Cases reported "Ureteral Obstruction"

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1/270. Renal trauma in occult ureteropelvic junction obstruction: CT findings.

    The aim of this study was to present CT findings of occult ureteropelvic junction obstruction in patients with renal trauma and to describe the clinical signs and singular CT features that are characteristically observed with trauma and are relevant to management of these patients. We retrospectively reviewed 82 helical CT studies in patients with renal trauma referred to our institution. We found 13 cases of occult preexisting renal pathology, six of which were occult ureteropelvic junction obstructions. The clinical presentation, radiologic findings of trauma according to the Federle classification, and CT findings of obstructed ureteropelvic junction are presented. We found three category-I lesions (one in horseshoe kidney), two of them treated with nephrostomy because of increased ureteropelvic junction obstruction due to pelvic clots; two category-II lesions (parenchymal and renal pelvis lacerations) that had presented only with microhematuria; and one category-IV lesion (pelvic laceration alone). Pelvic extension was demonstrated in all the cases with perirenal collections. The CT studies in all the cases with suspected ureteropelvic junction obstruction showed decreased parenchymal thickness and enhancement, and dilatation of the renal pelvis and calyx, with a normal ureter. Computed tomography can provide information to confidently diagnose underlying ureteropelvic junction obstruction in renal trauma, categorize the traumatic injury (at times clinically silent) and facilitate proper management according to the singularities observed, such us rupture of the renal pelvis alone (Federle category IV) and increasing ureteropelvic obstruction due to clots which can be decompressed by nephrostomy.
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2/270. Bilateral ureteritis cystica with unilateral ureteropelvic junction obstruction.

    Ureteritis cystica is a rare, benign, proliferative disorder characterized by multiple ureteral cysts and multiple filling defects noted on contrast ureteral imaging. A unique case of bilateral ureteritis cystica coincidental with chronic, congenital, unilateral ureteropelvic junction obstruction presenting with microscopic hematuria and lower urinary tract symptoms is described. The characteristic presentation as well as the diagnostic radiographic, ureteroscopic, and histologic features of pyeloureteritis cystica are reviewed.
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3/270. Ureteropelvic junction obstruction associated with extrarenal pelvis: A potential cause of cystic abdominal mass anterior to a normal-appearing kidney in the newborn.

    An extrarenal pelvis is associated with the absence of central sinus echoes on sonography. However, central sinus echoes are normally inapparent in some newborns. Furthermore, true absence of a central sinus may cause calices to simulate normal renal pyramids so that the kidney appears normal in a fetus or newborn. This case illustrates the potential for an obstructed extrarenal pelvis in a fetus or newborn to distend so that it is mistaken on sonography for a cystic anterior abdominal mass unrelated to the kidney. However, the absence of central sinus echoes should suggest the diagnosis of an obstructed extrarenal pelvis if the adjacent cystic abdominal mass is positioned to obstruct an intrarenal pelvis.
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4/270. Ureteropelvic junction obstruction presenting as early satiety and weight loss.

    We present a case of ureteropelvic junction (UPJ) obstruction which had the unusual presentation of early satiety and weight loss secondary to gastric compression by a distended renal pelvis. The patient was treated successfully with percutaneous antegrade endopyelotomy.
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5/270. Complications of retrograde balloon cautery endopyelotomy.

    PURPOSE: adult ureteropelvic junction obstruction is increasingly managed with endoscopic techniques. Retrograde balloon cautery endopyelotomy is quick, requires minimal hospital stay and allows most patients a rapid return to work. The complication rate of retrograde balloon cautery endopyelotomy ranges from 13 to 34%, with vascular injury in 0 to 16% of patients. We report 5 uncommon complications, including 4 vascular injuries, that clinicians should be familiar with when using this technique. MATERIALS AND methods: We reviewed 52 retrograde endoscopic endopyelotomy procedures performed during a 5-year period. There were 5 uncommon complications. RESULTS: Accessory lower pole renal artery injuries occurred in 3 patients, 1 of whom presented 12 days after endopyelotomy. Embolization was successfully performed in all 3 cases and none had subsequent hypertension. In 1 case a right ovarian vein laceration was not evident on preoperative or postoperative angiography. Emergency post-embolization abdominal exploration revealed a 2 mm. injury to the right ovarian vein before entering the right renal vein close to the ureteropelvic junction incision. nephrectomy and ovarian vein ligature were curative. In 1 case the electrocautery wire broke intracorporeally after firing, resulting in a bobby pin-like configuration. Successful removal was accomplished by twisting the catheter and wrapping the wire around the tip, enabling atraumatic removal. CONCLUSIONS: Retrograde balloon cautery endopyelotomy is an emerging technology with potential adverse outcomes. The complications we noted are complex and potentially life threatening. awareness of these complications may help avoid poor outcomes and expedite appropriate treatment.
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6/270. Mini-percutaneous antegrade endopyelotomy.

