1/43. Retrograde ureteroscopic endopyelotomy for the treatment of primary and secondary ureteropelvic junction obstruction in children.The use of endopyelotomy in children with ureteropelvic junction (UPJ) obstruction remains controversial. Although most investigators reported good results with percutaneous or retrograde balloon cautery incision, there are distinct advantages associated with a ureteroscopic approach. Three male children, ages 11, 12 and 17 years, underwent ureteroscopic endopyelotomy for treatment of UPJ obstruction (one primary and two secondary). The procedures were performed using 6F to 8.5F semirigid instruments and the holmium laser. All three patients underwent endopyelotomy without complication. The mean operative time was 80 minutes. Two patients were discharged home the day of the procedure, and the third patient was hospitalized for less than 24 hours postoperatively. With follow-up of 6 to 11 months, two patients are asymptomatic, with no radiographic evidence of obstruction. The 12-year-old boy had continued obstruction following endopyelotomy. At the time of open pyeloplasty, a large crossing vessel was noted, which appeared to be the source of obstruction. Ureteroscopic endopyelotomy can be performed with minimal morbidity and hospitalization in children. Further clinical experience is needed to assess the relative efficacy of this procedure in comparison with other forms of endopyelotomy in children.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/43. 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 = 3keywords = vessel (Clic here for more details about this article) |
3/43. 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 = vessel (Clic here for more details about this article) |
4/43. Pelviureteric junction obstruction in duplex system.An unusual case of a PUJ obstruction in the upper moiety of a duplex kidney is presented. PUG obstruction in duplex moieties is commonly seen in the lower moiety ureter and is usually due to extrinsic compression by a crossing vessel. In our case there was a long stenotic segment of the ureter draining a functionally insignificant and infected segment of the kidney. The opposite kidney was hypoplastic and non functional. An upper polar hemi nephrectomy was performed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/43. Rapid communication: laparoscopic Anderson-Hynes dismembered pyeloplasty using the da Vinci robot: technical considerations.PURPOSE: To present our initial experience with laparoscopic pyeloplasty utilizing the da Vinci robot for upper tract reconstruction. Case Report: A four-port transperitoneal approach was used in a 73-year-old man. The ureteropelvic (UPJ) obstruction was identified with a crossing vessel. After dismemberment of the UPJ, the renal pelvis was trimmed and reconstructed using the da Vinci robot. The total operative time was 5 hours; the time spent for reconstruction was 45 minutes. Blood loss was <150 mL. The postoperative analgesic requirement was 8 mg of morphine and 25 mg of hydrocodone. There were no intraoperative or postoperative complications. CONCLUSION: The da Vinci robot can serve as a vital surgical tool during pyeloplasty with extensive reconstruction.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/43. Ureteral stenosis as the sole manifestation of Wegener's granulomatosis.In Wegener's granulomatosis, necrotizing lesions are typically located in the upper and lower respiratory tract and kidneys, and ureteral involvement is uncommon. We report 2 cases in which intrinsic ureteral stenosis was the sole manifestation of this small-vessel vasculitis. Excisional surgery evidenced characteristic granulomatous inflammation that allowed adjuvant elective medical treatment. Urologists, nephrologists, and internists should be aware of this atypical presentation of Wegener's granulomatosis. Thorough clinical and biologic assessments are warranted in the initial workup of isolated intrinsic ureteral stenosis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/43. Ureteropelvic junction obstruction caused by accessory renal vessels in association with preureteral vena cava and vena caval duplication.An apparent ureteropelvic junction obstruction on the right side may herald an array of anomalous conditions for which the surgeon should be prepared. A case is presented in which ureteropelvic junction obstruction caused by accessory renal vessels was found in association with a preureteral vena cava and a vena caval duplication on the right side. The embryology of caval anomalies associated with preureteric vena cava is reviewed.- - - - - - - - - - ranking = 5keywords = vessel (Clic here for more details about this article) |
8/43. Laparoscopic treatment of ovarian vein syndrome.BACKGROUND: Ovarian vein syndrome is a rare cause of teral obstruction. In this report, we describe an unusual presentation of the syndrome successfully treated with laparoscopic techniques. methods: The patient presented with a 12-month history of right flank pain and a right abdominal mass. The preoperative evaluation revealed renal malrotation, hydronephrosis, decreased renal function, and presumed ureteropelvic junction obstruction. RESULTS: By using a transperitoneal laparoscopic approach, an enlarged ovarian vein was identified as the cause of the ureteral obstruction. The ovarian vein was divided with a laparoscopic stapler. The patient's postoperative course was unremarkable, and she was discharged from the hospital on the second postoperative day. At 3-months follow-up, the patient was completely asymptomatic without evidence of obstruction. DISCUSSION: Ovarian vein syndrome remains a rare diagnosis of exclusion. A careful preoperative evaluation is required to exclude other causes of ureteral obstruction. By using a laparoscopic approach, the ureter and obstructing vessel were readily identified to effectively treat the patient. With the minimally invasive approach, postoperative recovery and patient quality of life were improved.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/43. Dystrophic ureteral calcification associated with Churg-Strauss vasculitis.churg-strauss syndrome is an uncommon systemic vasculitis affecting small blood vessels. Renal involvement is typical; however, calcinosis of the urinary tract has not previously been described. Dystrophic calcification in the urinary tract is rare, although it is occasionally associated with schistosomiasis, tuberculosis, and polyarteritis nodosa. We report the case of a 19-year-old man with newly diagnosed churg-strauss syndrome who presented to us with dystrophic calcification in both ureters causing bilateral obstruction.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/43. 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 = 1keywords = vessel (Clic here for more details about this article) |
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