Postnatal management of antenatally detected hydronephrosis

With the increasing use of ultrasonography,congenital anomalies are often picked in utero.Antenatally detected hydronephrosis is amongst the most commonly detected abnormality.The management of this condition has raised considerable debate amongst clinicians dealing with it.This article is written with an idea to provide comprehensive information regarding the postnatal management of antenatally detected hydronephrosis.A detailed review of the current literature on this topic is provided.Also,guidelines have been given to facilitate the management of this condition.

Laparoscopic correction of hydronephrosis caused by left paraduodenal hernia in a child with cryptorchism:A case report

BACKGROUND Paraduodenal hernia(PDH)is a mesenteric-parietal hernia with retroperitoneal and retrocolic herniation of the small bowel into a sac,which is formed by a peritoneal fold located near the fourth portion of the duodenum.The present case revealed that PDH was a possible reason for hydronephrosis,and that the carful laparoscopic exploration surgery was necessary to find infrequent causes of hydronephrosis to avoid invalid Anderson–Hynes pyeloplasty surgery and its injury.CASE SUMMARY An 8-year-old boy presented to the pediatric department with a chief complaint of cryptorchidism.Afterwards,laparoscopy confirmed hydronephrosis secondary to left PDH with cryptorchid.Then,he received laparoscopic surgery,fixed operation for left PDH,release of the ureteropelvic junction obstruction,and treatment for hydronephrosis.It is necessary to perform secondary surgery for cryptorchidism and long-term follow-up.CONCLUSION The case revealed an extremely rare cause of hydronephrosis in children,suggesting a potential correlation between PDH and hydronephrosis.

Obstructed labour caused by foetal congenital hydronephrosis. Trans-abdominal drainage of the hydronephrosis with resultant delivery per vagina

A case of a 25 year old 2 alive Patient, with obstructed labour with fetal death and delivery of the fetus up to the trunk caused by congenital Bilateral Hydronephrosis is presented. Obstetric examination on admission supported by Abdominal Ultrasound revealed Bilateral Hydronephrosis which was then drained per abdomen using needle and intravenous fluid giving set with eventual relief of the obstruction and vaginal delivery of the stillborn baby.

Giant Hydronephrosis in Sourou Sanou University Teaching Hospital of Bobo-Dioulasso (Burkina-Faso). Two Cases Reports and Literature Review

Giant Hydronephrosis (GH) is a rare condition in urology literature and defined as a pelvicalyceal system of kidney containing more of 1000 ml of urine. This condition is not so rare in our setting. We herein, reported two cases of giant hydronephrosis, seen in two young patients respectively with 5 and 9 years old and their collecting system containing 4000 ml and 5000 ml of urines respectively. Only simple nephrectomy was performed for the two cases with renal function impairment and the post operative course was uneventful. Our purpose through these cases reports is to discuss diagnosis features and management of such condition in our setting, a context of low income countries as Burkina-Faso where diagnosis tool and further investigation are not always available.

Psoas Muscle Hydatid Cyst Causing Ureteric Compression and Hydronephrosis

Psoas muscle is a rare location for hydatid disease. Here we present a case of infected hydatid cyst left psoas muscle presenting as left flank pain, fever, local flank tenderness, and raised blood counts. Preoperative diagnoses was made by Ultrasonography (USG) and Computed Tomography (CT) abdomen, although serology for hydatid disease was negative.

Hydronephrosis and Ureteral Obstruction in Crohn’s Disease

Hydronephrosis and ureteral obstruction are rare sequelae of Crohn’s disease. Chronic obstruction can ultimately lead to dysfunction of the affected kidney, and atypical presenting symptoms create pitfalls in diagnosis. Few reviews in the literature focus on this process and are limited to isolated case reports and case reviews. We performed a PubMed search using such terms as “Hydronephrosis” AND “Crohn’s disease” AND/OR “ureteral obstruction.” References from selected papers were reviewed for relevance and used for information-gathering as well. Ureteral obstruction most commonly occurs on the right side, due to ileal involvement. Clinical diagnosis is difficult, as symptoms are notably not genitourinary in origin;rather they are more musculoskeletal in nature. Treatment centers on disease control and temporary drainage of the affected kidney. Though rare, hydronephrosis and ureteral obstruction may develop as a result of inflammatory bowel disease. Due to atypical presenting symptoms, a high clinical suspicion is needed to affirm the diagnosis and ensure proper treatment.

