Cases reported "Ureteral Obstruction"

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1/15. Laparoscopic ureteral reimplantation for ureteral lesion secondary to transvaginal ultrasonography for oocyte retrieval.

    Transvaginal ultrasound-guided follicular puncture for oocyte retrieval is a highly efficient and minimally invasive method for assisted reproductive techniques. Complications related to this procedure are rare. We report the case of a ureteral stricture secondary to ultrasound-guided follicular puncture for oocyte retrieval that was corrected by a laparoscopic approach. This approach can minimize postoperative pain, the length of hospitalization, and the period of convalescence and should be considered a minimally invasive option in the management of this rare complication of oocyte retrieval.
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2/15. 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.
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3/15. 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.
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4/15. Direct percutaneous ureteral approach for the treatment of ureteral stenosis or obstruction.

    Two cases are presented in which conventional approaches did not permit dilation of and stent placement in obstructed ureters. In patients with iatrogenic ureteral laceration or rigid ureteral kinking, direct percutaneous translumbar puncture may provide a safe alternative. The authors' technique is described.
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5/15. Puncture of unilateral renal cyst in utero.

    Although most authors do not recommend prenatal puncture of a unilateral single cystic renal mass, in case the contralateral kidney is normal and there is sufficient amniotic fluid, this case report shows that the procedure, which can be done very carefully under ultrasonic guidance, can be helpful in establishing the presumed diagnosis.
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6/15. 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.
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7/15. New techniques for stenting severely strictured or occluded ureters.

    Percutaneous stenting of the severely strictured ureter is facilitated by catheterization through a rigid curved tube leading through the kidney. Alternatively, bidirectional traction tensioning of a guide wire pulled through the entire urinary tract permits antegrade dilatation and stent drainage. Complete occlusion near the ureteric orifice may be bypassed by transureteral puncture of the bladder followed by stent insertion.
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8/15. 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.
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9/15. 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.
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10/15. Obstructive migration of renal calculi following cyst aspiration.

    The authors report 3 cases of ureteral obstruction secondary to puncture of peri-pelvic renal cysts which had been obstructing and dilating the renal pelvis. In each case, non-obstructive calculi passed from the upper collecting system into the ureter or infundibulum within 72 hours of decompression, causing acute renal colic and marked obstruction.
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