Fetal Urinary Obstruction and Intervention for Sacrococcygeal Teratoma:A Case Report From Kenya

Fetal lower urinary tract obstruction is a rare condition commonly associatedwith significant perinatalmorbidity andmortality,particularly when detected in the second trimester.The concurrent presentation of a recto-urethral fistula with membranous urethral atresia and sacrococcygeal teratoma has not been reported.We describe a case of extrinsic fetal lower urinary tract obstruction related to a recto-urethral fistula,diagnosed at 33 weeks gestation and managed by serial vesicocentesis until 38 weeks.This case,notable for its absence of hypoplasia despite late diagnosis,resulted in a term delivery of a male infant.After delivery,pediatric surgeons performed an abdominal perineal resection of the tumor.Fetal vesicocentesis remains a viable management option for patients without access to intrauterine surgical interventions.

Dynamic Renal Scintigraphy in Diagnosis of Upper Urinary Tract Obstruction in Transplanted Kidney

Nuclide renal dynamic imaging was performed on 88 transplanted kidney. Two kinds of renal scintigraphic characteristics were identified in recipients with supravesical obstruction of the graft. First, the regular type was characterized by radioactivity defect area in kidney parenchyma during early uptake period followed by ureteropelvic retention. Second, the tubular type was typified by cortical retention and attenuation in collecting system during the whole test period with a special sign of “hollow kidney”. Non obstructive dilated calyces showed similar signs as the regular type. Acute rejection reaction and tubule necrosis demonstrated obstructive time activity curves. However, the radioactivity retention appeared in cortex. It was suggested that dilated calyces and obstructive renogram might not be reliable evidence for upper urinary tract obstruction. The signs of radioactivity attenuation in kidney parenchyma during early uptake period followed by ureteropelvic retention may be more valuable for the evaluation. As for tubular obstruction, specified “hollow kidney” was the characteristic sign which is helpful for the diagnosis.

Obstructive uropathy: Overview of the pathogenesis, etiology and management of a prevalent cause of acute kidney injury

Obstructive uropathy is defined as the structural or functional interruption of urinary outflow at any level in the urinary tract.It is regarded as one of the most prevalent causes of acute kidney injury(AKI),accounting for 5%–10%of cases.Acute severe obstruction of the urinary tract is a potentially threatening situation for the kidneys and therefore requires prompt identification and management to relieve obstruction.The aim of the present article is to review and synthesize available evidence on obstructive uropathy,providing a clinical guideline for clinicians.A literature review on obstructive uropathy in the context of AKI was performed,focusing on the least clarified aspects regarding diagnosis and management.Recent literature searching was conducted in English and top-level evidence articles including systematic reviews,metanalyses and large series were prioritized.Acute obstruction of the urinary tract is a diagnostic and therapeutical challenge that may lead to important clinical complications together with direct structural and hemodynamic damage to the kidney.Early recognition of the leading cause and its exact location is essential to ensure prompt urinary drainage together with the most suitable drainage technique selection.A multidisciplinary approach,including urologists,nephrologists,and other medical specialties,is best suited to correctly manage concomitant hemodynamic changes,fluid and electrolyte imbalances,and other related issues.Obstructive uropathy is one of the leading causes of AKI.Recognition of patients suitable for early diversion and feasibility or adequate selection of the indicated technique is sometimes challeng-ing.A thorough understanding of the physiopathology behind the development of urinary obstruction is vital for correct diagnosis and management.

Pelvic lipomatosis and renal transplantation:A case report

BACKGROUND Pelvic lipomatosis is a rare disease of unknown etiology,characterized by the overgrowth of pelvic adipose tissue that causes compression of the urinary tract including the bladder and ureters,rectum and blood vessels.The patient may progressively develop obstructive uropathy which could subsequently lead to renal failure.At present,there are no reports of renal transplantation due to uremia caused by pelvic lipomatosis.The ideal management of patients with pelvic lipomatosis after renal transplantation is not yet well-established due to the lack of literature and follow-up data.CASE SUMMARY We report a 37-year-old male patient with pelvic lipomatosis who received a successful living donor renal transplantation on July 22,2015.The operation was complicated as the iliac vessels and bladder were wrapped entirely in excessive abnormal fat.The external iliac artery and vein were located using ultrasonographic guidance.The adipose tissue around the right bladder was removed as far as possible,and the graft ureter was reimplanted into the bladder,using the Lich-Gregoir technique.At 22 mo after transplantation,graft percutaneous nephrostomy was performed under ultrasonographic guidance for urinary diversion due to hydronephrosis of the graft kidney.Follow-up at four years showed that the renal allograft function was stable.CONCLUSION When patients with pelvic lipomatosis develop renal failure,renal transplantation could be a feasible treatment strategy.

