An evaluation of ureteral diameter ratio and vesicoureteral reflux index in the treatment of primary vesicoureteral reflux

Objective:Vesicoureteral reflux(VUR)index is a simple,validated tool that reliably predicts significant improvement and spontaneous resolution of primary reflux in children.The aim of this study was to evaluate and compare the ureter diameter ratio(UDR)and VUR index(VURx)of patients treated with endoscopic injection(EI)and ureteroneocystostomy(UNC)methods in the pediatric age group due to primary VUR.Methods:Patients under the age of 18 years old who underwent EI and UNC with the diagnosis of primary VUR between January 2011 and September 2021 were determined as the participants.The UDR was assessed using voiding cystourethrography,and the VURx score was determined prior to treatment based on hospital records included in the study.Results:A total of 255 patients,60(23.5%)boys and 195(76.5%)girls,with a mean age of 76.5(range 13.0e204.0)months,were included in the study.EI was applied to 130(51.0%)patients and UNC was applied to 125(49.0%)patients due to primary VUR.The optimum cut-off for the distal UDR was obtained as 0.17 with sensitivity and specificity of 73.0%and 63.0%,respectively.The positive and negative predictive values were 66.0%and 70.0%,respectively.Conclusion:When the UDR and VURx score are evaluated together for the surgical treatment of primary VUR in the pediatric age group,it is thought that it may be useful in predicting the clinical course of the disease and evaluating surgical treatment options.

Understanding intrarenal backflow: Intrarenal pressure during ureteroscopy and beyond

The number of ureterorenoscopic procedures for upper urinary tract stone management has increased dramatically during recent years worldwide[1].Developments in flexible ureteroscope and laser technology have made it possible to successfully address larger and more complex stone scenarios retrogradely.On the other hand,this means that more and more patients are exposed to the potential adverse effects of ureteroscopy[2].In general,ureteroscopy is considered a safe procedure.However,serious complications and even deaths do occur,and these events are most likely underreported[3,4].

The optimal stent pusher position to achieve successful ureteral stent insertion under fluoroscopic guidance

Objective: To examine factors to predict the optimal stent pusher position when inserting ureteral stents under fluoroscopy.Methods: We retrospectively reviewed 327 patients who underwent ureteral stent insertion. We considered the pubic bone as a useful anatomical landmark to insert ureteral stents under fluoroscopic guidance. Thus, we categorized patients into three groups (proximal, middle, and distal groups) according to the position of the radiopaque tip of the push catheter when inserting the ureteral stent. Success was defined as a completely curled ureteral stent tail. We compared stent insertion success rates among the three groups. A multivariate analysis was performed to identify the factors affecting stent insertion success.Results: In men, 36 (63.2%) cases were deemed successful in the proximal group compared with 40 (80.0%) cases in the middle group and 12 (20.7%) cases in the distal group (p<0.001). In women, 26 (45.6%) cases were deemed successful in the proximal group compared with 54 (98.2%) cases in the middle group and 38 (76.0%) cases in the distal group (p<0.001). With the multivariate analysis, the stent pusher position was the most significant factor influencing successful stent insertion (men: odds ratio 6.00, 95% confidence interval 2.66-13.51, p<0.001;women: odds ratio 37.80, 95% confidence interval 4.94-289.22, p<0.001).Conclusion: The position of the stent pusher affects stent insertion success. The middle of the pubic symphysis is the optimal position for the radiopaque tip of the pusher when inserting ureteral stents under fluoroscopic guidance.

Boari Kuss Technique for Iatrogenic Ureter Injury on Single Kidney at C.H.U le Luxembourg about a Case and Review of the Literature

Introduction: Ureteral lesions, most often iatrogenic, generally follow pelvic surgery. They are serious and can be life-threatening. Uretero-vesical reimplantation using the BOARI technique, modified by KUSS, was popularized in humans in 1954, and appears to be the most appropriate treatment for lesions of the lower ureter with significant loss of substance. Observation: We report in this work a case of iatrogenic ligation of the pelvic ureter on a single functional kidney (of fortuitous discovery) during gynecological surgery, having led to an Alteration of the General State (important Urinoma and collapse of the renal function) and treated by the surgical technique of BOARI KUSS at the urology department of the CHU Le Luxembourg. Follow-up and postoperative follow-up were excellent. Conclusion: Surgical repair of the ureter is very often indicated in cases of stenosis or iatrogenic lesions of the ureter. The BOARI KUSS technique is a good choice in cases of significant loss of substance due to injury to the lower ureter. Gynecological surgery is the main source of these lesions, and the prognosis of the treatment depends on how early the diagnosis is made, the anatomical condition of the ureter and the expertise of the surgical team.