About 4 Cases Report of Giant Hydronephrosis Inurology Department of the National University Healthcare, CNHU HKM of Cotonou

The authors report 4 different cases of giant hydronephrosis in the urology department of the national university healthcare, CNHU HKM of Cotonou. The frequency of the items, the etiologies and the different treatments carried out were elucidated. The patients were all females. The hydronephrosis affected the left kidney. The most frequent etiology was pyelouretral junction syndrome seconded by obstructive nephrolithiasis in the upper urinary tract. One of the last etiologies was lower pole vascular plexus. Three nephrectomies and one K?SS-HEYNES-ANDERSON pyeloplasty were carried out. Conclusion: Giant hydronephrosis is a rare condition. The etiologies were organic-based and malformed. The therapeutic attitude adopted shows the interest of an antenatal diagnosis for early care.

Migration of varicocele coil leading to ureteral obstruction and hydronephrosis:A case report

BACKGROUND Varicocele embolization,a minimally invasive treatment for symptomatic varicoceles,carries a rare risk of complications like ureteral obstruction and hydronephrosis.This case report documents such a case to raise awareness of these potential complications and showcase minimally invasive surgical management as a successful solution.CASE SUMMARY A 35-year-old male presented with flank pain and hematuria following varicocele embolization.Imaging confirmed left ureteral obstruction and hydronephrosis.Laparoscopic ureterolysis successfully removed the embolization coil and repaired the ureter,resolving the patient's symptoms.Follow-up at six months and two years showed sustained improvement.CONCLUSION Minimally invasive surgery offers an effective treatment option for rare complications like ureteral obstruction arising from varicocele embolization.

Subadventitial resection of the ureterd-new method for surgical corrections of the ureteropelvic junction and ureterovesical junction obstructions

Objective:The aim of our study was to examine results of pyeloplasty using the new methoddsubadventitial resection of the ureter with preservation of the ureteral artery proposed by us and the possibility of using this method in one-stage surgery with ureteropelvic junction(UPJ)and ureterovesical junction(UVJ)obstructions or vesicoureteral reflux.Methods:A retrospective analysis of 108 patients with hydronephrosis(including two patients with hydroureteronephrosis)who received treatment from March 1998 to March 2020 was carried out,with an average follow-up period of 36 months.Dismembered pyeloplasty using a subadventitial technique with preservation of ureteral blood supply was performed in 108 patients(including bilateral in two cases).In one patient with UPJ and UVJ obstructions and in one patient with UPJ obstruction and vesicoureteral reflux subadventitial resection of the ureter were performed in both segments.Results:All patients managed to preserve the integrity of the ureteral artery during dismembered pyeloplasty,and two patients simultaneously underwent ureterocystostomy by subadventitial resection of the ureter.The method of pyeloureteroplasty with subadventitial resection of the ureter makes it possible to improve long-term results in patients with hydronephrosis,including those with lesions of the UPJ and UVJ segments.In all cases,it was feasible to achieve a decrease in the degree of hydronephrosis.Postoperative complications were observed in five cases(4.6%),in none of which there were complications associated with the surgical technique,and were eliminated without loss of renal function.Conclusion:Our 22 years of experience shows that the technique of subadventitial resection of the ureter allows us to preserve the ureteral blood circulation during dismembered pyeloplasty and thus creates conditions for prevention of restenosis of UPJ and for single-stage ureteroplasty on the upper and lower ureteral segments.

Early diagnosis of renal pelvis villous adenoma:A case report

BACKGROUND Villous adenoma is a rare tumor in the urinary system that usually occurs in the bladder.It is extremely uncommon in the renal pelvis.Most of the previously reported cases have been diagnosed with severe hydronephrosis associated with renal parenchyma atrophy prior to surgery.Because of its rarity,available information on the pathogenesis,diagnosis,treatment and prognosis of the disease is limited.We reported a case of kidney stones with hydronephrosis.During percutaneous nephroscopic lithotripsy,a renal pelvis tumor was found.Biopsy confirmed that the tumor was a villous adenoma of the renal pelvis.CASE SUMMARY A 68-year-old female was admitted to the hospital due to right kidney stones with right hydronephrosis.After admission,a urinary system plain computed tomography scan was performed,which revealed right kidney stones with right hydronephrosis and right upper ureteral dilatation.Multiple new cauliflower-like papillary masses were then discovered in the renal pelvis and calyces during right percutaneous nephroscopic lithotripsy.Biopsy results indicated villous adenoma with high-grade glandular intraepithelial neoplasia.The patient underwent laparoscopic radical resection of the right kidney and ureter.Based on histopathological and immunohistochemical examination,the patient was diagnosed with villous adenoma without adenocarcinoma.CONCLUSION Villous adenoma is rare in the urinary system.We reported a case of renal pelvis villous adenoma,which may provide useful information for the early diagnosis and treatment of this tumor.

