1/32. Ureteral compromise after laparoscopic Burch colpopexy.ureteral obstruction occurred in two patients after laparoscopic Burch cystourethropexy. Both women experienced right flank pain and right hydronephrosis. cystoscopy revealed transmural passage of suture anterior and lateral to the ureteral orifice on the right side. One patient was managed by suprapubic cystoscopy to release the suture; the other was managed by preperitoneal laparoscopy to release suture at the bladder neck. In both patients efflux of urine was seen immediately from the ureteral orifice after suture release. Ultrasound confirmed prompt resolution of hydronephrosis. cystoscopy with confirmation of patent ureters should be performed after every case of retropubic cystourethropexy. Retrograde rigid cystoscopy may not afford adequate access to remove transmural sutures. Placement of sutures at the bladder neck from medial to lateral may avoid entrapment of the intramural portion of ureter. (J Am Assoc Gynecol Laparosc 6(2):217-219, 1999)- - - - - - - - - - ranking = 1keywords = flank pain, flank (Clic here for more details about this article) |
2/32. Geriatric ureteropelvic junction obstruction: the possible role of an arteriosclerotic lower pole branch of renal artery: report of two cases.An 83-year-old woman presented with left flank pain and high grade fever. After left ureteral catheterization and intensive chemotherapy with hemoperfusion, surgical exploration revealed the lower pole branches of the renal vessels were obstructing the ureteropelvic junction (UPJ), and dissection of the vessels released the obstruction. An 82-year-old man presented with right flank pain. angiography demonstrated UPJ obstruction caused by the lower pole branch of the renal artery. Arterial dissection with dismembered pyeloplasty resulted in improvement of obstruction. In both cases, the patients had a long history of hypertension with mild to severe arteriosclerosis. arteriosclerosis associated with fixation of the UPJ, may be one of the important factors leading to progressive hydronephrosis in geriatric patients.- - - - - - - - - - ranking = 2keywords = flank pain, flank (Clic here for more details about this article) |
3/32. Silent hydronephrosis/pyonephrosis due to upper urinary tract calculi in spinal cord injury patients.STUDY DESIGN: A study of four patients with spinal cord injury (SCI) in whom a diagnosis of hydronephrosis or pyonephrosis was delayed since these patients did not manifest the traditional signs and symptoms. OBJECTIVES: To learn from these cases as to what steps should be taken to prevent any delay in the diagnosis and treatment of hydronephrosis/pyonephrosis in SCI patients. SETTING: Regional spinal injuries Centre, Southport, UK. methods: A retrospective review of cases of hydronephrosis or pyonephrosis due to renal/ ureteric calculus in SCI patients between 1994 and 1999, in whom there was a delay in diagnosis. RESULTS: A T-5 paraplegic patient had two episodes of urinary tract infection (UTI) which were successfully treated with antibiotics. When he developed UTI again, an intravenous urography (IVU) was performed. The IVU revealed a non-visualised kidney and a renal pelvic calculus. In a T-6 paraplegic patient, the classical symptom of flank pain was absent, and the symptoms of sweating and increased spasms were attributed to a syrinx. A routine IVU showed non-visualisation of the left kidney with a stone impacted in the pelviureteric junction. In two tetraplegic patients, an obstructed kidney became infected, and there was a delay in the diagnosis of pyonephrosis. The clinician's attention was focused on a co-existent, serious, infective pathology elsewhere. The primary focus of sepsis was chest infection in one patient and a deep pressure sore in the other. The former patient succumbed to chest infection and autopsy revealed pyonephrosis with an abscess between the left kidney and left hemidiaphragm and xanthogranulomatous inflammation of perinephric fatty tissue. In the latter patient, an abdominal X-ray did not reveal any calculus but computerised axial tomography showed the presence of renal and ureteric calculi. CONCLUSIONS: The symptoms of hydronephrosis may be bizarre and non-specific in SCI patients. The symptoms include feeling unwell, abdominal discomfort, increased spasms, and autonomic dysreflexia. physicians should be aware of the serious import of these symptoms in SCI patients.- - - - - - - - - - ranking = 1keywords = flank pain, flank (Clic here for more details about this article) |
4/32. Transitional cell papilloma of ureter in young boy.A case of transitional cell papilloma of the ureter is reported in a seven-year-old boy who had a history of severe flank pain and was found to have hydronephrosis of the left kidney. A brief review of the literature has revealed that transitional cell papilloma of the ureter is extremely rare in children.- - - - - - - - - - ranking = 1keywords = flank pain, flank (Clic here for more details about this article) |
5/32. Uriniferous perirenal pseudocyst: new observations.The chronic encapsulated extravasation of urine, most accurately designated as uriniferous perirenal pseudocyst, causes urine to collect within a characteristic complex of radiographic findings including an elliptical soft-tissue mass in the cone of renal fascia. This results in the flank oriented inferomedially with upward and lateral displacement of the lower renal pole, medial displacement of the ureter, obstructive hydronephrosis, and perhaps evidence of extravasation into the mass. Since the clinical recognition of the mass is typically delayed several weeks following the original traumatic episode, prompt radiological diagnosis is essential before irreparable damage to the kidney occurs.- - - - - - - - - - ranking = 0.12411231397337keywords = flank (Clic here for more details about this article) |
