Cases reported "Ureteral Obstruction"

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1/35. Surgical treatment of reflux in completely duplicated ureters.

    Vesicoureteral reflux occurs in approximately 50% of duplex systems that undergo evaluation and most commonly involves the lower renal segment ureter. The therapeutic approach can be tailored for each case after careful evaluation of the anatomic and functional status of each renal unit. If reparative srugery is indicated and only one ureter is involved, then ureteropyelostomy or ureteroureterostomy have yielded excellent results. If more than one ureter is involved with either relfux or obstruction, then reimplantation of the paired ureters is indicated if the renal units are slavageable.
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ranking = 1
keywords = ureterostomy
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2/35. The laparoscopic Boari flap.

    PURPOSE: Laparoscopic management of ureteral pathologies, such as ureteropelvic junction obstruction, ureteral calculi and retroperitoneal fibrosis, has proved to be highly effective. We present our initial experience with the laparoscopic Boari flap in regard to feasibility, safety and short-term results. MATERIALS AND methods: Three patients who presented with distal ureteral obstruction underwent preoperative radiographic evaluation, including excretory urography, computerized tomography and retrograde pyelography, that showed upper urinary tract dilatation at the site of obstruction. The contralateral upper urinary tract was normal in all cases. Ureteroureterostomy and ureteroneocystostomy was not feasible because of stricture length and a laparoscopic Boari flap procedure was performed. Renal function, symptom improvement and radiological studies, including excretory urography and cystography, were assessed 3 and 6 months postoperatively. RESULTS: All procedures were successfully performed without any intraoperative complications or need for open conversion. Excretory urography showed good drainage with no obstruction of urine flow and all patients had grade I vesicoureteral reflux on cystography. CONCLUSIONS: The laparoscopic Boari flap is feasible using currently available laparoscopic suturing techniques. Longer followup and larger series of patients are necessary to provide data comparable to that of the open approach.
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ranking = 1
keywords = ureterostomy
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3/35. Transureteroureterostomy obstruction mimicking acute tubular necrosis.

    A patient receiving nephrotoxic chemotherapy for metastatic cervical cancer was examined for acute renal failure. A Tc-99m MAG3 scan showed symmetric function, bilateral increasing parenchymal activity, and no tracer excretion in either collecting system. The differential diagnosis included cisplatin-induced nephrotoxicity, dose infiltration, and obstruction of the common ureter. Analysis of the scan, an image over the injection site, and a delayed image of the urinary tract indicated obstruction of the common ureter at the anastomotic site of the transureteroureterostomy. In patients with a transureteroureterostomy, symmetric renal dysfunction, and no bladder activity, a delayed image of the urinary tract should be obtained to distinguish obstruction from acute tubular necrosis.
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ranking = 6
keywords = ureterostomy
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4/35. Distal ureteral replacement with tubularized porcine small intestine submucosa.

    Extensive ureteral injury can result from renal stone disease, iatrogenic injury, or penetrating trauma. A significant ureteral stricture can be repaired using various techniques, including the psoas hitch, Boari flap, transureteroureterostomy, ileal ureter, or renal autotransplantation. We describe a woman with a 5-cm, ischemic uretero-indiana pouch stricture that developed after cystectomy and urinary diversion. Severe pelvic fibrosis prevented adequate mobilization of the ureter and indiana pouch and would not permit any of the above-mentioned procedures. We report the first human use of tubularized small intestine submucosa to successfully replace a 5-cm strictured segment of distal ureter.
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ranking = 1
keywords = ureterostomy
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5/35. Pyeloureterostomy with interposition of the appendix.

    PURPOSE: We describe the successful repair of a 6 cm. ureteral stricture involving the right ureteropelvic junction and proximal ureter using appendix as a ureteral substitute. MATERIALS AND methods: A 37-year-old man involved in a motorcycle accident presented with a retroperitoneal urinoma and a 6 cm. proximal ureteral stricture. At flank exploration we were unable to perform successfully primary pyeloureterostomy through renal descensus with ureteral mobilization. The appendix was selected to bridge the ureteral defect. The right colon and cecum were mobilized to the area of the diseased ureter and the appendix was transected across the base of the cecum. Ureteral scar tissue was resected and the appendix was interposed in an isoperistaltic orientation from renal pelvis to proximal ureter. RESULTS: convalescence was unremarkable. Retrograde pyelography and flexible ureteroscopy 2 months postoperatively demonstrated a patent anastomosis and viable appendix. The ureteral stent was removed at that time. Excretory urography 3 months postoperatively revealed prompt enhancement of the 2 kidneys and visualization of the 2 ureters. Mercaptoacetyltriglycine-3 renal scan 5 months postoperatively confirmed no scintigraphic evidence of obstruction. The patient was asymptomatic 6 months postoperatively and renal function tests were normal. CONCLUSIONS: The appendix can be considered for proximal ureteral defects extending to the right renal pelvis.
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ranking = 5
keywords = ureterostomy
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6/35. Intrinsic form of ureteral endometriosis causing ureteral obstruction and partial loss of kidney function.

