Cases reported "Fetal Diseases"

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1/11. Outcome of patients with prenatally detected duplex system ureterocele; natural history of those managed expectantly.

    PURPOSE: We assessed the outcome of patients treated for prenatally detected duplex system ureterocele with particular reference to those treated expectantly. MATERIALS AND methods: We reviewed the records of 52 consecutive patients treated between 1984 and 1999 with a median followup of 8 years (range 1 to 16.2). RESULTS: Of the 38 patients who underwent surgical treatment 13 subsequently required unplanned secondary procedures. A total of 14 cases satisfying currently defined criteria, including less than 10% upper renal pole function, an unobstructed lower pole (absent nonrefluxing hydroureteronephrosis), lower pole vesicoureteral reflux not exceeding grade III and unobstructed bladder outflow, were managed expectantly with a median followup of 8 years (range 1.6 to 12.8). In this group of patients prophylactic antibiotics were routinely prescribed until the completion of toilet training or age 5 years in those with persistent reflux on repeat cystography. None has required surgery or had symptoms or urinary infection. In 6 cases followup ultrasonography showed substantial resolution of upper pole hydronephrosis with a collapsed ureterocele. Furthermore, 7 of the 38 patients who underwent surgical treatment early in our series would have been treated expectantly had the current criteria been applied. CONCLUSIONS: In 14 of the 52 patients (approximately 27%) with prenatally detected duplex system ureterocele the natural history of the complaint is essentially benign within the currently available followup.
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ranking = 1
keywords = ureterocele
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2/11. Prenatal sonographic diagnosis of bladder outlet obstruction caused by a ureterocele associated with hydrocolpos and imperforate hymen.

    We report a case of prenatal bladder obstruction due to a single system ureterocele associated with hydrocolpos. Ultrasound at 22 weeks demonstrated an enlarged bladder. Serial scans showed progressive ipsilateral obstructive uropathy, contralateral hydronephrosis, and oligohydramnios. Neonatal endoscopic decompression and hymenotomy was performed with residual decreased ipsilateral renal function and dilation. Prenatal bladder obstruction may cause permanent renal damage.
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ranking = 0.71428571428571
keywords = ureterocele
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3/11. In-utero treatment of fetal bladder-outlet obstruction by a ureterocele.

    Fetal bladder-outlet obstruction by ureteroceles is usually treated at birth. However, such obstruction may be detrimental to the health of the fetus and so in-utero correction is preferable. We describe the successful cytoscopy guided laser incision, with no complications, of a uterocele that was causing bladder-outlet obstruction in a fetus of 19 weeks and 6 days gestation.
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ranking = 0.71428571428571
keywords = ureterocele
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4/11. ureterocele causing anhydramnios successfully treated with percutaneous decompression.

    BACKGROUND: Ureteroceles are congenital cystic dilatations of the submucosal segment of the distal ureter. We present a case of an intravesical ureterocele causing anhydramnios at 31 weeks' gestation. CASE: A primiparous woman near 20 weeks' gestation had ultrasound evidence of a fetal duplicated right collecting system. At 31 weeks, an intravesical ureterocele was seen along with bilateral hydroureteronephrosis and anhydramnios. A single percutaneous needle decompression of the bladder and ureterocele successfully restored amniotic fluid volume. CONCLUSION: Follow-up ultrasounds are indicated when either a duplicated renal collecting system or a ureterocele is identified. In utero treatment is indicated only when amniotic fluid is compromised. Needle decompression should be first-line treatment, with more invasive methods reserved for failures of decompression.
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ranking = 0.57142857142857
keywords = ureterocele
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5/11. Ultrasound-guided laser treatment for fetal bladder outlet obstruction resulting from ureterocele.

    In a case of severe bilateral hydronephrosis in a female fetus associated with ureterocele at 28 weeks, under local anesthetic, ultrasound-guided neodymium:yttrium-aluminum-garnet laser was used to perforate the ureterocele and successfully overcome the obstruction. There was no recurrence of obstruction, and renal function was normal postnatally.
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ranking = 0.85714285714286
keywords = ureterocele
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6/11. Megacystis microcolon intestinal hypoperistalsis syndrome with bilateral duplicated systems.