6/32. Bilateral complete renal duplication with total obstruction of both lower pole collecting systems.sepsis and a flank mass developed in a twenty-two-year-old primagravida two days after a normal delivery. urography showed normal upper pole collecting structures bilaterally. A spherical mass containing curvilinear calcification occupied the left lower pole, and a large inflammatory mass filled the right inferior renal fossa. angiography and retrograde pyelography demonstrated marked bilateral lower pole hydronephrosis with complete obstruction of the water to each inferior duplicated collecting system.- - - - - - - - - - ranking = 0.12411231397337keywords = flank (Clic here for more details about this article) |
7/32. liposarcoma presenting as an intraluminal ureteral mass.An 86-year-old woman with a previous excision of a large retroperitoneal low-grade liposarcoma presented with a 4-month history of persistent left flank discomfort. Workup revealed left hydronephrosis secondary to obstruction, which was caused by a recurrent liposarcoma in the intraluminal ureter. She underwent a left nephroureterectomy for symptomatic palliation. Pathologic study revealed high-grade liposarcoma. Despite negative surgical margins, the tumor rapidly recurred, leading to death only 4 months after surgery. This case highlights the aggressive nature of liposarcoma.- - - - - - - - - - ranking = 0.12411231397337keywords = flank (Clic here for more details about this article) |
8/32. Hydronephrotic obstructed kidney mimicking a congenital multicystic kidney: case report with review of literature.OBJECTIVE: To report a case of obstructed hydronephrotic kidney mimicking a multicystic kidney and to review the literature regarding differentiation of the hydronephrotic variant of multicystic kidney from the obstructed hydronephronic kidney. To suggest a possible algorithm in distinguishing them. methods: We have reported a case of a 35-year-old male who presented with dull aching pain and a palpable right-sided cystic flank mass of several years duration. The initial workup suggested a nonfunctioning multicystic kidney while the operative findings and histopathology were suggestive of an obstructed hydroenphrotic kidney with pyelonephritic changes. We searched the literature using the key words hydronephrotic dysplastic kidney and multicystic kidney. RESULTS: A detailed literature search did not reveal any such publication describing the differentiation of the hydronephrotic multicystic dysplastic kidney from the obstructed hydronephrotic kidney of pelviureteral obstruction. We reviewed the existing literature on this subject, on the basis of which, we have suggested a six-stepladder approach to distinguish such cases. CONCLUSION: By using the 6 step ladder protocol algorithm suggested by us one can attempt to distinguish the hydronephrotic variant of multicystic dysplastic kidney from the hydronephrotic kidney due to pelviureteral obstruction in patients presenting with a symptomatic cystic flank masses of renal origin. Differentiation between the two may be difficult at times due to the medial/central placement of cysts in the former. This is necessary since renal salvage may be possible in the latter while timely nephrectomy may be considered in the former to prevent against the hazards of leaving behind a dysplastic kidney in situ.- - - - - - - - - - ranking = 0.24822462794673keywords = flank (Clic here for more details about this article) |
9/32. Huge maternal hydronephrosis: a rare complication in pregnancy.A huge maternal hydronephrosis is uncommon in pregnancy and might be mistaken as a pelvic mass. A 21-year-old primigravida was noted at 25th week of gestation to have a visible bulging mass on her left flank. The mass was originally mistaken as a large ovarian cyst but later proved to be a huge hydronephrosis. Retrograde insertion of ureteroscope and a ureteric stent failed, so we performed repeated ultrasound-guided needle aspiration to decompress the huge hydronephrosis, which enabled the patient to proceed to a successful term vaginal delivery. nephrectomy was performed after delivery and proved the diagnosis of congenital ureteropelvic junction obstruction.- - - - - - - - - - ranking = 0.12411231397337keywords = flank (Clic here for more details about this article) |
10/32. Laparoscopic ureterolysis and reconstruction of a retrocaval ureter.A 32-year-old man was investigated for repeated episodes of right-sided flank pain. ultrasonography showed a dilated right pelvicalyceal system and upper ureter as well as multiple gallstones; subsequent intravenous urogram demonstrated a retrocaval ureter. At surgery, a right-sided double-J ureteric stent was placed under fluoroscopic guidance. Initially, three laparoscopic ports were used. The dilated pelvis and upper ureter were mobilized, followed by the lower ureter. The pelvis was transected and transposed anterior to the inferior vena cava. Reconstruction was carried out with an intracorporeally sutured anastomosis over the double-J stent. A fourth port was added for completion of cholecystectomy. The patient had an uneventful recovery and was discharged on the third day. Fourteen months later he remains well, with a recent intravenous urogram showing regression of hydronephrosis. We review the previously reported cases of laparoscopic and retroperitoneoscopic reconstruction of retrocaval ureter to compare and contrast these minimal access approaches.- - - - - - - - - - ranking = 1keywords = flank pain, flank (Clic here for more details about this article) |
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