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Sample records for distal ureteral calculi

  1. 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

  2. Bilateral guaifenesin ureteral calculi.

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    Whelan, Chris; Schwartz, Bradley F

    2004-01-01

    We report on a patient with bilateral ureteral calculi composed of guaifenesin metabolite as determined by infrared spectroscopy. These stones may be associated with excessive guaifenesin intake related to the current popularity of ephedrine preparations.

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

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    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.)

  4. RANDOMIZED TRIAL OF THE SAFETY AND EFFICACY OF TAMSULOSIN AND SILODOSIN IN MEDICAL EXPULSIVE THERAPY FOR DISTAL THIRD URETERIC CALCULI

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    Rajanna

    2014-11-01

    Full Text Available INTRODUCTION: Urolithiasis is a common condition that affects approximately 5% to 10% of the population and the incidence of Urolithiasis is rising. Ureteric stones account for 20% of urinary tract stones and about 70% of them are found in the lower third of the ureter at presentation. Recent literatures show the efficacy of various drugs and minimally invasive procedures for the management of lower third ureteral stones. We performed a randomized, prospective study to assess and compare the efficacy of tamsulosin and silodosin as medical expulsive therapy for lower third ureteral stones. SETTING AND DURATION: Department of Surgery, Hassan Institute of Medical Sciences/ Teaching Hospital, Hassan. from August 2013 to August 2014. MATERIALS AND METHODS: The prospective data of 60 symptomatic patients with unilateral, lower third ureteral calculi of less than ≤10 mm were randomly allocated for out- patient treatment with tamsulosin and silodosin groups Patients aged ≥ 18 years with a single, unilateral, symptomatic, radio-opaque ureteric stone of 10 mm or smaller in the largest dimension located between the lower border of the sacroiliac joint and vesico-ureteric junction were included. For Group I tamsulosin a daily single dose of 0.4 mg for 28days and for Group II a daily single dose of silodosin 8mg was given. Nonsteroidal anti-inflammatory drugs were used on demand for both the groups. All the patients were told to observe passage of stone by filtering urine stream. The primary end point was the expulsion of the stone and the secondary end points were expulsion time, analgesic use, socioeconomic status, need for hospitalization, endoscopic treatment and drug side effects were documented. RESULTS: The stone expulsion rates in patients treated with tamsulosin and silodosin were 83.3% and 86.6% respectively. Mean stone expulsion times in tamsulosin group and silodosin group were 6.8 and 6.2 days respectively. Mean number of pain episodes were

  5. 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.

  6. Ureteral Stenting after Uncomplicated Ureteroscopy for Distal Ureteral Stones: A Randomized, Controlled Trial

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    Y. El Harrech

    2014-01-01

    Full Text Available Objectives. We compared outcome and complications after uncomplicated ureteroscopic treatment of distal ureteral calculi with or without the use of ureteral stents. Materials and Methods. 117 patients, prospectively divided into three groups to receive a double j stent (group 1, 42 patients, ureteral stent (group 2, 37 patients, or no stent (group 3, 38 patients, underwent ureteroscopic treatment of distal ureteral calculi. Stone characteristics, operative time, postoperative pain, lower urinary tract symptoms (LUTS, analgesia need, rehospitalization, stone-free rate, and late postoperative complications were all studied. Results. There were no significant differences in preoperative data. There was no significant difference between the three groups regarding hematuria, fever, flank pain, urinary tract infection, and rehospitalisation. At 48 hours and 1 week, frequency/urgency and dysuria were significantly less in the nonstented group. When comparing group 1 and group 3, patients with double j stents had statistically significantly more bladder pain (P=0.003, frequency/urgency (P=0.002, dysuria (P=0.001, and need of analgesics (P=0.001. All patients who underwent imaging postoperatively were without evidence of obstruction or ureteral stricture. Conclusions. Uncomplicated ureteroscopy for distal ureteral calculi without intraoperative ureteral dilation can safely be performed without placement of a ureteral stent.

  7. Ureteropyeloscopy and homium: YAG laser lithotripsy for treatment of ureteral calculi (report of 356 cases)

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    Wu, Zhong; Din, Qiang; Jiang, Hao-wen; Zen, Jing-cun; Yu, Jiang; Zhang, Yuanfang

    2005-07-01

    Objective: To evaluate the efficacy and safety of holmium YAG laser lithotripsy for the treatment of ureteral calculi. Methods: A total of 356 patients underwent ureteropyeloscopic lithotripsy using holmium YAG laser with a semirigid uretesopyeloscope, 93 upper, 135 middle, and 128 lower ureteral stones were treated. Results: The overall successful fragmentation rate for all ureteral stones in a single session achieved 98% (349/356). The successful fragmentation rate stratified by stone location was 95% 88/93 in the upper ureter, 99% (134/135) in the mid ureter , and 99%(127/128) in the distal ureter. 12 cases with bilateral ureteral stones which caused acute renal failure and anuria were treated rapidly and effectively by the holmium YAG laser lithotripsy. No complications such as perforation and severe trauma were encountered during the operations. 2 weeks 17months (with an average of 6.8 month ) follow up postoperatively revealed that the overall stone-free rate was 98%(343/349) and no ureteral stenosis was found. Conclusions Holmium YAG laser lithotripsy is a highly effective, minimally invasive and safe therapy for ureteral calculi. It is indicated as a first choice of treatment for patients with ureteral calculi, especially for the ones with mid- lower levels of ureteral calculi.

  8. Dissolution of Ureteral Uric Acid Calculi with Local Litholytic Irrigation

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    CHEN Zhiqiang; YAO Linfang; YE Zhangqun; YANG Weimin

    2005-01-01

    Summary: This study was designed to evaluate the efficacy of local litholytic irrigation (LLI) in the treatment of ureteral uric acid calculi. Fourteen cases of ureteral uric acid calculi were diagnosed by abdominal plain radiography (KUB),retrograde urography,ultrasonography(B-mode ultrasound),spiral computerized tomography(CT) and blood biochemical examinations. A ureteral catheter was passed retrogradely across ureteral calculi by cystoscopy. LLI with tromethamine-E(THAM-E) was performed via the ureteral catheter after the improvement of renal function and general situation and the control of urinary tract infection under the condition of intravenous application of antibiotics. The irrigation rate varied from 1000 to 1500 ml per day. Retrograde pyelography demonstrated complete dissolution of all the stones,13 cases within 10 days and 1 within 12 days. Mild hematuria was observed in the majority of the cases and temporary aggravated lumbago in 1 case,with no other side effects. It is concluded that LLI is a practical and effective method in the treatment of ureteral uric acid calculi for its advantages of shorter duration,lower cost,less physical suffering and no severe complications.

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

    African Journals Online (AJOL)

    M. El-Qadhi

    Significant advancement has been made in the medical and surgical management of urolithiasis over ... (MET) for stone passage, antegrade ureteroscopy, laparoscopic and open ureterolithotomy [6]. Ureteroscopy remained ..... Extracorporeal shock wave lithotripsy vs uretroscopic management for ureteral calculi. Cochrane ...

  10. Ureteroscopy and holmium:YAG laser lithotripsy: an emerging definitive management strategy for symptomatic ureteral calculi in pregnancy

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    Watterson, James D.; Girvan, Andrew R.; Beiko, Darren T.; Nott, Linda; Wollin, Timothy A.; Razvi, Hassan A.; Denstedt, John D.

    2003-06-01

    Objectives: Symptomatic urolithiasis in pregnancy that does not respond to conservative measures has traditionally been managed with ureteral stent insertion or percutaneous nephrostomy (PCN). Holmium:yttrium-aluminum-garnet (YAG) laser lithotripsy using state-of-the-art ureteroscopes represents an emerging strategy for definitive stone management in pregnancy. The purpose of this study was to review the results of holmium laser lithotripsy in a cohort of patients who presented with symptomatic urolithiasis in pregnancy. Methods: A retrospective analysis was conducted at 2 tertiary stone centers from January 1996 to August 2001 to identify pregnant patients who were treated with ureteroscopic holmium laser lithotripsy for symptomatic urolithiasis or encrusted stents. Eight patients with a total of 10 symptomatic ureteral calculi and 2 encrusted ureteral stents were treated. Mean gestational age at presentation was 22 weeks. Mean stone size was 8.1 mm. Stones were located in the proximal ureter/ureteropelvic junction (UPJ) (3), mid ureter (1), and distal ureter (6). Results: Complete stone fragmentation and/or removal of encrusted ureteral stents were achieved in all patients using the holmium:YAG laser. The overall procedural success rate was 91%. The overall stone-free rate was 89%. No obstetrical or urological complications were encountered. Conclusions: Ureteroscopy and holmium laser lithotripsy can be performed safely in all stages of pregnancy providing definitive management of symptomatic ureteral calculi. The procedure can be done with minimal or no fluoroscopy and avoids the undesirable features of stents or nephrostomy tubes.

  11. The Comparison of Ultrasonography and Non Enhanced Helical Computed Tomography in the Diagnosis of Ureteral Calculi

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    İlhan Kılınç

    2007-01-01

    Full Text Available Intravenous urography, ultrasonography, and non-contrast spiral computed tomography have been used to diagnose ureteral calculi. We aimed to compare the accuracy of non-contrast spiral computed tomography with ultrasonography in the evaluation of patients with renal colic.Fourty-one patients with flank pain were examined with both computed tomography and ultrasonography over a period of 11 months. Findings of ultrasonography and computed tomography of 28 patients in whom üreteral stones were confirmed by standart methods were comparedUreteral calculi were diagnosed in 28 of 41 patients. Ureteral stones could be demonstrated in 18 patients by ultrasonography and in 27 patients by computed tomography. Ultrasonography showed 64.3% sensitivity and 100% specificity in the diagnosis of ureterolithiasis; computed tomography showed 96.4% and 100%, respectively. Spiral computed tomography is superior to ultrasonography in the demonstration of ureteral calculi in patients with renal colic. But because of higher cost and higher radiation dose, it should be reserved for symptomatic cases in whom ultrasonography is non-diagnostic.

  12. AN UNASCENDED RIGHT KIDNEY WITH LEFT SIDED URETERIC CALCULI: A CADAVERIC CASE REPORT

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    Meril Ann Soman

    2014-06-01

    Full Text Available Anomalies of the urinary system constitute approximately 30% of all the congenital malformations. There are various associated anomalies involving number, size, shape, position and vascularity of the kidneys. Unascended kidneys refers to a halt in the migration of the kidneys during their normal embryological development. Defect in the ascent of the kidneys are closely related with variations in the branching pattern of aorta. Here we report a case of an unilateral unascended right kidney in a male cadaver encountered during routine medical dissection. A left sided ureteric calculi was also seen as an incidental finding in the same cadaver. Ureterolithiasis occurs worldwide in all sets of population with 80% of the stones found in the male sex in the age group of 30- 60 years. There are various factors which favour the formation of ureteric calculi which includes geographical, socio-economical as well as the mineral content of water consumed and some general medical causes. An attempt has been made to document the causes for this variation and the preventive measures that can be adopted to prevent the formation of ureteric calculi.

  13. Management of Ureteric Calculi in Dhule City of North-western Maharashtra

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    Lokesh Patni

    2013-01-01

    Full Text Available Background: Urolithiasis, usually affecting people in the prime of life, causes significant morbidity and loss of productivity. Uretericstones account for 2/3rd of all urinary calculi brought to attention of doctors. The damaging effects of the calculi may result in obstruction with dilatation of the urinary tract, leading to stasis and severe infection. Aims and Objectives: To evaluate patients with urinary stones with regards to the incidence, age, sex,clinical presentation, site, size, side, management and their complications. Material and Methods:It was a prospective study carried out by Department of Surgery at Annasaheb Chudaman Patil Memorial Medical College, and Hospital Dhule for a period of two years. Patients were selected after they were diagnosed as having ureteric calculi. The patients were treated by conservative or surgical methods, and the outcome was monitored. Statistical analysis of the data was done for obtaining results.Result: The majority of the patients were males with peak age group in the second and third decade. Pain in abdomen or loin tenderness was the most common presenting symptom. Most of the patients were treated by conservative medical management. Endourological procedures were the most commonly performed surgical intervention. Conclusion: Most of the patients with ureteric calculi present with painin abdomen and majority can be treated by medical management. With the availability of better facilities the requirement for open surgery is decreasing and endourological procedures are becoming the means of surgical intervention.Complications are minimal with surgical expertise for endourological procedures.

  14. Comparison of the trauma degree after retroperitoneoscopy and percutaneous nephtoscopy treatment of complicated upper ureteral calculi

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    Shu-Run Zhao; Zhan-Peng Lu

    2016-01-01

    Objective:To compare the trauma degree after retroperitoneoscopy and percutaneous nephtoscopy treatment of complicated upper ureteral calculi.Methods:A total of 82 cases of patients with complicated upper ureteral calculi who received surgical treatment in our hospital from July 2013 to January 2015 were included for study. According to the different surgical methods, included subjects were randomly divided into observation group 41 cases and control group 41 cases. Control group received percutaneous nephtoscopy treatment, observation group received retroperitoneoscopy treatment, and then differences in early postoperative coagulation indicators, blood glucose and insulin levels, stress protein levels as well as PI3K/Akt and p38MAPK signaling pathway expression were compared between two groups.Results:Early postoperative PLCR, PDW, APTT and D-D values of observation group were lower than those of control group while Ca2+ value was higher than that of control group; early postoperative GLU, fasting lactate, fasting lactate/pyruvic acid and HOMA-IR values of observation group were lower than those of control group while HOMA-β value was higher than that of control group; early postoperative HSP70, DNA ligaseⅣ, JAB1 and ATF4 expression levels of observation group were higher than those of control group whileβ-tubulin and IFIT1 expression levels were lower than those of control group; early postoperative p38MAPK mRNA and protein expression levels of observation group were lower than those of control group while PI3K and Akt mRNA and protein expression levels were higher than those of control group.Conclusion: Retroperitoneoscopy treatment of patients with complicated upper ureteral calculi causes less injury to patients and less effect on internal environment, and helps to patients’ early postoperative rehabilitation.

  15. MEDICAL EXPULSIVE THERAPY OF URETERIC CALCULI - OUR EXPERIENCE

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    Ramesh

    2015-09-01

    Full Text Available INTRODUCTION: Uretric stones can be treated with multiple modalities including medical therapy, uretroscopy, shockwave lithotripsy (SWS, percutaneous nephrolithotomy, open/laparoscopic stone removal, and/or combinations of these modalities. The aim is to study the effectivene ss of medical management of uretric stones and to compare the effectiveness of Tamsulosin and Tamsulosin with steroid . MATERIALS & METHODS: 120 Patients who came with acute uretric colic were categorized into III categories of less than 5mm, 5mm to 7mm and more than 7mm based on NCCT. They were consecutively allotted to one of the three groups, the group I patients received Anti - Biotics with NSAIDs group II received Tamsulosin in addition Anti - Biotics and NSAIDs and III rd group received Anti - Biotics, Tamsu losin, NSAIDs in addition Deflazacart 30mg for a period of 10 days. The results were evaluated at the end of 10 days medical treatment. RESULTS : 90 out of 120 patients were re - evaluated at the end of 10 days. The calculi of 7mm should be removed as the chances of passage is <20%. The medical treatment with Tamsulosin or Tamsulosin with Deflazacart does not offer significant benefit.

  16. Ureteroscopic pneumatic lithotripsy for treatment of complicated ureteral calculi%输尿管镜气压弹道碎石术治疗复杂性输尿管结石

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    王文生; 薛建; 俞小明; 张钢; 李鑫; 李保国; 唐科伟

    2011-01-01

    目的 探讨输尿管镜气压弹道碎石术治疗复杂性输尿管结石的疗效.方法 采用输尿管镜气压弹道碎石术治疗复杂性输尿管结石56例,其中输尿管上段结石15例,中下段结石41例,体外冲击波碎石术(ESWL)失败25例,合并高热8例.结果 56例患者中,中下段结石均一次完全粉碎,成功率100.0%(41/41).上段结石一次完全粉碎10例,成功率66.7%(10/15).3例结石术中移位至肾脏,后辅以ESWL治疗1~2次,1例进镜困难终止手术,1例因输尿管穿孔改行开放手术.术后4周结石总清除率87.5%(49/56).8例合并高热者均急诊手术,7例一次结石粉碎成功,1例结石移位至肾脏,但梗阻均经手术得以解除,术后高热停止.输尿管穿孔发生率为1.8%(1/56).结论 输尿管镜气压弹道碎石术治疗复杂性输尿管结石安全、有效.%Objective To evaluate the therapeutic efficacy of ureteroscopic pneumatic lithotripsy for treatment of complicated ureteral calculi. Methods Clinical data of 56 cases with complicated ureteral calculi who were treated with ureteroscopic pneumatic lithotripsy was reviewed. Among them 15 cases were proximal ureteral calculi,41 cases were middle and distal ureteral calculi. Treatment by extracorporeal shockwave lithotripsy (ESWL) failed in 25 cases,8 cases complicated with fever. Results In 41 cases with middle and distal ureteral calculi, successful lithotripsy was achieved after the first treatment session,the success rate was 100.0% (41/41). In 15 cases with proximal ureteral calculi ,successful lithotripsy was achieved in 10 cases after the first treatment session,the success rate was 66.7%(l0/15). Calculi migrated to kidney in 3 cases who treated by ESWL for 1-2 times. The failure was due to ureteral kink in 1 case and due to ureteral perforation that required surgical repair in another case. Forty-nine cases were calculi-free after 4 weeks,the calculi-free rate was 87.5%(49/56). Emergency operation was performed in 8

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

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    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.

  18. Does a retrograde pyelography prior to ureteroscopy influence stone-free rates and complication rates in ureteral calculi?

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    Seklehner, Stephan; Heißler, Ortwin; Engelhardt, Paul F; Riedl, Claus

    2015-01-01

    To evaluate the impact of retrograde pyelography (RPG) in patients treated with ureteroscopy (URS) for ureteral calculi. Retrospective analysis of patients treated with and without RPG prior to URS at a single institution from 2010 to 2013. Assessment of stone-free rates and intraoperative complications. Out of 469 URS, 211 (45%) were done with and 258 (55%) without RPG. Complete stone removal was achieved in 86.8% without RPG compared to 73% with RPG (p=0.0001). Partial stone removal rates were similar in both groups (p=0.77). Stone removal was not achieved in 9.3 vs. 22.7% (p=0.0001), with concordant findings in the distal (7.4 vs. 16.9%, p=0.007) and the proximal ureter (14.5 vs. 38.6%, p=0.002). Patients with RPG had a threefold higher chance of an unsuccessful URS (OR 3.05, 1.71-5.43, pRPG prior to URS had significantly inferior stone-free rates. RPG was identified as an independent risk factor for inferior results. RPG neither facilitates nor diminishes complication rates during URS. © 2014 S. Karger AG, Basel.

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

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    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....

  20. 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.

  1. 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.

  2. 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.

  3. Efficacy of nifedipine and alfuzosin in the management of distal ureteric stones: A randomized, controlled study

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    Sameer

    2014-01-01

    Conclusion: The use of alfuzosin and nifedipine as a medical expulsive therapy for distal ureteric stones proved to be safe and effective in term of increased stone-expulsion rate, reduced pain attacks and decrease hospital re-admissions.

  4. [Ureterorenoscopy (URS) in treatment of ureteral calculi. II. Ureteroscopic treatment of calculus debris after ESWL].

    Science.gov (United States)

    Fernandez De la Maza, S; Noldus, J; Huland, H

    1999-03-01

    We were interested in the efficacy and morbidity of the ureteroscopy (URS) in the treatment of "steinstrasse" after ESWL. From 1991 to 1996, 27 patients with "steinstrasse" were treated with a total of 32 ureteroscopic procedures. The URS alone had a stonefree success rate of 43.7% (n = 14). URS combined with ESWL was effective in 43.7% (n = 14), leading to an overall success rate of 87.4%. In 4 cases (12.6%) a second therapy was necessary (in 3 cases a second URS + ESWL and in one patient a nephrectomy due to septic pyonephrosis. The overall rate of auxiliary ESWL after URS was 53.1%. Mean operating time was 72 minutes (20-180 min). The rate of complications was 21.8% (n = 7) and mainly due to ureteral perforations or postoperative fever but none suffered from late complications like ureteral stricture. All treated patients received a double-J-stent and antibiotics. The treatment of "steinstrasse" in the middle portion of the ureter proved to be more difficult due to the anatomical position of the ureter and lasted in a longer operating time as the upper or distal "steinstrasse". The stone extraction and the lithoclast-lithotripsy alone or in combination were the most frequent used ureteroscopic procedures to eliminate stone fragments. The URS alone or in combination with the ESWL for the treatment of "steinstrasse" is a highly effective and safe approach.

  5. Ureteral Stent Placement for Ureteral Calculi during Pregnancy:An Analysis of 50 Cases%输尿管支架置入术治疗孕期输尿管结石50例临床分析

    Institute of Scientific and Technical Information of China (English)

    王进峰; 卢晓明; 王礼平; 尹九湖

    2015-01-01

    ABSTRACT:Objective To explorer the value of ureteral stent placement in the treatment of ure-teral calculi during pregnancy.Methods Clinical data of 50 patients who underwent ureteral stent placement for ureteral calculi during pregnancy were retrospectively analyzed.Auxiliary examina-tion confirmed that all patients had ureteral calculi complicated by renal colic and failed to respond to conservative drug treatment.Among the 50 patients,25 had right ureteral calculi,22 had left u-reteral calculi,3 had bilateral ureteral calculi,31 had middle/upper ureteral calculi,and 19 had lower ureteral calculi.Results Thirty-seven patients successfully underwent cystoscopic catheter-ization after topical anesthesia.Twelve patients underwent successful ureteroscopic catheterization after failed cystoscopic catheterization.One patient underwent successful percutaneous renal an-terograde catheterization under local anaesthesia after failed retrograde catheterization.After treatment,renal colic was relieved obviously and hydronephrosis was alleviated to varying degrees with no threatened abortion in all patients.Postoperative reexamination showed that ureteral stents were placed appropriately in 48 patients and were located in upper ureter in 1 patient.In ad-dition,ureteral stents fell out in 1 patient when urinary catheter was removed on postoperative day 3.However,ureteral stents were appropriately placed after recatheterization in this patient. Conclusion Ureteral stent placement is a simple,effective,safe and reliable treatment for ureteral calculi during pregnancy.%目的:探讨输尿管支架置入术在治疗孕期输尿管结石中的应用价值。方法对50例输尿管支架置入术治疗的孕期输尿管结石患者的临床资料进行回顾性分析。50例患者均经辅助检查证实输尿管结石,同时合并肾绞痛,经药物保守治疗无效,其中右输尿管结石25例、左输尿管结石22例、双侧输尿管结石3例,31例

  6. 急诊首选B超定位ESWL治疗输尿管结石%Preferred B-positioning emergency ESWL treatment of ureteral calculi

    Institute of Scientific and Technical Information of China (English)

    夏远峰

    2014-01-01

    目的:总结急诊首选B超定位ESWL治疗输尿管结石的临床经验。方法:回顾分析2010年5月~2014年3月急诊首选第五代JC-Eswl-B型体外碎石机治疗2328例输尿管结石患者临床资料。结果:ESWL治疗输尿管结石成功率97.2%(1次成功率86.3%)。结论:急诊首选B超定位ESWL治疗输尿管结石是有效的,但要严格掌握适应证,以提高治疗效果。%Objective:To summarize the preferred B ~positioning emergency ESWL treatment of ureteral calculi clinical experience . Methods:Analysis from May 2010-November 2014 B-positioning emergency preferred using electromagnetic shock wave lithotripsy ma -chine2328 cases of clinical data in patients with ureteral calculi .Results:ESWL treatment of ureteral calculi success rate of 97.2% ( a success rate of 86.3%).Conclusion:Preferred B-positioning emergency ESWL treatment of ureteral calculi was effective , but to strictly indications to improve the therapeutic effect .

  7. Evaluation of the efficacy of tamsulosin with or without deflazacort for stone clearance after extracorporeal shockwave lithotripsy for upper ureteral and renal calculi

    Directory of Open Access Journals (Sweden)

    Rajeev T. P.

    2016-02-01

    Conclusions: Addition of alpha-blocker tamsulosin along with deflazacort post ESWL for renal and upper ureteric calculi increases the stone expulsion rate and reduces the expulsion duration as shown by highly statistically significant results in group C. [Int J Res Med Sci 2016; 4(2.000: 643-648

  8. Sonography in acute ureteric colic: an experience in Dhulikhel Hospital.

    Science.gov (United States)

    Joshi, K S; Karki, S; Regmi, S; Joshi, H N; Adhikari, S P

    2014-01-01

    Computed tomography is considered as an imaging modality of choice in acute ureteric colic. However due to concerns regarding radiation exposure, sonograms are re-emerging as imaging methods in such situations. To evaluate the role of sonography in detection of calculus in acute ureteric colic. Total 384 patients were enrolled. Hydronephrosis was graded as mild, moderate or severe. Calculus was detected as an intraluminal echogenic focus with distal shadowing with twinkling artifact. Number, size and position of the calculi were assessed. Patients were categorized into four groups:I. ureteric colic only II. ureteric colic with hematuria III. ureteric colic with hydronephrosis and IV. ureteric colic with hematuria and hydronephrosis and then the possibility of detection of calculi has been compared among these groups. Out of 384 patients, 254 were found to have calculi ranging between 2.7-27 mm. Nineteen had in the pelvis/ pelviureteric junction, 64 in proximal ureter, 125 in distal ureter, 6 at iliac crossing and 40 at vesicoureteric junction. Two hundred forty one had single and 14 had multiple calculi. Calculus detection is easier in category III and IV patients. The sensitivity and specificity of ultrasonography were 87.98% and 93.07%. Degree of hydronephrosis is strongly correlated with the number of calculi but weakly correlated with the size of the calculus. Sonogram can be used in all cases of acute ureteric colic. Hydronephrosis is the most important finding because it paves the way out for the detection of calculus.

  9. Safety and efficacy of pneumatic lithotripters versus holmium laser in management of ureteral calculi: a randomized clinical trial.

    Science.gov (United States)

    Razzaghi, Mohammad Reza; Razi, Abdollah; Mazloomfard, Mohammad Mohsen; Golmohammadi Taklimi, Amin; Valipour, Reza; Razzaghi, Zahra

    2013-01-01

    To compare efficacy and safety of holmium:YAG laser and pneumatic lithotripter in the management of ureteral stones. One hundred and twelve patients with 1 to 2 cm ureteral calculi were selected for pneumatic or holmium:YAG laser transurethral ureterolithotripsy (56 patients in each group). Ultrasonography and plain abdominal x-ray were performed for all the patients before the operation. The pneumatic lithoclast was Swiss LithoClast, while in laser lithotripsy, holmium:YAG laser frequency was used, which was usually set between 5 and 10 Hz at a power of 10 to 15 Watt. Intravenous urography was performed for all the patients at 3 months to assess functional status and to delineate the ureteral anatomy. The mean patients' age and stones' size were the same in both groups, and there were no statistical differences. Mean duration of lithotripsy was 13.7 ± 12.6 minutes in laser group and 7.9 ± 4.2 minutes in pneumatic lithotripsy group. Immediate stone-free rate was 100% and 82.1% in the laser and pneumatic groups, respectively (P = .001). Stone pushing back occurred only in 10 (17.9%) patients in pneumatic group. In terms of complications, such as perforation, mucosal injury, and bleeding, there were no differences between the two groups. No intravenous pyelography related complication was seen at 3-month follow-up. Laser lithotripsy is a superior approach for the management of upper ureteral stones of 1 to 2 cm in size due to its higher rate of stone clearance.

  10. Optimal management of distal ureteric strictures following renal transplantation: a systematic review.

    Science.gov (United States)

    Kwong, Justin; Schiefer, Danielle; Aboalsamh, Ghaleb; Archambault, Jason; Luke, Patrick P; Sener, Alp

    2016-05-01

    Our objective was to define optimal management of distal ureteric strictures following renal transplantation. A systematic review on PubMed identified 34 articles (385 patients). Primary endpoints were success rates and complications of specific primary and secondary treatments (following failure of primary treatment). Among primary treatments (n = 303), the open approach had 85.4% success (95% CI 72.5-93.1) and the endourological approach had 64.3% success (95% CI 58.3-69.9). Among secondary treatments (n = 82), the open approach had 93.1% success (95% CI 77.0-99.2) and the endourological approach had 75.5% success (95% CI 62.3-85.2). The most common primary open treatment was ureteric reimplantation (n = 33, 81.8% success, 95% CI 65.2-91.8). The most common primary endourological treatment was dilation (n = 133, 58.6% success, 95% CI 50.1-66.7). Fourteen complications, including death (4 weeks post-op) and graft loss (12 days post-op), followed endourological treatment. One complication followed open treatment. This is the first systematic review to examine the success rates and complications of specific treatments for distal ureteric strictures following renal transplantation. Our review indicates that open management has higher success rates and fewer complications than endourological management as a primary and secondary treatment for post-transplant distal ureteric strictures. We also outline a post-transplant ureteric stricture evaluation and treatment algorithm.

  11. Influence of ureter mirror holmium laser lithotripsy on blood rheology and oxidative stress in patients with upper ureteral calculi

    Institute of Scientific and Technical Information of China (English)

    Guo-Dong Chen; Jian Dong; Jun Ding; Guo-Bo Li; Chen-Xi Zhou

    2016-01-01

    Objective:To explore the influence of ureter mirror holmium laser lithotripsy on blood rheology and oxidative stress in patients with upper ureteral calculi.Methods:A total of 113 cases patients who underwent surgical treatment of ureter mirror holmium laser lithotripsy were divided into observation group (n=76) and the control group (n=37) according to different therapeutic methods. Patients in the observation group were treated by ureteroscopy holmium laser lithotripsy treatment and patients in control group were treated by open surgery treatment. Venous blood was collected ro test the blood rheology and oxidative stress indicators respectively in the preoperative and postoperative 1 d, 7 d after treatment.Results:The postoperative backlog of red blood cells increased performance first decreased after treatment in two groups, the plasma viscosity and whole blood viscosity, high shear viscosity of whole blood were increased after the stable trend, the postoperative hematocritg, plasma viscosity, whole blood viscosity, high shear viscosity of whole blood were significantly lower than the control group in the observation group 1 d and 7 d after operation; The postoperative Cor, MDA in two groups showed a rising trend, SOD showed a decreasing trend, the difference was statistically significant; MDA in observation group 1 d and 7 d after operation was significantly lower than the control group, SOD was significantly higher than control group in the same point in time.Conclusions:Patients with upper ureteral calculi treated by surgical treatment may cause abnormal blood rheology and oxidative stress. And compared with open surgery, ureteroscopy holmium laser lithotripsy is of smaller side effect, and is beneficial for postoperative recovery.

  12. Hook Phenomenon: Intermittent distal ureteral obstruction following reimplantation

    Directory of Open Access Journals (Sweden)

    M. Mehdizadeh "

    2003-06-01

    Full Text Available Background/Objectives: To evaluate the child with intermittent ureteral obstruction following antireflux surgery and to introduce a new imaging technique for diagnosis of the socalled “hook” phenomenon, the most serious complication of antireflux surgery. Patients and Methods: Twenty-five children with a history of antireflux surgery who were referred for either persistent urinary tract infection (UTI or progressive hydronephrosis were included in the study. All the children with signs and symptoms of voiding dysfunction or persistent reflux were excluded. A new imaging technique was devised to evaluate these patients for the presence of “hook phenomenon”, in which a renal ultrasound was performed both on a full bladder and after voiding. If dilatation of the urinary tract was detected on full bladder, and this dilatation decreased dramatically following micturition, then a catheter was passed into the bladder and was filled with normal saline (based on the estimated bladder capacity in order to avoid over-distension. An intravenous urogram and saline cystogram were performed simultaneously. After 20 minutes, 2 abdominal radiographs were obtained on full and emptied bladder, both. Results: On the intravenous urogram, some children showed typical “J- hook-shaped” ureters. In all the cases marked hydronephrosis was noted, with no contrast material seen entering the bladder on the 20 minute radiogram. Upon evacuation of the bladder, both ureters promptly drained into the bladder and the”J-hooking” of the ureters and hydronephrosis resolved. Conclusion: "J- hook phenomenon” is one of the most common causes of hydronephrosis and hydroureter following ureteral re-implantation is intermittent ureteral obstruction from creation of the new ureteral hiatus at an inappropriate site. This complication is frequently misdiagnosed as irreversible uretero-vesical junction obstruction from ischemia or fibrosis. Once the diagnosis of “J- hook

  13. Ureteroscopy for treatment of obstructing ureteral calculi in pregnant women: Single center experience

    Directory of Open Access Journals (Sweden)

    T.K. Fathelbab

    2016-06-01

    Conclusion: Ureteroscopy is a safe and effective therapeutic option for the treatment of obstructing ureteral stones in pregnancy with stone-free and complication rates comparable to the non-pregnant population.

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

    Science.gov (United States)

    Arlen, Angela M; Leong, Traci; Guidos, Paul J; Alexander, Siobhan E; Cooper, Christopher S

    2017-07-08

    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.

  15. COMPARISON OF ROLE OF IVP AND USG IN EVALUATING URETERIC CALCULI DISEASE

    Directory of Open Access Journals (Sweden)

    Rajesh Rathore

    2016-07-01

    Full Text Available The incidence of urolithiasis varies according to geographic area, age, and sex distribution. 1 Various studies have shown that in economically developed countries the prevalence rate ranged between 4% and 20%. Urolithiasis may affect up to 10% of the population over the course of a lifetime. In India, upper and lower urinary tract stones occur frequently, but the incidence shows wide regional variation. Smaller stones (Up to 5 mm may cause severe symptoms such as flank pain and nausea, but pass without intervention. Though, they may need supportive care, but larger stones need intervention. Surgery has been used to remove stones (Lithotomy or to break them all into small pieces (Lithotripsy since antiquity. Twenty five years ago, open surgery was the sole form of therapy for urolithiasis, but now endourology is the surgical treatment of choice. 2 URETERIC JET When the bolus of urine being transmitted through the ureter reaches the terminal portion. It is ejected forcefully into the bladder through the Vesicoureteric Junction (VUJ. This creates a jet of urine that can be seen within the urinary bladder during cystoscopy and grey-scale Ultrasonography (US. Urine secreted from the renal glomeruli is excreted into the upper urinary tract including the collecting system, calyces-pelvis system, and ureter. Although, the precise mechanism of urine drainage through the whole system remains somewhat contentious. The trigger of ureteric jets is undoubtedly the pumping effect of calyceal peristalsis. 3 The latter comprises an autonomic and rhythmic minor calyceal peristalsis and a pressure-dependent major calyceal peristalsis, and the pressure of the major calyces comes from the resistance of the intrinsic tone of the upper ureter to the urine draining in the renal pelvic volume and tone and the rate of urine inflow. 4 Continuous discrete boluses of urine drainage into the ureter from pelvis, then fill the ureter, and finally, a ureteric jet is produced

  16. [The combination of extracorporeal lithotripsy and percutaneous nephrostomy in the treatment of obstructive ureteral urate calculi].

    Science.gov (United States)

    Del Boca, C; Ferrari, C; Dotti, E; Corsi, G; Guardamagna, A; Giuberti, A C; Colloi, D

    1994-04-01

    The authors report their experience with combined percutaneous nephrostomy and extracorporeal shock-wave lithotripsy to treat obstructive uratic ureteral stones. The role of nephrostomy is stressed as a diagnosis and treatment method before, during and after lithotripsy. Thus, the method proved especially useful to drain obstructed kidneys and restore peristalsis, to evacuate septic urine, to facilitate the elimination of lithiasic fragments, to perform anterograde pyelography before, during and after lithotripsy and finally to allow pharmacological litholysis. Fourteen patients were successfully treated with combined extracorporeal lithotripsy and percutaneous nephrostomy and the results compared with those obtained with other techniques--e.g., ureteroscopy, whose value appears lower because the method requires general anesthesia and is more traumatic to the ureter. The authors conclude that combined extracorporeal lithotripsy and percutaneous nephrostomy make the best technique to treat obstructive uric acid stones thanks to their positive results, low invasiveness and to patients compliance.

  17. Removal of ureteral calculi in two geldings via a standing flank approach.

    Science.gov (United States)

    Frederick, Jeremy; Freeman, David E; MacKay, Robert J; Matyjaszek, Sarah; Lewis, Jordan; Sanchez, L Chris; Meyer, Stephanie

    2012-11-01

    Two geldings, aged 11 and 17 years, were examined for treatment of ureteroliths located approximately 10 cm proximal to the bladder. Ureteral obstruction was an incidental finding in 1 horse that was referred because of urinary tract obstruction and a cystic calculus. This horse did not have clinical or laboratory evidence of renal failure, although severe hydronephrosis was evident on transabdominal ultrasonography. The second patient had a serum creatinine concentration of 6.3 mg/dL (reference range, 0.8 to 2.2 mg/dL) and mild hydronephrosis of the affected left kidney. In both patients, the obstructed ureter was exteriorized through a flank incision as a standing procedure, and the calculus was crushed and removed with a uterine biopsy forceps introduced through a ureterotomy approximately 25 cm proximal to the calculus. The cystic calculus was removed through a perineal urethrostomy by lithotripsy, piecemeal extraction, and lavage. The horse without azotemia developed pyelonephritis in the affected kidney and was euthanatized because of complications of a nephrectomy 13 months later. In the horse with azotemia, the serum creatinine concentration decreased after surgery, and the horse returned to its intended use. However, it was euthanatized approximately 2 years after surgery because of progressive renal failure, and a large nephrolith was found in the previously unobstructed right kidney. The technique used for ureterolith removal was successful in both horses in this report, did not require sophisticated equipment, and could be effective in the early stages of ureteral obstruction as a means of restoring urine flow and renal function. The outcome in the horse with advanced unilateral renal disease without azotemia would suggest that nephrectomy should be considered as a treatment in such patients.

  18. B超诊断输尿管结石的价值%Diagnostic value of B type ultrasound in ureteral calculi

    Institute of Scientific and Technical Information of China (English)

    李成

    2010-01-01

    Objective To evaluate the diagnostic value of B type ultrasound in ureteral calculi. Methods B type ultrasound examination were performed on 100 cases with ureteral calculi who were confirmed by open surgery, extracorporeal shock wave lithotripsy and comprehensive therapy. Results The diagnostic accuracy was 94. 00% in 100 cases,no false positive was found,and the rate of missed diagnosis was 6.00% (6 cases). Conclusion B type ultrasound has a high application value in the diagnosis of ureteral calculi, which has low false positive rate and can clear display negative stone. It can also afford some accurate clues for diagnosis and clinical treatment in tihe according to abdomenal B type ultrasound and it will be preferred in way for diagnosis of acute nephrite colic especially in basic hospitals.%目的 评价B超在输尿管结石中的诊断价值.方法 对100例经手术取石、体外震波碎石和综合疗法排石证实为输尿管结石患者进行B超检查诊断分析.结果 本组100例输尿管结石患者中,B超诊断正确率为94.00%,无假阳性,漏诊6例,占6.00%.结论 B超诊断输尿管结石假阳性率低,可清晰显示X线阴性结石,有较高的临床应用价值和为临床及时准确地提供诊断和治疗依据,是急性肾绞痛的首选检查方法,特别是在基层医疗单位为首选检查方法.

  19. A second cycle of tamsulosin in patients with distal ureteric stones: a prospective randomized trial.

    Science.gov (United States)

    Porpiglia, Francesco; Fiori, Cristian; Ghignone, Gianpaolo; Vaccino, Davide; Billia, Michele; Morra, Ivano; Ragni, Francesca; Scarpa, Roberto M

    2009-06-01

    To evaluate, in a prospective randomized pilot study, the effectiveness and safety of tamsulosin, administered in patients with distal ureteric stones and who have already undergone an unsuccessful first cycle of medical expulsive therapy (MET). We evaluated the effectiveness and safety of tamsulosin, administered as a further therapy, in patients previously unsuccessfully treated with combined expulsive 10-day therapy (tamsulosin + deflazacort) for distal ureteric stones. Ninety-one patients were enrolled and randomized into two groups, each receiving a different therapy for 10 days. Group A (46 patients) received a further cycle of tamsulosin (0.4 mg daily), and group B (45) did not. Age, gender, stone size, time to expulsion, number of acute episodes of colic during treatment and analgesic consumption were recorded. Patients who were not stone-free after the study period had ureteroscopy. The results were compared statistically using Student's t-, chi-square test and Fisher's exact test. The groups were comparable in age, gender and stone size (5.93 mm for group A and 6.03 mm for group B). The expulsion rate was significantly higher in group A (80%) than in group B (49%) (P < 0.01), whilst there were no differences between the groups in the number of colic episodes and analgesic use. There were no reported side-effects of medical therapy. A second cycle of 10 days of MET with tamsulosin in nonresponders to a 10-day first cycle of MET with tamsulosin and deflazacort is safe and effective, and therefore should be considered as an option in the management of uncomplicated distal ureteric stones.

  20. 头孢曲松钠相关双侧输尿管结石%Ceftriaxone sodium associated with bilateral ureteral calculi

    Institute of Scientific and Technical Information of China (English)

    陈锐; 岳明; 刘小勇

    2013-01-01

    1例26岁女性患者因上呼吸道感染静脉滴注头孢曲松钠2 g,1次/d.第4天突然出现下腹持续性胀痛,腹部超声及CT检查提示双侧输尿管结石.给予对症支持治疗.第5天患者尿中排出少许沉渣.当天腹痛缓解,尿频、尿急症状消失.第6天复查CT,双侧输尿管结石消失.%A 26-year-old female patient received an Ⅳ infusion of ceftriaxone 2 g once daily for upper respiratory tract infection.On day 4,the patient developed persistent distending pain in her lower abdomen.Abdominal ultrasonography and CT examinations revealed bilateral ureteral calculi.The patient received symptomatic treatments and supportive therapy.On day 5,little sediment was excreted in the urine.On the same day,the abdominal pain was alleviated and symptoms of urinary frequency and urgency disappeared.On day 6,CT reexamination showed that the bilateral ureteral calculi disappeared.

  1. Safety and Efficacy of Pneumatic Lithotripters Versus Holmium Laser on Multiple Ureteral Calculi.

    Science.gov (United States)

    Ercil, Hakan; Alma, Ergun; Bas, Okan; Unal, Umut; Sener, Nevzat Can; Vuruskan, Ediz; Senturk, Aykut Buğra; Gurbuz, Zafer Gokhan

    2016-11-01

    Different energy sources can be used for ureteroscopic stone fragmentation, such as pneumatic, ultrasonic, laser or electrohydraulic. The aim of this study was to compare the efficacy and safety of pneumatic lithotripters versus Ho: YAG laser in the treatment of multiple stones in the distal ureter. A retrospective evaluation was done using the data of patients to whom ureteroscopic lithotripsy (URL) was applied for ureter stones in our clinic. From these patients, those with multiple unilateral distal ureter stones were identified, then these patients were separated into 2 groups according to the type of lithotriptor used in stone fragmentation as laser lithotripsy (Group 1) and pneumatic lithotripsy (Group 2). Statistically, the two groups were similar in respect of the number of stones, stone burden and the number of double J stents applied intra-operatively. The mean operating time was similar in the 2 groups as 53.47 (±17.3) minutes in Group 1 and 50.59 (±15.3) minutes in Group 2. On postoperative day 1 after the URL, the stone free rate (SFR) of Group 1 (78.7%) was found to be significantly high compared to the SFR of Group 2 (63.6%), while at postoperative month 1, the SFR of both groups was found to be similar. Binary logistic regression was applied to determine the effect of related independent variables on the 1st month SFR. In this model, age and stone burden were affecting variables. Compared to the pneumatic lithotripter, the Ho: YAG laser seems to have advantages of a higher SFR in the early postoperative period, eventhough there are statistically similar success rates and complication rates.

  2. Comparison of tamsulosin with extracorporeal shock wave lithotripsy in treating distal ureteral stones

    Institute of Scientific and Technical Information of China (English)

    ZHANG Meng-yuan; DING Sen-tai; L(U) Jia-ju; LUE Yan-he; ZHANG Hui; XIA Qing-hua

    2009-01-01

    Background Tamsulosin,an alpha-1 receptor antagonist,has been demonstrated effective in promoting distal ureteral stone passage and in reducing pain associated with stone expulsion.This study aimed to evaluate the effect of tamsulosin in comparison with nifedipine and extracerporeal shock wave lithotripsy (ESWL) on the expulsion rate of distal ureteral stones at different sizes.Methods We assigned 314 patients to three categories:Ⅰ,the stone with maximal diameter of 4.0-5.9 mm;Ⅱ,6.0-7.9mm,and Ⅲ,8.0-9.9 mm.Patients in each category were randomly subdivided into three treatment subgroups:group A (nifedipine group),group B (tamsulosin group),and group C (ESWL group).Stone-free rate and the dose of analgesics were recorded weekly during the 4-week follow-up period.Results Three hundred and three patients completed the study.The results showed that nifedipine and tamsulosin treatments promoted a small (4-8 mm,categories Ⅰ and Ⅱ) stone expulsive rate that was comparable with ESWL treatment.Nonetheless,when the stone diameter was 8.0-9.9 mm,ESWL showed a greater stone free rate than nifedipine and tamsulosin treatments;no significant difference existed between the latter two therapies.Although the ESWL treatment group required the least analgesics,tamsulosin treatments required less pain medication than nifedipine (P <0.05).Conclusions Tamsulosin treatment is recommended for patients with the stone diameter smaller than 8 mm because of its feasibility,effectiveness and safety.ESWL is more appropriate than tamsulosin therapy for the patients whose stones are larger than 8 mm.

  3. Pneumatic lithotripsy through ureteroscope for treating ureteral calculi%输尿管镜气压弹道碎石术治疗输尿管结石

    Institute of Scientific and Technical Information of China (English)

    林飞鹤; 谢春发; 高海亮; 蔡伯基; 蔡道广

    2015-01-01

    Objective To evaluate the efficacy and safety of the pneumatic lithotripsy through ureteroscope for the treatment of ureteral calculi.Methods A total of 920 patients underwent ureteroscopic lithotripsy using pneu-matic lithotripsy 259 upper,375 middle,and 286 lower ureteral stone were treated.Results The overall successful fragmentation rate for all levels of ureteral stones in a single session achieved 94.0% (864 /920),failure rate 6.0%(56 /920).28 cases failed because of ureteral stricture.24 cases of stone moved up into the kidney.All worst -cases were in dewelled shock wave lithotripsy ESWL.Conclusion Ureteroscopic lithotripsy using pneumatic lithotripsy is a highly effective,minimally invasive and safe therapy for ureteral calculi.It is indicated as a first choice for treatment patients with ureteral stones,especially for the ones with the middle and lower uneteral stones.Develop particularly suitable for basic hospital.%目的:总结分析经尿道输尿管镜气压弹道碎石术治疗输尿管结石的疗效及其安全性。方法应用输尿管镜气压弹道碎石术治疗920例输尿管结石,其中输尿管上段结石259例,输尿管中段结石375例,输尿管下段结石286例。结果920例输尿管结石单次成功率94%(864/920),失败率6%(56/920)。失败原因:28例因输尿管口畸形狭窄而上镜失败,24例碎石过程中部分结石进入肾内,52例失败病例在留置双 J管条件下术后辅助冲击波体外碎石治疗。4例因既往有输尿管手术史或多次 ESWL 史,结石远端输尿管明显扭曲或狭窄,术中输尿管镜试图扩张通过而发生穿孔。结论输尿管镜气压弹道碎石术治疗输尿管结石有效,微创、安全、经济,是治疗输尿管结石特别是输尿管中、下段结石的首选治疗方法,特别适合在基层医院开展。

  4. 318 Cases of Ureteral Calculi Ultrasound Diagnosis Experience%318例输尿管结石超声诊断体会

    Institute of Scientific and Technical Information of China (English)

    孙秀丽; 于涛

    2012-01-01

    Objective: To evaluate the color doppler ultrasonography in the diagnosis value of ureteral calculi. Methods: In our hospital for the treatment of ureteral stones in 318 cases, of which 198 cases were male, female 120 cases, aged 17~69 years old, the GE Vivid7 color doppler ultrasound diagnostic instrument to the diagnosis. Results: the 318 cases are all the medication, gravel or surgery for stone confirmed. Accept ultrasound in patients 306 example actually ureter stone, misdiagnosis in 12 cases. Ultrasound performance as the main performance of the ureter water for no echo with strong echo light appeared at the far end, accompanied by the rear of sound, part of the stone color doppler figure visible "hui tail levy" strong light group with arc light band or avoid looking frumpy fine narrow light band, stone size of 0.3~1 .8 cm. Conclusion: color doppler ultrasound examination of the quick and convenient, and is now the preferred method of ureteral calculi.%目的 评价彩色多普勒超声对输尿管结石的诊断价值.方法 选取在我院进行诊治的输尿管结石患者318 例,其中男198 例,女120 例,年龄17~69 岁,采用GE Vivid7 彩色多普勒超声诊断仪对其进行诊断.结果 接318 例患者均经服药、碎石或手术后证实为结石.接受超声检查患者中306 例证实为输尿管结石,漏诊12 例.超声表现为主要表现为积水的输尿管无回声带远段出现强回声光团,伴有后方声影,部分结石彩色血流图可见"慧尾征"强光团呈弧形细狭光带或粗厚光带,结石大小为0.3~1.8cm.结论 彩色多普勒超声检查快捷方便,是目前输尿管结石的首选方法.

  5. 输尿管镜下气压弹道碎石术治疗输尿管结石的疗效分析%Efficacy Analysis of Ureteral Microscopically Pneumatic Ballistic Lithoclast in the Treatment of Ureteral Calculi

    Institute of Scientific and Technical Information of China (English)

    娄斌; 陈桂莲; 黄伟

    2011-01-01

    目的 观察经输尿管镜气压弹道碎石术治疗输尿管结结石的疗效和并发症.方法 随机选取牡丹江医学院第二附属医院泌尿外科自2007年10月至2010年10月收治的180例输尿管结石患者.根据治疗方法的不同,将180例患者分为两组,A组80例采用经输尿管镜超声碎石术,B组100例采用经输尿管镜气压弹道碎石.观察两组患者的单次手术操作成功率、结石排净率、平均住院时间及并发症发生率.结果 A组的首次结石排净率76.3%,尿路感染、输尿管狭窄、穿孔的发生率分别为12.5%、11.3%、12.5%,平均住院时间(6.0 ±2.3)d.B组的结石排净率89.0%,尿路感染、输尿管狭窄、穿孔的发生率分别为25.0%、3.0%、4.0%,平均住院时间(4.2 ±1.8)d,两组比较差异有统计学意义(P<0.05).结论 输尿管镜下气压弹道碎石术是高效、安全、易使用的方法.%Objective To observe the curative effect and complications of the ureteral mirror pneumatic ballistic lithoclast in the treatment of ureteral calculi.Methods To randomly selecte 180 patients since October 2007 October 2010 from urinary surgical of the second affiliated hospital of Mudanjiang medical School.According to the different treatment methods, 180 were divided into two groups, A group of 80 patients with ureteral mirror by ultrasonic lithotripsy,B group of 100 patients with ureteral mirror by pneumatic ballistic gravel.To observe two groups in single operation success rate, the stone row net rate, the average hospitalization time and complications.Results The first stone row net rate of group A was 76.3%, the incidence of urinary tract infection, ureteral stricture, fenestration showed 12.5 %, 11.3 %, 12.5 % respectively, the average hospitalization time was( 6.0 ±2.3 )d.The stone row net rate of group B was 89.0% ,the incidence of urinary tract infection,ureteral stricture,fenestration showed 25.0% 、3.0% 、4.0% respectively,the average

  6. The value of ultrasound-monitoring calculi drifting in transureteroscopic pneumatic lithotripsy for upper ureteral calculi%输尿管镜气压弹道碎石治疗输尿管上段结石时B超监测结石漂移的价值探讨

    Institute of Scientific and Technical Information of China (English)

    曹刚; 郑如华; 金永有; 陈尧康; 虞利民

    2014-01-01

    目的:探讨输尿管镜气压弹道碎石术(URSL)治疗输尿管上段结石时B超监测结石漂移的临床价值。方法对40例输尿管上段结石患者行URSL治疗时采用床边B超实时监测术中结石漂移情况。结果原位碎石成功32例(80.0%),结石一次清除23例(57.5%),碎石失败8例(20.0%)。进镜时B超发现结石整枚漂移9例(9/40),其中1例移入肾内;碎石时B超早于输尿管镜发现结石整枚漂移12例(12/36),其中2例移入肾内;结石粉碎后B超发现有结石碎片逆向漂移16例(16/32),其中5例共7枚碎片漂移入肾内,其余漂移碎片最后均被输尿管镜证实并在B超引导下成功清除。结论 URSL治疗输尿管上段结石时,B超监测能早于输尿管镜发现结石漂移,有助于减少结石漂移入肾内的风险。%Objective To evaluate the application of ultrasound- monitoring calculi drifting in transureteroscopic pneu-matic lithotripsy (URSL) for upper ureteral calculi. Methods From January 2010 to December 2012, a total of 40 patients with upper ureteral calculi underwent pneumatic lithotripsy through rigid ureteroscope, and intraoperative drifting stones were moni-tored by bedside ultrasonography(US) in our hospital. Results Among 40 cases of ureteral calculi, rate of successful fragmen-tation in situ was 80.0%(32/40), and the stones were cleared away immediately after a single procedure in 23 patients (57.5%) and 8 patients failed, among whom calculi integral drifted into the kidney pelvis in 3 cases. Before ureteroscope entering ureter and calculi were found, calculi integral drifting were detected by US in 9 patients(9/40). During stones broke, 12 cases with cal-culi integral drifting and 16 cases with calculi debris drifting were detected by US in time, and a total of 7 calculi debrises drifted into the kidney in 5 patients, the others debrises were cleaned away under ultrasound- guidance. Al the drifting stones

  7. 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.

  8. Management of ureteric calculi by ballistic lithotripsy%输尿管镜气压弹道碎石术治疗输尿管结石的临床分析

    Institute of Scientific and Technical Information of China (English)

    赵福军; 李虹; 唐秀泉

    2001-01-01

    Objective: To evaluate the clinical use of ballistic lithotriptorin the endoscopic management of ureteric calculi. Methods: Between Feb 2000 to Aug 2000, a total of 28 patients with ureteric calculi, including upper third ureteric stones, middle and lower ureteric stones, were treated with the ballistic lithotriptor. Results: Satisfactory fragmentation was obtained in 24 of the 28 stones (85.7%) and failed fragmentation, in 4(14.3%) in two of which stones were pushed up into pelvis and adjunctive ESWL was performed and in one of which ureteric perforation was emerged and it underwent open surgery and in another case of which the ureterorenoscope failed to be inserted in ureterostoma. Conclusion: The ballistic lithoclast, as a new technique, is claimed to be safe and a high success rate and less trauma, which is valuable to be greatly spread.%目的:探讨输尿管镜气压弹道碎石术治疗输尿管结石的临床疗效。方法:应用输尿管镜气压弹道碎石术治疗输尿管结石28例。结果:26例中、下段输尿管结石中24例获得成功,2例失败。2例上段输尿管结石,因推入肾盂内改行ESWL。结论;输尿管镜气压弹道碎石术作为一种新兴技术,具有碎石时间短、效果明显、工作时不产生热、不易损伤组织、手术并发症少等优点,是很值得推广的。

  9. 输尿管下段结石致尿脓毒血症1例及文献复习%Treatment of Urosepsis Caused by Lower Ureteral Calculi: A Case Report

    Institute of Scientific and Technical Information of China (English)

    刘桂勇; 张秉虎; 何安仁; 杜建兵; 万齐福; 宋洪飞

    2012-01-01

    目的:结合1例输尿管下段结石致尿脓毒血症患者的抢救经过,探讨梗阻性尿脓毒血症的救治流程.方法:报告1例输尿管下段结石致尿脓毒血症女性患者,经抗休克、急诊肾造瘘引流处理,随之生命体征改善后再加强抗感染治疗,持续引流3月,肾功能改善,一般情况好转后Ⅱ期行钬激光碎石去除梗阻,成功抢救并治愈.结合文献对梗阻性尿脓毒血症救治进行复习.结果:抗休克及肾穿刺造瘘后待生命体征稍稳定后加强抗感染,Ⅱ期钬激光碎石等治疗后治愈.结论:结石梗阻性尿脓毒血症需早期诊断积极救治,有效的抗感染须建立在早期抗休克及充分引流基础之上,引流数周肾功能好转、全身状态改善后再手术去除梗阻是安全有效的处理流程.%Objective; To evaluate the treatment of urosepsis by reporting a uroseptic case of lower ureteral calculi. Methods; A female uroseptic patient due to lower ureteral calculi was reported here. The processes of anti-shock and percutaneous nephrostomy were performed immediately, and anti-infection treatment followed when the vital sign was stable. Three months later, holmium laser lithotrity was performed and the calculi were removed. Results: Anti-infection treatment after the vital sign was stable was proved to be an effective method of the treatment of urosepsis, while the ureteral calculi was cured by holmium laser lithotrity later. Conclusion: Urosepsis should be treated immediately, and anti-infection treatment should be performed after the control of shock. Lithotrity is a safe therapy for uroseptic patients when shock and renal function were controlled

  10. 妊娠期输尿管结石合并感染的微创处理%Minimally Invasive Management of Ureteric Calculi Complicated with Urinary Tract Infection During Pregnancy

    Institute of Scientific and Technical Information of China (English)

    孟祥军; 米其武; 叶照华; 罗道升; 莫俊华

    2011-01-01

    Objective: To evaluate the feasibility and clinical effect of minimally invasive management of ureteric calculi complicated with urinary tract infection during pregnancy. Methods:From May 2006 to April 2010 ,the data of 21 pregnant women (gestational 6-36 weeks;mean, 24weeks ) with ureteric calculi complicated with infection were analyzed retrospectively. Theureteric calculi were 5-15 mm in greatest dimension. Five cases had calculi in upper ureter;10,in middle ureter and 6,in lower ureter. Routine urinary anlysis:WBC + + - + + + +. Eight cases received intra-ureteral double-J cannula alone; 12 cases received ureteroscopic holmium laser lithotripsy, 1 case received percutaneous nephrostomy. Results: Symptoms and signs of renal colic and fever were disappeared completely in all cases after operation. The stones were removed completely one time in 12 cases. Double J tube and nephrostomy tube were placed until post partum. No threaten edabortion or premature labor was happened. All cases were labor smoothly and infants were healthy, All procedures were successful, no ureteral perforation and other complications were found. Conclusions: Minimally invasive technique is a safe and effective method for the treatment of ureteric calculi complicated with urinary tract infection during pregnancy.%目的:探讨利用微创技术治疗妊娠期输尿管结石合并感染的可行性及临床效果.方法:2006年5月~2010年4月对21例妊娠期输尿管结石合并泌尿系感染患者行微创技术治疗.21例患者孕6~36周,平均24周.结石最大径5~15 mm.左侧输尿管结石9例,右侧12例.输尿管结石上段5例,中段10例,下段6例.尿常规:白细胞++~++++,伴不同程度发热.单纯留置双J管8例,12例采用输尿管镜下钬激光碎石术,1例行经皮肾穿刺造痿术.结果:所有患者肾绞痛、发热等急症症状经治疗后消失.结石一次性取净12例,留置双J管及肾造痿管者至分娩后再行微创手术取石.无一例

  11. Treatment of 88 Cases with Ureteral Calculi by Using Ureteroscopic Pneumatic Ballistic Lithotripsy%输尿管镜气压弹道碎石术治疗88例输尿管结石

    Institute of Scientific and Technical Information of China (English)

    阚乃尧; 杜耀安; 乔羽; 陈健

    2011-01-01

    Objective To evaluate the efficacy of ureteroscopic pneumatic ballistic lithotripsy for ureteral calculi. Methods A retrospective analysis was made in 88 cases treated by ureteroscopic pneumatic ballistic lithotripsy from June 2006 to November 2010. There are 9 cases of bilateral ureteral calculi ,7 cases of isolated renal and 14 cases of acute obstructive renal failure. Results The locations of ureteral calculi were in the upper portion in 20 sides,in the middle portion in 28 sides,in the lower portion in 50 sides. The total success rate of one stage for patients was 91.8% (75.0% in upper portion,92.8% in middle portion,98.0% in lower portion). The mean operation time was 56 minutes( range from 20 to 100 minutes). 3 cases were changed into open operation. 5 cases needed auxiliary ESWL. In the patients with acute obstructive renal failure, the serum Bun and Cr levels decreased at different degree or return to normal. Conclusion The ureteroscopic pneumatic ballistic lithotripsy is safe,effective and less invasive, and is the first choice in the treatment of lower and middle ureteral calculi, which can treat the bilateral ureteral calculi simultaneously;it can rapidly remove the obstruction for the patients with obstructive acute renal failure.%目的 探讨输尿管镜气压弹道碎石术治疗输尿管结石的效果.方法 回顾性分析2004年6月-2010年11月88例输尿管镜气压弹道碎石术治疗输尿管结石的临床资料.其中孤立肾7例,双侧结石9例,急性梗阻性肾功能衰竭14例.结果 输尿管结石位于上、中、下段分别为20侧、28侧、50侧.一次性碎石91.8%,其中上段75.0%,中段92.8%,下段98.0%.3例改开放手术,体外震波碎石术(ESWL)5例.手术时间20~100 min,平均56 min.急性肾功能衰竭患者血BUN,Cr恢复正常或接近正常.结论 输尿管镜气压弹道碎石术安全、高效、损伤小,可作为输尿管中下段结石的首选方法,能同时处理双侧结石.对梗阻性急

  12. Application and analysis of ureteral calculi with double J tube in pregnancy%双J管在治疗妊娠期输尿管结石的应用与分析

    Institute of Scientific and Technical Information of China (English)

    汪洋; 夏勇

    2016-01-01

    Objectives To discuss the clinical effect and safety of double J tube in treatment of pregnancy complicated with ureteral calculi.Methods Retrospective analysis of clinical data of 36 cases of pregnancy complicated with ureteral calculi treated with double J tube under the endoscope in the hospital from January 2009 to December 2014 were performed.The curative effect and the occurrence of adverse events were record and observed.Results The operations of 36 patients were successful and no serious complications occurred.36 patients with renal colic,kidney water and upper urinary tract infection were relieved after implantation of double J tube.Patients were successfully delivered at term.After delivery,22 cases of patients with stone self discharge,the other 14 cases were treated with extracorporeal lithotripsy and holmium laser lithotripsy.Conclusions For invalid conservative treatment of pregnancy with ureteral calculi,the occurrence of renal colic,kidney water and upper urinary tract infection,double J tube placed under the endoscope is a safe and effective treatment method.%目的 探讨放置双J管治疗妊娠合并输尿管结石的临床疗效和安全性.方法 回顾性分析汉中市中心医院2009年1月至2014年12月行膀胱镜下置入双J管治疗的36例妊娠合并输尿管结石患者的临床资料.观察其疗效并记录不良事件发生情况.结果 36例手术均成功,无严重并发症出现.置入双J管后36例患者肾绞痛、肾积水及上尿路感染均缓解,患者均足月顺利分娩.分娩后复查22例患者结石自行排出,另14例患者行体外碎石、输尿管镜钬激光碎石术.随访7~60个月,无严重不良反应发生.结论 对于保守疗法无效的妊娠合并输尿管结石患者,发生肾绞痛、肾积水及上尿路感染者,膀胱镜下放置双J管是一种安全、有效的治疗方法.

  13. Bladder augmentation: Distal ureterocystoplasty with proximal ureteric reimplantation: A novel technique

    Directory of Open Access Journals (Sweden)

    Ramesh Babu

    2012-01-01

    Full Text Available A novel technique of bladder augmentation is reported, wherein the distal dilated ends of tortuous ureters were used for ureterocystoplasty while proximal remaining ureters reimplanted back into the native bladder.

  14. Ureteroscope pneumatic lithotripsy for 204 cases of ureteral calculi%输尿管镜气压弹道碎石术治疗输尿管结石204例效果观察及治疗策略

    Institute of Scientific and Technical Information of China (English)

    张力; 胡兴平; 王凯

    2012-01-01

    Objective To investigate the effect of ureteroscope pneumatic lithotripsy for ureteral calculi. Methods Pneumatic lithotripsy under ureteroscopy was used to treat 204 cases of ureteral calculi, including 16 cases (8% ) in middle ureter and 188 cases (92% ) in lower ureter, in which 6 cases were in the wall of urinary bladder. Results The operation time varied from 15 to 116 min (45 min on average). The success rate of ureteroscope pneumatic lithotripsy was 98.0% (200 cases). The intraoperative stone free rate was 96. 6%. Stones in 2 cases transferred to kidney. Thus the surgery ended in failure. Some stones in 3 cases transferred to kidney after ureteroscope pneumatic lithotripsy (diameterIS3 mm). Stones in 1 case were exceptionally hard which could not be shattered by pneumatic lithotripsy probe and transferred to surgery. In another case, due to severe local mucosal edema with hemorrhage caused by swelling in the opening of the wall of urinary bladder, we could not find the front opening of ureter and insert a guide wire into it. This case was then cured by both surgery and ureteroscope pneumatic lithotripsy. Postoperative hematuria was observed by naked eye or microscope in all the cases, and disappeared 2-3 days after operation. No complications such as perforation and infection were found in any cases. Conclusions Ureteroscope pneumatic lithotripsy for ureteral calculi is effective, safe, with small damage of tissue, fewer complications, which can be used as the top choice for ureteral calculi in middle and lower ureter.%目的 观察输尿管镜气压弹道碎石术治疗输尿管结石的效果.方法 应用输尿管镜下气压弹道碎石治疗输尿管结石204例,其中输尿管中段结石16例(占8%),输尿管下段结石188例(占92%),膀胱壁内段结石6例.结果 204例手术时间15 ~116分钟,平均45分钟;碎石成功率98.0%(200例),术中结石排净率96.6%,2例结石漂移至肾脏,未能完成手术;3例碎石后,

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

    Directory of Open Access Journals (Sweden)

    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.