    Antegrade endopyelotomy is the endourologic treatment of choice for ureteropelvic junction obstruction with a coexisting renal calculus. We report the use of a mini-percutaneous procedure that allows us to perform an antegrade endopyelotomy and stone extraction through a 20F nephrostomy sheath.
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7/270. Retrograde ureteroscopic endopyelotomy for the treatment of primary and secondary ureteropelvic junction obstruction in children.

    The use of endopyelotomy in children with ureteropelvic junction (UPJ) obstruction remains controversial. Although most investigators reported good results with percutaneous or retrograde balloon cautery incision, there are distinct advantages associated with a ureteroscopic approach. Three male children, ages 11, 12 and 17 years, underwent ureteroscopic endopyelotomy for treatment of UPJ obstruction (one primary and two secondary). The procedures were performed using 6F to 8.5F semirigid instruments and the holmium laser. All three patients underwent endopyelotomy without complication. The mean operative time was 80 minutes. Two patients were discharged home the day of the procedure, and the third patient was hospitalized for less than 24 hours postoperatively. With follow-up of 6 to 11 months, two patients are asymptomatic, with no radiographic evidence of obstruction. The 12-year-old boy had continued obstruction following endopyelotomy. At the time of open pyeloplasty, a large crossing vessel was noted, which appeared to be the source of obstruction. Ureteroscopic endopyelotomy can be performed with minimal morbidity and hospitalization in children. Further clinical experience is needed to assess the relative efficacy of this procedure in comparison with other forms of endopyelotomy in children.
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8/270. Neonatal intervention for severe antenatal pyelocaliectasis.

    The postnatal management of the antenatally detected ureteropelvic junction obstruction relies on several factors, including the degree of hydronephrosis detected postnatally, the renogram washout curve, and the degree of renal function. It is imperative for the urologist to review all renal scans because of the inherent pitfalls in performing and interpreting these studies. A select population demonstrating severe pyelocaliectasis and poor function exists in which an intraoperative renal biopsy may be a better predictor of future renal function when compared with the preoperative renal scan. We present a patient with poor renal function that normalized with early surgical intervention.
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9/270. hypertension and pseudoaneurism on the renal artery following retrograde endopyelotomy (Acucise).

    Acucise endopyelotomy has gained widespread use in the treatment of ureteropelvic junction obstruction. Acute postoperative bleeding is a well-known complication. We report one case with a delayed postoperative formation of pseudoaneurism, and one case which developed arterial hypertension postoperatively.
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10/270. Geriatric ureteropelvic junction obstruction: the possible role of an arteriosclerotic lower pole branch of renal artery: report of two cases.

    An 83-year-old woman presented with left flank pain and high grade fever. After left ureteral catheterization and intensive chemotherapy with hemoperfusion, surgical exploration revealed the lower pole branches of the renal vessels were obstructing the ureteropelvic junction (UPJ), and dissection of the vessels released the obstruction. An 82-year-old man presented with right flank pain. angiography demonstrated UPJ obstruction caused by the lower pole branch of the renal artery. Arterial dissection with dismembered pyeloplasty resulted in improvement of obstruction. In both cases, the patients had a long history of hypertension with mild to severe arteriosclerosis. arteriosclerosis associated with fixation of the UPJ, may be one of the important factors leading to progressive hydronephrosis in geriatric patients.
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