolled and assessed for side-effects and bothersome LUTS using the validated Ureteric Stent Symptoms Questionnaire. Appropriate statistical analysis was carried out. In all, 150 male patients in the five groups were compared. LUTS were less in groups A and B ( P  JJ-stent insertion, anti-muscarinic medication, namely solifenacin 5 mg or trospium chloride 20 mg, was the best. The advantage of trospium over solifenacin is in the control of frequency rather than the other symptoms. Addition of an α-blocker (alfuzosin 10 mg) is valuable when nocturia is the predominant symptom.

Laser-welded ureteral anastomoses: experimental studies with three techniques.

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Gürpinar, T; Gürer, S; Kattan, M W; Wang, L; Griffith, D P

1996-01-01

Tissue welding with laser energy is a new technique for reconstructive surgery. The potential advantages of laser welding are (a) lack of foreign body reaction, (b) decreased operative time, (c) less tissue manipulation, and (d) effective union of tissues equivalent to sutured anastomoses. We have performed ureteral anastomoses in adult mongrel dogs using a KTP 532 nm laser at an intensity of 1.4 W. Multiple "spot welds" of 1-s duration were utilized in a single layer anastomosis. Laser-welded anastomoses were performed with and without protein solder (33% and 50% human albumin) and were compared to sutured anastomoses. The laser-welded anastomoses required less operative time and provided bursting pressure levels similar to those of traditional sutured anastomoses. There was no advantage or disadvantage to the addition of human albumin as a solder in these experimental studies.

Is an excretory urogram mandatory in patients with small to medium-sized renal and ureteric stones treated by extra corporeal shock wave lithotripsy?

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Akhtar Sobia

2004-04-01

Full Text Available Abstract Background An intravenous urogram (IVU has traditionally been considered mandatory before treating renal and ureteric stones by extracorporeal shock wave lithotripsy (ESWL. This study was designed to see whether there is a difference in complications and the need for ancillary procedures in patients managed by ESWL for renal and ureteric calculi, according to preoperative imaging technique. Methods This retrospective study compared 133 patients undergoing ESWL from January 2001 to July 2002. Patients were divided into three groups according to the preoperative imaging technique used: i IVU; ii non-contrast enhanced helical computed tomography (UHCT; and iii ultrasound (US + X-ray kidney, ureter and bladder (KUB. The groups were matched in terms of age and gender, as well as location, side and size of stones. Results There was no statistically significantly difference for number of ESWL sessions, number of shock waves and use of ancillary procedures between the three groups. The stone-free rate was 98% for the IVU and UHCT groups, and 97% for the US + X-ray KUB group. Conclusions The complication rate and need for ancillary procedures was comparable across the three groups. Patients imaged by UHCT or US + X-ray KUB prior to ESWL for uncomplicated renal and ureteric stones do not require IVU.

Renal access in PNL under sonographic guidance: Do we really need to insert an open end ureteral catheter in dilated renal systems? A prospective randomized study.

Science.gov (United States)

Eryildirim, Bilal; Tuncer, Murat; Camur, Emre; Ustun, Fatih; Tarhan, Fatih; Sarica, Kemal

2017-10-03

To evaluate the true necessity of open end ureteral catheter insertion in patients with moderate to severe pelvicalyceal system dilation treated with percutaneous nephrolithotomy (PNL) under sonographic guidance. 50 cases treated with PNL under sonographic guidance in prone position for solitary obstructing renal stones were evaluated. Patients were randomly divided into two groups; Group 1: Patients in whom a open end ureteral catheter was inserted prior to the procedure; Group 2: Patients receiving no catheter before PNL. In addition to the duration of the procedure as a whole and also all relevant stages as well, radiation exposure time, hospitalization period, mean nephrostomy tube duration, mean drop in Hb levels and all intra and postoperative complications have been evaluated. Mean size of the stones was 308.5 ± 133.2 mm2. Mean total duration of the PNL procedure in cases with open end ureteral catheter was significantly longer than the other cases (p < 0.001). Evaluation of the outcomes of the PNL procedures revealed no statistically significant difference between two groups regarding the stone-free rates (86% vs 84%). Additionally, there was no significant difference with respect to the duration of nephrostomy tube, hospitalization period and secondary procedures needed, complication rates as well as the post-operative Hb drop levels in both groups (p = 0.6830). Our results indicate that the placement of an open end ureteral catheter prior to a PNL procedure performed under sonographic access may not be indicated in selected cases presenting with solitary obstructing renal pelvic and/or calyceal stones.

Impact of Case Volume on Outcomes of Ureteroscopy for Ureteral Stones

DEFF Research Database (Denmark)

Kandasami, Sangam V; Mamoulakis, Charalampos; El-Nahas, Ahmed R

2014-01-01

of case volume on the outcomes of URS for ureteral stones. DESIGN, SETTING, AND PARTICIPANTS: The URS Global Study collected prospective data on consecutive patients with urinary stones treated with URS at 114 centres worldwide for 1 yr. Centres were identified as low or high volume based on the median...... overall annual case volume. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Pre- and intraoperative characteristics, and postoperative outcomes in patients at low- and high-volume centres were compared. The relationships between case volume and stone-free rate (SFR), stone burden, complications...... SFR was 91.9% and 86.3% at high- and low-volume centres, respectively (pstone-free outcome increased with increasing case volume (p

An experimental study on renal functional disturbance in rabbits after acute ureteral obstruction with dynamic Gd-DTPA enhanced MR imaging

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Shin, Kyoung Ja [Seoul Red Cross Hospital, Seoul (Korea, Republic of); Chung, Eun Chul; Rlee, Chung Sik [Ewha Womans University College of Medicine, Seoul (Korea, Republic of)

1994-05-15

To evaluate the anatomic and functional change in acutely obstructed kidneys, and probability of functional recovery after resolving the obstruction. There were 5 animal groups (6 rabbits in each group)-normal control group, 4 acute ureteral obstruction group. Each of the latter group was imaged with Gd-DTPA enhanced dynamic MR 2, 6, 24, and 48 hours after ligation of the left proximal urter, respectively. We compared the findings of dynamic MR imaging and histopathological findings. We could observe centripetal movement of dark band pattern which could be defined as 3 phases renal cortex, outer medulla, and inner medulla in normal rabbits. The appearance of the dark band pattern was delayed or absent in ureteral obstruction group with linear relationship to the duration of the obstruction. Gd-DTPA enhanced MR can be used to differentiate acute obstructive nephropathy from other causes of nephropathy and foretell the prognosis of the obstruction.

An experimental study on renal functional disturbance in rabbits after acute ureteral obstruction with dynamic Gd-DTPA enhanced MR imaging

International Nuclear Information System (INIS)

Shin, Kyoung Ja; Chung, Eun Chul; Rlee, Chung Sik

1994-01-01

To evaluate the anatomic and functional change in acutely obstructed kidneys, and probability of functional recovery after resolving the obstruction. There were 5 animal groups (6 rabbits in each group)-normal control group, 4 acute ureteral obstruction group. Each of the latter group was imaged with Gd-DTPA enhanced dynamic MR 2, 6, 24, and 48 hours after ligation of the left proximal urter, respectively. We compared the findings of dynamic MR imaging and histopathological findings. We could observe centripetal movement of dark band pattern which could be defined as 3 phases renal cortex, outer medulla, and inner medulla in normal rabbits. The appearance of the dark band pattern was delayed or absent in ureteral obstruction group with linear relationship to the duration of the obstruction. Gd-DTPA enhanced MR can be used to differentiate acute obstructive nephropathy from other causes of nephropathy and foretell the prognosis of the obstruction

The treatment of vesicoureteral reflux in children by endoscopic sub-mucosal intra-ureteral injection of dextranomer/hyaluronic acid: A case-series, multi-centre study.

Science.gov (United States)

Bawazir, Osama

2017-04-01

Vesicoureteral reflux is a risk factor for progressive renal damage. In addition to long-term antibiotic prophylaxis and open surgical re-implantation, endoscopic sub-mucosal intra-ureteral injection of implant material is a therapeutic alternative that gained a world-wide preference. The aim of this study was to determine the effectiveness and safety of the implant material, dextranomer/hyaluronic acid, in a cohort of Saudi children with vesicoureteral reflux. In this case-series study, 61 patients with vesicoureteral reflux, who were 7 months to 10 years old (mean age 2.6 years), underwent sub-mucosal intra-ureteral injection of dextranomer/hyaluronic acid at our institutions in the period from October 2003 to October 2013. The operative protocol was the same in all institutions. Dextranomer/hyaluronic acid was injected submucosally within the intramural ureter (modified STING). Renal ultrasonography was performed to detect the presence of hydronephrosis. At 6 weeks' fluoroscopic voiding cystourethrograms were used to evaluate the success of the technique. Data were analysed by SPSS version 19 using Pearson Chi square, Fisher's Exact and Cramér's V test. Reflux was corrected in 44 patients out of 61 (72.13%) and in 60 (75.00%) out of 80 ureteric units. Statistically, there was no significant difference (p>0.05) in success rate of the technique according to gender, age group and unilateral vs. bilateral cases. The success rate was significantly (p=0.025) higher in the lower grades (I-III) (87.50%) compared to grade IV (73.53%) and grade V (50.00%). No complications related to the technique were reported. The technique had failed in 17 patients (27.87%) or 20 ureters (25.00%). These cases underwent open surgery. Sub-mucosal intra-ureteral implantation with dextranomer/hyaluronic acid by the modified STING technique is a simple, safe and effective outpatient procedure for vesicoureteral reflux.

Prediction of spontaneous ureteral stone passage: Automated 3D-measurements perform equal to radiologists, and linear measurements equal to volumetric.

Science.gov (United States)

Jendeberg, Johan; Geijer, Håkan; Alshamari, Muhammed; Lidén, Mats

2018-01-24

To compare the ability of different size estimates to predict spontaneous passage of ureteral stones using a 3D-segmentation and to investigate the impact of manual measurement variability on the prediction of stone passage. We retrospectively included 391 consecutive patients with ureteral stones on non-contrast-enhanced CT (NECT). Three-dimensional segmentation size estimates were compared to the mean of three radiologists' measurements. Receiver-operating characteristic (ROC) analysis was performed for the prediction of spontaneous passage for each estimate. The difference in predicted passage probability between the manual estimates in upper and lower stones was compared. The area under the ROC curve (AUC) for the measurements ranged from 0.88 to 0.90. Between the automated 3D algorithm and the manual measurements the 95% limits of agreement were 0.2 ± 1.4 mm for the width. The manual bone window measurements resulted in a > 20 percentage point (ppt) difference between the readers in the predicted passage probability in 44% of the upper and 6% of the lower ureteral stones. All automated 3D algorithm size estimates independently predicted the spontaneous stone passage with similar high accuracy as the mean of three readers' manual linear measurements. Manual size estimation of upper stones showed large inter-reader variations for spontaneous passage prediction. • An automated 3D technique predicts spontaneous stone passage with high accuracy. • Linear, areal and volumetric measurements performed similarly in predicting stone passage. • Reader variability has a large impact on the predicted prognosis for stone passage.

Quality-of-Life Assessment After Palliative Interventions to Manage Malignant Ureteral Obstruction

International Nuclear Information System (INIS)

Monsky, Wayne Laurence; Molloy, Chris; Jin, Bedro; Nolan, Timothy; Fernando, Dayantha; Loh, Shaun; Li, Chin-Shang

2013-01-01

Purpose: Malignancies may cause urinary tract obstruction, which is often relieved with placement of a percutaneous nephrostomy tube, an internal double J nephro-ureteric stent (double J), or an internal external nephroureteral stent (NUS). We evaluated the affect of these palliative interventions on quality of life (QoL) using previously validated surveys. Methods: Forty-six patients with malignancy related ureteral obstruction received nephrostomy tubes (n = 16), double J stents (n = 15), or NUS (n = 15) as determined by a multidisciplinary team. QoL surveys were administered at 7, 30, and 90 days after the palliative procedure to evaluate symptoms and physical, social, functional, and emotional well-being. Number of related procedures, fluoroscopy time, and complications were documented. Kruskal–Wallis and Friedman’s test were used to compare patients at 7, 30, and 90 days. Spearman’s rank correlation coefficient was used to assess correlations between clinical outcomes/symptoms and QoL. Results: Responses to QoL surveys were not significantly different for patients receiving nephrostomies, double J stents, or NUS at 7, 30, or 90 days. At 30 and 90 days there were significantly higher reported urinary symptoms and pain in those receiving double J stents compared with nephrostomies (P = 0.0035 and P = 0.0189, respectively). Significantly greater fluoroscopy time was needed for double J stent–related procedures (P = 0.0054). Nephrostomy tubes were associated with more frequent minor complications requiring additional changes. Conclusion: QoL was not significantly different. However, a greater incidence of pain in those receiving double J stents and more frequent tube changes in those with nephrostomy tubes should be considered when choosing palliative approaches

Quality-of-Life Assessment After Palliative Interventions to Manage Malignant Ureteral Obstruction

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Monsky, Wayne Laurence, E-mail: wemonsky@msn.com [University of Washington Medical Center, Department of Radiology (United States); Molloy, Chris; Jin, Bedro [University of California, Davis, School of Medicine (United States); Nolan, Timothy; Fernando, Dayantha; Loh, Shaun [University of California Davis Medical Center, Department of Radiology (United States); Li, Chin-Shang [University of California, Davis, Division of Biostatistics, Department of Public Health Sciences (Canada)

2013-10-15

Purpose: Malignancies may cause urinary tract obstruction, which is often relieved with placement of a percutaneous nephrostomy tube, an internal double J nephro-ureteric stent (double J), or an internal external nephroureteral stent (NUS). We evaluated the affect of these palliative interventions on quality of life (QoL) using previously validated surveys. Methods: Forty-six patients with malignancy related ureteral obstruction received nephrostomy tubes (n = 16), double J stents (n = 15), or NUS (n = 15) as determined by a multidisciplinary team. QoL surveys were administered at 7, 30, and 90 days after the palliative procedure to evaluate symptoms and physical, social, functional, and emotional well-being. Number of related procedures, fluoroscopy time, and complications were documented. Kruskal-Wallis and Friedman's test were used to compare patients at 7, 30, and 90 days. Spearman's rank correlation coefficient was used to assess correlations between clinical outcomes/symptoms and QoL. Results: Responses to QoL surveys were not significantly different for patients receiving nephrostomies, double J stents, or NUS at 7, 30, or 90 days. At 30 and 90 days there were significantly higher reported urinary symptoms and pain in those receiving double J stents compared with nephrostomies (P = 0.0035 and P = 0.0189, respectively). Significantly greater fluoroscopy time was needed for double J stent-related procedures (P = 0.0054). Nephrostomy tubes were associated with more frequent minor complications requiring additional changes. Conclusion: QoL was not significantly different. However, a greater incidence of pain in those receiving double J stents and more frequent tube changes in those with nephrostomy tubes should be considered when choosing palliative approaches.

Regional changes in renal cortical glucose, lactate and urea during acute unilateral ureteral obstruction

DEFF Research Database (Denmark)

Krarup, Peter-Martin; Stolle, Lars B; Rawashdeh, Yazan F

2007-01-01

. Furthermore, we investigated regional variations in renal interstitial fluid (RIF) glucose, lactate and urea during acute UUO. MATERIAL AND METHODS: Eight anesthetized pigs were used. Microdialysis probes were inserted in the upper, middle and lower thirds of the left renal cortex and perfused with Ringer...... third. RIF lactate did not change. Interstitial urea increased in all regions of the kidney, but most markedly in the upper and lower poles. CONCLUSIONS: Microdialysis is of potential value for assessing the renal interstitial milieu under different pathophysiological conditions. Ureteral obstruction...

[Distal ureteral lithiasis. ESWL versus ambulatory URS].

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Miján Ortiz, J L; Gutiérrez Tejero, F; López Carmona, F; Nogueras Ocaña, M; Arrabal Martín, M; Zuluaga Gómez, A

2001-11-01

To present the results achieved in the treatment of 1802 distal ureteral stones treated at the Lithotripsy Unit of the San Cecilio University Hospital over the last 10 years (1990-2000). Stones were treated by extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy (URS). ESWL was the initial treatment in 81% of the cases (1460 calculi) and URS in the remaining 19% (342 stones). URS was performed for complication or failed ESWL (102 stones) and ESWL was performed for failed URS, basically due to stone migration (24 stones). Ureterolithotomy was required on 7 occasions. Sedation-analgesia with fentanyl and midazolam was routinely used in URS. Sedation was required in only 55% of the ESWL procedures. Elective ESWL resolved 93% of the cases, a percentage which is similar to that achieved with URS as first treatment. The ESWL retreatment rate was 1.3. URS was successful in 98% of the cases of failed ESWL. There are two treatment modalities for stones in the distal ureter: ESWL and URS. We advocate the use of outpatient URS with sedation preferably in the female patient, impacted stones, obstructive uropathy, stones larger than 2 cm and radiotransparent stones.

Local brain herniation after partial membranectomy for organized chronic subdural hematoma in an adult patient: case report and review of the literature.

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Kusano, Yoshikazu; Horiuchi, Tetsuyoshi; Seguchi, Tatsuya; Kakizawa, Yukinari; Tanaka, Yuichiro; Hongo, Kazuhiro

2010-01-01

Local brain herniation after removal of chronic subdural haematoma is extremely rare, especially in adult patients. This study reports a case of local brain herniation after partial membranectomy for organized chronic subdural haematoma. A 77-year-old man presented with dysarthria and dysphasia caused by local brain herniation of the right frontal lobe through a defect of the inner membrane. The herniated brain was detected by magnetic resonance (MR) imaging. The patient underwent a craniotomy to release the herniated and strangulated brain, which were consistent with the MR imaging findings. The patient recovered fully within 1 month after surgery. To date, five cases of brain herniation through the internal subdural membrane have been reported as complications of chronic subdural haematomas. All but one case occurred in the paediatric population. Urgent surgery should be performed, even if an adult patient suffers from local brain herniation, for preservation of brain function. This is the sixth reported case of brain herniation through a defect of the inner membrane and the second reported case in the adult population.

Lunar Phases and Emergency Department Visits for Renal Colic Due to Ureteral Calculus.

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Andy W Yang

Full Text Available Urolithiasis affects an estimated 5% of the population and the lifetime risk of passing a stone in the urinary tract is estimated to be 8-10%. Urinary calculus formation is highly variable and while certain risk factors such as age, gender, seasonality, anatomic abnormality, and metabolic diseases have been identified, not much is known regarding the association of environmental factors such as lunar phases on renal colic. We conducted a retrospective study to test the hypothesis that full moon phase is an environmental factor associated for increased emergency department (ED visits for renal colic due to ureteral calculus.We analyzed 559 renal colic diagnoses by the ED at the University of Nebraska Medical Center in a 24-month period and compared them with corresponding lunar phases as well as supermoon events. The lunar phases were defined as full moon ± two days, new moon ± two days, and the days in-between as normal days according to the lunar calendar. Supermoon event dates were obtained from NASA.90 cases (16.1% were diagnosed during full moon phase, 89 cases (15.9% were diagnosed during new moon phase, and 380 cases (68.0% were diagnosed during normal days. The incidence of renal colic showed no statistically significant association with lunar phases or supermoon events.In this retrospective longitudinal study with adequate power, neither full moon phase nor supermoon event exhibited an association with increased renal colic diagnoses due to ureteral calculus by the ED at the University of Nebraska Medical Center.

Lunar Phases and Emergency Department Visits for Renal Colic Due to Ureteral Calculus.

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Yang, Andy W; Johnson, Justin D; Fronczak, Carolyn M; LaGrange, Chad A

2016-01-01

Urolithiasis affects an estimated 5% of the population and the lifetime risk of passing a stone in the urinary tract is estimated to be 8-10%. Urinary calculus formation is highly variable and while certain risk factors such as age, gender, seasonality, anatomic abnormality, and metabolic diseases have been identified, not much is known regarding the association of environmental factors such as lunar phases on renal colic. We conducted a retrospective study to test the hypothesis that full moon phase is an environmental factor associated for increased emergency department (ED) visits for renal colic due to ureteral calculus. We analyzed 559 renal colic diagnoses by the ED at the University of Nebraska Medical Center in a 24-month period and compared them with corresponding lunar phases as well as supermoon events. The lunar phases were defined as full moon ± two days, new moon ± two days, and the days in-between as normal days according to the lunar calendar. Supermoon event dates were obtained from NASA. 90 cases (16.1%) were diagnosed during full moon phase, 89 cases (15.9%) were diagnosed during new moon phase, and 380 cases (68.0%) were diagnosed during normal days. The incidence of renal colic showed no statistically significant association with lunar phases or supermoon events. In this retrospective longitudinal study with adequate power, neither full moon phase nor supermoon event exhibited an association with increased renal colic diagnoses due to ureteral calculus by the ED at the University of Nebraska Medical Center.

Effect of Tamsulosin on Stone Passage for Ureteral Stones: A Systematic Review and Meta-analysis.

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Wang, Ralph C; Smith-Bindman, Rebecca; Whitaker, Evans; Neilson, Jersey; Allen, Isabel Elaine; Stoller, Marshall L; Fahimi, Jahan

2017-03-01

Tamsulosin is recommended for patients receiving a diagnosis of a ureteral stone less than 10 mm who do not require immediate urologic intervention. Because of conflicting results from recent meta-analyses and large randomized controlled trials, the efficacy of tamsulosin is unclear. We perform a systematic review and meta-analysis to investigate the effect of tamsulosin on stone passage in patients receiving a diagnosis of ureteral stone. MEDLINE, EMBASE, and CENTRAL databases were searched without language restriction through November 2015 for studies assessing the efficacy of tamsulosin and using a double-blind, randomized, controlled trial design. Meta-analysis was conducted with a random-effects model and subgroup analyses were conducted to determine sources of heterogeneity. Eight randomized controlled trials (N=1,384) contained sufficient information for inclusion. The pooled risk of stone passage in the tamsulosin arm was 85% versus 66% in the placebo arm, but substantial heterogeneity existed across trials (I 2 =80.2%; Ptamsulosin (risk difference=22%; 95% confidence interval 12% to 33%; number needed to treat=5). The meta-analysis of the small stone subgroup (Tamsulosin significantly improves stone passage in patients with larger stones, whereas the effect of tamsulosin is diminished in those with smaller stones, who are likely to pass their stone regardless of treatment. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Large impacted upper ureteral calculi: A comparative study between retrograde ureterolithotripsy and percutaneous antegrade ureterolithotripsy in the modified lateral position.

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Moufid, Kamal; Abbaka, Najib; Touiti, Driss; Adermouch, Latifa; Amine, Mohamed; Lezrek, Mohammed

2013-07-01

The treatment for patients with large impacted proximal ureteral stone remains controversial, especially at institutions with limited resources. The aim of this study is to compare and to evaluate the outcome and complications of two main treatment procedures for impacted proximal ureteral calculi, retrograde ureterolithotripsy (URS), and percutaneous antegrade ureterolithotripsy (Perc-URS). Our inclusion criteria were solitary, radiopaque calculi, >15 mm in size in a functioning renal unit. Only those patients in whom the attempt at passing a guidewire or catheter beyond the calculus failed were included in this study. Between January 2007 and July 2011, a total of 52 patients (13 women and 39 men) with large impacted upper-ureteral calculi >15 mm and meeting the inclusion criteria were selected. Of these, Perc-URS was done in 22 patients (group 1) while retrograde ureteroscopy was performed in 30 patients (group 2). We analyzed operative time, incidence of complications during and after surgery, the number of postoperative recovery days, median total costs associated per patient per procedure, and the stone-free rate immediately after 5 days and after 1 month. Bivariate analysis used the Student t-test and the Mann-Whitney test to compare two means and Chi-square and Fisher's exact tests to compare two percentages. The significance level was set at 0.05. The mean age was 42.3 years (range 22-69). The mean stone sizes (mm) were 34 ± 1.2 and 29.3 ± 1.8 mm in group 1 and 2, respectively. In the Perc-URS group, 21 patients (95.45%) had complete calculus clearance through a single tract in one session of percutaneous surgery, whereas in the URS group, only 20 patients (66.7%) had complete stone clearance (P = 0.007). The mean operative time was higher in the Perc-URS group compared to group 2 (66.5 ± 21.7 vs. 52.13 ± 17.3 min, respectively; P = 0.013). Complications encountered in group 1 included transient postoperative fever (2 pts) and simple urine outflow (2

Treatment of mid- and lower ureteric calculi: extracorporeal shock-wave lithotripsy vs laser ureteroscopy. A comparison of costs, morbidity and effectiveness

NARCIS (Netherlands)

Bierkens, A. F.; Hendrikx, A. J.; de la Rosette, J. J.; Stultiens, G. N.; Beerlage, H. P.; Arends, A. J.; Debruyne, F. M.

1998-01-01

To determine the efficacy and costs of extracorporeal shock-wave lithotripsy (ESWL) compared with ureteroscopy (URS) in the treatment of mid- and lower ureteric calculi. The records of patients treated primarily by ESWL and URS were analysed retrospectively. Treatment with ESWL included 63 patients

Clinical protocol levels are required in laboratory animal surgery when using medical devices: experiences with ureteral replacement surgery in goats

NARCIS (Netherlands)

Jonge, P.K.J.D. de; Sloff, M.; Janke, H.P.; Kortmann, B.B.M.; Gier, R.P.E. de; Geutjes, P.J.; Oosterwijk, E.; Feitz, W.F.J.

2017-01-01

It is common to test medical devices in large animal studies that are or could also be used in humans. In this short report we describe the use of a ureteral J-stent for the evaluation of biodegradable tubular constructs for tissue reconstruction, and the regeneration of ureters in Saanen goats.