  16. 3种微创手术治疗复杂性输尿管上段结石212例比较%A comparison of three surgical procedures of complicated upper ureteral calculi for 212 cases

    Institute of Scientific and Technical Information of China (English)

    李旭明; 程洪林; 郭闯; 程宗勇; 李锋; 张力; 李元仲

    2011-01-01

    Objective To compare the efficacy of three procedures, ureteroscopic litripsy(URL), minimally invasive percutaneous nephrolithotomy(MPCNL) ,and retroperitoneal laparoscopic ureterolithomy(RLU), for the treatment of complicated upper ureteral calculi. Methods Two hundred and thirteen cases of complicated upper ureteral calculi were treated in this hospital from February 2002 to February 2010,including fifty-two cases of URL, one hundred and seven cases of MPCNL, and fifty-four cases of RLU. Results The stone free rate seven days after operation:URL was 36.5%(19/52),MPCNL was 75.7%(81/107),RLU was 90.6% (48/53); the stone free rate one months after operation: URL was 71. 1% (38/52), MPCNL was 95. 3% (102/107), RLU was 96.2%(51/53); the stone-free rate three months after operation:URL was 82.7%(43/52),MPCNL was 98. 1%(105/107),RLU was 98.1%(52/53). There was significantly difference between URL and MPCNL(P<0.05) ,URL and RLU (P<0.05). There was also significantly difference between MPCNL and RLU in the near future(P<0. 05) ,but had no difference in long term. Conclusion High stone free rate can be obtained with RLU and MPCNL for impacted upper ureteral calculi. The stone-free rate is less satisfactory with URL.%目的 比较输尿管镜碎石(URL)、微创经皮肾镜取石(MPCNL)、后腹腔镜下输尿管切开取石(RLU)治疗复杂性输尿管上段结石的疗效.方法 回顾分析2002年2月至2010年2月复杂性输尿管上段结石212例,其中URL治疗52例,MPCNL治疗107例,RLU治疗54例.比较分析3种手术的治疗效果.结果 术后7 d结石清除率:URL组36.5%(19/52),MPCNL组75.7%(81/107),RLU组90.6%(48/53).术后1个月结石清除率:URL组73.1%(38/52),MPCNL组95.3%(102/107),RLU组96.2%(51/53).术后3个月结石清除率:URL组82.7%(43/52),MPCNL组98.1%(105/107),RLU组98.1%(52/53).URL组分别与MPCNL组、RLU组比较差异有统计学意义(P<0.05),MPCNL、RLU组之间比较近期差异有统计学意义(P<0.05),

  17. Clinical effect of percutaneous nephrolithotomy in upper ureteral calculi%经皮肾微造瘘取石术治疗输尿管上段结石的临床疗效

    Institute of Scientific and Technical Information of China (English)

    关宗杰; 李志军

    2015-01-01

    Objective To analyze the clinical effects of micro-channel percutaneous nephrolithotomy and standard channel percutaneous nephrolithotomy.Methods 118 patients with ureteral calculi in our hospital from May 2010 to May 2014 were selected and divided into micro-channel percutaneous nephrolithotomy group (MCPN) and standard channel percutaneous nephrolithotomy group (SCPN) according to the surgical approach.Observed and compared changes of each indicator in two groups before and after surgery and postoperative recovery.Results The operative time,flushing water volume and operation bleeding of SCPN group were (83.89±11.04)min,(14900±1800)ml,(68.54±8.10) ml respectively,those of MCPN group were (101.66±12.56)min,(21000±1400)ml,(58.28±6.90)ml respectively.After treatment,the level of Scr in MCPN group significantly lowered,with shorter hospital stay and less surgery cost,with statistically significant differences (P<0.05).There were no statistically significant differences in calculi clearance and complication rate (postoperative bleeding,embolization,perforation,sepsis and so on) (P>0.05).Conclusions Micro-channel percutaneous nephrolithotomy for upper ureteral calculi has good clinical efficacy,the type of actual operation can be selected according to the size of calculi.%目的 分析微通道经皮肾镜取石术和标准通道经皮肾镜取石术的临床效果.方法 选择2010年5月至2014年5月在我院接受治疗的输尿管结石患者118例,根据手术方式不同将所选病例分为微造瘘取石术组和标准取石术组,观察并比较两组患者手术前后各项指标以及术后恢复情况.结果 标准取石术组患者手术时间、冲水量以及术中出血量分别为(83.89±11.04)min、(14900±1800)ml、(68.54±8.10)ml,微造瘘取石术组患者分别为(101.66±12.56)min、(21000±1400)ml、(58.28±6.90)ml.与标准取石术组患者比较,微造瘘取石术组术后Scr明显降低,住院时间短,手术费用

  18. Treatment of ureteral calculus obstruction with laser lithotripsy in an Atlantic bottlenose dolphin (Tursiops truncatus).

    Science.gov (United States)

    Schmitt, Todd L; Sur, Roger L

    2012-03-01

    An adult female bottlenose dolphin (Tursiops truncatus) presented with acute anorexia secondary to progressive azotemia (blood urea nitrogen = 213 mg/dl, creatinine [Cr] = 9.5 mg/dl) and electrolyte abnormalities (K = 7.4 mEq/L). It was later diagnosed with postrenal obstruction secondary to bilaterally obstructing ureteral calculi seen on ultrasound. Treatment of the obstruction required two endoscopic procedures, cystoscopy for ureteral stent placement and ureteroscopy to perform intracorporeal lithotripsy on the obstructing calculi. Before the first procedure, the dolphin's azotemia was stabilized with aggressive fluid therapy, peritoneal dialysis, and treatment for acidosis. Diuresis subsequent to the fluid therapy enabled passage of the right obstructing urolith. For both endoscopic procedures, the dolphin was placed in left lateral recumbency due to the peritoneal dialysis catheter in the right retroperitoneal region. For the first procedure, a 12-French (Fr) flexible cystoscope was inserted retrograde into the bladder via the urethra, whereupon a calculus was seen obstructing the left ureteral orifice. A 4.8-Fr, 26-cm double-pigtail ureteral stent was placed up the left ureter to relieve the postrenal obstruction. Inadvertent proximal migration of the left ureteral stent occurred during the procedure. However, renal parameters (serum Cr = 5.8, K = 5.4) improved significantly by the next day. For the second procedure, 28 hr later, ureteroscopy was performed to treat the calculus and replace the existing stent with a longer stent. The left ureteral calculus was pulverized into tiny fragments by using a holmium:yttrium-aluminum-garnet laser inserted through a 6.9-Fr semirigid ureteroscope. The migrated stent was visualized in the distal left ureter and replaced with a 90-cm single-pigtail ureteral stent that was sutured exterior to the urogenital slit and removed 3 days later. Renal function normalized over the next several days, and the dolphin recovered over

  19. 输尿管硬镜下钬激光碎石取石术治疗输尿管上段结石112例%Study on treatment of upper ureteral calculi using rigid ureteroscope and holmium:YAG laser lithotripsy (report of 112 cases)

    Institute of Scientific and Technical Information of China (English)

    徐汉新; 吴兆春; 黄海

    2014-01-01

    Objective To investigate clinical effect and safety of holmium: YAG laser lithotripsy under ureteroscopy for managing upper ureteral calculi. Methods The clinical data of 112 cases of ureter calculi treated by ureteroscope with Holmium laser lithotripsy were retrospectively analyzed. Among these patients, 63 were male, and 49 were female. The age of the patients varied between 18~87 years with a mean age of 46.7 years. The largest diameter of the largest stone was 0.7~2.2 cm (1.2±0.5 cm). There are 5 cases of bilateral upper ureteral calculi, and the total number of left upper ureteral calculi was 61, and the right side was 46. There were 26 cases affiliated with ureteral polypus, and 31 cases with ESWL treatment history preoperative. All the cases had different degrees of hydronephrosis. Results The overall successful operation rate for all level of ureteral stones in single procedure was 88.4% (99/112). The operation time ranged 15~80 min (33.6 ±16.8 min), and the postoperative hospital stay was 3~14 d (4.7 ±2.1 d). No complications occurred such as severe hematouria, ureteral perforation, ureteral avulsion and ureteral stone street in this post cohort operation. There were three cases with urinary tract infection and suffered fever. Urosepsis occurred in one case , and cured by timely anti-infection treatment. Conclusion Rigid ureterorenoscopy using Ho:YAG laser lithotripsy for upper ureteral calculi can be an effective and safely performed technique.%目的:探讨输尿管硬镜下钬激光碎石取石术治疗输尿管上段结石的临床效果及安全性。方法应用输尿管硬镜下钬激光碎石取石术治疗112例输尿管上段结石患者。男63例,女49例,年龄18~87岁(46.7±13.6岁),左侧61例,右侧46例,双侧5例。结石长径0.7~2.2 cm (1.2±0.5 cm)。26例合并输尿管息肉,31例曾行体外冲击波碎石术,所有患侧肾脏均合并不同程度肾积水。结果手术成功率88.4

  20. [Current treatment of ureteral lithiasis].

    Science.gov (United States)

    Reina Ruiz, C; Quintero Rodríguez, R; Espinosa Olmedo, J; Arrabal Martín, M; Campoy Martínez, P; Salazar Murillo, R; García Pérez, M

    1995-01-01

    The treatment of ureteral lithiasis has undergone a revolution since the arrival of new techniques offering different therapeutical choices for which time is gradually elucidating the indications for each of the new procedures; although, to a large extent, a degree of controversy still persists. This paper reviews the different methods for ureteral lithiasis; spontaneous ejection and medical treatment, surgery, early endoscopic manoeuvres, backward and forward urethroscopy and, finally, extracorporeal lithority. This therapeutical experience in 3 series of ureteral lithiasis addressed with different criteria are revised together with 182 obstructive calculi of the lumbar ureter. We believe that grading the ureteral calculi according to their anatomical and functional features improves the results, since improved adjustment can be achieved for the indications of the various methods. Also it is noted that support endourology for extracorporeal lithotrity does not improve the results of treatment in lumbar calculi under 2 cm, and therefore our current approach is towards "in situ" treatment without complementary manoeuvres. Finally we show the therapeutic algorithm we are following actually to manage ureteral litiasis.

  1. Laparoscopic ureteral reimplant for ureteral stricture

    Directory of Open Access Journals (Sweden)

    Rodrigo S. Q. Soares

    2010-02-01

    Full Text Available PURPOSE: Evaluate the initial experience of laparoscopic ureteral reimplant for ureteral stenosis. MATERIALS AND METHODS: From January 2004 to June 2008, 10 patients underwent 11 laparoscopic reconstruction surgeries for ureteral stenosis. Seven cases of stenosis of the distal ureter, two at the level of iliac vessels, a case of bilateral distal stenosis and one in the medium third. Eight ureteroneocystotomies were performed by extravesical technique with anti-reflux mechanism, two cases of vesical reimplant with Boari technique and one case using the psoas hitch technique. RESULTS: The average surgical time was 166 minutes (115-245 min, mean blood loss was 162 mL (100-210 mL and the average hospital stay was 2.9 days (2-4 days. There were two complications: a lesion of the sigmoid colon identified peroperatively and treated with laparoscopic sutures with good evolution, and a case of ureteral stone obstruction at the 30th day postoperative, treated by laser ureterolitotripsy. All patients had resolution of the stenosis at an average follow-up period of 18 months (3-54 months. CONCLUSIONS: Laparoscopic surgery represents a feasible, safe and low morbidity technique for ureteral reimplant in ureteral stenosis.

  2. The management of urolithiasis (ureteral calculi)in pregnancy%妊娠合并泌尿系结石的治疗方法研究

    Institute of Scientific and Technical Information of China (English)

    赵纯雄; 陈洪波; 胡晓辉; 朱圣亮

    2015-01-01

    目的::探讨妊娠合并泌尿系结石的治疗方法。方法:对51例因泌尿系结石入院的患者先给予间苯三酚(40 mg,每天2次)止痛解痉;若症状无缓解,给予单纯双 J 管留置或者硬膜外麻醉下输尿管镜碎石术。结果:23例患者经过保守治疗结石自动排出;28例症状无缓解,12例给予单纯双 J 管留置(2例结石自动排出,10例产后给予碎石治疗后痊愈),16例给予输尿管镜下钬激光碎石术,术后3周结石完全排出。所有患者治疗期间无产科及泌尿外科相关并发症发生。结论:妊娠合并泌尿系结石,首选保守治疗;若保守治疗无效,双 J 管留置或者输尿管镜下钬激光碎石术亦是安全有效的治疗措施。%Objective:To explore the treatment of of urolithiasis in pregnancy.Methods:51 pregnant women with urinary stone were given the benzene three phenol (40 mg,2 times a day)firstly;if symptoms were not re-lieved,patients were treated with double J tube insertion or ureteroscopic lithotripsy under local anesthesia or contin-ued epidural anesthesia.Results:Twenty-eight cases received conservative therapy which resulted in spontaneous stone expulsion.For patients failed to passage stone spontaneously,ten cases were performed double J tube insertion and 1 6 cases were performed ureteroscopic lithotripsy.There was no complication occurring associated to obstetrics and urology.Conclusions:It is advisable that conservative treatment is preferred to pregnancy associated with urinary calculi.if conservative treatment is invalid,the double J tube insertion or ureteroscopic holmium laser lithotripsy is also safe and effective.

  3. 输尿管镜下气压弹道碎石术治疗复杂性输尿管结石影响因素分析%Influencing factors analysis of ureteroscopic pneumatic ballistic lithotripsy in the treatment of complicated ureteral calculi

    Institute of Scientific and Technical Information of China (English)

    左泽平; 方军; 宇洪涛; 钱俊杰; 朱金海

    2015-01-01

    Objective To investigate the influencing factors of ureteroscopic pneumatic ballistic lithotripsy ( URSL) in the treatment of complicated ureteral calculi. Methods From June 2009 to July 2013, clinical data of 132 cases with complicated ureteral calculi at Tongling People’s Hospital were retrospectively analyzed. Among them, the successful operation for 111 cases as group A and 21 failed cases as group B , test was used to investigate the effect of treatment and influencing factors of patients in two groups. Results When the course of disease was more than 8 weeks, incarceration stones, stone size had significant difference (all P values 8周 vs≤8周)、结石嵌顿与否、结石大小(>1.2 cm vs≤1.2 cm)等指标两组患者比较差异有统计学意义(P值均<0.05),是影响URSL治疗输尿管结石疗效的主要因素。结论病程长、结石嵌顿、结石较大等因素直接影响URSL的效果;采取有效的干预措施,可减少输尿管镜碎石术的失败比例。

  4. B超引导单通道经皮肾镜气压弹道联合超声碎石术治疗肾及输尿管上段结石%Percutaneous nephrolithotomy with pneumatic and ultrasonic power under single channel by B-type ultrasound guidance for treatment of renal and upper ureteral calculi

    Institute of Scientific and Technical Information of China (English)

    熊丙建; 张志伟; 江铎; 唐明忠; 徐宝海; 张胜茹; 耿红卫; 雷霆; 张选举; 余义

    2011-01-01

    Objective To study the possibility and safety of curing the renal and upper ureteral calculi by percutaneous nephrolithotripsy with pneumatic and ultrasonic powers under singel channel by the guide of B-typc ultrasound. Methods The clinical data of 258 cases(271 sides) were treated by percutaneous nephrolithotripsy of using pneumatic and ultrasonic system (EMS Ⅲ) carryed on analysis, the curing effect and surgical operation carryed on summary. Results All cases were performed with single channel, surgical operation time 30 ~180 mins. Single side first calculi clearance leaded 84. 9 % (230/ 271) , renal calculi (include renal merger upper ureteral calculi) clearance leaded 79. 8% (154/193) . 39 remaining calcului second clearance leaded 92. 3% (36/39). Single side upper ureteral calculi first clearance leaded 97. 4% (76/78). No nephrectomyhem.opneumothorax and septic shock. 2 cases with delayed hemorrhage were cured by selectivity thrombosis of renal artery, the colon hurted a, turned to open 2.Conclusions Percutancous nephrolithotrpsy with pneumatic and ultrasonic powers under single channel treating the renal and upper ureteral calculi have operation time shorter and small wound,successive rate higher and have the advantage of operation through passage again. safety of operation and reliable efficacy.%目的 探讨B超引导单通道经皮肾镜气压弹道联合超声碎石术治疗肾及输尿管上段结石的可行性和安全性.方法 对本组258例(271侧)采用经皮肾镜气压弹道联合超声碎石清石系统(EMS Ⅲ)治疗肾及输尿管上段结石的临床资料进行分析,对一期治疗效果及手术并发症进行总结.结果 271侧全部经单通道取石,手术时间30~180 min.一期单侧结石清除率84.9%(230/271),肾结石(包括肾合并输尿管上段结石)一期清除率79.8%(154/193).39例残余结石二期结石清除率92.3%(36/39).输尿管上段结石一期单侧结石清除率97.4%(76/78).无肾切除、血气

  5. Ureteroscopic pneumatic lithotripsy in the treatment of upper urinary tract obstruction by ureteral cal-culi during pregnancy%输管尿镜下气压弹道碎石术治疗妊娠期输尿管结石引起上尿路梗阻

    Institute of Scientific and Technical Information of China (English)

    郑卓敏; 庄泽平; 连乐林; 黄芸珊; 陈燕东

    2016-01-01

    Objective To evaluate the feasibility and clinical efficacy of ureteroscopic pneumatic lithotrips in the treatment of upper urinary tract obstruction by ureteral calculi in pregnant women.Methods Thirty six women diagnosed with upper urinary tract obstruction by ureteral calculi during pregnancy were char-acterized with persistent and recurrent severe renal colic.Ureteroscope-guided pneumatic lithotripsy was per-formed.Results The ureteral calculi were successfully treated in 32 patients by ureteroscopic pneumatic litho-trips.Double-J ureteral stents were retained in four patients complicated with pyonephrosis,who were treated with extracorporeal shock wave lithotripsy after parturition.Renal colic and fever were absent after surgery.No abortion,prematurity,fetal death,ureter perforation or avulsion was noted.All pregnant women had full-term delivery and all newborns were healthy.Conclusion Ureteroscopic pneumatic lithotripsy could effectively and safely alleviate renal colic and treat obstruction in pregnant women with upper urinary tract obstruction by ure-teral calculi.%目的:探讨利用输尿管镜气压弹道碎石术治疗妊娠期输尿管结石引起上尿路梗阻的可行性及临床效果。方法对36例持续性或反复发作剧烈肾绞痛的妊娠期输尿管结石引起上尿路梗阻患者,采用输尿管镜下气压弹道碎石术治疗,观察手术疗效及安全性。结果输尿管镜下气压弹道碎石术一次性碎石成功32例,4例输尿管上段结石患者因合并脓肾予留置双 J 管,待患者妊娠结束后行体外冲击波碎石。术后所有患者的肾绞痛、发热等症状消失。36例均未出现流产、早产或死胎,无出现输尿管穿孔、撕脱等并发症,所有孕妇均足月分娩,新生儿发育均正常。结论输尿管镜下气压弹道碎石术治疗妊娠期输尿管结石引起上尿路梗阻能有效缓解患者疼痛,解除梗阻,且安全性高。

  6. Modern Approach to Ureteral Stones

    Directory of Open Access Journals (Sweden)

    Geert G. Tailly

    2003-01-01

    Full Text Available Urolithiasis is a very common affliction of mankind. In western countries incidence is increasing steadily. An increasing proportion of patients are presenting with ureteral stones, of which renal colic most often is the first complaint and the most common reason for an emergency visit to a urologist. Proper imaging strategy is of paramount importance in the diagnosis of acute flank pain and in the subsequent therapy planning once a ureteral stone is diagnosed. Renal colic during pregnancy poses specific problems, both in imaging and therapy. Apart from the adequate treatment of renal colic, modern therapy of those ureteral calculi that will not pass spontaneously will consist of a judicious combination of ESWL (extracorporeal shock wave lithotripsy, endourology, and laparoscopy. Open surgery should only be reserved for limited and very specific indications. Although beyond the scope of this article, metaphylaxis should take an important role in the follow-up of stone patients in general.

  7. The use of alpha-1 adrenergic blockers in children with distal ureterolithiasis: a systematic review and meta-analysis

    Science.gov (United States)

    Glina, F.P.; Castro, P.M.V.; Monteiro, G.G.R.; Guerra, G.C. Del; Glina, S.; Mazzurana, M.; Bernardo, W.M.

    2015-01-01

    ABSTRACT Introduction: Urinary lithiasis is the main urologic cause of emergency treatment in adult patient. In the past years, the incidence in children population has increased. However, literature about the use of alpha-1 adrenergic blockers in pediatric population with distal ureterolithiasis is still scarce. The drug acts by decreasing ureter contractions, especially in the distal portion, facilitating calculus expulsion. Objective: This review has the objective to evaluate the use of alpha-1 adrenergic blockers as medical expulsive treatment in children with distal ureterolithiasis. Evidence Acquisition: An electronic literature search was performed using the MEDLINE, COCHRANE, and LILACS databases. We further searched manually the references of the primary studies. Searches were concluded on October 4th, 2014. Articles were selected, independently and in pairs, by the respective titles and summaries. Any divergence was resolved by consensus. Evidence Synthesis: Alpha-1 adrenergic antagonists increased the probability of calculus expulsion by 27% (NNT=4). Calculi smaller than 5mm, increased by 33% (NNT=3). Larger than 5mm, increased by 34% (NNT=3). Conclusion: Alpha-1 adrenergic blocker use is related with a greater incidence of expulsion of ureteral calculi, smaller or greater than 5mm, and fewer episodes of pain when compared to ibuprofen. However it is necessary larger samples to enhance the power analysis of the expulsion of ureteral calculi larger than 5mm and the episodes of pain. Patient Summary: This review analyzed the outcome of alpha adrenergic antagonist in children with ureteral calculi. We conclude that it is the best medicine for use, since it helps the expulsion of the stone. PMID:26717117

  8. The use of alpha-1 adrenergic blockers in children with distal ureterolithiasis: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    F.P. Glina

    2015-12-01

    Full Text Available Introduction: Urinary lithiasis is the main urologic cause of emergency treatment in adult patient. In the past years, the incidence in children population has increased. However, literature about the use of alpha-1 adrenergic blockers in pediatric population with distal ureterolithiasis is still scarce. The drug acts by decreasing ureter contractions, especially in the distal portion, facilitating calculus expulsion. Objective: This review has the objective to evaluate the use of alpha-1 adrenergic blockers as medical expulsive treatment in children with distal ureterolithiasis. Evidence Acquisition: An electronic literature search was performed using the MEDLINE, COCHRANE, and LILACS databases. We further searched manually the references of the primary studies. Searches were concluded on October 4th, 2014. Articles were selected, independently and in pairs, by the respective titles and summaries. Any divergence was resolved by consensus. Evidence Synthesis: Alpha-1 adrenergic antagonists increased the probability of calculus expulsion by 27% (NNT=4. Calculi smaller than 5mm, increased by 33% (NNT=3. Larger than 5mm, increased by 34% (NNT=3. Conclusion: Alpha-1 adrenergic blocker use is related with a greater incidence of expulsion of ureteral calculi, smaller or greater than 5mm, and fewer episodes of pain when compared to ibuprofen. However it is necessary larger samples to enhance the power analysis of the expulsion of ureteral calculi larger than 5mm and the episodes of pain. Patient Summary: This review analyzed the outcome of alpha adrenergic antagonist in children with ureteral calculi. We conclude that it is the best medicine for use, since it helps the expulsion of the stone.

  9. 双源双能量CT对新疆南疆地区儿童输尿管结石的诊断价值%The Value of Dual-source Dual-energy CT in the Diagnosis of Ureteral Cal-culi in Children in Southern Xinjiang

    Institute of Scientific and Technical Information of China (English)

    马依迪丽·尼加提; 田序伟

    2015-01-01

    Objective To explore the application value of low-dose dual-source dual-energy CT in the diagnosis of urinary tract stones in children. Methods This study will explore the dual energy CT technology in southern xinjiang xinjiang regional chil-dren's disease diagnosis and differential diagnosis of ureteral calculi application value, and the image quality, the signal-to-noise ratio, lesion detection rate and identify differences, evaluate the feasibility of its application in clinical, 56 children cases CT in-spection and ultrasonic inspection group, analysis between the two groups statistically for difficult diagnosis of ureteral calculi. Results The dual source CT dual energy diagnosis of 56 cases of ureteral calculi children, all cases by ultrasound, including 1 case of abdominal segment, 3 cases of basin section, 2 cases of multiple ultrasound was not diagnosed or missed diagnosis of ureteral calculi. CT in the diagnosis of 47 cases with kidney seeper, 14 patients with moderately severe water, 9 cases with merger of urinary tract infection, 2 cases of diagnosis of urinary tuberculosis, 1 case of neurogenic bladder. Conclusion Low-dose CT in the diagnosis of dual energy not diagnosed with routine inspection method and its complications, complications were found very good diagnostic value.%目的:双源双能量低剂量CT在诊断儿童泌尿系结石中的应用价值。方法该研究将探究采用双能量CT技术在新疆南疆地区儿童输尿管结石疾病诊断和鉴别诊断的意义,然后比较其图像质量、信噪比、病变检出率这几方面,分析其在临床诊断中的可行性,将56例儿童病例分CT检查组及超声检查组,分析两组间对于难诊断型输尿管结石的统计学差异。结果双源双能量CT诊断输尿管结石儿童56例,所有病例均经过B超检查,其中1例腹段、3例盆段、2例多发输尿管结石B超未诊出或漏诊;CT诊断47例有肾积水、其中14例伴有中重度积水,9

  10. Clinical management of ureteral calculi complicated with acute renal pelvis infec-tions during pregnancy%妊娠期输尿管结石合并急性肾盂感染43例临床治疗与分析

    Institute of Scientific and Technical Information of China (English)

    胡嘉盛; 袁鹤胜; 谢国海; 刘冠琳; 贾晓龙; 郑重; 程跃

    2015-01-01

    目的 探讨妊娠期输尿管结石合并急性肾盂感染的治疗方法,总结相关临床经验.方法 回顾性分析2012年1月~2014年8月妊娠期输尿管结石合并急性肾盂感染43例患者资料,积极抗感染治疗的同时积极在局麻下行输尿管支架置入,其中4例患者插管前后发生感染性休克.结果 本组43例,39例妊娠期输尿管结石合并急性肾盂感染患者行局麻下行输尿管支架置入后,体温在1~4 d内恢复,白细胞计数在3~6 d内恢复正常.4例发生感染性休克,转IC U 治疗.其中2例患者在支架管置入后发生感染性休克转IC U,1例入院后即刻发生感染性休克,转IC U积极抗感染、抗休克治疗1~2 d病情稳定后再行支架管置入,1例插管时出现感染性休克前兆,插管后立刻转入IC U治疗.所有患者内置双J管3月后更换或拔除.结论 输尿管双J管置入治疗妊娠期输尿管结石合并急性肾盂感染安全有效,即使出现感染性休克前兆,只要有可能应尽早行输尿管双J管置入,解除梗阻,生命体征不稳定时,积极抗感染,抗休克、补液对症治疗生命体征平稳后仍应尽早采取输尿管双J管置入,为感染性休克的控制治疗创造有利条件.%Objective To explore the treatment of ureteral calculi complicated with acute renal pelvis infections during pregnancy.Methods Clinical data of 43 pregnant patients who suffered from ureteral calculi complicated with acute renal pel-vis infections treated in our hospital during Jan.2012 to Aug.2014 were retrospectively analyzed.The patients received active anti-infection treatment,and then ureteral stents under local anesthesia were placed.Results After the placement of ureteral stents,the body temperature of 39 patients returned to normal within 1 to 4 days,and white blood cell count returned to nor-mal within 3 to 6 days.Septic shock occurred in 4 patients,who were immediately transferred to ICU.Of these 4 cases,septic shock occurred in 2

  11. Common site of urinary calculi in kidney, ureter and bladder region.

    Science.gov (United States)

    Chand, R B; Shah, A K; Pant, D K; Paudel, S

    2013-03-01

    Urolithiasis is an ancient disease with global distribution. It refers to stones originating anywhere in the urinary system. Urinary calculi or stones are the most common cause of acute urinary system obstruction. The study was aimed with finding out the common site of urinary calculus in kidney ureter bladder (KUB) region. This was a prospective cross-sectional study conducted from June 2012 to September 2012 at Tribhuvan University, Teaching Hospital, Maharajgunj. A total 240 urolitiasis patients were enrolled for plain KUB examination. Site of urinary calculus was identified by observing KUB film of the subjects under the supervision of radiologist. The data were analyzed prospectively with outcome measures of gender & stone location. Out of 240 patients, 138 were male and 102 were female with male to female ratio of 1.35:1. The age ranged from 9 to 83 years. Out of total 240 patients, 71.9% (187) patients belonged to productive age group (20-60 years). Total number of urinary calculi was 345 in which 208 were found in male patients and 137 were found in female patients. Of total 345 calculi, 237 were renal stones, 47 were ureteric stones, 22 of the stones were found in pelviureteric junction (PUJ), 33 of stones were found in vesicoureteric junction (VUJ), and 6 were in bladder. In conclusion, urinary stone disease is a major public health problem in a developing country like Nepal with male and productive age group predominance. Kidney stones are most common. Distal ureter is the most common site of ureteric stone.

  12. Clinical effect of extracorporeal shock wave lithotripsy combined with drug therapy in the treatment of lower ureteral calculi%体外冲击波碎石联合药物治疗输尿管下段结石的临床效果

    Institute of Scientific and Technical Information of China (English)

    王洪海; 谭琳

    2015-01-01

    Objective To explore the clinical effect of extracorporeal shock wave lithotripsy combined with terazosin hydrochloride in the treatment of lower ureteral calculi. Methods 184 patients with lower ureteral calculi in the urinary system in our hospital from November 2012 to November 2014 were selected and randomly divided into the control group and the experiment group,92 patients in each group.The control group was treated with extracorporeal shock wave lithotripsy alone,the experiment group was treated with extracorporeal shock wave lithotripsy combined with terazosin hydrochloride.The clinical effect in two groups was compared. Results The cure rate and the total effective rate in the experiment group was higher than that in the control group,with significant difference (P<0.05).The application rate of painkiller in the experiment group was lower than that in the control group,with significant difference (P<0.05). Con-clusion The effect of extracorporeal shock wave lithotripsy combined with terazosin hydrochloride in the treatment of lower ureteral calculi in the urinary system is significant,which can eliminate the stones inside patients’body,reduce patients’pain.%目的:探讨体外冲击波碎石联合盐酸特拉唑嗪治疗输尿管下段结石的临床效果。方法选取2012年11月~2014年11月本院收治的184例泌尿系统输尿管下段结石患者作为研究对象,随机分为对照组和试验组,各92例。对照组采用体外冲击波碎石治疗,试验组采用体外冲击波碎石联合盐酸特拉唑嗪治疗,比较两组的临床效果。结果试验组的治愈率与总有效率显著高于对照组,差异有统计学意义(P<0.05)。试验组的止痛药物使用率显著低于对照组,差异有统计学意义(P<0.05)。结论体外冲击波碎石联合盐酸特拉唑嗪治疗输尿管下段结石效果显著,能更好地清除患者体内的碎石,减少患者病痛。

  13. Acute ureteric calculus obstruction: unenhanced spiral CT versus HASTE MR urography and abdominal radiograph.

    Science.gov (United States)

    Regan, F; Kuszyk, B; Bohlman, M E; Jackman, S

    2005-06-01

    The aim of this study is to compare the performance of unenhanced spiral CT to the combination of HASTE MR urography (MRU) and plain abdominal radiography (KUB) in patients suspected of having acute calculus ureteric obstruction. 64 patients with suspected acute calculus ureteric obstruction were evaluated. The presence of perirenal fluid, presence and level of ureteric obstruction and calculi were assessed on both techniques. 44 of 64 (69%) patients had acute calculus ureteric obstruction based on clinical, radiographic or surgical findings. MRU showed perirenal fluid in acute ureteric obstruction (77%) with a greater sensitivity than CT showed stranding (45%). The combination of fluid and ureteric dilation on MRU showed a sensitivity of 93% (CT 80%), specificity of 95% (CT 85%), and accuracy of 94% (CT 81%). There were 61 findings of either fluid or ureteric dilatation on MRU in 44 acutely obstructed kidneys compared with 37 similar findings on CT (p0.75) in the finding of perirenal fluid on MRU, there was only fair interobserver agreement (KappaMRU/KUB showed ureteric calculi in 21/29 (72%) of patients with calculi seen by CT. Overall, MRU/KUB revealed 2.4 abnormalities per acutely obstructed ureter compared with 1.8 abnormalities detected by CT. MRU/KUB using HASTE sequences can diagnose the presence of acute calculus ureteric obstruction with similar accuracy to spiral CT. The technique has less observer variability and is more accurate than CT in detecting evidence of obstruction such as perirenal fluid.

  14. Accuracy of ultrasound versus computed tomography urogram in detecting urinary tract calculi.

    Science.gov (United States)

    Salinawati, B; Hing, E Y; Fam, X I; Zulfiqar, M A

    2015-08-01

    To determine the (i) sensitivity and specificity of ultrasound (USG) in the detection of urinary tract calculi, (ii) size of renal calculi detected on USG, and (iii) size of renal calculi not seen on USG but detected on computed tomography urogram (CTU). A total of 201 patients' USG and CTU were compared retrospectively for the presence of calculi. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value of USG were calculated with CTU as the gold standard. From the 201 sets of data collected, 59 calculi were detected on both USG and CTU. The sensitivity and specificity of renal calculi detection on USG were 53% and 85% respectively. The mean size of the renal calculus detected on USG was 7.6 mm ± 4.1 mm and the mean size of the renal calculus not visualised on USG but detected on CTU was 4 mm ± 2.4 mm. The sensitivity and specificity of ureteric calculi detection on USG were 12% and 97% respectively. The sensitivity and specificity of urinary bladder calculi detection on USG were 20% and 100% respectively. This study showed that the accuracy of US in detecting renal, ureteric and urinary bladder calculi were 67%, 80% and 98% respectively.

  15. ANALYSIS OF THE CURATIVE EFFECT OF URL AND ESWL ON URETERAL CALCULI TREAT OF THE OLD PATIENTS%URL与ESWL治疗老年输尿管结石的疗效分析

    Institute of Scientific and Technical Information of China (English)

    刘岩山

    2012-01-01

    [目的]探讨输尿管镜下气压弹道碎石(URL)和体外冲击波碎石(ESWL)治疗老年输尿管结石的疗效.[方法]回顾性分析2007年1月~2010年12月在某院分别采用URL与ESWL治疗的输尿管结石老年患者临床资料.[结果] URL组总成功率和中下段结石成功率明显高于ESWL组,差异有统计学意义(均P<0.01);上段结石成功率低于ESWL组,差异有统计学意义(P<0.05).URL组发热和肾绞痛均明显少于ESWL组,差异有统计学意义(均P<0.01);恶心呕吐、肉眼血尿和输尿管穿孔差异均无统计学意义(均P> 0.05).[结论]URL在微创性上更有优势,ESWL应作为老年输尿管上段结石的首选,URL应作为老年输尿管中下段结石的首选.%{Objective] To investigate the therapeutic effect of Ureteroscopic Iithotripsy (URL) and Extracorporeal Shock Wave Iithotripsy {ESWL) on the ureterai calculi in the old patients. [Methods] A retrospective analysis was carried out for the therapeutic effect of URL and ESWL treatment on ureterai calculi of elderly patients from January 2007 years to De* 0.0S). [Conclusion] Minimally invasive URL treatment has more advantages. ESWL should be the Crest choice with upper ureleral calculi, and URL should be the first choice for lower ureterai cal-cuili for the old patients.

  16. Management of ureteral stenting for postrenal failure during pregnancy after ureteral reimplantation: a case report.

    Science.gov (United States)

    Yoneoka, Yutaka; Kaku, Shoji; Tsuji, Shunichiro; Yamashita, Hiroto; Inoue, Takashi; Kimura, Fuminori; Murakami, Takashi

    2016-04-01

    Vesicoureteral reflux is thought to predispose to urinary tract infection and renal scarring, and ureteral reimplantation in childhood remains the gold standard for its treatment. It has been reported that the risk of postrenal failure during pregnancy is increased among women with Politano-Leadbetter ureteral reimplantation. In previous case reports on patients with progressive hydronephrosis and renal failure during pregnancy after ureteral reimplantation, percutaneous nephrostomy was always required, so there has been no information about the clinical management of such patients by ureteral stenting. Here we report a patient with a history of bilateral ureteral reimplantation, in whom severe hydronephrosis during pregnancy was managed with ureteral stents. A primigravida with severe hydronephrosis was referred to us at 29 weeks of gestation. Bilateral Politano-Leadbetter ureteral reimplantation had been performed at the age of 3 years. She was hospitalized immediately, and bilateral ureteral stents were successfully inserted. Post-obstructive diuresis occurred after the stents were placed. Urinary tract infection developed after removal of the urethral catheter 1 week later, but responded to antibiotic therapy and catheter replacement. Labor was induced at 39 weeks of gestation, with vaginal delivery of a healthy male infant. Both stents were found to have spontaneously migrated into the urethra after delivery. Repeat stenting under spinal anesthesia was required to improve postpartum symptoms of back pain and fever. Right distal ureteral obstruction persisted at 6 months after delivery and repeat ureteral reimplantation is planned. General obstetricians will not necessarily pay attention to a history of Politano-Leadbetter ureteral reimplantation, but these patients should undergo careful monitoring of renal function and urinary tract morphology during perinatal care. In the present case, ureteral stenting was effective for postrenal failure during pregnancy

  17. [Ureteral reimplantation].

    Science.gov (United States)

    Aboutaieb, R; Rabii, R; Joual, A; el Mrini, M; Benjelloun, S

    1996-01-01

    Various techniques of ureteral reimplantation have been described for different indications. After a retrospective study concerning 109 cases and 178 ureteral reimplantations, the authors propose the selective indications for each technique noting the most important results. The indications for reimplantations are numerous and varied: enterocystoplasty (60 cases), iatrogenic lesion of the pelvic ureter (11 cases), inflammatory stenosis (13 cases), renal transplantation (20 cases), primary megaureter (4 cases), stenosis of reimplantation (2 cases). 5 techniques were used in this study: Leduc-Camey, Leadbetter-Politano, Direct, Manchette, Lich-Gregoir. We conclude that in ureterodigestive reimplantation, Leduc-Camey modified method is indicated. In renal transplantation, Lich-Gregoir is the ideal technique. In primary megaureter, the Leadbetter-Politano procedure possibly with ureter modelling improves the results. In iatrogenic lesions of the pelvic ureter, Leadbetter-Politano technique and possibly a hitch-bladder gives a good result.

  18. Microscopic hematuria and calculus-related ureteral obstruction.

    Science.gov (United States)

    Stewart, D P; Kowalski, R; Wong, P; Krome, R

    1990-01-01

    The evaluation of patients with ureteral calculi in the emergency department has historically included urinalysis (UA) and intravenous pyelograms (IVP). This retrospective study was done to determine if a statistically significant relationship existed between the degree of calculus-related ureteral obstruction, proven by IVP, and the presence or absence of microscopic hematuria. Urine red blood cells were recorded as less than 3 rbc/hpf (negative) or greater than or equal to 3 rbc/hpf (positive). IVPs were recorded as nonsevere or severe. IVP criteria were based on the presence or absence of extravasation, greater than 2-hour ureteral filling times, and a numerical scoring system of 1 to 4 for ureteral or calyceal dilatation and nephrogenic effect. Eighty-nine men (72%) had non-severe obstructions and 34 (28%) had severe obstructions. Twenty-five women (68%) had nonsevere obstructions and 12 (32%) had severe obstructions. Of the 28 patients with normal UAs, 11 had severe ureteral obstructions and 17 had nonsevere ureteral obstructions. There were no statistically significant differences between the presence or absence of significant microscopic hematuria and the presence or absence of severe ureteral obstruction. Microscopic hematuria is neither sensitive nor specific in determining the degree of calculus-related ureteral obstruction.

  19. 膀胱镜下留置双 J 管治疗妊娠期输尿管结石的临床观察%The clinical observation and prognosis of indwelling double J tube by cystoscope for pregnancy with ureteral calculi

    Institute of Scientific and Technical Information of China (English)

    卢大乔; 周长春; 熊冰; 金亿里

    2016-01-01

    目的探讨膀胱镜下留置双 J 管治疗妊娠期输尿管结石临床效果,并观察与分析其预后,为临床治疗提供依据。方法选取妊娠期输尿管结石患者46例,均应用膀胱镜下留置双 J 管治疗。观测指标为手术时间、手术基本情况、术后一周随访观察其并发症等;治疗前后48 h 采用视觉类比量表(VAS)对疼痛程度进行评估。观察分娩前孕妇双 J 管位置情况及分娩状况。结果46例患者均成功置管,平均手术时间(29.14±3.27)min。37例患者的腰部绞痛及发热等症状经治疗后均得到缓解。6例患者均于双 J 管置入术2个月门诊复查后更换双 J 管。治疗后 VAS 评分为(1.16±0.83)分,低于治疗前(6.93±1.02)分,差异均有统计学意义(t =9.64,P <0.05);治疗后肾积水和尿路感染分别为4.35%(2/46)和0.00%(0/46),低于治疗前的32.61%(15/46)和19.57%(9/46),差异均有统计学意义(χ2=8.33、9.05,均 P <0.05);46例孕妇均顺利生产,无流产等产科并发症。平均留置双 J 管(5.08±1.16)个月。结论膀胱镜下留置双 J 管治疗妊娠期输尿管结石创伤较小、结石清除率高、术后并发症少且安全性高、预后良好,是一种安全有效的方法。%Objective To explore the effect of the cystoscope indwelling double J tube for the treatment of pregnancy with ureteral calculi,and to observe and analyze the prognosis,and provide the basis for clinical therapy. Methods 46 pregnant women with ureteral calculi were selected.All patients were treated by cystoscope indwelling double J tube.Observation indexes were the follow -up complications after a week of operation time,operation situa-tion,Visual analogue scale (VAS)was used to evaluate the degree of pain operation before and after treatment 48 h. To observe the pregnant women with double J tube placement and

  20. [Strategy changes in the treatment of ureteral lithiasis and nephritic colic].

    Science.gov (United States)

    González Enguita, C; Calahorra Fernández, F J; García de la Peña, E; Rodríguez-Miñón Cifuentes, J L; Vela Navarrete, R

    1996-04-01

    Since lithotripters were first introduced to the clinical practice in 1980, extracorporeal shock wave lithotrite (ESWL) has been universally recognized as the first choice to resolve urinary tract lithiasis, ureteral calculi being the most susceptible lithiasic site for controversy. The urologist approach to the lithiasic patient has changed mainly as compared to that of ureteral calculi. These profound changes translate an undeniable advance of the extracorporeal procedures versus those of endourology, basically based on ESWL low morbidity. In those cases when lithiasis is found in a situation of nephritic colic, there is a real therapeutical chance with ESWL, thus leading to drug therapy losing its major role. We present 768 patients with ureteral lithiasis (1991-1994), 20-25% of which were examined for a nephritic colic. Once the colic situation is overcome in all instances, 35% will require a new lithotrite for complete lithiasic resolution. Overall, our rate of successful ureteral lithiasis resolution is 97% (30% need repeated session).

  1. Use of Mitrofanoff and Yang–Monti Techniques as Ureteric ...

    African Journals Online (AJOL)

    Distal ureteric stricture is a common complication of urinary schistosomiasis which is a ... We report the case of a 17-year-old Nigerian with a long standing recurrent painless ... The patient had bilateral tube nephrostomy and antibiotic therapy.

  2. Evaluation of pneumatic versus holmium:YAG laser lithotripsy for impacted ureteral stones.

    Science.gov (United States)

    Binbay, Murat; Tepeler, Abdulkadir; Singh, Avinash; Akman, Tolga; Tekinaslan, Erdem; Sarilar, Omer; Baykal, Murat; Muslumanoglu, Ahmet Yaser

    2011-12-01

    We prospectively analyzed and compared the effectiveness and complications of pneumatic lithotripter with a holmium:yttrium-aluminum-garnet (Ho:YAG) laser for the ureterorenoscopic management of impacted ureteral stones. From January 2006 to January 2008, we performed retrograde endoscopic treatment in 288 patients with ureteral stones in our clinic. The patients with impacted stones were randomized into two groups according to the lithotripter used to fragment the stone: pneumatic (n = 40) and laser (n = 40). The preoperative, operative, and post-operative follow-up findings were analyzed and compared. The average stone size was similar in both groups (118.8 ± 58.3 mm(2) vs. 110.7 ± 54.4 mm(2)). The calculi were located in the distal ureter in most of the patients in both groups (65% in pneumatic group and 52.5% in laser group). The operation time was significantly diminished in the laser group (P = 0.001). The stone-free rates after a single ureteroscopic procedure were 80 and 97.5% in the pneumatic and laser groups, respectively (P = 0.03). Auxiliary treatments were needed in seven patients in the pneumatic group, while only one patient in the laser group (P = 0.05) needed this treatment. After the additional procedures, a 100% success rate was achieved in both groups. The rate of double J stent insertion was significantly higher in the pneumatic group (P = 0.01). In the pneumatic group, four cases of stone up-migration and one case of post-operative stricture were seen, whereas only one case of stone up-migration was noted in the laser group. Our comparative study has shown that the use of Ho:YAG as an intracorporeal lithotripter during ureteroscopic management of impacted ureteral stones is highly efficient with high success rates, regardless of the stone location.

  3. Percutaneous ureteral stent placement for the treatment of a benign ureteral obstruction in a Sumatran tiger (Panthera tigris sumatrae).

    Science.gov (United States)

    Delk, Katie W; Wack, Raymund F; Burgdorf-Moisuk, Anne; Palm, Carrie A; Zwingenberger, Allison; Glaiberman, Craig B; Ferguson, Kenneth H; Culp, William T N

    2015-01-01

    A 15-year-old, 113 kg intact male Sumatran tiger (Panthera tigris sumatrae) was evaluated for weight loss, polydipsia, and intermittent hematuria. The tiger was immobilized for diagnostic testing including blood work, urinalysis, and abdominal ultrasound. Laboratory testing demonstrated macro- and microhematuria, azotemia, and an increased urine protein:creatinine ratio. Abdominal ultrasound revealed bilateral ureterolithiasis as well as hydronephrosis and ureteral dilation. Ultrasonography performed 5 months later revealed worsening of the right-sided hydronephrosis and hydroureter and a decrease in the severity of dilation on the left side presumably from passage of the left-sided ureteral calculi. Nephroureteral decompression via the placement of a stent was elected. A pigtail ureteral catheter (8.2 French diameter) was placed in the right ureter via an antegrade percutaneous approach utilizing ultrasound and fluoroscopic-guidance. Following stent placement, macrohematuria resolved although microhematuria was noted in opportunistic urine samples. Five months after stent placement, the azotemia had mildly progressed, the urine protein:creatinine ratio was improved, the right hydronephrosis and hydroureter had completely resolved, and the ureteral stent remained in the appropriate position. The tiger had clinically improved with a substantial increase in appetite, weight, and activity level. Ureteral stenting allowed for nephroureteral decompression in the captive large felid of this report, and no complications were encountered. Ureteral stenting provided a minimally invasive method of managing ureteral obstruction in this patient and could be considered in future cases due to the clinical improvement and low morbidity.

  4. Non-contrast thin-section helical CT of urinary tract calculi in children

    Energy Technology Data Exchange (ETDEWEB)

    Strouse, Peter J. [Section of Pediatric Radiology, University of Michigan Medical Center, Ann Arbor, MI (United States); Bates, Gregory D. [Department of Radiology, Columbus Children' s Hospital, Columbus, OH (United States); Bloom, David A. [Department of Pediatric Imaging, Children' s Hospital of Michigan, Detroit, MI (United States); Goodsitt, Mitchell M. [Department of Radiology, University of Michigan Medical Center, Ann Arbor, MI (United States)

    2002-05-01

    Background: Non-contrast thin-section helical CT has gained acceptance for the diagnosis of urinary tract calculi in adults, but experience with the technique in children is limited. Purpose: To evaluate the utility of non-contrast thin section helical CT for the diagnosis of urinary tract calculi in children. Materials and methods: Radiology databases at three pediatric institutions were searched to identify all pediatric patients evaluated by ''renal stone'' protocol CT scans (no oral or intravenous contrast, scans covering the entire urinary tract obtained in helical mode with narrow collimation (< 5 mm)). CT scans were reviewed for the primary finding of urinary tract calculi, for secondary signs of acute urinary tract obstruction and for evidence of alternative diagnoses. Medical records were reviewed to determine clinical presentation and to confirm the eventual diagnosis. Results: One hundred thirty-seven scans of 113 children (mean age: 11.2 years) were studied. Thirty-eight of 94 examinations (40%) performed on 82 children for acute pain and/or hematuria showed ureteral calculi. Alternative diagnoses were suggested by CT on 16 scans (17%). Twenty-eight scans were performed on 10 asymptomatic children with known calculus disease confirming renal stone burden on 21 scans (75%) and persistent ureteral calculi on 6 scans (21%). Upper tract calculi were demonstrated on 10 of 15 scans (67%) performed to evaluate for calculi in patients with known non-calculus genitourinary tract abnormalities. Conclusions: Non-contrast thin section helical CT is a useful method to diagnose urinary tract calculi in children. Radiation dose in this retrospective study may exceed the lowest possible radiation dose for diagnostic accuracy. Further research is needed to optimize CT imaging parameters, while maintaining diagnostic accuracy and minimizing radiation dose. (orig.)

  5. [Unusual elements in renal calculi].

    Science.gov (United States)

    Rodríguez-Miñón Cifuentes, J L; Salvador, E; Traba Villameytide, M L

    2006-01-01

    A group of 54 renal calculi were spontaneously passed renal stone after a nephritic colic. Two groups of calculi were found: papillary and non-papillary calculi. All calculi were analyzed by infrared spectroscopy and electronic microscopy scan (EMS) and EDAX. When the stones were analyzed with EDAX, elements such as C, N, O, Na, S, Mg, Al, Si, Cl, K, Ca, Mn, Fe, Ni, Zn were detected. The possible origin of these elements is discussed in this work.

  6. PROSPECTIVE STUDY OF TAMSULOSIN IN THE MANAGEMENT OF CALCULI IN LOWER THIRD OF URETER

    Directory of Open Access Journals (Sweden)

    Arunabha

    2015-04-01

    Full Text Available INTRODUCTION: Urinary calculus disease is one of the 3 most common urological diseases . It affects about 12 % of the world population and has become a worldwide health problem . Of all the urinary tract stones 20% are ureteral stones , of which 70% are found in the lower third of ureter . Patients with ureteric calculi have wide range of complications which includes acute pain necessitating hospitalization , urinary tract infection , anuria , acute renal failure , chronic renal failure , hydronephrosis , pyonephrosis , pyelonephritis . The objective of the study is , t o study the effect of Tamsulosin in the passage of calculi in the lower one third of the ureter compared to NSAIDs and oral and IV fluids . MATERI AL AND METHOD: This study included a total of 82 patients between the study period from Nov 20 10 to May 201 3 . 42 patients were chosen randomly and advised to take plenty of oral fluids and treated with NSAIDs ( Diclofenac sodium and the other 40 patients w ere treated with Tamsulosin ( alpha blocker 0 . 4mg HS for one month along with oral fluids and NSAIDs ( Diclofenac sodium . RESULTS: Majority of the patients were in the age group of 20 - 40 yrs . The mean size of the calculus was 6 . 62 cms on the right side and 6 . 07 cms on the left side . Out of the 40 patients who were on alpha 1 blocker ( Tamsulosin 31 patients had passed the calculi and 9 patients had no results with a success rate of 77 . 5% . In the 42 patients who were not on Tamsulosin , 8 patients passed the calculi and 34 patients did not pass the calculi . 9 patients among the 42 underwent ureterorenoscopy ( URS . CONCLUSION : Tamsulosin is an effective and safe drug in the management of calculi in the lower 1/3 rd of the ureter . Most patients with ureteric calc uli were rendered stone free with endourological procedures if conservative treatment failed .

  7. US and MDCT findings in a caudal blind ending bifid ureter with calculi

    Directory of Open Access Journals (Sweden)

    Caglar Uzun

    2011-09-01

    Full Text Available Herein we present a rare ureteric duplication anomaly; blind ending bifid ureter with calculi which is asymptomatic unless complicated by infection, reflux, calculi or malignancy. The diagnosis is often missed at intravenous urography (IVU and US because the ipsilateral ureter and kidney are grossly normal. In this case the diagnosis was established with ultrasound (US and mainly with multidetector computerized tomography (MDCT imaging using multiplanar reformats and 3-D reconstructions which were unique to this case. MDCT scans not only revealed the exact diagnosis and anatomic relationships but also ruled out other pathologies included in the differential diagnosis as well, such as ureter and bladder diverticula.

  8. US and MDCT findings in a caudal blind ending bifid ureter with calculi

    Directory of Open Access Journals (Sweden)

    Evren Ustuner

    2011-11-01

    Full Text Available Herein we present a rare ureteric duplication anomaly; blind ending bifid ureter with calculi which is asymptomatic unless complicated by infection, reflux, calculi or malignancy. The diagnosis is often missed at intravenous urography (IVU and US because the ipsilateral ureter and kidney are grossly normal. In this case the diagnosis was established with ultrasound (US and mainly with multidetector computerized tomography (MDCT imaging using multiplanar reformats and 3-D reconstructions which were unique to this case. MDCT scans not only revealed the exact diagnosis and anatomic relationships but also ruled out other pathologies included in the differential diagnosis as well, such as ureter and bladder diverticula.

  9. Verification of Stochastic Process Calculi

    DEFF Research Database (Denmark)

    Skrypnyuk, Nataliya

    Stochastic process calculi represent widely accepted formalisms within Computer Science for modelling nondeterministic stochastic systems in a compositional way. Similar to process calculi in general, they are suited for modelling systems in a hierarchical manner, by explicitly specifying...... subsystems as well as their interdependences and communication channels. Stochastic process calculi incorporate both the quantified uncertainty on probabilities or durations of events and nondeterministic choices between several possible continuations of the system behaviour. Modelling of a system is often...

  10. Extracorporeal shock wave lithotripsy of urinary calculi. Results from the first 306 patients treated at the Copenhagen Municipal Stone Center with a second generation lithotriptor

    DEFF Research Database (Denmark)

    Andersen, J T; Mogensen, P

    1991-01-01

    The first Danish experience with Extracorporeal Shock Wave Lithotripsy (ESWL) using a second generation Lithotriptor (Siemens Lithostar) is reported. 306 patients underwent 392 treatments for 363 stones. There were 339 renal calculi including 5 staghorn calculi and 54 ureteral calculi. Treatments...... were performed under local analgesia (82%) or epidural or general anesthesia (18%) when invasive procedures had to be done in connection with the treatment. Stone fragmentation was achieved with 2487 +/- 1262 shocks. The first months stone clearance rate was 45%; 26% had fragments less than 6 mm; 29...

  11. Case series demonstrating the clinical utility of dual energy computed tomography in patients requiring stents for urinary calculi.

    Science.gov (United States)

    Jepperson, Maria A; Thiel, David D; Cernigliaro, Joseph G; Broderick, Gregory A; Haley, William E

    2014-02-01

    Dual energy computed tomography (DECT) utilizes the material change in attenuation when imaged at two different energies to determine the composition of urinary calculi as uric acid or non-uric acid. We discuss a series of case reports illustrating DECT's ability to provide immediate determination of uric acid versus non-uric acid calculi and facilitate more informed clinical decision-making. Further, these cases demonstrate a unique population of patients with ureteral stents and percutaneous nephrostomy tubes that benefit from DECT's ability to create a virtual color contrast between an indwelling device and the stone material and thereby significantly impacting patient morbidity.

  12. States in Process Calculi

    Directory of Open Access Journals (Sweden)

    Christoph Wagner

    2014-08-01

    Full Text Available Formal reasoning about distributed algorithms (like Consensus typically requires to analyze global states in a traditional state-based style. This is in contrast to the traditional action-based reasoning of process calculi. Nevertheless, we use domain-specific variants of the latter, as they are convenient modeling languages in which the local code of processes can be programmed explicitly, with the local state information usually managed via parameter lists of process constants. However, domain-specific process calculi are often equipped with (unlabeled reduction semantics, building upon a rich and convenient notion of structural congruence. Unfortunately, the price for this convenience is that the analysis is cumbersome: the set of reachable states is modulo structural congruence, and the processes' state information is very hard to identify. We extract from congruence classes of reachable states individual state-informative representatives that we supply with a proper formal semantics. As a result, we can now freely switch between the process calculus terms and their representatives, and we can use the stateful representatives to perform assertional reasoning on process calculus models.

  13. [Complications of urinary calculi].

    Science.gov (United States)

    Joual, A; Fekak, H; Rabii, R; el Moussasoui, A; Benjelloun, S

    1996-01-01

    Urinary stones is a frequent disease whose renal complications can engage both functional and vital prognosis. We report 769 complicated cases observed 10 years. The diagnosis was made by intravenous urography and ultrasonography. 607 cases were mechanical complications, 582 hydronephrosis, 25 anuria, 262 were infectious complications, 82 chronic pyelonephritis, 60 pyonephrosis, 10 perinephric abscess. Treatment included adapted antibiotic therapy, ureteral catheter in case of anuria ; surgical extraction of the stone nephrectomy was performed in 100 patients. Results were generally good. 9 patients had endstage chronic renal failure. The high frequency of urinary stone complications is due to the fact that most patients consult late. The diagnosis must obviously be made.

  14. The first use of Resonance® metallic ureteric stent in a case of obstructed transplant kidney

    Science.gov (United States)

    Abdulmajed, Mohamed I.; Jones, Vaughan W.; Shergill, Iqbal S.

    2014-01-01

    INTRODUCTION To date, double JJ stent is the mainstay ureteric stent used in a transplant kidney. We herein report the first use of Resonance® metallic ureteric stent to manage ureteric obstruction in a transplant kidney. PRESENTATION OF CASE A 45-year-old lady underwent an uneventful living related donor renal transplantation. Due to post-operative pelvi-ureteric obstruction and recurrent obstruction following multiple distal stent migration and expulsion necessitated frequent nephrostomy insertion and antegrade stenting, she underwent challenging but successful retrograde insertion of a 12 centimetres long and size 6.0 French Cook Resonance® metallic ureteric stent which was performed under general anaesthesia. DISCUSSION Metallic ureteric stents are a fairly recent introduction to modern urology and they have been successfully used in the management of benign and malignant obstruction of ureter. CONCLUSION This is the first case of therapeutic metallic ureteric stent insertion in a transplant kidney. PMID:24858983

  15. Differential calculi on finite groups

    CERN Document Server

    Castellani, L

    1999-01-01

    A brief review of bicovariant differential calculi on finite groups is given, with some new developments on diffeomorphisms and integration. We illustrate the general theory with the example of the nonabelian finite group S_3.

  16. Ureteroscopic removal of forgotten ureteral stent

    Science.gov (United States)

    Kawahara, Takashi; Ishida, Hiroaki; Kubota, Yoshinobu; Matsuzaki, Junichi

    2012-01-01

    A 69-year-old female had a right ureteral stent placed due to ureteral stricture resulting from cervical cancer in March 2008. The ureteral stent migrated to the ureter and was not exchanged. A new ureteral stent was inserted, and was exchanged every 3 months. The patient was referred to our department to remove the forgotten ureteral stent. In January 2012, her old ureteral stent was removed ureteroscopically, and no ureteral stent encrustation was found. PMID:22707678

  17. Ureteral strictures revisited…trying to see the light at the end of the tunnel: a comprehensive review.

    Science.gov (United States)

    Tyritzis, Stavros I; Wiklund, Nils Peter

    2015-02-01

    A ureteral stricture is a rather rare urological event defined as a narrowing of the ureter causing a functional obstruction and renal failure, if left untreated. The aim of this review article is to summarize and discuss current knowledge on the incidence, pathogenesis, management, and follow up of proximal, mid, and distal ureteral strictures.

  18. Dissolution of struvite calculi by hemiacidrin solution.

    Science.gov (United States)

    Massaro, F J; Weiner, B; Sant, G R; Meares, E M

    1983-01-01

    Struvite calculi result from urinary tract infections secondary to urease-producing bacteria. To prevent recurrent infection and stone formation complete removal of struvite calculi is recommended. Two illustrative reports of patients with renal struvite calculi are presented in which 10% hemiacidrin (Renacidin) irrigation was instituted for stone dissolution. After surgical removal of the calculi a nephrostomy tube was placed in the renal pelvis. With confirmation of residual struvite calculi, 10% hemiacidrin irrigation was initiated. Urine cultures, electrolytes and nephrotomograms were performed and adverse effects monitored. Using strict aseptic technique and appropriate precautions, hemiacidrin irrigation safely dissolves struvite calculi.

  19. [Exceptional iatrogenic ureteral rupture].

    Science.gov (United States)

    Martínez-Vieira, Almudena; Valera-Sánchez, Zoraida; Sousa-Vaquero, José María; Palacios-González, Carmen; García-Poley, Antonio; Bernal-Bellido, Carmen; Alamo-Martínez, José María; Millán-López, Ana; Blanco-Domínguez, Manuel; Galindo-Galindo, Antonio

    2005-08-01

    Rupture of the ureter is an infrequent event that can have serious consequences. The most frequent cause is surgical iatrogenic ureter disease. Other possible causes are urological procedures and urographic studies. In our patient, which, to our knowledge, is the first to be reported in the literature, the ureteral rupture was produced by a traumatic urinary catheterism, because the balloon was filled inside the ureter. The normal presentation is nephritic colic, although acute abdomen is also a possibility. The possibility of ureteral rupture in abdominopelvic surgery or in urological techniques should be evaluated when patients present these clinical symptoms. Treatment is surgical, although in some cases conservative measures can be used.

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

    Science.gov (United States)

    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.

  1. Ureteral retrograde brush biopsy

    Science.gov (United States)

    ... biopsy URL of this page: //medlineplus.gov/ency/article/003906.htm Ureteral retrograde brush biopsy To use ... minutes. A cystoscope is first placed through the urethra into the bladder. Cystoscope is a tube with a ... results may show cancer cells ( carcinoma ). This test is often used to ...

  2. Medical management of common urinary calculi

    African Journals Online (AJOL)

    University of Kansas Medical Center, Kansas City, Kansas. Correspondence to: Dr ... visualized on plain film radiography. Many calculi .... pain have urinary calculi, so an impor- tant aspect of ..... stones in spinal cord injury patients. J Urol 1988 ...

  3. Treatment of lower urethral calculi with extracorporeal shock-wave lithotripsy and pneumatic ureteroscopic lithotripsy: a comparison of effectiveness and complications

    Institute of Scientific and Technical Information of China (English)

    钟惟德; 曾广翘; 蔡岳斌; 戴奇山; 胡建波; 魏鸿蔼

    2003-01-01

    Objective To determine the efficacy and incidence of complications of extracorporeal shock-wave lithotripsy (ESWL) compared with pneumatic ureteroscopic lithotripsy (URSL) in the treatment of lower uretheral calculi. Methods From August 1997 to June 1999, 210 patients with lower ureteric calculi were treated with ESWL and the other 180 with URSL. The stones were fragmented with pneumatic lithotripter. The outcome was assessed by evacuation, retreatment and complication rates.Results ESWL for lower ureteric calculi resulted in a stone evacuation rate of 78.1%, compared with 93.3% for URSL (P<0.05). ESWL had a retreatment rate of 11.9% and a perforation rate of 0, while URSL caused perforation of ureters in 3.3% of patients and a refreatment of 2.2%. Conclusion For the management of lower ureteric calculi, ESWL provides a non-invasive, simple and safe option, and URSL has a higher stone evacuation rate but causes ureter perforation more frequently than ESWL does. Both ESWL and URSL have their respective advantages. It is recommended, however, that URSL be extensively developed for better treatment efficacy, given that the operator has an adequate technical background.

  4. Urinary calculi following traumatic spinal cord injury

    DEFF Research Database (Denmark)

    Hansen, Rikke Bølling; Biering-Sørensen, Fin; Kristensen, Jørgen Kvist

    2007-01-01

    calculi was higher in the SCI population compared to the normal population. Bladder calculi primarily occur early post-injury and renal calculi appear both early post-injury and years later. Therefore, it is important to follow individuals with SCI regularly by means of urological investigations from...

  5. Therapeutic ureteral occlusion with Ifabond cyanoacrylate glue: an interesting solution.

    Science.gov (United States)

    Oderda, Marco; Lacquaniti, Sergio; Fraire, Flavio; Antolini, Jacopo; Camilli, Marco; Mandras, Roberto; Puccetti, Luca; Varvello, Francesco; Fasolis, Giuseppe

    2017-08-01

    The aim of this study was to present a novel approach for complete and permanent ureteral occlusion using a percutaneous injection of Ifabond cyanoacrylate glue. We describe in detail all the steps of our surgery, performed on a 79-year-old patient with urinary leakage from ureteral stump following radical cystectomy. N-hexyl-cyanoacrylate glue (Ifabond) was used to occlude the distal ureter and solve the leakage. Our approach was successful, sparing our already frail patient further surgical procedures. Six months pyelography confirmed the complete ureteral blockage with absence of extravasation. In complicated scenarios with urinary leakages and frail patients, synthetic glues such as Ifabond might represent an interesting therapeutic option to solve the fistulas, leading to durable success with a minimally invasive approach.

  6. Primary Giant Cell Malignant Fibrous Histiocytoma of the Kidney with Staghorn Calculi

    Directory of Open Access Journals (Sweden)

    Chen C

    2003-01-01

    Full Text Available Malignant fibrous histiocytomas (MFH as primary renal tumours are rare, with less than 50 cases described in the literature. We report a case of primary renal MFH of giant cell type in a 56-year-old man, who presented with bilateral dull flank pain, intermittent gross haematuria and body weight loss (6 kg in 3 months. Intravenous urography, computerized tomography (CT and magnetic resonance image (MRI showed right ureteral stones with mild hydronephrosis, and a solid mass at the lower pole of the left kidney associated with staghorn calculi, as well as tumour thrombi in the left renal vein and inferior vena cava. Left radical nephrectomy and evacuation of tumour thrombi from the left renal vein and inferior vena cava were performed. Histopathologic examination revealed malignant fibrous histiocytoma (MFH of giant cell type. To the best of our knowledge, this is the first report of primary renal MFH associated with staghorn calculi.

  7. Extensive bilateral emphysematous pyelonephritis with calculi managed conservatively with antibiotics and DJ stent

    Directory of Open Access Journals (Sweden)

    Madhulika Mahashabde

    2013-01-01

    Full Text Available Emphysematous pyelonephritis is a life threatening, necrotizing upper urinary tract infection associated with gas within the kidney and/or perinephric space. To prevent mortality from this fulminant infection, early diagnosis is essential. CT scan should be done early in patients with suspected emphysematous pyelonephritis. Here, we present a case of Type II Diabetes Mellitus complicated with left obstructive ureteric calculi, diagnosed on CT scan to have extensive bilateral emphysematous pyelonephritis of class 4. We treated conservatively with antibiotics and DJ stent. The patient responded and a repeat CT scan was done after 4 weeks which showed no evidence of emphysematous pyelonephritis.

  8. Calculi of meta-variables

    Institute of Scientific and Technical Information of China (English)

    Masahiko SATO; Takafumi SAKURAI; Yukiyoshi KAMEYAMA; Atsushi IGARASH

    2008-01-01

    The notion of meta-variable plays a fun-damental role when we define formal systems such as logical and computational calculi. Yet it has been usually understood only informally as is seen in most textbooks of logic. Based on our observations of the usages of meta-variables in textbooks, we propose two formal systems that have the notion of meta-variable. In both calculi, each variable is given a level (non-negative integer), which classifies variables into object variables (level 0), meta-variables (level 1), metameta-variables (level 2) and so on. Then, simple arity systems are. used to exclude meaningless terms like a meta-level function operating on the metameta-level. A main difference of the two calculi lies in the definitions of substitution. The first calculus uses textual substitution, which can often be found in definitions of quantified formulae: when a term is substituted for a meta-variable, free object-level variables in the term may be captured. The second cal-culus is based on the observation that predicates can be regarded as meta-level functions on object-level terms, hence uses capture-avoiding substitution. We show that both calculi enjoy a number of properties including Church-Rosser and Strong Normalization, which are indispensable when we use them as frameworks to define logical systems.

  9. Percutaneous dissolution of renal calculi.

    Science.gov (United States)

    Dretler, S P; Pfister, R C

    1983-01-01

    The use of percutaneous nephrostomy catheters has allowed access to intrarenal urinary calculi for dissolution. Renacidin is the successful agent for dissolving struvite stones. THAM-E is the most effective agent for the intrarenal dissolution of cystine stone. Calcium oxalate stones are still resistant to dissolution techniques.