    INTRODUCTION: urinary tract endometriosis is rare and occurs in about 1% of all endometriotic lesions. About 30% of patients suffer from reduced kidney function at the time of diagnosis. CASE REPORT: A 49-year-old woman presented with a history of abdominal hysterectomy without adnexae because of uterus myomatosus without any signs of endometriosis 6 years before. Now she complained of dysuria and intermittent left loin pain. Sonography and retrograde pyelography demonstrated incomplete ureteric obstruction and scintigraphy revealed a partial loss of kidney function. Intraoperatively frozen section histology and final histologic examination demonstrated a tumor-like intrinsic form of ureteral endometriosis engulfing the left ureter. The patient was treated with uretero-ureterostomy and danazole for preventing recurrence. She is well 28 months postoperatively. CONCLUSIONS: In the extrinsic form (about 75% of all cases), ureteral endometriosis is localised to the adventitia or surrounding connective tissue of the ureter, whereas the intrinsic form of ureteral endometriosis is very rare and more often needs aggressive surgery.
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ranking = 1
keywords = ureterostomy
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7/35. Calycoureterostomy: a novel technique for post-renal transplant stricture.

    Stenosis and necrosis of the ureter are amongst the severe complications after renal transplantation. Several surgical techniques like simple nephrostomy or native pyeloureterostomy using the native ureter have been applied for repair. We report a case of modification to the conventional pyeloureterostomy where the native ureter was anastomosed to the transplant calyx to restore continuity of the urine collecting system. This technique is recommended as a feasible alternative when secondary reconstruction by native pyeloureterostomy is not possible.
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ranking = 7
keywords = ureterostomy
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8/35. Laparoscopic resection and ureteroureterostomy for congenital midureteral stricture.

    A 16-year-old boy presented with flank pain and was found to have right-sided hydronephrosis and hydroureter on ultrasonography and an intravenous urogram. A retrograde pyelogram revealed a tight, short-segment, non-negotiable stricture in the midureter. A CT scan excluded extrinsic compression. In the absence of any other pathology, the stricture was considered to be congenital. The diseased segment of the ureter was resected laparoscopically, and an intracorporeally sutured ureteroureterostomy was fashioned over a double- J stent. The patient made an uneventful recovery and was well at follow-up 18 months later. To the best of our knowledge, this is the first reported case of laparoscopic resection of a congenital midureteral stricture.
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ranking = 5
keywords = ureterostomy
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9/35. Case report: robot-assisted laparoscopic pyeloureterostomy in a transplanted kidney with ureteral stricture.

    ureteral obstruction secondary to ischemia is the most common urologic complication of kidney transplantation. Although endoscopic management has shown satisfactory short-term success rates, surgical repair is considered the definitive therapy. To our knowledge, this procedure has been performed only through open surgery. We present a minimally invasive approach for reconstruction of a ureteral stricture in a renal transplant patient using the Da Vinci robotic system.
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ranking = 4
keywords = ureterostomy
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10/35. Laparoscopic pyeloureterostomy: experience in three cases.

    PURPOSE: To report our experience with transperitoneal laparoscopic pyeloureterostomy for duplication of the collecting system. patients AND methods: Since January 2003, two adult patients with incomplete duplication of ureter with ureteropelvic junction obstruction of the lower moiety and a 4-month-old male baby with complete duplication of the ureter with reflux in the lower moiety underwent transperitoneal laparoscopic pyeloureterostomy. The baby also had excision of the lower-moiety ureter. RESULTS: There was no significant intraoperative or postoperative morbidity. Follow-up imaging revealed good drainage. CONCLUSION: With increasing experience in laparoscopic reconstructive urologic procedures, laparoscopic pyeloureterostomy is a feasible option, even in infants.
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ranking = 7
keywords = ureterostomy
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