Cases reported "Ureteral Diseases"

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1/18. Endovascular management of ureteroarterial fistula.

    Ureteroarterial fistulas, although rare, appear to be increasing in frequency. Because open surgical repair may be difficult and associated with significant risk for complications, endovascular intervention may provide an attractive treatment alternative. We review the diagnosis and management of a ureteroarterial fistula and iliac pseudoaneurysm that presented with massive hematuria during ureteral stent removal. The patient was treated by means of the percutaneous embolization of the right hypogastric artery and placement of an expanded polytetrafluoroethylene stent-graft. Endovascular stent-graft placement may serve as a safe and practical alternative in the treatment of these patients, whose cases are challenging.
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2/18. renal artery embolization with ethanol and gelfoam for the treatment of ureteric fistulae with one year follow-up.

    Two patients with ureteric fistulae who were unfit for reconstructive surgery were treated by renal ablation using intra-arterial ethanol, gelfoam fragments and in one case coils. In both cases the fistulae dried-up on the same day and both patients are well and normotensive a year later. Our conclusion is that renal ablation by arterial embolization with ethanol can be a valuable alternative to surgery to treat ureteric fistulae in patients who are poor surgical risks.
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3/18. Percutaneous endovascular repair of a ureteroarterial fistula with a stent graft.

    Ureteroarterial fistula is a rare but life-threatening cause of hematuria. The predisposing factors of a ureteroarterial fistula includes pelvic exenteration, radiation therapy, infection, primary vascular disease, vascular reconstructive surgery, and indwelling ureteral catheters or stents. We report a case of ureteroarterial fistula between the right ureter and a pseudoaneurysm originating from the right proximal external iliac artery in a female patient presenting with intermittent massive hematuria. She had previously undergone an operation for cervical cancer, radiation therapy, and ureteral stent placement. She was treated successfully by percutaneous endovascular stent graft placement to exclude the pseudoaneurysm. Percutaneous stent graft placement appears to be an effective and safe therapeutic alternative in the treatment of ureteroarterial fistula.
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4/18. Intermittent ureteral herniation--rare cause of flank pain.

    Ureteral herniation is rare and difficult to diagnose, especially when intermittent, and ureterocystoneostomy using the psoas hitch or boari flap techniques have so far been used as therapeutic options. We describe ureterolysis in two cases as a successful alternative approach.
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5/18. Subtrigonal phenol injection. How safe and effective is it?

    A series of 24 patients underwent 27 transtrigonal phenol injections for the treatment of bladder instability. Only 2 of 18 patients with detrusor instability and 2 of 6 with detrusor hyperreflexia continued to derive benefit from the procedure 6 months after it was carried out. Serious complications attributable to phenol were seen in 2 patients in this series and in a further 4 patients referred for complications resulting from this therapy in other centres. These results and a review of the literature lead us to suggest that transvesical phenol injection should not be used except in the hyper-reflexic bladder when no alternative treatment is possible. Particular care should be exercised in patients who have undergone extensive prior surgery or radiotherapy.
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6/18. A new technical alternative in the surgery for retroperitoneal fibrosis: the Gore-Tex surgical membrane.

    The case of a male patient with retroperitoneal fibrosis secondary to an abdominal aortic aneurysm which was surgically treated with success, is presented herein. What is considered technically new is the management of the ureters after surgical lysis. An expanded polytetrafluoroethylene Gore-Tex surgical membrane, initially developed for pericardial closure after open-heart surgery, was used to isolate the bifurcated aortofemoral graft from the duodenum and the ureters from the vascular prosthesis and surrounding retroperitoneal tissues. This is considered to be a simple and safe technique and a technical alternative when dealing with this complex situation. To date, there has been no other description of such a technique using this material. The potential value of this material to prevent reencasement in retroperitoneal fibrosis from other origins should be kept in mind.
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7/18. nephrectomy in situ: treatment of ureteral fistula due to progressive malignancy.

    The authors report 2 patients with recurrent retroperitoneal neoplasms in whom ureteral fistulas were treated successfully by percutaneous transcatheter embolization of the renal artery with absolute ethanol. Angio-occlusive nephrectomy is suggested as an alternative to surgical nephrectomy in seriously ill and high-risk patients to preserve their quality of life.
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8/18. Spontaneous perforation of the ureter diagnosed on technetium 99m DTPA excretory urography.

    A case of nontraumatic rupture of the ureter secondary to a nonopaque calculus is presented. Because of the inherent high image contrast caused by the leak of technetium 99m-DTPA-labeled urine, the technetium 99m-DTPA excretory urogram is seen as an alternative to the intravenous urogram or contrast-enhanced computed tomography in selected cases of suspected ureteral rupture.
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9/18. Common iliac artery-ureteral fistula: case report and literature review.

    Arterial-ureteral fistulas are rare complications of iliac artery reconstruction or ureteral manipulation. The diagnosis should be considered in patients with intermittent hematuria who have had ureteral catheterization, arterial bypass, or nephrectomy. The following case demonstrates the difficulty in making the diagnosis preoperatively. A review of the literature and alternative methods of surgical management are described.
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10/18. The management of urinary fistulas and strictures with percutaneous ureteral stent catheters.

    A method is described for percutaneous anterograde introduction of a ureteral stent catheter. The experience and treatment of 5 patients are reported: 2 ureterovaginal fistulas, 2 ureterocutaneous fistulas and 1 ureteral stricture. The capability of the technique to place a stent catheter in the presence of an almost complete separation of the ureter or through ureteral segments deformed by extensive cicatricial changes is emphasized. The method is advocated as a most effective alternative to supravesical drainage in patients with ureteral fistulas and impaired healing potential of ureters devitalized by surgical stripping and/or radiation therapy.
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