1/89. Prune-belly syndrome diagnosed at 14 weeks' gestation with severe urethral obstruction but normal kidneys.A fetus was diagnosed with prune-belly syndrome (PBS) found by ultrasound demonstration of cystomegaly at 12 weeks' gestation. Fetal urinary electrolyte and beta2-microglobulin concentrations at 14 weeks' gestation indicated a poor renal prognosis. The pregnancy was therefore terminated. An autopsy showed defects of the abdominal wall muscles and megalocystis caused by severe urethral obstruction. However, the kidneys were histologically normal. Together with previous reports, the present case suggests that renal dysplasia in PBS with severe uretheral obstruction may develop after 14 weeks' gestation. We discuss the possibility of preventing the development of renal dysplasia in PBS by early prenatal decompression of the obstructed fetal urinary tract.- - - - - - - - - - ranking = 1keywords = obstruction (Clic here for more details about this article) |
2/89. hydronephrosis after aorto bifemoral graft surgery: a marker for late graft complications.Ureteral obstructions are serious late complications after aortoiliac reconstructive vascular surgery, which lead to loss of kidney function if they remain untreated. One case report serves to describe the incidence, aetiology, clinical presentation and treatment options of an obstructive uropathy following graft surgery. hydronephrosis due to a ureteral obstruction is considered as a "marker" of graft complication. Therefore, ultrasound examination and close follow-up beyond 1 year are recommended in all patients who undergo aortoiliac surgery.- - - - - - - - - - ranking = 0.33333333333333keywords = obstruction (Clic here for more details about this article) |
3/89. Postpartum uterine retroversion causing bladder outflow obstruction: cure by laparoscopic ventrosuspension.A case of chronic urinary retention due to bladder outflow obstruction presenting at 7 months postpartum, following a history of early puerperal voiding difficulties, is outlined. The cause was found to be a markedly retroverted uterus obstructing the urethra. Laparoscopic ventrosuspension was performed, converting preoperative urinary residuals of over 400 ml to zero postoperatively.- - - - - - - - - - ranking = 0.83333333333333keywords = obstruction (Clic here for more details about this article) |
4/89. prenatal diagnosis of cystic bladder distension secondary to obstructive uropathy.We report the perinatal findings of a huge midline posterior cystic bladder distension secondary to lower urinary tract obstruction and prune-belly syndrome in a male fetus. A 40-year-old woman, gravida 3, para 0, was referred at 21 gestation weeks with sonographic findings of anhydramnios and a fetus with a 9.5 x 6.0 cm intra-abdominal cystic mass containing two chambers. The in utero ultrasound-guided fetal bladder drainage using a single needle aspiration and the ultrasound follow-ups of fetal bladder filling provided a diagnostic aid. This method helped to show the position of the bladder and the cystic bladder mass as well as the status of communication in response to decompression or filling of the fetal bladder. cytogenetic analysis revealed a 46,XY karyotype. autopsy showed agenesis of the posterior urethra, prominent megacystis, a cystically distended mass arising from the lower posterior bladder, hydronephrosis, megaureters, and anorectal agenesis with an intestinal blind end adherent to the posterior wall of the uterus. There were no urogenital duplication, hindgut duplication, or urachal abnormalities. The contracted bladder had a full-thickness muscular wall with a trigone and two ureteral orifices while the cystically distended bladder did not have any opening and was lined by a very thin wall. histology of the cystic bladder wall demonstrated typical urothelium, lamina propria and muscularis propria. The pathogenesis and differential diagnosis of cystic bladder distension are discussed.- - - - - - - - - - ranking = 0.16666666666667keywords = obstruction (Clic here for more details about this article) |
5/89. urethral obstruction and bilateral ureteral hydronephroses secondary to fecal impaction.We present a case report of the first adult woman reported to suffer from both urethral obstruction and bilateral ureteral hydronephroses secondary to fecal impaction. The work-up suggested that hypothyroidism might be the cause for fecal impaction. urinary tract obstruction caused by hypothyroidism-induced fecal impaction has never been reported. fecal impaction should be considered as one of the causes for urinary tract obstruction.- - - - - - - - - - ranking = 1.1666666666667keywords = obstruction (Clic here for more details about this article) |
