1/161. Single system ureteral ectopia in boys associated with bladder outlet obstruction. PURPOSE: Ureteral ectopia is frequently associated with dysplasia of the associated renal segment in girls with ureteral duplication. However, single system ureteral ectopia is an uncommon anomaly more frequently noted in boys. We report on 6 boys with single system ureteral ectopia into the prostatic urethra above the verumontanum, who presented with radiological and clinical findings of bladder outlet obstruction. MATERIALS AND methods: Antenatal ultrasound in 3 boys demonstrated renal abnormalities and postnatal studies suggested the diagnosis of posterior urethral valve obstruction. Older boys presented with symptoms suggestive of bladder outlet obstruction. RESULTS: An ectopic ureter inserting into the prostatic urethra was noted in all 6 boys. The distal ureter was dilated elevating the bladder neck causing outlet obstruction. Surgical management consisted of nephrectomy and transurethral endoscopic incision of the distal ureter or nephroureterectomy with reconstruction of the prostatic urethra. In 2 younger boys voiding dysfunction with inability to empty developed. CONCLUSIONS: Single system ectopic ureters in boys may present with symptomatic and radiological findings resembling posterior urethral valves. Surgical treatment should include nephroureterectomy with reconstruction of the hypoplastic prostate. Some patients may have later voiding dysfunction. ( info) |
2/161. Use of rigid hysteroscope for extraction of foreign bodies embedded in lower urinary tract. PURPOSE: To introduce the use of the 20F rigid hysteroscope in urologic procedures. MATERIALS AND methods: The 20F hysteroscope was used to remove deeply embedded foreign bodies from the lower urinary tract of three patients in whom previous attempts with standard cystoscopic equipment were unsuccessful. RESULTS: In all three cases, the hysteroscope easily passed into the urethra and with the use of rigid instruments was able to remove the foreign bodies without complication. CONCLUSION: Situations may arise when the removal of embedded foreign bodies is not possible with standard cystoscopic equipment. The hysteroscope, which is available in most operating rooms, was able to extirpate even deeply embedded foreign bodies. ( info) |
3/161. Closure of mouth of bladder diverticulum via endoscopic transvesico-transurethral approach. We successfully treated bladder diverticula in two patients using the endoscopic transvesico-transurethral approach. The mouth of the diverticulum was closed in two layers under pneumobladder, using two percutaneous ports placed into the bladder as well as the urethral route. This operation was performed 2 to 3 months after the bladder outlet obstruction was relieved by transurethral resection or incision of the prostate. The patients were able to void with a minimum of residual urine. The endoscopic transvesico-transurethral approach provided satisfactory vision. ( info) |
4/161. Renal aspergillosis giving rise to obstructive uropathy and recurrent anuric renal failure. A sixty-year-old previously healthy male patient presented with anuric renal failure of sudden onset. He was detected to have aspergillus fumigatus fungal balls in the renal pelvis, ureters and bladder which were removed and his renal function improved. He was treated with itraconazole and sent home. Three weeks later he again presented with anuria and renal failure. He had recurrence of the obstruction with the same fungus. The fungal ball was removed, a double 'J' stenting was performed and he was treated with amphotericin b and itraconazole. Hence we report a previously healthy patient with no evidence of immunosuppression presenting an obstructive anuric renal failure due to isolated renal aspergillosis. ( info) |
5/161. Bladder obstruction in Hunter's syndrome. We report a case of bladder obstruction in a patient with Hunter's syndrome, presenting with acute painful symptomatology, due to the impossibility of voiding, which was diagnosed with ultrasonography and cystometrography. Intermittent catheterization with intravesical oxybutynin chloride lead to successful functional resolution of the obstruction. ( info) |
6/161. Sphincterometry in the diagnosis of male bladder outflow obstruction. pressure patterns recorded during urethral sphincterometry in 281 male patients have been analyzed and measurements of prostatic length, peak, plateau height and pressure area have been made. These parameters show significant correlations with the established pressure-flow index of urethral resistance. Sphincterometry is a useful adjunct to the established urodynamic techniques for the diagnosis of bladder outflow obstruction in the male patient. ( info) |
7/161. Postpartum uterine retroversion causing bladder outflow obstruction: cure by laparoscopic ventrosuspension. A case of chronic urinary retention due to bladder outflow obstruction presenting at 7 months postpartum, following a history of early puerperal voiding difficulties, is outlined. The cause was found to be a markedly retroverted uterus obstructing the urethra. Laparoscopic ventrosuspension was performed, converting preoperative urinary residuals of over 400 ml to zero postoperatively. ( info) |
8/161. early diagnosis of fetal bladder outlet obstruction. Prenatal ultrasonography has facilitated early diagnosis of in utero bladder outlet obstruction. This represents one of the earliest diagnoses of prune-belly syndrome and sheds light on the natural history of the bladder outlet obstruction in the fetus. ( info) |
9/161. Inferior vena cava compression due to massive hydronephrosis from bladder outlet obstruction. A 71-year-old man presented with acute urinary retention due to benign prostatic hyperplasia and was found to have computed tomography-documented mechanical obstruction of the inferior vena cava (IVC) due to massive hydronephrosis. Obstruction of IVC flow promptly resolved after bladder decompression. ( info) |
10/161. Bladder outflow obstruction masquerading as pelviureteric junction (PUJ) obstruction. We report a case of bladder outflow obstruction presenting with upper tract dilatation mistaken initially as pelviureteric junction (PUJ) obstruction. The lower tract obstruction ought to be dealt with first before upper tract obstruction is assessed because the renal pelvic pressure is significantly affected by vesical filling and high bladder pressure. ( info) |