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Query: UMLS:C0403608 (ureter)
 9,655 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

About 5% of our population suffers from urinary incontinence. Basically urinary incontinence is caused by two mechanisms: (1) loss of voluntary control of the urinary bladder due to detrusor hyperactivity or detrusorhyperreflexia, resulting in urge or reflex incontinence and (2) sphincter weakness or sphincter paralysis resulting in urinary stress incontinence. Less frequent are overflow incontinence and loss of urine due to ectopic ureter or a fistula. Therapy of urge incontinence is basically conservative: Causes for secondary detrusor hyperactivity must be eliminated. With idiopathic hyperactivity "bladder drill" with or without support of parasympathicolytic agents is the method of choice. Also in patients with less severe degrees of genuine urinary stress incontinence conservative therapy is helpful: pelvic floor exercises, performed in an accurate ("feel and move"), regular and persistent way, reduction of body weight in obese persons, regular bladder emptying and the elimination of "stress situations", e.g. chronic bronchitis due to nicotine abuses may improve the situation considerably. The treatment of neurogenic incontinence is rather complex and must be based on the underlying pathophysiology of detrusor and sphincter dysfunction, but also in these patients therapy is mainly conservative. Elderly people have double the incidence of urinary incontinence found in younger age groups. About 20% of those in old persons homes have been found to be incontinent. 80% of these elderly people suffer from urge incontinence as a result of bladder hyperactivity, in about 30% bladder hyperactivity is combined with residual urine and consequent urinary tract infection which makes bladder instability worse. Moreover physical immobility increases the problem of urgency.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Urinary incontinence--conservative therapy]. 368 33

We present 12 cases with spontaneous healing of ureterovaginal (11 cases) and ureterouterine (1 case) fistulas. In every case disappearance of the fistula with normal renal function and restoration of the excretory tract was obtained. IVP and retrograde pyelographs were performed in every case. Spontaneous healing is feasible under the following conditions: continuity of the ureteral lumen and normality of the infralesional ureter. Spontaneous healing is independent of the number of affected ureters, age, gynecological pathology, gynecological intervention, latency period, urographical findings, duration of incontinence, and urinary infection.
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PMID:Spontaneous healing of ureterogenital fistulas: selection criteria. 378 Jul 96

Eighteen children and young adults with neurogenic bladder underwent enterocystoplasty as part of urinary undiversion or for treatment of incontinence associated with reduced bladder compliance or detrusor sphincter dyssynergia. In 12, tubular sigmoid enterocystoplasty with transureteroureterostomy was performed with the smaller diameter ureter implanted into the bowel tenia. In two patients the ileocecal segment was used to augment the bladder, and the ureters were anastomosed to the ileum. In four patients the cecum or a patch of sigmoid colon was used to augment the bladder. Young-Dees bladder neck reconstruction was performed on eight patients at the time of surgery; one later required bladder neck reconstruction, and two later required an artificial sphincter. After a mean follow-up of 20 months, 16 of the 17 available for follow-up are continent with clean intermittent catheterization every 3 to 4 hours. Nine patients require anticholinergic or smooth muscle relaxing medication to increase functional bladder capacity. Most of the patients need chronic antimicrobial treatment to control bacteriuria.
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PMID:Enterocystoplasty in the management and reconstruction of the pediatric neurogenic bladder. 382 15

A case of two ectopic ureteral openings into the bladder neck and the vagina is reported. A 6-year-old-girl was admitted with gross hematuria and incontinence. The left kidney could not be visualized by excretory pyelography. Voiding cystogram revealed left vesicoureteral reflux. Left ureteral orifice could not be confirmed by cystoscopic examination. In January 1982, left nephroureterectomy was carried out. Contrast material injected into the left ureter during the operation was found to be drained into the bladder and the vagina. Thus, left ureter was resected close to the end of the ureter to avoid injury of the urethra and its sphincter. After the operation, incontinence disappeared. This case is the second case of two ectopic openings of unduplicated ureter.
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PMID:[Two ectopic openings of an unduplicated ureter into the bladder neck and the vagina: a case report]. 405 Jun 30

The results of urethrocystography in 193 patients with urodynamically and clinically confirmed recurrent incontinence were analyzed. Severe displacement of the vesical cervix and the proximal section of the urethra predisposes the patient to recurrent stress incontinence. The roentgenological findings (difference of over 30 mm in the distance between the vesical cervix and the ischium, outflow of contrast medium next to the catheter under stress with differential values between 20 and 40 mm, angle of inclination of the proximal urethra of over 45 degrees) are significantly more frequent in cases of recurrent stress incontinence than in cases of first occurrence (132 patients). Of the 193 patients 164 (84%) had previously undergone a vaginal operation. In 60% of these 164 patients the difference in the distance between the vesical cervix and the ischium was 30 mm or more under "resting" stress, and in a further 19% it was between 26 and 30 mm, often with outflow of contrast medium during "pressing". Stress incontinence has a damaging effect on the supporting apparatus of the urethra and the bladder, and also on the ureter and the kidneys. Ureteral drainage disorders and chronic pyelonephritis are the changes most commonly diagnosed in roentgenograms. No statistically significant differences between recurrent and first-time stress incontinence were found. Urethrocystographic findings facilitate selection of the surgical procedure. It appears possible to reduce the frequency of recurrence if preoperative roentgenological findings are taken into account.
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PMID:[Recurrent stress incontinence]. 405 46