  10. [Urinary calculi and infection].

    Science.gov (United States)

    Trinchieri, Alberto

    2014-01-01

    Infection urinary stones resulting from urease-producing bacteria are composed by struvite and/or carbonate apatite. Bacterial urease splits urea and promotes the formation of ammonia and carbon dioxide leading to urine alkalinization and formation of phosphate salts. Proteus species are urease-producers, whereas a limited number of strains of other Gram negative and positive species may produce urease. Ureaplasma urealyticum and Corynebacterium urealyticum are urease-producers that are not isolated by conventional urine cultures, but require specific tests for identification. Primary treatment requires surgical removal of stones as complete as possible. Extracorporeal and endoscopic treatments are usually preferred, while open surgery is actually limited to few selected cases. Residual stones or fragments should be treated by chemolysis via ureteral catheter or nephrostomy or administration of citrate salts in order to achieve a stone-free renal unit. Postoperatively, recurrent urinary tract infection should be treated with appropriate antibiotic treatment although long-term antibiotic prophylaxis can cause resistance. Urinary acidification has been proposed for the prophylaxis of infection stones, but long-term acidification is difficult to achieve in urine infected by urease-producing bacteria. Urease inhibitors lead to prevention and/or dissolution of stones and encrustations in patients with infection by urea-splitting bacteria, but their use is limited by their toxicity. The administration of citrate salts involves an increase of the value of nucleation pH (pHn), that is the pH value at which calcium and magnesium phosphate crystallization occurs, in a greater way than the corresponding increase in the urinary pH due to its alkalinizing effect and resulting in a reduction of the risk of struvite crystallization. In conclusion prevention of the recurrence of infection stones can be achieved by an integrated approach tailored on the single patient. Complete

  11. Endourological Management of Forgotten Encrusted Ureteral Stents

    Directory of Open Access Journals (Sweden)

    Kusuma V. R. Murthy

    2010-08-01

    Full Text Available PURPOSE: To present our experience and discuss the various endourological approaches for treating forgotten encrusted ureteral stents associated with stone formation. MATERIALS AND METHODS: From July 2006 to December 2008, 14 patients (11 men and 3 women with encrusted ureteral stents were analyzed. The average indwelling time of the stent was 4.9 years (range 1 to 12. Plain-film radiography was used to evaluate encrustation, stone burden, and fragmentation of the stents. Intravenous urogram and a Tc99m diethylene triamine penta acetic-acid renogram was used to assess renal function. RESULTS: In seven patients, the entire stent was encrusted, in three patients the encrustation was confined to the ureteral and lower coil part of the stent, two patients had encrustation of the lower coil, and minimal encrustation was observed in two patients. Percutaneous nephrolithotomy was performed in 5 cases and retrograde ureteroscopy with intra-corporeal lithotripsy in 9 patients. Cystolithotripsy was used to manage the distal coil of the encrusted stent in eight patients. Simple cystoscopic removal of the stents with minimal encrustation was carried-out in two cases. Looposcopy and removal of the stent was performed in one patient with an ileal conduit and retained stent. Only one patient required open surgical removal of the stent. Thirteen out of 14 patients were rendered stone and stent free in one session. All except two stents were removed intact and stone analysis of encrustation and calcification revealed calcium oxalate and calcium phosphate in the majority of the cases. CONCLUSION: Endourological management of forgotten encrusted stents is highly successful and often avoids the need for open surgical techniques.

  12. Combined electrohydraulic and holmium: YAG laser ureteroscopic nephrolithotripsy of large (>2 cm) renal calculi.

    Science.gov (United States)

    Mariani, Albert J

    2008-10-01

    Percutaneous nephrolithotripsy (PCL) is a standard treatment for renal calculi >2 cm. Modern flexible ureteroscopes and accessories employing the complementary effects of electrohydraulic lithotripsy (EHL) and Ho:YAG laser lithotrites can treat these renal calculi in a minimally invasive fashion with similar or superior results. To assess the safety and efficacy of ureteroscopic nephrolithotripsy monotherapy for the management of >2 cm renal calculi in the community setting. Fifty nine patients with 63 renal calculi ranging from 20 to 97 mm (mean 44 mm) in length and 175 to 3300 mm2 (mean 728 mm2) area underwent staged ureteroscopic nephrolithotripsy monotherapy. Obesity (BMI > 30) was present in 54% and 19% were morbidly obese (BMI > 40). An infectious etiology was present in 49% and hard stone components in 89%. All patients presented with hematuria, pain, and/or recurrent urinary tract infection (UTI). Lithotripsy was performed with a single deflection flexible ureteroscope and predominantly EHL. Laser drilling was employed (n = 6) to weaken very hard stones prior to EHL. Low intrarenal pressure was maintained by continuous bladder drainage and placement of a stiff safety wire. Visibility was maintained using manual pulsatile irrigation. All patients were rendered pain and infection-free. No patient required a blood transfusion and there was no change in serum creatinine. Mobile stone-free status was achieved in 60/63 (95%) with a mean of 1.7 nephrolithotripsy stages and 0.38 secondary or ancillary procedures. Outpatient management was sufficient for 121/131 (92%) of the procedures. Operative time averaged 46 min/stage and 79 min/calculus. Complications included endotoxic shock (3), fever (5), ureteral fragments requiring treatment (11), delayed extubation (2), delayed pneumonia (1), and urinary retention (1). Staged ureteroscopic nephrolithotripsy of large renal calculi is feasible with low morbidity and stone clearance rates that compare favorably with PCL. It

  13. Combined electrohydraulic and holmium: YAG laser ureteroscopic nephrolithotripsy of large (>2 cm renal calculi

    Directory of Open Access Journals (Sweden)

    Albert J Mariani

    2008-01-01

    Full Text Available Percutaneous nephrolithotripsy (PCL is a standard treatment for renal calculi> 2 cm. Modern flexible ureteroscopes and accessories employing the complementary effects of electrohydraulic lithotripsy (EHL and Ho:YAG laser lithotrites can treat these renal calculi in a minimally invasive fashion with similar or superior results. Objective: To assess the safety and efficacy of ureteroscopic nephrolithotripsy monotherapy for the management of> 2 cm renal calculi in the community setting. Materials and Methods: Fifty nine patients with 63 renal calculi ranging from 20 to 97 mm (mean 44 mm in length and 175 to 3300 mm2 (mean 728 mm2 area underwent staged ureteroscopic nephrolithotripsy monotherapy. Obesity (BMI > 30 was present in 54% and 19% were morbidly obese (BMI > 40. An infectious etiology was present in 49% and hard stone components in 89%. All patients presented with hematuria, pain, and/or recurrent urinary tract infection (UTI. Lithotripsy was performed with a single deflection flexible ureteroscope and predominantly EHL. Laser drilling was employed (n = 6 to weaken very hard stones prior to EHL. Low intrarenal pressure was maintained by continuous bladder drainage and placement of a stiff safety wire. Visibility was maintained using manual pulsatile irrigation. Results: All patients were rendered pain and infection-free. No patient required a blood transfusion and there was no change in serum creatinine. Mobile stone-free status was achieved in 60/63 (95% with a mean of 1.7 nephrolithotripsy stages and 0.38 secondary or ancillary procedures. Outpatient management was sufficient for 121/131 (92% of the procedures. Operative time averaged 46 min/stage and 79 min/calculus. Complications included endotoxic shock (3, fever (5, ureteral fragments requiring treatment (11, delayed extubation (2, delayed pneumonia (1, and urinary retention (1. Conclusion: Staged ureteroscopic nephrolithotripsy of large renal calculi is feasible with low morbidity

  14. Differential calculi on noncommutative bundles

    OpenAIRE

    Pflaum, Markus J.; Schauenburg, Peter

    1996-01-01

    We introduce a category of noncommutative bundles. To establish geometry in this category we construct suitable noncommutative differential calculi on these bundles and study their basic properties. Furthermore we define the notion of a connection with respect to a differential calculus and consider questions of existence and uniqueness. At the end these constructions are applied to basic examples of noncommutative bundles over a coquasitriangular Hopf algebra.

  15. Severe Vesico-ureteral Reflux and Urine Sequestration: Mathematical Relations and Urodynamic Consequences

    CERN Document Server

    de Jesus, Lisieux Eyer

    2009-01-01

    Some simple mathematical formulae to calculate the volumes of proximal pyeloureteral reflexive systems are presented, and the results are compared to bladder capacity values. Using the results of the calculi, the author discusses possible implications of severe urinary sequestration in the pyeloureteral systems. Using geometrical and topological approximations we calculate the volumes of ureters and renal pelvises, applying in vivo measurements obtained from conventional ultrasound, retrograde cystourethrograms and topographic anatomic references. Approximations use 2 decimals and assumed $\\pi$ value was 3.14. Ureteral and pyelic volumes are calculated, respectively, from the mathematical formula for the cylinder and cone volumes. Dolicomegaureter are compensated using proportional calculi. Bladder volumes are estimated from conventional formulae. Proximal urinary sequestration is compared between infants and older children with VUR. Mechanisms of direct induction of bladder urodynamic failure from VUR are su...

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

    Directory of Open Access Journals (Sweden)

    Robab Maghsoudi

    2008-01-01

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

  17. Management Of Encrusted Ureteral stents

    African Journals Online (AJOL)

    imac-3

    Objectives: To present our experience in managing encrusted ureteral stents and to review the .... A single anesthetic session was required in 18 patients (81.8%) and ... fluid intake, chemotherapy-induced hyperuricosuria, persistent or.

  18. [A CASE OF ASCENDING COLON CANCER RECURRENCE WITH INTRALUMINAL URETERAL DISSEMINATION MIMICKING PRIMARY URETERAL CANCER, DETECTED DURING INVESTIGATION FOR FEVER].

    Science.gov (United States)

    Nishiyama, Ryuichi; Kubota, Masashi; Kanno, Toru; Okada, Takashi; Higashi, Yoshihito; Yamada, Hitoshi

    2015-10-01

    A 69-year-old woman visited our hospital with a chief complaint of fever. Five years ago, she was diagnosed as ascending colon cancer and received right hemi-colectomy. One year later, local recurrence with right hydronephrosis was detected, and she received chemotherapy -4 cycles of modified fluorouracil, leucovorin, and oxaliplatin (mFOLFOX6) plus bevacizumab, and 12 cycles of fluorouracil, leucovorin, and irinotecan (FOLFIRI) plus bevacizumab- for two years. Local recurrence and right hydronephrosis disappeared on positron emission tomography performed 4 years postoperatively. This time, abdominal computed tomography for investigation of fever showed a relapse of right hydronephrosis and pyonephrosis. Cystoscopy revealed non-papillary tumor from the right ureteral orifice. Pelvic magnetic resonance imaging showed multiple tumors in the right ureter, and the distal lesion projecting into the bladder. After the general condition became well by right nephrostomy for infection control, transurethral resection of bladder tumor was performed. Histological examination of the specimen revealed a metastatic tubular adenocarcinoma (colon origin). Although right nephrectomy was performed for pyonephrosis control, she died of local progression of ascending colon cancer 10 months after first visit. Intraluminal ureteral progression of carcinoma originating from organs other than urinary tract is very rare. To our knowledge, this is the 9th report in the English or Japanese literature. In this case we could not rule out primary ureteral cancer preoperatively, and histological examination revealed intraluminal ureteral dissemination of ascending colon cancer.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Hellstroem, M.; Hjaelmaas, K.; Jacobsson, B.; Jodal, U.

    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.

  1. Ureteral Access Sheath Influence on the Ureteral Wall Evaluated by Cyclooxygenase-2 and Tumor Necrosis Factor-α in a Porcine Model

    Science.gov (United States)

    Lildal, Søren Kissow; Nørregaard, Rikke; Andreassen, Kim Hovgaard; Christiansen, Frederikke Eichner; Jung, Helene; Pedersen, Malene Roland

    2017-01-01

    Abstract Objective: To examine the effect of ureteral access sheath (UAS) on the expression of the pro-inflammatory mediators cyclooxygenase-2 (COX-2) and tumor necrosis factor-α (TNF-α) in the ureteral wall. Material and Methods: In 22 pigs an UAS was inserted and removed after 2 minutes on one side and 2 hours on the contralateral side. Postoperatively ureters were excised in vivo, and tissue samples from the distal (2 minutes/2 hours) and proximal ureter (2 minutes/2 hours) were snap-frozen before quantitative polymerase chain reaction analysis of COX-2 and TNF-α. Five unmanipulated ureteral units from other pigs served as the control group. Results: Compared to controls COX-2 mRNA was significantly upregulated in all UAS treated ureteral groups. Similarly, TNF-α mRNA was upregulated in all groups except the 2-minute proximal ureteral group. Both COX-2 and TNF-α expression were significantly higher in the distal than in the proximal ureter in the UAS treated ureters. After UAS insertion for 2 minutes, expression levels in the distal ureter were increased 6.5- and 8-fold for COX-2 and TNF-α, respectively; and after 2 hours of UAS placement COX-2 and TNF-α mRNA expression levels were increased 9- and 9.5-fold, respectively. Conclusion: The pro-inflammatory mediators COX-2 and TNF-α were significantly upregulated in the ureteral wall by the influence of UAS. These findings may have implications for postoperative pain, drainage, and complications. PMID:27998175

  2. Magnetic resonance urography enhanced by gadolinium and diuretics: a comparison with conventional urography in diagnosing the cause of ureteric obstruction.

    Science.gov (United States)

    Jung, P; Brauers, A; Nolte-Ernsting, C A; Jakse, G; Günther, R W

    2000-12-01

    To compare the ability of magnetic resonance urography (MRU), enhanced using gadolinium and frusemide diuresis, and conventional intravenous urography (IVU) to diagnose the cause of ureteric obstruction. The study included 82 patients in whom IVU showed or suggested obstruction and who also underwent MRU. The images from both methods were interpreted by various investigators independently; two evaluated the IVU and two others the MRU, the latter being unaware of the diagnosis after IVU. If the diagnosis remained unclear, further investigations (e.g. computed tomography, retrograde pyelography or ureteroscopy) were conducted. The diagnoses were ureteric calculi in 72 patients, ureteric tumours in eight and extra-ureteric tumours in two. In those with urolithiasis, the diagnosis was correct with IVU in 49 patients and with MRU in 64. The diagnosis in this group was incorrect with MRU in only two patients. The main reason for the failure of IVU was absent contrast medium excretion. Three of eight patients with ureteric tumours were correctly diagnosed by IVU but in three patients the diagnosis was incorrect. MRU correctly diagnosed seven of the eight patients in this group, with no false diagnosis. IVU is currently likely to remain the standard procedure for imaging the upper urinary tract, but this study shows the potential of MRU when enhanced with gadolinium and frusemide. MRU may be helpful if there is a dilated system with no excretory function, in pregnant women, in children and in those with contrast medium allergy.

  3. Low power laser in the management of ureteral stones.

    Science.gov (United States)

    Tayib, Abdulmalik M

    2010-03-01

    To evaluate the outcome of the low power Holmium-Yag laser in management of ureteral stones, and to report the incidence rate of different types of stones. One hundred and seventy patients underwent ureteroscopy and fragmentation of ureteral stones at the International Medical Center, Jeddah, Kingdom of Saudi Arabia between March 2007 and August 2009. Stones were measured by their largest diameter on CT and classified according to their location from the ureter to the proximal middle and distal ureteral stones. We utilized 8-11 F Semi rigid or 7.5 F flexible ureteroscopes to identify the stones, and all stones were fragmented and evaporated using a 10 watt lower power Holmium-yag laser lithotripter. All stones were completely evaporated and fragmented using the Holmium-yag laser through ureteroscopy. The age of the patients varied between 21-76 years with a mean age of 38.6 years (males 113, and females 57). The largest diameter of the largest stone was 6-12mm (mean 8 mm) and classified according to its location in the ureter into proximal (93 [54.7%]), middle (26 [15.3%]), or distal ureteral stones (51 [30%]). We performed stone analysis in 122 patients (oxalate [n=87], uric acid [n=16], cystine [n=11], and calcium phosphate [n=8]). Laser lithotripsy using low power 10 watt laser lithotripter is safe and effective method for stone evaporation and disintegration, and can be carried out as a day care procedure. The types of stones in Saudi Arabia are same as it has been reported before in the literature.

  4. 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...

  5. Flow Logic for Process Calculi

    DEFF Research Database (Denmark)

    Nielson, Hanne Riis; Nielson, Flemming; Pilegaard, Henrik

    2012-01-01

    Flow Logic is an approach to statically determining the behavior of programs and processes. It borrows methods and techniques from Abstract Interpretation, Data Flow Analysis and Constraint Based Analysis while presenting the analysis in a style more reminiscent of Type Systems. Traditionally...... developed for programming languages, this article provides a tutorial development of the approach of Flow Logic for process calculi based on a decade of research. We first develop a simple analysis for the π-calculus; this consists of the specification, semantic soundness (in the form of subject reduction...... and adequacy results), and a Moore Family result showing that a least solution always exists, as well as providing insights on how to implement the analysis. We then show how to strengthen the analysis technology by introducing reachability components, interaction points, and localized environments...

  6. Ureteral Stent Insertion in the Management of Renal Colic during Pregnancy.

    Science.gov (United States)

    Choi, Chang Il; Yu, Young Dong; Park, Dong Soo

    2016-05-01

    To determine an optimal invasive intervention for renal colic patients during pregnancy after conservative treatments have been found to be unhelpful. Among the available invasive interventions, we investigated the reliability of a ureteral stent insertion, which is considered the least invasive intervention during pregnancy. Between June 2006 and February 2015, a total of 826 pregnant patients came to the emergency room or urology outpatient department, and 39 of these patients had renal colic. The mean patient age was 30.49 years. In this retrospective cohort study, the charts of the patients were reviewed to collect data that included age, symptoms, the lateralities and locations of urolithiasis, trimester, pain following treatment and pregnancy complications. Based on ultrasonography diagnoses, 13 patients had urolithiasis, and 13 patients had hydronephrosis without definite echogenicity of the ureteral calculi. Conservative treatments were successful in 25 patients. Among these treatments, antibiotics were used in 15 patients, and the remaining patients received only hydration and analgesics without antibiotics. Several urological interventions were required in 14 patients. The most common intervention was ureteral stent insertion, which was performed in 13 patients to treat hydronephrosis or urolithiasis. The patients' pain was relieved following these interventions. Only one patient received percutaneous nephrostomy due to pyonephrosis. No pregnancy complications were noted. Ureteral stent insertion is regarded as a reliable and stable first-line urological intervention for pregnant patients with renal colic following conservative treatments. Ureteral stent insertion has been found to be equally effective and safe as percutaneous nephrostomy, which is associated with complications that include bleeding and dislocation, and the inconvenience of using external drainage system.

  7. Primary dissolution therapy of struvite calculi.

    Science.gov (United States)

    Dretler, S P; Pfister, R C

    1984-05-01

    Percutaneous nephrostomy and hemiacidrin were used as primary treatment of magnesium ammonium phosphate calculi in 32 surgical candidates. Of 28 patients who actually received hemiacidrin 24 (85 per cent) had successful treatment (no surgery necessary), including 19 (68 per cent) who had total stone dissolution. There were no significant complications. Patients have been followed for 3 months to 7 years. Percutaneous nephrostomy with hemiacidrin infusion is another possible treatment in the growing alternatives available for patients with urinary struvite calculi.

  8. Characterization of ureteral stents by dual-energy computed tomography: Clinical implications

    Institute of Scientific and Technical Information of China (English)

    El-Sayed; H; Ibrahim; William; E; Haley; Maria; A; Jepperson; Michael; J; Wehle; Joseph; G; Cernigliaro

    2014-01-01

    Dual-energy computed-tomography(DECT) has been suggested as the method of choice for imaging urinary calculi due to the modality’s high sensitivity for detect-ing stones and its capability of accurately differentiat-ing between uric-acid(UA) and non-UA(predominantly calcium) stones. The clinical significance of the latter feature relates to the differences in management of UA vs non-UA calculi. Like calculi, ureteral stents are assigned color by the dual-energy post-processing algorithm, which may lead to improved or worsened stone visualization based on the resulting stent/stone contrast. Herein we depict the case of a nephrolithiasis patient with bilateral stents, each with different color, clearly displaying the effect of stent color on stone vi-sualization. Further, three-dimensional reconstruction of the DECT images illustrates advantages of this enhancement compared to conventional two-dimensional computed tomography. The resulting stent/stone contrast produces an unanticipated potential advantage of DECT in patients with urolithiasis and stents and may promote improved management decision-making.

  9. Artificial Ureter in Patients with Extensive Ureteral Damage.

    Science.gov (United States)

    Yazdani, Mohammad; Javid, Amir; Mohammadi Sichani, Mehrdad; Gharaati, Mohammad Reza; Yazdani, Emad

    2017-05-23

    loss of significant lengths of ureter when substitution with bowel or bladder fails is a disaster in urology. This study is conducted to evaluate the results of subcutaneous nephron-vesical bypass (SNVB) in ureteral damage of different etiologies. Seventeen SNVB were employed in patients with ureteral injuries. We employed a device consisted of an internal silicone tube covered by a coiled PTFE tube to replace the ureter. This is called artificial ureter (AU). Proximal end of the AU was introduced in the kidney percutaneously, the tube was passed through a subcutaneous tunnel, while the distal end was inserted in the bladder through a small suprapubic incision. Follow-up ranged from six months to ten years. We removed the prosthetic ureter in one patient due to gross hematuria two months after insertion. One of the patients was reoperated two days after the procedure because of urinary leakage. In all other patients, the procedure was safe and effective. Subcutaneous nephron-vesical bypass is a safe and appealing alternative to a nephrostomy tube. This is a permanent device with no need for exchange. The technique can be applied in ureteral injuries due to various causes.

  10. Renal pelvic calculi and neoplasm. New indication for treatment of asymptomatic renal pelvic calculi?

    DEFF Research Database (Denmark)

    Vibitis, H; Jørgensen, J B

    1990-01-01

    Metaplasia of the renal pelvis caused by chronic irritation, calculi, infection is a reversible pre-malignant condition. The application of ESWL on renal calculi as a safe treatment in relation to metaplasia is discussed and a case history is presented....

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

    Science.gov (United States)

    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.

  12. [Functional evaluation in patients with kidney calculi].

    Science.gov (United States)

    Stojimirović, B

    1998-01-01

    Nephrolithiasis is a common disorder and a significant problem because of incidence, recurrence and severe consequences. Stone disease is a surgical as well as a medical problem. Major progress has been made recently in understanding the pathophysiological disturbances responsible for stone formation as well as in the techniques of stone removal. The introduction of extracorporeal shock wave lithotripsy has considerably reduced the need for surgery. Improvements in methods of kidney stone removal have not diminished the need for the application of an effective prophylactic program. The internist should take a complete history of stone events (number, composition, location and outcome of stone event), family history of stones, dietary habits (focusing on the consumption of animal protein, salt and dairy products), medications and physical examination. Radiopaque stones should be documented by plane X-ray films. Ultrasonography should be used to image calculi that are nonopaque, and to easily distinguish them from masses such as tumour or blood clot. Computed tomography is also an excellent method for imaging nonopaque renal calculi but higher cost and radiation exposure are disadvantages [2]. Crystallographic analysis is the essential diagnostic procedure. If available, previous stones should also be examined. "In stone disease, everything is measurement. What the laboratory cannot tell you, you will not know; what it tells you in error, you will not correct by using your instincts, your medical experience, or your art [3]". Reliable diagnostic protocols are available for the identification of different causes of stones. The complexity of protocols depend on the severity of nephrolithiasis. Patients with a single stone episode undergo simple protocol, and extensive detailed protocol is used for patients with recurrent stone disease, or patients at increased risk. Simple protocol, besides the already mentioned history of stone events, radiographic investigation and

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

    Directory of Open Access Journals (Sweden)

    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.

  14. Holmium laser lithotripsy of bladder calculi

    Science.gov (United States)

    Beaghler, Marc A.; Poon, Michael W.

    1998-07-01

    Although the overall incidence of bladder calculi has been decreasing, it is still a significant disease affecting adults and children. Prior treatment options have included open cystolitholapaxy, blind lithotripsy, extracorporeal shock wave lithotripsy, and visual lithotripsy with ultrasonic or electrohydraulic probes. The holmium laser has been found to be extremely effective in the treatment of upper tract calculi. This technology has also been applied to the treatment of bladder calculi. We report our experience with the holmium laser in the treatment of bladder calculi. Twenty- five patients over a year and a half had their bladder calculi treated with the Holmium laser. This study was retrospective in nature. Patient demographics, stone burden, and intraoperative and post-operative complications were noted. The mean stone burden was 31 mm with a range of 10 to 60 mm. Preoperative diagnosis was made with either an ultrasound, plain film of the abdomen or intravenous pyelogram. Cystoscopy was then performed to confirm the presence and determine the size of the stone. The patients were then taken to the operating room and given a regional or general anesthetic. A rigid cystoscope was placed into the bladder and the bladder stone was then vaporized using the holmium laser. Remaining fragments were washed out. Adjunctive procedures were performed on 10 patients. These included transurethral resection of the prostate, transurethral incision of the prostate, optic internal urethrotomy, and incision of ureteroceles. No major complications occurred and all patients were rendered stone free. We conclude that the Holmium laser is an effective and safe modality for the treatment of bladder calculi. It was able to vaporize all bladder calculi and provides a single modality of treating other associated genitourinary pathology.

  15. Management of Pancreatic Calculi: An Update

    Science.gov (United States)

    Tandan, Manu; Talukdar, Rupjyoti; Reddy, Duvvur Nageshwar

    2016-01-01

    Pancreatolithiasis, or pancreatic calculi (PC), is a sequel of chronic pancreatitis (CP) and may occur in the main ducts, side branches or parenchyma. Calculi are the end result, irrespective of the etiology of CP. PC contains an inner nidus surrounded by successive layers of calcium carbonate. These calculi obstruct the pancreatic ducts and produce ductal hypertension, which leads to pain, the cardinal feature of CP. Both endoscopic therapy and surgery aim to clear these calculi and decrease ductal hypertension. In small PC, endoscopic retrograde cholangiopancreatography (ERCP) followed by sphincterotomy and extraction is the treatment of choice. Large calculi require fragmentation by extracorporeal shock wave lithotripsy (ESWL) prior to their extraction or spontaneous expulsion. In properly selected cases, ESWL followed by ERCP is the standard of care for the management of large PC. Long-term outcomes following ESWL have demonstrated good pain relief in approximately 60% of patients. However, ESWL has limitations. Per oral pancreatoscopy and intraductal lithotripsy represent techniques in evolution, and in current practice their use is limited to centers with considerable expertise. Surgery should be offered to all patients with extensive PC, associated multiple ductal strictures or following failed endotherapy. PMID:27784844

  16. A study of ureteric peristalsis using a single catheter to record EMG, impedance, and pressure changes.

    Science.gov (United States)

    Roshani, H; Dabhoiwala, N F; Tee, S; Dijkhuis, T; Kurth, K H; Ongerboer de Visser, B W; de Jong, J M; Lamers, W H

    1999-03-01

    Ureteric peristalsis transports a urinary bolus from the renal pelvis to the bladder. We developed an intraluminal catheter with a pressure transducer on it to study intraluminal pressure changes and a twin bipolar electrode to record the ureteric EMG and impedance (Z) changes during a peristaltic wave. Five female New Yorkshire pigs (50-60 kg) were studied under light halothane anesthesia (5% at induction/1% for maintenance). A steady state of hydration was maintained using intravenous saline infusion. EMG spike burst activity was studied at a 10-cm interval using low (0-30) Hz filters. Impedance between the same electrodes is measured simultaneously in higher frequencies (1-5 KHz) as a function of ureteric motor activity. Pressure generation in the ureteric lumen was also measured simultaneously by a transducer on the same catheter. A digital signal processing program (Poly 4.9) was used for analysis. Parenteral furosemide was used to induce diuresis. Resting ureteric impedance (Z(R)) decreases to Z(B) (Z bolus) during the passage of the urinary bolus. Passage of a contractile zone during a peristaltic wave increases impedance from Z(B) to its Z(R) level and initiates a pressure rise. Bolus length (the length Z(B)) is not constant and decreases distally. EMG corresponds well in time to impedance. Z(R) disappears after infusion of furosemide because of increased urine load and changes of intraluminal ionic environment. The contractile segment of a ureteric peristaltic wave appears to be represented by an elevated Z segment (Z(C)). Pressure rise is recorded only at the beginning of a contractile zone. A specially adapted intraluminal catheter can be used to study peristalsis in the upper urinary tract. One can study all the three components of ureteric peristalsis (excitation, contraction, and intraluminal pressure rise) using such a catheter.

  17. Transurethral exchange of double-J ureteral stent using goose- neck snare

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Chang Ho; Kim, Yun Hwan; Cho, Sung Bum; Kim, Chul Joong; Kim, Hyoung Rae; Kim, Hong Weon; Suh, Won Hyuck [College of Medicine, Korea University, Seoul (Korea, Republic of); Cho, Sung Bum [Eulji Hospital, Eulji College of Medicine, Taejon (Korea, Republic of)

    2000-09-01

    To evaluate the usefulness of transurethral exchange of double-J ureteral stent as an effective alternative to the cystoscopic approach. There were 20 exchange cases involving seven patients (six women and one man) who initially underwent anterograde manipulation of a double-J ureteral stent. Indications for stent placement were ureteral stricture caused by malignancy in six patients (cervical carcinoma (n=3D5), stomach carcinoma (n=3D1)), and renal tuberculosis in one. An 8-F Nelaton catheter was inserted in the bladder via the urethra and contrast material was injected until the bladder was fully distended. The distal end of a double-J ureteral stent was extracted to the urethral orifice using a goose-neck snare and a 0.035{sup s}tiff guide wire was then advanced to the renal pelvis through the stent. After that, the stent was removed and a 4-F Cobra catheter was advanced to the renal pelvis along the guide wire. Contrast material was injected through the catheter, and the renal pelvis, calyx and ureter were opacified. The 0.035 stiff guide wire was again inserted via the catheter, and a new double-J ureteral stent was inserted, and the catheter removed. Finally, the new double-J stent was properly located within the renal pelvis and the bladder. Double-J ureteral stents were successfully exchanged in 19 of 20 exchange cases. After the procedure, all patients reported tolerable, minimal lower abdominal pain. Transurethral exchange of double-J ureteral stent is a useful alternative to cystoscopy. (author)

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

    Energy Technology Data Exchange (ETDEWEB)

    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

  19. Analysis of ureteral length in adult cadavers

    Directory of Open Access Journals (Sweden)

    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.

  20. Adjunctive medical therapy with α-blocker after extracorporeal shock wave lithotripsy of renal and ureteral stones: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    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.

  1. A criterion for separating process calculi

    CERN Document Server

    Banti, Federico; Tiezzi, Francesco; 10.4204/EPTCS.41.2

    2010-01-01

    We introduce a new criterion, replacement freeness, to discern the relative expressiveness of process calculi. Intuitively, a calculus is strongly replacement free if replacing, within an enclosing context, a process that cannot perform any visible action by an arbitrary process never inhibits the capability of the resulting process to perform a visible action. We prove that there exists no compositional and interaction sensitive encoding of a not strongly replacement free calculus into any strongly replacement free one. We then define a weaker version of replacement freeness, by only considering replacement of closed processes, and prove that, if we additionally require the encoding to preserve name independence, it is not even possible to encode a non replacement free calculus into a weakly replacement free one. As a consequence of our encodability results, we get that many calculi equipped with priority are not replacement free and hence are not encodable into mainstream calculi like CCS and pi-calculus, t...

  2. Stochastic Simulation of Process Calculi for Biology

    CERN Document Server

    Phillips, Andrew; Paulevé, Loïc; 10.4204/EPTCS.40.1

    2010-01-01

    Biological systems typically involve large numbers of components with complex, highly parallel interactions and intrinsic stochasticity. To model this complexity, numerous programming languages based on process calculi have been developed, many of which are expressive enough to generate unbounded numbers of molecular species and reactions. As a result of this expressiveness, such calculi cannot rely on standard reaction-based simulation methods, which require fixed numbers of species and reactions. Rather than implementing custom stochastic simulation algorithms for each process calculus, we propose to use a generic abstract machine that can be instantiated to a range of process calculi and a range of reaction-based simulation algorithms. The abstract machine functions as a just-in-time compiler, which dynamically updates the set of possible reactions and chooses the next reaction in an iterative cycle. In this short paper we give a brief summary of the generic abstract machine, and show how it can be instant...

  3. Stents for malignant ureteral obstruction

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    Kristina Pavlovic

    2016-07-01

    Full Text Available Malignant ureteral obstruction can result in renal dysfunction or urosepsis and can limit the physician's ability to treat the underlying cancer. There are multiple methods to deal with ureteral obstruction including regular polymeric double J stents (DJS, tandem DJS, nephrostomy tubes, and then more specialized products such as solid metal stents (e.g., Resonance Stent, Cook Medical and polyurethane stents reinforced with nickel-titanium (e.g., UVENTA stents, TaeWoong Medical. In patients who require long-term stenting, a nephrostomy tube could be transformed subcutaneously into an extra-anatomic stent that is then inserted into the bladder subcutaneously. We outline the most recent developments published since 2012 and report on identifiable risk factors that predict for failure of urinary drainage. These failures are typically a sign of cancer progression and the natural history of the disease rather than the individual type of drainage device. Factors that were identified to predict drainage failure included low serum albumin, bilateral hydronephrosis, elevated C-reactive protein, and the presence of pleural effusion. Head-to-head studies show that metal stents are superior to polymeric DJS in terms of maintaining patency. Discussions with the patient should take into consideration the frequency that exchanges will be needed, the need for externalized hardware (with nephrostomy tubes, or severe urinary symptoms in the case of internal DJS. This review will highlight the current state of diversions in the setting of malignant ureteral obstruction.

  4. Outcomes of flexible ureteroscopic lithotripsy with holmium laser for upper urinary tract calculi

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    Marcello Cocuzza

    2008-03-01

    Full Text Available OBJECTIVE: To assess the perioperative and financial outcomes of flexible ureteroscopic lithotripsy with holmium laser for upper tract calculi in 44 patients. MATERIALS AND METHODS: Between February 2004 and September 2006, 44 patients treated for upper tract stone with flexible ureteroscopic lithotripsy were evaluated. Renal stones were associated with collecting system obstruction in 15 (34% patients, failed extracorporeal shock-wave lithotripsy (SWL occurred in 14 (32% patients, unilateral multiple stones in 18 (41% patients, and multiple bilateral stones in 3 (7%. In 29 (66% patients, the stone was located in the inferior calyx. Perioperative and financial outcomes were also evaluated. RESULTS: 50 procedures were performed in 44 patients. The mean stone burden on preoperative CT scan was 11.5 ± 5.8 mm. The mean operative time was 61.3 ± 29.4 min. The stone free rate was 93.1% after one procedure and 97.7% after a second procedure, with overall complication rate of 8%. Therapeutic success occurred in 92% and 93% of patients with lower pole stones and SWL failure, respectively. Treatment failure of a single session was associated with presence of a stone size larger than 15 mm (p = 0.007, but not associated with inferior calyx location (p = 0.09. Surgical disposables were responsible for 78% of overall costs. CONCLUSION: Flexible ureteroscopy using holmium laser is a safe and effective option for the treatment of upper urinary tract calculi. In addition, it can be considered an attractive option as salvage therapy after SWL failure or kidney calculi associated with ureteral stones. Stone size larger than 15 mm is associated with single session treatment failure.

  5. Low-cost semirigid ureteroscopy is effective for ureteral stones: Experience of a single high volume center

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    Roberto Giulianelli

    2014-06-01

    Full Text Available Aim of the study: To demonstrate how, in a center with a large number of patients, as our center is, it is possible to perform ureterolithotripsy using a limited set of instruments. Methods: We evaluated medical charts of our center related to semirigid ureteral ureteroscopy (URS with ureterolithotripsy using Holmium laser performed from July 2004 to July 2011. Overall, 658 URS for ureteral stones were performed in 601 patients, of which 204 in proximal ureter (31%, 86 in the mid (13.06% and 368 (57.76% in the distal ureter. In 504 patients (76.5% ureterohydronephrosis (Grade II-III was observed. In 57 patients (8.6%, we performed a bilateral approach at the same time, but most patients had a solitary distal ureteral stone. 106 patients (16.1% had more than one stone in their distal ureter and 96 (14.8% had a proximal ureteral stone treated in the same surgery as well. Results: The overall stone-free rate for ureteral stones was 86.1% (567/658. Success rates for proximal, medial and distal ureteral stones were 68.13% (139/204 patients, 84.8% (73/86 patients and 96.4% (355/368 patients, respectively. One hundred and twenty patients (18.3% required additional surgical treatment for their stones beyond the initial URS, including a second URS in 97 patients (14.74% and URS plus Retrograde Intra-Renal Surgery (RIRS in 23 patients (3.54%. The overall stonefree rate after the second treatment was 99.3%. Intra-operative complications accounted for 5.92% and consisted of ureteral perforations in 16 pts (2.4%, erosions of urothelium leading to significant bleeding in 15 pts (2.27%, severe pain in 4 pts (0.6%, fever in 3 pts (0.45% and one case of ureteral avulsion (0.15%. Conclusions: This study demonstrates that the use of Holmium laser lithotripsy is a safe and effective means of treating ureteral stones regardless of sex, age, stone location, or stone size. The instrumentation we used was extremely limited, in order to reduce costs related to the

  6. Flexible Ureteroscopic Management of Horseshoe Kidney Renal Calculi

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    Jie Ding

    2015-08-01

    Full Text Available ABSTRACTPurpose:To evaluate the clinical efficacy of flexible ureteroscope (F-URS combined with holmium laser lithotripter in treating renal calculi in horseshoe kidney.Materials and Methods:From November 2010 to December 2013, the medical history and charts of sixteen patients (mean age 42.9±11.6 years, range 26-66 years, including 13 males and 3 females were analyzed retrospectively. Mean stone burden was 29±8 mm (range 17-42 mm2. Mean stone digitized surface area (DSA was 321±94 mm2 (range 180-538 mm2. Under spinal anesthesia in a modified lithotomy position with the head down, rigid ureteroscope was placed firstly into the ureter to reach the level of the pelvis, a zebra guide wire was inserted and following the removal of the rigid ureteroscope, an ureteral access sheath was positioned along the guide wire, then passed the URF P-5 flexible ureteroscope into the renal cavities over the guidewire. After locating the stones, holmium laser lithotripsy was performed.Results:The average operative time was 92±16 minutes (range 74-127 min.. No major complications were encountered. Ten patients obtained stone-free status with one session, four obtained stone-free status after two sessions. Single session stone-free rate was 62.5%, overall stone-free rate was 87.5%. Two patients have small residual stones in the lower pole.Conclusions:F-URS combined with holmium laser lithotripter and nitinol basket, is safe and effective in dealing with moderate stone diameter (<30 mm in HSKs with high clearance rates and low complication rates.

  7. Mobility in process calculi and natural computing

    CERN Document Server

    Aman, Bogdan

    2011-01-01

    The design of formal calculi in which fundamental concepts underlying interactive systems can be described and studied has been a central theme of theoretical computer science in recent decades, while membrane computing, a rule-based formalism inspired by biological cells, is a more recent field that belongs to the general area of natural computing. This is the first book to establish a link between these two research directions while treating mobility as the central topic. In the first chapter the authors offer a formal description of mobility in process calculi, noting the entities that move

  8. First experience with blind lithotripsy of ureteral calculi by ruby laser

    Science.gov (United States)

    Pupkova, Ludmila S.; Reznikov, Leonid L.; Sokolovsky, Alexander A.; Mursin, A. G.; Soms, Leonid N.; Berenberg, Vladimir A.; Polikarpov, Sergey S.; Parkhomchuk, N. A.; Voskresensky, M. A.

    1994-05-01

    For the last two years we have applied continuous dual-wavelength Nd:YAG 20 - 60 W power laser to various urologic operations. Transmission of laser irradiation via a flexible quartz fiber permitted operating at any depth of the wound. High-intensity irradiation of 1.06 mkm wavelength was effective in making thin incisions into a variety of tissues, including skin, subcutaneous fat, aponeurosis, muscles, urinary bladder wall, prostate gland, renal pelvis, renal capsule and parenchyma, and urethra. The incisions were especially effective if the contact method was used. Operational access was accomplished in 3 - 5 minutes. At the same time, hemostasis occurred in small diameter vessels. More reliable hemostasis could be achieved by means of 1.32 mkm wavelength. With the present laser device, we carried out 57 different urologic operations in our clinic. Examples of such operations include prostatectomy, pyelolithotomy, ureterolithotomy, nephrectomy, resection of renal cysts, condylomata acuminata of the urogenital organs, and papilloma of the urethra and bladder. The results suggest that a combination of these two wavelengths may prove most effective. Advantages of this approach include a decreased blood loss and decreased surgical time, asepsis, good short- and long-term results, and no complications.

  9. US detection of renal and ureteral calculi in patients with suspected renal colic

    OpenAIRE

    Vallone, Gianfranco; Napolitano, Giuseppina; Fonio, Paolo; Antinolfi, Gabriele; Romeo, Antonio; Macarini, Luca; Genovese, Eugenio Annibale; Brunese, Luca

    2013-01-01

    Purpose The purpose of this study was to determine whether the color Doppler twinkling sign could be considered as an additional diagnostic feature of small renal lithiasis (_5mm). Methods 181 patients underwent CT scans performed for other pathologies; the images were also analyzed by a radiologists to identify the incidental presence of renal lithiasis equal to or smaller than 5 mm. These patients underwent an abdominal ultrasound examination, including grayscale analysis of the kidneys and...

  10. Complications of surgical management of upper tract calculi in spina bifida patients: analysis of nationwide data.

    Science.gov (United States)

    Wang, Hsin-Hsiao S; Wiener, John S; Ferrandino, Michael N; Lipkin, Michael E; Routh, Jonathan C

    2015-04-01

    The management of upper urinary tract stones in patients with spina bifida is challenging but poorly described in the literature. We compared urolithiasis interventions and related complications in patients with spina bifida to those in other stone formers using a national database. We retrospectively reviewed the NIS to identify hospital admissions for renal and ureteral stones from 1998 to 2011. We used ICD-9-CM codes to identify urological interventions, including shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy and ureteral stent placement. NSQIP data were used to identify postoperative complications. We identified 4,287,529 weighted stone hospital admissions, including 12,315 (0.3%) of patients with spina bifida. Compared to those without spina bifida the patients with spina bifida who had urolithiasis were significantly younger (mean age 34 vs 53 years), more likely to have public insurance (72% vs 44%) and renal vs ureteral calculi (81% vs 58%), and undergo percutaneous nephrolithotomy (27% vs 8%). After adjusting for age, insurance, comorbidity, treatment year, surgery type, stone location and hospital factors patients with spina bifida were more likely to have urinary tract infections (OR 2.5), urinary complications (OR 3.1), acute renal failure (OR 1.9), respiratory complications (OR 2.0), pneumonia (OR 1.5), respiratory insufficiency (OR 3.2), prolonged mechanical ventilation (OR 3.2), sepsis (OR 2.7), pulmonary embolism (OR 3.0), cardiac complications (OR 2.4) and bleeding (OR 1.6). Compared to those without spina bifida the patients with spina bifida who were hospitalized for urolithiasis were younger, and more likely to have renal stones and undergo percutaneous nephrolithotomy. Urolithiasis procedures in patients with spina bifida were associated with a significantly higher risk of in-hospital postoperative complications. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All

  11. 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.

  12. Stochastic Simulation of Process Calculi for Biology

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    Andrew Phillips

    2010-10-01

    Full Text Available Biological systems typically involve large numbers of components with complex, highly parallel interactions and intrinsic stochasticity. To model this complexity, numerous programming languages based on process calculi have been developed, many of which are expressive enough to generate unbounded numbers of molecular species and reactions. As a result of this expressiveness, such calculi cannot rely on standard reaction-based simulation methods, which require fixed numbers of species and reactions. Rather than implementing custom stochastic simulation algorithms for each process calculus, we propose to use a generic abstract machine that can be instantiated to a range of process calculi and a range of reaction-based simulation algorithms. The abstract machine functions as a just-in-time compiler, which dynamically updates the set of possible reactions and chooses the next reaction in an iterative cycle. In this short paper we give a brief summary of the generic abstract machine, and show how it can be instantiated with the stochastic simulation algorithm known as Gillespie's Direct Method. We also discuss the wider implications of such an abstract machine, and outline how it can be used to simulate multiple calculi simultaneously within a common framework.

  13. 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.

  14. Internalization of Calcium Oxalate Calculi Developed in Narrow Cavities

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    Fèlix Grases

    2014-03-01

    Full Text Available We describe the case of a patient with calcium oxalate monohydrate and calcium oxalate dihydrate calculi occluded in cavities. All those calculi were located inside narrow cavities covered with a thin epithelium that permits their visualization. Urinary biochemical analysis showed high calciuria, not hypercalciuria, hypocitraturia, and a ratio [calcium]/[citrate] >0.33. The existence of cavities of very low urodynamic efficacy was decisive in the formation of such calculi. It is important to emphasize that we observed a thin epithelium covering such cavities, demonstrating that this epithelium may be formed after the development of the calculi through a re-epithelialization process.

  15. Bladder calculi complicating intermittent clean catheterization.

    Science.gov (United States)

    Amendola, M A; Sonda, L P; Diokno, A C; Vidyasagar, M

    1983-10-01

    Eight male patients on clean intermittent catheterization programs for neurogenic bladder dysfunction developed vesical calculi around pubic hairs inadvertently introduced into the bladder, acting as a nidus for incrustation. In three patients, the radiographic appearance of serpentine calcifications in the pelvis was highly consistent with calcareous deposits on strands of hair. Familiarity with this radiologic appearance should suggest the diagnosis in the appropriate clinical setting and help avoid misinterpretation of these calcifications, atypical of usual bladder stones.

  16. Cyclic and Inductive Calculi are equivalent

    CERN Document Server

    Voicu, Razvan

    2011-01-01

    Brotherston and Simpson [citation] have formalized and investigated cyclic reasoning, reaching the important conclusion that it is at least as powerful as inductive reasoning (specifically, they showed that each inductive proof can be translated into a cyclic proof). We add to their investigation by proving the converse of this result, namely that each inductive proof can be translated into an inductive one. This, in effect, establishes the equivalence between first order cyclic and inductive calculi.

  17. Pseudotumoral tuberculous ureteritis: a case report

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    Bouchikhi Ahmed-Amine

    2013-02-01

    Full Text Available Abstract Introduction Tuberculosis is still endemic in Morocco and the urogenital form is common. This form is characterized by clinical polymorphism. However, the isolated ureteric form is very rare. The differential diagnosis might be raised in tumoral cases while undertaking surgical excision which is the realistic choice. Hence, we report an isolated ureteric tuberculosis case, and we discuss the clinical, imaging, diagnostic and therapeutical features. Case presentation A 30-year-old Moroccan man consulted us for left back pain associated with urinary frequency and a few macroscopic episodes of hematuria for the past six months. A computed tomography urography revealed a left hydronephrosis and hydroureter secondary to focal wall thickening of the left lumbar ureter. Hence, we had diagnosed a ureteral tumor. However, a clinical examination showed irritative voiding symptoms and epididymal disorders associated with prostate infection suggesting a Koch’s bacillus assessment of the patient’s urine of which the results proved strongly positive. The treatment consisted of establishing a double-J ureteric stent to drain the left kidney, followed by antituberculous antibiotics. Conclusion Urogenital tuberculosis is common in endemic countries, however isolated ureter affection is rare. It is important to consider a ureteral tuberculosis diagnosis whenever ureteral thickening is revealed in a patient living in a country in which tuberculosis is endemic.

  18. Emphysematous pyelonephritis in type II diabetes: A case report of an undiagnosed ureteric colic.

    Science.gov (United States)

    Vollans, Samuel R; Sehjal, Ranjit; Forster, James A; Rogawski, Karol M

    2008-09-30

    Emphysematous pyelonephritis (EPN) is a severe acute necrotising infection of the renal parenchyma and perirenal tissue, characterised by gas formation. 90% of cases are seen in association with diabetes mellitus. We report a case of undiagnosed ureteric obstruction in a type II diabetic, leading to EPN requiring emergency nephrectomy. A 59-year-old type II tablet controlled diabetic woman presented complaining of a five day history of right sided abdominal pain associated with vomiting, abdominal distension and absolute constipation. There were no lower urinary tract symptoms. Past surgical history included an open appendectomy and an abdominal hysterectomy. On examination, she was haemodynamically stable, the abdomen was soft, distended, and tender in the right upper and lower quadrants with no bowel sounds. Investigations revealed a CRP of 365 and 2+ blood and nitrite positive on the urine dipstick. The AXR was reported as normal on admission, however when reviewed in retrospect revealed the diagnosis. She was managed, therefore, as having adhesional bowel obstruction and a simple UTI. After four days, a CT was organised as she was not settling. This showed a right pyohydronephrosis with gas in the collecting system secondary to an 8 mm obstructing ureteric calculus. The kidney was drained percutaneously via a nephrostomy and the patient was commenced on a broad spectrum intravenous antibiotics. Despite this, she went on to need an emergency nephrectomy for uncontrolled severe sepsis. She was discharged in good health 15 days later. EPN carries a mortality of up to 40% with medical management alone. Early recognition of EPN in an obstructed kidney is essential to guide aggressive management, and in the presence of continued severe sepsis or organ dysfunction an urgent nephrectomy should be carried out. Diabetic patients who are known to have renal or ureteric calculi, whether symptomatic or not, should be considered for percutanous or ureteroscopic treatment. In

  19. Recurrent bilateral renal calculi in a tetraplegic patient

    DEFF Research Database (Denmark)

    Vaidyanathan, S; Soni, B M; Biering-Sorensen, F;

    1998-01-01

    annual urological evaluation. Urinary tract calculi, if detected, should be dealt with promptly to prevent renal damage due to urinary obstruction and urosepsis. Renal calculi can be treated effectively and safely by ESWL in spinal cord injury patients, thus avoiding the need for an invasive procedure...

  20. Malignant Ureteral Obstruction: Functional Duration of Metallic versus Polymeric Ureteral Stents.

    Directory of Open Access Journals (Sweden)

    Po-Ming Chow

    Full Text Available Ureteral obstruction caused by extrinsic compression is often associated with intra-abdominal cancers. Internal drainage with ureteral stents is typically the first-line therapy to relieve such obstructions. Novel designs of ureteral stents made of different materials have been invented to achieve better drainage. In this study, we described the functional outcomes of a Resonance metallic ureteral stent (Cook Medical, Bloomington, Indiana, USA in patients with malignant ureteral obstruction and compare the functional duration of Resonance stents with regular polymeric stents in the same cohort.Cancer patients who received polymeric stents and subsequent Resonance stents for ureteral obstruction between July 2009 and November 2012 were included in a chart review. Stent failure was detected by clinical symptoms, imaging studies, and renal function tests. The functional durations of each stent were calculated, and possible factors affecting stent patency were investigated.A total of 50 stents were successfully inserted into 50 ureteral units in 42 patients with malignant ureteral obstruction. There were 7 antegrade stents and 43 retrograde stents. There were no major complications. Stent-related symptoms were similar in both kinds of stents. After polymeric stents were replaced with Resonance metallic stents, hydronephrosis subsided or remained stable in 90% (45/50 of the ureteral units. Serum creatinine decreased or remained stable in 90% (38/42 of these patients. The Resonance stent exhibited a mean increase in functional duration of 4 months compared with the polymeric stents (p<0.0001, and 50% (25/50 of the Resonance stents exhibited a significant increase in functional duration (more than 3 months. Pre-operative serum creatinine < 2 was associated with a substantial increase in stent duration.Resonance stents are effective and safe in relieving malignant ureteral obstructions after polymeric stents failure. Resonance stents can provide a

  1. [Ambulatory ureteral lithotripsy with "Modulith SL-20"].

    Science.gov (United States)

    González Enguita, C; Calahorra Fernández, F J; García de la Peña, E; Rodríguez-Miñón Cifuentes, J L; Vela Navarrete, R

    1993-03-01

    Analysis of our experience in 'in situ' ambulatory shockwave extracorporeal lithofragmentation of ureteral stones in 104 patients seen in the Lithotrity Unit, Urology Service, Fundación "Jiménez Díaz". Using Modulith SL 20, a third generation lithotripter, 'in situ' disintegration was achieved in 82.69% of cases, 51.92% of which were fragmented in a single lithotrity session. As a first choice, no ureteral handling was used in any of the patients prior to lithotrity. In 9.62% of patients it was necessary to place a 'double J' by-pass catheter, due to the disease presenting with a septic picture. The patient's position was either dorsal or ventral decubitus depending on the lithiatic site, while location and focusing of the stones was done radiologically. All patients were treated ambulatory without hospitalization. Only 18% was given oral or i.v. anaesthesia. Fursemide 40 mg was administered to all patients shortly before starting the session. Each patient received an average of 3,200 shockwaves per session (14-18 Kv, average 16 Kv). Haematuria was the single and modest side effect that happened during the 24 hours following lithofragmentation in 30% of patients, while 20% reported slight discomfort at the time of eliminating the gritted stones. We conclude stating that 'in situ' shockwave extracorporeal lithotrity of ureteral stones with Modulith SL 20 allows for elective disintegration of ureteral stones in whatever location they are found, due to the patient's easy positioning. The simple location and focusing of ureteral stones has allowed us to treat and solve some cases of ureteral lithiasis at the precise moment of the nephritic colic painful emergency, thus speeding up and facilitating the resolution of the condition. Our results and our strategy imply a new change of direction in the management of these lithiasis, as opposed to the well established and historical doctrines in existence regarding stones with ureteral location.

  2. Actor Network Procedures as Psi-calculi for Security Ceremonies

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    Cristian Prisacariu

    2014-04-01

    Full Text Available The actor network procedures of Pavlovic and Meadows are a recent graphical formalism developed for describing security ceremonies and for reasoning about their security properties. The present work studies the relations of the actor network procedures (ANP to the recent psi-calculi framework. Psi-calculi is a parametric formalism where calculi like spi- or applied-pi are found as instances. Psi-calculi are operational and largely non-graphical, but have strong foundation based on the theory of nominal sets and process algebras. One purpose of the present work is to give a semantics to ANP through psi-calculi. Another aim was to give a graphical language for a psi-calculus instance for security ceremonies. At the same time, this work provides more insight into the details of the ANPs formalization and the graphical representation.

  3. Distal clavicle edema; Distales Klavikulaoedem

    Energy Technology Data Exchange (ETDEWEB)

    Vahlensieck, M.; Schmittke, I. [Radiologie Haydnhaus, Bonn (Germany); Schmidt, H.M. [Universitaet Bonn (Germany). Anatomisches Institut

    2006-07-15

    Distal clavicle marrow edema: frequency, MRI in the early stage and macroscopic correlation to the bone marrow distribution and to evaluate frequency and diagnostic criteria of a posttraumatic clavicula disorder with an edema pattern on MRI. An additional macroscopic study of the clavicle should elucidate anatomic pecularities which could explain the reaction of the distal clavicle. 285 MRI of traumatized patients were analyzed for edema pattern of the distal clavicle. Pattern A edema within the clavicle and the acromion was distinguished from pattern B edema within the clavicle only. Dissection in 20 cadavers should reveal vascular pecularities and the bone marrow distribution within clavicle and acromion or vascular pecularities. In 38 patients (13,3%) we found edema within the distal clavicle. Pattern A was found in 28 (9,8%) and pattern B in 10 patients (3,5%). Pattern A was usually associated with swelling of the AC joint (27 out of 28). Other injuries were not evident. 18 cadavers showed hematopoetic marrow within the distal clavicle and fatty marrow within the acromion. The distale clavicle can frequently react with edema pattern after trauma without evidence for another injury. Distinguish in cases with and cases without synovitis of the AC joint could have impact on therapy. A peculier vascular supply of the distal clavicle could not be found. (orig.) [German] Bestimmung der Haeufigkeit und diagnostischer Kriterien einer posttraumatischen Klavikulaerkrankung, die mit einem MR-tomographischen Oedemmuster auffaellt. Makroskopische Besonderheiten der Markhoehle sollten gesucht werden, die die besondere Reaktionsform der distalen Klavikula mit erklaeren koennten. 285 Patienten mit traumaassoziierten, zeitversetzt nach dem Unfallereignis bestehenden Schulterbeschwerden, wurden auf MR-tomographische Oedemmuster in der distalen Klavikula untersucht. Das Oedemmuster wurde in ''Klavikula allein'' (Muster B) und ''mit Beteiligung des

  4. A standardisation proof for algebraic pattern calculi

    CERN Document Server

    Kesner, Delia; Ríos, Alejandro; 10.4204/EPTCS.49.5

    2011-01-01

    This work gives some insights and results on standardisation for call-by-name pattern calculi. More precisely, we define standard reductions for a pattern calculus with constructor-based data terms and patterns. This notion is based on reduction steps that are needed to match an argument with respect to a given pattern. We prove the Standardisation Theorem by using the technique developed by Takahashi and Crary for lambda-calculus. The proof is based on the fact that any development can be specified as a sequence of head steps followed by internal reductions, i.e. reductions in which no head steps are involved.

  5. Ureteral metastasis from prostate cancer.

    Science.gov (United States)

    Hongo, Hiroshi; Kosaka, Takeo; Yoshimine, Shunsuke; Oya, Mototsugu

    2014-08-28

    A 59-year-old man had an elevated prostate-specific antigen (PSA) concentration (439 ng/mL) in December 2008. We diagnosed prostatic adenocarcinoma by prostate needle biopsy. CT and MRI showed a prostatic tumour with bone and lymph node metastases. Combined androgen blockade therapy reduced the PSA level temporarily. After the PSA level gradually started to increase again and reached 27.27 ng/mL in October 2010, the patient was diagnosed with castration-resistant prostate cancer and treated with docetaxel chemotherapy. Radiological examination detected left hydronephrosis and a tumour in the left lower ureter in March 2011. Retrograde pyelography and urine cytology of class 3 from the left ureter indicated that the ureteral mass was a urothelial carcinoma. A left nephroureterectomy was performed. After the operation, the pathological examination showed a metastatic prostate carcinoma, accompanied by a decrease in the serum PSA level from 59.56 to 45.33 ng/mL.

  6. 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...

  7. Concurrency Models with Causality and Events as Psi-calculi

    Directory of Open Access Journals (Sweden)

    Håkon Normann

    2014-10-01

    Full Text Available Psi-calculi are a parametric framework for nominal calculi, where standard calculi are found as instances, like the pi-calculus, or the cryptographic spi-calculus and applied-pi. Psi-calculi have an interleaving operational semantics, with a strong foundation on the theory of nominal sets and process algebras. Much of the expressive power of psi-calculi comes from their logical part, i.e., assertions, conditions, and entailment, which are left quite open thus accommodating a wide range of logics. We are interested in how this expressiveness can deal with event-based models of concurrency. We thus take the popular prime event structures model and give an encoding into an instance of psi-calculi. We also take the recent and expressive model of Dynamic Condition Response Graphs (in which event structures are strictly included and give an encoding into another corresponding instance of psi-calculi. The encodings that we achieve look rather natural and intuitive. Additional results about these encodings give us more confidence in their correctness.

  8. Origin and types of calcium oxalate monohydrate papillary renal calculi.

    Science.gov (United States)

    Grases, Fèlix; Costa-Bauzá, Antonia; Gomila, Isabel; Conte, Antonio

    2010-12-01

    Subepithelial hydroxyapatite calcification of renal papilla is thought to be involved in the formation of calcium oxalate monohydrate (COM) papillary calculi. To assess the mechanism of formation, we sought to correlate the fine structure of papillary renal calculi with specific pathophysiologic conditions and urinary alterations. The study included 831 COM papillary renal calculi with established fine inner structures. A total of 24 patients with chronic stone formation were randomly selected, and their urine was collected and analyzed. The case history and lifestyle habits of these patients were obtained. The 831 papillary calculi could be classified into 1 of 4 main groups. Type I included small calculi in which COM columnar crystals begin to develop in the concave zone in close contact with papillary tissue. Type II calculi contained a hydroxyapatite core located in or near the concave zone. Type III consisted of calculi that developed on the tip of the papillae and in the concave zone, containing hydroxyapatite, calcified tissue, and calcified tubules. Type IV consisted of papillary calculi in which the core, which is situated near, but not in, the concave zone, is formed by intergrown COM crystals and organic matter. Many factors, including urinary alterations (eg, hyperoxaluria), associated diseases (eg, hypertension, diabetes), and consumption or exposure to cytotoxic substances (eg, analgesic abuse) were associated with these types of calculi. Our findings have indicated that injury is the first cause of papillary COM calculus formation, with the location of the injury determining the morphology of the resulting calculus. Copyright © 2010 Elsevier Inc. All rights reserved.

  9. Taking the STING Out of Ureteral Obstruction

    Science.gov (United States)

    Aw, Ivan; Tan, Philip Huang Min; Clarke, David

    2016-01-01

    Abstract Vesicoureteral reflux (VUR) is diagnosed in ∼1% of children. The main goal of treatment is preservation of renal function by preventing recurrent urinary tract infection (UTI) refractory to antibiotic therapy. Surgical treatment options include endoscopic injection or ureteral reimplantation. Subureteral Teflon (polytetrafluoroethylene) injection (STING) is an endoscopic treatment option no longer in common practice. Use of Teflon is no longer advised because of a number of documented complications secondary to local and distant migration of injected material. We present a case of delayed ureteral obstruction secondary to the STING procedure occurring 21 years after initial surgery and managed using a novel endoscopic method. PMID:27785466

  10. Ureteritis Cystica: A Radiologic Pathologic Correlation

    Directory of Open Access Journals (Sweden)

    Jennifer G Rothschild

    2011-01-01

    Full Text Available Ureteritis cystica (UC is a benign condition that commonly affects the ureter and can mimic other conditions such as transitional cell carcinoma, blood clots, air bubbles, radiolucent stones, fibroepithelial polyps, and sloughed renal papillae. Radiographically, UC is characterized by multiple small, round, lucent defects, which cause scalloping of the ureteral margins when seen in profile. The scalloping is produced by the projection of the submucosal cysts into the lumen and represents an important differential feature of this disease. We present a case of UC with a radiological pathological correlation.

  11. Scintigraphy and Doppler ultrasonography for the evaluation of obstructive urinary calculi

    Directory of Open Access Journals (Sweden)

    L. Gandolpho

    2001-06-01

    Full Text Available Forty-seven patients with unilateral obstructive calculi (12 males and 35 females were submitted to 99mTc-diethylene triamine pentaacetic acid (DTPA or 99mTc-dimercaptosuccinic acid (DMSA scans for assessment of renal function. The scans revealed unilateral functional deficit in 68 and 66% of the patients, respectively. A calculus size of 1.1 to 2.0 cm was significantly associated with deficit detected by DTPA, but duration of obstruction and calculus localization were not. After relief of the obstruction, the mean percent renal function of the affected kidney was found to be significantly increased from 25 ± 12% to 29 ± 12% in DTPA and from 21 ± 15% to 24 ± 12% in DMSA. Initial Doppler ultrasonography performed in 35 patients detected an increased resistive index in 10 (29%. In the remaining patients with a normal resistive index, ureteral urinary jet was observed, indicating partial obstruction. The high frequency of renal function impairment detected by DTPA and of tubulointerstitial damage detected by DMSA as well as the slight amelioration of unilateral renal function after relief of obstruction suggest that scintigraphy assessment may help evaluate the unilateral percentage of renal function and monitor renal function recovery when it occurs. The presence of a urinary jet detected by Doppler ultrasonography further indicates the severity of obstruction and the recovery prognosis.

  12. SEM and X-ray microanalysis of human prostatic calculi

    Energy Technology Data Exchange (ETDEWEB)

    Vilches, J.; Lopez, A.; De Palacio, L.; Munoz, C.; Gomez, J.

    1982-02-01

    Calculi removed from human prostates affected with nodular hyperplasia were analyzed with scanning electron microscopy and EDAX system. The general spectrum was made up of Na, Al, Mg, S, P, Ca and Zn. Two types of stone were identified morphostructurally and microanalytically: calculi type I of nodular surface with high peaks of S, and calculi type II polyfaceted with high peaks of P and Ca. Their formation from corpora amylacea and/or exogenous constituents is discussed. The superficial deposit of Zn suggests its incorporation from the prostatic liquid and does not seem to play an important role in the genesis.

  13. [Pseudocystic ureteritis. Apropos of a case].

    Science.gov (United States)

    Joual, A; Sarf, I; Aboutaieb, R; el Mrini, M; Benjelloun, S

    1995-01-01

    The authors report one case of ureteritis cystica in a young adult. The diagnosis was made by intravenous urography and confirmed by histologic examination. The patient was treated surgically (nephro-ureterectomy). The etiopathogenic, clinical and therapeutic aspects are discussed with a review of literature.

  14. Nonlocal Operational Calculi for Dunkl Operators

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    Ivan H. Dimovski

    2009-03-01

    Full Text Available The one-dimensional Dunkl operator $D_k$ with a non-negative parameter $k$, is considered under an arbitrary nonlocal boundary value condition. The right inverse operator of $D_k$, satisfying this condition is studied. An operational calculus of Mikusinski type is developed. In the frames of this operational calculi an extension of the Heaviside algorithm for solution of nonlocal Cauchy boundary value problems for Dunkl functional-differential equations $P(D_ku = f$ with a given polynomial $P$ is proposed. The solution of these equations in mean-periodic functions reduces to such problems. Necessary and sufficient condition for existence of unique solution in mean-periodic functions is found.

  15. Inhibition of urinary calculi -- a spectroscopic study

    Science.gov (United States)

    Manciu, Felicia; Govani, Jayesh; Durrer, William; Reza, Layra; Pinales, Luis

    2008-10-01

    Although a considerable number of investigations have already been undertaken and many causes such as life habits, metabolic disorders, and genetic factors have been noted as sources that accelerate calculi depositions and aggregations, there are still plenty of unanswered questions regarding efficient inhibition and treatment mechanisms. Thus, in an attempt to acquire more insights, we propose here a detailed scientific study of kidney stone formation and growth inhibition based on a traditional medicine approach with Rotula Aquatica Lour (RAL) herbal extracts. A simplified single diffusion gel growth technique was used for synthesizing the samples for the present study. The unexpected Zn presence in the sample with RAL inhibitor, as revealed by XPS measurements, explains the inhibition process and the dramatic reflectance of the incident light observed in the infrared transmission studies. Raman data demonstrate potential binding of the inhibitor with the oxygen of the kidney stone. Photoluminescence results corroborate to provide additional evidence of Zn-related inhibition.

  16. Staghorn calculi and xanthogranulomatous pyelonephritis associated with transitional cell carcinoma

    Directory of Open Access Journals (Sweden)

    Chao-Wei Tseng

    2015-03-01

    Full Text Available Untreated staghorn calculi can cause xanthogranulomatous pyelonephritis (XGP, diminished renal function, and renal malignancy. Squamous cell carcinoma (SCC of the upper urinary tract is associated with kidney stones and chronic infection, but their association with transitional cell carcinoma (TCC has not been proven and has rarely been reported in literature. We present a rare case of staghorn calculi and XGP associated with TCC.

  17. Percutaneous ultrasonic lithotripsy of symptomatic renal calculi in children

    Energy Technology Data Exchange (ETDEWEB)

    Papanicolaou, N.; Pfister, R.C.; Yoder, I.C.; Young, H.H. II; Herrin, J.T.