Magnetic resonance urography in the diagnosis of urinary tract obstruction after renal transplantation

To evaluate magnetic resonance urography (MRU) in the diagnosis of urinary tract obstruction after renal transplantation Methods A total of 31 patients with suspected urinary tract obstruction after renal tran splantation were examined, and the results were compared with those from surgery and B ultrasound examination Results The urinary tract after renal transplantation was clearly shown using MRU, and a ll patients were clearly diagnosed by MRU Imaging results were consistent with those from surgery Conclusions MRU is suitable for detecting urinary tract obstruction after renal transplantat ion It is a alternative method for IVP and CT in patients with renal function impairment and uremia

Incidence and Risk Factors of De novo Stress Urinary Incontinence after Pelvic Floor Reconstruction： A Nested Case-control Study

Background： Some patients with pelvic organ prolapse may suffer from incontinence （SUI） named de novo SUI alter pelvic floor reconstruction of de novo SUI. ower urinary tract symptoms （LUTS）, especially stress urinary This study aimed to investigate the incidence and risk factors Methods： This is a nested case-control study of 533 patients who underwent pelvic floor reconstruction due to pelvic organ prolapse （POP） at the Department of Gynecology in Peking University People＇s Hospital from January 2011 to March 2013. According to the inclusion and exclusion criteria, 401 patients were enrolled in the study with the follow-up rate of 74.8% （101 patients lost to follow-up）. There were 75 patients with de novo SUI postoperatively. According to the ratio of 1：3, we ensured the number of control group （n = 225）. The preoperative urinary dynamics, POP-quantification scores, and LUTS were compared between the two groups by univariate and multivariate logistic regression analyses to investigate the risk factors of de novo SUI. Results： The incidence of de novo SUI was 25% （75/300）. Univariate analysis showed that the ratio of lower urinary tract obstruction （LUTO） before surgery in de novo SUI group was significantly higher than the control group （odds ratio [OR] = 2.1, 95% confidence interval [（7] [1.1-4.0], P = 0.022）. The interaction test of LUTO and other factors displayed that Aa value was an interaction factor. With the increasing score of Aa, the incidence of de novo SUI become higher （OR = 2.1, 95% CI [1.0-3.7], P = 0.045）. After multivariable adjustment, multiple regression analysis showed that LUTO was independently associated with a greater risk of de novo SUI after pelvic floor surgery （OR = 2.3, 95% CI [1.2-4.6], P = 0.013）. Conclusions： Preoperative LUTO in patients with POP is a high-risk factor of de novo SUI, and high score of Aa-point is related to the occurrence of de novo SUI, which might be due to the outlet obstruction caused by bladder prolapse.

Testosterone and benign prostatic hyperplasia

The use of testosterone to treat the symptoms of late-onset hypogonadal men has increased recently due to patient and physician awareness. However, concerns regarding the effect of testosterone on the prostate, in particular any possible effect on the risk of prostate cancer have prompted further research in this regard. Surprisingly, numerous retrospective or small, randomized trials have pointed to a possible improvement in male lower urinary tract symptoms （LUTS） in patients treated with testosterone. The exact mechanism of this improvement is still debated but may have a close relationship to metabolic syndrome. For the clinician, the results of these studies are promising but do not constitute high levels of evidence. A thorough clinical examination （including history, examination and laboratory testing of testosterone） should be undertaken before considering the diagnosis of late-onset hypogonadism or instigating treatment for it. Warnings still remain on the testosterone supplement product labels regarding the risk of urinary retention and worsening LUTS, and these should be explained to patients.