1/13. Fetoscopic placement of a transurethral stent for intrauterine obstructive uropathy.PURPOSE: Fetal urinary obstructive uropathy and consecutive oligohydramnios result in a poor outcome. Usually renal insufficiency and life threatening lung hypoplasia have developed at term. We report a case of in utero fetal cystoscopy and successful placement of a transurethral vesico-amniotic Double-J (Medical engineering Corp., new york, new york) stent. Indications, results and the potential benefits of different techniques are discussed. MATERIAL AND methods: A 36-year-old woman (primipara) was evaluated at week 26 due to a male fetus with bilateral hydronephrosis, massive distended bladder and an open posterior urethra. Using local anesthesia the fetal bladder was punctured, a 2.6 mm endoscope was inserted and a wire was advanced antegrade through the penis. A 2.8Fr Double-J stent was then placed between the bladder and amniotic cavity. RESULTS: The bladder drained into the amnion, hydronephrosis disappeared and the lung developed normally. At week 37 a healthy infant was delivered who voided spontaneously. CONCLUSIONS: After careful selection of candidates for fetal intervention in obstructive uropathy direct vision fetoscopy and transurethral stent placement can be performed in patients with oligohydramnios, favorable urinary electrolytes and normal appearing kidneys.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
2/13. Prenatal puncture of a unilateral hydronephrosis leading to fetal urinoma and postnatal nephrectomy.Fetal pelvicaliceal dilatation due to ureteropelvic junction obstruction is the most common cause of antenatal hydronephrosis; it rarely leads to a spontaneous rupture resulting in urinoma formation. Antenatal intervention has been recommended only in those cases of large urinomas that seem to interfere with the function of other organ systems (eg, pulmonary hypoplasia secondary to diaphragmatic elevation). We report the case of a fetal intervention (transuterine puncture) in a unilateral massive hydronephrosis leading to a perirenal urinoma and the preterm birth of a female infant. Postnatally, mechanical ventilation and oxygen were required, as was forced percutaneous urinoma drainage. Evaluation revealed a fistula formation between the perirenal space and the kidney's collecting system, possibly due to the fetal intervention. Unfortunately the kidney function was very poor, and surgery to remove the impaired kidney and the urinoma was performed. We discuss the possible effects of fetal intervention in cases of obstructive uropathy and the postnatal risks associated with it.- - - - - - - - - - ranking = 5keywords = puncture (Clic here for more details about this article) |
3/13. Ultrasonic evaluation of the unilateral nonvisualized kidney.There are several techniques for evaluating the nonvisualized kidney. Nephrotomography may be helpful in those patients who have some remaining renal function. Radionuclide renal flow and imaging studies are more sensitive than nephrotomography in detecting hydronephrosis, the most common cause of unilateral renal nonvisualization, but also require some renal function to be of diagnostic value. Diagnostic ultrasound, since it is independent of renal function, is an even more sinsitive indicator of urinary obstruction, detecting those cases where no functioning renal parenchyma is present. This non-invasive technique can accurately guide percutaneous puncture of the collecting system, permitting antegrade localization of the obstructing lesion. When ultrasonography demonstrates a solid mass in the renal fossa, angiography is recommended for definitive diagnosis. When no kidney is identified renal venography may be useful in differentiating between a small nonfunctioning kidney and renal agenesis.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
4/13. Giant hydroureteronephrosis. Case report and review of the literature.A case of giant hydroureteronephrosis in a man is reported. Diagnostic evaluation included ultrasound, urethrocystoscopy and percutaneous puncture to assess the outline of the urinary tract and to locate a suspected ectopic ureteral orifice. Standard treatment usually consists of primary nephroureterectomy. A review of the literature with respect to etiology, diagnostic criteria and treatment modalities is presented.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
5/13. Combined ultrasound--radiographic detection of ureteral obstruction in renal transplants.A case of renal transplantation is presented in which ultrasound was used to detect and control the puncture and aspiration of a renal abscess and a lymphocele. Subsequently, the combined sonographic-radiographic technique was used to diagnose and demonstrate the site of obstruction of the ureter. Ultrasound, in combination with fine-needle puncture when necessary, has many advantages in the management of renal transplantation.- - - - - - - - - - ranking = 2keywords = puncture (Clic here for more details about this article) |
6/13. A case of nonobstructed diuresis renography and positive Whitaker test.Three different tests are now widely used in evaluating hydronephrosis, a renal pelvic puncture with perfusion test, the furosemide urography and the furosemide renography. A case is reported in which the different tests result in different diagnosis concerning the degree of pyelourethral obstruction.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
7/13. Ultrasonic evaluation of the obstructed duplex kidney.The problem of a duplex collecting system associated with an obstructed ectopic ureter or ureterocele is common in pediatric urology. Four such patients were studied by gray scale ultrasound which was useful in demonstrating the dilated upper pole collecting system as well as an ectopic ureter and a ureterocele. Although the diagnosis of a nonfunctioning upper pole unit in a duplex kidney is usually suggested by the urogram, ultrasound provides a noninvasive means of confirmation which is independant of function. Further, ultrasound-guided puncture with antegrade pyelography demonstrates the course of the ectopic ureter, thus providing a more complete preoperative evaluation.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
8/13. Percutaneous puncture of abdominal cystic masses in children.A technique of percutaneous puncture and opacification of cystic abdominal masses is outlined, and its diagnostic and therapeutic potential demonstrated in a series of 16 masses in 15 children. It is suggested as an alternative to ultrasound and computed tomography in certain situations.- - - - - - - - - - ranking = 5keywords = puncture (Clic here for more details about this article) |
9/13. Congenital giant hydroureteronephrosis.Four patients with giant hydroureteronephrosis are reported to emphasize the massive proportions attained by a dilated ureter. ureteral obstruction was congenital in each case; duplication with ectopic insertion was present in three of the four patients. In three patients the massively dilated ureter caused partial obstruction of the contralateral ureter. If ultrasound and/or computed tomography demonstrate a huge, septate, cystic structure crossing the midline, massive megaureter should be suspected. Antegrade puncture can be used to confirm the diagnosis.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
10/13. Preoperative diagnosis of unilateral multicystic kidney with hydropelvis.We present 2 patients with congenital unialteral multicystic kidney disease with hydropelvis. In the first patient the diagnosis was made by precutaneous puncture of a renal cyst followed by injection of contrast medium; in the second the diagnosis was confirmed by percutaneous puncture of the renal pelvis and injection of contrast medium, although an earlier ultrasonic examination had been strongly suggestive. Since in this condition the cysts and the renal pelvis communicate, either can be punctured to make the diagnosis. The procedures herein described are definitive for the diagnosis and should be followed whenever the urologist desires such a diagnosis.- - - - - - - - - - ranking = 3keywords = puncture (Clic here for more details about this article) |
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