Comparative efficacy of tamsulosin versus nifedipine for distal ureteral calculi: a meta-analysis

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Wang H

2016-03-01

Full Text Available Hai Wang, Li Bo Man, Guang Lin Huang, Gui Zhong Li, Jian Wei WangDepartment of Urology, Beijing Jishuitan Hospital, Beijing, People’s Republic of China Objective: The aim of this study was to systematically compare the therapeutic effect and safety of tamsulosin with nifedipine in medical expulsive therapy for distal ureteral calculi.Methods: Databases, including PubMed, EMBASE, the Cochrane Library, and Clinical Trial Register Centers, were comprehensively searched. Relevant randomized controlled trials (RCTs were selected, and quality assessment was performed according to the Cochrane Handbook. RevMan software was used to analyze the outcome measures, which consisted of expulsion rate, expulsion time, and complications.Results: Twelve RCTs consisting of 4,961 patients were included (tamsulosin group, 2,489 cases; nifedipine group, 2,472 cases. Compared with nifedipine, tamsulosin significantly increased the expulsion rate (risk ratio =1.29, 95% CI [1.25, 1.33], P<0.0001 and reduced the expulsion time (standard mean difference =-0.39, 95% CI [−0.72, −0.05], P=0.02. Regarding safety, tamsulosin was associated with fewer complications than nifedipine (risk ratio =0.45, 95% CI [0.28, 0.72], P=0.0008, and further subgroup analysis showed that tamsulosin was associated with a lower risk of both mild and moderate-to-severe complications.Conclusion: On the bias of current evidence, tamsulosin showed an overall superiority to nifedipine for distal ureteral calculi <10 mm in aspects of expulsion rate, expulsion time, and safety. Tamsulosin was supposed to be the first drug to be recommended to patients willing to receive medical expulsive therapy.Keywords: tamsulosin, nifedipine, medical expulsive therapy, MET, lower urinary calculi

COMPARATIVE ANALYSIS OF SILODOSIN AND TAMSULOSIN IN DISTAL URETERIC CALCULUS TREATMENT

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Govind Sharma

2016-10-01

Full Text Available BACKGROUND The urinary stone disease is one of the most common afflictions of the modern society and it has been described since antiquity with the westernisation of global culture. It has led to a lot of distress physically, mentally and financially to the affected individuals. Mini-invasive techniques like ESWL and ureteroscopy have their own negative aspects with discomfort to the patient being the prime in it. Hence, a need for conservative management in the form of pharmacotherapy has arisen in the past years and here we are investigating the same. The aim of the study is to compare the efficacy of silodosin (8 mg vs. tamsulosin (0.4 mg both in terms of the stone expulsion rate and the time to stone expulsion. MATERIALS AND METHODS A study comprising of 120 patients between the age group of 18-50 years with sonography-proven unilateral, uncomplicated lower ureteric calculus was undertaken from January 2015 to November 2015. Exclusion criteria were calculus more than or equal to 1 cm. Patients were divided in 2 Groups; Group A received silodosin 8 mg once daily for a month while Group B received tamsulosin 0.4 mg once daily. The patients were followed up weekly or biweekly with imaging studies. The endpoint was the stone expulsion rate and time, the rate of the interventions and the side effects. Settings and Design- With ethical committee clearance, a prospective study was conducted in the Department of Urology, Mahatma Gandhi Medical College and Hospital, Jaipur, India. Statistical Analysis- The SPSS-16 software was used for the statistical analysis of the data. RESULTS Results of our analysis showed that Group A (silodosin patients were benefited more than Group B (tamsulosin and it was also backed by the data showing a statistical significance for spontaneous stone expulsion in favour of the silodosin group. CONCLUSION Hence, we concluded that silodosin’s efficacy in treating patients with distal ureteric calculus was much better when

LAPAROSCOPIC RECONSTRUCTION OF THE URINARY TRACT IN PATIENTS WITH URETERAL STRICTURE AFTER KIDNEY TRANSPLANTATION

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D. V. Perlin

2013-01-01

Full Text Available Aim. Ureteral obstruction secondary to ischemia is the most common urologic complication of kidney trans- plantation. Pyeloureteral anastomosis with recipient ureter has shown most satisfactory long-term results in its management. Existing urinary infection and immunosupression determine the high risk of wound complications. We have experience more than 50 reconstructive procedures of urinary tract after kidney transplantation by open surgery during 25 years. Till last time this procedure has been performed through open surgery. Method. We used pyeloureteral anastomosis with recipient ureter in two patients with ureteral stricture after kidney transplantation by laparoscopic approach. The operations lasted 215 and 275 min respectively. In both cases the surgery was per- formed after percutaneous nephrostomy because of deterioration of transplanted kidney function. Internal stent was indwelled laparoscopicaly. No drain tube was left. Results. The nephrostomy tubes were removed after 10 and 7 days respectively. The stents were removed after 27 and 20 days respectively. No complications were seen during the surgery and postoperative period. Now serum creatinine level is 0.12 mmol/l and 0.15 mmol/l after 15 and 12 months after surgery respectively. Conclusion. In spite of some difficulties related with topographic land- marks and severe tissues fibrosis after transplantation laparoscopic pyeloureterostomy in transplanted kidney is safe and feasible procedure. The main advantage is absence of risk of most serious complications related with wound infection in immune compromised patients. Moreover, early recovery to usual activity and diet facilita- tes to prevent pulmonary infections and to normalize intestinal absorbability of the immunosuppressive drugs. 

Comparison between Total Parenteral Nutrition Vs. Partial Parenteral Nutrition on Serum Lipids Among Chronic Ventilator Dependent Patients; A Multi Center Study.

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Radpay, Rojan; Poor Zamany Nejat Kermany, Mahtab; Radpay, Badiozaman

2016-01-01

Malnutrition is very common among chronically hospitalized patients, especially those in the intensive care unit (ICU). Identifying the patients at risk and providing suitable nutritional support can prevent and/or overcome malnutrition in them. Total parenteral nutrition (TPN) and partial parenteral nutrition (PPN) are two common routes to deliver nutrition to hospitalized patients. We conducted a multicenter, prospective double blind randomized controlled trial to evaluate the benefits and compare their adverse effects of each method. 97 patients were enrolled and divided into two groups based on the inclusion criteria. Serum protein, serum albumin, serum transferrin, and total lymphocyte count were measured on days 7 and 14. We did not find any statistically significant differences in clinical status or laboratory values between the two groups but there were significant improvements in measured lab values between days 7 and 14 (pnutritional status in each groups. This study shows that both TPN and PPN can be used safely in chronic ICU patients to provide nutritional support and prevent catabolic state among chronic critically ill patients. We need to develop precise selection criteria in order to choose the patients who would benefit the most from TPN and PPN. In addition, appropriate laboratory markers are needed to monitor the metabolic requirements of the patients and assess their progress.

MRI Shows that Exhaustion Syndrome Due to Chronic Occupational Stress is Associated with Partially Reversible Cerebral Changes.

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Savic, I; Perski, A; Osika, W

2018-03-01

The present study investigates the cerebral effects of chronic occupational stress and its possible reversibility. Forty-eight patients with occupational exhaustion syndrome (29 women) and 80 controls (47 women) underwent structural magnetic resonance imaging (MRI) and neuropsychological testing. Forty-four participants (25 patients, 19 controls) also completed a second MRI scan after 1-2 years. Only patients received cognitive therapy. The stressed group at intake had reduced thickness in the right prefrontal cortex (PFC) and left superior temporal gyrus (STG), enlarged amygdala volumes, and reduced caudate volumes. Except for the caudate volume, these abnormalities were more pronounced in females. They were all related to perceived stress, which was similar for both genders. Thickness of the PFC also correlated with an impaired ability to down-modulate negative emotions. Thinning of PFC and reduction of caudate volume normalized in the follow-up. The amygdala enlargement and the left STG thinning remained. Longitudinal changes were not detected among controls. Chronic occupational stress was associated with partially reversible structural abnormalities in key regions for stress processing. These changes were dynamically correlated with the degree of perceived stress, highlighting a possible causal link. They seem more pronounced in women, and could be a substrate for an increased cerebral vulnerability to stress-related psychiatric disorders. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Obstructing urethral calculus in a woman revealed to be the cause of chronic pelvic pain.

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Thomas, J S; Crew, J

2012-10-01

Urethral calculi are extremely rarely reported in Caucasian females and are usually associated with an anatomical abnormality such as a diverticulum or a stricture. Ureteric calculi can move to become lodged in the urethra, although this is rare in women because of their short urethral length. We present a case of a 55-year-old woman presenting with urinary retention secondary to an obstructing upper tract calculus that had moved into the urethra. Four years previously, the patient had been diagnosed with chronic pelvic pain following a primary posterior vaginal wall repair. Following treatment of the obstructing calculus, her symptoms of pelvic pain completely resolved. We report a very unusual case that highlights the importance of investigating chronic pelvic pain. This patient's symptom of vaginal pain, though highly localized, was caused by pathology elsewhere in the pelvis. Alternative diagnoses should be sought for such patients and investigation performed to detect any nonvisible hematuria.

Disruption of cyclooxygenase-2 prevents downregulation of cortical AQP2 and AQP3 in response to bilateral ureteral obstruction in the mouse

DEFF Research Database (Denmark)

Nilsson, Line; Madsen, Kirsten Morill; Topcu, Sukru Oguzkan

2012-01-01

Bilateral ureteral obstruction (BUO) in rats is associated with increased cyclooxygenase type 2 (COX-2) expression, and selective COX-2 inhibition prevents downregulation of aquaporins (AQPs) in response to BUO. It was hypothesized that a murine model would display similar changes in renal COX-2 ...

Is There Hope for Renal Growth on Imaging Studies Following Ureteral Reimplant for Boys With Fetal Hydronephrosis and Urinary Reflux?

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Ming-Hsien Wang

2015-07-01

Full Text Available Reflux nephropathy is thought to be the etiology for renal maldevelopment. We present two boys with fetal hydronephrosis and sterile vesicoureteral reflux (VUR. There was lack of renal growth of the refluxing renal units on surveillance renal ultrasound. Parents elected to undergo open ureteral reimplants. Post-surgical ultrasounds demonstrated improved renal growth.

Partial and complete tear of the anterior cruciate ligament. Direct and indirect MR signs

International Nuclear Information System (INIS)

Chen, W.T.; Tu, H.Y.; Chen, R.C.; Shih, T.T.F.; Shau, W.Y.

2002-01-01

Purpose: To analyze MR direct and indirect signs for knees with anterior cruciate ligament (ACL) partial or complete tear. Material and Methods: According to documented MR direct and indirect signs for ACL tear, we retrospectively reviewed the incidence of those signs in 15 partial ACL tear and 17 complete ACL tear patients. The findings were also compared with duration of injury (less or more than 6 weeks, as acute or chronic stages). Results: A residual straight and tight ACL fiber in at least one pulse sequence was more frequently detected in partial ACL tears. The empty notch sign, a wavy contour of ACL, bone contusion at lateral compartment and lateral meniscus posterior horn tear were significantly more frequently seen in complete tear cases. The posterior cruciate ligament angle in chronic complete ACL tear cases (109 deg ±20 deg) had a tendency to be less than in chronic partial ACL tear cases (119 deg ±18 deg). Conclusion: The empty notch sign, a wavy ACL, bone contusion, and posterior horn of lateral meniscus tears are suggestive of a complete ACL tear. A residual straight and tight ACL fiber seen in at least one image section is a helpful sign to diagnosis of partial ACL tear. In the acute ACL injury stage, a focal increase of the ACL signal intensity is more suggestive of a partial ACL tear

Use of drug therapy in the management of symptomatic ureteric stones in hospitalized adults (SUSPEND), a multicentre, placebo-controlled, randomized trial of a calcium-channel blocker (nifedipine) and an α-blocker (tamsulosin): study protocol for a randomized controlled trial

Science.gov (United States)

2014-01-01

Background Urinary stone disease is common, with an estimated prevalence among the general population of 2% to 3%. Ureteric stones can cause severe pain and have a significant impact on quality of life, accounting for over 15,000 hospital admissions in England annually. Uncomplicated cases of smaller stones in the lower ureter are traditionally treated expectantly. Those who fail standard care or develop complications undergo active treatment, such as extracorporeal shock wave lithotripsy or ureteroscopy with stone retrieval. Such interventions are expensive, require urological expertise and carry a risk of complications. Growing understanding of ureteric function and pathophysiology has led to the hypothesis that drugs causing relaxation of ureteric smooth muscle, such as the selective α-blocker tamsulosin and the calcium-channel blocker nifedipine, can enhance the spontaneous passage of ureteric stones. The use of drugs in augmenting stone passage, reducing the morbidity and costs associated with ureteric stone disease, is promising. However, the majority of clinical trials conducted to date have been small, poor to moderate quality and lacking in comprehensive economic evaluation. This trial aims to determine the clinical and cost-effectiveness of tamsulosin and nifedipine in the management of symptomatic urinary stones. Methods/design The SUSPEND (Spontaneous Urinary Stone Passage ENabled by Drugs) trial is a multicentre, double-blind, randomized controlled trial evaluating two medical expulsive therapy strategies (nifedipine or tamsulosin) versus placebo. Patients aged 18 to 65 with a ureteric stone confirmed by non-contrast computed tomography of the kidney, ureter and bladder will be randomized to receive nifedipine, tamsulosin or placebo (400 participants per arm) for a maximum of 28 days. The primary clinical outcome is spontaneous passage of ureteric stones at 4 weeks (defined as no further intervention required to facilitate stone passage). The

Use of drug therapy in the management of symptomatic ureteric stones in hospitalized adults (SUSPEND), a multicentre, placebo-controlled, randomized trial of a calcium-channel blocker (nifedipine) and an α-blocker (tamsulosin): study protocol for a randomized controlled trial.

Science.gov (United States)

McClinton, Sam; Starr, Kathryn; Thomas, Ruth; McLennan, Graeme; McPherson, Gladys; McDonald, Alison; Lam, Thomas; N'Dow, James; Kilonzo, Mary; Pickard, Robert; Anson, Ken; Burr, Jennifer

2014-06-20

Urinary stone disease is common, with an estimated prevalence among the general population of 2% to 3%. Ureteric stones can cause severe pain and have a significant impact on quality of life, accounting for over 15,000 hospital admissions in England annually. Uncomplicated cases of smaller stones in the lower ureter are traditionally treated expectantly. Those who fail standard care or develop complications undergo active treatment, such as extracorporeal shock wave lithotripsy or ureteroscopy with stone retrieval. Such interventions are expensive, require urological expertise and carry a risk of complications.Growing understanding of ureteric function and pathophysiology has led to the hypothesis that drugs causing relaxation of ureteric smooth muscle, such as the selective α-blocker tamsulosin and the calcium-channel blocker nifedipine, can enhance the spontaneous passage of ureteric stones. The use of drugs in augmenting stone passage, reducing the morbidity and costs associated with ureteric stone disease, is promising. However, the majority of clinical trials conducted to date have been small, poor to moderate quality and lacking in comprehensive economic evaluation.This trial aims to determine the clinical and cost-effectiveness of tamsulosin and nifedipine in the management of symptomatic urinary stones. The SUSPEND (Spontaneous Urinary Stone Passage ENabled by Drugs) trial is a multicentre, double-blind, randomized controlled trial evaluating two medical expulsive therapy strategies (nifedipine or tamsulosin) versus placebo.Patients aged 18 to 65 with a ureteric stone confirmed by non-contrast computed tomography of the kidney, ureter and bladder will be randomized to receive nifedipine, tamsulosin or placebo (400 participants per arm) for a maximum of 28 days. The primary clinical outcome is spontaneous passage of ureteric stones at 4 weeks (defined as no further intervention required to facilitate stone passage). The primary economic outcome is a

FIRST EXPERIENCE OF THE URETERO-URETEROANASTOMOSIS (URETEROPYELOANASTOMOSIS IN CHILDREN WITH COMPLETE URETERAL DUPLICATION

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I. M. Kagantsov

2017-01-01

Full Text Available Introduction. The Duplex kidney is one of the most common anomalies of urinary system. Approaches to the surgical management of these conditions significantly differ. Taking into account the preferences of surgeons, heminephroureterectomy is offered to perform openly or laparoscopically, uretero-cysto-anastomosis of ectopic ureter or two ureters en bloc. Some publications about the possibility of ureteroureteral anastomosis have lately begun to appear. We present the experience of ureteroureteral anastomosis performed openly and laparoscopically in 9 clinics of Russia and Belarus.Objective. Improvement of treatment results of ureterohydronephrosis in children with complete ureteral duplication.Material and methods. We retrospectively reviewed medical records of 38 children who underwent ureteroureteral anastomosis surgery from 2007 to 2016. There were 10 boys (26.3% and 28 girls (73.7%. The mean age of patients was 40.2 months. Right duplex kidney was confirmed in 15 (39.5% children, the left one was diagnosed in 23 (60.5% children. All the patients were divided into two groups according to the surgical technique used. Fourteen children 14 (36.8% were included in the first group, in whom the ureteroureteral anastomosis has been performed openly, the second group comprised 24 (63.2% patients with laparoscopically made anastomosis.Results. There weren’t any cases of conversion in this cohort. One patient in each group suffered from acute pyelonephritis. In the early postoperative period, urine leakage along the drainage occurred in 3 (12.5% patients after laparoscopically performed ureteroureteral anastomosis, one (4.2% child had residual ureteral stump. Thus, five (13.2% children had complications, one (2.6% patient required redo surgery.Conclusion. There are few clinics where ureteroureteral anastomosis is performed via open or laparoscopic approach. This operation is at the stage of development and accumulation of experience. It is a safe

Distal Ureteric Stones and Tamsulosin: A Double-Blind, Placebo-Controlled, Randomized, Multicenter Trial.

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Furyk, Jeremy S; Chu, Kevin; Banks, Colin; Greenslade, Jaimi; Keijzers, Gerben; Thom, Ogilvie; Torpie, Tom; Dux, Carl; Narula, Rajan

2016-01-01

We assess the efficacy and safety of tamsulosin compared with placebo as medical expulsive therapy in patients with distal ureteric stones less than or equal to 10 mm in diameter. This was a randomized, double-blind, placebo-controlled, multicenter trial of adult participants with calculus on computed tomography (CT). Patients were allocated to 0.4 mg of tamsulosin or placebo daily for 28 days. The primary outcomes were stone expulsion on CT at 28 days and time to stone expulsion. There were 403 patients randomized, 81.4% were men, and the median age was 46 years. The median stone size was 4.0 mm in the tamsulosin group and 3.7 mm in the placebo group. Of 316 patients who received CT at 28 days, stone passage occurred in 140 of 161 (87.0%) in the tamsulosin group and 127 of 155 (81.9%) with placebo, a difference of 5.0% (95% confidence interval -3.0% to 13.0%). In a prespecified subgroup analysis of large stones (5 to 10 mm), 30 of 36 (83.3%) tamsulosin participants had stone passage compared with 25 of 41 (61.0%) with placebo, a difference of 22.4% (95% confidence interval 3.1% to 41.6%) and number needed to treat of 4.5. There was no difference in urologic interventions, time to self-reported stone passage, pain, or analgesia requirements. Adverse events were generally mild and did not differ between groups. We found no benefit overall of 0.4 mg of tamsulosin daily for patients with distal ureteric calculi less than or equal to 10 mm in terms of spontaneous passage, time to stone passage, pain, or analgesia requirements. In the subgroup with large stones (5 to 10 mm), tamsulosin did increase passage and should be considered. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Alpha8 Integrin (Itga8 Signalling Attenuates Chronic Renal Interstitial Fibrosis by Reducing Fibroblast Activation, Not by Interfering with Regulation of Cell Turnover.

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Ines Marek

Full Text Available The α8 integrin (Itga8 chain contributes to the regulation of cell proliferation and apoptosis in renal glomerular cells. In unilateral ureteral obstruction Itga8 is de novo expressed in the tubulointerstitium and a deficiency of Itga8 results in more severe renal fibrosis after unilateral ureteral obstruction. We hypothesized that the increased tubulointerstitial damage after unilateral ureteral obstruction observed in mice deficient for Itga8 is associated with altered tubulointerstitial cell turnover and apoptotic mechanisms resulting from the lack of Itga8 in cells of the tubulointerstitium. Induction of unilateral ureteral obstruction was achieved by ligation of the right ureter in mice lacking Itga8. Unilateral ureteral obstruction increased proliferation and apoptosis rates of tubuloepithelial and interstitial cells, however, no differences were observed in the tubulointerstitium of mice lacking Itga8 and wild type controls regarding fibroblast or proliferating cell numbers as well as markers of endoplasmic reticulum stress and apoptosis after unilateral ureteral obstruction. In contrast, unilateral ureteral obstruction in mice lacking Itga8 led to more pronounced tubulointerstitial cell activation i.e. to the appearance of more phospho-SMAD2/3-positive cells and more α-smooth muscle actin-positive cells in the tubulointerstitium. Furthermore, a more severe macrophage and T-cell infiltration was observed in these animals compared to controls. Thus, Itga8 seems to attenuate tubulointerstitial fibrosis in unilateral ureteral obstruction not via regulation of cell turnover, but via regulation of TGF-β signalling, fibroblast activation and/or immune cell infiltration.

Generation of branching ureteric bud tissues from human pluripotent stem cells.

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Mae, Shin-Ichi; Ryosaka, Makoto; Toyoda, Taro; Matsuse, Kyoko; Oshima, Yoichi; Tsujimoto, Hiraku; Okumura, Shiori; Shibasaki, Aya; Osafune, Kenji

2018-01-01

Recent progress in kidney regeneration research is noteworthy. However, the selective and robust differentiation of the ureteric bud (UB), an embryonic renal progenitor, from human pluripotent stem cells (hPSCs) remains to be established. The present study aimed to establish a robust induction method for branching UB tissue from hPSCs towards the creation of renal disease models. Here, we found that anterior intermediate mesoderm (IM) differentiates from anterior primitive streak, which allowed us to successfully develop an efficient two-dimensional differentiation method of hPSCs into Wolffian duct (WD) cells. We also established a simplified procedure to generate three-dimensional WD epithelial structures that can form branching UB tissues. This system may contribute to hPSC-based regenerative therapies and disease models for intractable disorders arising in the kidney and lower urinary tract. Copyright © 2017 Elsevier Inc. All rights reserved.

Comparative efficacy of tamsulosin versus tadalafil as medical expulsive therapy for distal ureteric stones.

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Goyal, Suresh Kumar; Singh, Vikash; Pandey, Himanshu; Chhabra, Mahaveer Kumar; Aggarwal, Satinder Pal; Bhat, Amilal

2018-01-01

The objective of this study was to compare the relative efficacy of tamsulosin and tadalafil as medical expulsive therapy for distal ureteric stones. This was a prospective study performed between December 2014 and February 2016. A total of 123 adult patients (>18 years of age) presenting with distal ureteric stones sized 6-10 mm were randomized to treatment with tamsulosin 0.4 mg once daily (Group A) or tadalafil10 mg once daily (Group B). Therapy was given for a maximum of 4 weeks. The stone expulsion rate was the primary endpoint. Time to stone expulsion, number of colic episodes, analgesic use, number of hospital visits for pain, endoscopic treatment, and adverse effects of the drugs were noted. Statistical analyses were done using Fisher's exact test and Chi-square test. A total of 61 patients were included in tamsulosin group and 62 patients in tadalafil group. A statistically insignificant difference was found for stone clearance rate between both groups as a whole (Group A-73.77%, Group B-69.35%, P = 0.690) as well as when we considered both subgroups (A1-78.05%, B1-75.0%, P = 0.802; A2-65.0%, B2-55.6%, P = 0.741). All the primary and secondary outcome measures were more in favour of stones ≤8 mm size than stones >8 mm size. No statistical difference was found for adverse drug effects except for retrograde ejaculation, which was significantly high in tamsulosin group ( P tamsulosin is more effective for stone clearance than tadalafil, but this difference was not significant ( P = 0.690).

Three kinds of double-J ureteral stents: a comparison of biocompatibility%三种类型双J输尿管支架的生物相容性比较

Institute of Scientific and Technical Information of China (English)

玉银华

2015-01-01

BACKGROUND:Ureteral stents used in clinical treatment are mostly made of silicone or polyurethane polymer materials, but these materials cannot be degraded and absorbed in the human body. Therefore, to develop a new type of double-J biodegradable ureteral stent has become a research focus. OBJECTIVE:To summarize the clinical application and development of different kinds of double-J ureteral stents. METHODS: Related literatures were retrieved from Wanfang, CNKI and PubMed databases using the keywords of "double-J ureteral, stent, clinical" in Chinese and English, respectively. The retrieval time ranged from 2010 to 2015. RESULTS AND CONCLUSION:Traditional double-J Ureteral stents can be divided into polymer stents and metal stents, both of which have poor biocompatibility and easily cause various complications. With the in-depth studies of ureteral stents, biodegradable ureteral stents have been developed, which have good mechanical properties, biological inertness and in vivo degradation that can ensure drainage of urine after implantation in the human body without affecting the dynamics of the upper urinary tract; have good histocompatibility, little reactions between tissues, and can disappear after absorption; can avoid the impact on the anti-reflux function at the junction between the ureter and urinary bladder; and can be degraded and excretedvia the urine after completion of drainage and support to avoid the secondary use of cystoscopy, and also to avoid urinary tract infections, renal dysfunction and other complications.%背景:在临床治疗过程中使用的输尿管多为硅胶或聚氨酯高分子材料制造,由于此类材料在人体内不能够自行降解并被人体吸收,所以研制新型可生物降解双J输尿管支架管成为目前研究的重点.目的:总结不同类型双J输尿管支架管的临床应用和研制方向.方法:应用计算机检索万方数据库、中国知网和PubMed文献数据库2010至2015�

Stenting or not prior to extracorporeal shockwave lithotripsy for ureteral stones? Results of a prospective randomized study.

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Sfoungaristos, Stavros; Polimeros, Nikolaos; Kavouras, Adamantios; Perimenis, Petros

2012-06-01

To determine the need for pre-treatment stenting in patients undergoing extracorporeal shockwave lithotripsy (ESWL) for ureteral stones sized 4-10 mm. A prospective randomized study was conducted between September 2009 and March 2011. Included 156 patients randomized in stented and non-stented groups and underwent a maximum of 3 ESWL sessions. Radiographic follow-up was used to assess the stone fragmentation and clearance. Results were compared in terms of stone-free rates, post-treatment morbidity and complications. Overall efficacy was 76.9%. Stone-free rates were statistically significantly lower (P = 0.026) in the stented group (68.6%) compared to the non-stented ones (83.7%). Furthermore, stenting was significantly correlated with post-treatment lower urinary tract symptoms (P ≤ 0.001), need for more ESWL sessions (P = 0.019) and possibility for operation due to ESWL failure (P = 0.026). A multivariate analysis was conducted to identify the parameters which may predict complete stone removal after ESWL. Stone size (P = 0.026), stone location (P = 0.011) and stenting (P = 0.007) were the most significant factors. ESWL is an efficient and safe treatment for 4- to 10-mm ureteral stones. Pre-treatment stenting is limiting stone-free rates and is significantly influencing post-ESWL morbidity and quality of life in a negative manner, while it contributes minimally to the prophylaxis of complications.

