1/3. Congenital ureteral diverticulum coexistent with hydronephrosis caused by vascular compression involving the uterine artery and umbilical ligament: report of a case.Coexistence of congenital ureteral diverticulum and hydronephrosis caused by vascular compression is a rare entity. The authors experienced a case of congenital ureteral diverticulum coexistent with hydronephrosis caused by aberrant vascular compression by uterine and umbilical arteries in a 14-year-old girl. The authors could not diagnose accurately this abnormality preoperatively by 3-dimensional computed tomography. After partial ureterectomy, including resection of the saccular lesion and ureteroneocystostomy, the frequency of urinary tract infection decreased.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
2/3. Failure of laparoscopy to relieve ureteral obstruction secondary to endometriosis.OBJECTIVES: To present a case of hydronephrosis and hydroureter secondary to pelvic endometriosis and to discuss the pitfalls in laparoscopic management. CASE REPORT: A 37-year-old nulligravida woman had mild elevation of blood pressure for about 1 year without abdominal pain, dyspareunia, or dysmenorrhea. Renal ultrasound revealed left hydronephrosis and a 4-cm pelvic cyst. Intravenous pyelogram showed distal ureteral obstruction. An MRI with fat saturation disclosed a left ovarian endometrioma and a lesion in the uterosacral ligament causing periureteral compression. Laparoscopic findings included a dilated left ureter above the uterosacral ligament, left uterosacral ligament endometriosis with adhesions, and a 4-cm left ovarian endometrioma. Cystoureteroscopy showed external ureteral compression 2 cm above the ureteral orifice. A ureteral catheter was placed. The left endometrioma was enucleated and ureterolysis was performed. The latter procedure had to be discontinued because of bleeding from descending uterine vessels. The ureteral catheter was removed 2 months later and her blood pressure gradually returned to normal. However, after 1 year, she was found to have recurrent hydronephrosis and underwent segmental resection of the distal ureter and reconstruction by end-to-end reanastomosis. CONCLUSION: In women of reproductive age, hydronephrosis and hypertension may be the only symptoms of endometriosis. While laparoscopic treatment is useful in endometriosis, it may fail in the presence of chronic inflammation and severe fibrosis.- - - - - - - - - - ranking = 0.75keywords = ligament (Clic here for more details about this article) |
3/3. Pseudo-Meigs' syndrome due to broad ligament leiomyoma: a mimic of metastatic ovarian carcinoma.Pseudo-Meigs' syndrome is a rare complication of benign leiomyomas of the female genital tract. We report a patient with pseudo-Meigs' syndrome due to a large broad ligament leiomyoma, which also caused bilateral reversible hydronephrosis. This unusual combination of pseudo-Meigs' syndrome, broad ligament leiomyoma and hydronephrosis requiring ureteric stenting does not appear to have been reported previously. Features of the syndrome that led to a diagnostic problem, the mimicking of metastatic ovarian carcinoma, are presented. The little that is known of the pathogenesis of the pleural and ascitic fluids is discussed. An elevated level of serum CA 125 antigen is reported, we believe for the first time in association with pseudo-Meigs' syndrome.- - - - - - - - - - ranking = 1.5keywords = ligament (Clic here for more details about this article) |