Ureter

Ultrasound and computed tomographic images are described in a patient who underwent renal transplantation and presented with hydronephrosis and partial ureteral obstruction secondary to herniation of the transplant ureter into a left inguinal hernia. To our knowledge, this is the first report of herniation of a transplanted ureter in the inguinal canal resulting in or exacerbating ureteral obstruction.

Sistem perkemihan adalah suatu sistem yang di dalamnya terjadi penyaringan darah sehingga darah bebas dari zat yang tidak digunakan oleh tubuh. Zat ini akan larut dalam air dan dikeluarkan berupa urine. Sistem perkemihan melakukan fungsi ini dengan mengatur komposisi, volume, dan tekana darah yang melewati ginjal. Sistem ini secara terus menerus membuang dan mengasorbsi air dan subtansi terlarut dalam darah, mengeliminasi setiap subtansi yang tidak dibutuhkan atau yang menyebabkan ketidakseimbangan dalam tubuh, sementara subtansi yang berguba untuk tubuh tetap dipertahankan.

To review the guidelines released in the last decade by several organizations regarding the optimal evaluation and management of genitourinary injuries (renal, ureteral, bladder, urethral and genital). This is a review of the genitourinary trauma guidelines from the European Association of Urology (EAU) and the American Urological Association (AUA) and renal trauma guidelines from the Societe Internationale D'Urologie (SIU). Most recommendations are guided by the American Association for the Surgery of Trauma (AAST) organ injury severity system. Grade A evidence is very rare in genitourinary trauma, and most recommendations are based on Grade C evidence. The findings of the most recent urologic trauma guidelines are summarized. All guidelines recommend conservative management for low-grade injuries. The major difference is for high-grade renal trauma, where the SIU and EAU recommended exploratory laparotomy for Grade 5 renal injuries, while the more recent AUA guideline recommen...

Agenesis of the bladder is a rare anomaly, and it is usually associated with the absence of the urethra. In the case report herein, a normal urethra was found with ureters emptying into the posterior urethra. The right kidney was non-functioning and small.

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.

Congenital vesicovaginal fistula is an extreme rarity. We report on a case of a 22-year-old lady who presented with menouria and infertility. On evaluation, she was found to have congenital vesicovaginal fistula, a nonfunctioning right kidney with ectopic ureter and transverse vaginal septum. Abdominal repair of the fistula, right nephroureterectomy, and excision of the vaginal septum was performed.

Congenital absence of uterus and vagina, Mayer–Rokitansky–Kuster–Hauser (MRKH) syndrome, is mullerian agenesis and is the second most frequent cause of primary amenorrhea. Only atypical form of MRKH (type B) is associated with renal skeletal and ovarian abnormalities. We report the management of an unusual case of atypical MRKH, unilateral gonadal agenesis, and solitary ectopic pelvic kidney with pelviureteric junction obstruction (PUJO). After doing thorough Medline search, to the best of our knowledge, this is the first case reported with this combination.

Invasive urinary tumours are relatively rare, and their treatment may cause important changes in urinary, sexual and social functions. A systematic review of external radiation therapy studies in urinary cancers was performed. This synthesis of the literature is based on data from meta-analyses, randomised and prospective trials and retrospective studies. There are few controlled clinical trials using adjuvant or radical radiotherapy with or without chemotherapy in cancer of the kidney, ureter and urethra. There are several reports on multimodality treatment in invasive bladder cancer: intravesical surgery and neoadjuvant chemotherapy to radiotherapy or concomitant radiochemotherapy with organ preservation. The conclusions reached for renal cancer are controversial, and data on cancers of the urethra and ureter are few and inconclusive. Sufficient data now exist in the literature to demonstrate that conservative management with organ preservation is a valuable alternative to radical cystectomy, the traditional gold standard, in invasive bladder cancer I tumori invasivi del tratto urinario sono relativamente rari ed il loro trattamento può causare importanti cambiamenti nelle funzioni sessuali, sociali ed urinarie. È stata effettuata una review sistematica degli studi di radioterapia esterna nei tumori urinari. Questa sintesi della letteratura è basata su dati di meta-analisi, studi prospettici, randomizzati, e retrospettivi. Ci sono pochi studi clinici controllati che hanno utilizzato la radioterapia adiuvante o radicale±chemioterapia nei tumori del rene, degli ureteri e dell’uretra; ci sono diversi studi sul trattamento multimodale del carcinoma invasivo della vescica: chirurgia intravescicale e chemioterapia neoadiuvante alla radioterapia o radio-chemioterapia concomitante con preservazione dell’organo. Le conclusioni raggiunte sul carcinoma renale sono controverse; i dati sul carcinoma degli ureteri e dell’uretra sono pochi e inconclusivi; invece, vi sono ora in letteratura dati sufficienti che dimostrano come l’approccio con preservazione dell’organo, per il carcinoma vescicale invasivo rappresenta una valida alternativa alla cistectomia radicale, considerata per lungo tempo il gold standard.

