1/122. Ureteral compromise after laparoscopic Burch colpopexy.ureteral obstruction occurred in two patients after laparoscopic Burch cystourethropexy. Both women experienced right flank pain and right hydronephrosis. cystoscopy revealed transmural passage of suture anterior and lateral to the ureteral orifice on the right side. One patient was managed by suprapubic cystoscopy to release the suture; the other was managed by preperitoneal laparoscopy to release suture at the bladder neck. In both patients efflux of urine was seen immediately from the ureteral orifice after suture release. Ultrasound confirmed prompt resolution of hydronephrosis. cystoscopy with confirmation of patent ureters should be performed after every case of retropubic cystourethropexy. Retrograde rigid cystoscopy may not afford adequate access to remove transmural sutures. Placement of sutures at the bladder neck from medial to lateral may avoid entrapment of the intramural portion of ureter. (J Am Assoc Gynecol Laparosc 6(2):217-219, 1999)- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
2/122. Ureteric obstruction due to kinking of the reservoir inlet in a continent urinary reservoir.We report a case of symptomatic intermittent upper tract obstruction in a continent urinary reservoir. The ureters were of great intraperitoneal length and were positioned in front of the mesenterium, resulting in a mobile reservoir. Only the retroperitoneal part of the ureters was dilated due to kinking in the peritoneal passage. After the ureters were shortened and reanastomosed retroperitoneally, the repeated episodes of abdominal pain and discomfort disappeared..- - - - - - - - - - ranking = 3.7489088949539keywords = abdominal pain, pain (Clic here for more details about this article) |
3/122. Metal mesh stents for ureteral obstruction caused by hormone-resistant carcinoma of prostate.BACKGROUND: Long-segment ureteral obstruction by hormone-refractory carcinoma of the prostate is a difficult problem to manage. J-stents often obstruct by compression. Metal mesh stents have been used successfully in the management of extrinsic ureteral obstruction caused by malignant disease. In this paper, we review our results in three patients in terms of the defined objective of palliation. patients AND methods: All three patients presented with painful obstructed kidneys and renal failure from long (7-10-cm) distal ureteral strictures responding to nephrostomy drainage. Endoluminal metal mesh stents of 7 to 8-mm diameter of various lengths (depending on the size of the stricture) were implanted after antegrade balloon dilatation of the stricture by a standard technique. The case notes were reviewed for technical success, preservation of the renal units, complications, and the impact on the overall quality of life. RESULTS: All three stents were placed without any complication and showed patency on contrast study. In one patient, the stent obstructed after 5 months, necessitating placement of a nephrostomy tube. In the remaining two patients, the stents obstructed within 3 months. During these 3 months, both patients had multiple admissions for stent-related complications and other symptoms of their disease. overall quality of life was poor for these patients. CONCLUSION: Metal mesh ureteral stents give poor palliation in distal strictures caused by hormone-refractory carcinoma of the prostate. Permanent nephrostomy may be a more acceptable alternative in these patients with short life expectancies.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
4/122. Ureteric obstruction by shotgun pellet "pellet colic".Acute renal colic from retained missiles is an unusual and interesting delayed complication of missile injuries to the abdomen. It must be considered in patients who present with symptoms of renal colic following gunshot and shotgun wounds with retained missiles. We report a case of acute ureteral obstruction secondary to a migrating intraluminal projectile 3 days after a shotgun wound to the back.- - - - - - - - - - ranking = 0.10927233658186keywords = back (Clic here for more details about this article) |
5/122. Right ovarian vein syndrome. A case with pre- and peroperative electromyographic registration of ureteral activity.Electrophysiological studies of ureteral function in a patient with right ovarian vein syndrome demonstrated intermittent antiperistalsis as reflected from pre-operative endoureteral activity recordings. The antiperistalsis was related to the patient intermittent right flank pain. Per-operative EMG and pressure measurements revealed that the antiperistalsis apparently arose from the area of obstruction and caused pressure waves of higher amplitude than those seen during normal anterograde peristaltic activity. After section of the vein, exclusively anterograde peristalsis was observed, and at 3 month follow-up, the patient was free of right side colics.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
