Longitudinal ureteral split for retroperitoneal fibrosis with ureteral involvement

Idiopathic retroperitoneal fibrosis may rarely invade the ureteral wall, thereby rendering the attempt to perform classical ureterolysis futile. Possibilities for surgical correction include resection with end-to-end anastomosis, utilization of a spiral strip of ureter, small bowel substitution, iatrogenic nephroptosis or longitudinal incision of the involved ureter down to the mucosa. Two patients treated using the latter technique have been followed for 7 months and 132 months without recurrence of the obstructive process. The surgeon, when treating idiopathic retroperitoneal fibrosis, must be prepared to treat intrinsic ureteral involvement using the most appropriate surgical technique.     

The ureteral "J" sign: radiographic demonstration of iatrogenic distal ureteral obstruction after ureteral reimplantation

Progressive caliceal and ureteral dilatation in postoperative patients is assumed to be secondary to either postoperative distal ureteral stricture or ureteral atony. Any study used to differentiate obstruction from atony must be done with an awareness of the effect of a full bladder on the upper tracts, since it can by itself produce varying degrees of ureteral dilatation. We describe 2 patients who had virtually complete distal ureteral obstruction on anterograde pyelography with a "J" shaped distal ureteral segment. The striking observation was that the deformity and associated distal ureteral obstruction could be made to appear and disappear at will, merely by distending or emptying the bladder. We believe that this is an important factor in the progressive dilatation, as well as in the observed deterioration of renal function, and it is properly regarded as an iatrogenic complication.     

A case of ureteral tuberculosis appearing as a ureteral tumor

A 53-year-old female was admitted to our hospital after right hydronephrosis was found on the CT scan taken at another hospital. The urinary cytology and culture findings as well as the urinary culture for acid-fast bacilli results were all negative. At our hospital, CT scan revealed a thickening of the right ureteral wall, and right hydronephrosis. In spite of the fact that retrograde pyeloureterography showed a right ureteric obstruction at the ureterovesical junction, cystoscopic examination demonstrated a normal bladder. Since right lower tract carcinoma was suggested, we performed right nephroureterectomy with bladder cuff. Histopathological diagnosis, however, revealed renal and ureteral tuberculosis.     

Pediatric ureteral ureteral outlet obstruction and obstructive megaureter: observation or operation?

Thirty-nine extracts of 13 plants used traditionally as medicinal by the Ese'ejas were studied in order to determine their cytotoxic effect in the brine shrimp. Infusions showed no toxicity. Those plants that tested positive for methanolic and dichloromethane extracts were assayed for DNA-binding activity. Cytotoxicity was not due to the presence of compounds that interact with DNA. Antimicrobial activity of plants used to treat infectious diseases was also performed for the decoctions. These proved to be active against some of the test microrganisms used in the assay.     

Retrograde migration of ureteral calculi

Aspergillus parasiticus NRRL-2999 was inoculated into meat mixtures with curing salts and into yeast extractsucrose (YES) and sucrose-ammonium salts (SAS) broth with and without curing salts to determine if the presence of curing salts significantly affected growth and aflatoxin production by the mold. The effect of individual curing salts or curing salt mixtures on growth and toxin elaboration by the aspergillus was substrate dependent. When YES broth contained 100 ppm of NaNO2, 2% NaCl, or 1 or 2% NaCl plus 200 ppm of NaNO2 or 200 ppm of NaNO3, growth and/or aflatoxin production was depressed. Biosynthesis of aflatoxin B1 was enhanced by presence of 1 and 4% NaCl in YES broth. The SAS broth containing only NaCl or NaCl combined with nitrite or nitrate yielded less aflatoxin than did control broth or no aflatoxin at all. When compared to the control, an increase in growth and amount of aflatoxin occurred in SAS broth which contained 200 ppm of NaNO3. Sausages containing 100 and 200 ppm NaNO2 and no NaCl supported more mold growth and aflatoxin production than did control sausage with 3% NaCl and 100 ppm of NaNO2. Addition of 2 and 3% NaCl and no nitrite to sausage resulted in less aflatoxin than in control sausage.     