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.

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.

Analysis of the Efficacy of Prenatal B-Ultrasound in Diagnosing Fetal Abnormalities

Objective:To explore the positive significance of using prenatal B-ultrasound in diagnosing fetal abnormalities.Methods:A total of 200 pregnant women who visited Shaanxi Provincial People’s Hospital between January 2023 and January 2024 were recruited as the research subjects.All pregnant women received prenatal examinations.A retrospective analysis was carried out to analyze the positive significance of prenatal B-ultrasound examination in the diagnosis of fetal abnormalities.Results:Prenatal B-ultrasound examination detected 10 cases of fetal abnormalities,with a detection rate of 5.00%.When compared with the postnatal examination results of 5.50%,the difference was insignificant(P>0.05).Moreover,comparing the fetal limb abnormalities and cardiovascular abnormalities in prenatal B-ultrasound examination and postnatal examination,one case of congenital heart disease was missed in the prenatal B-ultrasound examination,and the others were consistent with the postnatal examination results,with a coincidence rate of 90.91%,indicating a high compliance rate.Conclusion:Fetal abnormalities have a great impact on mothers,babies,and families,and it is particularly important to strengthen diagnosis during this process.Prenatal B-ultrasound examination can improve the accuracy of diagnosis of fetal abnormalities and can be promoted in clinical practice as a basis for screening fetal abnormalities.

The Long Term Follow-Up Results of the Direct Nipple Ureteroneocystostomy Technique: A Prospective Study

Objective: To evaluate the long term follow-up results of the direct nipple ureteroneocystostomy technique. Materials and Methods: We studied a total of 16 patients (19 renal units) who underwent direct nipple ureteroneocystostomy. The mean age was 43 years and 3 patients had bilateral disease. In five units the ureters had been ligated during gynecological surgery, 11 renal units were obstructive and three units were reflexive megaureters. The ureters were spatulated for about 2 cm and folded back. Nipples 2 to 2.5 cm long were prepared. In two cases the ureters were thin-walled (2 mm or less) and they were not spatulated but folded back onto themselves. In one case the ureter could not be everted since it had a thick and fibrotic wall. The distal 2 to 2.5 cm segment of this ureter was directly inserted in to the bladder. Postoperative follow-up was at 3 month intervals for the first year at 6 month intervals for 2 - 3 years and yearly thereafter. At the time of follow-up serum creatinine, urine culture, ultrasound, intravenous urography, voiding cystoureterography, nuclear renal scintigraphy and cystometric evaluations were performed. The functions of 11 and 15 renal units were evaluated scintigraphically and stereologically, respectively, in the both preoperative and postoperative first year follow-up. The Wilcoxon Signed Ranks test was used for statistical evaluation and p < 0.05 was considered statistically significant. Results: Mean follow-up was 49 months. Three renal units had Grade III reflux (two of them during voiding) and one unit had Grade IV reflux. At follow-up this patient developed in the ureteral stricture. No patients had urinary tract infection, pyelonephritis or ureteral stricture follow-up period. Between the preoperative and postoperative first year, there was an increase in postoperative split renal function based on renal scintigraphy but this difference was not statistically significant. The stereologically calculated decrease in pelvicaliceal dilatation was statistically significant. Conclusion: Ease of application and no need to taper or plicate the ureter or prepare a submucosal tunnel may be the reasons to consider the direct nipple ureteroneocystostomy technique for megaureters of different etiologies.