Retrocaval Ureter: A Case Series of Three Cases Managed with Uretrouretrostomy

Retrocaval ureter is a very rare congenital malformation. We report a 10 years’ experience in the diagnosis and treatment of retrocaval ureter, a case series of 3 cases in two different countries of the Middle East. This is a retrospective study that included 3 cases of retrocaval ureters in Egypt and Saudi Arabia. Standard open ureteroureteric anastomosis was performed through a flank incision for each case. Patients’ symptoms were re-evaluated after two to four months. Complete recovery from symptoms occurred, and hydroureter and hydronephrosis regressed in all cases. Early diagnosis and treatment are the keys to prevent hydronephrosis and deterioration of renal functions.

Stents for malignant ureteral obstruction

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.

Evaluation of Outcome of Ureteroscopic Pneumatic Lithotripsy in Single Lower Ureteric Calculus and Its Association with CT Parameters

Objective: To evaluate the outcome of ureteroscopic pneumatic lithotripsy in single lower ureteric calculus and correlate its success with different CT parameters like HU, size of calculus and hydrnephrosis, if present. Patients and Methods: This study was conducted from October 2017 to March 2019 in Department of General Surgery, Maulana Azad Medical College, New Delhi. 30 patients (out of which 6 were excluded due to spontaneous passage of calculus), with single lower ureteric calculus were chosen and the outcome of URSL was compared with respect to CT parameters of Size, HU and Hydronephrosis and intra-operative clearance of calculus. Results: Success rate of URSL in single lower ureteric calculus was found to be 75%. Lower HU (774.12 ± 212.85) was associated with higher success rate. Similarly smaller size of calculus (9 ± 2.1) mm was associated with success group. Patients with gross hydronephrosis had a poor outcome of URSL. Lower urinary tract infection (8.33%) was the most common complication. Conclusion: Patients with small size calculus, low HU and absence of hydronephrosis have a better outcome of URSL.

Point of care renal ultrasonography for the busy nephrologist: A pictorial review

The application of bedside ultrasonography in routine clinical practice has dramatically evolved over the last few decades and will likely continue to grow as technological advances lead to enhanced portability and affordability of the equipment. Despite mounting interest, most nephrology fellowship training programs do not offer formal training in renal ultrasonography and there is inertia among practicing nephrologists to adopt this skill as a practice-changing advancement. Lack of familiarity with the topic is considered a key reason for this inertia. Understanding of basic ultrasound physics, instrumentation, principles of optimal image acquisition and interpretation is critical for enhanced efficiency and patient safety while using this tool. Herein, we provide a brief overview of the basic principles of diagnostic renal ultrasonography as well as introduction to common sonographic pathologies encountered in day-to-day nephrology practice with illustrative images.

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.

Pregnancy and delivery after augmentation cystoplasty:A case report and review of literature

BACKGROUND Augmentation cystoplasty,first described by Mikulicz in 1899 involves segments of bowel,stomach or mega-ureter to increase bladder capacity in those with inadequate bladder function or lack of detrusor compliance.The most widely used bowel segment is a detubularised patch of ileum.When ileum is not suitable for augmentation,sigmoid colon is the alternative.However,only eight pregnancies after sigmoidocystoplasty have been reported without detail and clinicians may be uncertain about the effects of sigmoidocystoplasty on reproductive health and pregnancy.CASE SUMMARY We followed the patient from gestational week 32+3 until 6 wk after delivery.During pregnancy,our patient suffered urinary tract infection twice and had to undergo percutaneous nephrostomy drainage due to progressive hydronephrosis.Despite a dense adhesion between the uterus and neobladder,we were able to deliver a healthy baby by cesarian section in the presence of the attending urologist.CONCLUSION Augmentation cystoplasty-afflicted women can have a healthy reproductive life.Certain perioperative measures may be advisable to avoid serious surgical complications.