    1986-01-01

    Percutaneous ultrasonic lithotripsy of upper urinary tract lithiasis is a well-established procedure in adults. We successfully applied this technique to completely remove symptomatic renal calculi in two children with idiopathic hypercalciuria. The procedure was well tolerated and no complications occurred. Both patients were discharged within 4 days of the lithotripsy. This method is an alternative to surgery for the removal of large or impacted calculi from the upper urinary tracts of pediatric patients. (orig.).

  18. Combined calculi for photon orbital and spin angular momenta

    Science.gov (United States)

    Elias, N. M.

    2014-08-01

    Context. Wavelength, photon spin angular momentum (PSAM), and photon orbital angular momentum (POAM), completely describe the state of a photon or an electric field (an ensemble of photons). Wavelength relates directly to energy and linear momentum, the corresponding kinetic quantities. PSAM and POAM, themselves kinetic quantities, are colloquially known as polarization and optical vortices, respectively. Astrophysical sources emit photons that carry this information. Aims: PSAM characteristics of an electric field (intensity) are compactly described by the Jones (Stokes/Mueller) calculus. Similarly, I created calculi to represent POAM characteristics of electric fields and intensities in an astrophysical context. Adding wavelength dependence to all of these calculi is trivial. The next logical steps are to 1) form photon total angular momentum (PTAM = POAM + PSAM) calculi; 2) prove their validity using operators and expectation values; and 3) show that instrumental PSAM can affect measured POAM values for certain types of electric fields. Methods: I derive the PTAM calculi of electric fields and intensities by combining the POAM and PSAM calculi. I show how these quantities propagate from celestial sphere to image plane. I also form the PTAM operator (the sum of the POAM and PSAM operators), with and without instrumental PSAM, and calculate the corresponding expectation values. Results: Apart from the vector, matrix, dot product, and direct product symbols, the PTAM and POAM calculi appear superficially identical. I provide tables with all possible forms of PTAM calculi. I prove that PTAM expectation values are correct for instruments with and without instrumental PSAM. I also show that POAM measurements of "unfactored" PTAM electric fields passing through non-zero instrumental circular PSAM can be biased. Conclusions: The combined PTAM calculi provide insight into mathematically modeling PTAM sources and calibrating POAM- and PSAM-induced measurement errors.

  19. Large bilateral star-shaped calculi in the seminal vesicles.

    Directory of Open Access Journals (Sweden)

    Namjoshi S

    2002-04-01

    Full Text Available Calculi in the seminal vesicles (SV are extremely rare. A patient having large bilateral star-shaped calculi in the SV is reported. They were seen on plain x-ray and confirmed by computed tomography. On the reconstructed CT scans the large stone on the right side measured about 35 X 35 X 50 mm and the one on the left, 30 X 20 X 45 mm. They were not felt on rectal examination, as they were situated laterally.

  20. Forgotten Ureteral Stents: An Avoidable Morbidity.

    Science.gov (United States)

    Murtaza, Badar; Alvi, Sarwar

    2016-03-01

    To assess the clinical presentation of forgotten ureteral stents and highlight the etiological factors resulting in the retention of these stents. Observational study. Department of Urology, Armed Forces Institute of Urology, Rawalpindi, from January 2010 to June 2011. Thirty-eight patients, with forgotten ureteral stents, retained for more than 6 months duration, were enrolled. A detailed evaluation was performed, along with the questions regarding the patients' opinion about the ureteral stents. They were specially asked whether they knew about the stents or were they formally informed regarding the stents. Subsequently, the patients were managed according to their clinical condition. The male to female ratio was 2.1:1 aged 23 - 69 years, mean being 40.24 ±12.59 years. The time of presentation after the ureteral stenting was 7 - 180 months (mean = 28.89 ±33.435 years). Seven patients (18.4%) reported with chronic kidney disease, including ESRD in two cases. Recurrent UTI was seen in 28 cases (73.6%), calculus formed over the stents in 20 cases (52.6%), and stent fragmented in 5 patients (13.1%). Majority of patients, (n = 23, 60.5%), were not even aware of the placement of these stents while 8 (21.0%) knew but were reluctant about its removal. In 3 cases (7.8%), the relatives knew about the stent but never informed the patients. The stent had been removed in 2 cases (5.2%), but the other broken fragment was missed. One case (2.6%) each had a misconception about the permanent placement of the stents like cardiac stents and regarding degradation of the stents in situ. Forgotten ureteral stents produce clinical features ranging from recurrent UTI to ESRD. This preventable urological complication is primarily due to the unawareness or ignorance of the patients and their relatives regarding the stent.

  1. [Strategies for endoscopic and surgical treatment of biliary tract calculi].

    Science.gov (United States)

    Stojanović, Dragos; Stojanović, Mirjana; Milojević, Predrag; Caparević, Zorica; Lalosević, Dorde; Radovanović, Dragan

    2003-01-01

    Common bile duct calculi represent a pathologic entity involving obstructive icterus, cholangitis, hepatic cirrhosis or pancreatitits. Common bile duct calculi mostly have a secondary origin (from gallbladder) in 95% of cases, while primary choledocholithiasis is rare. From surgical aspect, common bile duct calculi can be: 1. Asymptomatic, without manifested symptoms or signs, 2. Mobile, with intermittent biliar obstruction and disobstruction, 3. Fixed, with obstruction and signs of hepato-biliary and/or bilio-pancreatic duct, 4. Transitory, microcalculi which pass through Vater's Papilla by propulsion into duodenum with symptoms. Modern biliary surgery includes diagnosis of common bile duct calculi, and if possible preoperative endoscopic (endoluminal) surgery, which is less invasive for patients. If such approach is not possible, it is necessary to perform stone extraction and cholecystectomy. Common bile duct calculi represent a common disease of the digestive system. Endoscopic diagnostic procedure is very important in management of choledocholithiasis. Endoscopic treatment of common bile duct calculi prior to cholecystectomy is a method of choice and a strategy for associated cholecysto-choledocholithiasis.

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

    Science.gov (United States)

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

    2011-03-01

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

  3. Distal renal tubular acidosis

    Science.gov (United States)

    Renal tubular acidosis - distal; Renal tubular acidosis type I; Type I RTA; RTA - distal; Classical RTA ... excreting it into the urine. Distal renal tubular acidosis (Type I RTA) is caused by a defect ...

  4. The incidence and location of prostatic calculi on noncontrast computed tomography images in patients with renal calculi.

    Science.gov (United States)

    Balasar, Mehmet; Poyraz, Necdet; Göğer, Yunus Emre; Unal, Yunus; Pişkin, Mehmet Mesut

    2015-08-01

    In this study, the incidence and location of prostatic calculi on noncontrast abdominal computed tomography (NCACT) images of patients with and without renal stones were investigated. Between 2006 and 2013, NCACT images were taken of 133 patients treated for renal stones (Group I) and of 100 age-matched control patients with putative urinary stone disease (Group II) in our clinic. The incidence and location of prostatic calculi on these images were determined. The location of prostatic calculus was classified as type A if they were located in the main prostatic ducts, and type B if they were located outside the ducts. Prostatic calculi were present in 44.4% of patients in Group I and 21.0% of patients in Group II. The incidence of prostatic calculi was significantly higher in patients with urinary stones compared with those without (Pincidence of prostatic calculi is more prevalent in patients with renal stones. On NCACT images, prostatic calculi were mostly detected in the main prostatic ducts, which were defined as type A.

  5. Is the KUB radiograph redundant for investigating acute ureteric colic in the non-contrast enhanced computed tomography era?

    Energy Technology Data Exchange (ETDEWEB)

    Kennish, S.J.; Bhatnagar, P. [Department of Radiology, St James' University Hospital, Leeds (United Kingdom); Wah, T.M. [Department of Radiology, St James' University Hospital, Leeds (United Kingdom)], E-mail: Tze.wah@leedsth.nhs.uk; Bush, S. [Department of Emergency Medicine, St James' University Hospital, Leeds (United Kingdom); Irving, H.C. [Department of Radiology, St James' University Hospital, Leeds (United Kingdom)

    2008-10-15

    Aim: To establish whether non-contrast enhanced computed tomography (NCCT) renders the kidneys-ureters-bladder (KUB) radiograph redundant as the initial imaging investigation for suspected acute ureteric colic. Materials and methods: The imaging investigations for 120 patients consecutively admitted to an emergency department-led clinical decisions unit (CDU) with suspected acute ureteric colic were retrospectively reviewed. A multidisciplinary meeting reviewed the findings and recommended that KUB radiographs should not be routinely performed prior to NCCT. Prospective assessment of 116 consecutive patients admitted over a comparable period was then undertaken. Results: In the retrospective group, 61 (50.8%) patients had calculi to account for symptoms (positive NCCT) and 59 (49.2%) patients did not have stone disease (negative NCCT). Ninety (75%) patients had a KUB radiograph prior to NCCT. However, in 46 (38% of total) of these patients the NCCT was negative for stones, and therefore, they had been subjected to an unnecessary radiographic examination. These results prompted a change in practice. In the subsequent and prospectively studied group, preliminary KUB radiographs were performed in only 6% of the patients, with no significant change in the positive NCCT rate (50.8 versus 51.7%) or the total number of examinations performed (120 versus 116). Conclusion: NCCT should be the initial imaging examination for acute ureteric colic. Up to 50% of patients with clinical suspicion do not have stone disease, and therefore, preliminary KUB radiographs with attendant radiation and cost implications are unjustified. Preliminary KUB radiographs can be omitted from the imaging pathway with no resultant indication creep or increase in demand for NCCT examinations.

  6. [Intrinsic ureteral endometriosis: description of a striking instance].

    Science.gov (United States)

    Antonelli, Alessandro; Finotto, Elena; Zambolin, Tiziano; Fisogni, Simona; Simeone, Claudio

    2015-01-01

    Intrinsic ureteral endometriosis is a very rare condition. A 41 y. o. woman with right hydroureteronephrosis and other aspecific symptoms came to our attention. The CT scan showed an ureteral obstacle causing the hydroureteronephrosis. She underwent ureterorenoscopy with biopsies of the lesion that did not result to be diriment. Suspecting a ureteral neoplasm, the patient then underwent ureteral resection and ureterocystoneostomy, and the extemporary histological examination resulted as endometriosis. The abdominal exploration showed a parametrial and a peritoneal growth - both compatible with the extemporary histological examination - that were also excised. The post-operative course was uneventful. The definitive hystological examination confirmed the perioperatory diagnosis. Intrinsic ureteral endometriosis is confirmed as a rare pathology with an indefinite clinical presentation; its typical presentation, namely cyclic hematuria, seems to be an anecdotal feature. Therefore the diagnostics of intrinsic ureteral endometriosis is still difficult even despite such a striking presentation.

  7. Ureteral Metastasis Secondary to Prostate Cancer: A Case Report

    Directory of Open Access Journals (Sweden)

    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.

  8. Extensive prostatic calculi in alkaptonuria: An unusual manifestation of rare disease

    Directory of Open Access Journals (Sweden)

    Gaurav Sali

    2015-07-01

    Full Text Available Extensive prostatic calculi in a young man should always elicit the suspicion of alkaptonuria. Although prostatic calculi are seen in chronic prostatitis, chronic pelvic pain syndrome and benign prostate hyperplasia, none of these have prostatic calculi or calcification as extensive as in alkaptonuria. A 36 years young man who had severed obstructive lower urinary tract symptoms with extensive prostatic calculi was found to be alkaptonuric on further evaluation.

  9. Extensive prostatic calculi in alkaptonuria: An unusual manifestation of rare disease

    OpenAIRE

    Gaurav Sali; Appu Thomas; Ginil Kumar; Balagopalan Nair; Kalvampara Sanjeevan; Georgie Mathew; Kannan Nair

    2015-01-01

    Extensive prostatic calculi in a young man should always elicit the suspicion of alkaptonuria. Although prostatic calculi are seen in chronic prostatitis, chronic pelvic pain syndrome and benign prostate hyperplasia, none of these have prostatic calculi or calcification as extensive as in alkaptonuria. A 36 years young man who had severed obstructive lower urinary tract symptoms with extensive prostatic calculi was found to be alkaptonuric on further evaluation.

  10. Existence families, functional calculi and evolution equations

    CERN Document Server

    deLaubenfels, Ralph

    1994-01-01

    This book presents an operator-theoretic approach to ill-posed evolution equations. It presents the basic theory, and the more surprising examples, of generalizations of strongly continuous semigroups known as 'existent families' and 'regularized semigroups'. These families of operators may be used either to produce all initial data for which a solution in the original space exists, or to construct a maximal subspace on which the problem is well-posed. Regularized semigroups are also used to construct functional, or operational, calculi for unbounded operators. The book takes an intuitive and constructive approach by emphasizing the interaction between functional calculus constructions and evolution equations. One thinks of a semigroup generated by A as etA and thinks of a regularized semigroup generated by A as etA g(A), producing solutions of the abstract Cauchy problem for initial data in the image of g(A). Material that is scattered throughout numerous papers is brought together and presented in a fresh, ...

  11. Aeromedical certification of aircrew and controllers with renal calculi.

    Science.gov (United States)

    Drane, A Michael C; Navathe, Pooshan; Clem, Peter

    2013-10-01

    Acute renal colic is an incapacitating condition. Advances in understanding the pathogenesis of calculi and their detection and treatment require a new approach to aeromedical risk assessment. Can this new information support the stratification of aeromedical risk into "High" and "Low" categories, and fulfill the paramount responsibility of the Civil Aviation Safety Authority, Australia's aviation regulator, which isthe maintenance of aviation safety? This article reviews the epidemiology of calculi and finds 2-10% annual risk of a symptomatic event following incidental detection of a calculus. While calculi 4 mm or less in size may not require surgical intervention, this does not equate to a pain-free passage. Similarly, calculus recurrence rates may vary in different anatomical locations, but no location can be considered "safe." The recognition of parenchymal calcification and Randall's plaques as precursors to the development of calculi places such individuals at elevated risk of developing calculi. More recently evidence has supported a link between metabolic syndrome and calculus formation. In an occupational group where there is potential for elevated radiation exposure, appropriate imaging is of particular importance. CT, X-ray, and ultrasound modalities are reviewed with recommendations presented for aeromedical assessment and surveillance based on identification of those at high risk of colic and minimization of investigational radiation exposure.

  12. Large bifid ureteric calculus in a patient with an ileal conduit.

    Science.gov (United States)

    Rajaian, Shanmugasundaram; Kekre, Nitin S

    2012-09-01

    Urinary diversion after extirpative surgery of the bladder is done by various methods. Conduit urinary diversion is the most commonly practiced method of urinary diversion. It is relatively easy to perform and has a lower complication rate than other forms of diversion, e.g., orthotopic neobladder and continent cutaneous urinary diversion. Urolithiasis is a known and common complication of urinary diversion. Upper tract calculi in these cases often manifest symptomatically as occurs in the general population. Stones in the conduit can have a variable clinical presentation. Asymptomatic presentation is also noted in a few cases. We report a case of a large silent bifid ureteric calculus within an ileal conduit in a woman who had undergone urinary diversion 32 years earlier. Plain X-ray of the abdomen is the only investigation necessary to rule out urinary lithiasis in those who have had urinary diversion for a long time. This simple tool can diagnose the condition well in advance and aid in planning the management of this condition.

  13. Large bifid ureteric calculus in a patient with an ileal conduit

    Directory of Open Access Journals (Sweden)

    Shanmugasundaram Rajaian

    2012-01-01

    Full Text Available Urinary diversion after extirpative surgery of the bladder is done by various methods. Conduit urinary diversion is the most commonly practiced method of urinary diversion. It is relatively easy to perform and has a lower complication rate than other forms of diversion, e.g., orthotopic neobladder and continent cutaneous urinary diversion. Urolithiasis is a known and common complication of urinary diversion. Upper tract calculi in these cases often manifest symptomatically as occurs in the general population. Stones in the conduit can have a variable clinical presentation. Asymptomatic presentation is also noted in a few cases. We report a case of a large silent bifid ureteric calculus within an ileal conduit in a woman who had undergone urinary diversion 32 years earlier. Plain X-ray of the abdomen is the only investigation necessary to rule out urinary lithiasis in those who have had urinary diversion for a long time. This simple tool can diagnose the condition well in advance and aid in planning the management of this condition.

  14. Generic Methods for Formalising Sequent Calculi Applied to Provability Logic

    Science.gov (United States)

    Dawson, Jeremy E.; Goré, Rajeev

    We describe generic methods for reasoning about multiset-based sequent calculi which allow us to combine shallow and deep embeddings as desired. Our methods are modular, permit explicit structural rules, and are widely applicable to many sequent systems, even to other styles of calculi like natural deduction and term rewriting systems. We describe new axiomatic type classes which enable simplification of multiset or sequent expressions using existing algebraic manipulation facilities. We demonstrate the benefits of our combined approach by formalising in Isabelle/HOL a variant of a recent, non-trivial, pen-and-paper proof of cut-admissibility for the provability logic GL, where we abstract a large part of the proof in a way which is immediately applicable to other calculi. Our work also provides a machine-checked proof to settle the controversy surrounding the proof of cut-admissibility for GL.

  15. Forgotten ureteric stents in renal transplant recipients: three case reports.

    Science.gov (United States)

    Bardapure, Mallikarjun; Sharma, Ajay; Hammad, Abdul

    2014-01-01

    Ureteric stents are widely used in renal transplantation to minimize the early urological complications. Ureteric stents are removed between two and 12 weeks following trans-plantation, once the vesico-ureteric anastomosis is healed. Ureteric stents are associated with considerable morbidity due to complications such as infection, hematuria, encrustations and migration. Despite the patient having a regular follow-up in the renal transplant clinic, ureteric stents may be overlooked and forgotten. The retained or forgotten ureteric stents may adversely affect renal allograft function and could be potentially life-threatening in immunocompromised transplant recipients with a single transplant kidney. Retrieving these retained ureteric stents could be challenging and may necessitate multimodal urological treatments. We report three cases of forgotten stents in renal transplant recipients for more than four years. These cases emphasize the importance of patient education about the indwelling ureteric stent and possibly providing with a stent card to the patient. Maintaining a stent register, with a possible computer tracking system, is highly recommended to prevent such complications.

  16. Endourological management of ureteral obstruction after renal transplantation

    NARCIS (Netherlands)

    Bosma, RJ; vanDriel, MF; vanSon, WJ; deRuiter, AJ; Mensink, HJA

    1996-01-01

    Purpose: We evaluated endourological treatment of ureteral obstruction after renal transplantation. Materials and Methods: Between January 1986 and December 1993, 582 kidney transplantations were performed at our center, and ureteral obstruction was suspected in 31 cases (5.3%). Results: Initial tre

  17. Ureteral injuries during photoselective vaporization of the prostate

    DEFF Research Database (Denmark)

    Højgaard, M; Mikines, K.J.

    2010-01-01

    orifices are described, with hidden orifices, intravesical prostatic adenomas and prior prostatectomy as risk factors for laser-related injuries to ureteral orifices. A laser-coagulated ureteral orifice does not seem to regain patency spontaneously, so rapid nephrostomy and subsequent DJ stenting...

  18. A review of ureteral injuries after external trauma

    Science.gov (United States)

    2010-01-01

    Introduction Ureteral trauma is rare, accounting for less than 1% of all urologic traumas. However, a missed ureteral injury can result in significant morbidity and mortality. The purpose of this article is to review the literature since 1961 with the primary objective to present the largest medical literature review, to date, regarding ureteral trauma. Several anatomic and physiologic considerations are paramount regarding ureteral injuries management. Literature review Eighty-one articles pertaining to traumatic ureteral injuries were reviewed. Data from these studies were compiled and analyzed. The majority of the study population was young males. The proximal ureter was the most frequently injured portion. Associated injuries were present in 90.4% of patients. Admission urinalysis demonstrated hematuria in only 44.4% patients. Intravenous ureterogram (IVU) failed to diagnose ureteral injuries either upon admission or in the operating room in 42.8% of cases. Ureteroureterostomy, with or without indwelling stent, was the surgical procedure of choice for both trauma surgeons and urologists (59%). Complications occurred in 36.2% of cases. The mortality rate was 17%. Conclusion The mechanism for ureteral injuries in adults is more commonly penetrating than blunt. The upper third of the ureter is more often injured than the middle and lower thirds. Associated injuries are frequently present. CT scan and retrograde pyelography accurately identify ureteral injuries when performed together. Ureteroureterostomy, with or without indwelling stent, is the surgical procedure of choice of both trauma surgeons and urologists alike. Delay in diagnosis is correlated with a poor prognosis. PMID:20128905

  19. Forgotten ureteric stents in renal transplant recipients: Three case reports

    Directory of Open Access Journals (Sweden)

    Mallikarjun Bardapure

    2014-01-01

    Full Text Available Ureteric stents are widely used in renal transplantation to minimize the early urological complications. Ureteric stents are removed between two and 12 weeks following trans-plantation, once the vesico-ureteric anastomosis is healed. Ureteric stents are associated with considerable morbidity due to complications such as infection, hematuria, encrustations and migration. Despite the patient having a regular follow-up in the renal transplant clinic, ureteric stents may be overlooked and forgotten. The retained or forgotten ureteric stents may adversely affect renal allograft function and could be potentially life-threatening in immunocompromised transplant recipients with a single transplant kidney. Retrieving these retained ureteric stents could be challenging and may necessitate multimodal urological treatments. We report three cases of forgotten stents in renal transplant recipients for more than four years. These cases emphasize the importance of patient education about the indwelling ureteric stent and possibly providing with a stent card to the patient. Maintaining a stent register, with a possible computer tracking system, is highly recommended to prevent such complications.

  20. Labelled Lambda-calculi with Explicit Copy and Erase

    Directory of Open Access Journals (Sweden)

    Maribel Fernández

    2010-03-01

    Full Text Available We present two rewriting systems that define labelled explicit substitution lambda-calculi. Our work is motivated by the close correspondence between Levy's labelled lambda-calculus and paths in proof-nets, which played an important role in the understanding of the Geometry of Interaction. The structure of the labels in Levy's labelled lambda-calculus relates to the multiplicative information of paths; the novelty of our work is that we design labelled explicit substitution calculi that also keep track of exponential information present in call-by-value and call-by-name translations of the lambda-calculus into linear logic proof-nets.

  1. [Appendicular ureteroplasty to repair a ureteric lesion during disk surgery].

    Science.gov (United States)

    Joual, Abdenbi; Taha, Abdellatif; Querfani, Badereddine; Sahnoun, Abderrazak; Hamid, Fekak; El Mrini, Mohamed

    2005-09-01

    Extensive ureteric lesions raise difficult problems of surgical repair. This is also the case for upper ureteric lesions that often require replacement of the damaged segment or even autologous transplantation. The authors report a case of iatrogenic ureteric lesion resulting in a large defect in a patient operated 6 months previously for an L4-L5 disk hernia, which was treated successfully by interposition of an appendicular graft between the two ureteric stumps. In the light of this case, the authors discuss the various appearances of iatrogenic ureteric lesions with particular emphasis on the value of appendicular ureteroplasty due to its simplicity and low morbidity, while waiting for progress in the field of biocompatible substitutes.

  2. Distal Biceps Tendon Rupture

    Science.gov (United States)

    2010-06-01

    distal tendon . Although these findings overlap with those seen in tendinopathy , the presence of bone marrow edema at the radial tuberosity and fluid in...the bicipitoradial bursa suggests a partial tear rather than tendinopathy .3 When the distal biceps tendon tear is complete, MR imaging shows...Distal Biceps Tendon Rupture Military Medicine Radiology Corner, 2006 Radiology Corner Distal Biceps Tendon Rupture Contributors: CPT Michael

  3. The bladder ran dry: bilateral ureteral obstruction.

    Science.gov (United States)

    Schattner, Ami; Drahy, Yosef; Dubin, Ina

    2017-08-07

    A relatively young healthy man (barring obesity and distant gouty arthritis) was admitted with severe acute kidney injury (serum creatinine, 15.9 mg/dL) following acute gastroenteritis and occasional use of diclofenac. Abdominal ultrasound revealed mild left hydronephrosis due to staghorn stone and normal right kidney. Soon after, complete anuria necessitating haemodialysis developed without pain or evidence of infection. CT imaging revealed stones obstructing the right ureter. Following urological surgery, postobstructive diuresis developed and the serum creatinine came down to near normal. The stones were identified as uric acid stones.Anuria has a relatively narrow differential and painless (partially non-dilated) bilateral ureteral obstruction is a distinctly unusual cause. A review of the literature to cover all reported causes of bilateral ureteral obstruction is presented. Only a minority of cases were not associated with an underlying malignant disease or its treatment. The multifactorial aetiology of the patient's acute kidney injury (volume depletion, diclofenac and obstructive uropathy) is presented and discussed. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  4. ISOLATED GUNSHOT URETERAL INJURY – CASE REPORT

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    Dejan Bratuš

    2004-04-01

    Full Text Available Background. In the article a case report of an eleven years old child who suffered an air rifle gunshot injury of his right ureter is presented.Methods. The child was admitted to the hospital without any subjective complaints while both ultrasound and CT scan showed a metallic alien body just below the hilus of his right kidney with no surrounding liquid collection. After the condition of the child had worsened with right lumbar and abdominal pain, the control CT scan showed a huge urinoma in his right retroperitoneum.Results. During a surgical exploration an ureteral injury was found with the pellet lying inside the right ureter just below the injury, causing an obstruction of the ureter. After the removal of the pellet and suturing of the ureter over a double J stent the child recovered without any sequels.Conclusions. The ureter is the least often injured genitourinary organ. The management of these injuries is usually straightforward and is primarily a problem of recognition at the initial presentation, especially of a patient with multiple injuries. The delayed presentation is principally responsible for the morbidity that is associated with a ureteral injury.

  5. Hydronephrosis of one kidney

    Science.gov (United States)

    ... Acute hydronephrosis; Urinary obstruction; Unilateral hydronephrosis; Nephrolithiasis - hydronephrosis; Kidney stone - hydronephrosis; Renal calculi - hydronephrosis; Ureteral calculi - hydronephrosis; ...

  6. [Experimental study regarding the ureteral cicatrization pattern in rabbit].

    Science.gov (United States)

    Pintilie, R A; Grigorovici, Mirela

    2008-01-01

    This study aimed to elaborate an experimental model for ureteral cicatrization following surgical lesion, with direct involvement in urological therapy. The study was realized on a group of 9 female rabbits on which we have performed ureteral surgery. First surgical event consisted in partial cut of the left ureter following transperitoneal approach, ureteral stent insertion and the suture of the ureteral wound. The second surgical event has accomplished the harvesting of the ureteral fragment during cicatrisation process and was performed at various times from the first surgical event, accordingly at 1, 2, 3...6 days--on different rabbits. 3 rabbits composed the witness group. Fragments were fixed in formol 4%, and histologically stained with hematoxilin-eosin and van Gieson. In the first two days we have observed an obvious inflammatory process on the postoperative ureteral scar. In days 3 and 4, the limited fibrosis appeared in the 2nd day engaged a peak in the 4th day when appeared a sketch of ureteral lumen constriction. In the 5th and 6th day the fibrosis process underwent a moderate resolution, simultaneously with a local diffuse congestion, marker for the remodeling processes of the connective matrix. Animal cicatrisation model follows the same pattern as in human but at different timing so as extrapolation requires considering these facts.

  7. MANAGEMENT OF URETERAL ENDOMETRIOSIS:A REPORT OF TEN CASES

    Institute of Scientific and Technical Information of China (English)

    Chun-yan Li; Hong-qing Wang; Hai-yuan Liu; Jing-he Lang

    2008-01-01

    Objective To investigate the clinical features and management ofureteral endometriosis.Methods Patients surgically and histologically diagnosed as ureteral endometriosis from January 2001 to January 2007 in Peking Union Medical College Hospital were retrospectively reviewed.Results Ten patients were diagnosed as ureteral endometriosis among 7561 cases with surgically and histologically proved diagnosis of endometriosis,with an incidence of 0.132%.Nine out of 10 patients were extrinsic ureteral endometriosis and concomitant with severe pelvic endometriosis,and the other was intrinsic ureteral endometriosis.Hormone therapy failed in 2 patients with urinary tract obstruction.Ureterolysis was performed in 6 patients and ureterectomy was performed in 4 patients.One ease of ureteral recurrence was observed in a postmenopausal woman without hormonal replacement therapy who received laparoscopic ureterolysis and hysterectomy with bilateral adnexectomy.No relapse was observed in the other 9 patients.Conclusions Ureteral endometriosis is a rare entity.The upper urinary tract should be evaluated in patients with severe endometriosis,even in postmenopausal women.The treatment of ureteral endometriosis usually requires surgery,while ureterolysis should not be performed in patients with extensive disease.As a form of adjuvant therapy of surgery,hormonal therapy is an appropriate option.

  8. 输尿管软镜下钬激光碎石术治疗上尿路结石——附126例报告%Treatment of Upper Urinary Calculi with Holmium Laser Lithotriptor under Flexible Ureteroscope (Appended with Report of 126 Cases)

    Institute of Scientific and Technical Information of China (English)

    周振宇; 何朝晖; 杨江根; 曾国华

    2013-01-01

    Objective To evaluate the clinical effect of holmium laser with flexible ureteroscope on upper urinary calculi.Methods All 126 patients of upper urinary calculi were treated with Holmium laser lithotriptor under flexible ureteroscope in our hospital.Of them,75 patients had calculi in the right side and 51 patients in the left side.The calculi were in the kidney for 64 patients,in the upper ureteral for 33 patients,and both in the upper ureteral and kidney for 29 patients.The diameter of the calculi ranged 0.6-2.0 cm,mean 1.33 cm.After ureter dilation and placement of ureteral access sheath,the stone were fragmented and removed with 200μm Ho ∶ YAG laser fiber,energy 0.8-1.0 J,frequency 5-10 Hz.Results The successful rate of stone fragmentation after single session was 92.86% (117/126).Mean operation time was 48 min(23-71 min).Six patients had low fever after the operation.Neither ureteral perforation nor pyonephrosis was observed.Conclusions The therapy of Holmium laser lithotriptor under flexible ureteroscope is safe and effective for upper urinary calculi,especially for upper ureteral,pelvis,middle calyx and upper calyx stones.%目的 探讨输尿管软镜下钬激光碎石术治疗上尿路结石的疗效.方法 上尿路结石患者126例,其中右侧结石75例,左侧结石51例.输尿管上段结石33例,输尿管上段合并肾结石29例,肾结石64例.结石大小0.6 ~2.0 cm,平均1.33 cm.经输尿管硬镜扩张后留置输尿管扩张鞘寻找结石,采用输尿管软镜下钬激光碎石术治疗,光纤直径200μm,能量0.8~1.0J,频率5~10Hz.结果 单次碎石成功117例(占92.86%),手术时间25~ 75 min,平均48 min.术后6例出现低热,无脓肾、输尿管穿孔等并发症.结论 输尿管软镜下钬激光碎石术治疗上尿路结石安全有效,尤其适用于输尿管上段、肾盂、肾中盏及肾上盏结石.

  9. 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

  10. Vesical-ureteral reflux in children; Reflux vesico-ureteral chez l`enfant

    Energy Technology Data Exchange (ETDEWEB)

    Desvignes, V.; Palcoux, J.B. [Hotel-Dieu, 63 - Clermont-Ferrand (France); Cochat, P. [Hopital Edouard-Herriot, 69 - Lyon (France)

    1995-12-31

    The vesical-ureteral reflux is the most frequent uropathy in children. The diagnosis is made by uretero-cystography, often after pyelonephritis, sometimes after ante-natal diagnosis from echographic abnormalities. Spontaneous recovery is possible in 50 to 80% of cases. This is especially true in grade 1, 2 and 3, however complications may occur. They are more frequent in the case of reflux nephropathy with a resulting risk of hypertension and chronic renal failure. The therapeutic choice is between the conservative management with urinary antiseptics ad the surgical treatment with ureters re-implantation or endoscopic treatment. The therapeutic indications take into account vesical-ureteral reflux grades, the child`s age, the associated diseases and the child`s and parents` compliance. (authors). 22 refs., 2 figs.

  11. Spontaneous ureteral rupture in a patient with systemic lupus erythematosus

    Energy Technology Data Exchange (ETDEWEB)

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

    1983-08-01

    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.

  12. An Indwelling Ureteral Stent Forgotten for Over 12 Years

    Science.gov (United States)

    Bidnur, Samir; Huynh, Melissa; Hoag, Nathan

    2016-01-01

    Abstract Ureteral stents are one of the most commonly used urologic devices with the purpose of establishing and maintaining ureteral patency. They are also associated with a number of complications including infection, migration, stent-related symptoms, and encrustation, leading to lithiasis. Prolonged stent dwell time is associated with a greater degree of these complications. We present the case of a 36-year-old man who presented with a severely encrusted ureteral stent that had been placed 12.5 years prior for an obstructive left-sided ureteral stone and was lost to follow-up. The patient underwent a combination of percutaneous nephrolithomy, cystolitholapaxy, and ureteroscopy to remove the stent and associated 1.7 cm renal pelvic stone and 4.1 cm bladder stone, necessitating two operative sittings to render him stone free. PMID:27579442

  13. Inoperable aggressive mesenteric fibromatosis with ureteric fistula

    Energy Technology Data Exchange (ETDEWEB)

    Khanna, Paritosh C. [Radiology Department, Nanavati Hospital, Mumbai (India)]. E-mail: paritoshkhanna@hotmail.com; Lath, Chinar [Radiology Department, Nanavati Hospital, Mumbai (India); Gadewar, Swapna B. [Radiology Department, Nanavati Hospital, Mumbai (India); Agrawal, Dilpesh [Internal Medicine Department, Wockhardt Hospital, Mumbai (India)

    2006-07-15

    The purpose of our report is to illustrate an aggressive case of mesenteric fibromatosis in a 17-year-old girl with a ureteric fistula and to review imaging and pathological features, natural history and treatment options of this disease. Our patient underwent computed tomography that revealed a widespread intra-abdominal mass. The necrotic centre of this mass had a fistulous communication with the right ureter. Fibromatoses represent a spectrum of uncommon benign conditions characterised by proliferating fibrous tissue. The deep intra-abdominal form of mesenteric fibromatosis (MF), one of the rare subtypes of the 'fibromatoses' or 'desmoid tumours', grows rapidly and may become extensive. Surgery provides good results in limited disease and non-surgical modalities in cases of unresectable and residual disease.

  14. A review of ureteral injuries after external trauma

    Directory of Open Access Journals (Sweden)

    Marttos Antonio C

    2010-02-01

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

  15. Ureteral stent retrieval using the crochet hook technique in females.

    Directory of Open Access Journals (Sweden)

    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.

  16. Magnetic resonance urography for diagnosis of pediatric ureteral stricture.

    Science.gov (United States)

    Arlen, Angela M; Kirsch, Andrew J; Cuda, Scott P; Little, Stephen B; Jones, Richard A; Grattan-Smith, J Damien; Cerwinka, Wolfgang H

    2014-10-01

    Ureteral stricture is a rare cause of hydronephrosis in children and is often misdiagnosed on ultrasound (US) and diuretic renal scintigraphy (DRS), requiring intraoperative diagnosis. We evaluated ureteral strictures diagnosed by magnetic resonance urography (MRU) at our institution. Children with ureteral stricture who underwent MRU were identified. Patient demographics, prior imaging, MRU findings, and management were assessed. The efficacy of MRU in diagnosis of stricture was compared with US and DRS. Patients with ureteropelvic or ureterovesical junction obstruction were excluded. Twenty-eight ureteral strictures diagnosed by MRU between 2003 and 2013 were identified; 22% of strictures were diagnosed by DRS ± US. The mean age at MRU diagnosis was 2.4 years (range 4 weeks-15 years). Hydronephrosis was the most common presentation, accounting for 20 (71%) cases. Other etiologies included pain (3), incontinence (2), and urinary tract infection, cystic kidney, and absent kidney, present in one case each. A mean of 2.7 imaging studies was obtained prior to MRU diagnosis. Twenty-one (75%) ureteral strictures required surgical intervention, with the approach dependent upon location. MRU provides excellent anatomic and functional detail of the collecting system, leading to accurate diagnosis and management of ureteral stricture in children. Copyright © 2014 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  17. 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.

  18. The GDNF target Vsnl1 marks the ureteric tip.

    Science.gov (United States)

    Ola, Roxana; Jakobson, Madis; Kvist, Jouni; Perälä, Nina; Kuure, Satu; Braunewell, Karl-Heinz; Bridgewater, Darren; Rosenblum, Norman D; Chilov, Dmitri; Immonen, Tiina; Sainio, Kirsi; Sariola, Hannu

    2011-02-01

    Glial cell line-derived neurotrophic factor (GDNF) is indispensable for ureteric budding and branching. If applied exogenously, GDNF promotes ectopic ureteric buds from the Wolffian duct. Although several downstream effectors of GDNF are known, the identification of early response genes is incomplete. Here, microarray screening detected several GDNF-regulated genes in the Wolffian duct, including Visinin like 1 (Vsnl1), which encodes a neuronal calcium-sensor protein. We observed renal Vsnl1 expression exclusively in the ureteric epithelium, but not in Gdnf-null kidneys. In the tissue culture of Gdnf-deficient kidney primordium, exogenous GDNF and alternative bud inducers (FGF7 and follistatin) restored Vsnl1 expression. Hence, Vsnl1 characterizes the tip of the ureteric bud epithelium regardless of the inducer. In the tips, Vsnl1 showed a mosaic expression pattern that was mutually exclusive with β-catenin transcriptional activation. Vsnl1 was downregulated in both β-catenin-stabilized and β-catenin-deficient kidneys. Moreover, in a mouse collecting duct cell line, Vsnl1 compromised β-catenin stability, suggesting a counteracting relationship between Vsnl1 and β-catenin. In summary, Vsnl1 marks ureteric bud tips in embryonic kidneys, and its mosaic pattern demonstrates a heterogeneity of cell types that may be critical for normal ureteric branching.

  19. Bacterial spectrum of urine in staghorn calculi nephrolithiasis

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    Kogan М.I

    2011-09-01

    Full Text Available Purpose: to study the role of the bacterial spectrum of urine in the development and clinical course of staghorn calculi nephrolithiasis. Patients and Methods. From 2008 to 2010 in the urological department of Rostov State Medical University urine culture was assessed in 86 patients with staghorn calculi. Mean age was 50,4±5,9 (25-73 years. Results: Most of the patients with staghorn calculus (89,5% have microbial contamination of urine, which has a high correlation with leucocituria, and the spectrum of microorganisms often has the various bacterial associations, which caused more infection complications during treatment. Conclusion: In the urine urease-producing bacteria, E. Coli, gram-positive organisms, nonclostridial anaerobic bacteria were predominated

  20. Ureteroscopy assisted retrograde nephrostomy for complete staghorn renal calculi.

    Science.gov (United States)

    Kawahara, Takashi; Ito, Hiroki; Terao, Hideyuki; Ogawa, Takehiko; Uemura, Hiroji; Kubota, Yoshinobu; Matsuzaki, Junichi

    2012-09-01

    Complete staghorn calculi are typically managed with percutaneous nephrolithotomy (PCNL). However, dilating nephrostomy and inserting a nephro access sheath can be difficult to perform without hydronephrosis. We reported the procedure of ureteroscopy-assisted retrograde nephrostomy (UARN) during PCNL. UARN is effective without dilating the renal collecting system in cases of complete staghorn calculi. A 63-year old female with a left complete staghorn renal calculus was referred to our hospital. Under general and epidural anesthesia, the patient was placed in a modified-Valdivia position. A flexible ureteroscope was inserted and a Lawson retrograde nephrostomy puncture wire was advanced into the flexible ureteroscope. The puncture wire was forwarded along the route from the renal pelvis to the exit skin. Calculus fragmentation was done using a pneumatic lithotripter and the Ho: YAG laser. UARN during PCNL was effective for the treatment of a complete staghorn calculus.

  1. Distal and non-distal NIP theories

    CERN Document Server

    Simon, Pierre

    2011-01-01

    We study one way in which stable phenomena can exist in an NIP theory. We start by defining a notion of 'pure instability' that we call 'distality' in which no such phenomenon occurs. O-minimal theories and the p-adics for example are distal. Next, we try to understand what happens when distality fails. Given a type p over a sufficiently saturated model, we extract, in some sense, the stable part of p and define a notion of stable-independence which is implied by non-forking and has bounded weight. As an application, we show that the expansion of a model by traces of externally definable sets from some adequate indiscernible sequence eliminates quantifiers.

  2. Distal nail embbeding

    Directory of Open Access Journals (Sweden)

    Patricia Chang

    2014-01-01

    Full Text Available Male patient, 35 years old who came to dermatological consultation due to contact dermatitis on back, during his clinical examination alterations of his digits was seen. Dermatological examination reveals a rim of tissue at the distal edge of the nail of both big toenails and thickened nails (Fig.1a – c, 2a, b. Both big toenails were removed due to ingrown nails two times. Diagnosis of distal nail embedding was done. Distal nail embedding is a rim of tissue at the distal edge of the nail. Causes can de acquired or congenital.

  3. Pictorial essay: Distal colostography

    Directory of Open Access Journals (Sweden)

    Rahalkar Mukund

    2010-01-01

    Full Text Available Distal colostography (DC, also called distal colography or loopography, is an important step in the reparative management of anorectal malformations (ARMs with imperforate anus, Hirschsprung′s disease (occasionally and colonic atresia (rarely in children and obstructive disorders of the distal colon (colitis with stricture, carcinoma or complicated diverticulosis in adults. It serves to identify/confirm the type of ARM, presence/absence of fistulae, leakage from anastomoses, or patency of the distal colon. We present a pictorial essay of DC in a variety of cases.

  4. Determination of Lead in Human Calculi and Its Effects on Renal Function of Lead Occupational Workers

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    F. Memon

    2016-06-01

    Full Text Available Seventy five samples of renal and eighteen samples of supra gingival calculi of lead recycling workers were collected over the period of seven years (2008-2014 and studied for the accumulation of lead. The results were compared with those of non exposed subjects. The lead content of calculi was investigated for its dependence on type and composition of calculi, blood lead, job status and duration of exposure. The effect of blood lead and renal calculi was also investigated in relation to kidney function of respective subjects. The mean lead levels of various types of calculi were found to follow the order as phosphate > oxalate > urate .> cystine while single principal group of supra gingival calculi resulted in lower levels of metal. The lead content of calculi positively correlated with phosphate content of both of the renal (r = 0.655 and supra gingival calculi (r= 0.866, Impaired renal function was more pronounced in active workers and depended on blood lead levels in addition to presence of metal in renal calculi

  5. URETERAL ACCESS SHEATH INFLUENCE ON THE URETERAL WALL EVALUATED BY CYCLOOXYGENASE-2 AND TUMOUR NECROSIS FACTOR- α IN A PORCINE MODEL

    DEFF Research Database (Denmark)

    Lildal, Søren Kissow; Nørregaard, Rikke; Andreassen, Kim Hovgaard;

    2017-01-01

    OBJECTIVE: To examine the effect of ureteral access sheaths (UAS) on the expression of the proinflammatory mediators cyclooxygenase-2 (COX-2) and tumour necrosis factor-α (TNF-α) in the ureteral wall. MATERIAL AND METHODS: In 22 pigs a ureteral access sheath was inserted and removed after 2 minutes......, respectively. CONCLUSION: The pro-inflammatory mediators COX-2 and TNF-α were significantly up-regulated in the ureteral wall by the influence of ureteral access sheaths. These findings may have implications for postoperative pain, drainage and complications....

  6. 输尿管软镜下钬激光碎石术治疗肾盏内小结石%Flexible Ureteroscopy Combined with Holmium Laser Lithotripsy for Small Renal Calix Calculi

    Institute of Scientific and Technical Information of China (English)

    王彭; 于江; 尉春晓; 曲华伟; 陈修德; 张建军

    2013-01-01

    Objective To evaluate the efficacy of the flexible ureteroscopy with Holmium laser lithotripsy for renal calculi.Methods From May 2011 to Jan 2013, 21 cases of renal calculi(sized between 0.5 to 1.5cm in diameter , 72 calculi in total ) were treated by flexible ureteroscopy with Holmium laser lithotripsy in our hospi-tal.Observe the ureteric orifice and then a ureteric access sheath was placed and a Olympus URF -V flexible ureteroscopy with Holmium laser lithotripsy was used to perform the procedure , and a F5 double-J stent would be setup at the end of procedure for 4 weeks.Result In 2 cases the ureteric access sheath was failed to be placed.20 cases out of 21 (95.2%) had stone clearance at 4 weeks post primary operation , and the total stone clearance rate was 100% ( 21/21 ) .The average operation time was 42 minutes ( 18 ~65 mins ) .No serious complication occurred .Conclusion Flexible ureteroscopy combined holmium laser lithotripsy is a safe and effec-tive procedure for renal calculi , it has high clearance rate of stones and less complication and morbidity , it is the best option for managing small renal calculi .%目的:评价输尿管软镜联合钬激光治疗肾盏内小结石的效果。方法2011年5月至2013年1月21例输尿管软镜钬激光碎石病例。术前均行逆行造影检查,明确输尿管及集合系统解剖位置正常。共52枚结石,结石直径0.5~1.5 cm。探查输尿管口置入斑马导丝,导丝引导下置入 F12输尿管软镜鞘,经鞘置入日本Olympus URF-V输尿管软镜,抵达目标肾盏行钬激光碎石。留置5 F双J管一根4周。结果2例无法置入输尿管软镜鞘,斑马导丝引导下置入输尿管软镜。钬激光碎石成功率100.0%(21/21)。4周后结石清除率为95.2%(20/21)。总的结石清除率为100.0%(81/86)。平均手术时间为42分钟(18~65分钟)。术后平均住院时间3.8天(3~5天)。无严重并发症。结论输尿

  7. 微创治疗上尿路结石所致急性肾功能衰竭%Minimally Invasive Management of Acute Obstructive Renal Failure Caused by Upper Urinary Calculi

    Institute of Scientific and Technical Information of China (English)

    梁建奇; 林灼怡; 黄蔚山; 卓梅; 何仍富

    2014-01-01

    目的:探讨微创治疗上尿路结石所致急性肾功能衰竭的临床效果。方法2012年12月~2013年8月,对30例上尿路结石致急性梗阻性肾功能衰竭先行输尿管置管或经皮肾穿刺造瘘,根据病情行输尿管镜取石术或微通道经皮肾镜取石术。结果均成功解除尿路梗阻,输尿管镜气压弹道取石术18例,结石取净率94.4%(17/18);微通道经皮肾镜气压弹道取石术12例,结石取净率91.7%(11/12),无严重并发症发生。术后3~14 d血Cr由285~1162μmol/L 降至58~343μmol/L。术后随访1~6个月,平均3个月,肾功能恢复正常25例,5例仍有氮质血症,但肾功能明显改善。结论输尿管镜取石术或微通道经皮肾镜取石术治疗上尿路结石所致急性肾功能衰竭具有微创、安全、效果好等优点。%Objective-To-investigate-the-feasibility-and-clinical-effect-of-minimally-invasive-management-acute-obstructive-renal-failure-caused-by-upper-urinary-calculi-.-Methods-From-December-2012-to-August-2013,-data-of-30-patients-with-acute-obstructive-renal-failure-caused-by-upper-urinary-calculi-who-underwent-minimally-invasive-management-were-reviewed-retrospectively-.-All-the-patients-were-given-dwelling-ureteral-stent-or-percutaneous-nephrostomy-(-PCNL)-in-the-first-period,-and-then,-according-to-specific-conditions,-received-either-ureteroscopic-holmium-laser-lithotripsy-(URL)-or-mini-percutaneous-nephrostomy-(mini-PCNL).-Results-All-the-patients-were-treated-successfully-.The-stone-free-rate-of-URL-was-94.4%(17/18)-in-18-patients-with-middle-and-lower-ureteral-calculi,-and-the-stone-free-rate-of-mini-PCNL-was-91.7%-(11/12)-in-12-patients.No-ureteral-perforation-and-other-complications-were-recorded-.In-the-30-cases,-the-serum-Cr-level-decreased-from-285--1162-μmol/L-preoperatively-to-58--343μmol/L-at-3--14-days-postoperatively-.Renal-functions-recovered-to-normal-within-1-month-after-operation-in-25-cases

  8. Spontaneous Ureteral Rupture Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    E. Pampana

    2013-01-01

    Full Text Available Rupture of the urinary collecting system associated with perinephric or retroperitoneal extravasation of the urine is an unusual condition and it is commonly associated with renal obstructing disease. Perforation could occur at any level from the calix to the bladder but it is usually seen at the fornices and upper ureter. It may lead to several serious consequences including urinoma, abscess formation, urosepsis, infection, and subsequent irreversible renal impairment. We report a case of a 69-year-old woman who presented at the emergency department of our institution with severe abdominal pain. Due to symptomatology worsening, complete laboratory evaluation was performed and the patient underwent abdominal contrast enhanced computed tomography (CT evaluation which showed contrast agent extravasation outside the excretory system without any evidence of renal calculi at basal acquisition. It was decided to perform a double-J stent placement which was followed by complete healing of the ureter and its removal was performed 8 weeks later. Diagnosis and therapeutic approaches are discussed.

  9. Factors affecting calcium oxalate dihydrate fragmented calculi regrowth

    Directory of Open Access Journals (Sweden)

    Sanchis P

    2006-07-01

    Full Text Available Abstract Background The use of extracorporeal shock wave lithotripsy (ESWL to treat calcium oxalate dihydrate (COD renal calculi gives excellent fragmentation results. However, the retention of post-ESWL fragments within the kidney remains an important health problem. This study examined the effect of various urinary conditions and crystallization inhibitors on the regrowth of spontaneously-passed post-ESWL COD calculi fragments. Methods Post-ESWL COD calculi fragments were incubated in chambers containing synthetic urine varying in pH and calcium concentration: pH = 5.5 normocalciuria (3.75 mM, pH = 5.5 hypercalciuria (6.25 mM, pH = 6.5 normocalciuria (3.75 mM or pH = 6.5 hypercalciuria (6.25 mM. Fragment growth was evaluated by measuring increases in weight. Fragment growth was standardized by calculating the relative mass increase. Results Calcium oxalate monohydrate (COM crystals formed on COD renal calculi fragments under all conditions. Under pH = 5.5 normocalciuria conditions, only COM crystals formed (growth rate = 0.22 ± 0.04 μg/mg·h. Under pH = 5.5 hypercalciuria and under pH = 6.5 normocalciuria conditions, COM crystals and a small number of new COD crystals formed (growth rate = 0.32 ± 0.03 μg/mg·h and 0.35 ± 0.05 μg/mg·h, respectively. Under pH = 6.5 hypercalciuria conditions, large amounts of COD, COM, hydroxyapatite and brushite crystals formed (growth rate = 3.87 ± 0. 34 μg/mg·h. A study of three crystallization inhibitors demonstrated that phytate completely inhibited fragment growth (2.27 μM at pH = 5.5 and 4.55 μM at pH = 6.5, both under hypercalciuria conditions, while 69.0 μM pyrophosphate caused an 87% reduction in mass under pH = 6.5 hypercalciuria conditions. In contrast, 5.29 mM citrate did not inhibit fragment mass increase under pH = 6.5 hypercalciuria conditions. Conclusion The growth rate of COD calculi fragments under pH = 6.5 hypercalciuria conditions was approximately ten times that observed under

  10. 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....

  11. Percutaneous nephrolithotripsy with 2 μm laser in treating nephritic staghorn calculi%经皮肾镜下2μm激光碎石治疗肾铸型结石55例分析

    Institute of Scientific and Technical Information of China (English)

    刘津念; 陈强; 刘显中; 刘德云; 周健; 闻斌; 刘聪颖; 张茂; 田波; 周述银

    2011-01-01

    目的 探讨经皮肾镜下2 μm激光治疗肾铸型结石的有效性、安全性及相关技巧.方法 采用经皮肾镜下2 μm激光治疗肾铸型结石患者55例,其中双侧肾铸型结石8例.结果 55例患者中,一次碎石成功率为74.5%,手术平均时间70 min;术后恢复快、并发症少;随访3个月,无残余碎石,肾积水均有不同程度减轻或消失.结论 经皮肾镜下2 μm激光治疗肾铸型结石是安全、有效的微创治疗方法,具有避免开放手术、手术时间短、恢复快、创伤小等优点.%Objective To investigate the efficacy, safety and techniques of percutaneous nephrolithotripsy with 2 μm laser in treating nephritic staghorn calculi. Methods The clinical data of 55 patients treated with PCNL with 2 μm laser during January 2008 to December 2009 were analyzed. Results Among 55 cases of nephritic staghorn calculi,all calculi were successfully fragmented,the one-time calculi clearance rate was 74. 5% (41/55) and the clearance time was 40-120 min(mean 70 min). No severe complications such as massive haemorrhage, ureteral perforation, conglutinant stenosis happened. Infection or recurrence was observed during the postoperative follow-up for 3 months, and no recurrence was found. Conclusion The percutaneous nephrolithotripsy with 2 μm laser in treating nephritic staghorn calculi could avoid patency operation,reduce the operation time,have a quick recovery and take small wound for patients. So this method has the advantages of safety and efficacy, and has higher value for widespread application in clinic.

  12. Large subcapsular hematoma following ureteroscopic laser lithotripsy of renal calculi in a spina bifida patient: lessons we learn

    Directory of Open Access Journals (Sweden)

    Vaidyanathan S

    2016-08-01

    Full Text Available Subramanian Vaidyanathan,1 Azi Samsudin,2 Gurpreet Singh,3 Peter L Hughes,4 Bakul M Soni,1 Fahed Selmi1 1Regional Spinal Injuries Center, Southport and Formby District General Hospital, Southport, UK; 2Department of Urology, Whiston Hospital, Prescot, UK; 3Department of Urology, 4Department of Radiology, Southport and Formby District General Hospital, Southport, UK Introduction: Paraplegic patients are at greater risk of developing complications following ureteroscopic lithotripsy because of urine infection associated with neuropathic bladder, difficulties in access due to altered anatomy of urinary bladder and urethra, spinal curvature, spasticity, and contractures. We report the occurrence of large subcapsular hematoma following ureteroscopy and discuss lessons we learn from this case.Case report: A 48-year-old male patient with spina bifida underwent ureteroscopy with laser lithotripsy and ureteric stenting for left ureteric stone and staghorn calculus with hydronephrosis; laser lithotripsy was repeated after 3 months; both procedures were performed by a senior urologist and did not result in any complications. Ureteroscopic laser lithotripsy was performed 5 months later by a urological trainee; it was difficult to negotiate the scope as vision became poor because of bleeding (as a result of the procedure. Postoperatively, hematuria persisted; temperature was 39°C. Cefuroxime was given intravenously followed by gentamicin for 5 days; hematuria subsided gradually; he was discharged home. Ten days later, this patient developed temperature, the urine culture grew Pseudomonas aeruginosa, and ciprofloxacin was given orally. Computed tomography (CT of the urinary tract, performed 4 weeks after ureteroscopy, revealed a 9×7 cm subcapsular collection on the left kidney compressing underlying parenchyma. Percutaneous drainage was not feasible because of severe curvature of spine. Isotope renogram revealed deterioration in left renal function from 30

  13. Large subcapsular hematoma following ureteroscopic laser lithotripsy of renal calculi in a spina bifida patient: lessons we learn.

    Science.gov (United States)

    Vaidyanathan, Subramanian; Samsudin, Azi; Singh, Gurpreet; Hughes, Peter L; Soni, Bakul M; Selmi, Fahed

    2016-01-01

    Paraplegic patients are at greater risk of developing complications following ureteroscopic lithotripsy because of urine infection associated with neuropathic bladder, difficulties in access due to altered anatomy of urinary bladder and urethra, spinal curvature, spasticity, and contractures. We report the occurrence of large subcapsular hematoma following ureteroscopy and discuss lessons we learn from this case. A 48-year-old male patient with spina bifida underwent ureteroscopy with laser lithotripsy and ureteric stenting for left ureteric stone and staghorn calculus with hydronephrosis; laser lithotripsy was repeated after 3 months; both procedures were performed by a senior urologist and did not result in any complications. Ureteroscopic laser lithotripsy was performed 5 months later by a urological trainee; it was difficult to negotiate the scope as vision became poor because of bleeding (as a result of the procedure). Postoperatively, hematuria persisted; temperature was 39°C. Cefuroxime was given intravenously followed by gentamicin for 5 days; hematuria subsided gradually; he was discharged home. Ten days later, this patient developed temperature, the urine culture grew Pseudomonas aeruginosa, and ciprofloxacin was given orally. Computed tomography (CT) of the urinary tract, performed 4 weeks after ureteroscopy, revealed a 9×7 cm subcapsular collection on the left kidney compressing underlying parenchyma. Percutaneous drainage was not feasible because of severe curvature of spine. Isotope renogram revealed deterioration in left renal function from 30% to 17%. Follow-up CT revealed reduction in the size of subcapsular hematoma, no hydronephrosis, and several residual calculi. Risk of subcapsular hematoma following ureteroscopic lithotripsy can be reduced by avoiding prolonged endoscopy and performing ureteroscopy under low pressure. When a paraplegic patient develops features of infection after ureteroscopy, renal imaging should be carried out promptly

  14. A Syntactic Correspondence between Context-Sensitive Calculi and Abstract Machines

    DEFF Research Database (Denmark)

    Biernacka, Malgorzata; Danvy, Olivier

    2005-01-01

    We present a systematic construction of environment-based abstract machines from context-sensitive calculi of explicit substitutions, and we illustrate it with ten calculi and machines for applicative order with an abort operation, normal order with generalized reduction and call/cc, the lambda-mu-calculus...

  15. A Syntactic Correspondence between Context-Sensitive Calculi and Abstract Machines

    DEFF Research Database (Denmark)

    Biernacka, Malgorzata; Danvy, Olivier

    2007-01-01

    We present a systematic construction of environment-based abstract machines from context-sensitive calculi of explicit substitutions, and we illustrate it with ten calculi and machines for applicative order with an abort operation, normal order with generalized reduction and call/cc, the lambda-mu-calculus...

  16. Possible etiology of calculi formation in salivary glands: biophysical analysis of calculus.

    Science.gov (United States)

    Mimura, Masafumi; Tanaka, Nobuyuki; Ichinose, Shizuko; Kimijima, Yutaka; Amagasa, Teruo

    2005-09-01

    Sialolithiasis is one of the common diseases of the salivary glands. It was speculated that, in the process of calculi formation, degenerative substances are emitted by saliva and calcification then occurs around these substances, and finally calculi are formed. However, the exact mechanism of the formation of calculi is still unclear. In this study, we identify some possible etiologies of calculi formation in salivary glands through biophysical analysis. Calculi from 13 patients with submandibular sialolithiasis were investigated by transmission electron microscopy, scanning electron microscopy, X-ray microanalyzer, and electron diffraction. Transmission electron microscopic observation of calculi was performed in the submandibular gland (n = 13). In 3 of the 13 cases, a number of mitochondria-like structures and lysosomes were found near calcified materials. Scanning electron microscopic examination of these materials revealed that there were lamellar and concentric structures and that the degree of calcification was different among the calculi. X-ray microanalysis disclosed the component elements in the calculi to be Ca, P, S, Na, etc., and the main constituents were Ca and P. The calcium-to-phosphorus ratio was 1.60-1.89. Analysis of the area including mitochondria-like structures, lysosomes, and the fibrous structures by electron diffraction revealed the presence of hydroxyapatite and calcified materials. It is speculated that mitochondria and lysosomal bodies from the ductal system of the submandibular gland are an etiological source for calcification in the salivary gland.

  17. Unenhanced CT findings can predict the development of urinary calculi in stone-free patients

    Energy Technology Data Exchange (ETDEWEB)

    Ciudin, Alexandru; Luque Galvez, Maria Pilar; Franco de Castro, Agustin; Garcia-Cruz, Eduardo; Alcover Garcia, Juan; Alvarez-Vijande Garcia, Jose Ricardo; Alcaraz Asensio, Antonio [Hospital Clinic Barcelona, Urology Department, Barcelona (Spain); Salvador Izquierdo, Rafael; Nicolau, Carlos [Hospital Clinic Barcelona, Radiology Department, Barcelona (Spain)

    2012-09-15

    To determine if calcium deposits in the papillae can be identified by unenhanced computed tomography (uCT) even before renal stones develop. A retrospective review of 413 patients with calculi identified 31 patients (stone-forming group) with a history of urinary tract calculi with a calculus demonstrated by uCT and a stone-free uCT before calculi had developed. The control group (n = 31) was composed of live kidney donors with no history of calculi and a stone-free uCT. CT attenuation was measured in all CTs using two regions of interest of 0.05 cm{sup 2} and 0.1 cm{sup 2} over the tip and the neighbouring area of the papillae. Student's and Wilcoxon t-tests were used for comparing results in the two groups. The attenuation of the tip of the papilla was higher in the stone-forming group when compared to the controls after (45.2 HU versus 32.1 HU, P = 0.001) and even before frank calculi had developed (44.2 HU versus 32.1 HU, P = 0.003). There was no significant difference in papillary attenuation in the stone group before and after calculi had developed (45.2 HU versus 44.2 HU, P = 0.82). Stone-forming patients exhibit higher papillary density even before calculi develop. This could define a population at risk of developing calculi. (orig.)

  18. Outcomes of Extravesical Versus Intravesical Ureteral Reimplantation

    Directory of Open Access Journals (Sweden)

    Leah P. McMann

    2004-01-01

    Full Text Available Purpose: The purpose of our study was to examine outcomes and compare length of stay after extravesical and intravesical ureteral reimplantation at our institution. Materials and Methods: Retrospective review was performed of 30 patients (55 ureters with vesicoureteral reflux who underwent either the Cohen (intravesical cross-trigonal procedure or the extravesical (detrusorrhaphy approach. Each patient had documented follow-up consisting of a postoperative renal ultrasound and/or a voiding cystourethrogram (VCUG. Inclusion criteria was the presence of primary vesicoureteral reflux. Exclusion criteria were patients who had undergone a previous repair and patients in whom results of neither the renal ultrasound nor the VCUG were available. Results: There were no significant cases of obstruction or wound infection with either approach. Two patients who underwent the extravesical approach had persistent reflux on VCUG three months postoperatively, but both resolved by fifteen months. Average length of stay was only 3.00 ± 1.33 days for the extravesical approach, compared to 5.36 ± 1.75 days for the intravesical approach ( P = .0003 . Conclusions: Given that by fifteen months success rates were the same with either approach, the extravesical approach is comparable to the intravesical technique and is a viable option in terms of outcome and economics given the shorter length of hospital stay.

  19. Distal Radius Fracture (Broken Wrist)

    Science.gov (United States)

    .org Distal Radius Fracture (Broken Wrist) Page ( 1 ) The radius is the larger of the two bones of the forearm. The ... the distal end. A fracture of the distal radius occurs when the area of the radius near ...

  20. Forgotten and fragmented ureteral j stent with stone formation: combined endoscopic management.

    Science.gov (United States)

    Sen, Volkan; Bozkurt, Halil Ibrahim; Yonguc, Tarık; Aydogdu, Ozgu; Yarimoglu, Serkan; Degirmenci, Tansu; Minareci, Suleyman

    2015-01-01

    Ureteral stents are widely used in endo-urological procedures. However, ureteral stents can be forgotten and cause serious complications, including fragmentation, migration and urosepsis.There are few reports about forgotten and fragmented ureteral stents with stone formation. We aimed to present this rare case with successful combined endo-urological management.

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

    Directory of Open Access Journals (Sweden)

    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.

  2. Forgotten and fragmented ureteral j stent with stone formation: combined endoscopic management

    Directory of Open Access Journals (Sweden)

    Volkan Sen

    2015-06-01

    Full Text Available ABSTRACTObjective : Ureteral stents are widely used in endo-urological procedures. However, ureteral stents can be forgotten and cause serious complications, including fragmentation, migration and urosepsis.There are few reports about forgotten and fragmented ureteral stents with stone formation. We aimed to present this rare case with successful combined endo-urological management.

  3. Bilateral ureteral obstruction revealing a benign prostatic hypertrophy: a case report and review of the literature.

    Science.gov (United States)

    Riyach, Omar; Ahsaini, Mustapha; Kharbach, Youssef; Bounoual, Mohammed; Tazi, Mohammed Fadl; El Ammari, Jalal Eddine; Mellas, Soufiane; Fassi, Mohammed El Jamal; Khallouk, Abdelhak; Farih, Moulay Hassan

    2014-02-11

    Prostatic hyperplasia is the most frequent tumor in men older than 50 years of age. Bilateral hydronephrosis secondary to benign prostatic hypertrophy is a rare condition most often due to vesicoureteral reflux. Herein we report a case of a patient with bilateral hydronephrosis with distal ureter obstruction caused by detrusor hypertrophy due to prostatic hyperplasia, our analysis of the clinical data and a review of the relevant published literature. We report a case of a 65-year-old Berber man with clinically significant storage, bladder-emptying symptoms and bilateral low back pain with renal biologic failure and bilateral ureterohydronephrosis, distal ureteral stenosis, detrusor hypertrophy and prostate hyperplasia without significant post-void residual urine volume visualized by abdominal sonography. The patient underwent bilateral JJ stent insertion with transurethral resection of the prostate. The patient was discharged 3 days after surgery without any obvious complications. At his 3-month follow-up examination, the JJ stent was removed and the patient had comfortable urination without renal failure. This is an extremely rare condition that has important diagnostic considerations because of the possibility of comorbid severe obstructive uropathy and chronic renal failure.

  4. Papillary and Nonpapillary Calcium Oxalate Monohydrate Renal Calculi: Comparative Study of Etiologic Factors

    Directory of Open Access Journals (Sweden)

    Enrique Pieras

    2006-01-01

    Full Text Available Calcium oxalate monohydrate (COM renal calculi can be classified into two groups: papillary and nonpapillary. In this paper, a comparative study between etiologic factors of COM papillary and nonpapillary calculi is performed. The study included 40 patients with COM renal calculi. The urine of these individuals was analyzed. Case history, lifestyle, and dietetic habits were obtained.No significant differences between urinary biochemical data of both groups were observed; 50% of COM papillary stone formers and 40% of COM nonpapillary stone formers had urolithiasis family history. A low consumption of phytate-rich products was observed for both groups. A relationship between profession with occupational exposure to cytotoxic products and COM papillary renal lithiasis was detected.The results suggest that COM papillary calculi would be associated to papillary epithelium alterations together with a crystallization inhibitors deficit, whereas COM nonpapillary calculi would be associated to the presence of heterogeneous nucleants and a crystallization inhibitors deficit.

  5. [Subcutaneous ureteral bypass devices as a treatment option for bilateral ureteral obstruction in a cat with ureterolithiasis].

    Science.gov (United States)

    Heilmann, Romy M; Pashmakova, Medora; Lamb, Jodie H; Spaulding, Kathy A; Cook, Audrey K

    2016-06-16

    A 6-year-old female spayed Domestic Shorthair cat was presented with acute lethargy, dehydration, marked azotemia, metabolic acidosis, left-sided renomegaly, and bilateral hydronephrosis. Ureterolithiasis and ureteral obstruction were suspected based on further diagnostics including abdominal sonography. Medical treatment was not successful. Fluoroscopically guided antegrade pyelography confirmed the diagnosis of bilateral ureteral obstruction due to ureterolithiasis. Subcutaneous ureteral bypass (SUB) devices were placed bilaterally, followed by close patient monitoring. Frequent reassessment of patient parameters and blood work served to adjust the fluid needs of the patient and to ensure proper hydration, correction of azotemia at an appropriate rate, and cardiovascular stability. After significant improvement of all patient parameters within 5 days, the patient was discharged from the hospital. Treatment included a dietary change to reduce the risk of stone formation as well as a phosphorus binder. Clinical and clinicopathologic parameters were unchanged at the 1- and 4- and 7-month rechecks (consistent with IRIS CKD stage II-NP-AP0), and both SUB devices continued to provide unobstructed urine flow. Bilateral placement of subcutaneous ureteral bypass devices may be a safe and potentially effective treatment option for acute bilateral ureteral obstruction in cats with ureterolithiasis. Strict patient monitoring and patient-centered postoperative treatment decisions are crucial to successful treatment outcomes.