Utility of trans-vaginal ultrasound in diagnosis and follow-up of non-pregnant sexually active females with lower ureteric calculi

objective:To assess the utility of trans-vaginal ultrasonography in evaluation of non-pregnant sexually active female patients with lower ureteric calculi.Methods:A prospective study was done from January 2015 to December 2017 including non-pregnant sexually active females with suspected ureteric calculus.Trans-abdominal ultrasound was initially done in all patients.In those patients in whom trans-abdominal ultrasound was inconclusive or there was indirect evidence of lower ureteric calculus in form of ureteral dila-tion but no calculus was evident,trans-vaginal ultrasound was done.The patients with ureteric calculi detected on trans-vaginal ultrasound and kept on conservative management were also followed up with trans-vaginal ultrasound.Non-contrast computed tomography was done in patients with inconclusive trans-vaginal ultrasound.Results:As per the study protocol,156 out of the total 468 patients evaluated by trans-abdominal ultrasound were eligible for trans-vaginal ultrasound.Trans-vaginal ultrasound was done in 149 patients,as seven patients did not give consent.Seventy-nine patients were detected with a lower ureteric calculus on trans-vaginal ultrasound and 27 patients had gyne-cologic or other cause for their symptoms.Forty-three patients had an inconclusive trans-vaginal ultrasound of which 36 underwent non-contrast computed tomography,among them only one patient had a lower ureteric calculus.Stone free status could be easily demonstrated on follow-up trans-vaginal ultrasound.

Lump type crossed fused renal ectopia with bilateral vesicoureteral reflux: A case report

BACKGROUND Crossed fused renal ectopia is a rare congenital anomaly of the ascent of the kidney. This anomaly may be observed as a solitary kidney during initial evaluation. A solitary kidney must be evaluated for associated anomalies such as duplication,horseshoe kidney,or crossed renal ectopia.CASE SUMMARY An anomaly was observed in a 9-mo-old male child who was subsequently diagnosed with crossed fused renal ectopia and vesicoureteral reflux(VUR). In this condition,recurrent febrile urinary tract infection can be a serious problem,and can easily cause renal damage due to relatively short ureters and high pressure in the kidney.CONCLUSION To prevent urosepsis and preserve renal function,early diagnosis and proper management including surgical correction should be considered for the management of renal ectopia with VUR.

Relationship of Retinal Nerve Fiber Layer Thickness and Retinal Vessel Calibers with Cognitive Impairment in the Asymptomatic Polyvascular Abnormalities Population

Objective Cognitive impairment(CI)in older individuals has a high morbidity rate worldwide,with poor diagnostic methods and susceptible population identification.This study aimed to investigate the relationship between different retinal metrics and CI in a particular population,emphasizing polyvascular status.Methods We collected information from the Asymptomatic Polyvascular Abnormalities Community Study on retinal vessel calibers,retinal nerve fiber layer(RNFL)thickness,and cognitive function of 3,785participants,aged 40 years or older.Logistic regression was used to analyze the relationship between retinal metrics and cognitive function.Subgroups stratified by different vascular statuses were also analyzed.Results RNFL thickness was significantly thinner in the CI group(odds ratio:0.973,95%confidence interval:0.953–0.994).In the subgroup analysis,the difference still existed in the non-intracranial arterial stenosis,non-extracranial carotid arterial stenosis,and peripheral arterial disease subgroups(P<0.05).Conclusion A thin RNFL is associated with CI,especially in people with non-large vessel stenosis.The underlying small vessel change in RNFL and CI should be investigated in the future.

Multi-modality imaging review of congenital abnormalities of kidney and upper urinary tract

Congenital abnormalities of the kidney and urinary tract(CAKUT) include a wide range of abnormalities ranging from asymptomatic ectopic kidneys to life threatening renal agenesis(bilateral). Many of them are detected in the antenatal or immediate postnatal with a significant proportion identified in the adult population with varying degree of severity. CAKUT can be classified on embryological basis in to abnormalities in the renal parenchymal development, aberrant embryonic migration and abnormalities of the collecting system. Renal parenchymal abnormalities include multi cystic dysplastic kidneys, renal hypoplasia, number(agenesis or supernumerary), shape and cystic renal diseases. Aberrant embryonic migration encompasses abnormal location and fusion anomalies. Collecting system abnormalities include duplex kidneys and Pelvi ureteric junction obstruction. Ultrasonography(US) is typically the first imaging performed as it is easily available, noninvasive and radiation free used both antenatally and postnatally. Computed tomography(CT) and magnetic resonance imaging(MRI) are useful to confirm the ultrasound detected abnormality, detection of complex malformations, demonstration of collecting system and vascular anatomy and more importantly for early detection of complications like renal calculi, infection and malignancies. As CAKUT are one of the leading causes of end stage renal disease, it is important for the radiologists to be familiar with the varying imaging appearances of CAKUT on US, CT and MRI, thereby helping in prompt diagnosis and optimal management.