Quantification of the Range of Motion of Kidney and Ureteral Stones During Shockwave Lithotripsy in Conscious Patients.

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Harrogate, Suzanne R; Yick, L M Shirley; Williams, James C; Cleveland, Robin O; Turney, Benjamin W

2016-04-01

Effective shockwave lithotripsy requires accurate targeting of the stone throughout the course of treatment. Stone movement secondary to respiratory movement can make this more difficult. In vitro work has shown that stone motion outside the focal region reduces the efficacy of stone fragmentation; however, there are few clinical data on the degree of stone movement in patients during treatment. To investigate this, X-ray fluoroscopic images of the kidney and ureteral stones at the upper and lower limits of the normal respiratory cycle were acquired during shock wave lithotripsy of 58 conscious patients, and stone excursion was calculated from these images. In addition, the respiration rate and patient perceived pain were recorded during the course of the treatment. It was found that stone motion secondary to respiration was 7.7 ± 2.9 mm for kidney stones and 3.6 ± 2.1 mm for ureteral stones-less than has been reported in studies with anesthetized patients. There was no significant change of motion over the course of treatment although pain was found to increase. These data suggest that stone motion in conscious patients is less than in anesthetized patients. Furthermore, it suggests that lithotripters with focal regions of 8 mm or greater should not suffer from a marked drop in fragmentation efficiency due to stone motion.

Ureteral Involvement Within an Incarcerated Inguinal Hernia in a Patient With Crossed-fused Renal Ectopia

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Udit Singhal

2016-07-01

Full Text Available Crossed-fused renal ectopy is an uncommon abnormality of the genitourinary tract that results from errors during embryological development. Ureteral herniation represents another rare anatomic event and can often occur from spontaneous, postoperative, and congenital causes (Allam, Johnson, Grewal & Johnson 2015; Pollack, Popky & Blumberg 1975. Here, we discuss the complex clinical course of a patient with crossed-fused renal ectopia who presents with symptoms due to ureteroinguinal herniation and provide a brief overview of the literature. We highlight the clinical considerations in the management of this patient and provide a potential anatomical and embryological explanation for his presentation.

[Chronic appendicitis. A case report].

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Montiel-Jarquín, Alvaro José; Gómez-Conde, Eduardo; Reyes-Páramo, Pedro; Romero-Briones, Carlos; Mendoza-García, Aurelio Valentín; García-Ramírez, Ulises Noel

2008-01-01

The term chronic appendicitis has been used to describe any type of chronic pain that originates in the appendix, with or without inflammation. This broad category can be divided more specifically into: chronic or recurrent appendicitis and appendiceal colic pain. a 41-year-old female, suffering intestinal chronic constipation, abdominal pain, nausea, hiporexia and febricula, treated with antibiotics, vermifuges, analgesics and antispasmodics, showing a slight and partial improvement. She was suffering chronic pain in lower abdomen, mostly on the right side along a year. With these symptoms, she underwent an exploratory laparotomy, that showed chronic appendicitis. Appendix had been removed. The histopathological report corresponded to chronic appendicitis. the histopathological characteristics and the clinical manifestations of the chronic appendicitis are different from those of acute appendicitis. Criteria for chronic appendicitis include: symptoms lasting longer than 4 weeks, confirmation of chronic swelling through histopathological examination, improvement of symptoms after appendectomy. The ultrasonic images, the barium enema and the computerized helicoidal tomography could be suggestive for its diagnosis.

An Indwelling Urethral Catheter Knotted Around a Double-J Ureteral Stent: An Unusual Complication after Kidney Transplantation

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E. G. Warmerdam

2011-01-01

Full Text Available Urethral catheterization is a common procedure with a relatively low complication rate. Knotting of an indwelling urethral catheter is a very rare complication, and there are only a few case reports on knotted catheters, most of them concerning children. We report an especially rare case where a urethral catheter formed a knot around a double-J ureteral stent after a kidney transplantation. We will discuss the various risk factors for knotting of a catheter and the methods to untangle a knot.

A rare case of large isolated internal iliac artery aneurysm with ureteral obstruction and hydronephrosis: Compression symptoms are limitation for endovascular procedures.

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Nenezic, Dragoslav; Tanaskovic, Slobodan; Gajin, Predrag; Ilijevski, Nenad; Novakovic, Aleksandra; Radak, Djordje

2015-04-01

In this report, we aim to present a rare case of isolated internal iliac artery aneurysm with associated left ureteric obstruction and consequent hydronephrosis. A 66-year-old male patient was admitted for occasional pain in the lower back that appeared one month earlier. CT arteriography revealed isolated internal iliac artery (diameter 99 mm) with ureteral obstruction, hydroureter and left kidney hydronephrosis occurrence. Aneurysm was resected, after six months the patient was doing well. Bearing in mind that 77% of the patients with isolated internal iliac artery have symptoms caused by aneurysmal compression on adjacent organs, we wanted to highlight that despite the amazing expansion of endovascular procedures in the last decades, its therapeutic effect in isolated internal iliac artery's treatment is to a great extent limited since compression symptoms cannot be solved. Open surgery remains the gold standard for isolated internal iliac artery's treatment considering significant limitations of endovascular procedures due to the inability to eliminate problems caused by compression. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Chronic periaortitis and antiphospholipid syndrome: is there a link?

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Liliana Carneiro

2016-06-01

Full Text Available Chronic periaortitis (CP is a rare fibro-inflammatory disease characterized by periaortic fibrosis and/or aortic aneurysms formation, mostly localized in retroperitoneum and occasionally in the mediastinum. Recent studies have shown its common association with autoimmune diseases, therefore autoimmunity has been proposed as a contributing factor. Herein, we describe the second case in the literature of CP associated with antiphospholipid syndrome. A 64-year-old man with history of open surgery for inflammatory thoracic aneurysm and recurrent deep vein thrombosis was referred for abdominal pain and weight loss in the last 6 months. Further investigation revealed elevated acute-phase reactant levels, positive antiphospholipid autoantibodies, radiological and histological evidence of periaortic fibrosis and inflammation causing abdominal aneurysm and ureteral obstruction. Diagnosis of CP and antiphospholipid syndrome were made and steroid therapy was implemented with clinical and radiological improvement. The present report further supports the potentially immune-mediated origin of CP, highlighting its possible linkage with antiphospholipid syndrome.

Ureteroscopic Holmium Lasertripsy for Treatment of Impacted ...

African Journals Online (AJOL)

line therapy for chronically impacted ureteral stones, which are frequently associated with chronic infl ammation, polyps and strictures. It is quite safe and it avoids the futile repetition of ESWL and problems caused by a prolonged passage of ...

[Effect of oxygen tubing connection site on percutaneous oxygen partial pressure and percutaneous carbon dioxide partial pressure in patients with chronic obstructive pulmonary disease during noninvasive positive pressure ventilation].

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Mi, S; Zhang, L M

2017-04-12

Objective: We evaluated the effects of administering oxygen through nasal catheters inside the mask or through the mask on percutaneous oxygen partial pressure (PcO(2))and percutaneous carbon dioxide partial pressure (PcCO(2)) during noninvasive positive pressure ventilation (NPPV) to find a better way of administering oxygen, which could increase PcO(2) by increasing the inspired oxygen concentration. Methods: Ten healthy volunteers and 9 patients with chronic obstructive pulmonary disease complicated by type Ⅱ respiratory failure were included in this study. Oxygen was administered through a nasal catheter inside the mask or through the mask (oxygen flow was 3 and 5 L/min) during NPPV. PcO(2) and PcCO(2) were measured to evaluate the effects of administering oxygen through a nasal catheter inside the mask or through the mask, indirectly reflecting the effects of administering oxygen through nasal catheter inside the mask or through the mask on inspired oxygen concentration. Results: Compared to administering oxygen through the mask during NPPV, elevated PcO(2) was measured in administering oxygen through the nasal catheter inside the mask, and the differences were statistically significant ( P 0.05). Conclusion: Administering oxygen through a nasal catheter inside the mask during NPPV increased PcO(2) by increasing the inspired oxygen concentration but did not increase PcCO(2). This method of administering oxygen could conserve oxygen and be suitable for family NPPV. Our results also provided theoretical basis for the development of new masks.

Partial biotinidase deficiency associated with Coffin-Siris syndrome.

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Burlina, A B; Sherwood, W G; Zacchello, F

1990-06-01

Coffin-Siris syndrome is an infrequent condition characterised by mental retardation, nail hypoplasia or absence with fifth digit involvement and feeding problems. In addition, sparse scalp hair and chronic intractable eczema has been described in this syndrome. We report a 26-month-old girl with the disease and partial biotinidase deficiency.

Basigin/CD147 promotes renal fibrosis after unilateral ureteral obstruction.

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Kato, Noritoshi; Kosugi, Tomoki; Sato, Waichi; Ishimoto, Takuji; Kojima, Hiroshi; Sato, Yuka; Sakamoto, Kazuma; Maruyama, Shoichi; Yuzawa, Yukio; Matsuo, Seiichi; Kadomatsu, Kenji

2011-02-01

Regardless of their primary causes, progressive renal fibrosis and tubular atrophy are the main predictors of progression to end-stage renal disease. Basigin/CD147 is a multifunctional molecule-it induces matrix metalloproteinases and hyaluronan, for example-and has been implicated in organ fibrosis. However, the relationship between basigin and organ fibrosis has been poorly studied. We investigated basigin's role in renal fibrosis using a unilateral ureteral obstruction model. Basigin-deficient mice (Bsg(-/-)) demonstrated significantly less fibrosis after surgery than Bsg(+/+) mice. Fewer macrophages had infiltrated in Bsg(-/-) kidneys. Consistent with these in vivo data, primary cultured tubular epithelial cells from Bsg(-/-) mice produced less matrix metalloproteinase and exhibited less motility on stimulation with transforming growth factor β. Furthermore, Bsg(-/-) embryonic fibro blasts produced less hyaluronan and α-smooth muscle actin after transforming growth factor β stimulation. Together, these results demonstrate for the first time that basigin is a key regulator of renal fibrosis. Basigin could be a candidate target molecule for the prevention of organ fibrosis. Copyright © 2011 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

Genetic mosaic analysis reveals a major role for frizzled 4 and frizzled 8 in controlling ureteric growth in the developing kidney.

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Ye, Xin; Wang, Yanshu; Rattner, Amir; Nathans, Jeremy

2011-03-01

The developing mammalian kidney is an attractive system in which to study the control of organ growth. Targeted mutations in the Wnt receptors frizzled (Fz) 4 and Fz8 lead to reduced ureteric bud growth and a reduction in kidney size, a phenotype previously reported for loss of Wnt11. In cell culture, Fz4 and Fz8 can mediate noncanonical signaling stimulated by Wnt11, but only Fz4 mediates Wnt11-stimulated canonical signaling. In genetically mosaic mouse ureteric buds, competition between phenotypically mutant Fz4(-/-) or Fz4(-/-);Fz8(-/-) cells and adjacent phenotypically wild-type Fz4(+/-) or Fz4(+/-);Fz8(-/-) cells results in under-representation of the mutant cells to an extent far greater than would be predicted from the size reduction of homogeneously mutant kidneys. This discrepancy presumably reflects the compensatory action of a network of growth regulatory systems that minimize developmental perturbations. The present work represents the first description of a kidney phenotype referable to one or more Wnt receptors and demonstrates a general strategy for revealing the contribution of an individual growth regulatory pathway when it is part of a larger homeostatic network.

Clinical protocol levels are required in laboratory animal surgery when using medical devices: experiences with ureteral replacement surgery in goats.

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de Jonge, Paul K J D; Sloff, Marije; Janke, Heinz P; Kortmann, Barbara B M; de Gier, Robert P E; Geutjes, Paul J; Oosterwijk, Egbert; Feitz, Wout F J

2017-10-01

It is common to test medical devices in large animal studies that are or could also be used in humans. In this short report we describe the use of a ureteral J-stent for the evaluation of biodegradable tubular constructs for tissue reconstruction, and the regeneration of ureters in Saanen goats. Similarly to a previous study in pigs, the ureteral J-stent was blindly inserted until some resistance was met. During evaluation of the goats after three months, perforation of the renal cortex by the stent was observed in four out of seven animals. These results indicated that blind stent placement was not possible in goats. In four new goats, clinical protocols were followed using X-ray and iodinated contrast fluids to visualize the kidney and stent during stent placement. With this adaptation the stents were successfully placed in the kidneys of these four new goats with minimal additional effort. It is likely that other groups in other fields ran into similar problems that could have been avoided by following clinical protocols. Therefore, we would like to stress the importance of following clinical protocols when using medical devices in animals to prevent unnecessary suffering and to reduce the number of animals needed.

An Atypical Presentation of Subacute Encephalopathy with Seizures in Chronic Alcoholism Syndrome.

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Kim, Tae-Kyoung; Jung, Eui Sung; Park, Jong-Moo; Kang, Kyusik; Lee, Woong-Woo; Lee, Jung-Ju

2016-06-01

Subacute encephalopathy with seizures in chronic alcoholism syndrome is a rare clinical manifestation in patients with chronic alcohol abuse. We report the case of a patient with chronic alcoholism who presented with partial nonconvulsive status epilepticus associated with a thalamic lesion.

An Atypical Presentation of Subacute Encephalopathy with Seizures in Chronic Alcoholism Syndrome

OpenAIRE

Kim, Tae-Kyoung; Jung, Eui Sung; Park, Jong-Moo; Kang, Kyusik; Lee, Woong-Woo; Lee, Jung-Ju

2016-01-01

Subacute encephalopathy with seizures in chronic alcoholism syndrome is a rare clinical manifestation in patients with chronic alcohol abuse. We report the case of a patient with chronic alcoholism who presented with partial nonconvulsive status epilepticus associated with a thalamic lesion.

Efficacy of three different alpha 1-adrenergic blockers and hyoscine N-butylbromide for distal ureteral stones

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M. Cenk Gurbuz

2011-04-01

Full Text Available PURPOSE: To evaluate hyoscine N-butyl bromide (HBB and three different alpha-1 blockers in the treatment of distal ureteral stones. MATERIALS AND METHODS: A total of 140 patients with stones located in the distal tract of the ureter with stone diameters of 5 to 10mm were enrolled in the present study and were randomized into 4 equal groups. Group 1 received HBB, Group 2 received alfuzosin, Group 3 received doxazosin and Group 4 received terazosin. The subjects were prescribed diclofenac injection (75 mg intramuscularly on demand for pain relief and were followed-up after two weeks with x-rays of the kidneys, ureters, bladder and urinary ultrasonography every week. The number of pain episodes, analgesic dosage and the number of days of spontaneous passage of the calculi through the ureter were also recorded. RESULTS: The average stone size for groups 1, 2, 3 and 4 was comparable (6.13, 5.83, 5.59 and 5.48 mm respectively. Stone expulsion was observed in 11%, 52.9%, 62%, and 46% in groups 1, 2, 3 and 4 respectively. The average time to expulsion was 10.55 ± 6.21 days in group 1, 7.38 ± 5.55 days in group 2, 7.85 ± 5.11 days in group 3 and 7.45 ± 5.32 days in group 4. Alpha blockers were found to be superior to HBB (p < 0.05. CONCLUSIONS: Medical treatment of distal ureteral calculi with alfuzosin, doxazosin and terazosin resulted in a signi?cantly increased stone-expulsion rate and decreased expulsion time when compared with HBB. HBB seems to have a negative effect on stone-expulsion rate.

Preoperative Belladonna and Opium Suppository for Ureteral Stent Pain: A Randomized, Double-blinded, Placebo-controlled Study.

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Lee, Franklin C; Holt, Sarah K; Hsi, Ryan S; Haynes, Brandon M; Harper, Jonathan D

2017-02-01

To investigate whether the use of a belladonna and opium (B&O) rectal suppository administered immediately before ureteroscopy (URS) and stent placement could reduce stent-related discomfort. A randomized, double-blinded, placebo-controlled study was performed from August 2013 to December 2014. Seventy-one subjects were enrolled and randomized to receive a B&O (15 mg/30 mg) or a placebo suppository after induction of general anesthesia immediately before URS and stent placement. Baseline urinary symptoms were assessed using the American Urological Association Symptom Score (AUASS). The Ureteral Stent Symptom Questionnaire and AUASS were completed on postoperative days (POD) 1, 3, and after stent removal. Analgesic use intraoperatively, in the recovery unit, and at home was recorded. Of the 71 subjects, 65 had treatment for ureteral (41%) and renal (61%) calculi, 4 for renal urothelial carcinoma, and 2 were excluded for no stent placed. By POD3, the B&O group reported a higher mean global quality of life (QOL) score (P = .04), a better mean quality of work score (P = .05), and less pain with urination (P = .03). The B&O group reported an improved AUASS QOL when comparing POD1 with post-stent removal (P = .04). There was no difference in analgesic use among groups (P = .67). There were no episodes of urinary retention. Age was associated with unplanned emergency visits (P <.00) and "high-pain" measure (P = .02) CONCLUSION: B&O suppository administered preoperatively improved QOL measures and reduced urinary-related pain after URS with stent. Younger age was associated with severe stent pain and unplanned hospital visits. Copyright © 2016 Elsevier Inc. All rights reserved.

Impact of Pretreatment Hydronephrosis on the Success Rate of Shock Wave Lithotripsy in Patients with Ureteral Stone.

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Chang, Ki Don; Lee, Joo Yong; Park, Sung Yoon; Kang, Dong Hyuk; Lee, Hyung Ho; Cho, Kang Su

2017-09-01

To evaluate predictors of the success rate for one session of shock wave lithotripsy (SWL), focusing on the relationships between pretreatment hydronephrosis grade and one-session SWL success rates. The medical records of 1824 consecutive patients who underwent an initial session of SWL for treatment of urinary stones between 2005 and 2013 were reviewed. After exclusion, 700 patients with a single, 4-20 mm diameter radiopaque calculus were included in the study. The mean maximal stone length (MSL) and skin-to-stone distance were 9.2±3.9 and 110.8±18.9 mm, respectively. The average values for mean stone density (MSD) and stone heterogeneity index (SHI) were 707.0±272.1 and 244.9±110.1, respectively. One-session success rates were 68.4, 75.0, 75.1, 54.0, and 10.5% in patients with hydronephrosis grade 0, 1, 2, 3, and 4, respectively. Patients were classified into success or failure groups based on SWL outcome. Multivariate logistic regression analyses revealed that MSL [odds ratio (OR) 0.888, 95% confidence intervals (CI): 0.841-0.934, phydronephrosis grade (OR 0.601, 95% CI: 0.368-0.988, p=0.043) were significantly associated with one-session success. Pretreatment grades 3 or 4 hydronephrosis were associated with failure of SWL in patients with a single ureteral stone. In the presence of severe hydronephrosis, especially hydronephrosis grade 4; physicians should proceed cautiously in choosing and offering SWL as the primary treatment for ureteral stone. © Copyright: Yonsei University College of Medicine 2017

Angiopoietin-like protein 2 increases renal fibrosis by accelerating transforming growth factor-β signaling in chronic kidney disease.

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Morinaga, Jun; Kadomatsu, Tsuyoshi; Miyata, Keishi; Endo, Motoyoshi; Terada, Kazutoyo; Tian, Zhe; Sugizaki, Taichi; Tanigawa, Hiroki; Zhao, Jiabin; Zhu, Shunshun; Sato, Michio; Araki, Kimi; Iyama, Ken-ichi; Tomita, Kengo; Mukoyama, Masashi; Tomita, Kimio; Kitamura, Kenichiro; Oike, Yuichi

2016-02-01

Renal fibrosis is a common pathological consequence of chronic kidney disease (CKD) with tissue fibrosis closely associated with chronic inflammation in numerous pathologies. However, molecular mechanisms underlying that association, particularly in the kidney, remain unclear. Here, we determine whether there is a molecular link between chronic inflammation and tissue fibrosis in CKD progression. Histological analysis of human kidneys indicated abundant expression of angiopoietin-like protein 2 (ANGPTL2) in renal tubule epithelial cells during progression of renal fibrosis. Numerous ANGPTL2-positive renal tubule epithelial cells colocalized with cells positive for transforming growth factor (TGF)-β1, a critical mediator of tissue fibrosis. Analysis of M1 collecting duct cells in culture showed that TGF-β1 increases ANGPTL2 expression by attenuating its repression through microRNA-221. Conversely, ANGPTL2 increased TGF-β1 expression through α5β1 integrin-mediated activation of extracellular signal-regulated kinase. Furthermore, ANGPTL2 deficiency in a mouse unilateral ureteral obstruction model significantly reduced renal fibrosis by decreasing TGF-β1 signal amplification in kidney. Thus, ANGPTL2 and TGF-β1 positively regulate each other as renal fibrosis progresses. Our study provides insight into molecular mechanisms underlying chronic inflammation and tissue fibrosis and identifies potential therapeutic targets for CKD treatment. Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

Increased penile expression of transforming growth factor and elevated systemic oxidative stress in rabbits with chronic partial bladder outlet obstruction.

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Lin, W-Y; Chang, P-J; Lin, Y-P; Wu, S-B; Chen, C-S; Levin, R M; Wei, Y-H

2012-02-01

There is a growing body of evidence to support the direct link between obstructive bladder dysfunction and erectile dysfunction (ED). However, there have been few pathophysiological studies to determine the relationship between lower urinary tract syndrome (LUTS) and ED. As the transforming growth factor-β1 (TGF-β1) that induces the synthesis of collagen in the penile tissues is critical for the development of ED, the first aim of this study was to investigate the expression of TGF-β1 in the penis from male rabbits with chronic partial bladder outlet obstruction (PBOO). Besides, it has been suggested that oxidative stress plays a significant role in the pathophysiological mechanism of ED. Thus, the second aim of this study was to further investigate whether the urinary or serum oxidative stress markers are involved in chronic PBOO-induced penile dysfunction. A total of 16 male New Zealand White rabbits were separated equally into four groups: a control group and PBOO groups obstructed for 2, 4 and 8 weeks respectively. Using the RT-PCR and Western blot analysis, a progressive increase of TGF-β1 in penis was found at 2, 4 and 8 weeks after obstruction. Moreover, the biomarkers for oxidative stress or oxidative damage were significantly detected in the penis of rabbits after PBOO, which include the enhancement of 8-hydroxy-2'-deoxyguanosine (8-OHdG) in urine and plasma, plasma malondialdehyde (MDA) and total antioxidant capacity (TAC), as well as reduction of glutathione (GSH). On the basis of our results, the increase of TGF-β1 and elevated systemic oxidative stress may play key roles to contribute to penile dysfunction after chronic PBOO. © 2011 The Authors. International Journal of Andrology © 2011 European Academy of Andrology.

Influence of visual and auditory biofeedback on partial body weight support treadmill training of individuals with chronic hemiparesis: a randomized controlled clinical trial.

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Brasileiro, A; Gama, G; Trigueiro, L; Ribeiro, T; Silva, E; Galvão, É; Lindquist, A

2015-02-01

Stroke is an important causal factor of deficiency and functional dependence worldwide. To determine the immediate effects of visual and auditory biofeedback, combined with partial body weight supported (PBWS) treadmill training on the gait of individuals with chronic hemiparesis. Randomized controlled trial. Outpatient rehabilitation hospital. Thirty subjects with chronic hemiparesis and ability to walk with some help. Participants were randomized to a control group that underwent only PBWS treadmill training; or experimental I group with visual biofeedback from the display monitor, in the form of symbolic feet as the subject took a step; or experimental group II with auditory biofeedback associated display, using a metronome at 115% of the individual's preferred cadence. They trained for 20 minutes and were evaluated before and after training. Spatio-temporal and angular gait variables were obtained by kinematics from the Qualisys Motion Analysis system. Increases in speed and stride length were observed for all groups over time (speed: F=25.63; Phemiparesis, in short term. Additional studies are needed to determine whether, in long term, the biofeedback will promote additional benefit to the PBWS treadmill training. The findings of this study indicate that visual and auditory biofeedback does not bring immediate benefits on PBWS treadmill training of individuals with chronic hemiparesis. This suggest that, for additional benefits are achieved with biofeedback, effects should be investigated after long-term training, which may determine if some kind of biofeedback is superior to another to improve the hemiparetic gait.

Modified totally tubeless percutaneous nephrolithotomy: Is it an effective and safe treatment option for renal and upper ureteral stones?

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Chung, Ho Seok; Jung, Seung Il; Yu, Ho Song; Hwang, Eu Chang; Oh, Kyung Jin; Kwon, Dong Deuk; Park, Kwangsung

2016-01-01

We hypothesized that modified totally tubeless percutaneous nephrolithotomy (PNL) without indwelling ureteral stent would minimize postoperative discomfort without complications. To evaluate the safety, efficacy, and morbidity of standard, tubeless, and modified totally tubeless PNL as well as the usefulness of modified totally tubeless PNL. From November 2011 to February 2015, 211 patients who underwent PNL consecutively were enrolled in this study and divided into 3 groups (group 1: standard, group 2: tubeless, group 3: modified totally tubeless PNL). Patient and stone characteristics, operation time, hemoglobin change, length of hospitalization, stone-free rate, analgesic requirement, and perioperative complications were analyzed and compared among the 3 groups. There were no significant differences in preoperative patient characteristics among the three groups. In the postoperative analysis, the three groups had similar operation time, stone-free rate, perioperative fever and transfusion rate, but group 2 showed superior results in terms of length of hospitalization (p = 0.001). Group 2 and group 3 had a lower analgesic requirement (p = 0.010). Immediate postoperative hemoglobin change (p = 0.001) and tube site complications (p = 0.001) were more common in group 1. Modified totally tubeless PNL was not inferior in terms of postoperative outcomes and safety compared with the standard and tubeless PNL, and avoided the postoperative stent-related symptoms and cystoscopy for double-J stent removal. Modified totally tubeless PNL could be an alternative treatment of choice for management of renal or upper ureteral stones in selected patients.

