1/17. 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 = 1keywords = vessel (Clic here for more details about this article) |
2/17. Massive unilateral non-functioning hydronephrosis in horseshoe kidney.The occurrence of non-function in one half of a horseshoe kidney resulting from hydronephrosis can, if unrecognized, create a serious surgical as well as medical problem. The anterior position of the ureter in relation to the isthmus, as well as strictures and accessory vessels increase the incidence of hydronephrosis, which if severe enough, can go on to non-function. The key diagnostic factor is the observation of the visualised side, which shows the characteristic malrotation of the calyces and the deviation of the long axis of the kidneys; these are associated with a mass effect on the obstructed side, with or without a 'crescent' sign. Five cases of this unusual occurrence are presented.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
3/17. klippel-trenaunay-weber syndrome with hydronephrosis and vesicoureteral reflux: an unusual association.The klippel-trenaunay-weber syndrome is a rare disorder characterized by congenital vascular hamartomas, limb hypertrophy, cutaneous manifestations, lymphangiomas and atresia of lymph vessels with non-pitting edema. A three-year-old boy was referred to our clinic for progressive hypertrophy of leg and feet with 32-month history. We diagnosed klippel-trenaunay-weber syndrome, and determined vesicoureteral reflux in our patient. To our knowledge, hydronephrosis and vesicoureteral reflux have not been described previously in the KTWS.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
4/17. Giant hydronephrosis mimicking progressive malignancy.BACKGROUND: Cases of giant hydronephroses are rare and usually contain no more than 1-2 litres of fluid in the collecting system. We report a remarkable case of giant hydronephrosis mimicking a progressive malignant abdominal tumour. CASE PRESENTATION: A 78-year-old cachectic woman presented with an enormous abdominal tumour, which, according to the patient, had slowly increased in diameter. Medical history was unremarkable except for a hysterectomy >30 years before. A CT scan revealed a giant cystic tumour filling almost the entire abdominal cavity. It was analysed by two independent radiologists who suspected a tumour originating from the right kidney and additionally a cystic ovarian neoplasm. Subsequently, a diagnostic and therapeutic laparotomy was performed: the tumour presented as a cystic, 35 x 30 x 25 cm expansive structure adhesive to adjacent organs without definite signs of invasive growth. The right renal hilar vessels could finally be identified at its basis. After extirpation another tumourous structure emerged in the pelvis originating from the genital organs and was also resected. The histopathological examination revealed a >15 kg hydronephrotic right kidney, lacking hardly any residual renal cortex parenchyma. The second specimen was identified as an ovary with regressive changes and a large partially calcified cyst. There was no evidence of malignant growth. CONCLUSION: Although both clinical symptoms and the enormous size of the tumour indicated malignant growth, it turned out to be a giant hydronephrosis. Presumably, a chronic obstruction of the distal ureter had caused this extraordinary hydronephrosis. As demonstrated in our case, an accurate diagnosis of giant hydronephrosis remains challenging due to the atrophy of the renal parenchyma associated with chronic obstruction. Therefore, any abdominal cystic mass even in the absence of other evident pathologies should include the differential diagnosis of a possible hydronephrosis. Diagnostic accuracy might be increased by a combination of endourological techniques such as retrograde pyelography and modern imaging modalities.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
5/17. Leino-renal collaterals causing left pelviureteric junction obstruction.Pelviureteric junction obstruction of the kidneys secondary to crossing renal vessels is a known entity. We report a 26-year-old woman with obstruction secondary to portosystemic collaterals; she was incidentally detected to have extrahepatic portal vein obstruction.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