Artificial ureteral replacement for ureteral necrosis after renal transplantation: report of 3 cases

PURPOSE: We applied a new minimally invasive technique of artificial ureteral replacement for renal transplant ureteral necrosis. MATERIALS AND METHODS: Artificial ureteral replacement was performed in 3 renal transplant recipients with ureteral necrosis (complete in 1 and distal in 2) after failure of primary endoscopic treatment. Under fluoroscopic guidance a percutaneous tract is created and progressively dilated. The ureteral silicone polytetrafluoroethylene bonded tube is introduced into the pyelocaliceal renal graft cavities, tracked subcutaneously down to the suprapubic area and introduced into the bladder via a short incision. RESULTS: There were no immediate postoperative complications except for transient postoperative acute prostatitis in 1 patient. No secondary complications were observed with a mean followup of 2.5 years. All grafts have good late function and all tubes are patent with no evidence of encrustation or obstruction. The tubes are well tolerated underneath the skin. Reflux was present in all 3 cases with no clinical manifestation. An asymptomatic episode of lower urinary tract infection was observed in the female patient. CONCLUSIONS: In select cases of ureteral necrosis after renal transplantation artificial ureteral replacement by subcutaneous pyelovesical bypass offers a possible alternative to open ureteral reconstruction.     

Endoscopical management of ureteral trauma

Ureteric injuries are encountered with increasing frequency. Adequate definitions and etiologies are discussed. All treatment modalities are summarised with special attention for the use of JJ stents, the different endourological approaches and "urological pearls".     

Hypernephroma and associated ureteral involvement

The propensity of a hypernephroma to invade the renal vein and even the inferior vena cava is widely known. However, in contrast to papillary carcinoma of the kidney, hypernephromas rarely involve the ureter. Review of the English literature reveals 42 reported cases of ureteral involvement. Most represented metastases as opposed to direct, contiguous extension which is extremely rare. C case of hypernephroma with contiguous castlike extension into the ureter without mucosal violation is presented. Mechanisms of ureteral involvement and implications regarding treatment of hypernephromas are discussed.     

Free ureteral replacement in rats: regeneration of ureteral wall components in the acellular matrix graft

OBJECTIVES: To evaluate ureteral replacement by a free homologous graft of acellular matrix in a rat model. METHODS: In 30 male Sprague-Dawley rats, a 0.3 to 0.8-cm midsegment of the left ureter was resected and replaced with an acellular matrix graft of equal length placed on a polyethylene stent. The animals were killed at varying intervals, and the grafted specimens were prepared for light and electron microscopy. RESULTS: In all animals, the acellular matrix graft remained in its original position without evidence of incrustation or infection, and histologic examination showed complete epithelialization and progressive infiltration by vessels. At 10 weeks, smooth muscle fibers were observed; at 12 weeks, nerve fibers were first detected; at 4 months, smooth muscle cells had assumed regular configuration. CONCLUSIONS: The ureteral acellular matrix graft appears to promote the regeneration of all ureteral wall components.     

Retroperitoneal endometriosis causing cyclical ureteral obstruction

Cooperativity between redox and protonation centres is known to be crucial for the function of complex proteins, but it is often difficult to describe in terms of thermodynamic parameters. Cytochrome c3 is a good model for these studies since, while retaining the overall complexity of larger systems, it is suitable for detailed crystallographic and spectroscopic studies. Assignment of the haem substituent NMR resonances, together with NMR redox titrations of cytochrome c3 from D. desulfuricans ATCC 27774, was used to correlate relative redox potentials to specific haems in the structure: haem II approximately equal to haem I < haem IV < haem III. This order is different from that determined for the homologous proteins studied and in disagreement with that previously reported for this cytochrome (Morais, J., Palma, N., Fraz?o, C., Caldeira, J., LeGall, J., Moura, I., Moura, J.J.G. and Carrondo, M.A. (1995) Biochemistry 34, 12830-12841).     