IMPROVING THE RESULTS OF TREATMENT OF PATIENTS WITH URETERAL CONCREMENTS AFTER CONTACT URETEROLITHOTRIPSY

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R. M. Solh

2017-01-01

Full Text Available Purpose. Im proving the results of treatment of patients with ureteral stones and reducing the dam aging effects of contact lithotripsy.Materials and methods. In this study, 48 patients were examined aged 20 to 63 years. All patients admitted to the urology department with diagnoses: urolithiasis, calculus of the ureter. In all cases contact ureterolithotripsy with stenting of the upper urinary tract were performed. The patients were divided into two groups: main and control. 25 patients (52 .1% were included into the main group, which in the postoperative period, we used low-level laser therapy (L-therapy. 23 patients were included in a control group (47.9% who did not receive low-laser therapy. Laboratory tests and ultrasound with Doppler renal blood vessels scan were performed on admission, on the first day after the operation and on the 5-th day of hospitalization. Low-intensity laser therapy was performed within 5 days after contact ureterolithotripsy on projection of placement of stone and kidney projection by series for 5 minutes.Results. All patients admitted to the hospital, were spared from ureteral stones. In the main group during the treatment with L-therapy a decrease in the level of beta-2 microglobulin to normal was observed. (4.8 ± 0.1 mg/l on the first day. On the 5th day 2 .3 + 0.1 mg/l. In the control group during the treatment without the use of L-therapy, the average level of beta-2 microglobulin decreased but did not reach normal levels. (5.5 ± 0.1 mg/l on the first day. On the 5th day 3,2 ±0, l mg/l.Resistance index in the study group decreased compared to the control. In the control group, cases of acute pyelonephritis were observed. The average hospital stay for patients of the main group (6 days was less than in the control group (6 .5 + days.Conclusion. The use of laser therapy in the treatment of patients who did undergo ureterolithotripsy can reduce the length of stay of the patient in the hospital and reduce the

Impact of Tamsulosin, Tolterodine and drug-combination on the outcomes of lower urinary tract symptoms secondary to post-ureteroscopy ureteral stent: A prospective randomized controlled clinical study

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O. Abdelkader

2017-03-01

Conclusion: Combination of alpha blockers (Tamsulosin and Anticholinergics (Tolterodine seems to significantly improve post-URS lower urinary tract symptoms secondary to ureteral stents with lower need for analgesia and better quality of life. Adverse effect of used drugs mentioned as transient and tolerated by the patients without need for auxiliary medication.

Validation of the ureteral diameter ratio for predicting early spontaneous resolution of primary vesicoureteral reflux.

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Arlen, Angela M; Kirsch, Andrew J; Leong, Traci; Cooper, Christopher S

2017-08-01

Management of primary vesicoureteral reflux (VUR) remains controversial, and reflux grade currently constitutes an important prognostic factor. Previous reports have demonstrated that distal ureteral diameter ratio (UDR) may be more predictive of outcome than vesicoureteral reflux (VUR) grade. We performed an external validation study in young children, evaluating early spontaneous resolution rates relative to reflux grade and UDR. Voiding cystourethrograms (VCUGs) were reviewed. UDR was computed by measuring largest ureteral diameter within the pelvis and dividing by the distance between the L1 and L3 vertebral bodies (Figure). VUR grade and UDR were tested in univariate and multivariable analyses. Primary outcome was status of VUR at last clinical follow-up (i.e. resolution, persistence, or surgical intervention). Demographics, VUR timing, laterality, and imaging indication were also assessed. One-hundred and forty-seven children (98 girls, 49 boys) were diagnosed with primary VUR at a mean age of 5.5 ± 4.7 months. Sixty-seven (45.6%) resolved spontaneously, 55 (37.4%) had persistent disease, and 25 (17%) were surgically corrected. Patients who spontaneously resolved had significantly lower VUR grade, refluxed later during bladder filling, and had significantly lower UDR. In a multivariable model, grade of VUR (p = 0.001), age early spontaneous resolution than grade alone. Furthermore, unlike traditional VUR grading where children with grade 1-5 may outgrow reflux depending on other factors, there appears to be a consistent UDR cutoff whereby patients are unlikely to resolve. In the present study, no child with a UDR greater than 0.43 experienced early spontaneous resolution, and only three (4.5%) of those with spontaneous resolution had a UDR above 0.35. UDR correlates with reflux grade, and is predictive of early resolution in children with primary VUR. UDR is an objective measurement of VUR, and provides valuable prognostic information about spontaneous

In Vivo Zonal Variation and Liver Cell-Type Specific NF-κB Localization after Chronic Adaptation to Ethanol and following Partial Hepatectomy.

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Harshavardhan Nilakantan

Full Text Available NF-κB is a major inflammatory response mediator in the liver, playing a key role in the pathogenesis of alcoholic liver injury. We investigated zonal as well as liver cell type-specific distribution of NF-κB activation across the liver acinus following adaptation to chronic ethanol intake and 70% partial hepatectomy (PHx. We employed immunofluorescence staining, digital image analysis and statistical distributional analysis to quantify subcellular localization of NF-κB in hepatocytes and hepatic stellate cells (HSCs. We detected significant spatial heterogeneity of NF-κB expression and cellular localization between cytoplasm and nucleus across liver tissue. Our main aims involved investigating the zonal bias in NF-κB localization and determining to what extent chronic ethanol intake affects this zonal bias with in hepatocytes at baseline and post-PHx. Hepatocytes in the periportal area showed higher NF-κB expression than in the pericentral region in the carbohydrate-fed controls, but not in the ethanol group. However, the distribution of NF-κB nuclear localization in hepatocytes was shifted towards higher levels in pericentral region than in periportal area, across all treatment conditions. Chronic ethanol intake shifted the NF-κB distribution towards higher nuclear fraction in hepatocytes as compared to the pair-fed control group. Ethanol also stimulated higher NF-κB expression in a subpopulation of HSCs. In the control group, PHx elicited a shift towards higher NF-κB nuclear fraction in hepatocytes. However, this distribution remained unchanged in the ethanol group post-PHx. HSCs showed a lower NF-κB expression following PHx in both ethanol and control groups. We conclude that adaptation to chronic ethanol intake attenuates the liver zonal variation in NF-κB expression and limits the PHx-induced NF-κB activation in hepatocytes, but does not alter the NF-κB expression changes in HSCs in response to PHx. Our findings provide new

In Vitro Propagation and Branching Morphogenesis from Single Ureteric Bud Cells

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Shunsuke Yuri

2017-02-01

Full Text Available A method to maintain and rebuild ureteric bud (UB-like structures from UB cells in vitro could provide a useful tool for kidney regeneration. We aimed in our present study to establish a serum-free culture system that enables the expansion of UB progenitor cells, i.e., UB tip cells, and reconstruction of UB-like structures. We found that fibroblast growth factors or retinoic acid (RA was sufficient for the survival of UB cells in serum-free condition, while the proliferation and maintenance of UB tip cells required glial cell-derived neurotrophic factor together with signaling from either WNT-β-catenin pathway or RA. The activation of WNT-β-catenin signaling in UB cells by endogenous WNT proteins required R-spondins. Together with Rho kinase inhibitor, our culture system facilitated the expansion of UB tip cells to form UB-like structures from dispersed single cells. The UB-like structures thus formed retained the original UB characteristics and integrated into the native embryonic kidneys.

Impaired glucose-induced glucagon suppression after partial pancreatectomy

DEFF Research Database (Denmark)

Schrader, Henning; Menge, Bjoern A; Breuer, Thomas G K

2009-01-01

INTRODUCTION: The glucose-induced decline in glucagon levels is often lost in patients with type 2 diabetes. It is unclear whether this is due to an independent defect in alpha-cell function or secondary to the impairment in insulin secretion. We examined whether a partial pancreatectomy in humans...... would also impair postchallenge glucagon concentrations and, if so, whether this could be attributed to the reduction in insulin levels. PATIENTS AND METHODS: Thirty-six patients with pancreatic tumours or chronic pancreatitis were studied before and after approximately 50% pancreatectomy with a 240-min...... oral glucose challenge, and the plasma concentrations of glucose, insulin, C-peptide, and glucagon were determined. RESULTS: Fasting and postchallenge insulin and C-peptide levels were significantly lower after partial pancreatectomy (P

Clinical Application of Scaffolds for Partial Meniscus Replacement.

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Moran, Cathal J; Withers, Daniel P; Kurzweil, Peter R; Verdonk, Peter C

2015-09-01

Meniscal tears are common injuries often treated by partial meniscectomy. This may result in altered joint contact mechanics which in turn may lead to worsening symptoms and an increased risk of osteoarthritis. Meniscal scaffolds have been proposed as a treatment option aimed at reducing symptoms while also potentially reducing progression of degenerative change. There are 2 scaffolds available for clinical use at the present time; Collagen Meniscus Implant and Actifit. Medium-term to long-term data (4.9 to 11.3 y) demonstrate efficacy of partial meniscus replacement. The patients who seem to benefit most are chronic postmeniscectomy rather than acute meniscal injuries. Herein we report on available clinical data for Collagen Meniscus Implant and Actifit while describing our preferred surgical technique and postoperative rehabilitation program.

Modified totally tubeless percutaneous nephrolithotomy: Is it an effective and safe treatment option for renal and upper ureteral stones?

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Ho Seok Chung

2016-12-01

Full Text Available Introduction: We hypothesized that modified totally tubeless percutaneous nephrolithotomy (PNL without indwelling ureteral stent would minimize postoperative discomfort without complications. Aim : To evaluate the safety, efficacy, and morbidity of standard, tubeless, and modified totally tubeless PNL as well as the usefulness of modified totally tubeless PNL. Material and methods: From November 2011 to February 2015, 211 patients who underwent PNL consecutively were enrolled in this study and divided into 3 groups (group 1: standard, group 2: tubeless, group 3: modified totally tubeless PNL. Patient and stone characteristics, operation time, hemoglobin change, length of hospitalization, stone-free rate, analgesic requirement, and perioperative complications were analyzed and compared among the 3 groups. Results: There were no significant differences in preoperative patient characteristics among the three groups. In the postoperative analysis, the three groups had similar operation time, stone-free rate, perioperative fever and transfusion rate, but group 2 showed superior results in terms of length of hospitalization (p = 0.001. Group 2 and group 3 had a lower analgesic requirement (p = 0.010. Immediate postoperative hemoglobin change (p = 0.001 and tube site complications (p = 0.001 were more common in group 1. Conclusions : Modified totally tubeless PNL was not inferior in terms of postoperative outcomes and safety compared with the standard and tubeless PNL, and avoided the postoperative stent-related symptoms and cystoscopy for double-J stent removal. Modified totally tubeless PNL could be an alternative treatment of choice for management of renal or upper ureteral stones in selected patients.

[Application of fluid mechanics and simulation: urinary tract and ureteral catheters.

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Gómez-Blanco, J C; Martínez-Reina, J; Cruz, D; Blas Pagador, J; Sánchez-Margallo, F M; Soria, F

2016-10-01

The mechanics of urine during its transport from the renal pelvis to the bladder is of great interest for urologists. The knowledge of the different physical variables and their interrelationship, both in physiologic movements and pathologies, will help a better diagnosis and treatment. The objective of this chapter is to show the physics principles and their most relevant basic relations in urine transport, and to bring them over the clinical world. For that, we explain the movement of urine during peristalsis, ureteral obstruction and in a ureter with a stent. This explanation is based in two tools used in bioengineering: the theoretical analysis through the Theory of concontinuous media and Ffluid mechanics and computational simulation that offers a practical solution for each scenario. Moreover, we review other contributions of bioengineering to the field of Urology, such as physical simulation or additive and subtractive manufacturing techniques. Finally, we list the current limitations for these tools and the technological development lines with more future projection. In this chapter we aim to help urologists to understand some important concepts of bioengineering, promoting multidisciplinary cooperation to offer complementary tools that help in diagnosis and treatment of diseases.

Usefulness of 99mTc-DTPA renography and diuretic renography in predicting successful stone discharge following outpatient ESWL in patients with a single ureteral stone

International Nuclear Information System (INIS)

Soga, Norihito; Komeda, Yoshinori; Suzuki, Ryuichi; Kawamura, Juichi.

1996-01-01

We analyzed the 99m Tc-DTPA renogram with and without diuresis to predict the possibility of stone discharge on the outpatient basis by renogram patterns. Between October 1993 and December 1995, 99m Tc-DTPA renography was performed in 79 patients with a single ureteral stone. The 99m Tc-DTPA renogram pattern was classified into the three types of normal function, obstruction and lower function patterns and the complete stone discharge rate was 93, 63 and 25%, respectively. In addition, diuretic renography using Furosemide was performed in patients with an obstruction pattern and the three renogram patterns of return to the normal curve, a diuretic response and no response were obtained; the complete stone discharge rate was 44, 65.3 and 93%, respectively. From this study, patients with a single ureteral stone with a normal pattern on the regular DTPA renogram and patients with no response pattern on the diuretic renogram, even if in such patients an obstructive pattern was seen on the regular DTPA renogram, seem to be a good candidate for obtaining a high rate of a stone discharge with extracorporeal shock wave lithotripsy (ESWL) treatment in the outpatients basis. (author)

Does Combination Therapy with Tamsulosin and Tolterodine Improve Ureteral Stent Discomfort Compared with Tamsulosin Alone? A Double-Blind, Randomized, Controlled Trial.

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Sivalingam, Sri; Streeper, Necole M; Sehgal, Priyanka D; Sninsky, Brian C; Best, Sara L; Nakada, Stephen Y

2016-02-01

Ureteral stent discomfort is a significant postoperative problem for many patients. Despite the use of narcotics and α-blockers patients often experience bothersome lower urinary tract symptoms and pain, which impair daily activities. We compared combination therapy with an α-blocker and an anticholinergic to monotherapy with an α-blocker. A double-blind, randomized, controlled trial was performed from December 2012 to April 2014. A total of 80 patients were randomized, including 44 to the combination group (tamsulosin 0.4 mg and tolterodine early release 4 mg) and 36 to the monotherapy group (tamsulosin 0.4 mg and placebo). Patients with preexisting ureteral stent placement or current anticholinergic therapy were excluded from study. Patients completed USSQ (Urinary Stent Symptom Questionnaire) before stent placement on the day of surgery, the day after stent placement, the morning of stent removal and the day after stent removal. The questionnaire included questions regarding urinary symptoms, general health, body pain, and work and sexual history. A total of 80 patients (40 males and 40 females) were studied. Mean age was 51.5 vs 51.3 years (p = 0.95) and mean body mass index was 33.6 vs 31.9 kg/m(2) (p = 0.44) in monotherapy group 1 vs combination therapy group 2. Between the 2 groups there was no significant difference in urinary symptoms, body pain and activities of daily living from baseline to just before stent removal (p = 0.95, 0.40 and 0.95, respectively). Although there was no difference between the groups, both showed improvement in urinary symptoms from the time of initial stent insertion to just prior to stent removal (difference -0.50 for combination therapy and -0.40 for monotherapy). The mean stent indwelling time of 9.6 and 8.7 days in the combination and monotherapy groups, respectively, did not differ (p = 0.67). On ANOVA it had no significant impact on results (p = 0.64). Combination therapy with tamsulosin and tolterodine does not

Emergency room management of ureteral calculi: current practices.

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Phillips, Elizabeth; Kieley, Sam; Johnson, Elizabeth B; Monga, Manoj

2009-06-01

To evaluate current practice patterns in U.S. emergency departments (EDs) for the diagnosis, treatment, and counseling of patients with ureteral calculi. Hospital-based ED physicians were invited by e-mail to participate in a Survey-Monkey survey. E-mails were delivered in March 2008 by Direct Medical Data using a listserv provided by the American Medical Association. Of the e-mails sent, 173 e-mails were opened, and 135 physicians responded. Physicians were compensated with a $10 Amazon.com gift card. Ninety percent of ED physicians use noncontrast CT as their initial imaging modality, and 63% use alpha-blockers for medical expulsive therapy. Only 13% of evaluated EDs have guidelines for the management of renal colic, and only 58% of these guidelines that recommend the use of an alpha-blocker. Alpha-blocker use was more common with physicians who have been practicing fewer than 5 years (81%) compared with those with more than 10 years of experience (56%). The majority of physicians used ketorolac and morphine to achieve effective analgesia. Although the average responses concerning the chance of spontaneous stone passage for stones 4 mm (44%) were close to evidence-based values, great variation in the answers was noted (standard deviations: 12% and 22%, respectively). Indeed, 38% of respondents stated that stones 95% chance of passage. Twenty-eight percent of ED physicians would arrange follow-up with a primary care physician, while the remainder would arrange follow-up with a urologist. This study establishes a need for educational opportunities for ED physicians in the management of renal colic. The development of collaborative practice guidelines between urology and emergency medicine associations may be warranted.

Monotherapy for partial epilepsy: focus on levetiracetam

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Antonio Gambardella

2008-03-01

Full Text Available Antonio Gambardella1,2, Angelo Labate1,2, Eleonora Colosimo1, Roberta Ambrosio1, Aldo Quattrone1,21Institute of Neurology, University Magna Græcia, Catanzaro, Italy; 2Institute of Neurological Sciences, National Research Council, Piano Lago di Mangone, Cosenza, ItalyAbstract: Levetiracetam (LEV, the S-enantiomer of alpha-ethyl-2-oxo-1-pyrollidine acetamide, is a recently licensed antiepileptic drug (AED for adjunctive therapy of partial seizures. Its mechanism of action is uncertain but it exhibits a unique profile of anticonvulsant activity in models of chronic epilepsy. Five randomized, double-blind, placebo-controlled trials enrolling adult or pediatric patients with refractory partial epilepsy have demonstrated the efficacy of LEV as adjunctive therapy, with a responder rate (≥50% reduction in seizure frequency of 28%–45%. Long-term efficacy studies suggest retention rates of 60% after one year, with 13% of patients seizure-free for 6 months of the study and 8% seizure-free for 1 year. More recent studies illustrated successful conversion to monotherapy in patients with refractory epilepsy, and its effectiveness as a single agent in partial epilepsy. LEV has also efficacy in generalized epilepsies. Adverse effects of LEV, including somnolence, lethargy, and dizziness, are generally mild and their occurrence rate seems to be not significantly different from that observed in placebo groups. LEV also has no clinically significant pharmacokinetic interactions with other AEDs, or with commonly prescribed medications. The combination of effective antiepileptic properties with a relatively mild adverse effect profile makes LEV an attractive therapy for partial seizures.Keywords: levetiracetam, partial epilepsy, antiepileptic drugs

Usefulness of {sup 99m}Tc-DTPA renography and diuretic renography in predicting successful stone discharge following outpatient ESWL in patients with a single ureteral stone

Energy Technology Data Exchange (ETDEWEB)

Soga, Norihito; Komeda, Yoshinori [Yokkaichi Health Insurance Hospital, Mie (Japan); Suzuki, Ryuichi; Kawamura, Juichi

1996-11-01

We analyzed the {sup 99m}Tc-DTPA renogram with and without diuresis to predict the possibility of stone discharge on the outpatient basis by renogram patterns. Between October 1993 and December 1995, {sup 99m}Tc-DTPA renography was performed in 79 patients with a single ureteral stone. The {sup 99m}Tc-DTPA renogram pattern was classified into the three types of normal function, obstruction and lower function patterns and the complete stone discharge rate was 93, 63 and 25%, respectively. In addition, diuretic renography using Furosemide was performed in patients with an obstruction pattern and the three renogram patterns of return to the normal curve, a diuretic response and no response were obtained; the complete stone discharge rate was 44, 65.3 and 93%, respectively. From this study, patients with a single ureteral stone with a normal pattern on the regular DTPA renogram and patients with no response pattern on the diuretic renogram, even if in such patients an obstructive pattern was seen on the regular DTPA renogram, seem to be a good candidate for obtaining a high rate of a stone discharge with extracorporeal shock wave lithotripsy (ESWL) treatment in the outpatients basis. (author)

Efficacy of phosphodiesterase type 5 inhibitors for the treatment of distal ureteral calculi: A systematic review and meta-analysis

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Carlos Eduardo Montes Cardona

2017-03-01

Full Text Available Purpose: To determine the efficacy of phosphodiesterase type 5 inhibitors (PDE5i as medical expulsive therapy (MET for the treatment of distal ureteral calculi. Materials and Methods: A search strategy was conducted in the MEDLINE, CENTRAL, and Embase databases. Searches were also conducted in other databases and unpublished literature. Clinical trials were included without language restrictions. The risk of bias was evaluated with the Cochrane Collaboration’s tool. An analysis of random effects due to statistical heterogeneity was conducted. The primary outcome was the expulsion rate of the distal ureteral calculus in 28 days. The secondary outcomes were the time to expulsion, side effects of treatment, and amount (mg of nonopioid analgesia. The measure of the effect was the risk difference (RD with a 95% confidence interval (CI. The planned interventions were PDE5i vs. placebo, tadalafil vs. placebo, and tadalafil vs. tamsulosin. Results: Four articles were included in the qualitative and quantitative analysis. Records of 580 patients were found among the four studies. A low risk of bias was shown for the majority of the study items. The calculi expulsion rate had an RD of 0.26 (95% CI, 0.15–0.37 and a less prolonged expulsion as a secondary outcome with a mean difference of -4.39 days (95% CI, -6.69 to -2.09 in favor of PDE5i compared with the placebo. No significant difference was found for these outcomes when comparing tadalafil with tamsulosin. Conclusions: Compared with a placebo, PDE5i could be effective as MET for the treatment of distal ureter calculi.

正常中晚期妊娠输尿管射尿的彩色多普勒检查%Observations of ureteral jets in normal second- and third-trimester pregnancy with color Doppler sonography

Institute of Scientific and Technical Information of China (English)

王家刚

2001-01-01

目的：了解正常中晚期妊娠输尿管的尿动力学改变是否影响输尿管射尿。方法：彩色多普勒超声观察32例中晚期妊娠妇女和11例非妊娠对照者膀胱射尿情况，观察时间5分钟。结果：妊娠受试者平均射尿5.9次/分，左、右侧射尿频率平均差异百分比为49％。对照组平均射尿7.3次/分，左、右射尿频率差异百分比为13％。受试组与对照组之间射尿对称性方面具有显著性差异(P＜0.05)。32例妊娠受试者中有7例有单侧射尿缺乏，而对照者中无1例单侧射尿缺乏。结论：在妊娠中晚期，由于两侧输尿管射尿的不对称性，用彩色多普勒超声检测输尿管射尿诊断中晚期妊娠合并输尿管结石应慎用。%Objective: To understand whether ureteral urodynamic changes accompanying normal second- and third-trimester pregnancy altered the pattern of ureteral jets. Methods: Ureteral jets were observed with color Doppler sonography for five minutes in 32women during the second or third trimester of pregnancy and in 11 non-pregnant controls. Result: A mean of 5.9 jets/ minute were detected in the pregnant subjects. The mean percentage difference in frequency of jets between the right and left sides was 49%. A mean of 7.3 jets/ minute were detected and the mean percentage difference was 13% for controls. The two groups were significantly different in jet symmetry (P＜0.05). Unilateral absence of jets was observed in seven pregnant subjects and in no controls. Conclusion: Because of asymmetry in ureteral jet between the left and right sides during the later stages of pregnacy, caution is recommended in the use of color Doppler sonography to diagnose ureteral urolithiasis during the later stages of pregnancy.

Evaluation of endourological tools to improve the diagnosis and therapy of ureteral tumors – from model development to clinical application

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Wagner D.

2015-09-01

Full Text Available Adequate diagnosis of upper urinary tract (UUT tumors is essential for successful local treatment. Organsparing approaches are technically difficult and require consistent further development. Appropriate models for investigating new diagnostic and therapeutic methods are not yet available. This study demonstrates the incorporation of a fresh sample model into five different test levels (I-V for improving the diagnosis and therapy of ureteral tumors. In these test levels, new diagnostic and ablation techniques are evaluated for feasibility, application safety, efficacy and accuracy. An assessment of their suitability for broad preclinical and clinical application also took economic aspects into account.

Clinical efficacy, safety, and costs of percutaneous occlusive balloon catheter-assisted ureteroscopic lithotripsy for large impacted proximal ureteral calculi: a prospective, randomized study.

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Qi, Shiyong; Li, Yanni; Liu, Xu; Zhang, Changwen; Zhang, Hongtuan; Zhang, Zhihong; Xu, Yong

2014-09-01

To evaluate the clinical efficacy, safety, and costs of percutaneous occlusive balloon catheter-assisted ureteroscopic lithotripsy (POBC-URSL) for large impacted proximal ureteral calculi. 156 patients with impacted proximal ureteral stones ≥1.5 cm in size were randomized to ureteroscopic lithotripsy (URSL), POBC-URSL, and percutaneous nephrolithotomy (PNL) group between May 2010 and May 2013. For URSL, the calculi were disintegrated with the assistance of anti-retropulsion devices. POBC-URSL was performed with the assistance of an 8F percutaneous occlusive balloon catheter. PNL was finished with the combination of an ultrasonic and a pneumatic lithotripter. A flexible ureteroscope and a 200 μm laser fiber were used to achieve stone-free status to a large extent for each group. Variables studied were mean operative time, auxiliary procedure, postoperative hospital stay, operation-related complications, stone clearance rate, and treatment costs. The mean lithotripsy time for POBC-URSL was shorter than URSL, but longer than PNL (42.6±8.9 minutes vs 66.7±15.3 minutes vs 28.1±6.3 minutes, p=0.014). The auxiliary procedure rate and postoperative fever rate for POBC-URSL were significantly lower than URSL and comparable to PNL (pPNL (98.1% vs 75.0% vs 96.2%, pPNL group and similar to URSL group (p=0.016, pPNL.