6/89. Fetal hydrolaparoscopy and endoscopic cystotomy in complicated cases of lower urinary tract obstruction.OBJECTIVE: Vesicoamniotic shunting may be difficult or impossible in selected cases of fetal lower obstructive uropathy. The purpose of this article is to describe the performance of fetal hydrolaparoscopy and endoscopic fetal cystotomy in two fetuses with complicated lower obstructive uropathy. STUDY DESIGN: Fetal hydrolaparoscopy-endoscopic fetal cystotomy was performed in a patient with a markedly thickened bladder that could not be entered percutaneously. A peritoneoamniotic (bridge) shunt was also placed. Fetal hydrolaparoscopy-endoscopic fetal cystotomy was performed in a second patient with a collapsed bladder from a previous vesicocentesis, because vesicoinfusion resulted in further ascites. Fetal cystoscopy was performed after endoscopic fetal cystotomy, and posterior urethral valves were ablated with neodymium:yttrium-aluminum-garnet laser energy. A vesicoamniotic shunt was left in place. RESULTS: Adequate bladder drainage was obtained in both cases. The first baby required bilateral nephrotomy and a permanent cystotomy at birth and is scheduled for a bladder expansion procedure at the age of year. The second patient had premature rupture of membranes and fetal death from treatment of this complication 5 days after the original procedure. CONCLUSION: Fetal hydrolaparoscopy-endoscopic fetal cystotomy can be performed in complicated cases of lower obstructive uropathy. The procedure involves the creation of a defect in the bladder dome under direct endoscopic visualization within a spontaneous or intentional hydroperitoneum. Peritoneoamniotic shunting, vesicoamniotic shunting, or ablation of posterior urethral valves may then be performed. Fetal hydrolaparoscopy-endoscopic fetal cystotomy should be reserved only for complicated cases of lower obstructive uropathy in which conventional vesicoamniotic shunting is not safely possible. Further experience with fetal hydrolaparoscopy-endoscopic fetal cystotomy is necessary to establish its risks and benefits.- - - - - - - - - - ranking = 0.66666666666667keywords = obstruction (Clic here for more details about this article) |
7/89. epidermolysis bullosa, pyloric atresia, and obstructive uropathy: a report of two case reports with molecular correlation and clinical management.The epidermolysis bullosa-pyloric atresia-obstructive uropathy (EB-PA-OU) association is a rare, but well-described multisystem disease. While the prognosis at this time is still poor, an increasing number of patients are surviving to adolescence with aggressive care. It is important to understand this syndrome in order to anticipate medical complications and offer preventive strategies where possible. Prompt and expectant management of obstructive uropathy is crucial in these patients. Evidence of ureterovesicular obstruction may require bowel diversion, as excision of the obstructed ureterovesicular junction with reimplantation is often associated with a high risk of reobstruction. Many newborns succumb to sepsis or dehydration and electrolyte imbalance. Those infants who survive need close monitoring for the development of obstructive uropathy, failure to thrive, protein-losing enteropathy, respiratory compromise, and increased susceptibility to invasive infections. Once a clinical diagnosis is made, mutational analysis can confirm it and facilitate genetic counseling, as recurrence risks are 25% for this autosomal recessive condition. Mutational analysis enables direct genetic testing and accurate prenatal diagnosis. As more patients are studied, genotype/phenotype correlations may be possible.- - - - - - - - - - ranking = 0.33333333333333keywords = obstruction (Clic here for more details about this article) |
8/89. Posterior urethral valves with congenital megalo-urethra.A 3-year-old male child was admitted with complaints of dysuria and dribbling of urine since birth. There was a small plum sized swelling, on the ventral surface of penis, which increased in size during micturition and on compression of the swelling urine dribbled out. Voiding cysto-urethrogram showed posterior urethral valves with scaphoid megalo-urethra. Vesicostomy with fulguration of the valves and one year later reduction urethroplasty were performed.- - - - - - - - - - ranking = 2.40001737566E-5keywords = duct (Clic here for more details about this article) |
9/89. urinary retention resulting from incarceration of a retroverted, gravid uterus.urinary retention resulting from urethral obstruction by a retroverted, gravid uterus is an uncommon disorder that is reported only once in the emergency medicine literature. Yet these patients may present in extreme distress and precipitate considerable confusion regarding the cause of and solution to this problem. No study evaluating outcome, risk of complications, or therapy exists. We present two cases that clarify diagnostic and therapeutic controversies and provide a better understanding of what is known about the pathophysiology and treatment alternatives.- - - - - - - - - - ranking = 0.16666666666667keywords = obstruction (Clic here for more details about this article) |
10/89. prenatal diagnosis of fetal urinary ascites.We report on a rare in utero appearance of the rupture of the fetal bladder caused by low urinary tract obstruction with subsequent urinary ascites. The findings on prenatal sonography, postnatal X-ray examinations and postnatal surgical treatment are described and the literature is reviewed.- - - - - - - - - - ranking = 0.16666666666667keywords = obstruction (Clic here for more details about this article) |
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