Adult iatrogenic ureteral injury and strictureeincidence and treatment strategies

Iatrogenic ureteral injuries and strictures are relatively common complication of pelvic surgery and radiation treatment.Left untreated they are associated with severe shortand long-term complications such as urinoma,septic state,renal failure,and loss of a renal unit.Treatment depends on timing of diagnosis,as well as extent of injury,and ranges from simple endoscopic management to complex surgical reconstruction under usage of pedicled grafts.While recent advances in ureteral tissue engineering are promising the topic is still underreported.Historically a domain of open surgery,laparoscopic and robotic-assisted approaches have proven their feasibility in small case series,and are increasingly being utilized as means of reconstructive surgery.This review aims to give an outline of incidence and treatment of ureteral injuries and strictures in light of the latest advances.

Huge encrusted ureteral stent forgotten for over 25 years:A case report

BACKGROUND Ureteral stent insertion is a relatively non-invasive procedure commonly used in the field of urology to resolve urinary obstruction.However,they are sometimes forgotten and the risk of complications increases with time.CASE SUMMARY A 43-year-old woman with a history of recurrent urinary tract infections visited our hospital for evaluation of persistent left flank pain,and lower urinary tract symptoms despite anti-biotic treatment.She had received urological surgery in her teens but did not know the details of her surgery.Kidney,ureter,and bladder X-ray and abdominopelvic computed tomography revealed a forgotten left ureteral stent with huge encrustation at both ends and a severely dilated left kidney with parenchymal thinning.In order to remove the ureteral stent,a laparoscopic nephroureterectomy was planned.The ureteral stent was successfully removed,and she was discharged after recovery.The patient was followed up for two years after surgery and did not show any signs of long-term complications.CONCLUSION Long indwelling stents can cause dire complications requiring radical interventions.Stent registry systems,novel stent material development,and proper patient education is important for complication prevention.

Inverted Y ureteral duplication with an ectopic ureter and multiple urinary calculi:A case report

BACKGROUND In the clinical treatment of diseases related to ureteral duplication,it is very important to make a clear diagnosis before surgery because different types of ureteral duplication correspond to different treatment options.Inverted Y ureteral duplication with ectopic ureters and multiple urinary calculi is clinically rare.This case can help clinicians increase their understanding of this disease and gain some experience in its diagnosis and treatment.CASE SUMMARY A 36-year-old male who was previously healthy presented to the hospital with lumbar pain.Percussion of the right kidney area showed the patient had pain.Computed tomography scans revealed multiple urinary calculi in the right urinary system.Computed tomography urography revealed a duplicated ureteral malformation with an ectopic ureter.A transurethral ureteroscopic holmium laser lithotripsy was performed successfully.Intraoperative retrograde ureterography was performed,and the ectopic ureter was visible.We informed the family of the intraoperative findings and suggested laparoscopic ectopic ureterectomy for the ectopic ureteral stones.Unfortunately,the family temporarily refused laparoscopic surgery.The patient did not feel any discomfort after one year of followup.CONCLUSION Inverted Y ureteral duplication with an ectopic ureter and multiple urinary calculi is rare.Clinicians must be highly vigilant,make a correct diagnosis before surgery,determine the type of ureteral duplication and the distribution of urinary calculi,and then draw up a reasonable treatment plan to avoid unnecessary complications.

Acute kidney injury due to bilateral malignant ureteral obstruction:Is there an optimal mode of drainage?

There is a well-known relationship between malignancy and impairment of kidney functions,either in the form of acute kidney injury or chronic kidney disease.In the former,however,bilateral malignant ureteral obstruction is a surgically correctable factor of this complex pathology.It warrants urgent drainage of the kidneys in emergency settings.However,there are multiple controversies and debates about the optimal mode of drainage of the bilaterally obstructed kidneys in these patients.This review addressed most of the concerns and provided a comprehensive presentation of this topic from the recent literature.Also,we provided different perspectives on the management of the bilateral obstructed kidneys due to malignancy.Despite the frequent trials for improving the success rates and functions of ureteral stents,placement of a percutaneous nephrostomy tube remains the most recommended tool of drainage due to bilateral ureteral obstruction,especially in patients with advanced malignancy.However,the disturbance of the quality of life of those patients remains a major unresolved concern.Beside the unfavorable prognostic potential of the underlying malignancy and the various risk stratification models that have been proposed,the response of the kidney to initial drainage can be anticipated and evaluated by multiple renal prognostic factors,including increased urine output,serum creatinine trajectory,and time-to-nadir serum creatinine after drainage.