A critical assessment of the effects of tamsulosin and solifenacin as monotherapies and as a combination therapy for the treatment of ureteral stent-related symptoms: a 2 × 2 factorial randomized trial.

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Park, Jinsung; Yoo, Changhee; Han, Deok Hyun; Shin, Dong Wook

2015-11-01

To assess the efficacy of tamsulosin, solifenacin, and combination therapy of both agents for the treatment of ureteral stent-related symptoms (SRSs). An open-label, randomized controlled trial was conducted with 112 patients who underwent unilateral ureteral stent insertion following ureteroscopic stone surgery. Patients were randomized with a 2 × 2 factorial design to one of four groups, i.e., A (control), B (tamsulosin 0.2 mg once daily), C (solifenacin 5 mg once daily), and D (both active treatments). Patients were evaluated at week 2 by the ureteral stent symptom questionnaire (USSQ). The primary efficacy outcome was the urinary symptom score of the USSQ, and the secondary efficacy outcomes were the scores in the other five USSQ domains, the Euro-QOL score, and oral analgesic requirements during the 2 weeks. Efficacy outcomes were primarily analyzed for the per-protocol set population. The four groups were generally well balanced in terms of baseline characteristics. Eighty-one patients (72.3 %) completed the study protocol. Comparison of the six USSQ domain scores at week 2 showed no differences between the four groups. Similarly, comparison of the domain scores stratified by tamsulosin or solifenacin medication showed no differences for either medication. The other secondary outcomes were also similar in the group comparisons. Neither tamsulosin nor solifenacin medications provide beneficial effects for relieving various SRSs. In addition, the combination therapy did not have beneficial effects. Further studies are warranted to determine the benefit of medical therapy for the treatment of SRSs and to determine the optimal management strategy for SRSs.

In Vitro Propagation and Branching Morphogenesis from Single Ureteric Bud Cells.

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Yuri, Shunsuke; Nishikawa, Masaki; Yanagawa, Naomi; Jo, Oak D; Yanagawa, Norimoto

2017-02-14

A method to maintain and rebuild ureteric bud (UB)-like structures from UB cells in vitro could provide a useful tool for kidney regeneration. We aimed in our present study to establish a serum-free culture system that enables the expansion of UB progenitor cells, i.e., UB tip cells, and reconstruction of UB-like structures. We found that fibroblast growth factors or retinoic acid (RA) was sufficient for the survival of UB cells in serum-free condition, while the proliferation and maintenance of UB tip cells required glial cell-derived neurotrophic factor together with signaling from either WNT-β-catenin pathway or RA. The activation of WNT-β-catenin signaling in UB cells by endogenous WNT proteins required R-spondins. Together with Rho kinase inhibitor, our culture system facilitated the expansion of UB tip cells to form UB-like structures from dispersed single cells. The UB-like structures thus formed retained the original UB characteristics and integrated into the native embryonic kidneys. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Motor unit activation order during electrically evoked contractions of paralyzed or partially paralyzed muscles

NARCIS (Netherlands)

Thomas, CK; Nelson, G; Than, L; Zijdewind, Inge

The activation order of motor units during electrically evoked contractions of paralyzed or partially paralyzed thenar muscles was determined in seven subjects with chronic cervical spinal cord injury. The median nerve was stimulated percutaneously with pulses of graded intensity to produce

Deterioration of autoimmune condition associated with repeated injection of dextranomer/hyaluronic acid copolymer: A case report

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Kazuto Suda

2016-01-01

Full Text Available A 6-year-old girl underwent ureterocystoneostomy (UCN because of left flank pain due to delayed onset of ureteral stenosis one and a half years after endoscopic dextranomer/hyaluronic acid copolymer (Deflux injection for the treatment of vesicoureteral reflux (VUR. Histopathological examination indicated chronic inflammation with abundant eosinophils characteristic of a reaction to Deflux. Several autoimmune diseases developed during the treatment for ureteral stenosis. First, 2 weeks prior to the onset of left flank pain, she was diagnosed as having systemic lupus erythematosus. Finally, she died of pulmonary hemorrhage due to thrombotic thrombocytopenic purpura 4 months after UCN. The fatal outcome in this case was suspected to be caused by autoimmune syndrome induced by adjuvants, which in this case was the hyaluronic acid polymer injected into the ureteric orifice for the treatment of VUR.

Retroperitoneoscopy for treatment of renal and ureteral stones.

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Soares, Rodrigo S; Romanelli, Pedro; Sandoval, Marcos A; Salim, Marcelo M; Tavora, Jose E; Abelha, David L

2005-01-01

To assess the efficacy of retroperitoneoscopy for treating stones in the renal pelvis and proximal ureter. In the period from August 2003 to August 2004, 35 retroperitoneoscopies for treatment of urinary stones were performed on 34 patients. Fifteen patients (42%) had stones in the renal pelvis, and in 2 cases, there were associated stones in the upper caliceal group. Twenty patients (58%) had ureteral stones, all of them located above the iliac vessel. Twenty-five patients (71%) had previously undergone at least one session of extracorporeal lithotripsy and 8 patients (26%) also underwent ureteroscopy to attempt to remove the stone. Eight patients underwent retroperitoneoscopy as a primary procedure. Stone size ranged from 0.5 to 6 cm with a mean of 2.1 cm. Retroperitoneoscopy was performed by lumbar approach with initial access conducted by open technique and creation of space by digital dissection. We used a 10-mm Hasson trocar for the optics, and 2 or 3 additional working ports placed under visualization. Following identification, the urinary tract was opened with a laparoscopic scalpel and the stone was removed intact. The urinary tract was closed with absorbable 4-0 suture and a Penrose drain was left in the retroperitoneum. In 17 patients (49%), a double-J stent was maintained postoperatively. Surgical time ranged from 60 to 260 minutes with a mean of 140 minutes. The mean hospital stay was 3 days (1-10 days). The mean length of retroperitoneal urinary drainage was 3 days (1-10 days). There were minor complications in 6 (17.6%) patients and 1 case of conversion due to technical difficulty. Thirty-three patients (94%) became stone free. Retroperitoneoscopy is an effective, low-morbidity alternative for treatment of urinary stones.

Retroperitoneoscopy for treatment of renal and ureteral stones

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Rodrigo S. Soares

2005-04-01

Full Text Available OBJECTIVE: To assess the efficacy of retroperitoneoscopy for treating stones in the renal pelvis and proximal ureter. MATERIALS AND METHODS: In the period from August 2003 to August 2004, 35 retroperitoneoscopies for treatment of urinary stones were performed on 34 patients. Fifteen patients (42% had stones in the renal pelvis, and in 2 cases, there were associated stones in the upper caliceal group. Twenty patients (58% had ureteral stones, all of them located above the iliac vessel. Twenty-five patients (71% had previously undergone at least one session of extracorporeal lithotripsy and 8 patients (26% also underwent ureteroscopy to attempt to remove the stone. Eight patients underwent retroperitoneoscopy as a primary procedure. Stone size ranged from 0.5 to 6 cm with a mean of 2.1 cm. RESULTS: Retroperitoneoscopy was performed by lumbar approach with initial access conducted by open technique and creation of space by digital dissection. We used a 10-mm Hasson trocar for the optics, and 2 or 3 additional working ports placed under visualization. Following identification, the urinary tract was opened with a laparoscopic scalpel and the stone was removed intact. The urinary tract was closed with absorbable 4-0 suture and a Penrose drain was left in the retroperitoneum. In 17 patients (49%, a double-J stent was maintained postoperatively. Surgical time ranged from 60 to 260 minutes with a mean of 140 minutes. The mean hospital stay was 3 days (1-10 days. The mean length of retroperitoneal urinary drainage was 3 days (1-10 days. There were minor complications in 6 (17.6% patients and 1 case of conversion due to technical difficulty. Thirty-three patients (94% became stone free. CONCLUSION: Retroperitoneoscopy is an effective, low-morbidity alternative for treatment of urinary stones.

后腹腔镜下输尿管中上段结石治疗临床经验总结（附145例报告）%Clinical Experience Review in the Retroperitoneal Laparoscopy Ureterolithotomy in Treating Upper-Middle Ureteric Calculus(Report of 145 Cases)

Institute of Scientific and Technical Information of China (English)

李永响; 乔梁; 刘鲁东; 于淼; 周阳

2014-01-01

目的：探讨腹腔镜下输尿管切开取石术的技术要点和临床效果。方法2003年6月～2013年10月，本研究完成腹腔镜下输尿管切开取石145例，左侧79例，右侧66例。输尿管上段结石93例，输尿管中段结石52例。术中应用观察镜直接分离法建立后腹腔，自创单支架管技术放置肾盂D-J管，5-0可吸收线缝合输尿管切口。结果手术均取得成功，无中转开放手术，手术时间为30～180min，平均67min，失血20～50ml，平均35ml，术后住院时间为3～7d，平均3．6d，随访2个月～10年，无输尿管狭窄、尿漏等并发症。结论腹腔镜输尿管切开取石术是治疗输尿管结石有效、可行的微创技术，是输尿管中上段结石手术治疗推荐术式。%Objective To evaluate the key techniques and clinical value of retroperitoneal laparoscopy ureterolithot omy in trea -ting upper ureteric calculus .Methods The clinical data of 145 ureteral calculus patients treated by retroperitoneal laparoscopy ureterolithoto -my in our hospital from june 2003 to October 2013 were analyzed retrospectively ,including 79 cases left,66 cases right,93 cases upper ureter-al calculi,52 cases middle ureteral calculi .The retroperitoneal space was isolated and established through opening the machine of pneumoper -itoneum in the observation of endoscopic ,and single stent technology was used in the Place of D-J stent,5-0 absorbable line suture the inci-sion of ureter.Results All operation were successful,no conversion to open procedure.The operation time was 30~180min(mean,87min). The intraoperative blood loss was 10~50ml(mean,32.5ml).The postoperative length of hospitalization was 3~7 days.During the follow-up period from two months to ten yeas ,ureteric stricture and urinary leakage hadn't been found .Conclusion Retroperitoneal laparoscopy uret-erolithotomy is feasible and safe with the advantages of minimal invasion ,in the upper ureteral calculi surgery

Surgical treatment of partial biceps tendon ruptures at the elbow.

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Dellaero, David T; Mallon, William J

2006-01-01

We present the treatment and results of a consecutive series of 7 patients (mean age, 42.7 years) with partial ruptures of the distal biceps tendon. All injuries occurred as the result of either heavy labor or weightlifting. Diagnosis in all cases was made with magnetic resonance imaging. After failure of conservative therapy, the patients were treated with repair of the distal biceps tendon. Mean follow-up was 30.6 months (range, 25-39 months). Results were uniformly good, with all patients satisfied with the outcome. All patients maintained their preoperative range of motion, with none reporting significant postoperative pain. The only complication was transient neurapraxias of the lateral antebrachial cutaneous nerve in 2 cases. We conclude that patients presenting with chronic pain in the cubital fossa should be evaluated for possible partial biceps tendon tear. If the diagnosis of partial tendon tear is made, surgical repair is a safe and effective method of treatment.

Xanthogranulomatous Pyelonephritis with Incomplete Double Ureter

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Yutaro Hayashi

2017-01-01

Full Text Available Introduction. Xanthogranulomatous pyelonephritis (XGP is a type of chronic renal inflammation that usually occurs in immunocompromised middle-aged women with chronic urinary tract infection or ureteral obstruction induced by the formation of ureteral stones. XGP with an incomplete double ureter is extremely rare. Case Presentation. A 76-year-old woman was referred to our department to undergo further examination for a left renal tumor that was detected by ultrasonography. Dynamic contrast computed tomography (CT revealed an enhanced tumor in the upper renal parenchyma. Laparoscopic radical nephrectomy was performed based on a preoperative diagnosis of renal cell carcinoma. Histological sections showed the aggregation of foam cells; thus, XGP was diagnosed. Conclusion. We herein report a rare case of XGP in the upper pole of the kidney, which might have been associated with an incomplete double ureter.

The role of early nephrostomy in the management of patients with hyperkalaemia and renal failure due to ureteric obstruction

Institute of Scientific and Technical Information of China (English)

Bhaskar Kumar Somani; Harun Gupta; Alastair Todd

2014-01-01

Objective:To assess the outcomes of early percutaneous nephrostomy in obstructed hydronephrosis and hyperkalaemia from ureteric obstruction. Methods:Patients were diagnosed with hyperkalaemia with serum potassium >5.0 mmol/L and hyperkalaemia was graded as mild(5.0-6.0 mmol/L), moderate(6.1-7.0 mmol/L) or severe(>7.1 mmol/L).Data on age, sex, clinical presentation, presence of concurrent disease, creatinine, potassium, haemoglobin concentration, time interval in doing the nephrostomy since their first presentation, any prenephrostomy medical correction of hyperkalaemia and complications were collected. Results:A total of61 patients(40 males and21 females) with mean age of69.7 years(ranged35 to94 years) underwent69 procedures.Prior to the nephrostomy, the serum potassium was mildly elevated in42 cases, moderately elevated in17 cases and severely elevated in10 cases.The overall mean level of potassium before intervention was6.1 mmol/L(range:5.1 mmol/L-9.3 mmol/L).Forty(58%) had nephrostomy without prior medical treatment of the hyperkalaemia.The mean serum potassium in these patients was5.6 mmol/L(range:5.1 mmol/L-7.5 mmol/L).Twentynine (42%) had medical treatment of the hyperkalaemia prior to nephrostomy.The mean potassium level in these patients was reduced from6.7 mmol/L(range5.4 mmol/L-9.3 mmol/L) before medical treatment to5.8 mmol/L(4.0 mmol/L-7.4 mmol/L).Five patients(7%) had complications from percutaneous nephrostomy including temporary atrial fibrillation in3 patients and transient pyrexia in2 patients. Conclusions:Percutaneous nephrostomy as the initial management for hyperkalaemia from ureteric obstruction is a safe procedure with acceptable complication rates.

Adjunctive medical therapy with α-blocker after extracorporeal shock wave lithotripsy of renal and ureteral stones: a meta-analysis.

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Mingchao Li

Full Text Available Although some trials assessed the efficacy and safety of the α-blocker in facilitating renal and ureteral stones expulsion after extracorporeal shock wave lithotripsy (ESWL, the role of the α-blocker in facilitating upper urinary calculi expulsion after ESWL remain controversial.To determine the efficacy and safety of the α-blocker in facilitating renal and ureteral stones expulsion after ESWL.A literature search was carried out using the PubMed database, EMBASE and the Cochrane Library database to identify relevant studies. Two reviewers independently extracted data and assessed methodological quality. Pooled effect estimates were obtained using a fixed- and random-effects meta-analysis.The meta-analysis included 23 RCTs, α-blocker significantly enhanced expulsion rate of upper urinary tract calculi after ESWL (P<0.00001; RR 1.21; 95% CI 1.12-1.31, significantly promoted steinstrasse expulsion (P=0.03; RR 1.25; 95% CI 1.03-1.53, significantly shortened the discharge time of upper urinary tract calculi (P=0.0001; MD -2.12; 95% CI -3.20--1.04, significantly reduced the patient's pain VAS score (P=0.001; RR -1.0; 95% CI -1.61--0.39. Compared with the control group, dizziness (P=0.002; RR 5.48; 95% CI 1.91-15.77, anejaculation (P=0.02; RR 12.17; 95% CI 1.61-91.99 and headache (P=0.04; RR 4.03; 95% CI 1.04-15.72 in the α-blocker group was associated with a higher incidence.Treatment with α-blocker after ESWL appears to be effective in enhancing expulsion rate of upper urinary tract calculi, shortening the discharge time of upper urinary tract calculi, reducing the patient's pain. The side effects of α-blocker were light and few.

Impact of Partial and complete rupture of anterior cruciate ligament on medial meniscus: A cadavaric study

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Wei Jiang

2012-01-01

Conclusions: Similar to complete rupture, partial rupture of ACL can also trigger strain concentration on medial meniscus, especially posterior horn, which may be a more critical reason for meniscus injury associated with chronic ACL deficiency.

Chronic mesenteric volvulus in a dog

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Spevakow, Andrea B.; Nibblett, Belle Marie D.; Carr, Anthony P.; Linn, Kathleen A.

2010-01-01

A chronic, partial mesenteric volvulus was found on laparotomy of an adult Bernese mountain dog with a 4-month history of intermittent vomiting, diarrhea, and weight loss. The dog had elevated cholestatic and hepatocellular leakage enzymes, increased bile acids, azotemia, isosthenuria, and a hypokalemic, hypochloremic, metabolic alkalosis. The dog recovered fully following reduction of the volvulus. PMID:20357947

Ileocecal Adenocarcinoma and Ureteral Transitional Cell Carcinoma with Multiple Sebaceous Tumors and Keratoacanthomas in a Case of Muir-Torre Syndrome

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Michael C. Lynch

2010-01-01

Full Text Available Cutaneous neoplasms including sebaceous tumors, keratoacanthomas, and basal cell carcinomas with sebaceous differentiation can be markers of internal malignancy associated with the Muir-Torre Syndrome (MTS. We report a 56-year-old man with a diagnosis of hereditary nonpolyposis colorectal cancer (HNPCC and ureteral transitional cell carcinoma who subsequently developed two sebaceous gland neoplasms and several keratoacanthomas, leading to the diagnosis of MTS. Our case highlights the clinical advantages of immunohistochemistry (IHC in identifying mutations in the mismatch repair (MMR genes responsible for both HNPCC and MTS. The importance of continued clinical suspicion in the dermatological assessment of patients with sebaceous neoplasms is emphasized.

Increases in weight during chronic stress are partially associated with a switch in food choice towards increased carbohydrate and saturated fat intake.

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Roberts, Clifford J; Campbell, Iain C; Troop, Nick

2014-01-01

We examined if stress associated changes in weight and dietary restraint are associated with changes in the composition of foods consumed. Participants were 38 healthy women on a taught postgraduate university course. Data were obtained at the beginning of the semester and 15 weeks later just prior to a written course exam (the stressor). By using a within subject design, we measured the composition of food consumed, body mass index (BMI), levels of dietary restraint and salivary cortisol. In the larger study from which these data were obtained, it was shown that the effect of increased cortisol secretion on weight gain was mediated by a reduction in dietary restraint. The present data show that increased cortisol secretion, reduced dietary restraint and increased caloric intake, account for 73% of the variance in change in BMI. Further regression analysis indicated that the change in dietary restraint mediated the effect of change in cortisol on change in BMI. Final analysis revealed that the effect of these changes in dietary restraint on weight are partially mediated by increased caloric intake from carbohydrate and saturated fat, that is, a change in dietary composition partially accounts for the link between increased cortisol secretion through heightened hypothalamic-pituitary-adrenal activity resulting in weight gain. These data are consistent with a 'comfort food hypothesis', as they suggest that chronic stress can promote reward associated behaviour through reduced dietary restraint and consumption of food containing more carbohydrate and saturated fat. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.

Retrograde isotopic cystography in the diagnosis of paediatric vesico-ureteric reflex

International Nuclear Information System (INIS)

Guillet, J.; Basse-Cathalinat, B.; Christophe, E.; Wynchank, S.; Blanquet, P.; Hehunstre, J.P.; Higuet, P.; Sibille, G.; Battin, J.

1982-01-01

The diagnosis and monitoring of vesico-ureteric reflux involves high X-ray radiation levels. Extreme caution is therefore required, particularly with girls (2/3 of our patients) whose gonads are in the field of irradiation. Yet the reflux may cause serious renal damage which may remain undetected for a long time. Seventy children aged from 3 months to 15 years were examined, using both isotopic (IC) and conventional X-ray cystography (RC). For the IC examination, 0.5 mCi of 99mTc pertechnetate was introduced into the bladder, followed by a slow infusion of Isotonic saline. Images were obtained on films, computer display and polaroid films during filling and micturition. The radiation dose with IC (as evaluated with FLI dosimeters and by calculations) was about 2% of that delivered by RC. Fifty-nine refluxes were detected. IC and RC proved equally sensitive in children over 18 months. More information was recorded with IC in 12 refluxes, but 15 refluxes detected with RC were missed. RC missed 6 intrarenal refluxes (i.e. renal activity persisting for more than 1 hour), which were detected with IC. This may be important for the prognosis, since 3 children had corticopapillary lesions at presentation. It is concluded that IC seems to be a more sensitive method overall for the most serious refluxes and has a much lower level of irradiation than RC [fr

Autoimmune Hepatitis with Distal Renal Tubular Acidosis and Small Bowel Partial Malrotation.

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Kanaiyalal Modi, Tejas; Parikh, Hardik; Sadalge, Abhishek; Gupte, Amit; Bhatt, Pratin; Shukla, Akash

2015-01-01

Renal tubular acidosis (RTA) is not uncommon in patient with chronic autoimmune hepatitis (AIH), but usually remains latent. Here, we report a case of renal tubular acidosis RTA who presented with AIH. She was also diagnosed to have partial bowel malrotation. A 9-year-old girl, a case of distal RTA, presented with jaundice, abdominal distension and altered sensorium. She was diagnosed to be AIH, which was successfully treated with steroids and azathioprine. Coexistent midgut partial malrotation with volvulus was diagnosed during the treatment. She was treated successfully with anti-tuberculous treatment for cervical lymphadenitis. Autoimmune hepatitis should not be ruled out in each case of RTA presenting with jaundice. Modi TK, Parikh H, Sadalge A, Gupte A, Bhatt P, Shukla A. Autoimmune Hepatitis with Distal Renal Tubular Acidosis and Small Bowel Partial Malrotation. Euroasian J Hepato-Gastroenterol 2015;5(2):107-109.

Retrieval of proximally migrated double J ureteric stents in children using goose neck snare

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Sivasankar Jayakumar

2012-01-01

Full Text Available Purpose: Proximal migration of the ureteric double J stent is a rare but known complication. We describe three cases where a minimally invasive technique for retrieval of displaced double J stents using Amplatz™ goose-neck snare was successful. Materials and Methods: A retrospective review of patients with displaced double J stent was carried out, in whom cystoscopy guided retrieval of double J stent was attempted with the help of Amplatz goose-neck snare under radiological control. Results: All three patients were under the age of 3 years. Two patients had migrated double J stent following pyeloplasty and in one patient the double J stent was displaced during a retrograde insertion of double J stent. In all cases, retrieval of displaced double J stent was successfully achieved using Amplatz goose-neck snare. There were no postoperative complications. Conclusion: Our method of retrieval of stent from renal pelvis is simple, safe and minimally invasive. This technique is a useful and safe alternative option for retrieval of proximally migrated double J stents in children.

Coronal reconstruction of unenhanced abdominal CT for correct ureteral stone size classification

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Berkovitz, Nadav; Simanovsky, Natalia; Hiller, Nurith [Hadassah Mount Scopus - Hebrew University Medical Center, Department of Radiology, Jerusalem (Israel); Katz, Ran [Hadassah Mount Scopus - Hebrew University Medical Center, Department of Urology, Jerusalem (Israel); Salama, Shaden [Hadassah Mount Scopus - Hebrew University Medical Center, Department of Emergency Medicine, Jerusalem (Israel)

2010-05-15

To determine whether size measurement of a urinary calculus in coronal reconstruction of computed tomography (CT) differs from stone size measured in the axial plane, and whether the difference alters clinical decision making. We retrospectively reviewed unenhanced CT examinations of 150 patients admitted to the emergency room (ER) with acute renal colic. Maximal ureteral calculus size was measured on axial slices and coronal reconstructions. Clinical significance was defined as an upgrading or downgrading of stone size according to accepted thresholds of treatment: {<=}5 mm, 6-9 mm and {>=}10 mm. There were 151 stones in 150 patients (male:female 115:34, mean age 41 years). Transverse stone diameters ranged from 1 to 11 mm (mean 4 mm). On coronal images, 56 (37%) stones were upgraded in severity; 46 (30%) from below 5 mm to 6 mm or more, and ten (7%) from 6-9 mm to 10 mm or more. Transverse measurement on the axial slices enabled correct categorization of 95 stones (63%). Transverse calculus measurement on axial slices often underestimates stone size and provides incorrect clinical classification of the true maximal stone diameter. Coronal reconstruction provides additional information in patients with renal colic that may alter treatment strategy. (orig.)

Coronal reconstruction of unenhanced abdominal CT for correct ureteral stone size classification

International Nuclear Information System (INIS)

Berkovitz, Nadav; Simanovsky, Natalia; Hiller, Nurith; Katz, Ran; Salama, Shaden

2010-01-01

To determine whether size measurement of a urinary calculus in coronal reconstruction of computed tomography (CT) differs from stone size measured in the axial plane, and whether the difference alters clinical decision making. We retrospectively reviewed unenhanced CT examinations of 150 patients admitted to the emergency room (ER) with acute renal colic. Maximal ureteral calculus size was measured on axial slices and coronal reconstructions. Clinical significance was defined as an upgrading or downgrading of stone size according to accepted thresholds of treatment: ≤5 mm, 6-9 mm and ≥10 mm. There were 151 stones in 150 patients (male:female 115:34, mean age 41 years). Transverse stone diameters ranged from 1 to 11 mm (mean 4 mm). On coronal images, 56 (37%) stones were upgraded in severity; 46 (30%) from below 5 mm to 6 mm or more, and ten (7%) from 6-9 mm to 10 mm or more. Transverse measurement on the axial slices enabled correct categorization of 95 stones (63%). Transverse calculus measurement on axial slices often underestimates stone size and provides incorrect clinical classification of the true maximal stone diameter. Coronal reconstruction provides additional information in patients with renal colic that may alter treatment strategy. (orig.)

The role of solifenacin, as monotherapy or combination with tamsulosin in ureteral stent-related symptoms: a systematic review and meta-analysis.