Contralateral reflux after unilateral ureteral reimplantation

PURPOSE: We analyzed the incidence and outcome of postoperative contralateral reflux after unilateral ureteral reimplantation by the Cohen and Glenn-Anderson techniques. MATERIALS AND METHODS: We retrospectively reviewed the records of 120 patients 3 months to 21 years old in whom unilateral vesicoureteral reflux was treated by unilateral reimplantation. The incidence of postoperative contralateral reflux was documented by followup voiding cystourethrography. RESULTS: Overall 19% of patients who underwent unilateral reimplantation had contralateral vesicoureteral reflux postoperatively, including 21% after the Cohen and 17% after the Glenn-Anderson procedure. Of the cases 61% spontaneously resolved, 13% were surgically corrected and 26% continue to be followed. CONCLUSIONS: The rates of postoperative contralateral vesicoureteral reflux are not significantly different after Cohen and Glenn-Anderson repair. A majority of cases will resolve spontaneously within 2 years. The likelihood of trigonal distortion as the etiology of contralateral reflux is low given the similar incidence in cross-trigonal and ureteral advancement reimplantation.     

Prophylactic ureteral catheterization in gynecologic surgery

OBJECTIVES: To examine the frequency of ureteral catheter usage, its efficacy in preventing injury, and related complications, because the preoperative routine placement of ureteral catheters as a prophylactic measure to prevent ureteral injury is controversial. METHODS: All major gynecologic operations performed between January 1992 and December 1994 were identified. All gynecologic procedures that were preceded by ureteral catheter placement were also identified. A data base maintained by the Department of Quality Management allowed identification of all urinary tract complications and ureteral injuries. Four categories of surgery were analyzed: exploratory laparotomy with catheters, exploratory laparotomy without catheters, operative laparoscopy with catheters, and operative laparoscopy without catheters. The medical records of all patients with urinary tract complications were reviewed. RESULTS: Bilateral prophylactic ureteral catheterization was performed in 469 (15.3%) of 3071 patients. A ureteral injury occurred in 4 (0.13%) of 3071 patients. All four ureteral injuries (0.17%) occurred among 2338 patients who underwent exploratory laparotomy. None of the 733 patients who underwent operative laparoscopy suffered ureteral injury. The incidence of ureteral injury in patients who had ureteral catheters placed before exploratory laparotomy was 2 (0.62%) of 322. Two (0.10%) of 2016 patients who did not have prophylactic ureteral catheters suffered a ureteral injury. There was no statistically significant difference in the incidence of ureteral injury between patients who did and patients who did not undergo ureteral catheterization (P=0.094). CONCLUSIONS: The use of prophylactic ureteral catheters did not affect the rate of ureteral injury in our patients. The very low incidence of ureteral injury among our patients is attributed mainly to meticulous surgical technique.     

Successful treatment with end-to-end ureteral anastomosis for ureteral avulsion caused by abdominal blunt trauma: a case report

The nasopharynx and eustachian tube (auditory tube) were morphologically examined in the white rhinoceros. The narrow nasopharynx cavity was enlarged dorsoventrally. The most lateral part of both sides sharply rises in a dorsal direction and the volume is estimated at 173 cc. The eustachian tube is 145 mm in length from the auditory bulla to the nasopharynx. The hyaline cartilage is well-developed in the middle region of the eustachian tube wall. The results demonstrated that the white rhinoceros does not have a guttural pouch. We suggest that the occurrence of the guttural pouch may not be dependent on the phylogenetic status of perissodactyls such as horse, donkey and tapir.     

Techniques for bypassing and stenting ureteral obstructions

The advent of current endourological equipment and combined cystoscopic fluoroscopy allows the urologist to divert and/or stent the majority of benign and malignant ureteral obstructions in either a retrograde or antegrade fashion. We report on our recent experience in managing 105 obstructed renal units to formulate a troubleshooting endourological algorithm for bypassing and stenting ureteral obstructions. The methods described allow for safe and successful stent diversion in the majority of patients with ureteral obstruction requiring initial or primary endourological management. The algorithm presents alternative techniques for bypassing and stenting ureteral obstructions.