  6. Transphyseal Distal Humerus Fracture.

    Science.gov (United States)

    Abzug, Joshua; Ho, Christine Ann; Ritzman, Todd F; Brighton, Brian

    2016-01-01

    Transphyseal distal humerus fractures typically occur in children younger than 3 years secondary to birth trauma, nonaccidental trauma, or a fall from a small height. Prompt and accurate diagnosis of a transphyseal distal humerus fracture is crucial for a successful outcome. Recognizing that the forearm is not aligned with the humerus on plain radiographs may aid in the diagnosis of a transphyseal distal humerus fracture. Surgical management is most commonly performed with the aid of an arthrogram. Closed reduction and percutaneous pinning techniques similar to those used for supracondylar humerus fractures are employed. Cubitus varus caused by a malunion, osteonecrosis of the medial condyle, or growth arrest is the most common complication encountered in the treatment of transphyseal distal humerus fractures. A corrective lateral closing wedge osteotomy can be performed to restore a nearly normal carrying angle.

  7. Giant distal humeral geode

    Energy Technology Data Exchange (ETDEWEB)

    Maher, M.M. [Department of Radiology, Mater Misericordiae Hospital, Dublin (Ireland); Department of Radiology, St. Vincent' s Hospital, Elm Park, Dublin 4 (Ireland); Kennedy, J.; Hynes, D. [Department of Orthopaedics, Mater Misericordiae Hospital, Dublin (Ireland); Murray, J.G.; O' Connell, D. [Department of Radiology, Mater Misericordiae Hospital, Dublin (Ireland)

    2000-03-30

    We describe the imaging features of a giant geode of the distal humerus in a patient with rheumatoid arthritis, which presented initially as a pathological fracture. The value of magnetic resonance imaging in establishing this diagnosis is emphasized. (orig.)

  8. Distal splenorenal shunt

    Science.gov (United States)

    ... path. As a result, swollen blood vessels called varices form. They develop thin walls that can break ... or x-rays show that you have bleeding varices. Distal splenorenal shunt surgery reduces pressure on the ...

  9. Stone Formation and Fragmentation in Forgotten Ureteral Double J Stent

    Directory of Open Access Journals (Sweden)

    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.

  10. 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.

  11. Distal humeral epiphyseal separation.

    Science.gov (United States)

    Moucha, Calin S; Mason, Dan E

    2003-10-01

    Distal humeral epiphyseal separation is an uncommon injury that is often misdiagnosed upon initial presentation. To make a timely, correct diagnosis, the treating physician must have a thorough understanding of basic anatomical relationships and an awareness of the existence of this injury. This is a case of a child who sustained a separation of the distal humeral epiphysis, as well as multiple other bony injuries, secondary to child abuse.

  12. [Dissolution therapy of struvite calculi with solution G].

    Science.gov (United States)

    Hosomi, M; Maeda, O; Matsumiya, K; Koide, T; Takaha, M; Oka, T; Sonoda, T

    1988-07-01

    In 6 patients (9 kidneys) irrigation with Solution G in the renal pelvis was performed for the dissolution of their infectious stones. Staghorn calculi larger than 30 mm in diameter were observed in all patients. In two kidneys all stones were dissolved and the rest were dissolved into small fragments that constituted no problem in those kidneys. Irrigation was done with no major side effects or complications. The dissolution of infectious stones with Solution G is another possible treatment that could be first chosen among percutaneous nephrolithotripsy, extracorporeal shock wave lithotripsy and other treatments.

  13. Ultrasonic fragmentation in the treatment of male urethral calculi.

    Science.gov (United States)

    Durazi, M H; Samiei, M R

    1988-11-01

    In the last 8 months, 7 patients have presented with acute retention of urine due to impacted urethral stones. Four stones were in the posterior urethra, 2 in the penile urethra and 1 proximal to the external urethral meatus. The patients were managed as emergencies. Stone fragmentation by ultrasound (US) through a 24F obliquely offset eyepiece nephroscope was achieved with minimal urethral trauma. Follow-up was for 6 months and no evidence of urethral stricture or recurrent stones was found. It was concluded that US fragmentation of urethral calculi is a safe and efficient procedure with minimal complications when used in the management of impacted urethral stones.

  14. Spectral triples and differential calculi related to the Kronecker foliation

    Science.gov (United States)

    Matthes, R.; Richter, O.; Rudolph, G.

    2003-04-01

    Following the ideas of Connes and Moscovici, we describe two spectral triples related to the Kronecker foliation, whose generalized Dirac operators are related to first and second order signature operators. We also consider the corresponding differential calculi Ω D, which are drastically different in the two cases. For the second order signature operator we calculate the Chern character of the spectral triple and the Dixmier trace of certain powers of its Dirac operator. As a side-remark, we give a description of a known calculus on the two-dimensional noncommutative torus in terms of generators and relations.

  15. Utilidad de la ureterolitotomía endoscópica en el tratamiento de la litiasis ureteral: estudio descriptivo de una serie de casos utilizando un nuevo método de dilatación del meato ureteral

    Directory of Open Access Journals (Sweden)

    Carlos Mario Jiménez

    2008-02-01

    Full Text Available

     

    OBJETIVO: determinar la utilidad de la ureterolitotomía endoscópica y la dilatación del meato ureteral con pinza de ureteroscopio en el tratamiento de la litiasis ureteral.

    MATERIALES Y MÉTODOS: estudio descriptivo de una serie de casos atendidos en las clínicas Las Américas y Conquistadores de la ciudad de Medellín en un período de 9 meses. Se revisaron los procedimientos endoscópicos efectuados entre junio de 2004 y febrero de 2005, evaluando su utilidad en términos de la eliminación del cálculo ureteral y la seguridad según la presentación de complicaciones.

    RESULTADOS durante el tiempo del estudio se hicieron 44 ureterolitotomías endoscópicas. En 41 casos la localización del cálculo fue distal. El método diagnóstico más utilizado fue la urografía excretora en 21 pacientes. La duración promedio del procedimiento fue de 8 minutos y en 38 pacientes fue ambulatorio. El procedimiento fue exitoso en 42 pacientes (95,5%; en los otros dos casos se abortó la cirugía por dificultad para extraer el cálculo. Adicionalmente, en 37 pacientes (84,1% se hizo dilatación del meato ureteral con la pinza del ureteroscopio; en todos ellos el resultado final fue satisfactorio.

    CONCLUSIÓN: este estudio muestra que la

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

    Directory of Open Access Journals (Sweden)

    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

  17. Verification of relationships between anthropometric variables among ureteral stents recipients and ureteric lengths: a challenge for Vitruvian-da Vinci theory.

    Science.gov (United States)

    Acelam, Philip A

    2015-01-01

    To determine and verify how anthropometric variables correlate to ureteric lengths and how well statistical models approximate the actual ureteric lengths. In this work, 129 charts of endourological patients (71 females and 58 males) were studied retrospectively. Data were gathered from various research centers from North and South America. Continuous data were studied using descriptive statistics. Anthropometric variables (age, body surface area, body weight, obesity, and stature) were utilized as predictors of ureteric lengths. Linear regressions and correlations were used for studying relationships between the predictors and the outcome variables (ureteric lengths); P-value was set at 0.05. To assess how well statistical models were capable of predicting the actual ureteric lengths, percentages (or ratios of matched to mismatched results) were employed. The results of the study show that anthropometric variables do not correlate well to ureteric lengths. Statistical models can partially estimate ureteric lengths. Out of the five anthropometric variables studied, three of them: body frame, stature, and weight, each with a Pvariables: age (R (2)=0.01; P=0.20) and obesity (R (2)=0.03; P=0.06), were found to be poor estimators of ureteric lengths. None of the predictors reached the expected (match:above:below) ratio of 1:0:0 to qualify as reliable predictors of ureteric lengths. There is not sufficient evidence to conclude that anthropometric variables can reliably predict ureteric lengths. These variables appear to lack adequate specificity as they failed to reach the expected (match:above:below) ratio of 1:0:0. Consequently, selections of ureteral stents continue to remain a challenge. However, height (R (2)=0.68) with the (match:above:below) ratio of 3:3:4 appears suited for use as estimator, but on the basis of decision rule. Additional research is recommended for stent improvements and ureteric length determinations.

  18. Results of urinary dissolution therapy for radiolucent calculi

    Directory of Open Access Journals (Sweden)

    Sinha Maneesh

    2013-01-01

    Full Text Available Purpose In this paper we present our experience with dissolution therapy of radiolucent calculi. Materials and Methods This was a retrospective analysis of patients who were offered urinary dissolution therapy between January 2010 and June 2011. Patients were treated with tablets containing potassium citrate and magnesium oxide. Partial dissolution was defined as at least a 50% reduction in stone size. Patients with complete or partial dissolution were classified in the successful dissolution group. Patients with no change, inadequate reduction, increase in stone size and those unable to tolerate alkali therapy were classified as failures. Patient sex, stenting before alkalinization, stone size, urine pH at presentation and serum uric acid levels were analyzed using Fisher t-test for an association with successful dissolution. Results Out of 67, 48 patients reported for follow up. 10 (15% had complete dissolution and 13 (19% had partial dissolution. Alkalinization was unsuccessful in achieving dissolution in 25 (37%. Stenting before alkalinization, patient weight ( 75kg and serum uric acid levels (≤ 6 vs. > 6 were the only factors to significantly affected dissolution rates (p = 0.039, p 0.035, p 0.01 respectively. CONCLUSIONS A policy of offering dissolution therapy to patients with radiolucent calculi had a successful outcome in 34% of patients.

  19. Endoscopic treatment of vesico-ureteral reflux: Experience of 99 ureteric moieties

    Directory of Open Access Journals (Sweden)

    Minu Bajpai

    2013-01-01

    Full Text Available Aims: To study the outcome of endoscopic hyaluronic acid/dextranomer injection in patients with vesico-ureteric reflux (VUR. Materials and Methods: Sixty-three children were evaluated with a median follow up of 18 months (12-55 months before injecting hyaluronic acid/dextranomer in a total of 99 ureteric moieties. Median age at presentation was 24 months (6-72 months. Primary VUR was the main presenting diagnosis in 60%. Patients were monitored for urinary tract infection (UTI, glomerular filtration rate (GFR, renal scarring, persistence, or appearance of contra-lateral reflux. Results: Grade III VUR was the most common (38% followed by Grade IV (24%, Grade V (17%, Grade II (14%, and Grade I (7%. Most common cause for VUR was Primary (60%, followed by posterior urethral valve (PUV (19%, bladder exstrophy (5%, anorectal malformation (ARM, epispadias, and duplex system. Analysis of patients characteristics at presentation revealed renal scarring (40%, split renal functions 1.4 mg/dL (10%. Complete resolution (100% of Grade I and Grade II VUR was achieved after single injection. For Grade III VUR, single injection resolved reflux in 85.5% ureters, 100% resolution was seen after 2 nd injection. In Grade IV VUR, 1 st injection resolved VUR in 83.3% ureters, 95.8% ureters were reflux free after 2 nd injection, and 100% resolution was seen after 3 rd injection. In Grade V VUR, 94% ureters showed absent reflux after three injections. Conclusion: Hyaluronic acid/dextranomer injection holds promise even in higher grades of VUR.

  20. Pathophysiological aspects of ureterorenoscopic management of upper urinary tract calculi

    DEFF Research Database (Denmark)

    Osther, Palle J S; Pedersen, Katja V; Lildal, Søren K;

    2016-01-01

    PURPOSE OF REVIEW: Indications for ureterorenoscopy are expanding without hard scientific evidence to support its efficacy. Therefore, it is extremely important to focus on potential harmful effects of the procedure itself. This review explores how physiology of the upper urinary tract reacts...... of the β-receptor agonist isoproterenol in the irrigation fluid has shown a potential for reducing both intrarenal pressure and ureteral tone during ureterorenoscopy. SUMMARY: Upper urinary tract physiology has unique features that may be pushed into pathophysiological processes by the unique elements...

  1. How accurate is unenhanced multidetector-row CT (MDCT) for localization of renal calculi?

    Energy Technology Data Exchange (ETDEWEB)

    Goetschi, Stefan, E-mail: goetschi@gmx.net [Institute of Radiology, Triemli Hospital, Birmensdorferstrasse 497, 8063 Zuerich (Switzerland); Umbehr, Martin, E-mail: martin.umbehr@triemli.ch [Urology Clinic, Department of Surgery, Triemli Hospital, Birmensdorferstrasse 497, 8063 Zuerich (Switzerland); Ullrich, Stephan, E-mail: stephan.ullrich@triemli.ch [Institute of Radiology, Triemli Hospital, Birmensdorferstrasse 497, 8063 Zuerich (Switzerland); Glenck, Michael, E-mail: michael.glenck@triemli.ch [Institute of Radiology, Triemli Hospital, Birmensdorferstrasse 497, 8063 Zuerich (Switzerland); Suter, Stefan, E-mail: stefan.suter@triemli.ch [Urology Clinic, Department of Surgery, Triemli Hospital, Birmensdorferstrasse 497, 8063 Zuerich (Switzerland); Weishaupt, Dominik, E-mail: dominik.weishaupt@triemli.ch [Institute of Radiology, Triemli Hospital, Birmensdorferstrasse 497, 8063 Zuerich (Switzerland)

    2012-11-15

    Purpose: To investigate the correlation between unenhanced MDCT and intraoperative findings with regard to the exact anatomical location of renal calculi. Design, setting, and participants: Fifty-nine patients who underwent unenhanced MDCT for suspected urinary stone disease, and who underwent subsequent flexible ureterorenoscopy (URS) as treatment of nephrolithiasis were included in this retrospective study. All MDCT data sets were independently reviewed by three observers with different degrees of experience in reading CT. Each observer was asked to indicate presence and exact anatomical location of any calcification within pyelocaliceal system, renal papilla or renal cortex. Results were compared to intraoperative findings which have been defined as standard of reference. Calculi not described at surgery, but present on MDCT data were counted as renal cortex calcifications. Results: Overall 166 calculi in 59 kidneys have been detected on MDCT, 100 (60.2%) were located in the pyelocaliceal system and 66 (39.8%) in the renal parenchyma. Of the 100 pyelocaliceal calculi, 84 (84%) were correctly located on CT data sets by observer 1, 62 (62%) by observer 2, and 71 (71%) by observer 3. Sensitivity/specificity was 90-94% and 50-100% if only pyelocaliceal calculi measuring >4 mm in size were considered. For pyelocaliceal calculi {<=}4 mm in size diagnostic performance of MDCT was inferior. Conclusion: Compared to flexible URS, unenhanced MDCT is accurate for distinction between pyelocaliceal calculi and renal parenchyma calcifications if renal calculi are >4 mm in size. For smaller renal calculi, unenhanced MDCT is less accurate and distinction between a pyelocaliceal calculus and renal parenchyma calcification is difficult.

  2. AN IN VITRO MODEL FOR MURINE URETERIC EPITHELIAL CELLS

    Science.gov (United States)

    This report presents a model developed to study growth and differentiation of primary cultures of ureteric epithelial cells from embryonic C57BL/6N mouse urinary tracts. Single cells were resuspended in medium and plated onto transwells coated with collagen IV and laminin. Basa...

  3. Ureolytic Citrobacter freundii infection of the urine as a cause of dissolution of cystine renal calculi.

    Science.gov (United States)

    Gutierrez Millet, V; Praga, M; Miranda, B; Bello, I; Ruilope, L; Diaz Gonzalez, R; Leyva, O; Alcazar, J M; Barrientos, A; Rodicio, J L

    1985-03-01

    We report a case of cystinuria with staghorn renal lithiasis in a solitary right kidney and chronic renal failure. Right nephropyelolithotomy was performed and although 29 renal calculi were extracted many stones remained in situ. A permanent nephrostomy was left in the kidney. Several months later the urine was infected chronically with a ureolytic Citrobacter freundii bacteria and urinary pH oscillated between 8.0 and 9.2. Spontaneous dissolution of the cystine calculi was observed and many tiny fragments of cystine were expulsed through the nephrostomy, following which renal function improved. Despite the conditions favoring struvite calculi, formation did not occur.

  4. The Cost-Effectiveness of Treatment Modalities for Ureteral Stones

    Directory of Open Access Journals (Sweden)

    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.

  5. Laparoscopic Distal Pancreatectomy

    Science.gov (United States)

    Melotti, Gianluigi; Butturini, Giovanni; Piccoli, Micaela; Casetti, Luca; Bassi, Claudio; Mullineris, Barbara; Lazzaretti, Maria Grazia; Pederzoli, Paolo

    2007-01-01

    Objective: To describe the clinical characteristics, indications, technical procedures, and outcome of a consecutive series of laparoscopic distal pancreatic resections performed by the same surgical team. Summary Background Data: Laparoscopic distal pancreatic resection has increasingly been described as a feasible and safe procedure, although accompanied by a high rate of conversion and morbidity. Methods: A consecutive series of patients affected by solid and cystic tumors were selected prospectively to undergo laparoscopic distal pancreatectomy performed by the same surgical team. Clinical characteristics as well as diagnostic preoperative assessment and intra- and postoperative data were prospectively recorded. A follow-up of at least 3 months was available for all patients. Results: Fifty-eight patients underwent laparoscopic resection between May 1999 and November 2005. All procedures were successfully performed laparoscopically, and no patient required intraoperative blood transfusion. Splenic vessel preservation was possible in 84.4% of spleen-preserving procedures. There were no mortalities. The overall median hospital stay was 9 days, while it was 10.5 days for patients with postoperative pancreatic fistulae (27.5% of all cases). Follow-up was available for all patients. Conclusions: Our experience in 58 consecutive patients was characterized by the lack of conversions and by acceptable rates of postoperative pancreatic fistulae and morbidity. Laparoscopy proved especially beneficial in patients with postoperative complications as they had a relatively short hospital stay. Solid and cystic tumors of the distal pancreas represent a good indication for laparoscopic resection whenever possible. PMID:17592294

  6. Placement of subcutaneous ureteral bypasses without fluoroscopic guidance in cats with ureteral obstruction: 19 cases (2014-2016).

    Science.gov (United States)

    Livet, Véronique; Pillard, Paul; Goy-Thollot, Isabelle; Maleca, David; Cabon, Quentin; Remy, Denise; Fau, Didier; Viguier, Éric; Pouzot, Céline; Carozzo, Claude; Cachon, Thibaut

    2016-09-30

    The purpose of this study was to describe the perioperative and postoperative complications as well as short-term and long-term outcomes in cats with ureteral obstructions treated by placement of a subcutaneous ureteral bypass (SUB) device without imaging control. The second objective of this study was to compare cats treated by SUB device with cats treated by traditional surgical intervention. Data were obtained retrospectively from the medical records (2014-2016) of cats that underwent SUB placement (SUB cats) and cats that underwent traditional ureteral surgery (C cats). Nineteen SUB devices were placed without fluoroscopic, radiographic or ultrasonographic guidance in 13 cats. Fifteen traditional interventions (ureterotomy and neoureterocystostomy) were performed in 11 cats. Successful placement of the SUB device was achieved in all cats with only one major intraoperative complication (kinking of the kidney catheter) and one minor intraoperative complication (misplacement of the kidney catheter). Eleven SUB cats recovered from the surgical procedure; two SUB cats and three C cats died during the anaesthesia recovery period. Postoperative SUB complications included anaemia (n = 2), urinary tract infection (UTI) (n = 4), non-infectious cystitis (n = 5) and SUB device obstruction (n = 1). Postoperative traditional surgery complications included anaemia (n = 7), UTIs (n = 6), non-infectious cystitis (n = 1), re-obstruction (n = 4) and ureteral stricture (n = 1). Median postoperative duration of hospitalisation (3 days) was significantly shorter for SUB cats than for C cats (P = 0.013). Ten SUB cats (76.9%) and four C cats (40%) were still alive at a median follow-up of 225 days and 260 days, respectively. Owners were completely (90%) or mostly (10%) satisfied with the SUB device placement. SUB device placement appears to be an effective and safe option for treating ureteral obstruction in cats, and this study has shown that fluoroscopic guidance is not essential in

  7. Management of iatrogenic ureteric injury with retrograde ureteric stenting: an analysis of factors affecting technical success and long-term outcome.

    Science.gov (United States)

    Chung, Daniel; Briggs, James; Turney, Benjamin W; Tapping, Charles Ross

    2017-02-01

    Background Iatrogenic ureteral injuries arise as serious complication following obstetrics, gynecological, general, and urological surgery with incidence in the range of 0.5-10%. Retrograde placement of double-J ureteric stent is a possible treatment option if the injury is not recognized at the time of surgery. Purpose To assess technical success and long-term outcome associated with retrograde ureteric stent insertion for iatrogenic ureteric injury. Material and Methods Between 1999 and 2011, 26 patients with initially unrecognized iatrogenic ureteric injury underwent initial management with retrograde ureteric stenting. Full case-notes were available for review in 25 patients. Results The mean interval from injury to attempted stenting was 19.4 days. Successful retrograde ureteric stenting was achieved in 21/25 patients (81%). Retrograde stenting failed in four patients, and nephrostomy followed by alternative procedures were performed instead. At a median follow-up interval of 9.7 months, normal anatomy was demonstrated on 12/21 patients (57%) and a stricture was observed in 6/21 patients (28%) with three requiring surgical intervention. Conclusion Retrograde stenting is a safe and efficient initial management in patients with iatrogenic ureteric injuries.

  8. [Experiences with transparenchymal coral calculi removal under local hypothermia].

    Science.gov (United States)

    Albert, L; Zacher, W; Meyer, S

    1984-06-01

    Under certain conditions genuine coral calculi are an absolute offication for nephrotomy. In order to achieve complete hygienization of the cavity ischaemia times of more than 25-30 min are often necessary. Controlled surface cooling proved to be very good for improving ischaemia tolerance and reducing post-ischaemic loss of function in 21 necessary nephrotomies out of a total of 651 operations for concrements in the calyx system of the renal pelvis (= 3.2%; = 32.8% of all nephrotomies). A kidney thermometer with a temperature feeler developed by us allows fine control of the hypothermia induced by means of plastic bags filled with ice crystals. The technique of operation together with its advantages and disadvantages are described.

  9. Spectroscopic analysis of urinary calculi and inhibition of their growth

    Science.gov (United States)

    Manciu, Felicia; Durrer, William; Govani, Jayesh; Reza, Layra; Pinales, Luis

    2009-10-01

    We present here a study of kidney stone formation and growth inhibition based on a traditional medicine approach with Aquatica Lour (RAL) herbal extracts. Kidney stone material systems were synthesized in vitro using a simplified single diffusion gel growth technique. With the objective of revealing the mechanism of inhibition of calculi formation by RAL extracts, samples prepared without the presence of extract, and with the presence of extract, were analyzed using Raman, photoluminescence, and XPS. The unexpected presence of Zn revealed by XPS in a sample prepared with RAL provides an explanation for the inhibition process, and also explains the dramatic reflectance of incident light observed in attempts to obtain infrared transmission data. Raman data are consistent with the binding of the inhibitor to the oxygen of the kidney stone. Photoluminescence data corroborate with the other results to provide additional evidence of Zn-related inhibition.

  10. Medullary Sponge Kidney and Urinary Calculi Aeromedical Concerns

    Science.gov (United States)

    Jones, Jeffrey A.; Cherian, Sebastian F.; Barr, Yael R.; Stocco, Amber

    2008-01-01

    Medullary Sponge Kidney (MSK) is a benign disorder associated with renal stones in 60% of patients. Patients frequently have episodic painless hematuria but are otherwise asymptomatic unless renal calculi or infections complicate the disease. Nephrolithiasis is a relative, but frequently enforced, contraindication to space or other high performance flight. Two case reports of asymptomatic NASA flight crew with MSK and three cases of military aviators diagnosed with MSK are reviewed, all cases resulted in waiver and return to flight status after treatment and a vigorous follow up and prophylaxis protocol. MSK in aviation and space flight necessitates a highly case-by-case dependent evaluation and treatment process to rule out other potential confounding factors that might also contribute to stone formation and in order to re-qualify the aviator for flight duties.

  11. Verification of relationships between anthropometric variables among ureteral stents recipients and ureteric lengths: a challenge for Vitruvian-da Vinci theory

    Directory of Open Access Journals (Sweden)

    Acelam PA

    2015-08-01

    Full Text Available Philip A Acelam Walden University, College of Health Sciences, Minneapolis, MN, USA Objective: To determine and verify how anthropometric variables correlate to ureteric lengths and how well statistical models approximate the actual ureteric lengths. Materials and methods: In this work, 129 charts of endourological patients (71 females and 58 males were studied retrospectively. Data were gathered from various research centers from North and South America. Continuous data were studied using descriptive statistics. Anthropometric variables (age, body surface area, body weight, obesity, and stature were utilized as predictors of ureteric lengths. Linear regressions and correlations were used for studying relationships between the predictors and the outcome variables (ureteric lengths; P-value was set at 0.05. To assess how well statistical models were capable of predicting the actual ureteric lengths, percentages (or ratios of matched to mismatched results were employed. Results: The results of the study show that anthropometric variables do not correlate well to ureteric lengths. Statistical models can partially estimate ureteric lengths. Out of the five anthropometric variables studied, three of them: body frame, stature, and weight, each with a P<0.0001, were significant. Two of the variables: age (R2=0.01; P=0.20 and obesity (R2=0.03; P=0.06, were found to be poor estimators of ureteric lengths. None of the predictors reached the expected (match:above:below ratio of 1:0:0 to qualify as reliable predictors of ureteric lengths. Conclusion: There is not sufficient evidence to conclude that anthropometric variables can reliably predict ureteric lengths. These variables appear to lack adequate specificity as they failed to reach the expected (match:above:below ratio of 1:0:0. Consequently, selections of ureteral stents continue to remain a challenge. However, height (R2=0.68 with the (match:above:below ratio of 3:3:4 appears suited for use as

  12. Contemporary surgical trends in the management of upper tract calculi.

    Science.gov (United States)

    Oberlin, Daniel T; Flum, Andrew S; Bachrach, Laurie; Matulewicz, Richard S; Flury, Sarah C

    2015-03-01

    Upper tract nephrolithiasis is a common surgical condition that is treated with multiple surgical techniques, including shock wave lithotripsy, ureteroscopy and percutaneous nephrolithotomy. We analyzed case logs submitted to the ABU by candidates for initial certification and recertification to help elucidate the trends in management of upper tract urinary calculi. Annualized case logs from 2003 to 2012 were analyzed. We used logistic regression models to assess how surgeon specific attributes affected the way that upper tract stones were treated. Cases were identified by the CPT code of the corresponding procedure. A total of 6,620 urologists in 3 certification groups recorded case logs, including 2,275 for initial certification, 2,381 for first recertification and 1,964 for second recertification. A total of 441,162 procedures were logged, of which 54.2% were ureteroscopy, 41.3% were shock wave lithotripsy and 4.5% were percutaneous nephrolithotomy. From 2003 to 2013 there was an increase in ureteroscopy from 40.9% to 59.6% and a corresponding decrease in shock wave lithotripsy from 54% to 36.3%. For new urologists ureteroscopy increased from 47.6% to 70.9% of all stones cases logged and for senior clinicians ureteroscopy increased from 40% to 55%. Endourologists performed a significantly higher proportion of percutaneous nephrolithotomies than nonendourologists (10.6% vs 3.69%, p <0.0001) and a significantly smaller proportion of shock wave lithotripsies (34.2% vs 42.2%, p = 0.001). Junior and senior clinicians showed a dramatic adoption of endoscopic techniques. Treatment of upper tract calculi is an evolving field and provider specific attributes affect how these stones are treated. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  13. Acute urinary retention in women due to urethral calculi: A rare case

    OpenAIRE

    2014-01-01

    We present a case of a 51-year-old woman with acute urinary retention caused by a urethral calculus. Urethral calculi in women are extremely rare and are usually formed in association with underlying genitourinary pathology. In this case, however, no pathology was detected via thorough urological evaluation. We discuss the pathogenesis, clinical presentation and treatment of urethral calculi. To our knowledge, this is the second reported case of a primary urethral calculus in a female with an...

  14. 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.

  15. 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

  16. Distal radioulnar joint injuries

    Directory of Open Access Journals (Sweden)

    Binu P Thomas

    2012-01-01

    Full Text Available Distal radioulnar joint is a trochoid joint relatively new in evolution. Along with proximal radioulnar joint , forearm bones and interosseous membrane, it allows pronosupination and load transmission across the wrist. Injuries around distal radioulnar joint are not uncommon, and are usually associated with distal radius fractures,fractures of the ulnar styloid and with the eponymous Galeazzi or Essex_Lopresti fractures. The injury can be purely involving the soft tissue especially the triangular fibrocartilage or the radioulnar ligaments.The patients usually present with ulnar sided wrist pain, features of instability, or restriction of rotation. Difficulty in carrying loads in the hand is a major constraint for these patients. Thorough clinical examination to localize point of tenderness and appropriate provocative tests help in diagnosis. Radiology and MRI are extremely useful, while arthroscopy is the gold standard for evaluation. The treatment protocols are continuously evolving and range from conservative, arthroscopic to open surgical methods. Isolated dislocation are uncommon. Basal fractures of the ulnar styloid tend to make the joint unstable and may require operative intervention. Chronic instability requires reconstruction of the stabilizing ligaments to avoid onset of arthritis. Prosthetic replacement in arthritis is gaining acceptance in the management of arthritis.

  17. Ureteral inguinal hernia: an uncommon trap for general surgeons

    Science.gov (United States)

    Yahya, Zarif; Al-habbal, Yahya; Hassen, Sayed

    2017-01-01

    Inguinal hernias involving the ureter, a retroperitoneal structure, is an uncommon phenomenon. It can occur with or without obstructive uropathy, the latter posing a trap for the unassuming general surgeon performing a routine inguinal hernia repair. Ureteral inguinal hernia should be included as a differential when a clinical inguinal hernia is diagnosed concurrently with unexplained hydronephrosis, renal failure or urinary tract infection particularly in a male. The present case describes a patient with a known ureteroinguinal hernia who proceeded to having a planned hernia repair and ureteric protection. The case is a reminder that when faced with an unexpected finding such an indirect sliding inguinal hernia, extreme care should be taken to ensure that no structures are inadvertently damaged and that a rare possibility is the entrapment of the ureter in the inguinal canal. PMID:28275027

  18. Independent roles of Fgfr2 and Frs2α in ureteric epithelium

    OpenAIRE

    Sims-Lucas, Sunder; Cusack, Brian; Eswarakumar, Veraragavan P.; Zhang, Jue(Institute for Fundamental Theory, Department of Physics, University of Florida, Gainesville, FL, 32611, U.S.A.); Wang, Fen; Bates, Carlton M.

    2011-01-01

    Mice with conditional deletion of fibroblast growth factor receptor 2 (Fgfr2) in the ureteric bud using a Hoxb7cre line (Fgfr2UB−/−) develop severe ureteric branching defects; however, ureteric deletion of fibroblast growth factor receptor substrate 2α (Frs2α), a key docking protein that transmits fibroblast growth factor receptor intracellular signaling (Frs2αUB−/−) leads to mild ureteric defects. Mice with point mutations in the Frs2α binding site of Fgfr2 (Fgfr2LR/LR) have normal kidneys. ...

  19. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  1. Ureteric re-implant for the strictured renal allograft: How I do it.

    Science.gov (United States)

    McGregor, Thomas; Kroczak, Tadeuz; Huang, Chun; Koulack, Joshua

    2016-06-01

    Ureteric stricture is the most common urologic complication following renal transplantation. Initial treatment should consist of endoscopic management, however patients that fail endoscopic management or strictures that are not amendable to endoscopic management are appropriate candidates for open surgical repair. In this manuscript we describe the steps and surgical technique we use to manage complicated ureteric strictures refractory to endoscopic management at our center. Ureteric re-implant with the use of a Boari flap is a safe, effective and definitive option for repair of ureteric strictures following renal transplantation. This approach provides excellent long term outcomes in terms of renal function preservation and negligible recurrence rates.

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

    Science.gov (United States)

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

    2009-01-01

    Background this study aims to evaluate the effectiveness and safety of laparoscopic conservative management of ureteral endometriosis. Methods Eighty cases of histologically confirmed endometriosis affecting the ureter, 10 of which with bladder involvement were prospectively studied. In detail, patients were 13 women with ureteral stenosis (7 with hydronephrosis), 32 with circular lesions totally encasing the ureter, and 35 with endometriotic foci on the ureteral wall, but not completely encasing it. They were submitted to laparoscopic ureterolysis with or without partial cystectomy, ureteroneocistostomy. The rate of surgical complications, the recurrence rate, the patients' satisfaction rate was assessed during 22 months (median) follow-up. Results Laparoscopic ureterolysis was employed for all patients and set free the ureter from the disease in 95% of cases, whereas ureteroneocystostomy was necessary for 4 patients showing severe stenosis with hydronephrosis, among which 2 had intrinsic endometriosis of the ureteral muscularis. Three post-surgery ureteral fistulae occurred in cases with ureteral involvement longer than 4 cm: two cases were successfully treated placing double J catheter, the third needed ureteroneocistostomy. During follow-up, ureteral endometriosis recurred in 2 patients who consequently underwent ureteroneocystostomy. Most patients expressed high satisfaction rate throughout the whole follow-up period. Conclusion laparoscopic ureterolysis is effective and well tolerated in most cases of ureteral endometriosis. Ureteroneocystostomy is a better strategy for patients with extended (more than 4 cm) ureteral involvement or with severe stenosis with or without hydronephrosis. PMID:19818156

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

    Directory of Open Access Journals (Sweden)

    Migliaretti Giuseppe

    2009-10-01

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

  4. Acute bilateral ureteral obstruction secondary to guaifenesin toxicity.

    Science.gov (United States)

    Cockerill, Patrick A; de Cógáin, Mitra R; Krambeck, Amy E

    2013-10-01

    Several medications or their metabolites have been associated with urolithiasis, although overall they remain an infrequent cause of urolithiasis. Guaifenesin stones were originally reported as complexed with ephedrine, and subsequent reports have demonstrated pure guaifenesin stones, occurring after long term abuse. We report a case of a 23-year-old male who ingested a large, one time dose of guaifenesin, resulting in acute bilateral ureteral obstruction, which, to our knowledge, is the first such reported case in the literature.

  5. Evaluating kidney damage from vesico-ureteral reflux in children

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    Zaffanello M

    2009-01-01

    Full Text Available To review the most relevant clinical studies that evaluate kidney damage in children with primary vesico-ureteral reflux (VUR, we reviewed and compared randomized controlled trials and clinical trials from scientific literature. In these studies, vesico-ureteral reflux was diagnosed by voiding cystourethrogram and kidney damage was assessed by either DMSA scan or urography. Relative risk with 95% confidence intervals was calculated using Review Manager Software (The Cochrane Collaboration, 2000. The overall relative risk of kidney damage shown by DMSA scan and urography was statistically higher in children with vesico-ureteral reflux of various degrees than in controls (3.7 times and 2.8 times, respectively. However, in high-grade VUR, the relative risk of congenital kidney damage was 5.6 times that of controls. We conclude that severe VUR is frequently associated with early kidney damage, perhaps with prenatal onset. Progression of kidney damage may depend on the severity of VUR and untreated urinary tract infections. Prevention of congenital kidney damage from severe VUR is possible when there is early intervention, even during fetal growth.

  6. Papain immobilized polyurethane as an ureteral stent material.

    Science.gov (United States)

    Maria Manohar, Cynthya; Doble, Mukesh

    2016-05-01

    Long term use of polyurethane-based ureteral stent is hampered by the development of infection due to the formation of bacterial biofilm and salt deposition. Here papain, is covalently immobilized to polyurethane using glutarldehyde and is investigated as a possible anti-infective ureteral stent material. Fourier transform infrared spectrum confirmed its immobilization. Immobilized enzyme retained 85% of the activity of the free enzyme and about 12% loss of enzyme was observed from the polymer surface in one month. The modified polyurethane showed 8 log reduction in Staphylococcus aureus and 7 log reduction in Escherichia coli live colonies and 3-4 times decrease in the protein and carbohydrate in the biofilms than bare polymer. The amount of calcium and magnesium salts deposited on the polymer surface reduced by 40% after enzyme immobilization. 80% of L6 myoblast cells were viable on this material which indicated that it was noncytotoxic. A linear regression equation with hydrophilicity of the polymer surface and the cell surface hydrophobicity as the two independent variables was able to predict the number of live cells attached on the modified PU. This study indicated the possibility of using such an approach to overcome the problems of ureteral stent associated biofilm and salt encrustation.

  7. Renal Autotransplantation for Iatrogenic High-Grade Ureteric Stricture

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    Jose Soto Soto

    2012-01-01

    Full Text Available A 47-year-old Hispanic woman developed a chronically obstructed left kidney, due to a long-segment ureteric stricture deemed not amenable to reimplantation, following left ovarian cyst excision in 2004. Therefore, a ureteral stent requiring exchange every 3 months was necessary, due to hydronephrosis, recurrent urosepsis, chronic pain, and a poor quality of life. Her medical history was complicated by hypertension, poorly controlled diabetes mellitus, and microalbuminuria, suggesting early diabetic nephropathy. A left nephrectomy was recommended. This was deferred, due to concern for progressive kidney failure associated with her comorbidities. A radionuclide Tc-99m MAG3 renal scan revealed differential perfusion as follows: 44% left kidney and 56% right kidney, with symmetrical uptake on the renogram phase and delayed excretion on the left, which were correctted following furosemide administration. A left ureteronephrectomy with autotransplantation of the left kidney and ureteroneocystostomy was performed in 2009. Since then, the patient has experienced no further complications or need for invasive procedures, with excellent diabetic control and stable renal function (eGFR > 60 mL/min/1.73 m2. This technique is seldom employed in the surgical management of complex ureteral injuries, but may be an alternative for appropriate cases.

  8. 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.

  9. Scintigraphic Demonstration of Urine Extravasation Secondary to Acute Ureteral Obstruction: A Case Report and Some Considerations about Acute Ureteral Obstruction

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    Federico M. Sarmiento

    2006-01-01

    Full Text Available Acute ureteral obstruction produces renal damage and complications that are proportional to the severity and length of the obstruction. Anatomic diagnosis of the obstruction may be insufficient to manage the patient. Intravenous urogram (IVU is the method usually advised by radiologists to obtain functional information, but requires iodinated contrast agents. IVU anatomic information is superior to anatomic information obtained with renal scintigraphy, but normally the physician already has the anatomic information (unenhanced CT or ultrasound. A renal scan offers better physiologic information than the IVU, has neither adverse effects nor complications, is accurate to confirm or discard significant ureteral obstruction, and depicts obstruction complications. This paper presents a patient with spontaneous urine extravasation secondary to acute renal obstruction who is diagnosed with renal scintigraphy. The authors describe the scintigraphic signs of extraperitoneal, diffuse perinephric, urine extravasation and emphasize the role of renal scintigraphy in diagnosis and follow-up of renal colic.

  10. Association between schizophrenia and urinary calculi: a population-based case-control study.

    Directory of Open Access Journals (Sweden)

    Shih-Ping Liu

    Full Text Available BACKGROUND: People with schizophrenia have been demonstrated to have higher overall morbidity and all-cause mortality rates from general medical conditions. However, little attention has been given to the urinary system of people with schizophrenia. As no direct evidence has been reported demonstrating a link between schizophrenia and urinary calculi, this study utilized a population-based case-control study design to investigate the possibility of an association between schizophrenia and the occurrence of urinary calculi. METHOD: This study used data from the Taiwan Longitudinal Health Insurance Database. Cases consisted of 53,965 urinary calculi patients newly diagnosed between 2002 and 2008. In total, 269,825 controls were randomly selected and matched with the cases in terms of age and sex. Each person was traced to discern whether he had previously received a diagnosis of schizophrenia. Conditional logistic regression models were performed for the analysis. RESULTS: A total of 3,119 (1.0% subjects had been diagnosed with schizophrenia prior to the index date. This included 0.7% of the patients with urinary calculi, and 1.0% of the controls. A prior diagnosis of schizophrenia was independently associated with a 30% decrease (95% CI = 0.62-0.76 in the occurrence of urinary calculi. The reduction was even more remarkable in males (38%, 95% CI = 0.55-0.71 and in elder individuals independent of gender (48% in those aged >69, 95% CI = 0.36-0.77. CONCLUSION: Our findings suggest that there is an inverse association between schizophrenia and urinary calculi. Future studies are needed to elucidate the mechanisms by which schizophrenia negatively associates with urinary calculi.

  11. The results of 15 years of consistent strategy in treating antenatally suspected pelvi-ureteric junction obstruction

    DEFF Research Database (Denmark)

    Thorup, Jørgen Mogens; Jokela, R; Cortes, Dina;

    2003-01-01

    To determine how to select patients for surgery among those with antenatally detected pelvi-ureteric junction (PUJ) obstruction.......To determine how to select patients for surgery among those with antenatally detected pelvi-ureteric junction (PUJ) obstruction....

  12. Unilateral versus bilateral ultrasound-guided transversus abdominis plane blocks during ureteric shock wave lithotripsy: A prospective randomized trial

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    Ali Mohamed Ali Elnabtity

    2016-01-01

    Conclusion: Ultrasound-guided unilateral TAP block is as safe and effective analgesic technique as bilateral TAP blocks during unilateral ureteric SWL. It can be used as the sole analgesic technique during ureteric SWL.

  13. Nondestructive analysis of urinary calculi using micro computed tomography

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    Lingeman James E

    2004-12-01

    Full Text Available Abstract Background Micro computed tomography (micro CT has been shown to provide exceptionally high quality imaging of the fine structural detail within urinary calculi. We tested the idea that micro CT might also be used to identify the mineral composition of urinary stones non-destructively. Methods Micro CT x-ray attenuation values were measured for mineral that was positively identified by infrared microspectroscopy (FT-IR. To do this, human urinary stones were sectioned with a diamond wire saw. The cut surface was explored by FT-IR and regions of pure mineral were evaluated by micro CT to correlate x-ray attenuation values with mineral content. Additionally, intact stones were imaged with micro CT to visualize internal morphology and map the distribution of specific mineral components in 3-D. Results Micro CT images taken just beneath the cut surface of urinary stones showed excellent resolution of structural detail that could be correlated with structure visible in the optical image mode of FT-IR. Regions of pure mineral were not difficult to find by FT-IR for most stones and such regions could be localized on micro CT images of the cut surface. This was not true, however, for two brushite stones tested; in these, brushite was closely intermixed with calcium oxalate. Micro CT x-ray attenuation values were collected for six minerals that could be found in regions that appeared to be pure, including uric acid (3515 – 4995 micro CT attenuation units, AU, struvite (7242 – 7969 AU, cystine (8619 – 9921 AU, calcium oxalate dihydrate (13815 – 15797 AU, calcium oxalate monohydrate (16297 – 18449 AU, and hydroxyapatite (21144 – 23121 AU. These AU values did not overlap. Analysis of intact stones showed excellent resolution of structural detail and could discriminate multiple mineral types within heterogeneous stones. Conclusions Micro CT gives excellent structural detail of urinary stones, and these results demonstrate the feasibility

  14. A PROSPECTIVE STUDY COMPARING TAMSULOSIN AND SILODOSIN IN MEDICAL EXPULSIVE THERAPY FOR LOWER URETERIC STONES

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    Sreedhar Reddy

    2016-07-01

    , but it was statistically insignificant. CONCLUSION Tamsulosin and silodosin are equally effective as MET for distal ureteric stones sized 10 mm or smaller. MET with silodosin is associated with a lower incidence of side effects related to peripheral vasodilation, but a higher incidence of retrograde ejaculation when compared to tamsulosin. However, a multicentre study on a larger scale is needed to evaluate the current medicines.

  15. A Novel Type of Ureteral Stents in the Treatment of a Bilateral Iatrogenic Transaction of the Ureters

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    Ernesto Mazza

    2013-01-01

    Full Text Available This report illustrates the case of a patient who suffered an iatrogenic complete injury of both ureters after a complex surgical procedure to remove a large sacral chordoma. Ureteral recanalization was achieved with two removable, autoexpandable, and polytetrafluoroethylene covered nitinol stents. To our knowledge, we describe the first application of this type of stents to treat a bilateral ureteral transection. Despite the bad general conditions of the patient, the ureteral stents successfully restored and maintained the bilateral ureteral continuity.

  16. The feasibility of using microwave-induced thermoacoustic tomography for detection and evaluation of renal calculi.

    Science.gov (United States)

    Cao, Caijun; Nie, Liming; Lou, Cunguang; Xing, Da

    2010-09-01

    Imaging of renal calculi is important for patients who suffered a urinary calculus prior to treatment. The available imaging techniques include plain x-ray, ultrasound scan, intravenous urogram, computed tomography, etc. However, the visualization of a uric acid calculus (radiolucent calculi) is difficult and often impossible by the above imaging methods. In this paper, a new detection method based on microwave-induced thermoacoustic tomography was developed to detect the renal calculi. Thermoacoustic images of calcium oxalate and uric acid calculus were compared with their x-ray images. The microwave absorption differences among the calcium oxalate calculus, uric acid calculus and normal kidney tissue could be evaluated by the amplitude of the thermoacoustic signals. The calculi hidden in the swine kidney were clearly imaged with excellent contrast and resolution in the three orthogonal thermoacoustic images. The results indicate that thermoacoustic imaging may be developed as a complementary method for detecting renal calculi, and its low cost and effective feature shows high potential for clinical applications.

  17. "THE ROLE OF HARDNESS OF POTABLE WATER IN THE FORMATION OF URINARY CALCULI IN UROMIEH, Iran"

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    K.Imandel

    1995-06-01

    Full Text Available The formation of renal and urinary calculi is not due to a single cause but occurs as a multifactor entity, by which some of them still are unknown. Three theories of Stones formation including nucleation, stone matrix and inhibition of crystallization do not accuse water hardness as a main cause of the formation of urinary calculi 120 patients suffering from renal and urinary calculi and the same number of control persons were studied in the city of Uromieh. The analysis of uroliths and water samples fulfilled the laboratory Standard methods Chi-square test was done on the results obtained The results of water analyses showed that the total hardness of Calcium and Magnesium were 300, 69, 32 mg/I as CaCo3 , TDS , 410 mg/I, electrical conductivity 600 us/cm and water classified as very hard. The abundance of uroliths were, oxalate, cystjne, uric acid infectious respectively, There was no statistical significant association between water hardness and urinary calculi of patients under study with respect to age and sex. The abundance blood groups in patients were A , 0 , AB and B respectively and the occurrence of 3 renal calculi mentioned above were more in men than Women The formation of renal stones were most occurred in summer season. The most abundant was calcium oxalate, the incidence was between the ages 30 to 50 years old and calcium stones were 2.7 times more in men than woman.

  18. Outcomes of urethral calculi patients in an endemic region and an undiagnosed primary fossa navicularis calculus.

    Science.gov (United States)

    Verit, Ayhan; Savas, Murat; Ciftci, Halil; Unal, Dogan; Yeni, Ercan; Kaya, Mete

    2006-02-01

    Urethral calculus is a rare form of urolithiasis with an incidence lower than 0.3%. We determined the outcomes of 15 patients with urethral stone, of which 8 were pediatric, including an undiagnosed primary fossa navicularis calculus. Fifteen consecutive male patients, of whom eight were children, with urethral calculi were assessed between 2000 and 2005 with a mean of 19 months' follow-up. All stones were fusiform in shape and solitary. Acute urinary retention, interrupted or weak stream, pain (penile, urethral, perineal) and gross hematuria were the main presenting symptoms in 7 (46.7%), 4 (26.7%), 3 (20%) and 1 (6.6%) patient, respectively. Six of them had accompanying urethral pathologies such as stenosis (primary or with hypospadias) and diverticulum. Two patients were associated with upper urinary tract calculi but none of them secondary to bladder calculi. A 50-year-old patient with a primary urethral stone disease had urethral meatal stenosis accompanied by lifelong lower urinary tract symptoms. Unlike the past reports, urethral stones secondary to bladder calculi were decreasing, especially in the pediatric population. However, the pediatric patients in their first decade are still under risk secondary to the upper urinary tract calculi or the primary ones.

  19. Prostatic calculi influence the antimicrobial efficacy in men with chronic bacterial prostatitis.

    Science.gov (United States)

    Zhao, Wei-Ping; Li, Yong-Tao; Chen, Jun; Zhang, Zhi-Gen; Jiang, Hai; Xia, Dan; Wang, Shuo; Wang, Ping

    2012-09-01

    We studied the efficacy of culture-specific antibiotic therapy for chronic bacterial prostatitis (CBP) patients with or without prostatic calculi. This study included 101 patients (21-62 years old) who met the consensus criteria for CBP (National Institutes of Health category II). According to the results of transrectal ultrasonography (TRUS), all patients were divided into two groups: Group 1, CBP with prostatic calculi, n=39; Group 2, CBP without prostatic calculi, n=62. All patients received optimal antimicrobial therapy for 4 weeks and followed up for a minimum of 3 months (range: 3-8 months). In addition to expressed prostatic secretions (EPS) and urine culture, all patients were asked to complete the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and the subjective global assessment (SGA). The microbiological eradication rate at the end of treatment were 32/39 (82.1%) and 54/62 (87.1%), while the rates for continued eradication at the end of study were 17/39 (43.6%) and 45/62 (72.6%) in Group 1 and Group 2 (Pquality of life (QoL; Pprostatic calculi influence the antimicrobial efficacy in men with CBP. There was a noticeable decrease in the cure rate of CBP patients with prostatic calculi due to relapse after antimicrobial therapy.

  20. Is joint hypermobility associated with vesico-ureteral refl ux? An assessment of 50 patients.

    NARCIS (Netherlands)

    Eerde, M. van Albertien; Verhoeven, J.M. Virginie; Jong, P.V.M. de Tom; Putte, M. van de Elise; Giltay, C. Jacques; Engelbert, H.H. Raoul

    2011-01-01

    Recent studies have already shown associations between generalized joint hypermobility (GJH) and voiding and defecation dysfunction and/or slow transit constipation. Changes in extracellular matrix composition in vesico-ureteric junction of vesico-ureteral refl ux (VUR) patients were also observed p

  1. Analysis of 136 ureteral injuries in gynecological and obstetrical surgery from completed insurance claims

    DEFF Research Database (Denmark)

    Hove, L.D.; Michelsen, Jonas Bock; Christoffersen, J.K.

    2010-01-01

    . Evaluation of claims concerning ureteral injuries reported to the Danish Patient Insurance Association. Setting. Danish Patient Insurance Association. Sample. All registered claims for ureteral injuries from 1996 to 2006. Methods. Retrospective study of medical records and data from Danish Patient Insurance...

  2. Analysis of 136 ureteral injuries in gynecological and obstetrical surgery from completed insurance claims

    DEFF Research Database (Denmark)

    Hove, L.D.; Michelsen, Jonas Bock; Christoffersen, J.K.;

    2010-01-01

    Association. Main outcome measures. Preventable ureteral injuries. Results. From 1996 to 2006, 136 submitted claims concerning ureteral injuries were registered. Among these, 73 claims were approved (54%), and compensation paid. In 44 of these, the injury was caused by negligence. Failure to dissect...

  3. OT位ESWL与URL治疗输尿管下段结石比较%Comparison OT ESWL and URL in treatment of lower ureteral calculi

    Institute of Scientific and Technical Information of China (English)

    左庆军; 王国增; 章璟; 顾燕; 杨佳伟; 贾德升

    2014-01-01

    目的 通过比较OT位体外冲击波碎石术(ESWL)和输尿管镜钬激光碎石术(URL)治疗输尿管下段结石的结石排净率和卫生经济学,研究经济有效的治疗手段.方法 将120例输尿管下段结石患者分为2组,OT位ESWL组与URL组,ESWL组60例患者采用OT位体外冲击波碎石术,URL组60例患者采用输尿管镜钬激光碎石术.结果 术后3d的排石率、排净率,URL组明显高于OT位ESWL组,2组差异有统计学意义(P<0.05);术后2周、3个月的排石率、排净率,URL组高于OT位ESWL组,但2组差异无统计学意义(P>0.05);手术时间、效率商(EQ)URL组明显低于OT位ESWL组,差异有统计学意义(P<0.05);住院时间、住院花费:URL组明显高于OT位ESWL组,2组差异有统计学意义(P<0.05);并发症率URL组低于OT位ESWL组,2组差异无统计学意义(P>0.05).结论 OT位ESWL、URL均是输尿管下段结石高效安全的治疗方法,OT位ESWL结石的排净率低于URL,但URL治疗周期及住院花费高于OT位ESWL.

  4. Treatment of benign ureteral stricture by double J stents using high-pressure balloon angioplasty

    Institute of Scientific and Technical Information of China (English)

    YU Hua-liang; YE Lin-yang; LIN Mao-hu; YANG Yu; MIAO Rui; HU Xiao-juan

    2011-01-01

    Background Balloon dilatation angioplasty is a minimally invasive surgery for treating benign ureteral stricture. The aim of this study was to investigate the effect of placing double J (D-J) stents using high-pressure balloon angioplasty in treating benign ureteral stricture.Methods A total of 42 patients (48 cases) with benign ureteral stricture (42 had benign ureteral stricture) were investigated by inserting dual D-J stents using high-pressure balloon angioplasty. The control group contained 50 patients (57 cases) employing the conventional balloon angioplasty with a single D-J stent inserted for comparison.Results The overall effective rate of the treated and control groups was 87.8% (36/41) and 62.7% (32/51), respectively (P <0.05).Conclusion This new approach produces a better curative effect than the conventional balloon angioplasty with a single D-J stent insertion in treating benign ureteral stricture.

  5. 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.

  6. 输尿管结石梗阻致尿脓毒症急症减压方法的探讨%Discussion on urgent decompression for urosepsis associated with ureteral obstruction caused by ureteral calculi

    Institute of Scientific and Technical Information of China (English)

    解海杰; 史启铎

    2013-01-01

    目的:本研究探讨输尿管结石梗阻致尿脓毒症的急症减压方法.方法:输尿管结石梗阻导致尿脓毒症患者106例,根据病情分期采取不同急症减压方法解除梗阻:①膀胱镜下逆行留置双J管引流.②经皮肾造瘘引流.③经尿道输尿管镜气压弹道碎石术后留置双J管引流.结果:所有患者均减压成功,其中105例患者术后情况有不同程度的改善,感染得到控制.一般脓毒症患者术后恢复时间(3.25±1.71)d,严重脓毒症患者术后恢复时间(6.38±1.94)d,脓毒性休克患者术后恢复时间(15.55±2.46) d(P<0.01);1例脓毒性休克伴有弥漫性血管内凝血患者死亡.结论:根据病情分期选择适当的急症减压方法及时解除梗阻对于控制输尿管结石梗阻致尿源性脓毒症至关重要.

  7. Curative effect of extracorporeal shock wave lithotripsy in the treatment of urinary calculi%体外冲击波碎石术治疗泌尿系结石的效果

    Institute of Scientific and Technical Information of China (English)

    徐红亮

    2014-01-01

    Objective To observe the curative effect of extracorporeal shock wave lithotripsy in the treatment of urinary calculi. Methods The clinical data of 98 cases with urinary calculi admitted to People's Hospital of Yunyang County in Chongqing City from January 2012 to January 2014 were analyzed retrospectively. All patients were taken the therapy of extracorporeal shock wave lithotripsy, and the curative effect and conditions of complications were observed. Results Among patients of this study, 44 cases of patients egested calculi completely for once, accounting for 44.90%, 30 cases of patients egested calculi completely for twice, accounting for 30.61%, 21 cases of patients egested calculi completely for three times, accounting for 22.45%, 3 cases of patients were failed after extracorporeal shock wave lithotripsy and then took open surgery. The clinical curative effect showed that, there were 54 cases of cured, 41 cases of improved, 3 cases of failed, the total effective rate was 96.94%. Complications after extracorporeal shock wave lithotripsy, all pa-tients showed more or less gross hematuria or microscopic hematuria, 1-2 days later, they were disappeared;the skin of 5 cases of patients showed petechiae or ecchymosis, the symptoms were disappeared without any treatment; 4 cases of patients showed more or less ureteral colic, the symptoms were improved through symptomatic treatment;2 cases of pa-tients were formed ureteral “stone street”, the symptom was disappeared after another extracorporeal shock wave lithotripsy; 1 case was combined with slight ureteral stricture; 2 cases had fever, the symptom was improved through antifebrile precessing; there were no other serious complications. Conclusion Extracorporeal shock wave lithotripsy in the treatment of urinary calculi has advantages of simple handling, safe and fast, exact curative effect, less side effects, and so on, which is worthy of clinical promotion and application.%目的:观察体外冲击波碎石

  8. Distal arthrogryposis syndrome

    Directory of Open Access Journals (Sweden)

    Kulkarni K

    2008-01-01

    Full Text Available A 5-month-old male infant presented with weak cry, decreased body movements, tightness of whole body since birth, and one episode of generalized seizure on day 4 of life. He was born at term by elective caesarian section performed for breech presentation. The child had failure to thrive, contractures at elbow and knee joints, hypertonia, microcephaly, small mouth, retrognathia, and camptodactyly. There was global developmental delay. Abdominal examination revealed umbilical and bilateral inguinal hernia. Visual evoked response and brainstem evoked response audiometry were abnormal. Nerve conduction velocity was normal. Magnetic resonance imaging of brain revealed paucity of white matter in bilateral cerebral hemispheres with cerebellar and brain stem atrophy. The differential diagnoses considered in the index patient were distal arthrogryposis (DA syndrome, cerebroculofacioskeletal syndrome, and Pena Shokier syndrome. The index patient most likely represents a variant of DA: Sheldon Hall syndrome.

  9. First-order differential calculi over multi-braided quantum groups

    CERN Document Server

    Durdevic, M

    1996-01-01

    A differential calculus of the first order over multi-braided quantum groups is developed. In analogy with the standard theory, left/right-covariant and bicovariant differential structures are introduced and investigated. Furthermore, antipodally covariant calculi are studied. The concept of the *-structure on a multi-braided quantum group is formulated, and in particular the structure of left-covariant *-covariant calculi is analyzed. A special attention is given to differential calculi covariant with respect to the action of the associated braid system. In particular it is shown that the left/right braided-covariance appears as a consequence of the left/right-covariance relative to the group action. Braided counterparts of all basic results of the standard theory are found.

  10. Proceedings Fourth Workshop on Membrane Computing and Biologically Inspired Process Calculi 2010

    CERN Document Server

    Ciobanu, Gabriel; 10.4204/EPTCS.40

    2010-01-01

    The 4th Workshop on Membrane Computing and Biologically Inspired Process Calculi (MeCBIC 2010) is organized in Jena as a satellite event of the Eleventh International Conference on Membrane Computing (CMC11). Biological membranes play a fundamental role in the complex reactions which take place in cells of living organisms. The importance of this role has been considered in two different types of formalisms introduced recently. Membrane systems were introduced as a class of distributed parallel computing devices inspired by the observation that any biological system is a complex hierarchical structure, with a flow of biochemical substances and information that underlies their functioning. The modeling and analysis of biological systems has also attracted considerable interest of the process algebra research community. Thus the notions of membranes and compartments have been explicitly represented in a family of calculi, such as ambients and brane calculi. A cross fertilization of these two research areas has ...

  11. Toward the classification of differential calculi on κ-Minkowski space and related field theories

    Energy Technology Data Exchange (ETDEWEB)

    Jurić, Tajron; Meljanac, Stjepan; Pikutić, Danijel [Ruđer Bošković Institute, Theoretical Physics Division,Bijenička c.54, HR-10002 Zagreb (Croatia); Štrajn, Rina [Dipartimento di Matematica e Informatica, Università di Cagliari,viale Merello 92, I-09123 Cagliari (Italy); INFN, Sezione di Cagliari,Cagliari (Italy)

    2015-07-13

    Classification of differential forms on κ-Minkowski space, particularly, the classification of all bicovariant differential calculi of classical dimension is presented. By imposing super-Jacobi identities we derive all possible differential algebras compatible with the κ-Minkowski algebra for time-like, space-like and light-like deformations. Embedding into the super-Heisenberg algebra is constructed using non-commutative (NC) coordinates and one-forms. Particularly, a class of differential calculi with an undeformed exterior derivative and one-forms is considered. Corresponding NC differential calculi are elaborated. Related class of new Drinfeld twists is proposed. It contains twist leading to κ-Poincaré Hopf algebra for light-like deformation. Corresponding super-algebra and deformed super-Hopf algebras, as well as the symmetries of differential algebras are presented and elaborated. Using the NC differential calculus, we analyze NC field theory, modified dispersion relations, and discuss further physical applications.

  12. Molecular pathology of murine ureteritis causing obstructive uropathy with hydronephrosis.

    Directory of Open Access Journals (Sweden)

    Osamu Ichii

    Full Text Available 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.

  13. Comparison of a biodegradable ureteral stent versus the traditional double-J stent for the treatment of ureteral injury: an experimental study.

    Science.gov (United States)

    Fu, Wei-Jun; Wang, Zhong-Xin; Li, Gang; Cui, Fu-Zhai; Zhang, Yuanyuan; Zhang, Xu

    2012-12-01

    Ureteral injury remains a major clinical problem; here we developed a biodegradable ureteral stent and compared its effectiveness with a double-J stent for treating ureteral injury. Eighteen dogs with injured ureters were subdivided into two groups. In group A, one injured ureter was treated with a biodegradable stent, whereas only end-to-end anastomosis was performed on the other side. In group B, one injured ureter was treated with a biodegradable stent, while a double-J stent was used on the other side. Intravenous urography, radioactive renography, histological examinations, scanning electron microscopy (SEM) and elemental composition analysis were performed at 40, 80 and 120 days postoperatively. Results showed that the biodegradable stent could effectively prevent hydronephrosis and hydroureter secondary to ureteral injury. Moreover all biodegradable stents gradually degraded and discharged completely in 120 days. SEM and elemental composition analysis of the surface of the double-J stent confirmed calcification at 80 days and calcific plaque at 120 days, while no signs of calcification were found in the biodegradable stent group. Histological studies found no difference between the biodegradable stented ureters and double-J stented ureters. It is concluded that the biodegradable ureteral stent was more advantageous than the double-J stent for treating ureteral injury in a canine model.

  14. Therapeutic ureteral occlusion in advanced pelvic malignant tumors

    Energy Technology Data Exchange (ETDEWEB)

    Kinn, A.C.; Ohlsen, H.; Brehmer-Andersson, E.; Brundin, J.

    1986-01-01

    A technique for ureteral occlusion, combining insertion of nylon plugs with injection of polidocanol, is described. The method was used in 15 patients with vesicovaginal fistulas after operation and irradiation for advanced gynecological malignancy, or with severe malfunction and fibrosis of the bladder after radiotherapy for bladder carcinoma. The urinary leakage ceased in 11 patients, was greatly diminished in 2 and was unchanged in 2. Migration of plugs to the renal pelvis was the most serious complication and may have been the cause of pyelonephritis in 1 case. The technique is recommended for patients with a short life expectancy and uncontrolled, distressing leakage of urine.

  15. Huge pelvic mass secondary to wear debris causing ureteral obstruction.

    Science.gov (United States)

    Hananouchi, Takehito; Saito, Masanobu; Nakamura, Nobuo; Yamamoto, Tetsuya; Yonenobu, Kazuo

    2005-10-01

    We report an unusual granulomatous reaction of wear debris that produced a huge pelvic mass causing ureteral obstruction. A 72-year-old woman, who received a cemented total hip arthroplasty 30 years ago, was referred to the department of gynecology for examination of a pelvic mass. A computed tomography scan revealed a huge homogenous mass, measuring approximately 20 x 16 x 12 cm, including extensive osteolysis of the left pelvis around the acetabular component. Intravenous pyelogram revealed complete obstruction of the left ureter resulting in hydronephrosis of the left kidney. Histological examination from the biopsy specimen detected polyethylene wear debris in the mass.

  16. Routine intraoperative ureteric stenting for kidney transplant recipients.

    Science.gov (United States)

    Wilson, C H; Bhatti, A A; Rix, D A; Manas, D M

    2005-10-19

    Major urological complications (MUCs) after kidney transplantation contribute to patient morbidity and compromise graft function. The majority arise from the vesico-ureteric anastomosis and present early after transplantation. Ureteric stents have been successfully used to treat such complications. A number of centres have adopted a policy of universal prophylactic stenting, at the time of graft implantation, to reduce the incidence of urine leaks and ureteric stenosis. Stents are associated with specific complications and some centres advocate a policy of only stenting selected anastomoses. To examine the benefits and harms of routine ureteric stenting to prevent urological complications in kidney transplant recipients. We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library), MEDLINE, EMBASE, reference lists of articles, books and abstracts and contacted companies, authors and experts to identify relevant randomised controlled trials (RCTs). All RCTs and quasi-RCTs were included in our meta-analysis. Four reviewers assessed the trials for quality against four criteria (allocation concealment, blinding, intention-to-treat and completeness of follow-up). The primary outcome was the incidence of MUCs. Further outcomes of interest were graft and patient survival and the incidence of adverse events (urinary tract infection (UTI), haematuria, irritative symptoms, pain and stent migration). Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) with 95% confidence intervals (CI). Seven RCTs (1154 patients) of low or moderate quality were identified. The incidence of MUCs was significantly reduced (RR 0.24, 95% CI 0.07 to 0.77, P = 0.02, NNT 13) by universal prophylactic stenting. This was dependent on whether the same surgeon performed, or was in attendance, during the operations. Two patients lost their grafts to infective urinary tract complications in the stented group

  17. Insights of the dental calculi microbiome of pre-Columbian inhabitants from Puerto Rico

    Directory of Open Access Journals (Sweden)

    Tasha M. Santiago-Rodriguez

    2017-05-01

    Full Text Available Background The study of ancient microorganisms in mineralized dental plaque or calculi is providing insights into microbial evolution, as well as lifestyles and disease states of extinct cultures; yet, little is still known about the oral microbial community structure and function of pre-Columbian Caribbean cultures. In the present study, we investigated the dental calculi microbiome and predicted function of one of these cultures, known as the Saladoid. The Saladoids were horticulturalists that emphasized root-crop production. Fruits, as well as small marine and terrestrial animals were also part of the Saladoid diet. Methods Dental calculi samples were recovered from the archaeological site of Sorcé, in the municipal island of Vieques, Puerto Rico, characterized using 16S rRNA gene high-throughput sequencing, and compared to the microbiome of previously characterized coprolites of the same culture, as well modern plaque, saliva and stool microbiomes available from the Human Microbiome Project. Results Actinobacteria, Proteobacteria and Firmicutes comprised the majority of the Saladoid dental calculi microbiome. The Saladoid dental calculi microbiome was distinct when compared to those of modern saliva and dental plaque, but showed the presence of common inhabitants of modern oral cavities including Streptococcus sp., Veillonella dispar and Rothia mucilaginosa. Cell motility, signal transduction and biosynthesis of other secondary metabolites may be unique features of the Saladoid microbiome. Discussion Results suggest that the Saladoid dental calculi microbiome structure and function may possibly reflect a horticulturalist lifestyle and distinct dietary habits. Results also open the opportunity to further elucidate oral disease states in extinct Caribbean cultures and extinct indigenous cultures with similar lifestyles.