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Wang, Jue; Zhang, Xiaobei; Zhang, Tiande; Mu, Jianjun; Bai, Bing; Lei, Yi

2017-11-01

Ureteral stenting is associated with various morbidity and reduced quality of life. We systematically evaluated the efficacy and safety of solifenacin as monotherapy, or combined therapy with tamsulosin versus control or tamsulosin monotherapy in stent-related symptoms (SRSs). Randomized controlled trials evaluating solifenacin or its combination with tamsulosin for the treatment of SRSs were identified via a comprehensive search of Pubmed, Embase, Ovid, The Cochrane Library and relevant sources up to February 2017. Ureteral stent symptom questionnaire (USSQ) and drug-related complications were pooled for meta-analysis. Mean difference and risk difference were calculated as appropriate for each outcome to determine the cumulative effect size. There were 10 studies involving 1786 participants finally eligible in the quantitative analysis. Solifenacin monotherapy significantly reduced the total score of USSQ [MD -14.90; 95% CI (-25.19, -4.60); P = 0.005], as well as indexes of urinary symptoms, body pain, general health, sexual performance, and hematuria (P = 0.02, P = 0.009, P = 0.004, P = 0.02, P = 0.02, respectively), but the differences were insignificant when compared with tamsulosin except improved sexual performance (P = 0.004). Combined therapy of solifenacin and tamsulosin showed no beneficial effects in all indexes of USSQ over solifenacin monotherapy. Only slightly higher incidence of dry mouth (P = 0.02) was found with solifenacin versus control. The result demonstrates the safety and efficacy of solifenacin in reducing SRSs, but no significant advantage was found over tamsulosin. In addition, combination of solifenacin and tamsulosin did not show beneficial effects over solifenacin monotherapy. More high quality trials are warranted to further address this issue, however.

Use of the Escape nitinol stone retrieval basket facilitates fragmentation and extraction of ureteral and renal calculi: a pilot study.

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Kesler, Stuart S; Pierre, Sean A; Brison, Daniel I; Preminger, Glenn M; Munver, Ravi

2008-06-01

Advances in ureteroscope and stone basket design have catapulted ureteroscopy to the forefront of surgical stone management; however, persistent problems such as stone migration continue to challenge urologists. The Escape nitinol stone retrieval basket (Boston Scientific, Natick, MA) is a stone basket designed to capture calculi and facilitate simultaneous laser lithotripsy in situ. We report our initial experience with the Escape basket for the management of urinary calculi and compare the use of this device with other methods of optimizing ureteroscopic stone management. A prospective evaluation of 23 patients undergoing ureteroscopic holmium:yttrium-aluminum-garnet laser lithotripsy of urinary calculi was performed at two institutions by two surgeons (R.M. and G.M.P). The Escape basket was used to prevent retrograde ureteral stone migration or to facilitate fragmentation and extraction of large renal calculi. Patient demographics and perioperative parameters were assessed. Twenty-three patients (16 men, 7 women), with a mean age of 55.5 years (range 33-74 yrs) were treated for renal (n = 9) or ureteral (n = 14) calculi. The mean stone diameter was 1.4 cm (range 0.4-2.5 cm), mean fragmentation time was 44.1 minutes (range 10-75 min), and mean energy used was 3.1 kJ (range 0.4-10.6 kJ). No complications were encountered. Eighty-seven percent (20/23) of patients were rendered completely stone free after ureteroscopic laser lithotripsy using the Escape basket. Of the three patients with residual calculi, one patient with a 2.5-cm renal calculus had residual fragments larger than 3 mm, and two patients with large renal calculi had residual fragments smaller than 3 mm. The Escape basket appears to be safe and effective in preventing stone migration and facilitating ureteroscopic laser lithotripsy and stone extraction.

Use of XenX™, the latest ureteric occlusion device with guide wire utility: results from a prospective multicentric comparative study.

Science.gov (United States)

Sanguedolce, Francesco; Montanari, Emanuele; Alvarez-Maestro, Mario; Macchione, Nicola; Hruby, Stephan; Papatsoris, Athanasios; Kallidonis, Panagiotis; Villa, Luca; Honeck, Patrick; Traxer, Olivier; Greco, Francesco

2016-11-01

This is a prospective multicentric comparative study evaluating the performance of XenX-a new dual-purpose device for the prevention of stone fragments migration during ureteroscopic lithotripsy (URS). Between March 2014 and January 2015, 41 patients undertaking URS + XenX were matched with 41 patients undergoing standard URS. Patients included had unilateral ureteric stone(s) of 0.5-1.5 cm in maximum size. Demographics, complication rates and surgical outcomes were recorded for comparison. A Likert-like 5-grade scoring system was used for surgeons' evaluation of XenX properties. Cost analysis was performed by comparing weighted mean costs of the relevant procedures. Patients' characteristics between the two groups were comparable. Lasering time was longer for XenX group (13.59 vs. 5.17 min; p = 0.0001) whilst use of basket and need of JJ stent insertion was more frequent in control group (19.5 vs. 97.6 %; p = 0.0001 and 22 vs. 35 %; p = 0.001, respectively). Intra-operative SFR was significantly higher for XenX group (100 vs. 85.4 %; p = 0.0001), but not at 4-week follow-up, after ancillary procedures were needed in 17.1 % of the control group. Surgeons' evaluations for XenX were suboptimal for "Ease of Basketing" (2/5) and "Advancement of double J stent" (3/5). The use of XenX increased costs of procedures, but spared the costs associated to ancillary procedures and stent removals. XenX confirmed to be a safe and effective device especially for the treatment of upper ureteric tract stones; moreover, XenX may reduce the risk for the need of auxiliary procedures and for the insertion of a JJ stent.

Evidence-Based Surgical Treatments for Chronic Pancreatitis.

Science.gov (United States)

Kleeff, Jörg; Stöß, Christian; Mayerle, Julia; Stecher, Lynne; Maak, Matthias; Simon, Peter; Nitsche, Ulrich; Friess, Helmut

2016-07-25

If conservative treatment of chronic pancreatitis is unsuccessful, surgery is an option. The choice of the most suitable surgical method can be difficult, as the indications, advantages, and disadvantages of the available methods have not yet been fully documented with scientific evidence. In April 2015, we carried out a temporally unlimited systematic search for publications on surgery for chronic pancreatitis. The target parameters were morbidity, mortality, pain, endocrine and exocrine insuffi - ciency, weight gain, quality of life, length of hospital stay, and duration of urgery. Differences between surgical methods were studied with network meta-analysis, and duodenum-preserving operations were compared with partial duodenopancreatectomy with standard meta-analysis. Among the 326 articles initially identified, 8 randomized controlled trials on a total of 423 patients were included in the meta-analysis. The trials were markedly heterogeneous in some respects. There was no significant difference among surgical methods with respect to perioperative morbidity, pain, endocrine and exocrine insufficiency, or quality of life. Duodenumpreserving procedures, compared to duodenopancreatectomy, were associated with a long-term weight gain that was 3 kg higher (p chronic pancreatitis is superior to partial duodenopancreatectomy in multiple respects. Only limited recommendations can be given, however, on the basis of present data. The question of the best surgical method for the individual patient, in view of the clinical manifestations, anatomy, and diagnostic criteria, remains open.

Differential mRNA expression of renal cortical tissue inhibitor of metalloproteinase-1, -2, and -3 in experimental hydronephrosis

NARCIS (Netherlands)

Engelmyer, E; van Goor, H; Edwards, D R; Diamond, J R

The pathophysiologic sequelae of both acute and chronic experimental unilateral ureteral obstruction (UUO) in the rat are the result of a variety of complex humoral and cellular interactions. The development of interstitial fibrosis is dependent on the tightly coupled regulation of synthesis and

Feminist Therapy with Chronically and Profoundly Disturbed Women.

Science.gov (United States)

Alyn, Jody H.; Becker, Lee A.

1984-01-01

Assessed the effectiveness of feminist therapy with 28 chronically disturbed female clients enrolled in a partial hospitalization program. Significant improvement in self-esteem, and significant increase in sexual knowledge, were produced for participants in the feminist therapy groups. No changes were produced on the Attitudes Toward Women Scale.…

[Partial response of solar urticaria to omalizumab therapy].

Science.gov (United States)

Kowalzick, L; Thiel, W; C Bielfeld; Ziegler, H; Eickenscheidt, L

2017-06-01

The treatment of solar urticaria is regarded as difficult. In some cases good responses to the anti-IgE antibody omalizumab (Xolair®), approved for treatment of chronic spontaneous urticaria, have been reported. We report on a 50-year-old Caucasian woman who for the last 5 years has developed localized itching and stinging erythemas following exposure to sunlight accompanied sometimes by anaphylactic reactions. Oral antihistamines in three- to four-fold doses and a topical sun screen had been only partially effective in long-term use. Positive immediate-type reactions with whealing appeared in phototesting with low doses of UVB and UVA. Three weeks after s. c. injection of 300 mg omalizumab, the minimal urticarial dose (MUD) for UVB was increased at least 20-fold (from omalizumab administration to 14 points in weeks two and three. Overall, a partial response of solar urticaria to omalizumab therapy could be observed in the present case.

Food cravings mediate the relationship between chronic stress and body mass index.

Science.gov (United States)

Chao, Ariana; Grilo, Carlos M; White, Marney A; Sinha, Rajita

2015-06-01

This study examined the relationships between chronic stress, food cravings, and body mass index. A community-based sample of adults (N = 619) completed a comprehensive assessment battery and heights and weights were measured. Chronic stress had a significant direct effect on food cravings, and food cravings had a significant direct effect on body mass index. The total effect of chronic stress on body mass index was significant. Food cravings partially mediated the relationship between chronic stress and body mass index. These findings are consistent with research that chronic stress may potentiate motivation for rewarding substances and behaviors and indicate that high food cravings may contribute to stress-related weight gain. © The Author(s) 2015.

Cutting Whole Length or Partial Length of Internal Anal Sphincter in Managementof Fissure in Ano

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Furat Shani Aoda

2017-12-01

Full Text Available A chronic anal fissure is a common painful perianal condition.The main operative procedure to treat this painful condition is a lateral internal sphincteretomy (LIS.The aim of study is to compare the outcome and complications of closed LIS up to the dentate line (whole length of internal sphincter or up to the fissure apex (partial length of internal sphincter in the treatment of anal fissure.It is a prospective comparativestudy including 100 patients with chronic fissure in ano. All patients assigned to undergo closed LIS. Those patients were randomly divided into two groups: 50 patients underwent LIS to the level of dentate line (whole length and other 50 patients underwent LIS to the level of fissure apex (partial length. Patients were followed up weekly in the 1st month, twice monthly in the second month then monthly   for next 2 months and finally after 1 year. There was satisfactory relief of pain in all patients in both groups & complete healing of the fissure occurred. Regarding post operative incontinence no major degree of incontinence occur in both group but minor degree of incontinence persists In 7 patients after whole length LIS after one year. In conclusion, both whole length & partial length LIS associated with improvement of pain, good chance of healing but whole length LIS associated with more chance of long term  flatus incontinence. Hence,we recommend partial length LIS as treatment forchronic anal fissure.

Vesico-ureteral reflux: diagnosis and staging with voiding color doppler US Preliminary experience

International Nuclear Information System (INIS)

Farina, Renato; Arena, Carmela; Pennisi, Francesco; Di Benedetto, Vincenzo; Politi, Guido; Di Benedetto, Aurelio

2000-01-01

Introduction: The aim of this study is to assess the accuracy of a new US examination: 'voiding color Doppler US ' in the early diagnosis and staging of vesico-ureteral reflux (VUR). The contrast agent US was SH U 508A (Levovist, Schering, Berlin), which produces a chromatic accentuation of the signals picked up by the color Doppler US. Eighteen patients (10 females, eight males) were recruited for the study. In two patients a second examination was performed for follow-up after a VUR conservative therapy. All patients were taken under examination for the evaluation of possible VUR. In all patients the voiding color Doppler US was followed by voiding cystourethrography (VCUG) and the data obtained were compared. Materials and methods: A total of 18 patients aged between 3 months and 10 years, were recruited for the study. The results of the examination were the following: urinary tract infections, follow-up of VUR after conservative or surgical therapy, miscellaneous indications. Voiding color Doppler US was performed, followed by a VCUG. The voiding color Doppler US consists in the trans-catheter introduction of a contrast agent SHU 508 A (Levovist, Schering, Ag. Berlin) into the bladder and a subsequent test with the color Doppler US to show or exclude the presence of reflux into the ureters and/or into the pyelo-caliceal cavity of the kidneys. After the introduction of the contrast agent US the ultrasound scanning of the bladder, the ureters and the pyelo-caliceal cavity was performed to examine the reflux degree. The ultrasonographic investigations were perfomed with AU 590 asyncronus US (Esaote Biomedica, Genova) with a 3.5 MHz convex probe. Results: After the trans-catheter introduction of the contrast agent US, vesico-ureteral reflux occured in 13 patients (77.2%). The reflux degree was also measured by means of ultrasound and was later confirmed by VCUG. The mean times of each examination were as follows: initial US, 10 min; catheterization, 8 min; voiding

A method for measuring brain partial pressure of oxygen in unanesthetized unrestrained subjects: the effect of acute and chronic hypoxia on brain tissue PO(2).

Science.gov (United States)

Ortiz-Prado, E; Natah, Siraj; Srinivasan, Sathyanarayanan; Dunn, Jeff F

2010-11-30

The level of tissue oxygenation provides information related to the balance between oxygen delivery, oxygen utilization, tissue reactivity and morphology during physiological conditions. Tissue partial pressure of oxygen (PtO(2)) is influenced by the use of anesthesia or restraint. These factors may impact the absolute level of PtO(2). In this study we present a novel fiber optic method to measure brain PtO(2). This method can be used in unanesthetized, unrestrained animals, provides absolute values for PO(2), has a stable calibration, does not consume oxygen and is MRI compatible. Brain PtO(2) was studied during acute hypoxia, as well as before and after 28 days of high altitude acclimatization. A sensor was chronically implanted in the frontal cortex of eight Wistar rats. It is comprised of a fiber optic probe with a tip containing material that fluoresces with an oxygen dependent lifetime. Brain PtO(2) declines by 80% and 76% pre- and post-acclimatization, respectively, when the fraction of inspired oxygen declines from 0.21 to 0.08. In addition, a linear relationship between brain PtO(2) and inspired O(2) levels was demonstrated r(2)=0.98 and r(2)=0.99 (pre- and post-acclimatization). Hypoxia acclimatization resulted in an increase in the overall brain PtO(2) by approximately 35%. This paper demonstrates the use of a novel chronically implanted fiber optic based sensor for measuring absolute PtO(2). It shows a very strong linear relationship in awake animals between inspired O(2) and tissue O(2), and shows that there is a proportional increase in PtO(2) over a range of inspired values after exposure to chronic hypoxia. Copyright © 2010 Elsevier B.V. All rights reserved.

Resultados de la litotricia extracorpórea utilizando el litotritor MODULITH SLX-MX (STORZ para el tratamiento de la litiasis ureteral Results of the shock waves extracorporeal lithotripsy using the MODULITH SLX-MX (STORZ lithotriptor for treatment or ureteral lithiasis

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María Victoria Labrada

2010-09-01

Full Text Available INTRODUCCIÓN. La litiasis del uréter constituye una gran preocupación para los médicos debido a que frecuentemente ocasiona una uropatía obstructiva y el deterioro progresivo de la función renal ipsolateral, estado patológico de alta prevalencia, por lo que los hospitales con frecuencia no pueden dar solución quirúrgica con la celeridad necesaria. El objetivo de esta investigación fue conocer los resultados de la litotricia extracorpórea por ondas de choque (LEC con el litotritor MODULITH SLX-MX (STORZ para el tratamiento de la litiasis ureteral. MÉTODOS. Se incluyeron 598 pacientes con litiasis radiopaca del uréter, atendidos en el Hospital «Hermanos Ameijeiras» entre enero de 2007 y diciembre de 2008. Se conformaron 4 grupos según la localización del cálculo: en la unión pieloureteral (UPU (96, uréter lumbar (UL (263, iliaco (UI (40, pelviano (UP (199 y se analizó su relación con la superficie litiásica, sesiones de tratamiento, maniobras complementarias previas a la litotricia, aplicación de procedimientos auxiliares posteriores, resolución definitiva por otra técnica quirúrgica y eficacia terapéutica. La colimación se realizó por fluoroscopia. RESULTADOS. El mayor número de cálculos se localizó en el uréter lumbar, y en segundo lugar, en el uréter pelviano. El tamaño medio de la litiasis fue de 0,8 ± 0,5233 cm², en rango de 0,09-4 cm². La media de sesiones utilizadas fue de 1,24 ± 0,531, rango de 1-4. Se realizaron maniobras complementarias previas en 72 pacientes (12,04 % y la más utilizada fue la nefrostomía percutánea (40; 6,6 %. Después de la LEC fue necesaria la conversión a otro procedimiento para la solución del 4,68 % de los casos. La LEC fue eficaz en el 95,32 %, con mejores resultados en el UP (96,99 % y peores en el UI (92,50 %. CONCLUSIONES. Los resultados fueron buenos utilizando el litotritor MODULITH SLX-MX (STORZ. Los mejores resultados se obtuvieron en el uréter pelviano y en

Bilateral uric acid nephrolithiasis and ureteral hypertrophy in a free-ranging river otter (Lontra canadensis)

Science.gov (United States)

Grove, Robert A.; Bildfell, Rob; Henny, Charles J.; Buhler, D.R.

2003-01-01

We report the first case of uric acid nephrolithiasis in a free-ranging river otter (Lontra canadensis). A 7 yr old male river otter collected from the Skagit River of western Washington (USA) had bilateral nephrolithiasis and severely enlarged ureters (one of 305 examined [0.33%]). The uroliths were 97% uric acid and 3% protein. Microscopic changes in the kidney were confined to expansion of renal calyces, minor loss of medullary tissue, and multifocal atrophy of the cortical tubules. No inflammation was observed in either kidney or the ureters. The ureters were enlarged due to marked hypertrophy of smooth muscle plus dilation of the lumen. Fusion of the major calyces into a single ureteral lumen was several cm distal to that of two adult male otters used as histopathologic control specimens. This case report is part of a large contaminant study of river otters collected from Oregon and Washington. It is important to understand diseases and lesions of the otter as part of our overall evaluation of this population.

Non-surgical management of a chronic periapical lesion associated ...

African Journals Online (AJOL)

A case is reported of a chronic periapical lesion involving maxillary central incisors with a history of traumatic injury eight years previously and subsequent development of a painful swelling that occasionally caused partial blockage of the nasal cavities. Retrograde surgery for removal of the suspected cystic lesion was ...

Temporal dynamics of hippocampal neurogenesis in chronic neurodegeneration

Science.gov (United States)

Suzzi, Stefano; Vargas-Caballero, Mariana; Fransen, Nina L.; Al-Malki, Hussain; Cebrian-Silla, Arantxa; Garcia-Verdugo, Jose Manuel; Riecken, Kristoffer; Fehse, Boris; Perry, V. Hugh

2014-01-01

The study of neurogenesis during chronic neurodegeneration is crucial in order to understand the intrinsic repair mechanisms of the brain, and key to designing therapeutic strategies. In this study, using an experimental model of progressive chronic neurodegeneration, murine prion disease, we define the temporal dynamics of the generation, maturation and integration of new neurons in the hippocampal dentate gyrus, using dual pulse-chase, multicolour γ-retroviral tracing, transmission electron microscopy and patch-clamp. We found increased neurogenesis during the progression of prion disease, which partially counteracts the effects of chronic neurodegeneration, as evidenced by blocking neurogenesis with cytosine arabinoside, and helps to preserve the hippocampal function. Evidence obtained from human post-mortem samples, of both variant Creutzfeldt-Jakob disease and Alzheimer’s disease patients, also suggests increased neurogenic activity. These results open a new avenue into the exploration of the effects and regulation of neurogenesis during chronic neurodegeneration, and offer a new model to reproduce the changes observed in human neurodegenerative diseases. PMID:24941947

Chronic Enhancement of Serotonin Facilitates Excitatory Transcranial Direct Current Stimulation-Induced Neuroplasticity.

Science.gov (United States)

Kuo, Hsiao-I; Paulus, Walter; Batsikadze, Giorgi; Jamil, Asif; Kuo, Min-Fang; Nitsche, Michael A

2016-04-01

Serotonin affects memory formation via modulating long-term potentiation (LTP) and depression (LTD). Accordingly, acute selective serotonin reuptake inhibitor (SSRI) administration enhanced LTP-like plasticity induced by transcranial direct current stimulation (tDCS) in humans. However, it usually takes some time for SSRI to reduce clinical symptoms such as anxiety, negative mood, and related symptoms of depression and anxiety disorders. This might be related to an at least partially different effect of chronic serotonergic enhancement on plasticity, as compared with single-dose medication. Here we explored the impact of chronic application of the SSRI citalopram (CIT) on plasticity induced by tDCS in healthy humans in a partially double-blinded, placebo (PLC)-controlled, randomized crossover study. Furthermore, we explored the dependency of plasticity induction from the glutamatergic system via N-methyl-D-aspartate receptor antagonism. Twelve healthy subjects received PLC medication, combined with anodal or cathodal tDCS of the primary motor cortex. Afterwards, the same subjects took CIT (20 mg/day) consecutively for 35 days. During this period, four additional interventions were performed (CIT and PLC medication with anodal/cathodal tDCS, CIT and dextromethorphan (150 mg) with anodal/cathodal tDCS). Plasticity was monitored by motor-evoked potential amplitudes elicited by transcranial magnetic stimulation. Chronic application of CIT increased and prolonged the LTP-like plasticity induced by anodal tDCS for over 24 h, and converted cathodal tDCS-induced LTD-like plasticity into facilitation. These effects were abolished by dextromethorphan. Chronic serotonergic enhancement results in a strengthening of LTP-like glutamatergic plasticity, which might partially explain the therapeutic impact of SSRIs in depression and other neuropsychiatric diseases.

Cast Partial Denture versus Acrylic Partial Denture for Replacement of Missing Teeth in Partially Edentulous Patients

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Pramita Suwal

2017-03-01

Full Text Available Aim: To compare the effects of cast partial denture with conventional all acrylic denture in respect to retention, stability, masticatory efficiency, comfort and periodontal health of abutments. Methods: 50 adult partially edentulous patient seeking for replacement of missing teeth having Kennedy class I and II arches with or without modification areas were selected for the study. Group-A was treated with cast partial denture and Group-B with acrylic partial denture. Data collected during follow-up visit of 3 months, 6 months, and 1 year by evaluating retention, stability, masticatory efficiency, comfort, periodontal health of abutment. Results: Chi-square test was applied to find out differences between the groups at 95% confidence interval where p = 0.05. One year comparison shows that cast partial denture maintained retention and stability better than acrylic partial denture (p< 0.05. The masticatory efficiency was significantly compromising from 3rd month to 1 year in all acrylic partial denture groups (p< 0.05. The comfort of patient with cast partial denture was maintained better during the observation period (p< 0.05. Periodontal health of abutment was gradually deteriorated in all acrylic denture group (p

Neuronal Activity in the Subthalamic Cerebrovasodilator Area under Partial-Gravity Conditions in Rats

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Zeredo L Zeredo

2014-03-01

Full Text Available The reduced-gravity environment in space is known to cause an upward shift in body fluids and thus require cardiovascular adaptations in astronauts. In this study, we recorded in rats the neuronal activity in the subthalamic cerebrovasodilator area (SVA, a key area that controls cerebral blood flow (CBF, in response to partial gravity. “Partial gravity” is the term that defines the reduced-gravity levels between 1 g (the unit gravity acceleration on Earth and 0 g (complete weightlessness in space. Neuronal activity was recorded telemetrically through chronically implanted microelectrodes in freely moving rats. Graded levels of partial gravity from 0.4 g to 0.01 g were generated by customized parabolic-flight maneuvers. Electrophysiological signals in each partial-gravity phase were compared to those of the preceding 1 g level-flight. As a result, SVA neuronal activity was significantly inhibited by the partial-gravity levels of 0.15 g and lower, but not by 0.2 g and higher. Gravity levels between 0.2–0.15 g could represent a critical threshold for the inhibition of neurons in the rat SVA. The lunar gravity (0.16 g might thus trigger neurogenic mechanisms of CBF control. This is the first study to examine brain electrophysiology with partial gravity as an experimental parameter.

Retroperitoneal Laparoscopic Ureteral Incision and Analysis of Two Kinds of Ureteral Stents Placement Method Contrast Stone Taken During the Operation%后腹腔镜输尿管上段切开取石术中两种放置输尿管支架方法的对比分析

Institute of Scientific and Technical Information of China (English)

高飞; 刘清学; 彭洪; 刘建洪; 李万华; 凌思果; 杨军

2015-01-01

目的 探讨后腹腔镜输尿管上段切开取石术中输尿管支架的放置方法. 方法 2006年7月至2014年5月共完成后腹腔镜输尿管上段切开取石术428例,术中均放置输尿管支架. 预先将输尿管支架分别向两端穿好导丝,经输尿管切口将其向远端插入至膀胱,拔出远端导丝,再向近端插入至肾盂,拔出近端导丝52例(方法一);将输尿管支架上端卷曲部分留下约1cm,其余部分剪掉,将具有可塑性钢丝从输尿管支架直行处侧孔插入至顶端,用操作钳辅助将全部输尿管支架置入输尿管内,包括卷曲部分,操作钳夹在输尿管支架与钢丝分叉处,倒退回抽钢丝,输尿管支架倒退进入输尿管-肾盂内,"倒退法"放置输尿管支架376例(方法二). 结果 所有患者输尿管支架放置均成功,输尿管均用4-0可吸收线间断缝合,其中方法一耗时7～12min,方法二耗时25S～3min. 所有患者拔出引流管时间、拔出导尿管时间、漏尿时间以及术后平均住院日差异无统计学意义(P＞0. 05). 结论 "倒退法"放置输尿管支架操作简单易学、耗时明显减少,大大降低了该手术的难度,值得推广.%Objective To investigate the retroperitoneal laparoscopic ureteral incision method of placing Ureteral stents stone surgery. Methods In July 2006 to May 2014,after the completion of the 428 cases of laparoscopic incision in the upper u-reter stone extraction for intraoperative are placed D-J tube. In advance to D-J tube to wear good thread on both ends respectively, the ureter incision insert it to the distal to the bladder, pull out the remote thread,proximally insert again to the renal pelvis,pull out the proximal godet 52 cases( method a);Part D-J tube top crimping left about 1 cm,cut off,the rest will have plasticity steel wire from D-J tube straight side hole insert to the top,with operating forceps auxiliary all D-J tube placement within the ureter,in-cluding curly part

[Effectiveness of partial and complete instrumental masking in chronic tinnitus. Studies with reference to retraining therapy].