6/17. Aberrant vessels in ipsilateral malrotated kidney associated with contralateral cross ectopia without fusion.Aberrant vessels is the most common cause of extrinsic uretero-pelvic junction (UPJ) obstruction. Due to the left flank pain, 18-year-old male patient with UPJ obstruction due to aberrant vessels in left malrotated kidney and right renal cross ectopia without fusion, had been operated. Ureter was reconstructed and anastomosed anterior to the aberrant vessels after the Double-J-Stent has been placed. At the postoperative period there were improvements in the clinical symptoms and renal function. So, even in the later childhood surgical choice is still the acceptable treatment modality in such cases. To the best of our knowledge, although there are some papers about aberrant vessels which cause UPJ obstruction, there is no such a case with ipsilateral renal hydronephrosis due to aberrant vessels associated with contralateral renal cross ectopia without fusion.- - - - - - - - - - ranking = 4.5keywords = vessel (Clic here for more details about this article) |
7/17. Laparoscopic pyeloplasty and isthmectomy for hydronephrosis of horseshoe kidney: a pediatric case.A 4-year-old boy suffering from hydronephrosis of a horseshoe kidney underwent laparoscopic pyeloplasty with isthmectomy. Pyeloplasty was performed by the transposition of crossing vessels and the Anderson-Hynes method. In isthmectomy, Ligasure was used for transection of the isthmus. The surgery time was 310 minutes, the estimated blood loss was 10 mL, and the patient required no analgesia postoperatively. convalescence was complete within 14 days. The follow-up diuretic renal scan showed prompt emptying of the radioisotope from the left collecting system, with a T1/2 of 12 minutes.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
8/17. Failure of laparoscopy to relieve ureteral obstruction secondary to endometriosis.OBJECTIVES: To present a case of hydronephrosis and hydroureter secondary to pelvic endometriosis and to discuss the pitfalls in laparoscopic management. CASE REPORT: A 37-year-old nulligravida woman had mild elevation of blood pressure for about 1 year without abdominal pain, dyspareunia, or dysmenorrhea. Renal ultrasound revealed left hydronephrosis and a 4-cm pelvic cyst. Intravenous pyelogram showed distal ureteral obstruction. An MRI with fat saturation disclosed a left ovarian endometrioma and a lesion in the uterosacral ligament causing periureteral compression. Laparoscopic findings included a dilated left ureter above the uterosacral ligament, left uterosacral ligament endometriosis with adhesions, and a 4-cm left ovarian endometrioma. Cystoureteroscopy showed external ureteral compression 2 cm above the ureteral orifice. A ureteral catheter was placed. The left endometrioma was enucleated and ureterolysis was performed. The latter procedure had to be discontinued because of bleeding from descending uterine vessels. The ureteral catheter was removed 2 months later and her blood pressure gradually returned to normal. However, after 1 year, she was found to have recurrent hydronephrosis and underwent segmental resection of the distal ureter and reconstruction by end-to-end reanastomosis. CONCLUSION: In women of reproductive age, hydronephrosis and hypertension may be the only symptoms of endometriosis. While laparoscopic treatment is useful in endometriosis, it may fail in the presence of chronic inflammation and severe fibrosis.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
9/17. Sonographic visualization of the ureter in pregnancy.We describe a method of differentiating physiological from pathological dilatation of the renal collecting system in pregnant patients. In physiological hydronephrosis the dilated ureter extends down only to the level of the common iliac artery. In 2 patients with distal ureteral stones a dilated ureter was visualized past the vessels. To determine the frequency and reliability of visualizing the ureters in pregnant patients 105 consecutive asymptomatic pregnant patients were examined. hydronephrosis was found in 83 kidneys in 59 of the patients. The dilated ureter was visualized in 64 of the renal units. The anatomy was well demonstrated by color flow Doppler scanning and in all of these cases the dilated ureter was seen to taper where it crossed the common iliac artery. These results suggest that the presence of a dilated ureter past the iliac artery is strong evidence for pathological distal ureteral obstruction in pregnancy.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
10/17. Intermittent hydronephrosis as a cause of a false-negative pressure-flow study.A case is reported of a negative pressure-flow study in a patient with intermittent hydronephrosis. This is the first known report of a properly performed pressure-flow study failing to diagnose obstruction due to the intermittent nature of the obstruction itself. This case also supports the concept that the ureteropelvic junction (UPJ) can be intrinsically normal in patients with intermittent hydronephrosis secondary to a crossing renal vessel. It also reaffirms the need to study these patients while they are symptomatic.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
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