  18. Combined oral and local therapy for the dissolution of urinary calculi.

    Science.gov (United States)

    Götz, F; Frang, D; Hübler, J; Nagy, Z

    1982-01-01

    The factors underlying the formation of Ca-phosphate and struvite calculi, as well as the present possibilities for oral and local therapy, their advantages and drawbacks are discussed in the light of published evidence. In this context a clinical case of multiple injuries is reported in which practically complete chemolitholysis has been achieved by combined oral and local therapy. The rapid growth of the calculi and their alarming tendency to recurrence in case of inadequate treatment is emphasized. The therapeutic method used in this case is regarded as suitable for practical purposes.

  19. Which ureteral access sheath is compatible with your flexible ureteroscope?

    Science.gov (United States)

    Al-Qahtani, Saeed M; Letendre, Julien; Thomas, Alexandre; Natalin, Ricardo; Saussez, Thibaud; Traxer, Olivier

    2014-03-01

    Our aim is to evaluate different ureteral access sheaths (UASs), which are available in the international market and their compatibility with different available flexible ureteroscopes (F-URSs) to help the urologist choose the proper ureteral access sheath for his or her endoscope before commencing the procedure. A total of 21 UASs and 12 F-URSs were evaluated. Measurements were obtained in French (F) units considering different characteristics for each UAS and each F-URS. Insertion test without friction between F-URS and UAS was considered as a successful test and was referred as (YES). All UASs and F-URSs were successfully submitted to the insertion test. All F-URSs that were inserted into UASs without friction had an internal diameter of at least 12F. Different lengths of UAS did not influence the test outcome. This study was able to establish a correlation table between different UASs and different flexible ureteroscopes. As of now, the 12/14F UAS is considered the universal UAS that accepts all F-URSs that are available in the endourology field. Nevertheless, we are expecting a significant change with the new standard size 10/12F UAS as well as huge advances in minimizing the size of different endoscopes.

  20. Distal corporoplasty for distal cylinders extrusion after penile prosthesis implantation.

    Science.gov (United States)

    Carrino, Maurizio; Chiancone, Francesco; Battaglia, Gaetano; Pucci, Luigi; Fedelini, Paolo

    2017-02-03

    Distal extrusion of cylinders is a potential complication of the penile prosthesis implantation. Several methods have been proposed for repairing a distal penile erosion. We present our preliminary experience in "Distal corporoplasty" technique. We enrolled 18 consecutive patients whose underwent a distal corporoplasty with simultaneous reimplantation of an "AMS 700 inflatable penile prosthesis (LGX)" from January 2013 to November 2015 at our hospital. All procedures were performed by a single surgical team. Intraoperative and postoperative complications have been classified and reported according to Satava6 and Clavien-Dindo (CD) system.7 Mean values with standard deviations (±SD) were computed and reported for all items. Mean age of the patients was 53.61 (±11.90) years. Mean body max index (BMI) was 24.22 (±2.51). Mean operative time was 85.2 (±13.1) minutes. Blood losses were minimal. No intraoperative complications are reported according to Satava classification. Four out of 18 patients (22.22%) experienced postoperative complications according to CD system. All patients had sexual intercourse for the first time postsurgery after a mean of 59.11 ± 2.08 days. Mean follow-up was 22.11 (±9.95). Distal extrusion of cylinders is a potential complication of the penile prosthesis implantation. Distal corporoplasty was first described by Mulcahy. He reported a series of 14 patients with a follow-up of about 2 years with optimal functional outcomes. Moreover, distal corporoplasty resulted in shorter operative time, better function, less pain, and fewer recurrences than Gortex windsock repair.10 In our experience, distal corporoplasty is a simple and safe procedure in the treatment of distal cylinders extrusion when the prosthetic material is not exposed to the exterior.

  1. TROP2 expressed in the trunk of the ureteric duct regulates branching morphogenesis during kidney development.

    Science.gov (United States)

    Tsukahara, Yuko; Tanaka, Minoru; Miyajima, Atsushi

    2011-01-01

    TROP2, a cell surface protein structurally related to EpCAM, is expressed in various carcinomas, though its function remains largely unknown. We examined the expression of TROP2 and EpCAM in fetal mouse tissues, and found distinct patterns in the ureteric bud of the fetal kidney, which forms a tree-like structure. The tip cells in the ureteric bud proliferate to form branches, whereas the trunk cells differentiate to form a polarized ductal structure. EpCAM was expressed throughout the ureteric bud, whereas TROP2 expression was strongest at the trunk but diminished towards the tips, indicating the distinct cell populations in the ureteric bud. The cells highly expressing TROP2 (TROP2(high)) were negative for Ki67, a proliferating cell marker, and TROP2 and collagen-I were co-localized to the basal membrane of the trunk cells. TROP2(high) cells isolated from the fetal kidney failed to attach and spread on collagen-coated plates. Using MDCK cells, a well-established model for studying the branching morphogenesis of the ureteric bud, TROP2 was shown to inhibit cell spreading and motility on collagen-coated plates, and also branching in collagen-gel cultures, which mimic the ureteric bud's microenvironment. These results together suggest that TROP2 modulates the interaction between the cells and matrix and regulates the formation of the ureteric duct by suppressing branching from the trunk during kidney development.

  2. TROP2 expressed in the trunk of the ureteric duct regulates branching morphogenesis during kidney development.

    Directory of Open Access Journals (Sweden)

    Yuko Tsukahara

    Full Text Available TROP2, a cell surface protein structurally related to EpCAM, is expressed in various carcinomas, though its function remains largely unknown. We examined the expression of TROP2 and EpCAM in fetal mouse tissues, and found distinct patterns in the ureteric bud of the fetal kidney, which forms a tree-like structure. The tip cells in the ureteric bud proliferate to form branches, whereas the trunk cells differentiate to form a polarized ductal structure. EpCAM was expressed throughout the ureteric bud, whereas TROP2 expression was strongest at the trunk but diminished towards the tips, indicating the distinct cell populations in the ureteric bud. The cells highly expressing TROP2 (TROP2(high were negative for Ki67, a proliferating cell marker, and TROP2 and collagen-I were co-localized to the basal membrane of the trunk cells. TROP2(high cells isolated from the fetal kidney failed to attach and spread on collagen-coated plates. Using MDCK cells, a well-established model for studying the branching morphogenesis of the ureteric bud, TROP2 was shown to inhibit cell spreading and motility on collagen-coated plates, and also branching in collagen-gel cultures, which mimic the ureteric bud's microenvironment. These results together suggest that TROP2 modulates the interaction between the cells and matrix and regulates the formation of the ureteric duct by suppressing branching from the trunk during kidney development.

  3. Invasion of distal nephron precursors associates with tubular interconnection during nephrogenesis.

    Science.gov (United States)

    Kao, Robert M; Vasilyev, Aleksandr; Miyawaki, Atsushi; Drummond, Iain A; McMahon, Andrew P

    2012-10-01

    Formation of a functional renal network requires the interconnection of two epithelial tubes: the nephron, which arises from kidney mesenchyme, and the collecting system, which originates from the branching ureteric epithelium. How this connection occurs, however, is incompletely understood. Here, we used high-resolution image analysis in conjunction with genetic labeling of epithelia to visualize and characterize this process. Although the focal absence of basal lamina from renal vesicle stages ensures that both epithelial networks are closely apposed, we found that a patent luminal interconnection is not established until S-shaped body stages. Precursor cells of the distal nephron in the interconnection zone exhibit a characteristic morphology consisting of ill-defined epithelial junctional complexes but without expression of mesenchymal markers such as vimentin and Snai2. Live-cell imaging revealed that before luminal interconnection, distal cells break into the lumen of the collecting duct epithelium, suggesting that an invasive behavior is a key step in the interconnection process. Furthermore, loss of distal cell identity, which we induced by activating the Notch pathway, prevented luminal interconnection. Taken together, these data support a model in which establishing the distal identity of nephron precursor cells closest to the nascent collecting duct epithelium leads to an active cell invasion, which in turn contributes to a patent tubular interconnection between the nephron and collecting duct epithelia.

  4. Psoas hitch ureteral reimplantation in adults--analysis of a modified technique and timing of repair.

    Science.gov (United States)

    Ahn, M; Loughlin, K R

    2001-08-01

    The psoas hitch ureteral reimplantation technique has been used with great success to bridge defects in ureteral length due to injury or planned resection. Several surgical principles have been historically stressed when performing this procedure, including adequate mobilization of the bladder, fixation of the bladder to the psoas tendon before reimplantation, the use of a submucosal nonrefluxing-type ureteral anastomosis, and a 6-week delay before attempting repair after a surgical injury. We retrospectively reviewed patients who underwent ureteroneocystostomy with a psoas hitch, evaluated the relevance of these principles, and describe a modification of the technique. All patients undergoing psoas hitch ureteral reimplantation were reviewed. The indications, complications, and long-term outcomes were assessed. Between 1989 and 1999, 24 patients underwent psoas hitch reimplantation at our institution. The indications were operative injury in 11, planned surgical resection during nonurologic pelvic surgery in 4, cancer in 4, stricture in 4, and trauma in 1. Refluxing-type ureteral anastomoses were performed in 17 cases. One case of postoperative urosepsis occurred. A delayed repair after operative injury did not improve the operative time or overall morbidity. No cases of chronic flank pain, recurrent pyelonephritis, persistent severe hydronephrosis, or compromised renal function, as measured by a change in baseline serum creatinine level, occurred. No patient required reoperation for either early or delayed complications or failure of the repair at a follow-up of 1 to 122 months (mean 32.75). Psoas hitch ureteral reimplantation is an effective means of treating defects in ureteral length. Immediate repair may be safely undertaken as soon as the ureteral injury is recognized. Long-term sequelae are unusual in adults, even when using refluxing-type ureteral anastomoses.

  5. Evaluation of low-dose dual energy computed tomography for in vivo assessment of renal/ureteric calculus composition.

    Science.gov (United States)

    Mahalingam, Harshavardhan; Lal, Anupam; Mandal, Arup K; Singh, Shrawan Kumar; Bhattacharyya, Shalmoli; Khandelwal, Niranjan

    2015-08-01

    This study aimed to assess the accuracy of low-dose dual-energy computed tomography (DECT) in predicting the composition of urinary calculi. A total of 52 patients with urinary calculi were scanned with a 128-slice dual-source DECT scanner by use of a low-dose protocol. Dual-energy (DE) ratio, weighted average Hounsfield unit (HU) of calculi, radiation dose, and image noise levels were recorded. Two radiologists independently rated study quality. Stone composition was assessed after extraction by Fourier transform infrared spectroscopy (FTIRS). Analysis of variance was used to determine if the differences in HU values and DE ratios between the various calculus groups were significant. Threshold cutoff values to classify the calculi into separate groups were identified by receiver operating characteristic curve analysis. A total of 137 calculi were detected. FTIRS analysis differentiated the calculi into five groups: uric acid (n=17), struvite (n=3), calcium oxalate monohydrate and dihydrate (COM-COD, n=84), calcium oxalate monohydrate (COM, n=28), and carbonate apatite (n=5). The HU value could differentiate only uric acid calculi from calcified calculi (p80% sensitivity and specificity to differentiate them. The DE ratio could not differentiate COM from COM-COD calculi. No study was rated poor in quality by either of the observers. The mean radiation dose was 1.8 mSv. Low-dose DECT accurately predicts urinary calculus composition in vivo while simultaneously reducing radiation exposure without compromising study quality.

  6. Laparoscopic ureterolithotomy for lower ureteric stones: Steps to make it a simple procedure

    Directory of Open Access Journals (Sweden)

    Anil Mandhani

    2009-01-01

    Full Text Available Despite advances in endoscopy and availability of holmium lithotripsy there are ureteric stones, which primarily need to be treated with laparoscopic ureterolithotomy. Literature is replete with the stone retrieval in upper ureteric stone but there are a very few reports on stones removal from ureter below the lower sacroiliac joint. Putting a double J stent before starting the procedure does not give any extra advantage; rather it takes away significant operating room time. This point of technique describes port placement strategy, proximal ureteral occlusion; stone localization, ureterotomy, stone retrieval and laparoscopic stenting are the important steps where one would like to be careful enough to complete the procedure successfully.

  7. From exponential coordinates to bicovariant differential calculi on matrix quantum groups

    NARCIS (Netherlands)

    Hijligenberg, N.W. van den; Martini, R.

    1995-01-01

    A procedure to obtain bicovariant differential calculi on matrix quantum groups is presented. The construction is based on the description of the matrix quantum group as a quantized universal enveloping algebra by the use of exponential coordinates. The procedure is illustrated by applying it to the

  8. Declarative event based models of concurrency and refinement in psi-calculi

    DEFF Research Database (Denmark)

    Normann, Håkon; Johansen, Christian; Hildebrandt, Thomas

    2015-01-01

    -calculi representation of Dynamic Condition Response Graphs, which conservatively extends prime event structures to allow finite representations of (omega) regular finite (and infinite) behaviours and have been shown to support run-time adaptation and refinement. We end by outlining the final aim of this research, which...

  9. On the expressiveness and decidability of higher-order process calculi

    NARCIS (Netherlands)

    Lanese, Ivan; Perez, Jorge A.; Sangiorgi, Davide; Schmitt, Alan

    2011-01-01

    In higher-order process calculi, the values exchanged in communications may contain processes. A core calculus of higher-order concurrency is studied; it has only the operators necessary to express higher-order communications: input prefix, process output, and parallel composition. By exhibiting a d

  10. A Case of Randall's Plugs Associated to Calcium Oxalate Dihydrate Calculi

    Directory of Open Access Journals (Sweden)

    Felix Grases

    2016-07-01

    Full Text Available A case of a patient who developed multiple calcium oxalate dihydrate calculi, some of them connected to intratubular calcifications (Randall's plugs, is presented. Randall's plugs were isolated and studied. The mechanism of Randall's plug development is also suggested.

  11. Therapeutic effects of potassium sodium hydrogen citrate on melamine-induced urinary calculi in China

    Institute of Scientific and Technical Information of China (English)

    GAO Jie; SHEN Ying; SUN Ning; JIA Li-qun; PAN Yue-song; SUN Qiang

    2010-01-01

    Background In 2008, a sharp increase of the number of children diagnosed with urinary calculi was observed in China, 9433 children were diagnosed as having melamine-induced urinary calculi at outpatient clinic in Beijing Children's Hospital. This study examined the therapeutic efficacy of potassium sodium hydrogen citrate (PSHC) used to treat melamine-induced urinary stones in Chinese children who consumed melamine-containing infant formula. Methods Seventy-two infants and children (average age (18.2±7.7) months) who were diagnosed with urinary calculi were icuidomly divided into three treatment groups using the SAS Plan program. Group 1 was given a low dose (1 g/d) of PSHC, group 2 was given high dose of PSHC (2 g/d) and group 3 was given no PSHC (control group). The dose of drug was adjusted according to the baseline urinary pH. This study analyzed the influence of the dose of PSHC, the age of patients, stone size and position, and urinary pH on the level of efficacy of PSHC (cured, effectively treated or not cured).Results After 1-6 months of therapy, 19 patients from group 1, five patients from group 2 and six patients from group 3 were cured. Five patients from group 1, five patients from group 2 and four patients from group 3 were effectively treated. There were significant differences in therapeutic efficacy between the two treatment doses after 3 and 6 months as measured by the increase in the successful expulsion rate and time of melamine-induced urinary calculi. After 6 months the mean time of expulsion of urinary calculi in groups 1 and 2 was significantly shorter than in the control group. Conclusions PSHC can significantly increase the successful expulsion rate and time of melamine-induced urinary calculi. The therapeutic efficacy is affected by PSHC dose, treatment duration, calculi position, and urinary pH. There is no relationship between the therapeutic efficacy and the stone size or patient age.

  12. Flexible ureteroscopic lithotripsy for the treatment of upper urinary tract calculi in infants.

    Science.gov (United States)

    Li, Jun; Xiao, Jing; Han, Tiandong; Tian, Ye; Wang, Wenying; Du, Yuan

    2017-01-01

    We evaluated the clinical value of flexible ureteroscopic lithotripsy for the treatment of upper urinary tract calculi in infants. Fifty-five infants with upper urinary tract calculi were included in this study: 41 males and 14 females. Retrograde intrarenal surgery was performed by an 8 Fr/30 cm flexible ureterorenoscope (POLY®) combined with a holmium laser. CT scanning or radiography of the kidneys, ureters, and bladder region was performed one month after the operation to confirm the clearance of calculi. All the 55 infants with calculi in 74 sides underwent 66 flexible ureteroscopic lithotripsy procedures. The median operation time was 30 min. The median amount of flushing fluid was 500 mL. The stone-free rate after a single session treatment was 94.6%, within which 10 infants underwent simultaneous bilateral flexible ureteroscopy lithotripsy. Catheters were retained in 45 infants for 24-48 h after the operation. Continuous high fever due to reflux was present in two cases. Flushing fluid extravasation was found in one infant. Some patients with minor complications, such as mild hematuria, irritation symptoms, and low fever, recovered without treatment. The duration of hospitalization time after the operation was approximately 1-5 days. Flexible ureteroscopic lithotripsy is a safe, highly efficient, minimally invasive, and reproducible operation for removal of upper urinary tract calculi in infants. This technique is a convenient method for postoperative management of patients that enhances their rapid recovery. It is a promising option for therapy of infants ineffectively treated by extracorporeal shockwave lithotripsy.

  13. The management of renal matrix calculi: a single-centre experience over 5 years.

    Science.gov (United States)

    Shah, Hemendra N; Kharodawala, Shabbir; Sodha, Hiren S; Khandkar, Amit A; Hegde, Sunil S; Bansal, Manish B

    2009-03-01

    To define incidence of renal matrix calculi in patients undergoing percutaneous nephrolithotomy (PCNL), and describe its clinical, laboratory and radiological features; we also studied the efficacy of PCNL in managing this rare entity. We retrospectively reviewed the records of 1368 PCNLs performed from April 2003 to March 2008, and identified 17 patients (mean age 44.3 years; 11 women and six men) having matrix calculi. The patients' clinical, laboratory and radiological features were studied, and the perioperative outcome and follow-up data analysed. Flank pain was commonest mode of presentation (15) followed by recurrent urinary tract infection (five). Pyuria was present in 14 patients and urine culture showed significant growth in 10. A plain X-ray showed a small radio-opaque calculus (10 renal units) and faint laminated calcification (four). Intravenous urography showed a filling defect and non-visualized system in nine and five patients, respectively. Non-contrast computed tomography and magnetic resonance urography diagnosed calculi in two and one patient, respectively, on haemodialysis. PCNL was abandoned initially in four patients due to pyonephrosis. The mean hospital stay was 3.4 days and decrease in haemoglobin was 0.89 g/dL. One patient developed sepsis. Of 11 stones analysed, two were composed entirely of proteins and the remaining nine had crystalline components. At a mean follow-up of 12.6 months, no patients had recurrence of stone. Matrix calculi occurred in 1.24% of patients undergoing PCNL. Although considered radiolucent, plain X-ray showed a small radio-opaque calculi or faint laminated calcifications in 10 of 17 patients. PCNL rendered patients stone-free with minimum morbidity.

  14. Use of Corticosteroids for Urinary Tuberculosis Patients at Risk of Developing Ureteral Obstruction

    Science.gov (United States)

    Matsui, Kosuke; Furumoto, Akitsugu; Ohba, Kojiro; Mochizuki, Kota; Tanaka, Takeshi; Takaki, Masahiro; Morimoto, Konosuke; Ariyoshi, Koya

    2016-01-01

    A 77-year-old man with urinary tuberculosis developed post renal anuria two days after starting an anti-tuberculosis drug regimen. He had bilateral hydronephrosis, and his right kidney was radiologically diagnosed to be non-functioning. A transurethral catheter was placed in the left ureter. No improvement in the ureteral stricture was noted during the initial three weeks of treatment; however, the stricture did thereafter improve after the commencement of oral prednisolone. In cases of urinary tuberculosis, ureteral stricture can deteriorate and result in ureteral obstruction during anti-tuberculosis treatment. Pre-emptive administration of corticosteroids may be beneficial for preventing such stricture in patients with a pre-existing ureteral lesion. PMID:27904125

  15. Forgotten/retained double J ureteric stents: A source of severe morbidity in children.

    Science.gov (United States)

    Nerli, Rajendra B; Magdum, Prasad V; Sharma, Vikas; Guntaka, Ajay Kumar; Hiremath, Murigendra B; Ghagane, Shridhar

    2016-01-01

    The increase in the usage of double J (DJ) ureteral stents in the management of a variety of urinary tract disease processes mandates familiarity with these devices, their consequences and their potential complications, which at times can be devastating. We retrospectively reviewed our series of children with forgotten/retained DJ ureteric stents. Hospital records of all patients' forgotten/retained DJ ureteral stent at our hospital were reviewed for age, gender, indication for insertion of DJ stent, duration of stent insertion, radiological images and surgical procedures performed. During the study period, January 2000 to December 2014 (a 15-year period), a total of 14 children underwent removal of forgotten/retained DJ ureteral stent. A combination of extracorporeal shock wave lithotripsy, cystolitholapaxy and percutaneous nephrolithotomy was done to free the DJ stent and extract it. Forgotten/retained stents in children are a source of severe morbidity, additional/unnecessary hospitalisation and definitely financial strain.

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

    Directory of Open Access Journals (Sweden)

    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.

  17. Distal DVT: worth diagnosing? Yes.

    Science.gov (United States)

    Schellong, S M

    2007-07-01

    Much of the argument for or against diagnosis of distal deep vain thrombosis (DVT) depends on the extra effort that has to be spent on it. This review presents the data on ultrasound of paired calf veins and calf muscle veins (distal ultrasound) in terms of protocols, feasibility, reliability and expected findings. In summary, provided there is adequate and anatomically sound training of sonographers, distal ultrasound is a valid, 4-minute procedure, which can easily be added to the examination of proximal veins. The second part of the review refers to the pathophysiology of ascending DVT, which is the most common type. Adequate patient care in terms of benefit, harm and cost includes a single non-invasive examination followed by risk adopted treatment allocation. This concept ideally should be valid for any type of DVT. The data extending this concept to distal DVT can only be derived from studies that look closely at this entity (i.e. in fact diagnose distal DVT). Even before these data are available, diagnosing distal DVT at least doubles the number of symptomatic patients in which signs and symptoms can be ascribed to a definitive diagnosis, which in itself is a benefit for patient care.

  18. Idiopathic retroperitoneal fibrosis causing unilateral ureteral and sigmoid colon obstruction

    Science.gov (United States)

    Yan, Ting; Wang, Yujuan; Liu, Zhijun; Zhang, Xiaolei; Wu, Qian; Xi, Mingrong

    2017-01-01

    Abstract Objective: The present report aimed to present a unique case of idiopathic retroperitoneal fibrosis (RPF) presenting features of unilateral ureteral and sigmoid colon obstruction. RPF is a rare disorder with unclear etiology. Case report: A 43-year-old female had a 10-day history of lower right abdominal and lumbar pain. Gynecological examination, ultrasound, and computed tomography (CT) were all suggestive of right ovarian tumor. An enhanced CT showed right-sided hydronephrosis. The patient was diagnosed as having ovarian cancer. Ten days after hospitalization, a right intraureteral stent with a double-J catheter was inserted. Upon exploring the abdomen, unyielding RPF was encountered. A partial sigmoidectomy and colostomy were performed. Postoperative pathological results suggested idiopathic RPF. She received steroid treatments. Conclusion: RPF is a rare disease that can be misdiagnosed. Our understanding about its presentation has to be improved and it should be considered as a differential diagnosis for patients presenting with abdominal diseases. PMID:28207528

  19. Encrustation and stone formation: complication of indwelling ureteral stents.

    Science.gov (United States)

    Schulze, K A; Wettlaufer, J N; Oldani, G

    1985-06-01

    Severe encrustation and stone formation on indwelling ureteral stents in 2 patients with a lithogenic history are reported. In both cases this complication occurred in the presence of sterile urine and treatment required pyelolithotomy in one and renal pelvic irrigation with urologic G solution in the other. Analyses of these stones revealed struvite and apatite, respectively. Dissolution of encrustations and stones via renal pelvic irrigation is suggested as a viable alternative to surgical intervention for this problem. A review of the literature shows a correlation between chronic stone formers and stent encrustation, rather than from bacteriuria alone. Long-term antibiotic suppression, more frequent followup with abdominal roentgenograms, and shorter periods of internal stenting are suggested for patients with a lithogenic history.

  20. Lessons learned over a decade of pediatric robotic ureteral reimplantation

    Science.gov (United States)

    Baek, Minki

    2017-01-01

    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-than-expected 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. PMID:28097262

  1. Preventing the Forgotten Ureteral Stent by Using a Mobile Point-of-Care Application.

    Science.gov (United States)

    Ziemba, Justin B; Ludwig, Wesley W; Ruiz, Leticia; Carvalhal, Eduardo; Matlaga, Brian R

    2017-07-01

    The forgotten ureteral stent (FUS) can lead to patient morbidity. To date, tracking ureteral stents is a cumbersome task, given their high frequency of insertion and variable indwelling times. To simplify this process, an application was developed to track patients with indwelling ureteral stents. We report our initial user experience and clinical outcomes with this application. Ureteral Stent Tracker™ (UST) is a secure, Health Insurance Portability and Accountability Act (HIPPA)-compliant, cloud-based point-of-care application. It is designed for logging stent insertion, scheduling the date of anticipated stent extraction, and confirming stent removal. It is accessible via a mobile phone application or web browser interface. We consecutively enrolled all patients who underwent ureteral stent insertion for any indication by two urologists from January 10, 2015, to October 10, 2016. A retrospective chart review was performed of all patients included in the UST database. Data extracted included patient demographics, diagnosis, procedure, and stent characteristics. A total of 115 patients were included with a mean age of 52.4 years; 54% (62/115) were male and 58% (67/115) were Caucasian. This cohort represented 146 ureteral stent care plans with 23 patients (23/115; 20%) having more than one care plan during the study period. The most common procedure performed was ureteroscopy (70/146; 48%) for a diagnosis of nephrolithiasis (108/146; 74%). The median indwelling ureteral stent time was 14 days (interquartile range: 7-45 days). A total of three patients (3/115; 3%) did not return for their scheduled extraction, but were identified only through the application. Each patient was contacted, resulting in effective removal of all three stents in the office. Tracking of ureteral stents is critical to prevent the patient safety issue of the FUS. The UST is a secure, HIPPA-compliant, cloud-based application, which once incorporated into the workflow of a urologic practice

  2. Extraction of a long-forgotten ureteral stent by ureteroscopic pneumatic lithotripsy

    Institute of Scientific and Technical Information of China (English)

    江军; 朱方强; 姜庆; 王洛夫

    2004-01-01

    @@ A long-forgotten ureteral stent is occasionally encountered in urological practice. It can be complicated by encrustation and may pose a management and legal dilemma. Here, we report on a long-forgotten ureteral stent that had completely calcified after 30 months in a patient with chronic renal insufficiency due to obstructive uropathy. The stent was extracted successfully by means of ureteroscopic pneumatic lithotripsy.

  3. Spontaneous rupture of renal pelvis secondary to ureteral obstruction by urothelial tumor

    Energy Technology Data Exchange (ETDEWEB)

    Fernandes, Daniel Alvarenga; Palma, Ana Laura Gatti; Kido, Ricardo Yoshio Zanetti; Barros, Ricardo Hoelz de Oliveira; Martins, Daniel Lahan; Penachim, Thiago Jose; Caserta, Nelson Marcio Gomes, E-mail: daniel_alvafer@yahoo.com.br, E-mail: daniel_alvafer@icloud.com [Universidade Estadual de Campinas (UNICAMP), SP (Brazil). Fac. de Medicina. Dept. de Radiologia

    2014-09-15

    Partial spontaneous rupture of the upper urinary tract is rare and usually associated with nephrolithiasis. Other reported causes, apart from instrumentation and trauma, involve obstructive ureteral tumor in the pelvic cavity, retroperitoneal fibrosis, fluid overload, and pregnancy. We report a case of spontaneous rupture of renal pelvis secondary to ureteral obstruction caused by urothelial tumor, clinically suspected and evaluated by CT scans and MRIs, discussing the relevant findings for diagnosis.(author)

  4. Reverse Distal Transverse Palmar Arch in Distal Digital Replantation.

    Science.gov (United States)

    Wei, Ching-Yueh; Orozco, Oscar; Vinagre, Gustavo; Shafarenko, Mark

    2017-07-22

    Refinements in microsurgery have made distal finger replantation an established technique with high success rates and good functional and aesthetic outcomes. However, it still represents a technically demanding procedure due to the small vessel caliber and frequent lack of vessel length, requiring the use of interpositional venous grafts in some instances. We describe a new technique for anastomosis in fingertip replantation, whereby the need for venous grafts is eliminated. Applying the reverse distal transverse palmar arch technique, 11 cases of distal digital replantation were performed between January 2011 and July 2016. The described procedure was used for arterial anastomosis in 10 cases and arteriovenous shunting for venous drainage in 1 case. A retrospective case review was conducted. The technical description and clinical outcome evaluations are presented. Ten of the 11 replanted digits survived, corresponding to an overall success rate of 91%. One replant failed due to venous insufficiency. Blood transfusions were not required for any of the patients. Follow-up (range, 1.5-5 months) revealed near-normal range of motion and good aesthetic results. All of the replanted digits developed protective sensation. The average length of hospital admission was 5 days. All patients were satisfied with the results and were able to return to their previous work. The use of the reverse distal transverse palmar arch is a novel and reliable technique in distal digital replantation when an increase in vessel length is required, allowing for a tension-free arterial repair without the need for vein grafts.

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

    Directory of Open Access Journals (Sweden)

    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.

  6. Unenhanced CT for the evaluation of acute ureteric colic: the essential pictorial guide.

    Science.gov (United States)

    Kennish, Steven J; Wah, Tze M; Irving, Henry C

    2010-07-01

    Acute ureteric colic is a common emergency, often dealt with by the emergency physician or general practitioner and referred on to the urologist. Unenhanced CT of the kidneys, ureters and bladder (CTKUB) is the 'gold standard' imaging investigation for establishing a diagnosis and guiding management. An appreciation of the CTKUB signs, which support or refute a diagnosis of ureteric colic, is highly valuable to the clinician when making a urological referral, and to the urologist, who must make appropriate management plans. All salient diagnostic and supportive features of ureteric colic are carefully illustrated, as are important radiological mimics, with the objectives of educating and informing the non-radiologist. Ready access to the picture archive and communication system (PACS) allows all specialists involved to interpret the radiological report with the benefit of images. A stone within the ureter may not always be readily apparent. Soft tissue rim sign around a calcific focus is an important indicator of a ureteric stone, whereas a comet tail sign suggests a phlebolith (a calcified venous thrombosis), a radiological mimic of a ureteric stone. Numerous secondary signs of ureteric obstruction may be present including hydronephrosis and perinephric stranding, and can help to confirm the diagnosis. The relative diagnostic weighting of signs is discussed, and a checklist is provided to assist with interpretation. Unexpected alternative radiological diagnoses are also illustrated, which may have significant management consequences necessitating specialist referral.

  7. Scanning electron microscopy and electron probe microanalyses of the crystalline components of human and animal dental calculi.

    Science.gov (United States)

    LeGeros, R Z; Orly, I; LeGeros, J P; Gomez, C; Kazimiroff, J; Tarpley, T; Kerebel, B

    1988-03-01

    A review of the use of scanning electron microscopy (SEM) and electron probe microanalyses in the study of dental calculus showed that such studies provided confirmatory and supplementary data on the morphological features of human dental calculi but gave only limited information on the identity of the crystalline or inorganic components. This study aimed to explore the potential of combined SEM and microanalyses in the identification of the crystalline components of the human and animal dental calculi. Human and animal calculi were analyzed. Identification of the crystalline components were made based on the combined information of the morphology (SEM) and Ca/P molar ratios of the crystals with the morphology and Ca/P molar ratio of synthetic calcium phosphates (brushite or DCPD; octacalcium phosphate, OCP; Mg-substituted whitlockite, beta-TCMP; CO3-substituted apatite, (CHA); and calcite. SEM showed similarities in morphological features of human and animal dental calculi but differences in the forms of crystals present. Microanalyses and crystal morphology data suggested the presence of CaCO3 (calcite) and CHA in the animal (cat, dog, tiger) and of OCP, beta-TCMP and CHA in human dental calculi. X-ray diffraction and infrared (IR) absorption analyses confirmed these results. This exploratory study demonstrated that by taking into consideration what is known about the crystalline components of human and animal dental calculi, combined SEM and microanalyses can provide qualitative identification.

  8. Scanning electron microscopy and electron probe microanalyses of the crystalline components of human and animal dental calculi

    Energy Technology Data Exchange (ETDEWEB)

    LeGeros, R.Z.; Orly, I.; LeGeros, J.P.; Gomez, C.; Kazimiroff, J.; Tarpley, T.; Kerebel, B.

    1988-03-01

    A review of the use of scanning electron microscopy (SEM) and electron probe microanalyses in the study of dental calculus showed that such studies provided confirmatory and supplementary data on the morphological features of human dental calculi but gave only limited information on the identity of the crystalline or inorganic components. This study aimed to explore the potential of combined SEM and microanalyses in the identification of the crystalline components of the human and animal dental calculi. Human and animal calculi were analyzed. Identification of the crystalline components were made based on the combined information of the morphology (SEM) and Ca/P molar ratios of the crystals with the morphology and Ca/P molar ratio of synthetic calcium phosphates (brushite or DCPD; octacalcium phosphate, OCP; Mg-substituted whitlockite, beta-TCMP; CO/sub 3/-substituted apatite, (CHA); and calcite. SEM showed similarities in morphological features of human and animal dental calculi but differences in the forms of crystals present. Microanalyses and crystal morphology data suggested the presence of CaCO/sub 3/ (calcite) and CHA in the animal (cat, dog, tiger) and of OCP, beta-TCMP and CHA in human dental calculi. X-ray diffraction and infrared (IR) absorption analyses confirmed these results. This exploratory study demonstrated that by taking into consideration what is known about the crystalline components of human and animal dental calculi, combined SEM and microanalyses can provide qualitative identification.

  9. Single ectopic ureteral orifice with bilateral duplicated renal collecting systems in an adult girl: Diagnosis by magnetic resonance urography.

    Science.gov (United States)

    Tang, Min; Wang, Quanrongzi; Liu, Bianjiang; Li, Jie; Lu, Qiang; Song, Ninghong; Wang, Zengjun; Zhang, Wei

    2015-01-01

    Renal duplication accompanied by ureteral ectopia is an uncommon urinary congenital abnormality. We report the case of a 21-year-old girl who suffered from lifelong continuous urinary leakage. She was finally diagnosed with bilateral duplicated collecting systems complicated with right ectopic ureteral orifice - an extremely rare case. The patient underwent ureteric re-implantation for the ectopic side, and her urinary incontinence ceased soon thereafter. In this case, traditional imaging failed to show the exact insertion of an ectopic ureter. However, magnetic resonance urography combined with retrograde intubation radiography successfully depicted the point of ureteric insertion, which may make the diagnostic process accurate and efficient.

  10. Radiologic Findings of Distal Ureter with Partially Double Lumen: First Case in the Literature

    Directory of Open Access Journals (Sweden)

    Elif Karadeli

    2013-08-01

    Full Text Available Ureter duplication is the most common congenital anomaly of the urinary system. Ureteral duplication varies from a bifid pelvis to completely separate ureters. The reported incidence varies from 0.8% in an autopsy series, to 40% in a pyelography review, and displays a wide spectrum of imaging findings . The unilateral form occurs about 6 times more commonly than the bilateral form, with the left and right sides being almost equally involved. A 37 year old male with no previous history for stone disease presented to the urology department with right sided colicky pain for three hours. Ultrasonography and Computurized Tomography (CT were performed. We demonstrated radiologic findings of distal ureter with partially double lumen. According to our knowledge, it has not been reported in the literature previously.

  11. [Distal humerus fractures in children].

    Science.gov (United States)

    Schneidmueller, D; Boettger, M; Laurer, H; Gutsfeld, P; Bühren, V

    2013-11-01

    Fractures of the distal humerus belong to the most common injuries of the upper arm in childhood. Most frequently occurring is the supracondylar fracture of the distal humerus. In these cases and in the second most common epicondylar fractures, the metaphysis is affected and these fractures are therefore extra-articular. They have to be distinguished from articular fractures regarding therapy and prognosis. The growth potential of the distal epiphysis is very limited as is the possibility of spontaneous correction so that major dislocations should not be left uncorrected. Unstable and especially dislocated articular fractures must be anatomically reconstructed employing various osteosynthetic techniques, mostly combined with immobilization. Insufficient reconstruction, growth disturbance and non-union can result in axial deformities, such as cubitus valgus and varus, restriction of motion, pain and nerve palsy.

  12. Cystic calculi removal in African spurred Tortoise (Geochelone sulcata using transplstron coeliotomy

    Directory of Open Access Journals (Sweden)

    Azlan Che' Amat

    Full Text Available The present report was carried out to manage a case of calculi in the bladder of African spurred tortoise. A 6 year old African spurred tortoise presented with history of anorexia and whitish discharged from the vent. Upon physical examination, the tortoise were 10% dehydrated, hindlegs muscle wasting and whitish materials came out from the vent. Plain radiograph revealed increased radiopacity in the bladder and also both right and left kidney. Contrast gastrointestinal radiograph showed less possibility of foreign body. Inconclusive radiological findings required the decision to proceed with exploratory transplastron coeliotomy by using dental burr. About 4 cm solid, hard whitish mass was removed from the bladder and both kidney was congested with whitish material. The findings were suggestive for urates crystal calculi based on histology result. [Vet. World 2012; 5(8.000: 489-492

  13. [Microscopic investigation of the partial stages of dissolution processes in urinary calculi (author's transl)].

    Science.gov (United States)

    Seyfarth, H H; Hahne, B; Rostek, F P; Sluka, G; Eismann, D

    1975-11-14

    The formation of urinary calculi cannot yet be prevented with certainty. Consequently the dissolution of stones remains a focus of medical interest. The speed of solution of a calculus is not a quantity typical of the substance, but depends largely on the structural formation of the urinary calculi. With very different types of structure (e.g. Whewellite and Weddellite stones) the rate of dissolution can therefore fluctuate between wide limits in spite of similar phase composition. Consequently, type of structure, course of solution and rate of solution can be clearly correlated. Stones with relatively uniform structure formation (e.g. Struvite stones) on the other hand show largely similar solution rates. Medically, it is of interest that in certain structural types, solution may lead to disintegration of the stone into isolated solution residues.

  14. Swapping: a natural bridge between named and indexed explicit substitution calculi

    CERN Document Server

    Mendelzon, Ariel; Ziliani, Beta; 10.4204/EPTCS.49.1

    2011-01-01

    This article is devoted to the presentation of lambda_rex, an explicit substitution calculus with de Bruijn indexes and a simple notation. By being isomorphic to lambda_ex - a recent formalism with variable names -, lambda_rex accomplishes simulation of beta-reduction (Sim), preservation of beta-strong normalization (PSN) and meta-confluence (MC), among other desirable properties. Our calculus is based on a novel presentation of lambda_dB, using a swap notion that was originally devised by de Bruijn. Besides lambda_rex, two other indexed calculi isomorphic to lambda_x and lambda_xgc are presented, demonstrating the potential of our technique when applied to the design of indexed versions of known named calculi.

  15. In-vitro fragmentation of biliary calculi with a 308-nm excimer laser

    Science.gov (United States)

    Shi, Wei-Qiang; Papaioannou, Thanassis; Vari, Sandor G.; Daykhovsky, Leon; Grundfest, Warren S.

    1990-06-01

    We report the use of a 308 mu XeC1 exciiuer laser for- biliary stone fragnientation. The 130 nsec laser pulses are delivered through tJV grade fused silica fibers to the target stones inmiersed in normal saline solution and placed in direct contact with the fiber. Sixty biliary calculi, 20 cholesterol and 40 pigment, were fragmented in vitro. The effect of laser repetition rate, energy fluence, and fiber core size on stone fragmentation was studied. Fragmentation thresholds for biliary calculi of different compositions were measured. It was found that higher fragmentation efficiency was obtained with larger fluence, lower repetition rate and fiber of larger core. Our study suggests that the long pulse 308 nm excimer laser may be an effective device for laser lithotripsy with low threshold and good efficiency for biliary stone fragmentation.

  16. Traumatic Distal Ulnar Artery Thrombosis

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    Ahmet A. Karaarslan

    2014-01-01

    Full Text Available This paper is about a posttraumatic distal ulnar artery thrombosis case that has occurred after a single blunt trauma. The ulnar artery thrombosis because of chronic trauma is a frequent condition (hypothenar hammer syndrome but an ulnar artery thrombosis because of a single direct blunt trauma is rare. Our patient who has been affected by a single blunt trauma to his hand and developed ulnar artery thrombosis has been treated by resection of the thrombosed ulnar artery segment. This report shows that a single blunt trauma can cause distal ulnar artery thrombosis in the hand and it can be treated merely by thrombosed segment resection in suitable cases.

  17. Ketoprofen-eluting biodegradable ureteral stents by CO2 impregnation: In vitro study.

    Science.gov (United States)

    Barros, Alexandre A; Oliveira, Carlos; Reis, Rui L; Lima, Estevão; Duarte, Ana Rita C

    2015-11-30

    Ureteral stents are indispensable tools in urologic practice. The main complications associated with ureteral stents are dislocation, infection, pain and encrustation. Biodegradable ureteral stents are one of the most attractive designs with the potential to eliminate several complications associated with the stenting procedure. In this work we hypothesize the impregnation of ketoprofen, by CO2-impregnation in a patented biodegradable ureteral stent previously developed in our group. The biodegradable ureteral stents with each formulation: alginate-based, gellan gum-based were impregnated with ketoprofen and the impregnation conditions tested were 100 bar, 2 h and three different temperatures (35 °C, 40 °C and 50 °C). The impregnation was confirmed by FTIR and DSC demonstrated the amorphization of the drug upon impregnation. The in vitro elution profile in artificial urine solution (AUS) during degradation of a biodegradable ureteral stent loaded with ketoprofen was evaluated. According to the kinetics results these systems have shown to be very promising for the release ketoprofen in the first 72 h, which is the necessary time for anti-inflammatory delivery after the surgical procedure. The in vitro release studied revealed an influence of the temperature on the impregnation yield, with a higher impregnation yield at 40 °C. Higher yields were also obtained for gellan gum-based stents. The non-cytotoxicity characteristic of the developed ketoprofen-eluting biodegradable ureteral stents was evaluated in L929 cell line by MTS assay which demonstrated the feasibility of this product as a medical device.

  18. Sema4C-Plexin B2 signalling modulates ureteric branching in developing kidney.

    Science.gov (United States)

    Perälä, Nina; Jakobson, Madis; Ola, Roxana; Fazzari, Pietro; Penachioni, Junia Y; Nymark, Mariann; Tanninen, Tiina; Immonen, Tiina; Tamagnone, Luca; Sariola, Hannu

    2011-02-01

    Semaphorins, originally identified as axon guidance molecules, have also been implicated in angiogenesis, function of the immune system and cancerous growth. Here we show that deletion of Plexin B2 (Plxnb2), a semaphorin receptor that is expressed both in the pretubular aggregates and the ureteric epithelium in the developing kidney, results in renal hypoplasia and occasional double ureters. The rate of cell proliferation in the ureteric epithelium and consequently the number of ureteric tips are reduced in the kidneys lacking Plexin B2 (Plxnb2-/-). Semaphorin 4C, a ligand for Plexin B2, stimulates branching of the ureteric epithelium in wild type and Plxnb2+/- kidney explants, but not in Plxnb2-/- explants. As shown by co-immunoprecipitation Plexin B2 interacts with the Ret receptor tyrosine kinase, the receptor of Glial-cell-line-derived neurotrophic factor (Gdnf), in embryonic kidneys. Isolated Plxnb2-/- ureteric buds fail to respond to Gdnf by branching, but this response is rescued by Fibroblast growth factor 7 and Follistatin as well as by the metanephric mesenchyme. The differentiation of the nephrogenic mesenchyme, its morphology and the rate of apoptosis in the Plxnb2-/- kidneys are normal. Plexin B2 is co-expressed with Plexin B1 (Plxnb1) in the kidney. The double homozygous Plxnb1-Plxnb2-deficient mice show high embryonic lethality prior to onset of nephrogenesis. The only double homozygous embryo surviving to E12 showed hypoplastic kidneys with ureteric branches and differentiating mesenchyme. Taken together, our results show that Sema4C-Plexin B2 signalling regulates ureteric branching, possibly through modulation of Gdnf signalling by interaction with Ret, and suggest non-redundant roles for Plexin B1 and Plexin B2 in kidney development. Copyright © 2010 International Society of Differentiation. Published by Elsevier B.V. All rights reserved.

  19. Towards a Theory of Bisimulation for the Higher-Order Process Calculi

    Institute of Scientific and Technical Information of China (English)

    Yong-JianLi; Xin-XinLiu

    2004-01-01

    In this paper, a labelled transition semantics for higher-order process calculi is studied. The labelled transition semantics is relatively clean and simple, and corresponding bisimulation equivalence can be easily formulated based on it. And the congruence properties of the bisimulation equivalence can be proved easily. To show the correspondence between the proposed semantics and the well-established ones, the bisimulation is characterized as a version of barbed equivalence and a version of context bisimulation.

  20. Towards a Theory of Bisimulation for the Higher-Order Process Calculi

    Institute of Scientific and Technical Information of China (English)

    Yong-Jian Li; Xin-Xin Liu

    2004-01-01

    In this paper, a labelled transition semantics for higher-order process calculi is studied. The labelled transition semantics is relatively clean and simple, and corresponding bisimulation equivalence can be easily formulated based on it. And the congruence properties of the bisimulation equivalence can be proved easily.To show the correspondence between the proposed semantics and the well-established ones, the bisimulation is characterized as a version of barbed equivalence and a version of context bisimulation.

  1. Spectroscopic study of the inhibition of calcium oxalate calculi by Larrea tridentata

    Science.gov (United States)

    Pinales, Luis Alonso

    The causes of urolithiasis include such influences as diet, metabolic disorders, and genetic factors which have been documented as sources that aggravate urinary calculi depositions and aggregations, and, implicitly, as causes of urolithiasis. This study endeavors to detail the scientific mechanisms involved in calcium oxalate calculi formation, and, more importantly, their inhibition under growth conditions imposed by the traditional medicinal approach using the herbal extract, Larrea tridentata. The calculi were synthesized without and with Larrea tridentata infusion by employing the single diffusion gel technique. A visible decrease in calcium oxalate crystal growth with increasing amounts of Larrea tridentata herbal infusion was observed in photomicrographs, as well as a color change from white-transparent for pure crystals to light orange-brown for crystals with inhibitor. Analysis of the samples, which includes Raman, infrared absorption, scanning electron microscopy (SEM), and X-ray powder diffraction (XRD) techniques, demonstrate an overall transition in morphology of the crystals from monohydrate without herbal extract to dihydrate with inhibitor. Furthermore, the resulting data from Raman and infrared absorption support the possibilities of the influences, in this complex process, of NDGA and its derivative compounds from Larrea tridentata, and of the bonding of the magnesium of the inhibitor with the oxalate ion on the surface of the calculi crystals. This assumption corroborates well with the micrographs obtained under higher magnification, which show that the separated small crystallites consist of darker brownish cores, which we attribute to the dominance of growth inhibition by NDGA, surrounded by light transparent thin shells, which possibly correspond to passivation of the crystals by magnesium oxalate. The SEM results reveal the transformation from the dominant monoclinic structure of the calcium oxalate crystals grown alone to the tetragonal

  2. SAFETY AND EFFICACY OF PERCUTANEOUS NEPHROLITHOTOMY IN INFANTS PRESENTING WITH OBSTRUCTIVE RENAL CALCULI AND ANURIA

    Directory of Open Access Journals (Sweden)

    Yugesh

    2015-04-01

    Full Text Available BACKGROUND : Urolithiasis in infancy is rare but important health issue. Etiology is multi factorial . Optimal management of pediatric stone disease is still evolving . Infants with bilateral obstructive renal stones are unique group of patients in whom prompt evaluation and management is necessary. AI MS AND OBJECTIVE: To evaluate safety and efficacy of PCNL in infants presenting with bilateral obstructive renal calculi and anuria . MATERIALS AND METHOD S: From N ov . 2012 to M arch 2014, 18 renal units with calculi in 9 infants (6 boys, 3 girls were treated with PCNL ( P ercutaneous N ephrolithotomy at our institution. All infants presented with anuria, rised serum creatinin (mean 6.1mg/dl and uremic symptoms due to bilateral obstructive renal calculi. All patients managed initially with peritoneal dialysis a t nephrology u nit, followed by bilateral DJ (D ouble J stenting, then bilateral PCNL performed in two sittings. Mean age 8.5 months (4m to 12m, mean stone burden 1.7 cm (0.6cm to 3.0 cm, 20 F pediatric nephroscope through 22F percutaneous access was used . Stones were fragmented with pneumatic lithotripter. RESULTS: Mean operative time was 60.22 mins (30 mins to 90 mins. Complete stone clearance was done in all cases without need for second look PCNL. Mean post op serum creatinin is 0.6 mg/dl. No patient r equired blood transfusion, developed urosepsis, or had a procedure related complications. CONCLUSION: When performed by experienced urologists, PCNL is safe and effective procedure in infants presenting with bilateral obstructive renal calculi and anuria, provided these patients managed preoperatively with peritoneal dialysis and DJ stenting to optimise renal function and to relieve sepsis.

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

    Directory of Open Access Journals (Sweden)

    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.

  4. Er:YAG removal of subgingival calculi: efficiency, temperature, and surface quality

    Science.gov (United States)

    Stock, Karl; Hibst, Raimund; Keller, Ulrich

    1996-12-01

    Aim of this study was to evaluate a handpiece with a special fiber tip for Er:YAG laser removal of subgingival calculus. The morphological changes of the treated areas were observed by light microscopy and SEM. To evaluate the efficiency, the time for complete removal of the calculi was measured. The temperature development in the pulp during laser treatment was investigated by a thermocouple inserted into a root canal. After calculi ablation, only smooth ablation traces are visible. The depth of the ablation traces is about 100 micrometers . Roughness of the treated area is similar to the untreated area. The ablation efficiency depends strongly on the shape and location of the calculi and varies between 4.6 and 20 mm2/min. During non stop preparation the maximum occurred temperature in pulp was 7.8 K. The results show that the Er:YAG laser with the used fiber delivery systems and handpiece is suitable for effective and sparing removal of subgingival calculus in periodontal treatment.

  5. Proteomic analysis of renal calculi indicates an important role for inflammatory processes in calcium stone formation.

    Science.gov (United States)

    Merchant, Michael L; Cummins, Timothy D; Wilkey, Daniel W; Salyer, Sarah A; Powell, David W; Klein, Jon B; Lederer, Eleanor D

    2008-10-01

    Even though renal stones/calculi occur in approximately 10% of individuals, they are an enormous economic burden to the entire US health system. While the relative metabolic composition of renal calculi is generally known, there is no clear understanding of the genetics of renal stone formation, nor are there clear prognostic indicators of renal stone formation. The application of proteomics to the analysis of renal calculi axiomatically holds that insight into renal stone pathobiology can be gained by a more comprehensive understanding of renal calculus protein composition. We analyzed isolated renal stone matrix proteins with mass spectrometric and immunohistochemical methods identifying 158 proteins with high confidence, including 28 common proteins. The abundant proteins included those identified previously in stones and proteins identified here for the first time, such as myeloid lineage-specific, integral membrane and lipid regulatory proteins. Pathway analyses of all proteins identified suggested that a significant fraction of the most abundant matrix proteins participate in inflammatory processes. These proteomic results support the hypothesis that stone formation induces a cellular inflammatory response and the protein components of this response contribute to the abundant stone matrix proteome.

  6. Rhazes, a genius physician in diagnosis and treatment of kidney calculi in medical history.

    Science.gov (United States)

    Changizi Ashtiyani, Saeed; Cyrus, Ali

    2010-04-01

    Abu Bakr Mohammad Ibn Zakariya Razi, known in the west as Rhazes (865 to 925 AD), was born in the ancient city of Rayy, near Tehran, Iran. He was a renowned physician in medical history and not only followed Hippocrates and Galen, but also greatly extended the analytical approach of his predecessors. Based on the existing documents, he was known as the most distinguished character in the world of medicine up to the 17th century. A great number of innovations and pioneering works in the medical science have been recorded in the name of Rhazes. His fundamental works in urology as part of his research in the realm of medicine have remained unknown. Pathophysiology of the urinary tract, venereal diseases, and kidney and bladder calculi are among his main interests in this field. He also purposed and developed methods for diagnosis and treatment of kidney calculi for the first time in medical history. He also presented a very exact and precise description of neuropathic bladder followed by vertebral fracture. He advanced urine analysis and studied function and diseases of the kidneys. Rhazes recommendations for the prevention of calculi are quite scientific and practical and in accordance with current recommendations to avoid hypercalciuria and increased saturation of urine. Rhazes was not only one of the most important Persian physician-philosophers of his era, but for centuries, his writings became fundamental teaching texts in European medical schools. Some important aspects of his contributions to medicine are reviewed.

  7. Retroperitoneoscopic pyelolithotomy: a good alternative treatment for renal pelvic calculi in children

    Directory of Open Access Journals (Sweden)

    Bruno Nicolino Cezarino

    Full Text Available ABSTRACT Introduction: Nephrolitiasis, once considered an adult disease, has become increasingly prevalent in children, with an increase from 6% to 10 % annually in past 25 years. Kidney stones in pediatric population can result from metabolic diseases in up to 50% of children affected. Other factors associated with litiasis are infection, dietary factors, and anatomic malformations of urinary tract. Standard treatment procedures for pediatric population are similar to adult population. Extracorporeal shock wave lithotripsy (ESWL, ureterorenoscopy (URS, percutaneous nepfrolithotomy (PCNL, as well as laparoscopic and retroperitoneoscopic approaches can be indicated in selected cases. The advantages of laparoscopic or retroperitoneoscopic approaches are shorter mean operation time, no trauma of renal parenchyma, lower bleeding risk, and higher stone-free rates, especially in pelvic calculi with extrarenal pelvis, where the stone is removed intact. Patient and Methods: A 10 year-old girl presented with right abdominal flank pain, macroscopic hematuria, with previous history of urinary infections‥ Further investigation showed an 1,5 centimeter calculi in right kidney pelvis. A previous ureterorenoscopy was tried with no success, and a double J catheter was placed. After discussing options, a retroperitoneoscopic pielolithotomy was performed. Results: The procedure occurred with no complications, and the calculi was completely removed. The foley catheter was removed in first postoperative day and she was discharged 2 days after surgery. Double J stent was removed after 2 weeks. Conclusions: Retroperitoneoscopic pielolithotomy is a feasible and safe procedure in children, with same outcomes of the procedure for adult population.

  8. Distal esophageal spasm: an update.

    Science.gov (United States)

    Achem, Sami R; Gerson, Lauren B

    2013-09-01

    Distal esophageal spasm (DES) is an esophageal motility disorder that presents clinically with chest pain and/or dysphagia and is defined manometrically as simultaneous contractions in the distal (smooth muscle) esophagus in ≥20% of wet swallows (and amplitude contraction of ≥30 mmHg) alternating with normal peristalsis. With the introduction of high resolution esophageal pressure topography (EPT) in 2000, the definition of DES was modified. The Chicago classification proposed that the defining criteria for DES using EPT should be the presence of at least two premature contractions (distal latencylong acting), calcium-channel blockers, anticholinergic agents, 5-phosphodiesterase inhibitors, visceral analgesics (tricyclic agents or SSRI), and esophageal dilation. Acid suppression therapy is frequently used, but clinical outcome trials to support this approach are not available. Injection of botulinum toxin in the distal esophagus may be effective, but further data regarding the development of post-injection gastroesophageal reflux need to be assessed. Heller myotomy combined with fundoplication remains an alternative for the rare refractory patient. Preliminary studies suggest that the newly developed endoscopic technique of per oral endoscopic myotomy (POEM) may also be an alternative treatment modality.

  9. Ureteric Obstruction Caused by a Migrated Intrauterine Device

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    Xuesong Yang

    2017-01-01

    Full Text Available We present an extremely rare case of ureteric obstruction caused by a migrated intrauterine device. A 36-year-old female with complaints of almost 10 months left flank pain presented to our hospital. She used an IUD for contraception for 6 months after the birth of her first child. The IUD was not visible then. Ultrasonography (US revealed that left severe hydronephrosis and upper ureterectasis. Pelvic computed tomography (CT found that IUD was located very close to the lower ureter which was adjacent to the third anatomize physiological narrow. Laparoscopy was performed to remove the migrated IUD. After 5 months of surgery, left hydronephrosis was exacerbated. This time we chose to perform the ureterocystostomy to relieve the hydronephrosis. We reported this rare case to remind that we must keep alert to the loss of the IUD to prevent it may cause severe injury of the nearby organs. IUD must be carefully researched for possible perforation of the uterus and migration to the pelvic organs.

  10. Chronic partial ureteral obstruction and the developing kidney

    Energy Technology Data Exchange (ETDEWEB)

    Chevalier, Robert L. [University of Virginia, Department of Pediatrics, Box 800386, Charlottesville, VA (United States)

    2008-01-15

    Although congenital urinary tract obstruction is a common disorder, its pathophysiology remains poorly understood and clinical practice is controversial. Animal models have been used to elucidate the mechanisms responsible for obstructive nephropathy, and the models reveal that renal growth and function are impaired in proportion to the severity and duration of obstruction. Ureteral obstruction in the neonatal rat or mouse leads to activation of the renin-angiotensin system, renal infiltration by macrophages, and tubular apoptosis. Nephrons are lost by glomerular sclerosis and the formation of atubular glomeruli, and progressive injury leads to tubular atrophy and interstitial fibrosis. Recovery following release of obstruction depends on the timing, severity, and duration of obstruction. Growth factors and cytokines are produced by the hydronephrotic kidney, including MCP-1 and TGF-{beta}1, which are excreted in urine and can serve as biomarkers of renal injury. Because MRI can be used to monitor renal morphology, blood flow, and filtration rate, its use might supplant current imaging modalities (ultrasonography and diuretic renography), which have significant drawbacks. Combined use of MRI and new urinary biomarkers should improve our understanding of human congenital obstructive nephropathy and should lead to new approaches to evaluation and management of this challenging group of patients. (orig.)

  11. Ureteric Injury due to the Use of LigaSure

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    Muazzam Tahir

    2013-01-01

    Full Text Available Background. LigaSure is a bipolar clamping device used in open and laparoscopic surgeries for producing haemostasis in vascular pedicles up to 7 mm in diameter (“Covidien LigaSure technology: consistent, reliable, trusted vessel sealing,” 2012. The use of LigaSure has made securing haemostasis and tissue dissection relatively easy especially in laparoscopic surgery; however, if not used with care it can cause damage to the surrounding structures through lateral spread of energy. Case Report. This case report discusses the induction of a thermal ureteral injury associated with the use of LigaSure. An 80-year-old gentleman was operated for bowel cancer. LigaSure was used for securing haemostasis and tissue dissection. Postoperatively, he was found to have damage to the right ureter secondary to lateral spread of energy from the jaws of LigaSure with high abdominal drain output. Conclusion. Judicious and careful use of electrosurgical devices should be done to prevent inadvertent damage to the surrounding structures. Early recognition and involvement of a urologist can prevent long-term complications.

  12. Updates on the use of ureteral stents: focus on the Resonance® stent

    Directory of Open Access Journals (Sweden)

    Thomas MT Turk

    2010-12-01

    Full Text Available Manoj V Rao, Anthony J Polcari, Thomas MT TurkDepartment of Urology, Loyola University Medical Center, Maywood, IL, USAAbstract: The Resonance® metallic ureteral stent is one of the latest additions to the urologist’s armamentarium in managing ureteral obstruction. One advantage of this stent over traditional polymer-based stents is resistance to encrustation with stone material, which allows longer dwell times and less frequent exchange procedures. Although exchanging a metallic stent is slightly more complicated than exchanging a polymer stent, the fluoroscopic techniques required are familiar to most urologists. The Resonance stent is also more resistant to compression by external forces, potentially allowing greater applicability in patients with metastatic cancer. Furthermore, the use of this stent in patients with benign ureteral obstruction is shown to be associated with significant cost reduction. Clinical studies on the use of this stent are accumulating and the results are mixed, although Level 1 evidence is lacking. In this article we present a comprehensive review of the available literature on the Resonance metallic ureteral stent.Keywords: resonance, metallic, ureteral, stent, obstruction

  13. Degradation and antibacterial properties of magnesium alloys in artificial urine for potential resorbable ureteral stent applications.

    Science.gov (United States)

    Lock, Jaclyn Y; Wyatt, Eric; Upadhyayula, Srigokul; Whall, Andrew; Nuñez, Vicente; Vullev, Valentine I; Liu, Huinan

    2014-03-01

    This article presents an investigation on the effectiveness of magnesium and its alloys as a novel class of antibacterial and biodegradable materials for ureteral stent applications. Magnesium is a lightweight and biodegradable metallic material with beneficial properties for use in medical devices. Ureteral stent is one such example of a medical device that is widely used to treat ureteral canal blockages clinically. The bacterial colony formation coupled with the encrustation on the stent surface from extended use often leads to clinical complications and contributes to the failure of indwelling medical devices. We demonstrated that magnesium alloys decreased Escherichia coli viability and reduced the colony forming units over a 3-day incubation period in an artificial urine (AU) solution when compared with currently used commercial polyurethane stent. Moreover, the magnesium degradation resulted in alkaline pH and increased magnesium ion concentration in the AU solution. The antibacterial and degradation properties support the potential use of magnesium-based materials for next-generation ureteral stents. Further studies are needed for clinical translation of biodegradable metallic ureteral stents.

  14. Prostatic calculi influence the antimicrobial efficacy in men with chronic bacterial prostatitis

    Institute of Scientific and Technical Information of China (English)

    Wei-Ping Zhao; Yong-Tao Li; Jun Chen; Zhi-Gen Zhang; Hai Jiang; Dan Xia; Shuo Wang; Ping Wang

    2012-01-01

    We studied the efficacy of culture-specific antibiotic therapy for chronic bacterial prostatitis (CBP) patients with or without prostatic calculi.This study included 101 patients (21-62 years old) who met the consensus criteria for CBP (National Institutes of Health category Ⅱ).According to the results of transrectal ultrasonography (TRUS),all patients were divided into two groups:Group 1,CBP with prostatic calculi,n=39; Group 2,CBP without prostatic calculi,n=62.All patients received optimal antimicrobial therapy for 4 weeks and followed up for a minimum of 3 months (range:3-8 months).In addition to expressed prostatic secretions (EPS) and urine culture,all patients were asked to complete the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and the subjective global assessment (SGA).The microbiological eradication rate at the end of treatment were 32/39 (82.1%) and 54/62 (87.1%),while the rates for continued eradication at the end of study were 17/39 (43.6%) and 45/62 (72.6%) in Group 1 and Group 2 (P<0.01 ),respectively.We observed a decrease in the total NIH-CPSI score median values from 24 to 1 9 in Group 1 and from 24 to 11 in Group 2.The pain subscore (P<0.01),urinary sunscore (P<0.05) and quality of life (QoL; P<0.05) as well as the total NIH-CPSI score (P<0.01) were significantly improved after antimicrobial treatment in Group 2 compared to Group 1.Response,defined as a decrease of the NIH-CPSI total score by at least 50%,was seen in Group 1 versus Group 2 in 38.5% and 58.1% (P<0.01 ),respectively.Our results showed that prostatic calculi influence the antimicrobial efficacy in men with CBP.There was a noticeable decrease in the cure rate of CBP patients with prostatic calculi due to relapse after antimicrobial therapy.

  15. Real-time Three-dimensional Ultrasound and Two-dimensional Ultrasound Diagnosis of 150 Cases of Lower Ureteral Stones Comparative Analysis%实时三维超声与二维超声诊断输尿管下段结石150例对比分析

    Institute of Scientific and Technical Information of China (English)

    张逸仲

    2014-01-01

    目的:对比二维超声检查结果,评估实时三维超声成像技术诊断输尿管下段结石的应用价值。方法:分析输尿管下段结石病例150例共152个病变,均作二维超声及实时三维超声诊断,并以手术取石、碎石、药物排石后结果作为验证标准。结果:输尿管下段结石在合并肾盂积液情况下,两种方法之间无显著差别(P>0.05);当无肾盂积液情况下,两种方法有显著差异(P<0.05),实时三维超声比二维超声确诊率高;总体上两种方法有显著差异(P<0.05),实时三维超声比二维超声准确率要高,漏诊少。结论:经实时三维超声诊断输尿管下段结石比经二维超声准确率高,具有直观、立体感强的特点,应用容积存储效应,结合多切面选择,可协助疑难病例的诊断,对减少漏诊输尿管下段结石有实用价值。%Objective: Contrast two-dimensional ultrasound examination results to assess the real-time three-dimensional ultrasound imaging diagnosis of lower ureteral stones application.Methods: Analysis of cases of lower ureteral stones 150 cases, are treated as two-dimensional ultrasound and real-time three-dimensional ultrasound diagnosis, X-ray urography, CT, surgery to take stone, gravel, drug row of results as the Standard.Results: Lower Ureteral calculi by real-time three-dimensional ultrasound-dimensional imaging rate of 90.7% (136/150); the renal pelvis lfuid in the consolidated cases, the two methods was no signiifcant difference between them (P>0.05); when no renal pelvic lfuid circumstances, the two methods were signiifcantly different (P<0.05), real-time three-dimensional ultrasound diagnosis rate more than of two-dimensional ultrasound; overal signiifcant difference between the two methods (P<0.05), real-time three-dimensional Ultrasound accuracy rate than the two-dimensional ultrasound is higher, fewer missed.Conclusion: The real-time three

  16. 联用多种措施提高经皮肾镜取石术治疗鹿角形肾结石的清除率%Several strategies of increasing the stone-free rate of staghorn calculi by percutaneous nephrolithotomy

    Institute of Scientific and Technical Information of China (English)

    钟东亮; 吴玉姬; 刘冠炤; 吴文起

    2016-01-01

    目的::总结提高经皮肾镜取石术(PCNL)治疗鹿角形肾结石的结石清除率的措施。方法:83例鹿角形肾结石术前行 CT 平扫,PCNL术时,如患侧输尿管扩张,留置两条 F5输尿管导管,术中见尿液混浊或合并多发微细结石,联用负压吸引器,用气压弹道碎石器有序碎石,手术结束前必须用C 臂复查结石残余情况,术后2~4 d 行 KUB 检查,统计结石清除率。结果:一期手术后56例鹿角形肾结石完全清除(67.5%,56/83),手术时间平均81 min(28~142 min),血红蛋白平均下降23 g/L(0~54 g/L),1例患者术后血红蛋白持续下降,行肾动脉造影+超选择性血管栓塞术,术后发热7例,无尿源性脓毒血症发生,无周围脏器损伤,无患者死亡。结论:术前CT平扫,术中必要时留置两条输尿管导管、联用负压吸引器,有序碎石,手术结束前C臂机检查结石残余等综合措施有助提高鹿角形肾结石PCNL术的结石清除率。%Objective:To summarize the strategies of increasing the stone-free rate of staghorn calculi by per-cutaneous nephrolithotomy (PCNL).Methods:Eighty-three cases of staghorn calculi were subjected to kidney non-contrast CT (NCCT)scan preoperatively.During PCNL,two F5 ureteral catheters were indwelled when the expansion of the ipsilateral ureter was found,together with a suction device if preoperative diagnosis of urinary tract infection was done or cloudy urine or merge multiple tiny stones were found intraoperatively.Pneumatic lith-otripsy device was used to shatter stones orderly.The C-arm was used to check the residual stones before the end of operation.KUB radiography was carried out to statistically analyze the stone free-rate 2-4 days postoperation. Results:After the first stage PCNL,56 cases of staghorn calculi were removed completely (67.5%,56/83).The mean operative time was 81 min (28-142 min),and mean hemoglobin decrease was 23 g/L (0-54 g/L),In one case of postoperatively declined

  17. Routine vs "on demand" postoperative ERCP for small bile duct calculi detected at intraoperative cholangiography. Clinical evaluation and cost analysis.