Science.gov (United States)

von Wedel, H; von Wedel, U C; Streppel, M; Walger, M

1997-09-01

Jastreboff und Hazell [9] developed a neurophysiological approach to tinnitus perception, including the important role of the central nervous system in the maintenance and intrusiveness of tinnitus. They introduced tinnitus-retraining therapy, consisting of four different strategies: (1) directive and person-centered counseling; (2) hearing aids and/or noise generators and/or environmental sounds; (3) psychological therapy; (4) adjacent therapies. Tinnitus should not be masked as with a tinnitus-masker, but must be able to be heard in addition to the noise! A noise generator or hearing aid should be worn at least 6-8 h per day over a period of up to 18 months. In additions several clinical visits are required in order to reinforce the counseling. The actual results show complete tinnitus remission for about 20-30% and partial remission for 50-60% of the patients [6]. We report on a retrospective study in patients wearing hearing aids or tinnitus-maskers over a period of 3 years. We compared the results of patients using partial tinnitus masking to those using complete masking. The tinnitus-related and general psychological complaints were acquired by the 52-item tinnitus questionnaire developed by Hallam et al. [4] and modified by Goebel and Hiller [3]. To describe the dimensions of tinnitus-related distress the scales are labelled emotional distress, cognitive distress, emotional and cognitive distress, intrusiveness, auditory perceptual difficulties, sleep disturbance and somatic complaints. Positive changes for the global tinnitus questionnaire score of more than 10 points are significant in the dimensions of tinnitus-related distress and are described as partial tinnitus-reduction. The group with partial masking effects can be compared to those performing retraining therapy to day because directive and personal centered counseling were integrated for all patients. Patients reporting partial masking effects through their aids (hearing aid or noise generator

Treatment of chronic heel osteomyelitis in vasculopathic patients. Can the combined use of Integra® , skin graft and negative pressure wound therapy be considered a valid therapeutic approach after partial tangential calcanectomy?

Science.gov (United States)

Fraccalvieri, Marco; Pristerà, Giuseppe; Zingarelli, Enrico; Ruka, Erind; Bruschi, Stefano

2012-04-01

Osteomyelitis of the calcaneus is a difficult problem to manage. Patients affected by osteomyelitis of the calcaneus often have a below-the-knee amputation because of their comorbidity. In this article, we present seven cases of heel ulcerations with chronic osteomyelitis treated with Integra(®) Dermal Regeneration Template, skin graft and negative pressure wound therapy after partial tangential calcanectomy, discussing the surgical and functional results. In this casuistic of patients, all wounds healed after skin grating of the neodermis generated by Integra(®), with no patient requiring a below-knee amputation. © 2011 The Authors. © 2011 Blackwell Publishing Ltd and Medicalhelplines.com Inc.

Continuous antibiotic prophylaxis reduces the risk of febrile UTI in children with asymptomatic antenatal hydronephrosis with either ureteral dilation, high-grade vesicoureteral reflux, or ureterovesical junction obstruction.

Science.gov (United States)

Herz, Daniel; Merguerian, Paul; McQuiston, Leslie

2014-08-01

The efficacy and utility of continuous antibiotic prophylaxis (CAP) in children with congenital antenatal hydronephrosis (ANH) is uncertain. The literature has both supportive and contradictory evidence. The growing trend not to place children with ANH on CAP has created varied clinical practice based on anecdotal individual case characteristics. Our goal was to compare individual infant characteristics between those children who were maintained on CAP to those that were not to try to determine predisposing risk factors to febrile. All electronic medical records (EMRs) of children referred to our institution for congenital ANH over a period from 2001 to 2011 were examined. We excluded those referred for urinary tract infection (UTI) who had a history of congenital ANH. We also excluded those with incomplete records, or follow-up less than 2 years. Children were divided into two groups: those maintained on CAP (YCAP) and those not maintained on CAP (NCAP). Our primary endpoint was febrile UTI. Follow-up was at least 24 months. Demographic, perinatal and postnatal clinical data were recorded. Statistical analysis was performed using STATA Version 11.1. Of the 405 children fitting inclusion criteria, 278 (68.6%) children were maintained on CAP and 127 (31.4%) were not on CAP. The incidence of prematurity, oligohydramnios, perinatal respiratory complications, use of perinatal antibiotics, circumcision status, renal anomalies, associated medical diagnoses, and low birth weight did not differ between the two groups. Overall the incidence of febrile UTI during the follow-up period was 22.2%. The incidence of febrile UTI between the YCAP and NCAP groups was significant (YCAP = 7.9% and NCAP 18.7%, p = 0.021). Multivariate logistic regression using CAP as the dichotomous dependent variable revealed that ureteral dilation, high-grade vesicoureteral reflux (VUR), and ureterovesical junction (UVJ) obstruction were independent risk factors for febrile UTI. More specifically

Colonic, ureteral, and vascular injuries secondary to stick impalement in a dog.

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Menard, Julie; Schoeffler, Gretchen L

2011-08-01

To report the surgical repair, case management, and outcome of a dog with sepsis and severe intraabdominal trauma secondary to a penetrating stick injury. A 1.5-year-old, spayed female, mixed-breed dog was presented to the emergency service after incurring a small laceration on the medial aspect of the left pelvic limb while running in the woods. The wound was surgically explored and a primary closure achieved. The patient was discharged the same day with oral antimicrobial therapy. The following morning the dog was represented to the emergency service for acute vomiting. Abdominal radiographs were performed and demonstrated loss of serosal detail and pneumoperitoneum. An emergency celiotomy was performed and revealed distal colonic perforation, left ureteral laceration, and lacerations of the left common iliac vein. Ureteronephrectomy, as well as primary closure of the distal colonic perforation and left common iliac vein lacerations, were performed. The patient recovered and was ultimately discharged from the hospital 5 days later. Follow-up 1 year later revealed no significant physical exam or biochemical abnormalities. A seemingly benign penetrating stick injury initially deemed to be superficial in nature was later demonstrated to have resulted in sepsis following severe intraabdominal trauma that included lacerations of the distal colon, left ureter, and left common iliac vein in a dog. Successful surgical management and intensive care led to a full recovery without any residual impairment noted a year later. © Veterinary Emergency and Critical Care Society 2011.

Analysis of Urine Flow in Three Different Ureter Models

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Kyung-Wuk Kim

2017-01-01

Full Text Available The ureter provides a way for urine to flow from the kidney to the bladder. Peristalsis in the ureter partially forces the urine flow, along with hydrostatic pressure. Ureteral diseases and a double J stent, which is commonly inserted in a ureteral stenosis or occlusion, disturb normal peristalsis. Ineffective or no peristalsis could make the contour of the ureter a tube, a funnel, or a combination of the two. In this study, we investigated urine flow in the abnormal situation. We made three different, curved tubular, funnel-shaped, and undulated ureter models that were based on human anatomy. A numerical analysis of the urine flow rate and pattern in the ureter was performed for a combination of the three different ureters, with and without a ureteral stenosis and with four different types of double J stents. The three ureters showed a difference in urine flow rate and pattern. Luminal flow rate was affected by ureter shape. The side holes of a double J stent played a different role in detour, which depended on ureter geometry.

Uterine Artery Embolization for Ureteric Obstruction Secondary to Fibroids

International Nuclear Information System (INIS)

Mirsadraee, Saeed; Tuite, David; Nicholson, Anthony

2008-01-01

This case series examines the safety and efficacy of uterine artery embolization (UAE) in the treatment of obstructive nephropathy caused by large fibroids. Between 2004 and 2007, 10 patients referred with symptomatic uterine fibroids that were found to be causing either unilateral (7 patients) or bilateral (3 patients) hydronephrosis were treated by UAE. Presenting complaints included menorrhagia, dysmenorrhea, bulk symptoms, loin pain, postobstructive atrophy, and mild renal impairment. All had posterior intramural dominant fibroids >11 cm in maximum sagittal diameter and uterine volumes between 3776 and 15,625 ml. Outcome measures at between 12 and 36 months included procedural success, repeat intervention, relief of symptoms, resolution of hydronephrosis, stable renal function and size, and avoidance of hysterectomy. In all cases the cause of renal obstruction was confirmed to be a giant fibroid compressing the ureter at the pelvic brim. In all cases UAE was technically successful, though two patients required a repeat procedure. In eight patients hydronephrosis resolved and the obstruction was relieved, though two still had some bulk symptoms not requiring further treatment. Renal function improved or was stable in all cases. Renal size was stable in all cases. Where menorrhagia was part of the symptom complex it was relieved in all cases. Two patients diagnosed as having postobstructive atrophy of one kidney underwent retrograde ureteric stenting on the nonatrophied side prior to UAE. This was unsuccessful in one of the cases due to the distortion caused by the fibroid. Despite improvement in hydronephrosis this patient underwent hysterectomy at 7 months after a renogram demonstrated persistent obstruction at the pelvic brim. In the second patient a double pigtail stent was inserted with difficulty and eventually removed at 8 months. This patient has had stable renal function and size for 3 years post-UAE. We conclude that UAE is safe and effective in

Inactivation of basolateral amygdala prevents chronic immobilization stress-induced memory impairment and associated changes in corticosterone levels.

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Tripathi, Sunil Jamuna; Chakraborty, Suwarna; Srikumar, B N; Raju, T R; Shankaranarayana Rao, B S

2017-07-01

Chronic stress causes detrimental effects on various forms of learning and memory. The basolateral amygdala (BLA) not only plays a crucial role in mediating certain forms of memory, but also in the modulation of the effects of stress. Chronic immobilization stress (CIS) results in hypertrophy of the BLA, which is believed to be one of the underlying causes for stress' effects on learning. Thus, it is plausible that preventing the effects of CIS on amygdala would preclude its deleterious cognitive effects. Accordingly, in the first part, we evaluated the effect of excitotoxic lesion of the BLA on chronic stress-induced hippocampal-dependent spatial learning using a partially baited radial arm maze task. The BLA was ablated bilaterally using ibotenic acid prior to CIS. Chronically stressed rats showed impairment in spatial learning with decreased percentage correct choice and increased reference memory errors. Excitotoxic lesion of the BLA prevented the impairment in spatial learning and reference memory. In the retention test, lesion of the BLA was able to rescue the chronic stress-induced impairment. Interestingly, stress-induced enhanced plasma corticosterone levels were partially prevented by the lesion of BLA. These results motivated us to evaluate if the same effects can be observed with temporary inactivation of BLA, only during stress. We found that chronic stress-induced spatial learning deficits were also prevented by temporary inactivation of the BLA. Additionally, temporary inactivation of BLA partially precluded the stress-induced increase in plasma corticosterone levels. Thus, inactivation of BLA precludes stress-induced spatial learning deficits, and enhanced plasma corticosterone levels. It is speculated that BLA inactivation-induced reduction in corticosterone levels during stress, might be crucial in restoring spatial learning impairments. Our study provides evidence that amygdalar modulation during stress might be beneficial for strategic

Abdominal fat distribution on computed tomography predicts ureteric calculus fragmentation by shock wave lithotripsy

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Juan, Hsu-Cheng; Chou, Yii-Her [Kaohsiung Medical University Hospital, Department of Urology, Kaohsiung (China); Lin, Hung-Yu [Kaohsiung Medical University, Graduate Institute of Medicine, Kaohsiung (China); E-Da Hospital/ I-Shou University, Department of Urology, Kaohsiung (China); Yang, Yi-Hsin [Kaohsiung Medical University, Institute of Oral Health Sciences, Kaohsiung (China); Shih, Paul Ming-Chen [Kaohsiung Municipal Hsiao-Kang Hospital, Department of Radiology, Kaohsiung (China); Kaohsiung Medical University, Department of Radiology, Kaohsiung (China); Chuang, Shu-Mien [Yuh-Ing Junior College of Health Care and Management, Kaohsiung (China); Shen, Jung-Tsung [Kaohsiung Municipal Hsiao-Kang Hospital, Department of Urology, Kaohsiung (China); Juan, Yung-Shun [Kaohsiung Medical University Hospital, Department of Urology, Kaohsiung (China); Kaohsiung Medical University, Graduate Institute of Medicine, Kaohsiung (China); Kaohsiung Medical University, Department of Urology, Faculty of Medicine, Kaohsiung (China)

2012-08-15

To assess the effects of abdominal fat on shock wave lithotripsy (SWL). We used pre-SWL unenhanced computed tomography (CT) to evaluate the impact of abdominal fat distribution and calculus characteristics on the outcome of SWL. One hundred and eighty-five patients with a solitary ureteric calculus treated with SWL were retrospectively reviewed. Each patient underwent unenhanced CT within 1 month before SWL treatment. Treatment outcomes were evaluated 1 month later. Unenhanced CT parameters, including calculus surface area, Hounsfield unit (HU) density, abdominal fat area and skin to calculus distance (SSD) were analysed. One hundred and twenty-eight of the 185 patients were found to be calculus-free following treatment. HU density, total fat area, visceral fat area and SSD were identified as significant variables on multivariate logistic regression analysis. The receiver-operating characteristic analyses showed that total fat area, para/perirenal fat area and visceral fat area were sensitive predictors of SWL outcomes. This study revealed that higher quantities of abdominal fat, especially visceral fat, are associated with a lower calculus-free rate following SWL treatment. Unenhanced CT is a convenient technique for diagnosing the presence of a calculus, assessing the intra-abdominal fat distribution and thereby helping to predict the outcome of SWL. (orig.)

Abdominal fat distribution on computed tomography predicts ureteric calculus fragmentation by shock wave lithotripsy

International Nuclear Information System (INIS)

Juan, Hsu-Cheng; Chou, Yii-Her; Lin, Hung-Yu; Yang, Yi-Hsin; Shih, Paul Ming-Chen; Chuang, Shu-Mien; Shen, Jung-Tsung; Juan, Yung-Shun

2012-01-01

To assess the effects of abdominal fat on shock wave lithotripsy (SWL). We used pre-SWL unenhanced computed tomography (CT) to evaluate the impact of abdominal fat distribution and calculus characteristics on the outcome of SWL. One hundred and eighty-five patients with a solitary ureteric calculus treated with SWL were retrospectively reviewed. Each patient underwent unenhanced CT within 1 month before SWL treatment. Treatment outcomes were evaluated 1 month later. Unenhanced CT parameters, including calculus surface area, Hounsfield unit (HU) density, abdominal fat area and skin to calculus distance (SSD) were analysed. One hundred and twenty-eight of the 185 patients were found to be calculus-free following treatment. HU density, total fat area, visceral fat area and SSD were identified as significant variables on multivariate logistic regression analysis. The receiver-operating characteristic analyses showed that total fat area, para/perirenal fat area and visceral fat area were sensitive predictors of SWL outcomes. This study revealed that higher quantities of abdominal fat, especially visceral fat, are associated with a lower calculus-free rate following SWL treatment. Unenhanced CT is a convenient technique for diagnosing the presence of a calculus, assessing the intra-abdominal fat distribution and thereby helping to predict the outcome of SWL. (orig.)

Recent progress in the clinical application of partial splenic embolization

International Nuclear Information System (INIS)

Zhou Yaojun; Liu Changjiang; Wang Yaojun

2012-01-01

Partial splenic embolization (PSE) is a non-surgical procedure used to treat hypersplenism in various clinical settings and thus to avoid the disadvantages of splenectomy. PSE can be employed for the treatment of a variety of diseases including hypersplenism, thrombocytopenia, portal hypertension, splenic arterial aneurysms, etc. PSE can effectively relieve the splenic artery steal syndrome which occurred after liver transplantation, and therefore significantly improve the blood perfusion of the recipient liver. Besides, PSE can also be adopted to reduce the bleeding risk in patients with esophageal and gastric varices caused by portal hypertension. PSE is beneficial to the improvement of peripheral hematologic parameters, which helps the patients successfully undergo the high-dose chemotherapy or interferon therapy. In addition, PSE possesses potential curative effect for thrombocytopenia related diseases such as chronic idiopathic thrombocytopenic purpura. This paper aims to make a comprehensive review of the recent progress in the clinical application of partial splenic embolization. (authors)

Dilated uropathies in children; Dilatation des reins et voies urinaires chez l`enfant

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Bouissou, F. [Centre Hospitalier Universitaire Purpan, 31 - Toulouse (France)

1995-12-31

These uropathies are frequent in children and are often diagnosed by ante-natal ultrasound examination. The dilatation, hydronephrosis or uretero-hydro-nephrosis may be due to a large pattern of malformations, either anatomical dysplasia, vesico-ureteric reflux or obstruction of the pelvi-ureteric junction, of the vesical-ureteric junction or due to a chronic urethral obstruction. The investigations must determine the exact urinary tract abnormalities, the renal function and the uro-dynamic change. They are guided by the ultrasound findings and cystography. In obstructive malformation, the MAG3 renogram with furosemide test is the best way to precise the uro-dynamic status, but it requires a careful technique in children and its interpretation is sometimes equivocal. DMSA scan is very useful to give precise separate kidney function and to follow the maturational change with age. All the results must be carefully analysed ; the final therapeutic decision and specially surgery is dependent of the type of uropathy and its natural history. In many cases, surgical treatment is only indicated after a longer follow-up and repeated evaluations. (authors). 11 refs., 2 figs.

Alveolar Soft Part Sarcoma of Urinary Bladder Occurring as a Second Primary Malignancy: A Case Report and Literature Review

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Manint Usawachintachit

2016-01-01

Full Text Available We report a case of bladder alveolar soft part sarcoma in an 18-year-old Thai male patient who had been treated with testicular radiation and systemic chemotherapy for acute lymphoblastic leukemia with testicular relapse. He presented with recurrent dysuria and gross hematuria. Cystoscopy revealed a 2-centimeter irregular sessile mass at the bladder base adjacent to left ureteral orifice. Transurethral resection of the tumor was performed. The histopathological diagnosis was alveolar soft part sarcoma. Chest and abdominal computed tomography showed no evidence of metastasis. He was treated with partial cystectomy and left ureteral reimplantation with negative surgical margin. No evidence of recurrence was found during a 28-month follow-up period with surveillance cystoscopy and computed tomography of the chest and abdomen.

Partial achilles tendon rupture presenting with giant hematoma; MRI findings of 4 year follow up.

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Sarsilmaz, Aysegul; Varer, Makbule; Coskun, Gulten; Apaydın, Melda; Oyar, Orhan

2011-12-01

In the young population, spontaneous rupture of Achilles tendon is very rare. The big hematoma is also rare finding of the Achilles tendon partial rupture. It is usually seen with complete rupture. We presented imaging findings of 4 years follow up of the spontaneous partial rupture of Achilles tendon presenting with giant expanding hematoma and mimicking complete rupture radiologically. We discussed the alterations of tendon signal intensity and result of conservative therapy after partial rupture with big hematoma in the long term. A 29 year-old man, applied with pain and swelling in the retrocalcaneal region of left ankle. He did not have chronic metabolic disease. He was not active in physical activities. X-ray radiograms were normal. At magnetic resonance images (MRI), there was an intratendinous big hematoma, subcutanous fat planes were edematous around tendon. The diagnosis was partial rupture and giant hematoma. Hematoma was drained. The conservative treatment was applied and his complaints disappeared. After treatment, approximately 4 years later, control MRI showed thickened and hypointense tendon in all images. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

Recurrent Partial Words

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Francine Blanchet-Sadri

2011-08-01

Full Text Available Partial words are sequences over a finite alphabet that may contain wildcard symbols, called holes, which match or are compatible with all letters; partial words without holes are said to be full words (or simply words. Given an infinite partial word w, the number of distinct full words over the alphabet that are compatible with factors of w of length n, called subwords of w, refers to a measure of complexity of infinite partial words so-called subword complexity. This measure is of particular interest because we can construct partial words with subword complexities not achievable by full words. In this paper, we consider the notion of recurrence over infinite partial words, that is, we study whether all of the finite subwords of a given infinite partial word appear infinitely often, and we establish connections between subword complexity and recurrence in this more general framework.

[Differential diagnosis of chronic myeloic leucemia in infancy (author's transl)].

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Binder, C; Pichler, E; Radaskiewicz, T; Scheibenreiter, S

1976-01-01

A 3 months old girl presented with significant enlargement of liver, spleen and lymphnodes, with moderate anemia, thrombopenia and leucocytosis. In the differential count there was a shift to the left and an increase of monocyte-like cells (35%). Differential diagnosis included leucemoid reaction, infectious mononucleosis, myelo-proliferative disorder with a missing C chromosome and chronic myeloid leucemia. Clinical symptoms, cytochemistry and caryotype of bone marrow cells suggested infantile chronic myeloic leucemia and normal ALP index and possibly normal HbF. Treatment with 6-mercaptopurine was followed by partial remission. The therapeutic consequences of exact differential diagnosis are discussed.

Iron deficiency across chronic inflammatory conditions: International expert opinion on definition, diagnosis, and management.

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Cappellini, Maria Domenica; Comin-Colet, Josep; de Francisco, Angel; Dignass, Axel; Doehner, Wolfram; Lam, Carolyn S; Macdougall, Iain C; Rogler, Gerhard; Camaschella, Clara; Kadir, Rezan; Kassebaum, Nicholas J; Spahn, Donat R; Taher, Ali T; Musallam, Khaled M

2017-10-01

Iron deficiency, even in the absence of anemia, can be debilitating, and exacerbate any underlying chronic disease, leading to increased morbidity and mortality. Iron deficiency is frequently concomitant with chronic inflammatory disease; however, iron deficiency treatment is often overlooked, partially due to the heterogeneity among clinical practice guidelines. In the absence of consistent guidance across chronic heart failure, chronic kidney disease and inflammatory bowel disease, we provide practical recommendations for iron deficiency to treating physicians: definition, diagnosis, and disease-specific diagnostic algorithms. These recommendations should facilitate appropriate diagnosis and treatment of iron deficiency to improve quality of life and clinical outcomes. © 2017 The Authors American Journal of Hematology Published by Wiley Periodicals, Inc.

A novel, non-invasive diagnostic clinical procedure for the determination of an oxygenation status of chronic lower leg ulcers using peri-ulceral transcutaneous oxygen partial pressure measurements: results of its application in chronic venous insufficiency (CVI).

Science.gov (United States)

Barnikol, Wolfgang K R; Pötzschke, Harald

2012-01-01

The basis for the new procedure is the simultaneous transcutaneous measurement of the peri-ulceral oxygen partial pressure (tcPO(2)), using a minimum of 4 electrodes which are placed as close to the wound margin as possible, additionally, as a challenge the patient inhales pure oxygen for approximately 15 minutes. In order to evaluate the measurement data and to characterise the wounds, two new oxygen parameters were defined: (1) the oxygen characteristic (K-PO(2)), and (2) the oxygen inhomogeneity (I-PO(2)) of a chronic wound. The first of these is the arithmetic mean of the two lowest tcPO(2) measurement values, and the second is the variation coefficient of the four measurement values. Using the K-PO(2) parameter, a grading of wound hypoxia can be obtained. To begin with, the physiologically regulated (and still compensated) hypoxia with K-PO(2) values of between 35 and 40 mmHg is distinguished from the pathological decompensated hypoxia with K-PO(2) values of between 0 and 35 mmHg; the first of these still stimulates self-healing (within the limits of the oxygen balance). The decompensated hypoxia can be (arbitrarily) divided into "simple" hypoxia (Grade I), intense hypoxia (Grade II) and extreme hypoxia (Grade III), with the possibility of intermediate grades (I/II and II/III).Measurements were carried out using the new procedure on the skin of the right inner ankle of 21 healthy volunteers of various ages, and in 17 CVI (chronic venous insufficiency) wounds. Sixteen of the 17 CVI wounds (i.e., 94%) were found to be pathologically hypoxic, a state which was not found in any of the healthy volunteers. The oxygen inhomogeneity (I-PO(2)) of the individual chronic wounds increased exponentially as a function of the hypoxia grading (K-PO(2)), with a 10-fold increase with extreme hypoxia in contrast to a constant value of approximately 14% in the healthy volunteers. This pronounced oxygen inhomogeneity explains inhomogeneous wound healing, resulting in the so

Screening for a Chronic Disease: A Multiple Stage Duration Model with Partial Observability.

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Mroz, Thomas A; Picone, Gabriel; Sloan, Frank; Yashkin, Arseniy P

2016-08-01

We estimate a dynamic multi-stage duration model to investigate how early detection of diabetes can delay the onset of lower extremity complications and death. We allow for partial observability of the disease stage, unmeasured heterogeneity, and endogenous timing of diabetes screening. Timely diagnosis appears important. We evaluate the effectiveness of two potential policies to reduce the monetary costs of frequent screening in terms of lost longevity. Compared to the status quo, the more restrictive policy yields an implicit value for an additional year of life of about $50,000, while the less restrictive policy implies a value of about $120,000.

A comparison of nifedipine and tamsulosin as medical expulsive therapy for the management of lower ureteral stones without ESWL

Science.gov (United States)

Cao, Dehong; Yang, Lu; Liu, Liangren; Yuan, Haichao; Qian, Shenqiang; Lv, Xiao; Han, Pin; Wei, Qiang

2014-01-01

Administration of nifedipine or tamsulosin has been suggested to augment stone expulsion rates. We aimed to compare the stone expulsion rates and adverse effects associated with the use of nifedipine or tamsulosin as medical expulsive therapy (MET) for the management of lower ureteral stones (LUS) without extracorporeal shock wave lithotripsy (ESWL) via a literature review and meta-analysis. Relevant randomized controlled trials (RCTs) were identified from the Medline, EMBASE, Cochrane CENTRAL, and Google Scholar databases. Finally, a total of 7 RCTs with 3897 patients were included. Our meta-analysis showed that tamsulosin could significantly increase the stone expulsion rate relative to nifedipine in patients with LUS (random-effects model; risk ratio [RR] = 0.81; 95% confidence interval [CI] = 0.75–0.88; P tamsulosin was more effective than nifedipine in patients with LUS, as evidenced by the higher stone expulsion rate. Tamsulosin treatment should therefore be considered for patients with LUS. PMID:24919112

Chlorpyrifos chronic toxicity in broilers and effect of vitamin C

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A.M. Kammon

2011-02-01

Full Text Available An experiment was conducted to study chlorpyrifos chronic toxicity in broilers and the protective effect of vitamin C. Oral administration of 0.8 mg/kg body weight (bw (1/50 LD50 chlorpyrifos (Radar®, produced mild diarrhea and gross lesions comprised of paleness, flaccid consistency and slightly enlargement of liver. Histopathologically, chlorpyrifos produced degenerative changes in various organs. Oral administration of 100 mg/kg bw vitamin C partially ameliorated the degenerative changes in kidney and heart. There was insignificant alteration in biochemical and haematological profiles. It is concluded that supplementation of vitamin C reduced the severity of lesions induced by chronic chlorpyrifos toxicity in broilers.