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.

Analyses of the Anatomy of the Ureter near Ureterovesical Junction on the Unenhanced CT

Purpose: There has been no report evaluating the anatomy of the ureter on CT images. The purpose of this study was to retrospectively evaluate the anatomy of the ureter near the ureterovesical junction on preoperative CT. Methods: Forty patients were analyzed the craniocaudal level of the ureterovesical junction, the transverse distance from the medial line of the body to the ureterovesical junction, the direction of the ureter from the ureterovesical junction, and the length of the ureter from the point of turning medially to the ureterovesical junction. Results: The ureterovesical junction was almost at the level of the upper or middle of the left femoral head. The mean transverse distance on the right and left side was 19.0 and 19.3 mm. The direction of the ureter was almost posterior, lateral, and cranial, but had a wide range of angles. The mean length of the ureter on the right and left side was 24.0 and 23.9 mm. Conclusions: We can evaluate the anatomy of the ureter near the ureterovesical junction on preoperative CT.

Characteristics of ocular abnormalities in gout patients

·AIM: To characterize the clinical features of ocular surface in gout patients in coastal area of Shandong Province in China. ·METHODS: A total of 380 consecutive gout patients were examined from January 2011 to May 2011. According to the course of gout, patients were divided into group A (【5 years), B (5 -10 years) and C (】10 years). Group D (control group) was consist of 50 healthy subjects. Eyelids, lateral canthus, medial canthus, palpebral conjunctiva, sclera and cornea, anterior chamber, lens, anterior vitreous were examined by slit lamp to find whether there were deposition of uric acid crystals, ocular vascular tortuosity, redness and subconjunctival hemorrhage. The ophthalmic exams of visual acuity, intraocular pressure, fundus were used to assess any gout-related eye disease. ·RESULTS: Uric acid crystals were found in 3 patients and the positions of the deposite were in corneal stroma, corneal epithelium and superficial stroma, and sclera respectively. The incidence was 0.79% . Dilatated and tortuous blood vessels in conjunctiva and sclera surface were found in 38 (23.8% ), 40 (44.0% ), 58 (45.0% ), 9 (18.0% ) patients in groups A, B, C and D, respectively. The differences between group B and D, group C and D were statistically significant( 【0.01, 【0.01).Transparent vesicles with metal -like reflected light in subconjunctiva were seen in 26 (16.2%), 29 (31.9%), 41 (31.8%), 2 (4.00%) patients in groups A, B, C and D, respectively. The differences between A and D, B and D, C and D were statistically significant ( 【0.05, 【0.01, 【0.01). Subconjunctival hemorrhage was found in all groups, the difference among the four groups showed no statistically significance. · CONCLUSION: Gout can cause ocular surface abnormalities, such as tophi deposition, subconjunctival transparent vesicles and hemorrhage, and vascular changes. These features have important clinical significance in early detection of the gout and prevention of eye injury. ·

FISH studies of chromosome abnormalities in germ cells and its relevance in reproductive counseling

Chromosome abnormalities are one of the major causes of human infertility. In infertile males, abnormal karyotypes are more frequent than in the general population. Furthermore, meiotic disorders affecting the germ cell-line have been observed in men with normal somatic karyotypes consulting for infertility. In both cases, the production of unbalanced spermatozoa has been demonstrated. Basically addressed to establish reproductive risks, fluorescence in situ hybridization （FISH） on decondensed sperm heads has become the most frequently used method to evaluate the chromosomal constitution of spermatozoa in carriers of numerical sex chromosome abnormalities, carriers of structural chromosome reorganizations and infertile males with normal karyotype. The aim of this review is to present updated figures of the information obtained through sperm FISH studies with an emphasis on its clinical significance. Furthermore, the incorporation of novel FISH-based techniques （Multiplex-FISH; Multi-FISH） in male infertility studies is also discussed. （Asian J Androl 2005 Sep; 7： 227-236）