    Science.gov (United States)

    Ammori, B J; Birbas, K; Davides, D; Vezakis, A; Larvin, M; McMahon, M J

    2000-12-01

    The detection of small and often asymptomatic gallbladder calculi within the bile duct at intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) frequently poses a management dilemma. Therefore, we set out to compare the outcomes and costs of two management strategies for small stones that remain in the bile duct after LC-routine postoperative endoscopic retrograde cholangiopancreatography (ERCP) vs observation alone with "on-demand" ERCP. We studied 70 patients with bile duct stones among 922 consecutive patients who underwent LC between 1990 and 1997. Data were collected prospectively. Bile duct calculi were detected in 70 of 705 patients (9.9%) with successful IOC. Of these, 44 patients had large calculi (> or =5 mm in diameter) and were subjected to a laparoscopic common bile duct exploration. The remaining 26 patients had small calculi (duct clearance and were therefore excluded from analysis. Patients with small duct calculi were assigned, according to individual surgeon policy, to either routine postoperative ERCP (group A, n = 8) or observation (group B, n = 14). ERCP was reserved for those who become symptomatic. The two groups were comparable for age and sex distribution. No complications developed during the follow-up period in patients assigned to observation, although four became symptomatic and underwent ERCP. In group A, ERCP demonstrated a clear biliary tree in four patients and bile duct calculi in three patients; it failed in one patient. In group B, ERCP demonstrated a clear bile duct in one patient and bile duct calculi in two patients; it also failed in one patient. Endoscopic sphincterotomy and duct clearance were achieved in all patients with demonstrable bile duct calculi at ERCP. There was no morbidity or mortality associated with ERCP. The overall hospital stay was significantly longer in group A than in group B (median 5 vs 1.5 days; p = 0.011); however, the number of outpatient clinic visits was significantly

  18. Ureteral obstruction associated with pelvic inflammatory disease in a long-term intrauterine contraceptive device user.

    Science.gov (United States)

    Yonemura, Shigenori; Moriya, Mitsuhiko; Hori, Yasuhide; Arima, Kiminobu; Toyoda, Nagayasu; Sugimura, Yoshiki

    2006-03-01

    We report herein a case of ureteral obstruction associated with pelvic inflammatory disease in a long-term intrauterine contraceptive device (IUD) user. A 62-year-old woman presented with a 2-week history of left flank pain and high fever, but no abdominal pain. She had forgotten the use of an IUD. Retrograde pyelography showed a stricture in the lower third of the left ureter. Magnetic resonance showed swelling of the uterus wall and left parametria, but did not reveal the presence of an IUD. Subtotal hysterectomy, bilateral salpingo-oophorectomy and left nephronureterectomy was performed. The IUD was then found in the uterine cavity. The results of pathological and bacteriological findings for Actinomyces infection were negative. Therefore we diagnosed this case as ureteral obstruction associated with pelvic inflammatory disease. Ureteral obstruction associated with pelvic inflammatory disease in a long-term IUD user is extremely rare.

  19. Distal clavicle fractures in children☆

    Science.gov (United States)

    Labronici, Pedro José; da Silva, Ricardo Rodrigues; Franco, Marcos Vinícius Viana; Labronici, Gustavo José; Pires, Robinson Esteves Santos; Franco, José Sergio

    2015-01-01

    Objective To analyze fractures of the distal clavicle region in pediatric patients. Methods Ten patients between the ages of five to eleven years (mean of 7.3 years) were observed. Nine patients were treated conservatively and one surgically. All the fractures were classified using the Nenopoulos classification system. Results All the fractures consolidated without complications. Conservative treatment was used for nine patients, of whom three were in group IIIB, three IIb, two IIa and one IV. The only patient who was treated surgically was a female patient of eleven years of age with a group IV fracture. Conclusion The treatment indication for distal fractures of the clavicle in children should be based on the patient's age and the displacement of the fragments. PMID:26962489

  20. Distal clavicle fractures in children

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    Pedro José Labronici

    2016-02-01

    Full Text Available ABSTRACT OBJECTIVE: To analyze fractures of the distal clavicle region in pediatric patients. METHODS: Ten patients between the ages of five to eleven years (mean of 7.3 years were observed. Nine patients were treated conservatively and one surgically. All the fractures were classified using the Nenopoulos classification system. RESULTS: All the fractures consolidated without complications. Conservative treatment was used for nine patients, of whom three were in group IIIB, three IIb, two IIa and one IV. The only patient who was treated surgically was a female patient of eleven years of age with a group IV fracture. CONCLUSION: The treatment indication for distal fractures of the clavicle in children should be based on the patient's age and the displacement of the fragments.

  1. Diagnosis of ureteral obstruction in patients with compromised renal function: the role of noninvasive imaging modalities.

    Science.gov (United States)

    Shokeir, Ahmed A; El-Diasty, Tarek; Eassa, Waleed; Mosbah, Ahmed; El-Ghar, Mohamed Abou; Mansour, Osama; Dawaba, Mohamed; El-Kappany, Hamdy

    2004-06-01

    We compared the role of noncontrast computerized tomography (NCCT), magnetic resonance urography (MRU), and combined abdominal radiography (KUB) and ultrasonography (US) in the diagnosis of the cause of ureteral obstruction in patients with compromised renal function. The study included 149 patients, of whom 110 had bilateral obstruction and 39 had obstruction of a solitary kidney. Therefore, the total number of renal units was 259. All patients had renal impairment with serum creatinine greater than 2.5 mg/dl. Besides conventional KUB and US all patients underwent NCCT and MRU. The gold standard for diagnosis of the cause of obstruction included retrograde or antegrade ureterogram, ureteroscopy and/or open surgery. The sensitivity, specificity and overall accuracy of NCCT, MRU, and combined KUB and US in the diagnosis of ureteral obstruction were calculated in comparison with the gold standard. The definitive cause of ureteral obstruction was calculous in 146 and noncalculous in 113 renal units, including ureteral stricture in 65, bladder or ureter in 43, extraurinary collection in 3 and retroperitoneal fibrosis in 2. The site of stone impaction was identified by NCCT in all 146 renal units (100% sensitivity), by MRU in 101 (69.2% sensitivity), and by combined KUB and US in 115 (78.7% sensitivity) with a difference of significant value in favor of NCCT (p MRU in 54 of 65 (83%). Bladder and ureteral tumors causing ureteral obstruction could be diagnosed in approximately half of the patients by NCCT (22 of 43) and in all except 1 by MRU (42 of 43). NCCT and MRU could identify all extraurinary causes of obstruction. Overall of the 113 kidneys with noncalculous obstruction the cause could be identified by MRU in 101 (89% sensitivity), by NCCT in 45 (40% sensitivity), and by combined KUB and US in only 20 (18% sensitivity) with a difference of significant value in favor of MRU (p MRU is superior for identifying noncalculous lesions.

  2. Chondroblastoma of the distal phalanx.

    Science.gov (United States)

    Gregory, James R; Lehman, Thomas P; White, Jeremy R; Fung, Kar-Ming

    2014-05-01

    Chondroblastoma is a rare, benign primary bone tumor that usually occurs at the epiphysis of long bones. The authors present an example of the diagnosis and successful treatment of this neoplasm in an exceedingly rare location in the distal phalanx. Clinical and radiographic outcomes after 68 months of follow-up are presented. A 15-year-old, right hand-dominant, boy developed painful swelling of the right ring finger. Radiographs revealed a radiolucent lesion of the distal phalanx with expansile remodeling of the bone. An excisional biopsy was performed with curettage and bone grafting of the lesion. The diagnosis of chondroblastoma was made based on pathologic evaluation of the biopsy specimen. Sixty-six months after surgical treatment, the patient was free of recurrence and metastatic disease with excellent clinical and functional outcomes. To the authors' knowledge, this represents only the second reported case of chondroblastoma of the distal phalanx. The diagnosis of chondroblastoma in this rare location was made by pathologic review of the resection specimen. It is imperative to confirm the diagnosis of any resected bone specimen even when the concern for an aggressive or malignant lesion is low. A tumor presenting in an unusual location may require a change in treatment or surveillance.

  3. TROP2 Expressed in the Trunk of the Ureteric Duct Regulates Branching Morphogenesis during Kidney Development

    OpenAIRE

    Yuko Tsukahara; Minoru Tanaka; Atsushi Miyajima

    2011-01-01

    TROP2, a cell surface protein structurally related to EpCAM, is expressed in various carcinomas, though its function remains largely unknown. We examined the expression of TROP2 and EpCAM in fetal mouse tissues, and found distinct patterns in the ureteric bud of the fetal kidney, which forms a tree-like structure. The tip cells in the ureteric bud proliferate to form branches, whereas the trunk cells differentiate to form a polarized ductal structure. EpCAM was expressed throughout the ureter...

  4. A rare cause of anuria: Bilateral synchronous isolated mid-ureteric tubercular lesions

    Directory of Open Access Journals (Sweden)

    Anuj D Dangi

    2015-01-01

    Full Text Available A young female presenting with right flank pain, fever, raised creatinine and bilateral hydronephrosis was treated with antibiotics elsewhere, with presumptive diagnosis of bilateral pyelonephritis. She had partial relief in symptoms and her creatinine level showed an improvement. Three months later during evaluation at our center she had anuria, hypertensive crisis and pulmonary edema which were managed with emergency bilateral percutaneous nephrostomies. Cross-sectional imaging and ureteroscopy suggested bilateral synchronous intramural mid-ureteric lesions as underlying pathology. Histopathology of the ureteric segments during laparotomy revealed caseating granulomas suggestive of tuberculosis. This clinical presentation has not been previously described in urinary tuberculosis.

  5. A rare cause of massive haematuria: Internal iliac artery-ureteric fistula.

    Science.gov (United States)

    Rao, Ahsan M; Khalil, Ahmed; Suttie, Stuart

    2015-04-01

    Ureteric fistula into the arterial tree is a well-recognised, but uncommon condition. The involvement of internal iliac artery is rare. We present a rare case of fistulous communication and subsequent infection of an internal iliac artery aneurysm and ureter secondary to insertion of ureteric stent following endovascular exclusion of the aneurysm and its management. Nephrostogram identified the fistula not seen on computerised tomography. This case highlights the awareness of such pathology allowing for prompt recognition of the condition and importance of appropriate imaging.

  6. Pneumatic v electrokinetic lithotripsy in treatment of ureteral stones.

    Science.gov (United States)

    Vorreuther, R; Klotz, T; Heidenreich, A; Nayal, W; Engelmann, U

    1998-06-01

    Recently, a new device (Combilith) for electrokinetic lithotripsy (EKL) has become available which is very similar to the well-known device for pneumatic (ballistic) lithotripsy (Swiss Lithoclast). The Lithoclast uses air pressure to push a projectile within the handpiece against the end of a metal probe, which is thereby accelerated and thrown like a jackhammer against the stone. In principle, the same stroking movement of a small metal probe is provided by EKL; the difference is that instead of a projectile, a magnetic core within the handpiece is accelerated by the electromagnetic principle. This paper compares the clinical efficacy and the features of the two devices. Testing the devices on a stone model, taking into account stone propulsion, the systems turned out to equally effective regarding stone disintegration. However, stone displacement was more pronounced with the Lithoclast applied on easily breaking stones. In a second experiment, an optoelectronic movement-measuring apparatus (Zimmer camera) was employed to measure the range and velocity of the movement of the probe tip without any contact. The linear acceleration velocity ranged from 5 to a maximum of 12.5 m/sec with both systems, but the maximum height of the stroke was 2.5 mm with the Lithoclast and 1 mm with EKL. After the initial break-up of soft stones, further impact of the probe tip against the stone resulted merely in propulsion; thus, the greater probe stroke height is the cause of the stone displacement. In a clinical trial, 22 ureteral stones were treated with the Lithoclast and 35 with the EKL. The two devices were equally effective in terms of stone disintegration and safety margin. Fixation using a Dormia basket was necessary in 12 cases (8 Lithoclast, 4 EKL). Although a difference in probe stroke height was noted when comparing pneumatic and electrokinetic lithotripsy, there were no clinically significant differences in the efficacy of stone fragmentation or stone-free rates. At the

  7. 气压弹道和钬激光治疗输尿管单个结石效果的比较%A study on pneumatic lithotripsy versus holmium laser lithotripsy for the treatment of single ureteral stone

    Institute of Scientific and Technical Information of China (English)

    刘武; 钱坤

    2015-01-01

    ObjectiveThe aim of this study was to analyze the stone-free (SF) rates between pneumatic lithotripsy (PL) and holmium laser lithotripsy (HLL) for the treatment of single ureteral stones and to evaluate potentially single ureteral stones. MethodsFrom January2010 to August2014,131 consecutive patients with single stones were prospectively enrolled, and117 patients were brought into at last, which were divided into PL group(n=57) and HLL group(n=60). Uni- and multivariate logistic regression were performed to estimate predictive factors of a SF status.ResultsThe SF rate in the PL group was80.7 and86.1% in the HLL group. Success rates with regard of stone position were not significantly different between groups. At uni-variate logistic regression, middle ureteral stone (OR3.33,P=0.04), distal ureteral stone (OR4.4,P=0.02), HLL (OR3.05,P=0.04) and Hounsfield units (HUs) (OR1.07,P=0.03) were significantly predictive factors of a SF status. At a multivariate logistic regression, middle ureteral stone, distal ureteral stone, HLL and HUs ≥1200 were significantly associated with a SF status. Conclusion HLL significantly influences the SF status after ureteroscopy, allowing a higher SF rate when compared to PL. HUs may significantly influence this success rate.%目的:对比气压弹道和钬激光治疗输尿管单个结石的无石(SF)率,评价影响SF状态潜在的预测指标。方法:前瞻性选择2010年1月~2014年8月的131个患有输尿管单个结石的患者,最终纳入117人,将其分为气压弹道碎石组(PL组,57人)和钬激光碎石组(HLL组,60人)。应用单变量和多元线性回归分析,评价SF状态潜在的预测指标。结果:PL组的SF率是80.7%,而HLL组的SF率是86.1%,有显著差异。两组的相同位置的输尿管结石的碎石成功率无显著差异。通过单变量线性回归分析,确定输尿管中段结石(OR 3.33,P=0.04)、输尿管下段结石(OR 4.4,P=0.02

  8. Corticosteroids and tamsulosin in the medical expulsive therapy for symptomatic distal ureter stones: single drug or association?

    Science.gov (United States)

    Porpiglia, Francesco; Vaccino, Davide; Billia, Michele; Renard, Julien; Cracco, Cecilia; Ghignone, Gianpaolo; Scoffone, Cesare; Terrone, Carlo; Scarpa, Roberto Mario

    2006-08-01

    To assess the clinical role of corticosteroids in the medical expulsive therapy of symptomatic distal ureteral stones. Between January 2004 and September 2005, 114 patients with symptomatic distal ureteral stones with a >/=5mm diameter were enrolled in this prospective study and divided into four groups based on the urologist (of four) who treated them in the emergency unit. Group A (33 patients) received tamsulosin (0.4mg daily), group B (24 patients) received deflazacort (30mg daily), group C (33 patients) received both (0.4mg tamsulosin+30mg deflazacort daily), and control group D (24 patients) received only analgesics. The treatment duration was 10 d to prevent the side-effects of prolonged corticosteroid therapy. The end points were the expulsion rate, analgesic consumption, number of ureteroscopies, and safety. The groups were comparable in terms of age, sex, and stone location. The stone diameter was 5.96+/-0.33mm for group A, 5.83+/-0.4mm for group B, 5.88+/-0.23mm for group C, and 5.71+/-0.5mm (p>0.05) for group D. The rates of expulsion for the four groups were 60%, 37.5%, 84.8%, and 33.3%, respectively. There was a significant difference between group C and the other groups (p<0.001). The mean analgesic consumption was 42.5+/-0.4mg for group A, 50+/-0.3mg for group B, 27.3+/-0.5mg for group C, and 81+/-0.33mg for group D, with a significant difference between group C and the other groups (p<0.001). During the treatment period, only two cases of drug side-effects related to tamsulosin (without any drop-outs) were recorded. When the medical expulsive therapy for symptomatic distal ureteral stones is considered, the use of steroids (deflazacort) proves efficient only when administered together with alpha(1)-blockers (tamsulosin). In addition, tamsulosin used on its own as a medical expulsive therapy can be considered as an alternative treatment for those patients who are not suitable for steroid therapy, as it is generally efficient.

  9. Treatment of small lower pole calculi--SWL vs. URS vs. PNL?

    Science.gov (United States)

    Knoll, Thomas; Tasca, Andrea; Buchholz, Noor P

    2011-03-01

    According to current guideline recommendations extracorporeal shock wave lithotripsy (SWL) remains the first choice treatment for small and mid-sized renal calculi. However, the results of SWL treatment for lower pole stones can be disappointing whilst more invasive endoscopic modalities, such as flexible ureterorenoscopy (fURS) and percutaneous nephrolithotomy (PNL) are often considered more effective. This article summarizes a point-counterpoint discussion at the 9th eULIS symposium in Como, Italy, and discusses the potential advantages and disadvantages of the different therapeutic approaches.

  10. Hemiacidrin irrigation in the management of struvite calculi: long-term results.

    Science.gov (United States)

    Sant, G R; Blaivas, J G; Meares, E M

    1983-12-01

    Renacidin (10 per cent hemiacidrin) irrigation has been used in the management of renal struvite calculi in 25 patients. Of these patients 22 were free of stone after irrigation: 16 after dissolution of residual stone fragments postoperatively, 4 after prophylactic postoperative irrigation and 2 after primary, nonsurgical percutaneous dissolution. Recurrent urinary tract infections owing to the original urease-producing bacteria occurred in 14 per cent of these patients and recurrent nephrolithiasis occurred in 9 per cent during an average followup period of 66 months.

  11. Sialendoscopic Pneumatic Lithotripsy for Salivary Calculi: A New Technique and a Long-term Clinical Experience.

    Science.gov (United States)

    Serbetci, Erhun; Celikoyar, M Mazhar; Altundag, Aytug

    2017-07-01

    We report our results comprising a series of 34 cases of sialolithiasis that were approached sialendoscopically with conventional instruments (ie, basket and/or forceps) and for which stone removal was unsuccessful and so were thereafter treated with pneumatic lithotripsy. Intraductal pneumatic lithotripsy was able to fragment 30 of 34 (88%) salivary calculi in total. No major complications occurred. All 30 treated glands returned to normal function without any symptoms. We believe that the success of sialendoscopy is closely related to the success of salivary stone fragmentability.

  12. [Infection-induced urinary calculi in children; current therapeutic schedule and prevention of recurrence].

    Science.gov (United States)

    Bach, D; Brühl, P; Hesse, A

    1988-01-01

    Infection stones have an outstanding position in childhood urolithiasis. In non-infection stones one can mostly find a certain--for example metabolic--causes of stone formation. In infection stones, the urease-producing and thus urea-cleaving properties of some gram-negative bacteria are responsible for alkalization of the urine and lead especially in combination with disturbances of urine transport to the staghorn calculi. Therefore in such children early diagnosis, adequate therapy and consequent maintenance is the crucial point for good life quality in future. Preliminary condition for therapeutic success is a close coworking between pediatric nephrologist, pediatric urologist, family doctor and parents.

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

    Directory of Open Access Journals (Sweden)

    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.

  14. Genetic analysis reveals an unexpected role of BMP7 in initiation of ureteric bud outgrowth in mouse embryos.

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    Alexandre Gonçalves

    Full Text Available BACKGROUND: Genetic analysis in the mouse revealed that GREMLIN1 (GREM1-mediated antagonism of BMP4 is essential for ureteric epithelial branching as the disruption of ureteric bud outgrowth and renal agenesis in Grem1-deficient embryos is restored by additional inactivation of one Bmp4 allele. Another BMP ligand, BMP7, was shown to control the proliferative expansion of nephrogenic progenitors and its requirement for nephrogenesis can be genetically substituted by Bmp4. Therefore, we investigated whether BMP7 in turn also participates in inhibiting ureteric bud outgrowth during the initiation of metanephric kidney development. METHODOLOGY/PRINCIPAL FINDINGS: Genetic inactivation of one Bmp7 allele in Grem1-deficient mouse embryos does not alleviate the bilateral renal agenesis, while complete inactivation of Bmp7 restores ureteric bud outgrowth and branching. In mouse embryos lacking both Grem1 and Bmp7, GDNF/WNT11 feedback signaling and the expression of the Etv4 target gene, which regulates formation of the invading ureteric bud tip, are restored. In contrast to the restoration of ureteric bud outgrowth and branching, nephrogenesis remains aberrant as revealed by the premature loss of Six2 expressing nephrogenic progenitor cells. Therefore, very few nephrons develop in kidneys lacking both Grem1 and Bmp7 and the resulting dysplastic phenotype is indistinguishable from the one of Bmp7-deficient mouse embryos. CONCLUSIONS/SIGNIFICANCE: Our study reveals an unexpected inhibitory role of BMP7 during the onset of ureteric bud outgrowth. As BMP4, BMP7 and GREM1 are expressed in distinct mesenchymal and epithelial domains, the localized antagonistic interactions of GREM1 with BMPs could restrict and guide ureteric bud outgrowth and branching. The robustness and likely significant redundancy of the underlying signaling system is evidenced by the fact that global reduction of Bmp4 or inactivation of Bmp7 are both able to restore ureteric bud outgrowth

  15. Repeat knot formation in a patient with an indwelling ureteral stent

    Directory of Open Access Journals (Sweden)

    Brian Eisner

    2006-06-01

    Full Text Available A patient treated for nephrolithiasis formed knots in 2 occasions, in 2 separate indwelling ureteral stents. This rare complication may make stent removal difficult. To our knowledge, this is the first case report of repeat knot formation in a single patient.

  16. Validation of screening examinations of the ureteral orifices in dogs: Comparison of ultrasonography with dissection.

    Science.gov (United States)

    Balogh, O; Degrandi, F; Hässig, M; Reichler, I M

    2015-08-01

    In dogs, ultrasonography is performed to locate the ureteral orifices in the urinary bladder, but reference values for their normal location using this technique are missing. In this study, the ureterovesical-vesicourethral and inter-ureterovesical distances were determined in 20 freshly euthanized medium size dogs by detecting artificially produced ureteral jets in color-flow Doppler ultrasonography at two different bladder volumes, and comparing them to manual measurements in the dissected bladder. All distances determined by ultrasonography were in agreement with values found by dissection (P ≥ 0.100). With increasing bladder volume only the left ureterovesical-vesicourethral distance changed (P = 0.041). The right ureteral opening was more cranial than the left in 16 dogs. The inter-ureterovesical distances differed by gender (P = 0.016), but spay/neuter status had no influence (P ≥ 0.847). In conclusion, ultrasonography is a reliable modality for screening ureteral orifices in medium size dogs and agrees with anatomical findings.

  17. A guidewire introducer as a ureteral foreign body: A case report.

    Science.gov (United States)

    Sener, Tarik Emre; Cloutier, Jonathan; Audouin, Marie; Villa, Luca; Traxer, Olivier

    2015-01-01

    A 63-year-old male, previously treated for a ureteral tumour by a right-sided segmental ureterectomy and end-to-end anastomosis of ureteral segments, was referred to our clinic for endoscopic follow-up. During his follow-up, he was diagnosed with partial right-sided ureteral stricture which eventually progressed to complete obstruction. During the ureteroscopy, as the stenotic segment did not allow passage of an hydrophilic guidewire, an antegrade-retrograde approach was decided. On the antegrade endoscopic view, a near-complete stenosis was diagnosed and a nephrostomy catheter (12 Fr) was placed. A second intervention was planned and from the nephrostomy tract, the ureteroscope was placed into the right pyelocaliceal system. The diagnostic ureteroscopy revealed a foreign object proximal to the stenotic area. Right-sided segmental ureterectomy of the stenotic segment with ureteroneocystostomy and removal of the foreign object was performed. This is the only case in literature to reveal a guidewire introducer as a ureteral foreign body. This case also highlights the importance of the fragility of the ureter, the importance of the equipment, of always being watchful during a surgery, and the importance of checking the integrity of the equipment at the end of each procedure.

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

    Directory of Open Access Journals (Sweden)

    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.

  19. 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

    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...... dilation seems to have no place in the treatment of primary congenital UPJO in children....

  20. One-stage Percutaneous Nephroscopy for Secondary Upper Urinary Stricture Combined with Renal Calculi%经皮肾镜一期治疗继发性上尿路狭窄合并肾结石

    Institute of Scientific and Technical Information of China (English)

    范先明; 郭昭建; 林剑锋; 王世先; 涂建平; 叶振扬; 郑健忠; 梁福律

    2014-01-01

    目的:探讨经皮肾镜一期治疗继发性上尿路狭窄合并肾结石的可行性与临床疗效。方法回顾分析我院2006年7月~2013年7月97例继发性上尿路狭窄合并肾结石的临床资料。建立F24标准经皮肾镜操作通道,超声联合气压弹道将结石击碎并吸出体外,应用自制电钩或钬激光直视下将狭窄段切开。放置F5双J管2枚内引流。结果93例一期手术成功,手术时间30~180 min,平均75 min。1例因输尿管管腔完全闭塞,改开放手术;2例穿刺出脓性尿液,肾镜下碎石取石后,放置肾造瘘,二期内切开术;1例碎石时间较长,改二期内切开术。93例一期手术成功者术后随访3个月~3年,平均12个月。治愈84例,有效6例,无效3例。结论经皮肾镜一期治疗继发性上尿路狭窄合并肾结石,临床效果较好,手术创伤较小,术后恢复好、快,安全,具有可重复性的优点。%Objective To investigate the feasibility and the efficacy of one-stage percutaneous nephroscopy in the treatment of secondary upper urinary stricture combined with renal calculi. Methods A retrospective analysis was carried out on clinical data of 97 patients with secondary upper urinary stricture complicated with renal calculi from July 2006 to July 2013. Percutaneous nephroscopy was performed through the F24 standard approach.The renal stones were broken and sucked out by the combination of pneumatic and ultrasonic measures.The ureterostenosis segment was opened by using endoscopic incision with monopolar or holmium laser.Two F5 D-J stent were placed after the operation. Results The operation was successfully accomplished in one session in 93 patients.The operation time ranged from 30 to 180 min, with a mean of 75 min.Conversion to open surgery was required in 1 patient because of complete ureteral occlusion.Two patients with renal stones were accompanied with pyonephrosis, and after a renal cannula was

  1. Laparoscopic reconstruction of iatrogenic-induced lower ureteric strictures: Does timing of repair influence the outcome?

    Directory of Open Access Journals (Sweden)

    George P Abraham

    2011-01-01

    Full Text Available Context: Influence of timing of repair on outcome following laparoscopic reconstruction of lower ureteric strictures Aims: To assess the influence of timing of repair on outcome following laparoscopic reconstruction of lower ureteric strictures in our adult patient population. Settings and Design: Single surgeon operative experience in two institutes. Retrospective analysis. Materials and Methods: All patients were worked up in detail. All patients underwent cystoscopy and retrograde pyelography prior to laparoscopic approach. Patients were categorised into two groups: early repair (within seven days of inciting event and delayed repair (after two weeks. Operative parameters and postoperative events were recorded. Postprocedure all patients were evaluated three monthly. Follow-up imaging was ordered at six months postoperatively. Improvement in renal function, resolution of hydronephrosis and unhindered drainage of contrast through the reconstructed unit on follow-up imaging was interpreted as a satisfactory outcome. Statistical Analysis Used: Mean, standard deviation, equal variance t test, Mann Whitney Z test, Aspin-Welch unequal variance t test. Results: Thirty-six patients (37 units, 36 unilateral and 1 simultaneous bilateral underwent laparoscopic ureteral reconstruction of lower ureteric stricture following iatrogenic injury - 21 early repair (Group I and 15 delayed repair (Group II. All patients were hemodynamically stable at presentation. Early repair was more technically demanding with increased operation duration. There was no difference in blood loss, operative complications, postoperative parameters, or longterm outcome. Conclusions: In hemodynamically stable patients, laparoscopic repair of iatrogenically induced lower ureteric strictures can be conveniently undertaken without undue delay from the inciting event. Compared to delayed repairs, the procedure is technically more demanding but morbidity incurred and outcome is at par.

  2. Robot-assisted Surgery for Benign Ureteral Strictures: Experience and Outcomes from Four Tertiary Care Institutions.

    Science.gov (United States)

    Buffi, Nicolò Maria; Lughezzani, Giovanni; Hurle, Rodolfo; Lazzeri, Massimo; Taverna, Gianluigi; Bozzini, Giorgio; Bertolo, Riccardo; Checcucci, Enrico; Porpiglia, Francesco; Fossati, Nicola; Gandaglia, Giorgio; Larcher, Alessandro; Suardi, Nazareno; Montorsi, Francesco; Lista, Giuliana; Guazzoni, Giorgio; Mottrie, Alexandre

    2017-06-01

    Minimally invasive treatment of benign ureteral strictures is still challenging because of its technical complexity. In this context, robot-assisted surgery may overcome the limits of the laparoscopic approach. To evaluate outcomes for robotic ureteral repair in a multi-institutional cohort of patients treated for ureteropelvic junction obstruction and ureteral stricture (US) at four tertiary referral centres. This retrospective study reports data for 183 patients treated with standard robot-assisted pyeloplasty (PYP) and robotic uretero-ureterostomy (UUY) at four high-volume centres from January 2006 to September 2014. Robotic PYP and robot-assisted UUY were performed according to previously reported surgical techniques. Preoperative, intraoperative, and postoperative variables and outcomes were assessed. A descriptive statistical analysis was performed. No robot-assisted UUY cases required surgical conversion, while 2.8% of PYP cases were not completed robotically. The median operative time was 120 and 150min for robot-assisted PYP and robot-assisted UUY, respectively. No intraoperative complications were reported. The overall complication rate for all procedures was 11% (n=20) and complications were mostly of low grade. The high-grade complication rate was 2.2% (n=4). At median follow-up of 24 mo, the overall success rate was >90% for both procedures. The study limitations include its retrospective nature and the heterogeneity of the study population. Robotic surgery for benign US is safe and effective, with limited risk of high-grade complications and good intermediate-term results. In this study we review the use of robotic surgery at four different tertiary care centres in the treatment of patients affected by benign ureteral strictures. Our results demonstrate that robotic surgery is a safe alternative to the standard open approach in the treatment of ureteral strictures. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All

  3. Ureteral stent duration and the risk of BK polyomavirus viremia or bacteriuria after kidney transplantation.

    Science.gov (United States)

    Wingate, Jonathan T; Brandenberger, Jared; Weiss, Andrew; Scovel, Lauren G; Kuhr, Christian S

    2017-02-01

    Ureteral stents are used in kidney transplantation (KTX) to decrease post-operative complications, but they are associated with BK polyomavirus viremia (BKV). Our primary outcome was to determine the association between ureteral stent duration and BKV. Secondary outcome measures were the association between bacteriuria and stent duration or use of ureteral stent strings. Between January 2010 and January 2015, 403 patients underwent KTX at the Virginia Mason Medical Center and met inclusion criteria. Stent duration was classified as short (3 weeks). Multivariate logistic regression models were created to assess for factors associated with BKV. The covariates in the BKV model were chosen a priori based on stent duration and risk factors previously described in the literature. Ureteral stents were placed in 304 (75.4%) transplants. Stent strings were left attached in 166 (54.6%) patients. On multivariate analyses, long stent duration was significantly associated with increased risk of BKV compared with no stent (odds ratio [OR] 1.92, P=.044, 95% confidence interval [CI] 1.04-3.74). Short stent duration was not associated with BKV. Sixty-two (15.4%) patients had bacteriuria. Bacteriuria was associated with female gender (OR 2.77, P<.001, 95% CI 1.58-4.95), and there was a dose-dependent effect with stent duration compared with no stent-short duration (OR 2.46, P=.049, 95% CI 1.05-6.49) and long duration (OR 3.58, P=.004, 95% CI 1.58-9.25). Stent strings were not associated with either complication. The association between ureteral stents and BKV may be dose dependent. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  4. Avicenna's Canon of Medicine and modern urology: part II: bladder calculi.

    Science.gov (United States)

    Madineh, Sayed Mohammad Ali

    2009-01-01

    In the previous issue of the Urology Journal, a comparison of Avicenna's Canon of Medicine with modern urologic findings was done in part I of this article, addressing bladder anatomy and physiology and bladder calculi. In part II of this review, the remaining chapters of the Canon of Medicine on bladder calculi are reviewed. Avicenna points to perineal urethrostomy (perineostomy), which is today performed as the last therapeutic line or as a temporary remedy before surgical treatment. He also describes surgery via transperineal route and warns the surgeon of the proximity of vasa deferentia, prostate gland, and neurovascular bundle and their exposure in this position. Usage of grasping forceps for removal of bladder calculus and emphasis on removing all calculus fragments are the interesting points of this chapter. Avicenna explains a technique similar to the use of a Babcock forceps for prevention of calculus migration. Complications of bladder calculus surgery and cystostomy are also addressed with scientific precision in the Canon. It is noteworthy that 8 centuries before Fournier described necrotizing fasciitis in male genitalia, Avicenna had described Fournier gangrene in his book.

  5. Plasma levels and urinary excretion of amino acids by subjects with renal calculi.

    Science.gov (United States)

    Atanassova, Stoyanka Slavcheva; Panchev, P; Ivanova, M

    2010-05-01

    Plasma levels and urinary amino acid excretions were estimated by high-performance liquid chromatography in 15 control subjects and 36 stone formers (SFs) classified according to the stone type: (1) 22 cases with calcium oxalate stones; (2) four cases with pure uric acid stones; (3) 10 cases with magnesium-ammonium phosphate stones, either pure or mixed with apatite. Some types of stones (namely oxalate and uric acid calculi) are mainly formed as a result of a metabolic deficiency that may affect the amino acid metabolism, and thus may be reflected in the urinary amino acid pattern. Data demonstrated clearly that there is a general tendency towards decreased amino acid excretions in all SFs with all types of stones. As a whole, one can observe a higher percentage of patients with calcium oxalate and phosphate calculosis, who have low urine excretions of amino acids; about 50% are the SFs with lower urine excretion of serine, glycine, taurine and i-leucine; the high percentage of patients with CaOX calculi shows lower urine excretions of tyrosine and ornithine.

  6. Ureteroscopy-assisted retrograde nephrostomy for lower calyx calculi in horseshoe kidney: two case reports.

    Science.gov (United States)

    Kawahara, Takashi; Ito, Hiroki; Terao, Hideyuki; Tanaka, Katsuyuki; Ogawa, Takehiko; Uemura, Hiroji; Kubota, Yoshinobu; Matsuzaki, Junichi

    2012-07-10

    We previously reported on the effectiveness of ureteroscopy-assisted retrograde nephrostomy during percutaneous nephrolithotomy and report two cases of lower calyx calculi in horseshoe kidney that were successfully treated with ureteroscopy-assisted retrograde nephrostomy. During the ureteroscopy-assisted retrograde nephrostomy procedure, a ureteroscope is advanced in the desired calyx and a Lawson retrograde nephrostomy puncture wire is inserted. The wire is advanced through the calyx to exit the skin. The wire is then used for the percutaneous dilation. Case 1 was a 68-year-old man who was shown on radiography to have left lower calyx calculi (19 × 15mm, 7 × 5mm, and 7 × 3mm) in horseshoe kidney. Case 2 was a 36-year-old woman shown on radiography to have a left lower calyx calculus (10 × 8mm) in horseshoe kidney. Both patients were stone-free after ureteroscopy-assisted retrograde nephrostomy during percutaneous nephrolithotomy. Ureteroscopy-assisted retrograde nephrostomy is a promising procedure for safely and effectively treating lower calyx stones in horseshoe kidney.

  7. Ureteroscopy-assisted retrograde nephrostomy for lower calyx calculi in horseshoe kidney: two case reports

    Directory of Open Access Journals (Sweden)

    Kawahara Takashi

    2012-07-01

    Full Text Available Abstract Introduction We previously reported on the effectiveness of ureteroscopy-assisted retrograde nephrostomy during percutaneous nephrolithotomy and report two cases of lower calyx calculi in horseshoe kidney that were successfully treated with ureteroscopy-assisted retrograde nephrostomy. During the ureteroscopy-assisted retrograde nephrostomy procedure, a ureteroscope is advanced in the desired calyx and a Lawson retrograde nephrostomy puncture wire is inserted. The wire is advanced through the calyx to exit the skin. The wire is then used for the percutaneous dilation. Case presentation Case 1 was a 68-year-old man who was shown on radiography to have left lower calyx calculi (19 × 15mm, 7 × 5mm, and 7 × 3mm in horseshoe kidney. Case 2 was a 36-year-old woman shown on radiography to have a left lower calyx calculus (10 × 8mm in horseshoe kidney. Conclusions Both patients were stone-free after ureteroscopy-assisted retrograde nephrostomy during percutaneous nephrolithotomy. Ureteroscopy-assisted retrograde nephrostomy is a promising procedure for safely and effectively treating lower calyx stones in horseshoe kidney.

  8. SCANNING ELECTRON-MICROSCOPIC EVALUATION OF THE FRACTURED SURFACES OF CANINE CALCULI FROM SUBSTRATA WITH DIFFERENT SURFACE FREE-ENERGY

    NARCIS (Netherlands)

    UYEN, HMW; JONGEBLOED, WL; BUSSCHER, HJ

    1991-01-01

    The strength of adhesion between dental calculus and enamel or dentin surfaces determines the ease with which the calculus can be removed by brushing or professional dental treatment. In this study, we examined the adhesion of canine calculi formed on substrata with different surface free energies

  9. The Dual Action of Varunadi Kwath in Renal Calculi as well as Uterine Fibroid- A Case Study

    Directory of Open Access Journals (Sweden)

    Padavi D. M.

    2015-09-01

    Full Text Available Mutrashmari (Renal Calculi is very common disorder. This distressing urinary disorder affects around 5-7 million people in India [11]. The chances of recurrence are always high and the surgery having disadvantage of high cost. The available treatment in modern science is only conservative and surgical in this present study an effort was made to evaluate the role of Varunadi Kwath in Mutrashmari. The main aim of this particular study was inclined towards the disintegration, dissolution, dislodgement and expulsion of renal calculi. The contents of Varunadi Kwath are easily available, economical and are easy to administer, which are having Anti-inflammatory, Diuretic and Antilithic properties. A case of renal calculi with uterine fibroid was diagnosed and the treatment was given for a period of 9 months. The size of the calculus was studied by periodic ultrasonography; the symptoms Mutrakruchrata (Dysuria, Shula (Pain in abdomen, Sadaha Mutrata (Burning micturition are significantly reduced within less than 45 days and total expulsion of calculi in less than 180 days.

  10. Large bifid ureteric calculus in a patient with an ileal conduit

    OpenAIRE

    2012-01-01

    Urinary diversion after extirpative surgery of the bladder is done by various methods. Conduit urinary diversion is the most commonly practiced method of urinary diversion. It is relatively easy to perform and has a lower complication rate than other forms of diversion, e.g., orthotopic neobladder and continent cutaneous urinary diversion. Urolithiasis is a known and common complication of urinary diversion. Upper tract calculi in these cases often manifest symptomatically as occurs in the ge...

  11. Transvesical Laparoendoscopic Single-Site Management of Distal Ureter During Laparoscopic Radical Nephroureterectomy.

    Science.gov (United States)

    Nunez Bragayrac, Luciano A; Machuca, Victor; Saenz, Eric; Cabrera, Marino; de Andrade, Robert; Sotelo, Rene J

    2014-09-11

    Abstract Objective: To describe the management of the distal ureter during radical nephroureterectomy with the transvesical laparoendoscopic single-site surgery (T-LESS) approach. Methods: Between January 2010 and October 2013, five patients underwent laparoscopic radical nephroureterectomy for upper urinary tract carcinoma (UTUC) with the T-LESS approach. Patients were placed in the supine position. A 2.5-cm skin incision was made in the line between the pubis and the umbilicus. The bladder was identified and a multiport was inserted into the bladder. The patients were repositioned to a lateral decubitus position; pneumovesicum was established and the ureteral openings were identified. We marked the bladder cuff with electrocautery all the way through to the extravesical fat. The bladder defect was sealed with sutures. After checking for any leak or bleeding, the multiport was removed and the bladder was closed. At this point, we continued with nephrectomy by standard laparoscopy or LESS. A 18F Foley catheter was placed into the bladder. Results: The mean age was 70 years (range 58-81 years), the mean operative time was 198 minutes (range 115-390 minutes), the mean time for the management of the distal ureter was 35 minutes (range 27-45 minutes), the mean estimated blood loss was 234 mL (range 60-850 mL), and the mean hospital stay was 3.8 days (range 2-8 days). In all patients the bladder cuff was free of disease. Conclusion: The transvesical laparoendoscopic single-site approach to the distal ureter for UTUC appears safe and reproducible, with faster closure of the bladder defect and improved cosmesis.

  12. Distal realignment (tibial tuberosity transfer).

    Science.gov (United States)

    Feller, Julian Ashley

    2012-09-01

    Although tibial tuberosity (TT) transfer has for many years been the basis of many protocols for the management of patellar instability, the role of pure medial transfer in particular appears to be declining. In contrast, the greater recognition of the importance of patella alta as a predisposing factor to recurrent patellar dislocation has resulted in a resurgence in the popularity of distal TT transfer. When TT transfer is performed, the direction and amount of transfer is based on the patellar height and the lateralization of the TT relative to the trochlear groove. Patellar height is best assessed on a lateral radiograph with the knee in flexion using a ratio that uses the articular surface of the patella in relation to the height above the tibia. Assessment of lateralization of the TT relative to the trochlear groove can be made using either computed tomography or magnetic resonance imaging scans.

  13. Encrustation of the Ureteral Double J Stent in Patients with a Solitary Functional Kidney – a Case Report

    Science.gov (United States)

    Milicevic, Snjezana; Bijelic, Radojka; Jakovljevic, Branislava

    2015-01-01

    Introduction: The efficacy of ureteric stents in the management of various urological conditions causing the upper urinary tract obstruction has been extensively proven, and their contribution to urology remains enormous. The clinical use of ureteric stents is associated with several complications. “Stent syndrome,” encrustation, migration and urothelial hyperplasia are the most common problems related to long-term ureteral stenting. Case report: This work presents an interesting case from our practice: a complete encrustation of a classical polyurethane double J stent two and a half months after its initial instillation, in a 70 year old man, with a solitary functioning kidney, as well as successful removal of it by using a simultaneous treatment of extracorporeal lithotripsy and ureteroscopy with a contact disintegration of encrustations and with percutaneous nephrostomy, as an auxiliary procedure for providing of additional urine derivation. Conclusion: These problems can be overcome by the introduction of new advanced ureteral stent designs and biomaterials. PMID:26543316

  14. Effect of ciprofloxacin and N-acetylcysteine on bacterial adherence and biofilm formation on ureteral stent surfaces

    National Research Council Canada - National Science Library

    El-Feky, Mohamed A; El-Rehewy, Mostafa S; Hassan, Mona A; Abolella, Hassan A; Abd El-Baky, Rehab M; Gad, Gamal F

    2009-01-01

    The aim of this study was to evaluate the effect of ciprofloxacin (CIP), N-acetylcysteine (NAC) alone and in combination on biofilm production and pre-formed mature biofilms on ureteral stent surfaces...

  15. [A 8-year-forgotten ureteral stent after kidney transplantation: treatment and long-term follow-up].

    Science.gov (United States)

    Lasaponara, Fedele; Dalmasso, Ettore; Santià, Silvia; Sedigh, Omidreza; Bosio, Andrea; Pasquale, Giovanni; Segoloni, Giuseppe P; Fontana, Dario

    2013-01-01

    Forgotten indwelling ureteral stents can cause significant urological complications. Only few cases are reported after kidney transplantation. We present a case of a 39-year-old woman, transplanted in 1993 and referred to our Transplant Center 8 years later, because of a serious urinary tract infection with renal function impairment. Abdominal CT scan showed pyelonephritis and hydronephrosis in the transplanted kidney and the presence of a calcific ureteral stent, which had been forgotten in situ for 8 years. The stent was removed, but it was impossible to replace it with a new stent both retrogradely and anterogradely, because of a tight obstruction of the mid ureter. So a uretero-ureteral anastomosis with up urinary tract was performed. No intra- or post-operative complications occurred. At 9 years' follow-up, the patient shows an optimal renal function, with no urinary tract infection. A forgotten ureteral stent in a transplanted kidney can cause a lot of complications and can lead to graft loss. The prosthesis may cause an irreversible ureteral damage, so, as in our experience, forgetting a ureteral stent can result in a complex surgery.

  16. Interlocking nailing in fractures of distal tibia

    Directory of Open Access Journals (Sweden)

    Akshay Phadke

    2016-04-01

    Conclusions: Intramedullary nailing is an effective alternative for the treatment of distal metaphyseal tibial fractures. A proper patient selection, adjuvant fixation of fibula and use of at least two distal interlocking screws is suggested for better outcome. [Int J Res Med Sci 2016; 4(4.000: 1132-1135

  17. Giant cell tumour of distal ulna.

    Science.gov (United States)

    Archik, Shreedhar; Tripathi, Sanjay Kumar; Nanda, Saurav Narayan; Choudhari, Ashlesh

    2017-01-01

    Giant cell tumor (GCT) of distal end epiphysis ulna is a rare presentation, and only few cases are reported in the scientific literature. We report a case of GCT of distal end epiphysis ulna treated at our Tertiary Care Hospital, Mumbai.

  18. Robotic distal pancreatectomy: a valid option?

    Science.gov (United States)

    Jung, M K; Buchs, N C; Azagury, D E; Hagen, M E; Morel, P

    2013-10-01

    Although reported in the literature, conventional laparoscopic approach for distal pancreatectomy is still lacking widespread acceptance. This might be due to two-dimensional vision and decreased range of motion to reach and safely dissect this highly vascularized retroperitoneal organ by laparoscopy. However, interest in minimally invasive access is growing ever since and the robotic system could certainly help overcome limitations of the laparoscopic approach in the challenging domain of pancreatic resection, notably in distal pancreatectomy. Robotic distal pancreatectomy with and without spleen preservation has been reported with encouraging outcomes for benign and borderline malignant disease. As a result of upgraded endowristed manipulation and three-dimensional visualization, improved outcome might be expected with the launch of the robotic system in the procedure of distal pancreatectomy. Our aim was thus to extensively review the current literature of robot-assisted surgery for distal pancreatectomy and to evaluate advantages and possible limitations of the robotic approach.

  19. Universal Enveloping Algebra and Differential Calculi on Orthogonal q-groups

    CERN Document Server

    Aschieri, Paolo; Aschieri, Paolo; Castellani, Leonardo

    1997-01-01

    We review the construction of the multiparametric quantum group $ISO_{q,r}(N)$ as a projection from $SO_{q,r}(N+2) $ and show that it is a bicovariant bimodule over $SO_{q,r}(N)$. The universal enveloping algebra $U_{q,r}(iso(N))$, characterized as the Hopf algebra of regular functionals on $ISO_{q,r}(N)$, is found as a Hopf subalgebra of $U_{q,r}(so(N+2))$ and is shown to be a bicovariant bimodule over $U_{q,r}(so(N))$. An R-matrix formulation of $U_{q,r}(iso(N))$ is given and we prove the pairing $U_{q,r}(iso(N))\\leftrightarrow ISO_{q,r}(N)$. We analyze the subspaces of $U_{q,r}(iso(N))$ that define bicovariant differential calculi on $ISO_{q,r}(N)$.

  20. Multimodal stone therapy for two forgotten and encrusted ureteral stents: a case report

    Science.gov (United States)

    2009-01-01

    Introduction Ureteral stent placement is a common procedure in daily urologic practice. To manage the problems of forgotten stents for many years needs multimodal stone therapy. Case presentation We present a case of a 26-years-old Caucasian, white woman with two forgotten encrusted ureteral stents for 48 months. Multimodal stone therapy including extracorporeal shock wave (SWL), percutaneous nephrolithotomy (PCNL), ureterorenoscopy (URS), cystolithotripsy with Lithoclast, and open surgery was necessary to remove all the stones. Using the described combination of techniques, our patient was rendered stone and stent free. Urologists should bear in mind the presence of severe encrustations when they have to deal with a forgotten stent. Conclusion This case shows that combined urologic techniques can achieve successful and safe management of forgotten stents, but treatment should be tailored to the volume of encrustation and associated stone. PMID:19183439

  1. Diagnóstico Ecográfico de Refluxo Vesico-Ureteral

    OpenAIRE

    Santos, José Fonseca

    2014-01-01

    Objectivo: Comparação de Ecocistografia e da Cistografia Radiológica no diagnóstico do refluxo vesico-ureteral.Material e Métodos: De Abril a Agosto de 1999, foram examinadas 25 crianças (8 raparigas e 17 rapazes, com idades compreendidas entre os 8 dias e os 14 anos), com 50 unidades renoureterais, para o diagnóstico de refluxo vesico-ureteral, realizando Ecocistografia e Cistografia Radiológica na mesma sessão. As indicações para o exame foram infecção do tracto urinário, diagnóstico pré-na...

  2. Intelligent Optimization of the Film-to-Fiber Ratio of a Degradable Braided Bicomponent Ureteral Stent

    Directory of Open Access Journals (Sweden)

    Xiaoyan Liu

    2015-11-01

    Full Text Available A hierarchical support vector regression (SVR model (HSVRM was employed to correlate the compositions and mechanical properties of bicomponent stents composed of poly(lactic-co-glycolic acid (PGLA film and poly(glycolic acid (PGA fibers for urethral repair for the first time. PGLA film and PGA fibers could provide ureteral stents with good compressive and tensile properties, respectively. In bicomponent stents, high film content led to high stiffness, while high fiber content resulted in poor compressional properties. To simplify the procedures to optimize the ratio of PGLA film and PGA fiber in the stents, a hierarchical support vector regression model (HSVRM and particle swarm optimization (PSO algorithm were used to construct relationships between the film-to-fiber weight ratio and the measured compressional/tensile properties of the stents. The experimental data and simulated data fit well, proving that the HSVRM could closely reflect the relationship between the component ratio and performance properties of the ureteral stents.

  3. Beware! Fungal urosepsis may follow endoscopic intervention for prolonged indwelling ureteral stent.

    Science.gov (United States)

    Gautam, Gagan; Singh, A K; Kumar, Rajeev; Hemal, A K; Kothari, Atul

    2006-07-01

    We present a 38-year-old lady with a prolonged indwelling ureteral stent that had been placed for pain relief after development of Steinstrasse following extracorporeal lithotripsy for a 2.5-cm left renal calculus. The patient developed candidal urosepsis within 6 hours after ureteroscopy and percutaneous nephrolithotomy (PCNL) for the removal of residual fragments. She subsequently recovered on systemic antifungal therapy in the form of intravenous amphotericin B and achieved complete stone clearance after repeat ureteroscopy and PCNL. Fungal urosepsis is known to complicate the postoperative course in chronically debilitated patients with poor nutritional status or those with diabetes or other significant comorbities. To our knowledge, this is the first reported case of a patient with no significant comorbities developing fungal urosepsis after endoscopic intervention for a long-term indwelling ureteral stent.

  4. Uretero-Internal Pudendal Artery Fistula with Longterm Indwelling of Ureteral Stent: A Case Report

    Directory of Open Access Journals (Sweden)

    Hideo Yuki

    2012-01-01

    Full Text Available A 74-year-old woman presenting with bilateral ureteral stricture was referred to our hospital. She had undergone radical hysterectomy and adjuvant irradiation therapy for cervical cancer in 2000. Double-J stents were inserted in both the ureters and replaced at regular intervals. Eighteen months after ureteral stenting, she complained of gross hematuria and was managed with hemostatic agents. During a routine replacement of the right double-J stent, massive bleeding was observed from the urethra which continued intermittently. The source of bleeding was not identified on computed tomography and angiography. We kept her at rest, which reduced the bleeding. However, she required intermittent transfusions. Angiography was performed at the time of bleeding on March 5, 2011. A uretero-internal pudendal artery fistula was found, and coil embolization was performed. Thereafter, hematuria did not recur up to the last followup in July 2011.

  5. Helical CT evaluation of the chemical composition of urinary tract calculi with a discriminant analysis of CT-attenuation values and density

    Energy Technology Data Exchange (ETDEWEB)

    Bellin, Marie-France; Meric, Jean-Baptiste [AP-HP, Department of Radiology, Hopital Paul-Brousse, Villejuif Cedex (France); Renard-Penna, Raphaelle; Grenier, Philippe [AP-HP, Department of Radiology, Hopital Pitie-Salpetriere, Paris Cedex 13 (France); Conort, Pierre; Richard, Francois [AP-HP, Department of Urology, Hopital Pitie-Salpetriere, Paris Cedex 13 (France); Bissery, Anne; Mallet, Alain [AP-HP, Department of Biostatistics, Hopital Pitie-Salpetriere, Paris Cedex 13 (France); Daudon, Michel [AP-HP, Department of Biochemistry, Hopital Necker, Paris Cedex 15 (France)

    2004-11-01

    The aim of this study was to evaluate the efficacy of helical CT using a combination of CT-attenuation values and visual assessment of stone density as well as discriminant linear analysis to predict the chemical composition of urinary calculi. One hundred human urinary calculi were obtained from a stone-analysis laboratory and placed in 20 excised pig kidneys. They were scanned at 80, 120 and 140 kV with 3-mm collimation. Average, highest and lowest CT-attenuation values and CT variability were recorded. The internal calculus structure was assessed using a wide window setting, and visual assessment of stone density was recorded. A stepwise discriminant linear analysis was performed. The following three variables were discriminant: highest CT-attenuation value, visual density, and highest CT-attenuation value/area ratio, all at 80 kV. The probability of correctly classifying stone composition with these three variables was 0.64, ranging from 0.54 for mixed calculi to 0.69 for pure calculi. The probabilities of correctly classifying calculus composition were: 0.91 for calcium oxalate monohydrate and brushite, 0.89 for cystine, 0.85 for uric acid, 0.11 for calcium oxalate dihydrate, 0.10 for hydroxyapatite, and 0.07 for struvite calculi. When the first two ranks of highest probability for the accurate classification of each calculus type were taken into account, 81% of the calculi were correctly classified. Assessment at 80 kV of the highest CT-attenuation value, visual density and the highest CT-attenuation value/area ratio accurately predicts the chemical composition of 64-81% of urinary calculi. When the first two ranks of highest probability for the accurate classification of each calculus type were taken into account, all cystine, calcium oxalate monohydrate and brushite calculi were correctly classified. (orig.)

  6. PRE-AND POST-OPERATIVE CORTICAL FUNCTION OF THE KIDNEY WITH STAGHORN CALCULI ASSESSED BY 99mTc-DMSA RENAL SCINTIGRAPHY

    OpenAIRE

    川村, 寿一

    1982-01-01

    99mTc-DMSA renal scintigraphy consisting of the cortical image and DMSA renal uptake was used to assess the pre- and post-operative renal function in 39 patients with staghorn calculi or complicated calculi occupying more than 2 major calices. Extended pyelolithotomy was performed on 14 patients, nephrolithotomy on 14 patients, pyelolithotomy combined with nephrotomy on 7 patients, and partial nephrectomy on 4 patients. Nine out of 14 patients who underwent pyelolithotomy and 4 out of 14 pati...

  7. Use of Corticosteroids for Urinary Tuberculosis Patients at Risk of Developing Ureteral Obstruction

    OpenAIRE

    Matsui, Kosuke; Furumoto, Akitsugu; Ohba, Kojiro; Mochizuki, Kota; Tanaka, Takeshi; Takaki, Masahiro; Morimoto, Konosuke; Ariyoshi, Koya

    2016-01-01

    A 77-year-old man with urinary tuberculosis developed post renal anuria two days after starting an anti-tuberculosis drug regimen. He had bilateral hydronephrosis, and his right kidney was radiologically diagnosed to be non-functioning. A transurethral catheter was placed in the left ureter. No improvement in the ureteral stricture was noted during the initial three weeks of treatment; however, the stricture did thereafter improve after the commencement of oral prednisolone. In cases of urina...

  8. Ureteric erosion and obstruction: A rare but dreaded complication of intrauterine contraceptive device

    Science.gov (United States)

    Priyadarshi, Vinod; Sehgal, Nidhi; Sen, Dipanwita

    2017-01-01

    Though intrauterine contraceptive device (IUCD) is a safe and most frequently used long-term contraceptive method, it has some complications. Uterine perforation and intra-abdominal migration have been reported often, but a retroperitoneal migration is exceptional. Here, we are reporting an IUCD which perforated the uterus and migrated to the retroperitoneum; impinging into and obstructing left ureter causing severe hydroureteronephrosis due to the development of the left lower ureteric stricture. PMID:28216944

  9. Ureteric erosion and obstruction: A rare but dreaded complication of intrauterine contraceptive device

    Directory of Open Access Journals (Sweden)

    Vinod Priyadarshi

    2017-01-01

    Full Text Available Though intrauterine contraceptive device (IUCD is a safe and most frequently used long-term contraceptive method, it has some complications. Uterine perforation and intra-abdominal migration have been reported often, but a retroperitoneal migration is exceptional. Here, we are reporting an IUCD which perforated the uterus and migrated to the retroperitoneum; impinging into and obstructing left ureter causing severe hydroureteronephrosis due to the development of the left lower ureteric stricture.

  10. Effect of Simvastatin on Renal Fibrosis after Unilateral Ureteral Obstruction in Rat

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    M.H. Khayat Nouri

    2009-01-01

    Full Text Available Introduction & Objective: Comparative reductase inhibitors, such as simvastatin increase HDL-cholestrol and decrease serum triglyceride and cholesterol. It is widely recognized that statins have organ protective nature and most effective for organ damage progressing. Obstructive uropathy can be used to indicate any obstruction to urinary flow; which causes a developing of hydronephrosis, tubular atrophy and associated renal impairment. The aim of this study was evaluation of the simvastatin effect on renal fibrosis after unilateral ureteral obstruction in rat. Materials & Methods: In this experimental study, 50 adult male Sprague-Dawley rats were subjected to unilateral ureteral obstruction (UUO and randomly divided into five groups (ten rats in each group as follows: (1 control group; (2 UUO; (3 UUO/SIM; (4 Sham-operated; (5 Sham/SIM. Control animals received orally drug solvent by gavage for 15 days (started one day before operation. Unilateral ureteral obstruction was performed in groups 2 and 3 and sham operations were performed in groups 4 and 5. In group 2 animals received drug solvent and in group 3 animals received simvastatin (2 mg/kg/twice daily for 15 days (started one day before operation. Rats were sacrificed either at day 14 for histopathological evaluation with H&E, masson-trichrome and PAS technique. Results: In this investigation histopathologic evaluation approved that in UUO group, renal interstitial fibrosis, tubular epithelial necrosis, hemorrhage, interstitial infiltration of mononuclear cells, tubular atrophy, glumerular tufts expanding, periglomerular sclerosis, subcapsular fibrosis, glomerulosclerosis and peritubular capillaries edema were observed. But in simvastatin treated animals this histopatologic lesions and fibrosis significantly (p<0.05 decreased. There was no difference between control and sham groups.Conclusion: In this investigation our results showed that ureteral obstruction increased renal fibrosis and

  11. Ureteral Stent Insertion in the Management of Renal Colic during Pregnancy

    OpenAIRE

    2016-01-01

    To determine an optimal invasive intervention for renal colic patients during pregnancy after conservative treatments have been found to be unhelpful. Among the available invasive interventions, we investigated the reliability of a ureteral stent insertion, which is considered the least invasive intervention during pregnancy. Between June 2006 and February 2015, a total of 826 pregnant patients came to the emergency room or urology outpatient department, and 39 of these patients had renal col...

  12. Noninvasive management of obstructing ureteral stones using electromagnetic extracorporeal shock wave lithotripsy.

    Science.gov (United States)

    Sighinolfi, M C; Chiara, S M; Micali, S; Salvatore, M; De Stefani, S; Stefano, D S; Saredi, G; Mofferdin, A; Grande, M; Bianchi, G; Giampaolo, B

    2008-05-01

    Extracorporeal shock wave lithotripsy (ESWL) represents noninvasive management of urolithiasis. Since the first HM3 model, technological progress has improved the efficacy and safety of this treatment. The current study aimed to evaluate the role of ESWL as a first-line emergency therapy of renal colic due to ureteral stone with impaired renal function. This prospective study enrolled all the patients admitted from the emergency room with acute renal colic meeting the following criteria: serum creatinine level ranging from 1.5 to 2.5 mg/dl, hydronephrosis, ureteral stones 6 to 15 mm in size, body mass index less than 30, normal renal function at baseline, and no evidence of urinary tract infection. The patients were submitted to a single-session emergency treatment using Dornier Litothripter S. Follow-up assessment, performed at 24 and 72 h, included radiologic and ultrasound examinations with renal function serum assessment. The end points were a decrease in creatinine level and a stone-free condition. A total of 40 patients were eligible for the study. The mean creatinine level at admission was 1.93 +/- 0.26 mg/dl. After the treatment, renal function recovery occurred for 34 subjects (85%), with a significant global decrease in creatinine levels (p = 0.00). The global stone-free rate 72 h after SWL was 67.5% (27/40). The patients with residual fragments were managed using re-SWL (n = 7) and endoscopic technique (n = 6). Emergency SWL represents an effective tool in the treatment of ureteral stones with hydronephrosis and slight renal impairment. Although complete stone clearance after one treatment still remains a difficult target, the actual role of SWL in the management of acute obstruction is to obtain ureteral canalization and renal function recovery.

  13. Treatment of distal clavicle fracture with distal radius volar locking compression plate

    Institute of Scientific and Technical Information of China (English)

    YU Chao; SUN Yue-hua; ZHAO Chang-qing; SHI Ding-wei; WANG You

    2009-01-01

    Objective: To observe the early clinical outcomes of the internal fixation with distal radius volar locking compression plate (LCP) in treatment of distal clavicle fracture.Methods: Six patients with unilateral distal clavicle fractures, identified as type Ⅱ according to Neer classification system, including 4 males and 2 females, were treated with open reduction and internal fixation using a distal radius volar LCP. Bone union was evaluated by routine X-ray radiography, and shoulder joint function were assessed by Constant score system.Results: All fractures achieved bone union at 6 to 8 weeks postoperatively, and Constant scores ranged from 95 to 100 at the postoperative 10 to 12 weeks.Conclusion: Fixation of distal clavicle fracture with distal radius volar LCP demonstrates excellent effects of bone union with rarely early complications, thus providing a new technique to treat distal clavicle fracture.

  14. Combined electrohydraulic and holmium:YAG laser ureteroscopic nephrolithotripsy of large (greater than 4 cm) renal calculi.

    Science.gov (United States)

    Mariani, Albert J

    2007-01-01

    Percutaneous nephrolithotripsy is standard treatment for renal calculi larger than 2 cm. Modern flexible ureteroscopes and accessories using the complimentary effects of electrohydraulic lithotripsy and holmium:YAG laser lithotrites can treat large (greater than 4 cm) branched renal calculi in a minimally invasive fashion with similar or superior results. This report is an assessment of the safety and efficacy of ureteroscopic nephrolithotripsy monotherapy for the management of large (greater than 4 cm) branched renal calculi in the community setting. A total of 16 patients with 17 branched renal calculi ranging from 41 to 97 mm (mean 65) in length and 560 to 2,425 mm2 (mean 1,169) in area underwent staged ureteroscopic nephrolithotripsy monotherapy. Obesity (body mass index greater than 30) was present in 81% and 38% were morbidly obese (body mass index greater than 40). An infectious etiology was present in 81% and hard stone components were present in 94%. All patients presented with hematuria, pain and/or recurrent urinary tract infection. Lithotripsy was performed with a single deflection flexible ureteroscope and predominantly electrohydraulic lithotripsy. Laser drilling was used (in 4) to weaken hard stones before electrohydraulic lithotripsy. Low intrarenal pressure was maintained by continuous bladder drainage and placement of a stiff safety wire. Visibility was maintained using manual pulsatile irrigation. All patients were rendered pain and infection-free. No patient required a blood transfusion and there was no change in serum creatinine. Mobile stone-free status was achieved in 15 of 17 renal units (88%) with a mean of 2.4 stages and 36 of 40 (90%) procedures performed on an outpatient basis. Operative time averaged 49 minutes per stage and 115 minutes per calculus. There were 3 patients admitted for fever and 1 patient (90 years old) admitted for pneumonia 3 days postoperatively. There were also 3 patients with calculi larger than 75 mm who required

  15. Retrograde versus Antegrade Approach for the Management of Large Proximal Ureteral Stones

    Science.gov (United States)

    Mykoniatis, Ioannis; Isid, Ayman; Gofrit, Ofer N.; Rosenberg, Shilo; Hidas, Guy; Landau, Ezekiel H.; Pode, Dov; Duvdevani, Mordechai

    2016-01-01

    Objective. To evaluate and compare the efficacy and safety of retrograde versus antegrade ureteroscopic lithotripsy for the treatment of large proximal ureteral stones. Patients and Methods. We retrospectively analyzed the medical records of patients with proximal ureteral stones >15 mm, treated in our institution from January 2011 to January 2016. Intraoperative parameters, postoperative outcomes, and complications were recorded and compared between the two techniques. Results. Our analysis included 57 patients. Thirty-four patients (59.6%) underwent retrograde and 23 patients (40.4%) underwent antegrade ureteroscopy. There was no significant difference in patients' demographics and stone characteristics between the groups. Stone-free rate was significantly higher (p = 0.033) in the antegrade group (100%) compared to retrograde one (82.4%). Fluoroscopy time, procedure duration, and length of hospitalization were significantly (p < 0.001) lower in retrograde approach. On the other hand, the need for postoperative stenting was significantly lower in the antegrade group (p < 0.001). No difference was found between the groups (p = 0.745) regarding postoperative complications. Conclusions. Antegrade ureteroscopy is an efficient and safe option for the management of large proximal ureteral stones. It may achieve high stone-free rates compared to retrograde ureteroscopy with the drawback of longer operative time, fluoroscopy time, and length of hospitalization. PMID:27766263

  16. 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

  17. Factors determining renal impairment in unilateral ureteral colic secondary to calcular disease: a prospective study.