Severe obstructive uropathy due to infection with S. hematobium often requires reconstructive surgery. Recent reports, have emphasized that many lesions will disappear after specific chemotheraphy given the necessary time. Time for effective chemotherapy may be impossible to allow in severe obstruction. The necessary surgical procedures range from ureteric dilatation to ureteric resection with ileal loop replacement. We suggest that temporary long-term bypass of the diseased ureter using silastic tubes may offer an alternative to resection in many cases while the effect of specific chemotheraphy is awaited. One case is described in which ureterostomy with suprapubic intravesical drainage adequetely bypassed the diseased and obstructed lower two thirds of the left ureter. In the following six months specific chemotherapy had encouraging effects on the bypassed area.

Aim: Improvements in extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy have almost eradicated the need for open surgery in ureteral stones. The aim of this study was to assess characteristics of patients who underwent open ureterolithotomy.Methods: During a 5-year period, a total of 654 patients with ureteral stones were treated. Initial management consisted of ureteroscopy in 524 patients, ESWL in 62 patients and percutaneous nephrolithotomy (PCNL) in 12 patients. Open surgery was performed in 56 patients. Stone location, size and success rates were retrospectively analyzed.Results: Ureteroscopy resulted in successful stone removal in 94%, 98% and 98.5% of proximal, mid and distal ureteral stones, respectively. A total of 14 patients with ureteroscopy failure were referred for open surgery. ESWL treatment resulted in success in 55 patients (88%), and those with ESWL failure were referred for either ureteroscopy (n = 3) or open surgery (n = 4). Open surgery was performed in a total of 56 patients, 38 of whom had been referred from other centers. Stone location was proximal ureter in 25 (44.6%) patients (stone size: 2–12 cm2), mid ureter in five (8.9%) patients (stone size: 2–6 cm2) and distal ureter in 26 (46.4%) patients (stone size: 4–9 cm2). A history of previous unsuccessful endourological procedure was observed in 33 (58%) of 56 patients. Children under age 16 (range 1–15 years) comprised 17.8% of patients undergoing open surgery.Conclusion: Open surgery, which is nowadays being replaced with laparoscopic techniques, is generally indicated for failed endourological procedures (58%), particularly in centers that do not have flexible ureteroscopy or laser lithotriptor, and in patients with larger stones (>3 cm). Children (17.8%) are also candidates for open surgery, if specifically designed endourological equipment is not available.

Accurate analysis of the three-dimensional (3D) architecture of developing organs is critical to understanding how developmental defects can be linked with structural abnormalities. Here, we describe a 3D reconstruction technique of the developing kidney including the outer kidney capsule, ureteric epithelium, and developing nephrons. This 3D reconstructive process involves generating serial sections of the developing kidney, followed by histological staining. Each serial image is projected on the monitor and each tissue lineage or structure is traced. The kidney tracings are aligned and a 3D image is rendered. Each reconstructed tissue/lineage can then be subjected to quantitative analysis (e.g., surface area or volume). The reconstructed ureteric epithelium can be skeletonized to determine the branching architecture.