6/122. Lower ureteral obstruction due to a persistent umbilical artery.A 32-year-old lady presented with primary infertility and a 1-year history of recurrent left-flank pain. She was found to have left lower ureteric obstruction on intravenous urography. No specific cause for the obstruction could be determined preoperatively. The patient underwent open extraperitoneal surgery to determine the cause and to treat the obstruction. A 4-mm vessel was seen crossing over the ureter at the site of narrowing. It was the persistent umbilical artery traced in continuity from the internal iliac artery. The vessel was resected, and the ureter was reimplanted into the bladder. Extrinsic obstruction of the distal ureter because of aberrant or persistent vessels has been infrequently reported. Such reports predominantly refer to children, and the diagnosis is usually made at laparotomy, frequently following previous failed attempts at endourological management.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
7/122. 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.- - - - - - - - - - ranking = 2keywords = pain (Clic here for more details about this article) |
8/122. Unilateral hydronephrosis resulting from intraluminal obstruction of the ureter by adenosquamous endometrioid carcinoma arising from disseminated endometriosis.A case of adenosquamous carcinoma arising in the background of disseminated pelvic endometriosis presented as unilateral hydronephrosis and a polypoid intraluminal ureteral mass. This is the first case of a malignancy arising in endometriosis presenting as an obstructive ureteral mass. The patient had a history of total hysterectomy and bilateral salpingo-oophorectomy 5 years earlier because of an endometriotic cyst, and had since been under unopposed estrogen replacement therapy. An analysis of the case and related literature is presented. Possible pathogenic mechanisms are discussed.- - - - - - - - - - ranking = 0.10927233658186keywords = back (Clic here for more details about this article) |
9/122. Laparoscopic treatment of retroperitoneal fibrosis: report of two cases and review of the literature.OBJECTIVES: We present the results of treatment by laparoscopy of two patients with retroperitoneal fibrosis and review the literature since 1992, when the first case of this disease that was treated using laparoscopy was published. We also discuss the contemporary alternatives of clinical treatment with corticosteroids and tamoxifen. CASE REPORT: Two female patients, one with idiopathic retroperitoneal fibrosis, and other with retroperitoneal fibrosis associated with Riedel's thyroiditis, were treated using laparoscopic surgery. Both cases had bilateral pelvic ureteral obstruction and were treated using the same technique: transperitoneal laparoscopy, medial mobilization of both colons, liberation of both ureters from the fibrosis, and intraperitonealisation of the ureters. Double-J catheters were inserted before the operations and removed 3 weeks after the procedures. The first patient underwent intraperitonealisation of both ureters in a single procedure. The other had 2 different surgical procedures because of technical difficulties during the first operation. Both patients were followed for more than 1 year and recovered completely from the renal insufficiency. One of them still has occasional vague lumbar pain. There were no abnormalities in the intravenous pyelography in either case. CONCLUSIONS: Surgical correction of retroperitoneal fibrosis, when indicated, should be attempted using laparoscopy. If possible, bilateral ureterolysis and intraperitonealisation of both ureters should be performed in the same operation.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
10/122. Imaging in ureteral complications of renal transplantation: value of static fluid MR urography.ureteral obstruction is an infrequent complication after renal transplantation that may cause rapid loss of transplant function. We tested static fluid MR urography for determining the cause of graft hydronephrosis. Magnetic resonance urography was performed in nine transplants with dilated collecting systems on ultrasound. A heavily T2-weighted 3D turbo spin-echo sequence on a 1.5-T scanner was used and maximum intensity projections were obtained. The patients also underwent excretory urography (n = 1), renal scintigraphy (n = 1), antegrade pyelography (n = 3), voiding cystourethrography (n = 4), and non-enhanced CT (n = 2). Six patients had pathologic conditions including ureteral stricture, compression by lymphoceles, implantation stenosis, vesicoureteral reflux, and late-occurring transitional cell carcinoma at the implantation site. Static MRU was able to diagnose or exclude a dilation of the graft collecting system. It visualized the course of the ureters and localized the obstruction site in four of five obstructed transplants. In one case the ureter was obscured by lymphoceles, which were demonstrated by hydrographic MRU as well. The definite cause for obstruction was provided in only 2 of 5 cases. Dilation due to vesicoureteral reflux could not be differentiated. The current multimodality approach to renal transplant imaging already provides comprehensive assessment of graft hydronephrosis. Static MRU may be useful in some cases since complications associated with intravenous iodinated contrast or antegrade pyelography can be avoided. Its main drawback, the lack of functional information, may be overcome by combining it with contrast-enhanced MRU.- - - - - - - - - - ranking = 0.10927233658186keywords = back (Clic here for more details about this article) |
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