Modified duval procedure for small-duct chronic pancreatitis without head dominance.

Science.gov (United States)

Oida, Takatsugu; Aramaki, Osamu; Kano, Hisao; Mimatsu, Kenji; Kawasaki, Atsushi; Kuboi, Youichi; Fukino, Nobutada; Kida, Kazutoshi; Amano, Sadao

2011-01-01

In the case of small-duct chronic pancreatitis, surgery for pain relief is broadly divided into resection and drainage procedures. These procedures should be selected according to the location of dominant lesion, diameter of the pancreatic duct and extent of the disease. The appropriate procedure for the treatment of small-duct chronic pancreatitis, especially small-duct chronic pancreatitis without head dominance, remains controversial. We developed the modified Duval procedure for the treatment of small-duct chronic pancreatitis without head dominance and determined the efficacy of this procedure. We retrospectively studied 14 patients who underwent surgical drainage with or without pancreatic resection for chronic pancreatitis with small pancreatic duct (Puestow procedure group and the modified Duval procedure group. No complications occurred in the modified Duval group. In the modified Puestow procedure group, complete and partial pain relief were observed in 62.5%, and 37.5% of patients respectively. In contrast, complete pain relief was observed in all the patients in the modified Duval procedure group. Our modified Duval procedure is useful and should be considered the appropriate surgical technique for the treatment of small-duct chronic pancreatitis without head dominance.

Partial tooth gear bearings

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Vranish, John M. (Inventor)

2010-01-01

A partial gear bearing including an upper half, comprising peak partial teeth, and a lower, or bottom, half, comprising valley partial teeth. The upper half also has an integrated roller section between each of the peak partial teeth with a radius equal to the gear pitch radius of the radially outwardly extending peak partial teeth. Conversely, the lower half has an integrated roller section between each of the valley half teeth with a radius also equal to the gear pitch radius of the peak partial teeth. The valley partial teeth extend radially inwardly from its roller section. The peak and valley partial teeth are exactly out of phase with each other, as are the roller sections of the upper and lower halves. Essentially, the end roller bearing of the typical gear bearing has been integrated into the normal gear tooth pattern.

Energy stores are not altered by long-term partial sleep deprivation in Drosophila melanogaster.

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Susan T Harbison

2009-07-01

Full Text Available Recent human studies reveal a widespread association between short sleep and obesity. Two hypotheses, which are not mutually exclusive, might explain this association. First, genetic factors that reduce endogenous sleep times might also impact energy stores, an assertion that we confirmed in a previous study. Second, metabolism may be altered by chronic partial sleep deprivation. Here we address the second assertion by measuring the impact of long-term partial sleep deprivation on energy stores using Drosophila as a model. We subjected flies to long-term partial sleep deprivation via two different methods: a mechanical stimulus and a light stimulus. We then measured whole-body triglycerides and glycogen, two important sources of energy for the fly, and compared them to un-stimulated controls. We also measured changes in energy stores in response to a random circadian clock shift. Sex and line-dependent alterations in glycogen and/or triglyceride levels occurred in response to the circadian clock shift and in flies subjected to a single night of sleep deprivation using light. Thus, consistent with previous studies, our findings suggest that acute sleep loss and changes to the circadian clock can alter metabolism. Significant changes in energy stores were also observed when flies were subjected to chronic sleep loss via the mechanical stimulus, although not the light stimulus. Interestingly, mechanical stimulation resulted in the same change in energy stores even when it was not associated with sleep deprivation, suggesting that the changes are caused by stress rather than sleep loss. These findings emphasize the importance of taking stress into account when evaluating the relationship between sleep loss and metabolism.

Physical activity as a mediator of the impact of chronic conditions on quality of life in older adults.

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Sawatzky, Richard; Liu-Ambrose, Teresa; Miller, William C; Marra, Carlo A

2007-12-19

Chronic conditions could negatively affect the quality of life of older adults. This may be partially due to a relative lack of physical activity. We examined whether physical activity mediates the relationship between different chronic conditions and several health outcomes that are important to the quality of life of older adults. The data were taken from the Canadian Community Health Survey (cycle 1.1), a cross-section survey completed in 2001. Only respondents who were 65 years or older were included in our study (N = 22,432). The Health Utilities Index Mark 3 (HUI3) was used to measure overall quality of life, and to measure selected health outcomes (dexterity, mobility, pain, cognition, and emotional wellbeing) that are considered to be of importance to the quality of life of older adults. Leisure-time physical activity was assessed by determining weekly energy expenditure (Kcal per week) based on the metabolic equivalents of self-reported leisure activities. Linear and logistic regression models were used to determine the mediating effect of leisure-time physical activity while controlling for demographic variables (age and sex), substance use (tobacco use and alcohol consumption), and obesity. Having a chronic condition was associated with a relative decrease in health utility scores and a relative increase in mobility limitations, dexterity problems, pain, emotional problems (i.e., decreased happiness), and cognitive limitations. These negative consequences could be partially attributed to a relative lack of physical activity in older adults with a chronic condition (14% mediation for the HUI3 score). The corresponding degree of mediation was 18% for mobility limitations, 5% for pain, and 13% for emotional wellbeing (statistically significant mediation was not observed for the other health attributes). These values varied with respect to the different chronic conditions examined in our study. Older adults with chronic conditions are less likely to engage

Achillodynia. Radiological imaging of acute and chronic overuse injuries of the Achilles tendon

International Nuclear Information System (INIS)

Syha, R.; Springer, F.; Grosse, U.; Tuebingen Univ.; Ketelsen, D.; Kramer, U.; Horger, M.; Ipach, I.; Schick, F.

2013-01-01

In the past decades the incidence of acute and chronic disorders of the Achilles tendon associated with sport-induced overuse has steadily increased. Besides acute complete or partial ruptures, achillodynia (Achilles tendon pain syndrome), which is often associated with tendon degeneration, represents the most challenging entity regarding clinical diagnostics and therapy. Therefore, the use of imaging techniques to differentiate tendon disorders and even characterize structure alterations is of growing interest. This review article discusses the potential of different imaging techniques with respect to the diagnosis of acute and chronic tendon disorders. In this context, the most commonly used imaging techniques are magnetic resonance imaging (MRI), B-mode ultrasound, and color-coded Doppler ultrasound (US). These modalities allow the detection of acute tendon ruptures and advanced chronic tendon disorders. However, the main disadvantages are still the low capabilities in the detection of early-stage degeneration and difficulties in the assessment of treatment responses during follow-up examinations. Furthermore, differentiation between chronic partial ruptures and degeneration remains challenging. The automatic contour detection and texture analysis may allow a more objective and quantitative interpretation, which might be helpful in the monitoring of tendon diseases during follow-up examinations. Other techniques to quantify tendon-specific MR properties, e.g. based on ultrashort echo time (UTE) sequences, also seem to have great potential with respect to the precise detection of degenerative tendon disorders and their differentiation at a very early stage. (orig.)

Overexpression of mineralocorticoid receptors partially prevents chronic stress-induced reductions in hippocampal memory and structural plasticity

NARCIS (Netherlands)

Kanatsou, Sofia; Fearey, Brenna C.; Kuil, Laura E.; Lucassen, Paul J.; Harris, Anjanette P.; Seckl, Jonathan R.; Krugers, Harm; Joels, Marian

2015-01-01

Exposure to chronic stress is a risk factor for cognitive decline and psychopathology in genetically predisposed individuals. Preliminary evidence in humans suggests that mineralocorticoid receptors (MRs) may confer resilience to these stress-related changes. We specifically tested this idea using a

Hg uptake in ureteral obstructions

International Nuclear Information System (INIS)

Desgrez, J.P.; Bourguignon, M.; Raynaud, C.; CEA, 91 - Orsay

1976-01-01

In the presence of a total obstruction the results obtained with the Hg uptake test, as indeed with other functional tests, inform on the value of the kidney function at the time but have no prognostic value where repair possibilities are concerned. Some preliminary results seem to show however that very soon after the obstacle is removed, by the 10th or 15th day perhaps, quantitative functional tests may once more be used to evaluate the functional prognosis. This would mean that by waiting about two weeks after the disappearance of a total obstruction the Hg uptake test may again be used in all confidence. In order to check this deduction, which is based on slender evidence but which nevertheless has important practical implications, the measurement of the Hg uptake rate during the days following removal of the obstacle appears essential. In long-standing partial obstructions the Hg uptake rate gives an accurate assessment of the functional balance and helps considerably in the choice of therapy [fr

Pharmacological TLR4 Inhibition Protects against Acute and Chronic Fat-Induced Insulin Resistance in Rats.

Science.gov (United States)

Zhang, Ning; Liang, Hanyu; Farese, Robert V; Li, Ji; Musi, Nicolas; Hussey, Sophie E

2015-01-01

To evaluate whether pharmacological TLR4 inhibition protects against acute and chronic fat-induced insulin resistance in rats. For the acute experiment, rats received a TLR4 inhibitor [TAK-242 or E5564 (2x5 mg/kg i.v. bolus)] or vehicle, and an 8-h Intralipid (20%, 8.5 mg/kg/min) or saline infusion, followed by a two-step hyperinsulinemic-euglycemic clamp. For the chronic experiment, rats were subcutaneously implanted with a slow-release pellet of TAK-242 (1.5 mg/d) or placebo. Rats then received a high fat diet (HFD) or a low fat control diet (LFD) for 10 weeks, followed by a two-step insulin clamp. Acute experiment; the lipid-induced reduction (18%) in insulin-stimulated glucose disposal (Rd) was attenuated by TAK-242 and E5564 (the effect of E5564 was more robust), suggesting improved peripheral insulin action. Insulin was able to suppress hepatic glucose production (HGP) in saline- but not lipid-treated rats. TAK-242, but not E5564, partially restored this effect, suggesting improved HGP. Chronic experiment; insulin-stimulated Rd was reduced ~30% by the HFD, but completely restored by TAK-242. Insulin could not suppress HGP in rats fed a HFD and TAK-242 had no effect on HGP. Pharmacological TLR4 inhibition provides partial protection against acute and chronic fat-induced insulin resistance in vivo.

Experts' understanding of partial derivatives using the Partial Derivative Machine

OpenAIRE

Roundy, David; Dorko, Allison; Dray, Tevian; Manogue, Corinne A.; Weber, Eric

2014-01-01

Partial derivatives are used in a variety of different ways within physics. Most notably, thermodynamics uses partial derivatives in ways that students often find confusing. As part of a collaboration with mathematics faculty, we are at the beginning of a study of the teaching of partial derivatives, a goal of better aligning the teaching of multivariable calculus with the needs of students in STEM disciplines. As a part of this project, we have performed a pilot study of expert understanding...

Post-radiational ureteric fibrosis with extrarenal renal failure as a rare complication after adjuvant treatment of gastric cancer - a case report

International Nuclear Information System (INIS)

Swieboda-Sadlej, A.; Staszewska-Skurczynska, M.; Piyush Vyas; Zurawinska, E.; Heleniak, H.; Kocik, J.; Danek, A.; Tragarz, E.

2008-01-01

The principles of chemoradiotherapy for treating patients with radically resected gastric cancer are not fully established. In many oncological centres patients with unfavourable prognostic factors who previously had radical gastrectomy are treated with Macdonald regimen which includes combined fluorouracil with radiotherapy. Statistics indicate that more then 30% patients treated with chemoradiotherapy suffer from serious complication. In this article we describe a case of a patient who developed ureteric fibrosis with consequent renal failure as a rare life threatening complication of Macdonald regimen. The patient received chemoradiotherapy because of unfavourable prognostic factors and good performance status however he was in advanced age and with other comorbidities. These data support the notion of the high toxicity of this regimen and suggest that selection of patients for this treatment should be done very carefully. This is discussed in the context of other available therapies in gastric cancer. (author)

Intraspecific Variation in Physiological Condition of Reef-Building Corals Associated with Differential Levels of Chronic Disturbance

Science.gov (United States)

Pisapia, Chiara; Anderson, Kristen; Pratchett, Morgan S.

2014-01-01

Even in the absence of major disturbances (e.g., cyclones, bleaching), corals are subject to high levels of partial or whole-colony mortality, often caused by chronic and small-scale disturbances. Depending on levels of background mortality, these chronic disturbances may undermine individual fitness and have significant consequences on the ability of colonies to withstand subsequent acute disturbances or environmental change. This study quantified intraspecific variations in physiological condition (measured based on total lipid content and zooxanthellae density) through time in adult colonies of two common and widespread coral species (Acropora spathulata and Pocillopora damicornis), subject to different levels of biological and physical disturbances along the most disturbed reef habitat, the crest. Marked intraspecific variation in the physiological condition of A. spathulata was clearly linked to differences in local disturbance regimes and habitat. Specifically, zooxanthellae density decreased (r2 = 26, df = 5,42, pzooxanthellae density was strongly and negatively correlated with the individual level of partial mortality (r2 = 26, df = 5,42, p<0.02, B =  −7386077, p = 0.01). Conversely, P. damicornis exhibited very limited intraspecific variation in physiological condition, despite marked differences in levels of partial mortality. This is the first study to relate intraspecific variation in the condition of corals to localized differences in chronic disturbance regimes. The next step is to ascertain whether these differences have further ramifications for susceptibility to periodic acute disturbances, such as climate-induced coral bleaching. PMID:24626395

Follistatin, an Activin Antagonist, Ameliorates Renal Interstitial Fibrosis in a Rat Model of Unilateral Ureteral Obstruction

Directory of Open Access Journals (Sweden)

Akito Maeshima

2014-01-01

Full Text Available Activin, a member of the TGF-β superfamily, regulates cell growth and differentiation in various cell types. Activin A acts as a negative regulator of renal development as well as tubular regeneration after renal injury. However, it remains unknown whether activin A is involved in renal fibrosis. To clarify this issue, we utilized a rat model of unilateral ureteral obstruction (UUO. The expression of activin A was significantly increased in the UUO kidneys compared to that in contralateral kidneys. Activin A was detected in glomerular mesangial cells and interstitial fibroblasts in normal kidneys. In UUO kidneys, activin A was abundantly expressed by interstitial α-SMA-positive myofibroblasts. Administration of recombinant follistatin, an activin antagonist, reduced the fibrotic area in the UUO kidneys. The number of proliferating cells in the interstitium, but not in the tubules, was significantly lower in the follistatin-treated kidneys. Expression of α-SMA, deposition of type I collagen and fibronectin, and CD68-positive macrophage infiltration were significantly suppressed in the follistatin-treated kidneys. These data suggest that activin A produced by interstitial fibroblasts acts as a potent profibrotic factor during renal fibrosis. Blockade of activin A action may be a novel approach for the prevention of renal fibrosis progression.

Comparison of a 4.5 F semi-rigid ureteroscope with a 7.5 F rigid ureteroscope in the treatment of ureteral stones in preschool-age children.

Science.gov (United States)

Atar, Murat; Sancaktutar, Ahmet Ali; Penbegul, Necmettin; Soylemez, Haluk; Bodakci, Mehmet Nuri; Hatipoglu, Namik Kemal; Bozkurt, Yasar; Cakmakci, Suleyman

2012-12-01

The aim of this study was to compare the success and complication rates of a 4.5 F ureteroscope with a 7.5 F ureteroscope in the treatment of urolithiasis in preschool-age children. We retrospectively reviewed 69 ureteroscopy (URS) procedures in a pediatric population (40 boys, 29 girls). We divided the patients into two groups according to the type of ureteroscope used: group 1 (n = 42, Storz 7.5 F) and group 2 (n = 27, Wolf 4.5 F). We statistically compared all the procedures performed in both groups regarding patient age, complication rates, whether the procedure was therapeutic, and whether we used a guidewire. Additionally, in cases with ureteral stones, we also compared the stone clearance rate and the necessity of X-ray imaging between the two groups. The mean patient age was 56.04 months in group 1 and 47.48 months in group 2 (p = 0.057). The stone-free rate was 78.6 % in group 1 and 92.6 % in group 2 (p > 0.05). However, when we compared the stone-free rates for patients younger than 3 years, the rate was 66.7 % in group 1 and 93.8 % in group 2 (p < 0.05). The difference was not statistically significant for patients between the ages of 4 and 7 years. The success and failure rates revealed better outcomes for treatment of ureteral stones with a 4.5 F ureteroscope. We recommend the use of the mini-ureteroscope, especially in infants and preschool-age children.

Applying a coping with stress questionnaire for cancer patients to patients with non-cancer chronic illnesses.

Science.gov (United States)

Orive, Miren; Quintana, Jose M; Vrotsou, Kalliopi; Las Hayas, Carlota; Bilbao, Amaia; Barrio, Irantzu; Matellanes, Begoña; Padierna, Jesús A

2013-06-01

One of the few instruments to evaluate coping skills among patients with chronic illnesses is the Cuestionario de Afrontamiento al Estrés para Pacientes Oncológicos (CAEPO), created initially for cancer patients. We evaluate how well CAEPO applies to patients with non-cancer chronic illnesses. A total of 344 patients (115 with chronic hepatitis C, 120 with inflammatory bowel disease and 109 with recurrent vertigo) completed the CAEPO. Exploratory factor analysis and Cronbach's alpha provide only partial support for the seven factors suggested by the original CAEPO. A streamlined version with fewer dimensions and items may be a better solution for identifying coping strategies among these patients.

Type-Directed Partial Evaluation

DEFF Research Database (Denmark)

Danvy, Olivier

1998-01-01

Type-directed partial evaluation uses a normalization function to achieve partial evaluation. These lecture notes review its background, foundations, practice, and applications. Of specific interest is the modular technique of offline and online type-directed partial evaluation in Standard ML...

Type-Directed Partial Evaluation

DEFF Research Database (Denmark)

Danvy, Olivier

1998-01-01

Type-directed partial evaluation uses a normalization function to achieve partial evaluation. These lecture notes review its background, foundations, practice, and applications. Of specific interest is the modular technique of offline and online type-directed partial evaluation in Standard ML of ...

Hepatitis B Virus Reactivation after Partial Hepatic Irradiation Alone: A Case Report

Energy Technology Data Exchange (ETDEWEB)

Kim, Bo Kyung [Dankook University College of Medicine, Cheonan (Korea, Republic of)

2010-11-15

Reactivation of the hepatitis B virus (HBV) is a well-recognized complication in patients with chronic HBV infection who receive cytotoxic or other immunosuppressive therapy. In cases of patients treated by radiotherapy however, only a few of such reports exist and most of these include the patients previously treated by chemotherapy or transarterial chemoembolization. The results of this study point to a case of a patient with reactivation of HBV after radiotherapy alone. This study shows the possibility of HBV reactivation by partial hepatic irradiation alone hence, special attention should be paid to patients with HBV disease.

Hepatitis B Virus Reactivation after Partial Hepatic Irradiation Alone: A Case Report

International Nuclear Information System (INIS)

Kim, Bo Kyung

2010-01-01

Reactivation of the hepatitis B virus (HBV) is a well-recognized complication in patients with chronic HBV infection who receive cytotoxic or other immunosuppressive therapy. In cases of patients treated by radiotherapy however, only a few of such reports exist and most of these include the patients previously treated by chemotherapy or transarterial chemoembolization. The results of this study point to a case of a patient with reactivation of HBV after radiotherapy alone. This study shows the possibility of HBV reactivation by partial hepatic irradiation alone hence, special attention should be paid to patients with HBV disease.

Etiology of chronic skin lesions in subjects with peripheral arterial disease.

Science.gov (United States)

Chisari, G; Chisari, E M; Borzì, A M; Grasso, A; Chisari, C G

2018-01-01

Skin lesions can be defined as lesions that result in loss of tissues and their joints, and often this cutaneous skin process is a primary or secondary consequence of the structural changes in the skin itself. Subjects with peripheral arteripathies that develop chronic skin lesions in the lower extremities of the Western world are constantly increasing. We conducted a study on the etiologic incidence of chronic skin lesions in peripheral arterial disease CSLpa subjects in the lower limbs compared to subjects with chronic skin lesions CSL (controls). 30 subjects with peripheral atheropathies PA (22 F - 8 M mean age 74,5 ± 4,9) and with chronic skin lesions (CSLpa) in the lower limbs "A" group were admitted to our study according to a randomized and compared to 30 no peripheral atheropathies subjects (19 F-11 M, mean age 81,5 ± 7,3 - controls) group B with chronic skin lesions (CSL). These two groups "A" and "B" have been studied and compared on the basis of infectious etiology responsible for the infectious skin process. In the subjects of the "A" group we found a 12 positive assay of 40.0% of the examinations, while in the group "B" we achieved a total cultured positivity of 9 cases corresponding to 30.0% of the examinations . For the number of bacterial species identified for "A" group we obtained 3 mono microbial and 6 poly microbial bacteriological tests and for group "B" we observed 7 mono microbial and 2 poly microbial tests. All bacteriological isolates showed "in vitro" sensitivity to satisfactory ciprofloxacin with MICs range of 0.78-1.56mg/L. The data observed after 4 weeks after the amniotic membrane (MA) in the two study groups A and B were respectively the following: and for group A 50% scarring, 46.6% partial resolution and in one case worsening for the B-healing group in 63.3%, the partial resolution in the remaining 36.6. The data from this study show a different etiology between subjects with CSLpa than subjects with CSL. This phenomenon confirms

Success rate of split-thickness skin grafting of chronic venous leg ulcers depends on the presence of Pseudomonas aeruginosa

DEFF Research Database (Denmark)

Høgsberg, Trine; Bjarnsholt, Thomas; Thomsen, Jens Schiersing

2011-01-01

that once chronic venous leg ulcers were colonized (weeks or months preoperatively) by P. aeruginosa, the success rate of skin grafting deteriorated despite aggressive treatment. To investigate this, a retrospective study was performed on the clinical outcome of 82 consecutive patients with chronic venous...... regression analysis was carried out leaving P. aeruginosa as the only predictor left in the model (p¿=¿0.001). This study supports our hypothesis that P. aeruginosa in chronic venous leg ulcers, despite treatment, has considerable impact on partial take or rejection of split-thickness skin grafts....

Characterization of nanostructured ureteral stent with gradient degradation in a porcine model

Directory of Open Access Journals (Sweden)

Wang XQ

2015-04-01

Full Text Available Xiaoqing Wang,1 Hongli Shan,2 Jixue Wang,1 Yuchuan Hou,1 Jianxun Ding,3 Qihui Chen,1 Jingjing Guan,1 Chunxi Wang,1 Xuesi Chen31Department of Urology, the First Hospital of Jilin University, 2Department of Clinical Laboratory, the First Hospital of Jilin University, 3Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, People’s Republic of ChinaAbstract: A tubular poly(ε-caprolactone (PCL/poly(lactide-co-glycolide (PLGA ureteral stent composed of nanofibers with micropores was fabricated by double-needle electrospinning. The stent was ureteroscopically inserted into six Changbai pigs, and the commercial polyurethane Shagong® stent was inserted into four pigs as control. Intravenous pyelography revealed that the PCL/PLGA stent gradually degraded from the distal end to proximal terminal, and all stents were completely degraded at 10 weeks post-insertion. No significant difference was observed in hydronephrosis severity between the two groups. The levels of serum creatinine and urine pH remained similar throughout the study in the two groups, but the number of white blood cells in the urine was significantly higher in the Shagong® stent group. On Day 70, histological evaluation indicated equivalent histological severity scores in the middle and distal ureter sections and bladder in the two groups. However, the PCL/PLGA stent-implanted pigs had significantly lower mean severity scores in the kidney and proximal ureter sites. These data revealed that the PCL/PLGA stent degraded in a controlled manner, did not induce obstruction, and had a lower urothelial impact in comparison to the Shagong® stent, indicating that the stent exhibited great potential for clinical application.Keywords: nanocomposites, polyesters, poly(ε-caprolactone, poly(lactide-co-glycolide, hydronephrosis severity

Compatriot partiality and cosmopolitan justice: Can we justify compatriot partiality within the cosmopolitan framework?

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Rachelle Bascara

2016-10-01

Full Text Available This paper shows an alternative way in which compatriot partiality could be justified within the framework of global distributive justice. Philosophers who argue that compatriot partiality is similar to racial partiality capture something correct about compatriot partiality. However, the analogy should not lead us to comprehensively reject compatriot partiality. We can justify compatriot partiality on the same grounds that liberation movements and affirmative action have been justified. Hence, given cosmopolitan demands of justice, special consideration for the economic well-being of your nation as a whole is justified if and only if the country it identifies is an oppressed developing nation in an unjust global order.This justification is incomplete. We also need to say why Person A, qua national of Country A, is justified in helping her compatriots in Country A over similarly or slightly more oppressed non-compatriots in Country B. I argue that Person A’s partiality towards her compatriots admits further vindication because it is part of an oppressed group’s project of self-emancipation, which is preferable to paternalistic emancipation.Finally, I identify three benefits in my justification for compatriot partiality. First, I do not offer a blanket justification for all forms of compatriot partiality. Partiality between members of oppressed groups is only a temporary effective measure designed to level an unlevel playing field. Second, because history attests that sovereign republics could arise as a collective response to colonial oppression, justifying compatriot partiality on the grounds that I have identified is conducive to the development of sovereignty and even democracy in poor countries, thereby avoiding problems of infringement that many humanitarian poverty alleviation efforts encounter. Finally, my justification for compatriot partiality complies with the implicit cosmopolitan commitment to the realizability of global justice