    Science.gov (United States)

    Al-Ani, Ammar; Al-Jalham, Khaled; Ibrahim, Tarek; Majzoub, Ahmad; Al-Rayashi, Maged; Hayati, Ahmed; Mubarak, Walid; Al-Rayahi, Jehan; Khairy, Ahmed T

    2015-07-01

    To evaluate all possible risk factors that can cause impairment of overall renal function in patients with unilateral ureteral calculus and a normal contralateral kidney. This is a prospective study of 90 patients who presented to our institute complaining of renal colic secondary to unilateral ureteral calculus. All patients were evaluated with a thorough history, physical examination, and laboratory and radiological investigations including renal function testing, urine analysis, non-contrast computed topography, and radionucleotide scan. Patients were divided into two groups according to their calculated creatinine clearance using the Modification of Diet in Renal Disease (MDRD) formula. Group I (favorable group) had a creatinine clearance >60 ml/min, while group II (unfavorable group) had a creatinine clearance II included 36 patients (40 %). On univariate analysis, factors that were associated with overall renal function impairment were patients' age, urea-to-creatinine ratio (UCR), use of nonsteroidal anti-inflammatory drugs, stone location, and presence of obstruction. However, using binary logistic regression analysis, only patients' age, UCR, and presence of obstruction sustained statistical significance in association with renal function impairment. The study of factors that help explain the presence of renal impairment in patients with unilateral ureteral calculus is important in the clinical setting. Patients' age, urea-to-creatinine ratio, and degree of obstruction seem to be significantly associated with overall renal function impairment.

  18. Modulation of ureteric Ca signaling and contractility in humans and rats by uropathogenic E. coli.

    Science.gov (United States)

    Floyd, Rachel V; Winstanley, Craig; Bakran, Ali; Wray, Susan; Burdyga, Theodor V

    2010-04-01

    Ascending urinary tract infections, a significant cause of kidney damage, are predominantly caused by uropathogenic Escherichia coli (UPEC). However, the role and mechanism of changes in ureteric function during infection are poorly understood. We therefore investigated the effects of UPEC on Ca signaling and contractions in rat (n = 17) and human (n = 6) ureters. Ca transients and force were measured and effects of UPEC on the urothelium were monitored in live tissues. In both species, luminal exposure of ureters to UPEC strains J96 and 536 caused significant time-dependent decreases in phasic and high K depolarization-induced contractility, associated with decreases in the amplitude and duration of the Ca transients. These changes were significant after 3-5 h and irreversible over the next 5 h. The infection causes increased activity of K channels, causing inhibition of voltage-gated Ca entry, and K channel blockers could reverse the effects of UPEC on ureteric function. A smaller direct effect on Ca entry also occurs. Nonpathogenic E. coli (TG2) or abluminal application of UPEC did not produce changes in Ca signaling or contractility. UPEC exposure also caused significant impairment of urothelial barrier function; luminal application of the Ca channel blocker nifedipine caused a reduction in contractions as it entered the tissue, an effect not observed in untreated ureters. Thus, UPEC impairs ureteric contractility in a Ca-dependent manner, largely caused by stimulation of potassium channels and this mechanism is dependent on host-urothelium interaction.

  19. Melatonin protects kidney against apoptosis induced by acute unilateral ureteral obstruction in rats

    Science.gov (United States)

    Badem, Hüseyin; Cakmak, Muzaffer; Yilmaz, Hakki; Kosem, Bahadir; Karatas, Omer Faruk; Bayrak, Reyhan; Cimentepe, Ersin

    2016-01-01

    Introduction To investigate whether there was a protective effect of melatonin on apoptotic mechanisms after an acute unilateral obstruction of the kidney. Material and methods A total of 25 rats consisting of five groups were used in the study, designated as follows: Group 1: control, Group 2: sham, Group 3: unilateral ureteral obstruction treated with only saline, Group 4: unilateral ureteral obstruction treated with melatonin immediately, and Group 5: unilateral obstruction treated with melatonin one day after obstruction. Melatonin was administered as a 10 mg/kg dose intraperitoneally. The kidneys were evaluated according to the apoptotic index and Ki-67 scores. Results Comparison of all obstruction groups (Group 3, 4, and 5), revealed that the apoptotic index was significantly higher in Groups 1 and 2. Despite melatonin reduced apoptotic mechanisms in Groups 4 and 5, there was no significant difference between Groups 4 and 5 in terms of the reduction of apoptosis. However, the reduction of apoptosis in the melatonin treated group did not decrease to the level of Groups 1 and 2. Conclusions Despite melatonin administration, which significantly reduces the apoptotic index occurring after acute unilateral ureteral obstruction, the present study did not observe a return to normal renal histology in the obstruction groups. PMID:27551563

  20. PNEUMATIC LITHOTRIPSY VERSUS HOLMIUM:YAG LASER LITHOTRIPSY I N THE MANAGEMENT OF URETERAL STONES

    Directory of Open Access Journals (Sweden)

    Sebastiano Cimino

    2013-04-01

    Full Text Available Background: Pneumatic lithotripsy (PL and Holmium:YAG laser lithotripsy (LL are two valid mini-invasive approaches in the treatment of urologic stones disease. The aim of this study was to compare stone free rates between these two treatment options. Material and methods: From January 2010 to January 2011, 120 consecutive patients with single and primary ureteral stones were prospectively enrolled in this prospective study. The study was single-blinded and none of the patients knew which approach for stone fragmentation would be used. Results: The ureteral stone-free rate (SFRs in the PL group was 80.7% and 86.1 % in the LL group (p=0.002. The mean operating time was 60 (± 25 minutes in the LL group and 61 (± 21 minutes in the PL group, without significant differences (p=0.68. Multivariate logistic analysis revealed that stone location was not significantly predictive of SFRs (p=0.47. None of the patients had blood transfusions and no other severe complications appeared in either group. Conclusions: In our study LL was significantly associated with a stone 80.7% in the PL group and 86.1% in the LL group (p<0.05. Also, Holmium:YAG laser lithotripsy was demonstrated to be the more efficacious endoscopic procedure for the treatment of ureteral stones, allowing stones to be successfully fragmented, with few complications.

  1. Molecular genetics of distal hereditary motor neuropathies.

    Science.gov (United States)

    Irobi, Joy; De Jonghe, Peter; Timmerman, Vincent

    2004-10-01

    Inherited peripheral neuropathies comprise a wide variety of diseases primarily affecting the peripheral nervous system. The best-known peripheral neuropathy is Charcot-Marie-Tooth disease (CMT) described in 1886 by J.-M. Charcot, P. Marie and H.H. Tooth. In 1980, A.E. Harding and P.K. Thomas showed that in a large group of individuals with CMT, several only had motor abnormalities on clinical and electrophysiological examination, whereas sensory abnormalities were absent. This exclusively motor variant of CMT was designated as spinal CMT or hereditary distal spinal muscular atrophy, and included in the distal hereditary motor neuropathies (distal HMN). The distal HMN are clinically and genetically heterogeneous and are subdivided according to the mode of inheritance, age at onset and clinical evolution. Since the introduction of positional cloning, 12 chromosomal loci and seven disease-causing genes have been identified for autosomal dominant and recessive distal HMN. Most of the genes involved have housekeeping functions, as in RNA processing, translation synthesis, glycosylation, stress response, apoptosis, but also axonal trafficking and editing. Functional characterization of the mutations will help to unravel the cellular processes that underlie the specificity of motor neuropathies leading to neurogenic muscular atrophy of distal limb muscles. Here we review the recent progress of the molecular genetics of distal HMN and discuss the genes implicated.

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

    Directory of Open Access Journals (Sweden)

    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.

  3. Unilateral Molar Distalization: A Nonextraction Therapy

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    M. Bhanu Prasad

    2012-01-01

    Full Text Available In the recent years, nonextraction treatment approaches and noncompliance therapies have become more popular in the correction of space discrepancies. One of the conventional approaches for space gaining in the arches without patient compliance is done by using certain extra oral appliances or intraoral appliance. The greatest advantage of certain appliances like fixed functional and molar distalization appliances is that they minimize the dependence on patient cooperation. Molar distalization appliances like pendulum appliance which distalizes the molar rapidly without the need of head gear can be used in patients as a unilateral space gaining procedure due to buccal segment crowding.

  4. The distal hereditary motor neuropathies.

    Science.gov (United States)

    Rossor, Alexander M; Kalmar, Bernadett; Greensmith, Linda; Reilly, Mary M

    2012-01-01

    The distal hereditary motor neuropathies (dHMN) comprise a heterogeneous group of diseases that share the common feature of a length-dependent predominantly motor neuropathy. Many forms of dHMN have minor sensory abnormalities and/or a significant upper-motor-neuron component, and there is often an overlap with the axonal forms of Charcot-Marie-Tooth disease (CMT2) and with juvenile forms of amyotrophic lateral sclerosis and hereditary spastic paraplegia. Eleven causative genes and four loci have been identified with autosomal dominant, recessive and X-linked patterns of inheritance. Despite advances in the identification of novel gene mutations, 80% of patients with dHMN have a mutation in an as-yet undiscovered gene. The causative genes have implicated proteins with diverse functions such as protein misfolding (HSPB1, HSPB8, BSCL2), RNA metabolism (IGHMBP2, SETX, GARS), axonal transport (HSPB1, DYNC1H1, DCTN1) and cation-channel dysfunction (ATP7A and TRPV4) in motor-nerve disease. This review will summarise the clinical features of the different subtypes of dHMN to help focus genetic testing for the practising clinician. It will also review the neuroscience that underpins our current understanding of how these mutations lead to a motor-specific neuropathy and highlight potential therapeutic strategies. An understanding of the functional consequences of gene mutations will become increasingly important with the advent of next-generation sequencing and the need to determine the pathogenicity of large amounts of individual genetic data.

  5. Villous adenoma of the distal appendix.

    Science.gov (United States)

    Taylor, J V; Thomas, M G; Kelly, S; Sutton, R

    1997-04-01

    Villous adenoma confined to the distal appendix has not been previously reported in conjunction with acute apendicitis. The presence of an adenoma indicates a need for further investigation due to an association with neoplasia elsewhere.

  6. Genetics Home Reference: distal arthrogryposis type 1

    Science.gov (United States)

    ... This Page Bamshad M, Bohnsack JF, Jorde LB, Carey JC. Distal arthrogryposis type 1: clinical analysis of ... 5. Citation on PubMed Bamshad M, Jorde LB, Carey JC. A revised and extended classification of the ...

  7. Peel-away鞘在处理女性输尿管石街及下段结石中的应用%Treatment of the ureteral steinstrasse or distal ureteral stones through ureteroscopic lithotripsy using peel-away sheath

    Institute of Scientific and Technical Information of China (English)

    刘建河; 夏术阶; 鲁军; 陈辉榕

    2006-01-01

    目的:总结Peel-away鞘在处理女性输尿管石街及输尿管下段结石中的经验.方法:对ESWL术后输尿管石街形成及输尿管下段结石的15例女性患者,应用输尿管镜在Peel-away鞘辅助下进行取石.结果:所有患者均一次性取尽输尿管内结石,且无输尿管穿孔、狭窄及大出血等并发症发生.结论:在女性患者中采用Peel-away鞘辅助输尿管镜处理输尿管下段结石,可以最大程度地避免由于输尿管镜频繁进出输尿管而引起的损伤,并且缩短手术时间,降低输尿管损伤的风险.

  8. Çocuklarda Distal Hipospadias Cerrahisi: Deneyimlerimiz

    OpenAIRE

    2013-01-01

    Objective: In this study, patients treated with distal hypospadias and discuscion of our results with literature were aimed. Material and Methods: 46 patients, who underwent distal hypospadias repair in the recent 2,5 years, were avaluated according to age, meatal localization, chordee status, the type of operation technique, postoperative urethral catheterization and hospitalization time, associated genitourinary anomalies, early and late complications. Results: 4 of 46 cases were treated wi...

  9. Application of fast-track surgery concept in perioperative patients with biliary calculi and liver cirrhosis: a prospective study

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    WANG Hua

    2014-11-01

    Full Text Available ObjectiveTo investigate the advantage and safety of the concept of fast-track surgery (FTS applied in perioperative patients with biliary calculi and liver cirrhosis. MethodsFifty-two patients undergoing operation for biliary calculi and liver cirrhosis from January 2011 to September 2013 were included in this study. These patients were randomly divided into FTS group (n = 30 and control group (n = 22. Patients in the FTS group received perioperative care measures guided by FTS concept, while patients in the control group received traditional perioperative management measures. The intraoperative situation of patients, time to postoperative recovery of intestinal function, length of postoperative hospital stay, total medical expenses during hospitalization, and postoperative complications were compared between the two groups. Continuous data and categorical data were compared by t-test and χ2 test, respectively. ResultsAs compared with the control group, the FTS group had significantly time to postoperative recovery of intestinal function (t = 2.239, P = 0.045, a significantly shortened length of postoperative stay (t = 4.246, P = 0.038, and significantly reduced total medical expenses during hospitalization (t = 3.045, P = 0.033. No significant difference in postoperative complications was observed between the two groups (P>0.05. ConclusionThe concept of FTS can be safely and effectively applied in perioperative patients with biliary calculi and liver cirrhosis, which can accelerate rehabilitation without increasing the risk of surgery.

  10. Lower urinary tract symptoms in benign prostatic hyperplasia patients: orchestrated by chronic prostatic inflammation and prostatic calculi?.

    Science.gov (United States)

    Kim, Sang Hoon; Jung, Kyu In; Koh, Jun Sung; Min, Ki Ouk; Cho, Su Yeon; Kim, Hyun Woo

    2013-01-01

    This study aims to examine the relationship between chronic prostatic inflammation and prostatic calculi, and clinical parameters of benign prostatic hyperplasia (BPH). This study was based on 225 patients who underwent transurethral resection of the prostate for BPH. Chronic inflammation was graded as 0 (n = 44), I (n = 54), II (n = 88) or III (n = 39) according to severity. Prostatic calculi were classified into types A (n = 66), B (n = 44), M (n = 77) and N (n = 38). The relationship between inflammation and calculus type was analyzed, and clinical parameters of BPH were compared for each group. There was no correlation between severity of inflammation and calculus type. Prostatic volume increased with the severity of inflammation and showed significant differences between G2, G3 and G0. The International Prostate Symptom Score also increased with increasing inflammation. There was no significant difference between each clinical parameter according to calculus type. Prostatic calculi had no significant association with chronic inflammation and clinical parameters of BPH. Chronic inflammation was associated with the volume of the prostate and storage symptoms; thus, it is not only presumed to be related to the progression of BPH, but may also be one of the causes of lower urinary tract symptoms. Copyright © 2012 S. Karger AG, Basel.

  11. Influence of ultrasonic adsorption lithotripsy by percutaneous nephroscope on inflammation mediators and stress hormones of patients with infectious renal calculi

    Institute of Scientific and Technical Information of China (English)

    Dong Lu; Xiao-Lei Jiang; Ming-Hui Wu; Yun-Jun Wu; Qiang Yuan

    2016-01-01

    Objective:To investigate the influence of ultrasonic adsorption lithotripsy by percutaneous nephroscope on inflammation mediators and stress hormones of the patients with infectious renal calculi. Methods:A total of 62 patients with infectious renal calculi in our hospital from January 2014 to June 2015 were selected as the study object,and they were randomly divided into control group(pneumatic ballistic lithotripsy by percutaneous nephroscope group) 31 cases and observation group(ultrasonic adsorption lithotripsy by percutaneous nephroscope group) 31 cases,then the serum expression levels of inflammation mediators and stress hormones of two groups before the treatment and at 12 h-24 h and 48 h after the treatment were compared. Results:The serum expression levels of inflammation mediators and stress hormones of two groups before the treatment were compared,all P>0.05,and the serum expression levels of observation group at 12 h-24 h and 48 h after the treatment were significantly lower than those of control group,while the expression levels of two groups after the treatment were all significantly higher than those before the treatment,all P<0.05. Conclusions:The inflammation mediators and stress hormones of patients with infectious renal calculi who are treated with pneumatic ballistic lithotripsy by percutaneous nephroscope are relatively lower,and it shows that the trauma and bad stress for the body are better controlled, so its clinical application value are relatively higher.

  12. Time-resolved dynamic contrast-enhanced MR urography for the evaluation of ureteral peristalsis: initial experience.

    Science.gov (United States)

    Kim, Sooah; Jacob, Jason S; Kim, Danny C; Rivera, Rafael; Lim, Ruth P; Lee, Vivian S

    2008-11-01

    To determine the feasibility of time-resolved dynamic contrast-enhanced magnetic resonance urography (MRU) for the evaluation of ureteral peristalsis using a data-sharing 3D gradient echo sequence with spiral k-space filling. Eight patients (M=3, F=5, mean 48.1 years) were referred for MRU for the evaluation for renal mass (n=3), hematuria (n=2), urinary tract tuberculosis (n=1), postoperative bladder cancer (n=1), and postoperative ureteric reimplantation (n=1). Dynamic MRU was performed for 120 seconds at 1.5T after intravenous furosemide and gadolinium administration using an oblique sagittal, time-resolved T1 3D gradient echo sequence with 1 second effective temporal resolution. Study quality was assessed based on artifacts and extent of ureteric visualization. Frequency of peristalsis from the renal pelvis to urinary bladder was evaluated for each subject. A total of 16 ureters were examined. Image quality was good in four ureters, satisfactory in 11 ureters, and poor in one ureter. Mean peristaltic frequency was 3.5 waves per minute (range, 2.5-6.5 waves/minute) in normal ureters (n=11). Five ureters were considered abnormal (one urinary tract tuberculosis and four postsurgical ureters), and all had decreased or no peristalsis (0-1.5 waves per minute). MRU using a time-resolved, data-sharing 3D contrast-enhanced technique is able to demonstrate ureteral peristalsis and permits quantification of ureteral peristaltic frequency. Copyright (c) 2008 Wiley-Liss, Inc.

  13. Pharmacological Relaxation of the Ureter When Using Ureteral Access Sheaths during Ureterorenoscopy: A Randomized Feasibility Study in a Porcine Model

    Directory of Open Access Journals (Sweden)

    Søren Kissow Lildal

    2016-01-01

    Full Text Available Objective. High intraluminal pressure during ureterorenoscopy (URS increases risk of infectious and haemorrhagic complications. Intrarenal pressure may be reduced by the use of ureteral access sheaths (UASs, which on the other hand may cause ureteral damage. We have previously shown that the β-agonist isoproterenol (ISO, when administered topically in the irrigation fluid, is able to inhibit ureteral muscle tone and lower intrarenal pressure during URS. The aim of this study was to examine the effect of ISO on the success rate of UAS insertion in a porcine model. Materials and Methods. 22 pigs in which a UAS could not initially be placed were randomized to endoluminal irrigation with either ISO (0.1 μg/mL or saline before a new insertion trial. Subsequently, it was registered whether the UAS could be passed without resistance. During extraction of the sheath, any ureteral lesions were characterized ureteroscopically using the PULS classification system. Surgeons were blinded to randomization. Results. In the ISO group, the observed effect of irrigation was 63% successful UAS insertions, compared to 27% in the saline group. No serious lesions (ureteral lesions.

  14. Operative Treatment and Perioperative Management for Mid and Lower Ureteric Stones After Mechanical Heart Valve Replacement%心脏机械瓣膜置换术后输尿管中下段结石的手术及围术期处理

    Institute of Scientific and Technical Information of China (English)

    杨军; 范本祎; 何本林; 袁俊斌

    2016-01-01

    探讨心脏机械瓣膜置换术后输尿管中下段结石的手术方法选择及围手术期抗凝药物的使用及其安全性。【方法】8例心脏机械瓣膜置换术后罹患输尿管中下段结石患者,长期口服华法林抗凝治疗,入院后停用华法林,改用普通肝素0.5 mg/kg ,q4 h 静脉注射,调整凝血酶原时间(PT )至正常范围之内,于手术前24 h 停用抗凝药物。手术方式采用全麻下输尿管硬镜气压弹道碎石加 D‐J 管内置术,手术时间控制在30 min 之内,术后24~48 h 口服华法林并与肝素重叠使用,3 d 后停用肝素,单服华法林并维持国际标准化比率(INR)于治疗范围之内。【结果】8例患者均顺利渡过围术期,一次性碎石排石率100%。【结论】针对心脏机械瓣膜置换术后输尿管中下段结石患者,在合理调整抗凝药物种类、剂量及用法,掌握合适的抗凝强度,并注意术中操作及术后处理的前提条件下,输尿管镜碎石+ D‐J 管内置术,其疗效确,安全可靠。%Objective]To investigate the choice of surgical methods for the middle and lower ureteral cal‐culi after mechanical heart valve replacement and the safety of the use of anticoagulant drugs during periopera‐tive period .[Methods] Eight patients suffered from middle and lower ureteral calculi after mechanical heart valve replacement received long‐term oral anticoagulation therapy with warfarin .After admission ,warfarin was discontinued ,and heparin 0 .5 mg/kg ,q4h intravenous injection was used instead to adjust the prothrombin time (PT ) to the normal range .Anticoagulant drugs was discontinued 24h before surgery .The surgery was con‐ducted under ureter hard mirror pneumatic ballistic lithotripsy under general anesthesia plus D‐J tube internal operation .The operation time was controlled within 30 min .In 24 to 48 h after operation ,warfarin was adminis‐trated with heparin overlap

  15. Bilateral single system ectopic ureter with urolithiasis: a rare case entity.

    Science.gov (United States)

    Bansal, Ankur; Kumar, Manoj; Sokhal, Ashok; Purkait, Bimalesh; Kanodia, Gautam

    2016-11-18

    ABSTRACTBilateral single system ureteral ectopia (BSSEU) is an uncommon entity. Ureteric calculi in BSSEU are never reported so far. We herein report a case of BSSEU with left lower urtereic calculi managed by bilateral ureteric tapering and reimplantation with stone removal.

  16. Cap mesenchyme cell swarming during kidney development is influenced by attraction, repulsion, and adhesion to the ureteric tip.

    Science.gov (United States)

    Combes, Alexander N; Lefevre, James G; Wilson, Sean; Hamilton, Nicholas A; Little, Melissa H

    2016-10-15

    Morphogenesis of the mammalian kidney requires reciprocal interactions between two cellular domains at the periphery of the developing organ: the tips of the epithelial ureteric tree and adjacent regions of cap mesenchyme. While the presence of the cap mesenchyme is essential for ureteric branching, how it is specifically maintained at the tips is unclear. Using ex vivo timelapse imaging we show that cells of the cap mesenchyme are highly motile. Individual cap mesenchyme cells move within and between cap domains. They also attach and detach from the ureteric tip across time. Timelapse tracks collected for >800 cells showed evidence that this movement was largely stochastic, with cell autonomous migration influenced by opposing attractive, repulsive and cell adhesion cues. The resulting swarming behaviour maintains a distinct cap mesenchyme domain while facilitating dynamic remodelling in response to underlying changes in the tip. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Case report of a ureteral obstruction by Candida albicans fungus balls detected by magnetic resonance imaging in kidney transplant recipient.

    Science.gov (United States)

    Arichi, Naoko; Yasumoto, Hiroaki; Ogawa, Kohei; Nagami, Taichi; Anjiki, Haruki; Nakamura, Shigenobu; Mitsui, Yozo; Hiraoka, Takeo; Sumura, Masahiro; Shiina, Hiroaki

    2014-12-01

    In kidney transplant recipients, acute renal failure resulting from a ureteral obstruction by fungus balls is uncommon. We report a 60-year-old man diagnosed with ureteral obstruction caused by Candida albicans fungus balls early after transplant. Diagnosis was made by a T2-weighted magnetic resonance image, which demonstrated fungus balls as a low-intensity mass in the pelvis and microscopic examination findings in the urine. The patient was treated successfully with an antifungal agent and direct irrigation. It should be noted that fungus balls may cause ureteral obstruction of transplanted kidneys, possibly resulting in graft failure. Imaging of the kidneys and collecting system and aggressive debridement that adds to systemic therapy are necessary for early diagnosis and are central to a successful outcome.

  18. Immediate and late management of iatrogenic ureteric injuries: 28 years of experience

    Science.gov (United States)

    El Abd, Ahmed S.; El-Abd, Shawky A.; El-Enen, Mohamed Abo; Tawfik, Ahmed M.; Soliman, Mohamed G.; Abo-Farha, Mohamed; Gamasy, Abd-El Naser El; El-Sharaby, Mahmoud; El-Gamal, Samir

    2015-01-01

    Objective To evaluate the long-term results after managing intraoperative and late-diagnosed cases of iatrogenic ureteric injury (IUI), treated endoscopically or by open surgery. Patients and methods Patients immediately diagnosed with IUI were managed under the same anaesthetic, while those referred late had a radiological assessment of the site of injury, and endoscopic management. Open surgical procedures were used only for the failed cases with previous diversion. Results In all, 98 patients who were followed had IUI after gynaecological, abdominopelvic and ureteroscopic procedures in 60.2%, 14.3% and 25.5%, respectively. The 27 patients diagnosed during surgery were managed immediately, while in the late-referred 71 patients ureteroscopic ureteric realignment with stenting was successful in 26 (36.6%). Complex open reconstruction with re-implantation or ureteric substitution, using bladder-tube or intestinal-loop procedures, was used in 27 (60%), 16 (35.5%) and two (4.5%) patients of the late group, respectively. A long-term radiological follow-up with a mean (range) of 46.6 (24.5–144) months showed recurrent obstruction in 16 (16.3%) patients managed endoscopically and reflux in six (8.3%) patients. Three renal units only (3%) were lost in the late-presenting patients. Conclusion Patients managed immediately had better long-term results. More than a third of the late-diagnosed patients were successfully managed endoscopically with minimal morbidity. Open reconstruction by an experienced urologist who can perform a complex substitutional procedure was mandatory to preserve renal units in the long-term. PMID:26609443

  19. Double-J Versus External Ureteral Stents in Kidney Transplantation: A Retrospective Analysis

    Directory of Open Access Journals (Sweden)

    Vogel

    2015-07-01

    Full Text Available Background Kidney transplantation has long been recognized as the best available therapy for end stage kidney disease. Objectives This study aimed to compare outcomes of double-J versus percutaneous ureteral stent placement in renal transplantation. Patients and Methods A retrospective analysis was performed on data of renal transplantations performed at our institution in a 12-month period. In this period, external and double-J stents were used in parallel. Length of hospital stay and stent-associated complications were evaluated. Results In 76 kidney transplants, 43 external (group 1 and 33 double-J (group 2 urinary stents were used. No significant difference was observed in the number of urinary tract infections, ureteric stenosis or necrosis. The mean overall length of hospital stay was comparable in both groups (20.7 days in group 1 vs 19.3 days in group 2, P = 0.533. For patients without immunological complications, the hospital stay was significantly reduced using double-J stents (12.9 days in group 1, 10.8 days in group 2, P = 0.018. Leakage of the ureteroneocystostomy occurred in 6 out of 43 patients in group 1 (13.9%. No case of anastomotic insufficiency was observed in group 2 (P = 0.035. Macrohematuria was detected in 13 out of the 43 patients in group 1 (30.2%, compared to 3 out of 33 patients in group 2 (9.1%; P = 0.045. Conclusions This nonrandomized comparison of stent types in kidney transplantation supports the use of prophylactic double-J stents in terms of decreased ureteric complications and reduced length of hospital stay.

  20. Serum cytocines values in patients after endoscopic surgery for ureteral lithiasis.

    Science.gov (United States)

    Bantis, Athanasios; Tsakaldimis, Georgios; Zissimopoulos, Athanasios; Kalaitzis, Christos; Gianakopoulos, Stilianos; Pitiakoudis, Michail; Polichronidis, Alexandros; Touloupidis, Stavros

    2014-01-01

    Obstructive uropathy due to ureteral stones can cause renal infection and, if left untreated, can cause impairment of renal function. Endoscopic surgery such as ureteroscopy (URS) and laser lithotripsy are the primary therapeutic approach. Cytokines as non invasive markers may have a role to diagnose ureteral damage and infection. We aimed to evaluate serum cytokine levels of tumor necrosis factor-a (TNFa) and interleukin-6 (IL6) in patients undergoing URS and holmium laser lithotripsy. The study included 40 patients (male 25 and 15 female) with a mean age of 47 years and 10 healthy blood donors serving as the control group. None of them had any additional systemic diseases, previous insertion of a ureteral double "j" stent or of a nephrostomy tube, neoplasmatic disease ot renal insufficiency. Routine urine examination and urine culture were obtained to exclude urinary infection. Preoperatively and 1h, 2h, 24h and 48h postoperatively serum samples of TNF-a and IL-6 were collected and measured. Serum TNFa and IL-6 values were correlated with the other variables measured from blood samples after the URS using paired samples Students t-test with confidence interval 95%. A P value of less than 0.01 was considered statistically significant. Correlation between serum TNF-a and IL6 levels with healthy donors were statistically significant in 1h (0.004), 2h (0.001), 24h (0.001) and 48h (0.001 and 0.001) postoperatively, respectively. In conclusion, our study shows that cytokines could be helpful as markers of renal tissue damage. However, further studies are needed to get more accurate results.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  2. Minimally invasive percutaneous nephrolithotomy for the treatment of upper ureteral calculi:A Report of 216 cases%微创经皮肾镜取石术治疗输尿管上段结石216例

    Institute of Scientific and Technical Information of China (English)

    马宇杰; 黄志远; 杨建设; 张毅; 王威; 何育霖

    2010-01-01

    目的 探讨微创经皮肾镜取石术(minimally invasive percutaneous nephrolithotomy,MPCNL)治疗输尿管上段结石的疗效.方法 2004年7月至2010年1月对采用MPCNL治疗的216例输尿管上段结石患者的临床资料进行回顾性分析.结果 216例均为一期取石,结石清除率98.5%,平均手术时间70 min,术中平均估计出血量50 ml,无严重并发症发生.结论 MPCNL治疗输尿管上段结石,结石清除率高,创伤小,出血少,恢复快,安全有效.

  3. Identification of mineral compositions in some renal calculi by FT Raman and IR spectral analysis

    Science.gov (United States)

    Tonannavar, J.; Deshpande, Gouri; Yenagi, Jayashree; Patil, Siddanagouda B.; Patil, Nikhil A.; Mulimani, B. G.

    2016-02-01

    We present in this paper accurate and reliable Raman and IR spectral identification of mineral constituents in nine samples of renal calculi (kidney stones) removed from patients suffering from nephrolithiasis. The identified mineral components include Calcium Oxalate Monohydrate (COM, whewellite), Calcium Oxalate Dihydrate (COD, weddellite), Magnesium Ammonium Phosphate Hexahydrate (MAPH, struvite), Calcium Hydrogen Phosphate Dihydrate (CHPD, brushite), Pentacalcium Hydroxy Triphosphate (PCHT, hydroxyapatite) and Uric Acid (UA). The identification is based on a satisfactory assignment of all the observed IR and Raman bands (3500-400 cm- 1) to chemical functional groups of mineral components in the samples, aided by spectral analysis of pure materials of COM, MAPH, CHPD and UA. It is found that the eight samples are composed of COM as the common component, the other mineral species as common components are: MAPH in five samples, PCHT in three samples, COD in three samples, UA in three samples and CHPD in two samples. One sample is wholly composed of UA as a single component; this inference is supported by the good agreement between ab initio density functional theoretical spectra and experimental spectral measurements of both sample and pure material. A combined application of Raman and IR techniques has shown that, where the IR is ambiguous, the Raman analysis can differentiate COD from COM and PCHT from MAPH.

  4. Photothermal ablation is the primary mechanism in holmium:YAG laser lithotripsy of urinary calculi

    Science.gov (United States)

    Glickman, Randolph D.; Teichman, Joel M. H.; Corbin, Nicole S.; Vassar, George J.; Weintraub, Susan T.; Chan, Kin Foong; Welch, Ashley J.

    1999-09-01

    Because of the >= 250 microsecond(s) pulsewidth emitted by the Ho:YAG laser used in clinical lithotripsy, it is unlikely that stress confinement occurs within the irradiated stones. Experimental data supports a thermal mechanism for Ho:YAG laser stone ablation. Previous work has shown that stone fragmentation occurs soon after the onset of the laser pulse, is uncorrelated to cavitation bubble formation or collapse, and is associated with low pressures. Moreover, lithotripsy proceeds fastest with desiccated stones in air (data based on laser ablation of calcium oxalate monohydrate stones), indicating that direct absorption of the laser radiation by the stone material is required for the most efficient ablation. Lowering the initial temperature of calculi reduces the stone mass-loss following 20 J of delivered laser energy: 2.2 +/- 1.1 mg vs 5.2 +/- 1.6 mg for calcium oxalate monohydrate (COM) stones (-80 vs 23 degree(s)C), and 0.8 +/- 0.4 mg vs 2.2 +/- 1.1 mg for cystine stones (-80 vs 23 degree(s)C), p cystine; Ca2O7P2 from calcium hydrogen phosphate dihydrate, and cyanide and alloxan from uric acid. All of these observations are most consistent with a photothermal breakdown process induced by Ho:YAG laser lithotripsy.

  5. Combined micro-and standard percutaneous nephrolithotomy for complex renal calculi

    Science.gov (United States)

    Buldu, İbrahim; Tepeler, Abdulkadir; Karatağ, Tuna; İnan, Ramazan; Armağan, Abdullah; İstanbulluoğlu, Okan

    2016-01-01

    Objective We aimed to present the technique of combination of standard percutaneous nephrolithotomy (PNL) with microperc for achieving higher success rates without increasing complication rates in the management of complex renal calculi. Material and methods The patients who underwent microperc procedure as a complementary procedure to standard PNL for complex kidney stones in two reference hospitals between 2013 and 2015, were evaluated retrospectively. Results All patients underwent a total of two accesses one for standard PNL and one for microperc. The mean stone size was measured as 54.3 mm. The procedures were completed after an average operative time of 88.2 minutes and fluoroscopy time of 5.3 minutes. Stone free status was achieved in 18 cases (78.2%) and small residual fragments (≤4 mm) were detected in 3 cases (13.1%). Complications were seen in three patients (13%) as hemorrhage in one and postoperative fever in two patients. Conclusion Despite the limitations of this study, the combination of standard PNL and microperc might reduce the complication rates and increase the success rates when treating complex kidney stones. Future prospective and comparative studies are needed. PMID:27635289

  6. Tratamiento no quirúrgico de la litiasis biliar Non-Surgical treatment of biliary calculi

    Directory of Open Access Journals (Sweden)

    Felipe Franco

    1992-01-01

    Full Text Available

    Se describen diversos procedimientos para el tratamiento no quirúrgico de la colelitiasis: la administración de ácidos billares orales, la litotripsia extracorpórea, la colecistostomía percutánea, la escleroterapia de la vesícula y la litotripsia mecánica; se consignan las indicaciones, ventajas, desventajas y limitaciones de cada uno de ellos.

    Several procedures are described for non-surgical treatment of biliary calculi, namely: oral administration of bile acids, extracorporeal shock-wave lithotrypsy I percutaneous cholecystostomy I gallbladder sclerotherapy

    and mechanicallithotrypsy. lndications, advantages, disadvantages and limitations of each procedure are discussed.

  7. Sextant of Sapphires for Molar Distalization

    Science.gov (United States)

    Palla, Yudistar Venkata; Ganugapanta, Vivek Reddy

    2016-01-01

    Introduction Space analysis quantifies the amount of crowding within the arches estimating the severity of space discrepancy. The space gaining procedures include extraction and non-extraction procedures like expansion, proximal stripping and molar distalization. Aim To identify features seen in molar distalization cases. Materials and Methods The sample size comprised 20 patients in whom molar distalization was decided as the treatment plan. The study models and lateral cephalograms of all the patients were taken. Occlusograms were obtained. Model analysis and cephalometric analysis were performed. Descriptive statistical analysis like mean, standard deviation, standard error and mode were done. Results The parameters in Question gave following results. The Bolton analysis showed anterior mandibular excess with mean value of 1.56mm±1.07. The first order discrepancy between maxillary central and lateral incisors was 5±1.95. The premolar rotation showed mean value of 16.58±5.12. The molar rotation showed the value of 7.66±2.26. The nasolabial angle showed the mean of 101.25±8.7 IMPA of 101.4±5.74. Conclusion The six features studied in molar distalization cases [First order discrepancy between upper central and lateral incisors; Rotation of premolars and molars; Bolton’s discrepancy in anterior dentition; Average to horizontal growth pattern; Proclined lower incisors and Obtuse nasolabial angle] can be taken as patterns seen in molar distalization cases and considered as a valid treatment plan. PMID:27656572

  8. Ureteral Stents and Foley Catheters-Associated Urinary Tract Infections: The Role of Coatings and Materials in Infection Prevention

    Directory of Open Access Journals (Sweden)

    Joey Lo

    2014-03-01

    Full Text Available Urinary tract infections affect many patients, especially those who are admitted to hospital and receive a bladder catheter for drainage. Catheter associated urinary tract infections are some of the most common hospital infections and cost the health care system billions of dollars. Early removal is one of the mainstays of prevention as 100% of catheters become colonized. Patients with ureteral stents are also affected by infection and antibiotic therapy alone may not be the answer. We will review the current evidence on how to prevent infections of urinary biomaterials by using different coatings, new materials, and drug eluting technologies to decrease infection rates of ureteral stents and catheters.

  9. Combined percutaneous and transurethral lithotripsy for forgotten ureteral stents with giant encrustation.

    Science.gov (United States)

    Rabani, Seyed Mohammadreza

    2012-01-01

    Ureteral stents are widely used in many urologic practices. However, stents can cause significant complications including migration, fragmentation, and encrustation and it may possibly be forgotten. Successful management of a retained, encrusted stent requires combined endourological approaches. To present our experience with the approaches for treating forgotten ureteral stents associated with giant stone formation. Seventy four patients with forgotten ureteral stents were managed by different open (nephrolithotomy and/or cystolithotomy), or endoscopic procedures in our center. Among these, 11 patients had severe encrustation (stones larger than 35 mm within the bladder or kidney) and seven patients of this group, presented at our department between July 2007 and December 2010. Combined endourological procedures percutaneous nephrolithotripsy (PCNL), cystolithotripsy (CLT), transurethral lithotripsy (TUL) were performed in one or 2 separate sessions. In these 7 patients the whole of the stents, especially both ends were encrusted. Initially, cystolithotripsy, retrograde ureteroscopy and TUL were performed in the dorsal lithotomy position. Following this, a gentle attempt was made to retrieve the stent with the help of an ureteroscopic grasper. In some cases the stent was grasped by a hemostat clamp out of the urethral meatus with a gentle traction to facilitate lithotripsy in the ureter and even in the kidney. Finally, a ureteric catheter was placed adjacent to the stent for injection of radio-contrast material to delineate the renal pelvis and the calyces. Then in the same session or later in another session the patient was placed in the prone position and PCNL of the upper coil of the encrusted stent along with calculus was done and the stent was removed. In 5 out of seven patients, the initial indication for stent placement was for urinary stone disease after open nephrolithotomy and pyeloplasty in other centers and in two patients after TUL. All patients

  10. Successful resuscitation after suspected carbon dioxide embolism during laparoscopic ureteric reconstructive surgery

    Directory of Open Access Journals (Sweden)

    Kalpana S Vora

    2013-01-01

    Full Text Available Carbon dioxide (CO2 embolism is a rare but potentially fatal complication of laparoscopic surgery. We report a case of presumed CO2 embolism in a 35-year-old female during laparoscopic ureteric reconstructive surgery. After 2 h of operating time, a sudden decrease in end-tidal carbon dioxide and deterioration of hemodynamic status followed by cardiac arrest with pulseless electrical activity suggested gas embolism. Immediate cardiopulmonary resuscitation and inotropic support resulted in successful outcome. Thus, early recognition of the complication and prompt treatment can avoid catastrophy.

  11. Extravasation of Urine Associated with Bilateral Complete Ureteral Duplication, Vesicoureteral Reflux and Benign Prostatic Hyperplasia.

    Science.gov (United States)

    Suzuki, Issei; Kaga, Kanya; Takei, Kohei; Tokura, Yuumi; Sakamoto, Kazumasa; Nishihara, Daisaku; Mizuno, Tomoya; Yuki, Hideo; Betsunoh, Hironori; Abe, Hideyuki; Yashi, Masahiro; Fukabori, Yoshitatsu; Yamanishi, Tomonori; Kamai, Takao

    2017-02-01

    We report a rare case of extravasation of urine, which may be associated with bilateral complete ureteral duplication, vesicoureteral reflux (VUR), and benign prostatic hyperplasia (BPH). A 71-year-old male presented with a complaint of right abdominal pain. An extravasation of urine was noted, and was improved by indwelling urethral catheterization. Transurethral resection of the prostate and the endoscopic subureteral injection of dextanomer/hyaluronic acid were performed for the treatment of BPH and VUR, respectively. The post-surgery recovery was successful.

  12. Ureteral Involvement Within an Incarcerated Inguinal Hernia in a Patient With Crossed-fused Renal Ectopia

    Directory of Open Access Journals (Sweden)

    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.

  13. Topographic matching of distal radius and proximal fibula articular surface for distal radius osteoarticular reconstruction.

    Science.gov (United States)

    Zhang, H; Chen, S; Wang, Z; Guo, Y; Liu, B; Tong, D

    2016-07-01

    During osteoarticular reconstruction of the distal radius with the proximal fibula, congruity between the two articular surfaces is an important factor in determining the quality of the outcome. In this study, a three-dimensional model and a coordinate transformation algorithm were developed on computed tomography scanning. Articular surface matching was performed and parameters for the optimal position were determined quantitatively. The mean radii of best-fit spheres of the articular surfaces of the distal radius and proximal fibula were compared quantitatively. The radial inclination and volar tilt following reconstruction by an ipsilateral fibula graft, rather than the contralateral, best resembles the values of the native distal radius. Additionally, the ipsilateral fibula graft reconstructed a larger proportion of the distal radius articular surface than did the contralateral. The ipsilateral proximal fibula graft provides a better match for the reconstruction of the distal radius articular surface than the contralateral, and the optimal position for graft placement is quantitatively determined.

  14. Physeal arrest of the distal radius.

    Science.gov (United States)

    Abzug, Joshua M; Little, Kevin; Kozin, Scott H

    2014-06-01

    Fractures of the distal radius are among the most common pediatric fractures. Although most of these fractures heal without complication, some result in partial or complete physeal arrest. The risk of physeal arrest can be reduced by avoiding known risk factors during fracture management, including multiple attempts at fracture reduction. Athletes may place substantial compressive and shear forces across the distal radial physes, making them prone to growth arrest. Timely recognition of physeal arrest can allow for more predictable procedures to be performed, such as distal ulnar epiphysiodesis. In cases of partial arrest, physeal bar excision with interposition grafting can be performed. Once ulnar abutment is present, more invasive procedures may be required, including ulnar shortening osteotomy or radial lengthening.

  15. CHONDROBLASTOMA IN DISTAL TIBIA - A CASE REPORT

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    Chinmaya

    2013-04-01

    Full Text Available INTRODUCTION: Chondroblastoma was first described as calcified gi ant cell tumour by Ewing. Codman described it as epiphyseal chondromatous giant cell tumour. Jaffe and Lichtenstein named it as chondroblastoma, a rare benign cartilag inous tumour. It represents less than 1% of all primary bone tumours and most commonly originate from the epiphyses of long bones, particularly from the epiphyses of the proximal and dis tal parts of the femur, the proximal part of the humerus, and the proximal part of the tibia. O ther reported sites are talus, scapula , patella, pelvis, distal radius, distal tibia , ribs, proximal fibula, calcaneum. Its occurrence in distal tibia is very rare with 2 documented cases in UK from 1974 to 2000, 3 documented cases in FRANCE from 1950 to 200 5 , no documented case from 1977 to 2000 in Harvard, USA. The purpose is to present a rare tumour occurring at an unusual site.

  16. Management of Malunions of the Distal Radius

    OpenAIRE

    Yaniel Truffin Rodriguez; Osmany Pérez Martínez; Rafael Esmandy Gómez Arregoitía; Indira L. Gómez Gil

    2015-01-01

    Fractures of the distal radius often present with a group of major complications. Of these, malunion is one of the most disabling. Its management through salvage procedures is essential for its correction. The case of a 60-year-old healthy woman of urban origin treated at the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos because of a malunion of the distal end of the left radius as a result of a previous Colles' fracture is presented. The patient complained of severe p...

  17. Contemporary Management of Primary Distal Urethral Cancer.

    Science.gov (United States)

    Traboulsi, Samer L; Witjes, Johannes Alfred; Kassouf, Wassim

    2016-11-01

    Primary urethral cancer is one of the rare urologic tumors. Distal urethral tumors are usually less advanced at diagnosis compared with proximal tumors and have a good prognosis if treated appropriately. Low-stage distal tumors can be managed successfully with a surgical approach in men or radiation therapy in women. There are no clear-cut indications for the choice of the most appropriate treatment modality. Organ-preserving modalities have shown effective and should be used whenever they do not compromise the oncological safety to decrease the physical and psychological trauma of dismemberment or loss of sexual/urinary function. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Calcifying aponeurotic fibroma of the distal phalanx.

    Science.gov (United States)

    Schonauer, Fabrizio; Avvedimento, Stefano; Molea, Guido

    2013-02-01

    Calcifying aponeurotic fibroma is a rare benign soft tissue tumor that primarily occurs on the distal portion of the extremities of children and adolescents. It appears like a firm, painless and slowly growing mass with high local recurrence rates. The lesion has characteristic histological features with areas of proliferative plumps of fibroblasts, chondrocytes and foci of calcification. We present a case of calcifying aponeurotic fibroma of the sub-ungual area of the index finger distal phalanx with bone erosion, surgically treated. A 2 year follow up showed satisfactory functional result and no evidence of recurrence.

  19. Distal splenorenal shunt with partial spleen resection

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    Gajin Predrag

    2007-01-01

    Full Text Available Introduction: Hypersplenism is a common complication of portal hypertension. Cytopenia in hypersplenism is predominantly caused by splenomegaly. Distal splenorenal shunt (Warren with partial spleen resection is an original surgical technique that regulates cytopenia by reduction of the enlarged spleen. Objective. The aim of our study was to present the advantages of distal splenorenal shunt (Warren with partial spleen resection comparing morbidity and mortality in a group of patients treated by distal splenorenal shunt with partial spleen resection with a group of patients treated only by a distal splenorenal shunt. Method. From 1995 to 2003, 41 patients with portal hypertension were surgically treated due to hypersplenism and oesophageal varices. The first group consisted of 20 patients (11 male, mean age 42.3 years who were treated by distal splenorenal shunt with partial spleen resection. The second group consisted of 21 patients (13 male, mean age 49.4 years that were treated by distal splenorenal shunt only. All patients underwent endoscopy and assessment of oesophageal varices. The size of the spleen was evaluated by ultrasound, CT or by scintigraphy. Angiography was performed in all patients. The platelet and white blood cell count and haemoglobin level were registered. Postoperatively, we noted blood transfusion, complications and total hospital stay. Follow-up period was 12 months, with first checkup after one month. Results In the first group, only one patient had splenomegaly postoperatively (5%, while in the second group there were 13 patients with splenomegaly (68%. Before surgery, the mean platelet count in the first group was 51.6±18.3x109/l, to 118.6±25.4x109/l postoperatively. The mean platelet count in the second group was 67.6±22.8x109/l, to 87.8±32.1x109/l postoperatively. Concerning postoperative splenomegaly, statistically significant difference was noted between the first and the second group (p<0.05. Comparing the

  20. Rigid ureteroscopic lithotripsy versus percutaneous nephrolithotomy for large proximal ureteral stones: A meta-analysis

    Science.gov (United States)

    Hu, Henglong; Lu, Yuchao; Zhang, Jiaqiao; Qin, Baolong; Wang, Yufeng; Zhang, Zongbiao

    2017-01-01

    Object To compare the safety and efficacy of rigid ureteroscopic lithotripsy (rigid URSL) and percutaneous nephrolithotomy (PCNL) in treating large proximal ureteral stones. Methods A systematic search of PubMed, EMBASE, Cochrane Library, and Web of Science databases was performed to find out relevant studies. After literature screening according to the predetermined inclusion and exclusion criteria, data of eligible studies was extracted and then a meta-analysis was conducted via RevMan 5.3 software. Results Five randomized controlled trials (RCTs), one prospective and four retrospective cohort studies involving 837 patients were included. Patients underwent rigid URSL were associated with shorter operation time (WMD, -23.66min; 95%CI, −45.00 to -2.32; p = 0.03), shorter hospital stay (WMD, -2.76d; 95%CI, −3.51 to −2.02; phematuria (RR, 0.38; 95%CI, 0.25 to 0.57; p < 0.0001). No significant difference was observed in terms of incidence of embolization, pain and ureterostenosis. When cohort studies or studies in which flexible ureteroscopy was used as an intraoperative auxiliary procedure were excluded, we both found that most of the results kept stable. Conclusions Both PCNL and rigid URSL are safe for patients with large proximal ureteral stones while PCNL is more effective in stone clearance. PMID:28182718

  1. Effect of beraprost sodium (BPS) in a new rat partial unilateral ureteral obstruction model.

    Science.gov (United States)

    Takenaka, Masahiko; Machida, Noboru; Ida, Nobutaka; Satoh, Nahoko; Kurumatani, Hajimu; Yamane, Yoshihisa

    2009-01-01

    Unilateral ureteral obstruction (UUO) is a representative model for investigating the common mechanism of decreasing renal function in chronic renal failure. In this study, we present a new partial UUO model in adult rats and evaluated the effect of beraprost sodium (BPS: stable prostaglandin I(2) (PGI(2)) analog). We could make reproductive and uniform partial UUO by ligating the left ureter together with a 0.5 mm diameter stainless steel wire with nylon thread, and withdrawing the stainless wire. One week later, the ureteral obstruction was released. After 3 weeks from the release of UUO, all animals of control group, without BPS administration, developed basophilic degeneration of tubular epithelium, tubular dilatation and interstitial fibrosis. The areas of tubular degeneration and fibrosis were significantly reduced in the BPS group, orally administered BPS 300 microg/kg twice a day from the next day of the release of obstruction, than in control group. In conclusion, we can established the adult rat partial UUO-release model and revealed that BPS can inhibit renal tubular damage and tubulointerstitial fibrosis.

  2. Cost-effective analysis of pneumatic and laser lithotripsy techniques in ureteral stones

    Directory of Open Access Journals (Sweden)

    Mehmet Bilgehan Yüksel

    2013-03-01

    Full Text Available Objective: Ureteroscopic lithotripsy (URSL is a commontreatment alternative in ureteral stones. We aimedto evaluate pneumatic and laser lithotripsy techniques,which are used for fragmentation of stones.Materials and methods: The data of 100 patients whounderwent URSL by using pneumatic and laser lithotriptorswere analyzed. The sample divided in 2 groups, eachincluding 50 patients. URSL was performed in lithotomyposition under general anesthesia. The absence of residualstone at second week urinary system graphy wasaccepted as the criteria of success. We evaluated thepresence of differences in terms of efficiency and costeffectivityof pneumatic and laser lithotripsy techniques.Results: The mean ages were 42 and 45 years, respectively.The mean operation time was 43.1 min in pneumaticgroup and 40 min in laser group. Stone-free rates werefound 93.9% and 78%, respectively. The stone migrationrate was determined 16% in pneumatic group and 4.1% inlaser group. Complication rates were 4.1% in pneumaticgroup and 8% in laser group. The cost analysis showedthat pneumatic lithotriptor device cost 10000 TL and laserlithotriptor system cost 76000 TL. Nevertheless, the SocialSecurity Administration paid the same cost for bothlithotripsy techniques.Conclusion: Higher stone-free and lower stone migrationrates were determined in laser lithotripsy application.Therefore, low incidence of the requirement of subsequentsecondary treatments for residual stones in lasertreatment decreased the treatment costs. Nevertheless,the cost is significantly higher in laser technique. It requiresmore detailed studies.Key words: Ureteral stone, ureteroscopy, lithotripsy, efficiency,cost

  3. [Tubeless cutaneous ureterostomy through a single stoma with new extraperitoneal ureteral route up to stoma].

    Science.gov (United States)

    Ishizuka, E; Iwasaki, A; Oogo, Y; Ueki, T; Sawada, T

    1999-01-01

    Tubeless cutaneous ureterostomy through a single stoma has been said to be difficult to establish in patients with normal ureters or normal ureters combined with thick fatty abdominal wall, because of the poor blood supply at the end of the ureters. The technical improvements observed were as follows: 1) The peritoneal fold and the upward traction of the gonadal vessels decrease the ureteral tension and keep the blood supply to the ureters in the extraperitoneal approach. 2) The gonadal vessels and its surrounding tissue, covering the subcutaneous fatty tissue, help the ureteral adhesion at the anastomotic site. 3) Full diminution of the skin defect caused by flap formation, decreases the horizontal tension of the side-to-side anastomized ureters. Sixteen patients with normal ureters underwent this procedure. In a short-term (4-37 months) observation, 4 of the patients, including one with thick abdominal fat, showed unilateral hydronephrosis and 2 patients unilateral non-function kidney. The remaining 10 patients had no complications. Moreover, all the patients have kept their ureterostomies tubeless and their serum blood urea nitrogen and creatinine levels were within normal limits except for one patient. It is reasonably concluded that the new method will result in success clinically even in patients with normal ureters and thick abdominal fatty tissue.

  4. A mathematical model for the induction of the mammalian ureteric bud.

    Science.gov (United States)

    Lawson, Brodie A J; Flegg, Mark B

    2016-04-07

    Congenital abnormalities of the kidney and urinary tract collectively form the most common type of prenatally diagnosed malformations. Whilst many of the crucial genes that direct the kidney developmental program are known, the mechanisms by which kidney organogenesis is achieved is still largely unclear. In this paper, we propose a mathematical model for the localisation of the ureteric bud, the precursor to the ureter and collecting duct system of the kidney. The mathematical model presented fundamentally implicates Schnakenberg-like ligand-receptor Turing patterning as the mechanism by which the ureteric bud is localised on the Wolfian duct as proposed by Menshykaul and Iber (2013). This model explores the specific roles of regulatory proteins GREM1 and BMP as well as the domain properties of GDNF production. Our model demonstrates that this proposed pattern formation mechanism is capable of naturally predicting the phenotypical outcomes of many genetic experiments from the literature. Furthermore, we conclude that whilst BMP inhibits GDNF away from the budding site and GREM1 permits GDNF to signal, GREM1 also stabilises the effect of BMP on GDNF signalling from fluctuations in BMP sensitivity but not signal strength.

  5. Application of Skin Electrical Conductance of Acupuncture Meridians for Ureteral Calculus: A Case Report

    Directory of Open Access Journals (Sweden)

    Wu-Chou Lin

    2011-01-01

    Full Text Available Renal colic is a common condition seen in the emergency department (ED. Our recent study showed that measures of electrical conductance may be used as supplementary diagnostic methods for patients with acute renal colic. Here, we describe the case of a 30-year-old male subject with a left ureteral calculus who presented with frequency and normal-looking urine. He had already visited the outpatient department, but in vain. Normal urinalysis and nonobstructive urogram were reported at that time. Two days later, he was admitted to the ED because of abdominal pain in the left lower quadrant. The urinalysis did not detect red blood cells. Ultrasonography did not indicate hydronephrosis. The meridian electrical conductance and index of sympathovagal balance were found to be abnormal. High level of electrical conductance on the left bladder meridian was found. An unenhanced helical computed tomography was scheduled to reveal a left ureterovesical stone. Ureteroscopic intervention was later uneventfully performed, and the patient's pain was relieved. The follow-up measurements showed that the meridian parameters had returned to normal one month after treatment. This case suggests that bladder meridian electrical conductance might be used as a supplemental method for ureteral calculus diagnosis.

  6. Metformin prevents renal interstitial fibrosis in mice with unilateral ureteral obstruction.

    Science.gov (United States)

    Cavaglieri, Rita C; Day, Robert T; Feliers, Denis; Abboud, Hanna E

    2015-09-05

    Unilateral ureteral obstruction causes important tubulo-interstitial fibrosis in the kidney. Metformin reduces fibrosis in mice with diabetic nephropathy. We examined the effects of metformin in a mouse model of unilateral ureteral obstruction (UUO). Expression of inflammation and fibrosis markers was studied by immunohistochemistry, immunoblot and quantitative real-time polymerase chain reaction. Seven days after UUO, kidneys presented dilated tubules, expansion of the tubulo-interstitial compartment, and significant infiltration of inflammatory cells. Macrophage infiltration and inflammation markers expression were increased in obstructed kidneys and reduced by metformin. Metformin reduced expression of extracellular matrix proteins and profibrotic factor TGFβ in obstructed kidneys, measured by immunohistochemistry. Interstitial fibroblast activation was evident in obstructed kidneys and ameliorated by metformin. UUO did not affect adenosine monophosphate-activated kinase (AMPK) activity, but metformin activated AMPK. Our results show that metformin prevents or slows down the onset of renal inflammation and fibrosis in mice with UUO, an effect that could be mediated by activation of AMPK.

  7. Circumcaval Ureter with Vesico Ureteral Reflux: The First Association in Literature

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    Ilhan Ciftci

    2012-06-01

    Full Text Available A circumcaval ureter is a rare congenital anomaly in which the ureter passes behind, and is compressed by, the inferior vena cava. Its etiology is assumed to be abnormal embryologic development of the inferior vena cava as a result of atrophy failure of the right subcardinal vein in the lumbar portion. A circumcaval ureter is also termed a retrocaval ureter. The right supracardinal system fails to develop, whereas the right posterior cardinal vein persists. With one reported exception, the anomaly always occurs on the right side. Patients with this anomaly may develop partial right ureteral obstruction or recurrent urinary tract infections. Therapeutic options include surgical relocation of the ureter anterior to the cava. A 14-year-old female patient came with complaints of fever, intermittent colic and dysuria 4 years ago. A right ureteric fourth-grade VUR and circumcaval ureter were established. An anomaly in which both of these are together could not be found in literature. If after the VUR treatment he has progressive abdomen pain and advancing hydronephrosis, a circumcaval ureter as an additive anomaly must not be forgotten. For that reason, in a patient having a urinary system anomaly, a likely extra anomaly should be searched. [Arch Clin Exp Surg 2012; 1(3.000: 191-194

  8. A new approach in ureteral access sheath locating in retrograde intrarenal surgery (RIRS by endovisional technique

    Directory of Open Access Journals (Sweden)

    Mehmet Giray Sönmez

    2016-01-01

    Full Text Available Objective: To compare the results of patients who underwent retrograde intrarenal surgery (RIRS using endovisional technique for ureteral sheat locating with control group in which endovisional technique was not applied. Material and Methods: Of the 41 patients who underwent RIRS treatment for kidney stone, between March 2014- August 2015, 19 patients treated with endovisional technique formed the study group and remaining 22 patients formed the control group. Patients were evaluated for age and gender, baseline and post procedural creatinine level, duration of operation, fluoroscopy and hospitalization time, size and localization of the stone, presence of multiple stones, previous shock wave lithotripsy (SWL procedure, double J catheter requirement, complication rate, residual stone rate and absence of stone ratio. Results: There was no statistically significant difference between age, gender, location of the stone, previous SWL procedure, presence of multiple stones, baseline and postprocedural creatinine level, absence of stone ratio, double J catheter requirement and hospitalization duration between the groups. The duration of operation and fluoroscopy of the patients were significantly shorter than the control group (p = 0.036 and p < 0.001, respectively. The complication rates of the endovisional technique group was significantly lower than that of the control group (p = 0.032. Conclusion: Endovisional technique is considered to be an appropriate and useful technique in order to locate the sheath safely in patients who has difficulty in ureteral access sheath locating and to decrease the duration of operation and fluoroscopy.

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

    Directory of Open Access Journals (Sweden)

    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.

  10. Allium stent for the treatment of a malignant ureteral stenosis: a paradigmatic case.

    Science.gov (United States)

    Oderda, Marco; Lacquaniti, Sergio; Fasolis, Giuseppe

    2017-06-14

    The aim of this study was to present a paradigmatic case where the new-generation Allium URS stent was the optimal choice to treat a malignant ureteral stenosis. We describe in detail all the steps of our surgery, performed on a 69-year-old patient with left hydronephrosis caused by lumbo-aortic nodal metastases compressing the ureter. The patient was intolerant to double-J stent due to strong irritative urinary symptoms. Allium URS stent was positioned under fluoroscopy in replacement of pre-existing double-J stent. Our approach was successful and irritative urinary symptoms disappeared. At 6 months, the Allium URS was correctly positioned and no hydronephrosis was detected on ultrasound. The stent can be left in place for a maximum of 3 years. In complicated scenarios of chronic ureteral stenosis, the new-generation Allium URS can be an interesting option to treat the obstruction while sparing the patient the irritative urinary symptoms and periodic replacements typical of a double-J stent.

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

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Li-Jen; Wong, Yon-Cheong [Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing St., Gueishan, 33333, Taipei (Taiwan); Ng, Chip-Jin; Chen, Jih-Chang; Chiu, Te-Fa [Department of Emergency Medicine, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing St., Gueishan, 33333, Taipei (Taiwan)

    2004-09-01

    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.)

  12. Hyperextension trauma to the elbow joint induced through the distal ulna or the distal radius

    DEFF Research Database (Denmark)

    Tyrdal, Stein; Olsen, Bo Sanderhoff

    1998-01-01

    Loads applied to the forearm result in hyperextension of the elbow. The pathomechanics of hyperextension trauma with load applied to the distal radius and ulna were studied in 10 macroscopically normal cadaver elbow joint specimens to reveal patterns of injury with radial traction (n = 5) compared...... trauma to the elbow joint induced through the distal ulna or the distal radius produced the same pattern of injury as reported in hyperextension of the elbow with traction to the forearm when free rotation of the radius relative to the ulna was allowed....

  13. Intramedullary nailing in distal tibial fracture

    Directory of Open Access Journals (Sweden)

    Damian Arroquy

    2015-11-01

    Methods The inclusion criteria of this study were skeletally mature patients with displaced fractures of the distal tibia treated with intramedullary nail with a minimum follow up of one year. Gustilo III open fractures and type C fractures of the AO classification (complete articular Stroke were excluded. The sample comprised 35 patients remained. The follow-up was 29.2 months. We evaluated the time of consolidation, malunion and complications. The functional results were described according to the AOFAS score. Results Of the 35 patients with fracture of the distal third of the tibia all of them presented fracture healing. The average time to union was 17.2 weeks (range: 11-26. Of the total sample, 5 patients had delayed union, requiring dynamic nail on average at 12 weeks. The malunion was present in 4 (11.4% patients. We found no  difference (p = 0.201 in the time to union between fractures associated with fractures of the fibula treated (13sem or not (17sem. The AOFAS score was 86 points. Conclusion Intramedullary nailing with multiple distal locks like a good alternative treatment for distal tibia fractures AO type A or B, with low complication rate and a high rate of consolidation.

  14. Conceptualizing distal drivers in land use competition

    DEFF Research Database (Denmark)

    Niewhöner, Jörg; Nielsen, Jonas Ø; Gasparri, Gasparri

    2016-01-01

    This introductory chapter explores the notion of ‘distal drivers’ in land use competition. Research has moved beyond proximate causes of land cover and land use change to focus on the underlying drivers of these dynamics. We discuss the framework of telecoupling within human–environment systems...

  15. Double Plating of Distal Fibula Fractures.

    Science.gov (United States)

    Vance, Danica D; Vosseller, J Turner

    2017-02-01

    Distal fibula fractures are common orthopaedic injuries that often require open reduction internal fixation (ORIF) to anatomically reduce the fracture and minimize the risk of posttraumatic arthritis. In certain clinical situations, stouter fixation may be advantageous to decrease the risk of fixation failure. In this study, the authors report on 12 patients who underwent distal fibula ORIF with 2 one-third tubular plates. Twelve consecutive patients who underwent distal fibula ORIF with 2 one-third tubular plates were retrospectively reviewed. Clinical and radiographic outcomes were reviewed, and functional outcomes were obtained using the Foot and Ankle Outcome Score (FAOS). Institutional review board approval was obtained. All 12 fractures healed clinically and radiographically. One patient was lost to follow-up after healing of the fracture. One patient had removal of fibular hardware at 15 months after surgery. Ten patients had no hardware related pain and good ankle function. FAOS scores were obtained at a mean of 25.6 months after surgery and were as follows: pain (87.6, SD = 9.5), activities of daily living (90.4, SD = 14.5), symptoms (93.3, SD = 9.5), sports (89.5, SD = 18.1), and quality of life (57.4, SD = 21.3). Double plating of distal fibula fractures is a viable technique for problem fractures that potentially provides a readily accessible, low-cost alternative to other means of enhancing fixation. Level IV.

  16. Potassium secretion in mammalian distal colon

    DEFF Research Database (Denmark)

    Sørensen, Mads Vaarby

    2009-01-01

    pre-mRNA splicing and that at least one splice variant could be activated with cAMP. Using molecular biological techniques two different BK subunit splice variants both expressed in the distal colonic epithelial were identified. By the use of two different knock-out mice models, the BK-/- and the CFTR...

  17. 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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  18. Flexible Ureteroscopy versus Retroperitoneal Laparoscopic Ureterolithotomy for the Treatment of Proximal Ureteral Stones >15 mm: A Single Surgeon Experience.

    Science.gov (United States)

    Tugcu, Volkan; Resorlu, Berkan; Sahin, Selcuk; Atar, Arda; Kocakaya, Ramazan; Eksi, Mithat; Tasci, Ali Ihsan

    2016-01-01

    To compare safety and effectiveness of flexible ureteroscopy (F-URS) and laparoscopic retroperitoneal ureterolithotomy (L-RU) in treatment of proximal ureteral stones larger than 15 mm. This study included 103 patients treated with L-RU (Group I), and 80 patients treated with F-URS (Group II) due to proximal ureteral stones larger than 1.5 cm, in a single center. Patients' characteristics and procedure-related parameters including success rate, operation time, hospital stay, postoperative visual analogue scale (VAS) scores, auxiliary procedures, and complications were compared between Groups I and II. It was seen that both methods were effective in the treatment of large ureteral stones; however, R-LU provided a higher stone-free rate (100 vs. 87.5%), a lower complication rate (10.6 vs. 23.7%), and a shorter operation time (65.4 vs. 75.1 min). On the other hand, patients treated with F-URS had less postoperative pain, a shorter hospital stay, a faster return to daily activities. For treatment of large proximal ureteral stones, L-RU provides significantly higher success and lower retreatment rate compared with F-URS. Our results also indicate that R-LU, which has been regarded as an invasive procedure is not as invasive as it is thought to be, and it must be kept in mind that F-URS may cause complications despite its noninvasive nature. © 2015 S. Karger AG, Basel.

  19. Management of urine leak after laparoscopic cyst decortication with retrograde endoscopic fibrin glue application and ureteral stent placement.

    Science.gov (United States)

    Chen, Mang L; Tomaszewski, Jeffrey J; Matoka, Derek J; Ost, Michael C

    2011-01-01

    Urine leakage is an uncommon complication after renal cyst decortication that typically resolves with adequate drainage. With prolonged large volume urine leakage from a perinephric drain, however, consideration for open surgical repair must be taken into account. We present the successful management of persistent urine leakage after laparoscopic cyst decortication with endoscopic retrograde fibrin glue injection and ureteral stent placement.

  20. Is There Hope for Renal Growth on Imaging Studies Following Ureteral Reimplant for Boys With Fetal Hydronephrosis and Urinary Reflux?

    Directory of Open Access Journals (Sweden)

    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.