    A 29-year-old multigravida woman presented for her second prenatal ultrasound evaluation at 30 weeks of gestation. The study showed a female fetus, bilateral duplicated systems with severe hydronephrosis in the upper pole moieties and a massively distended bladder. Initial interpretation suggested ectopic/obstructing bilateral ureteroceles. To evaluate these findings further, a prenatal magnetic resonance imaging scan was obtained, documenting the absence of ureteroceles. The presumptive diagnosis of megacystis microcolon intestinal hypoperistalsis syndrome was made. After birth, contrast enema confirmed the presence of microcolon. This appears to be the first reported case of megacystis microcolon intestinal hypoperistalsis syndrome with bilateral duplex systems evaluated with prenatal magnetic resonance imaging.
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ranking = 0.28571428571429
keywords = ureterocele
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7/11. Ectopic ureter and ureterocele: their varied sonographic manifestations.

    The sonographic examinations of four patients with simple ectopic ureters and 11 with ectopic ureteroceles were reviewed to determine distinguishing characteristics. Ectopic ureters, in cases of extreme dilatation and tortuosity, sometimes mimic multiseptated, cystic abdominal masses. However, the proximal portions of some severely dilated ureters are surprisingly small. Ectopic ureters sometimes indent the lower vesical wall, simulating a ureterocele. Ectopic ureteroceles are dynamic structures, changing in shape and size according to intravesical pressure. The lower pole of a duplex kidney may be difficult to detect because of displacement by the dilated upper renal pelvis and ureter. The renal parenchyma associated with an ectopic ureter may be equally difficult or impossible to find because of diminutive dysplasia or, less commonly, acquired atrophy. Dysplasia is characterized sonographically by highly echogenic parenchyma, lack of corticomedullary differentiation, and occasionally massive enlargement by cysts. Ectopic ureters and ureteroceles can be identified by fetal sonography.
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ranking = 1.1428571428571
keywords = ureterocele
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8/11. Prenatal sonographic diagnosis and subsequent conservative surgical management of bilateral ureteroceles.

    Prenatal sonographic diagnosis of ureteroceles usually involves clearly duplicated urinary collecting systems associated with ectopic ureters draining the upper renal moieties. We present an unusual case in which an initial sonographic examination was consistent with bilateral orthotopic ureteroceles in association with bilateral single renal systems. The possibility of single systems raised perinatal considerations unique to this anomaly. Repeat prenatal sonography was suggestive of duplex systems and subsequently confirmed as such by neonatal ultrasound and voiding cystourethrogram. At the age of 1 month, the infant underwent bilateral ipsilateral ureteroureterostomy with conservation of the bilateral dilated upper renal moieties. We discuss the possible pathophysiology underlying the different conflicting sonographic findings and address current management of such lesions.
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ranking = 0.85714285714286
keywords = ureterocele
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9/11. Prenatally diagnosed ureterocele presenting as fetal bladder outlet obstruction.

    The prenatal detection of fetal genitourinary abnormalities is becoming more frequent. The exact nature of these anomalies is frequently difficult to delineate before delivery. We report a case of fetal bladder outlet obstruction caused by an ectopic ureterocele associated with a duplicated renal collecting system, which was visible on prenatal ultrasonographic examination. Postnatal follow-up is presented.
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ranking = 0.71428571428571
keywords = ureterocele
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10/11. Renal abnormalities on obstetric ultrasound as a presentation of digeorge syndrome.

    We describe three pregnancies that presented with renal anomalies on obstetric ultrasound as the main abnormality and were subsequently found to have interstitial deletions within chromosome 22q11. A cardiac defect, double-outlet right ventricle, was also seen in the first case. Amnio infusion was refused in the second pregnancy and the perimembranous ventricular septal defect was not identified prior to termination. In the third case, there was no cardiac defect. The genitourinary abnormalities were a right hydroureter and hydronephrosis with a ureterocele bulging into the bladder lumen, bilateral multicystic kidneys with associated oligohydramnios, and a left multicystic kidney with right renal agenesis and associated oligohydramnios. Absence of thymus at autopsy in all three cases led to fluorescent in situ hybridization studies looking for the submicroscopic deletion of chromosome 22q11 associated with digeorge syndrome.
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ranking = 0.14285714285714
keywords = ureterocele
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