A novel spherical-headed fascial dilator is feasible for second-stage ultrasound guided percutaneous nephrolithotomy:A pilot study

Objective:In second-stage percutaneous nephrolithotomy(PCNL),because the hydronephrosis has been decompressed,the dilated renal pelvis has resolved and the space is small.Consequently,introduction of the tip of the Amplatz dilator can cause injury to the opposite side of the renal-pelvic mucosa.In this study,we report the experimental and initial clinical performance of a spherical-headed fascial dilator developed specifically for second-stage PCNL.Methods:The novel spherical-headed dilator was compared with existing tapered-headed dilators in configuration and in puncture resistance utilizing a static puncture test.Subsequently,a pilot clinical study was conducted during which patients scheduled to undergo second-stage PCNL from June 2019 to October 2019 in our center were enrolled.A typical ultrasound guided PCNL procedure was performed with the exception that the new spherical-headed fascial dilator was substituted for a tapered-headed one.Results:Experimentally,stab resistance against polyethylene film was significantly increased using the novel spherical-headed dilator compared to the traditional tapered-headed dilators(p<0.005).In the clinical study,the novel dilators were successfully introduced into the renal pelvis and passed down the collecting system in all eight second-stage PCNL cases.There were no cases of renal pelvic perforation or brisk hemorrhage nor need for transfusion.

Successful management of infected right iliac pseudoaneurysm caused by penetration of migrated inferior vena cava filter:A case report

BACKGROUND Indwelling inferior vena cava(IVC)filters might cause various complications,including filter penetration,filter fracture,filter migration,and thrombosis of the IVC.Penetration and migration complications are common,while a caudal migrated double-basket filter with associated infected iliac pseudoaneurysm has seldom been reported.CASE SUMMARY We report a 64-year-old female admitted for sudden onset of severe right abdominal pain after IVC filter placement for 3 mo.The patient had a history of failed endovascular IVC filter retrieval.Computed tomography showed that the retrieval hook of the filter penetrated the right common iliac artery and vein,leading to right iliac artery pseudoaneurysm accompanied by right ureteral obstruction with ipsilateral hydronephrosis,and bilateral iliac veins were occluded.Emergency open repair was performed to remove the IVC filter,the right iliac pseudoaneurysm,and the compromised segments of the iliac veins and IVC with right common iliac artery reconstruction.Staphylococcus aureus was isolated from the tissue culture.The patient was discharged on postoperative day 12 with anticoagulation therapy and antibiotic therapy after discharge.Six-month follow-up computed tomography revealed that the right common iliac artery was patent,and only mild hydronephrosis was detected.CONCLUSION An indwelling IVC filter,even‘embedded’within organized thrombus,could still cause life-threatening complications.Open procedures remain the last resort for IVC filters with severe complications.

Surgical excision of a large retroperitoneal lymphangioma: A case report

BACKGROUND Lymphangiomas are rare benign tumors most commonly found in children under 2 years of age;adult cases are extremely rare.Retroperitoneal lymphangiomas represent less than 1%of all lymphangiomas.Because of their benign nature and possibility of spontaneous resolution,lymphangiomas are sometimes left untreated for long periods of time.However,if they grow large enough to compress surrounding structures,retroperitoneal lymphangiomas may cause symptoms such as abdominal pain,nausea or vomiting.We report a case of a rapidly growing retroperitoneal lymphangioma in an adult,treated with complete surgical excision.CASE SUMMARY A 60-year-old female who was diagnosed with an intra-abdominal cystic mass(11 cm×9.5 cm)seven years ago presented to our hospital with symptoms of early satiety,nausea,and intermittent abdominal pain.Computed tomography(CT)scan confirmed interval enlargement to a 24 cm×22 cm-sized huge left retroperitoneal mass,causing left hydronephrosis by external compression.Laparotomy was done via long midline incision.Due to severe adhesion between the aorta and the medial border of the mass,the cyst was intentionally opened for fluid aspiration and size reduction.After suture closure of the opening,we proceeded carefully with dissection.Aspiration showed light yellowish serous fluid.The mass was excised completely,and the pathology was consistent with cystic lymphangioma.The post-operative period was uneventful,and the patient was discharged without complications.Follow-up CT scan one month after surgery confirmed complete removal of the mass and decreased left hydronephrosis.CONCLUSION Excision of the huge retroperitoneal cystic mass resulted in relief of the patient’s symptoms,originally caused by external compression,and also ruled out the possibility of malignancy.

Retrocaval ureter presenting at 6 years of age in a girl child e An extreme rarity

Retrocaval ureter is one of the very rare congenital anomalies.We report a case of retrocaval ureter in a 6-year-old girl who presented with right flank pain and hydronephrosis.The diagnosis was made on intravenous urography which showed typical“J”shape deformity in the proximal dilated ureter with moderate hydronephrosis.CT scan delineated the course of ureter.The patient was operated and findings were confirmed.The ureter was transected near the pelvis and a pyeloureteric anastomosis with pre-caval transposition of the ureter was performed and the patient was discharged in fair health.