Supravesical urinary diversion by ureterotransversopyelostomy (UTPS) with unilateral nephrostomy was performed in 57 patients. The age of the 33 women ranged between 42 and 86 (mean 65), of the 24 men between 39 and 77 (mean 62) years. With a single exception, the indication for diversion was palliative: 25 patients had advanced bladder cancer (T3/T4), and 19 had undergone irradiation; 24 patients showed vesico- (recto-) vaginal fistulas due to radiation for gynecological carcinomas. In 2 patients, the indication was urge-incontinence following former radiation therapy for uterine cancer, whereas 5 patients had advanced malignancies originating in the urethra, prostate, rectum or ovaries. The only case without malignant disease exhibited a contracted bladder of uncertain origin, together with an immunodeficiency syndrome. The approach used was an upper abdominal cross incision. In 35 patients, an anastomosis was done between the ureter and contralateral renal pelvis; in 22, a terminoterminal ureteral anastomosis was performed. For placement of the nephrostomy (49 terminal, 8 U-tube nephrostomies) we preferred the right side in 41 of 57 cases. The mean follow-up time in the 22 surviving patients was 36 months (range 2-108); the mean survival time in the 30 deceased patients was 12 months (range 0.5-87). With 4 exceptions, the cause of death was progression of the underlying tumors. Operative lethality was 1.75%, early surgical complication rate 7%, and rate of severe late complications 10.5%. The most frequent problems arose from the nephrostomy and from stenoses of the ureteropelvic or ureteral anastomosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Ureterotransversopyelostomy with unilateral nephrostomy]. 409 Jan 30

Cervical carcinomas of stage Ib and II have been treated for extended radical therapy by radioisotope radical surgery at the First Department of Obstetrics and Gynecology, University of Vienna, Austria. This extension of a more radical surgery requires to take measures in order to prevent urological and other postoperative complications. Chromocystoscopy, intravenous urography and functional scintigraphy of the kidney are carried out as routine preoperative investigations. Preservation of the adureter and an exact drainage of the field of operation are taken as intraoperative measures. Main emphasis of postoperative prophylaxis is the stimulation of ureter activity by distigminbromide and hexoprenaline. Distigminbromide stimulates the prevesical part of the ureter and increases the number of urinary excretions into the bladder. Hexoprenaline is a betamimetic substance which increases both local blood flow and number of ureter contractions. In addition, treatment by antibiotics, thrombosis prophylaxis with heparin and marcoumar and urine drainage by catheter are performed during surgery. The results of 187 radioisotope radical operations show that an uretero vaginal fistula was observed ruly in one patient (0.53%). Hydronephrosis was registered in 10 females (5.3%) and 42 subjects (22.5%) lack of bladder feeling was noted and incontinence was observed in 22 patients (11.8%) in the postoperative period.
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PMID:Prevention of urological complications after radical operation of cervical carcinoma. 612 38

Most procedures for diverting urine sacrifice continence, but Kock's modification of the ileal conduit promises the ideal of appliance-free urine storage with voluntary control of emptying. The authors report on two men who underwent this procedure. One was a paraplegic who had total urinary incontinence after a sphincterotomy. The other had a carcinoma of the rectosigmoid obstructing the right ureter. He had congenital bladder exstrophy and had undergone ureteric implantation into the sigmoid colon at 3 years of age. In both patients, the reservoir was created from an isolated 60-cm segment of the middle portion of small bowel. Two nipple valves were created - one to prevent reflux and one to provide continence of urine. Follow-up was 27 and 17 months respectively. One patient had his outlet valve revised because of sliding and incontinence. He is now completely continent of urine and he intubates his reservoir three to four times daily. Postoperatively, the second patient had a leak at the ureteroileal anastomosis, but this healed spontaneously. The continent urinary diversion is a major intestinal operation and should not be performed in conjunction with exenteration. It should be confined to a few centres where greater experience can be accumulated.
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PMID:Continent, nonrefluxing urinary reservoir constructed from ileum: report of two cases. 647 29

Ureterosigmoidostomy (US) is an acceptable procedure for urinary diversion. Despite problems with ascending pyelonephritis, anal incontinence, and recently a reported 100- to 500-fold increase in the incidence of colonic carcinoma, the popularity of US is predicted to increase. The records of 110 patients who have undergone US at our institution have been reviewed. Invasive colon cancer developed at the site of ureter implantation in three of these patients. All patients had rectal bleeding and obstipation as initial symptoms. We have located 17 of our US patients and all consented to colonoscopy and urologic follow-up. At colonoscopy 41% of these patients had one to three polyps (0.5 to 6 cm) involving or near the site of the US. No polyps were seen proximal to the US sites. Polyps were histologically defined as tubovillous adenomas or mixed tubovillous-transitional cell adenomas. A single patient with three 4 to 6 cm polyps had superficial adenocarcinoma found in two of the polyps. Recurrent polyps or dysplasia has not been found on follow-up examination. Despite the disadvantages of US, the likely increased popularity of this procedure mandates that all patients be followed regularly for polyps and cancer. Our data support the following recommendations: (1) surveillance colonoscopy should be started soon after US, and (2) conversion to an alternative diversion should be made if recurrent polyps, cancer, or dysplasia is found. Yearly colonoscopy and screening for occult blood must be part of the comprehensive follow-up on all patients after US.
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PMID:Value of colonoscopy after ureterosigmoidostomy. 648 15

Urine incontinence in elderly patients can be observed in about 7% of men and 12% of women. Short review of the anatomy of the urinary bladder, continence mechanism, micturation and bladder innervation. Description of urodynamic examination and the various forms of incontinence with differentiation between extrasphincteric urinary leakage (ectopic ureter, fistula) and incontinence due to weakness of the sphincter or detrusor dysfunction. Discussion of the detrusor function in "neurogenic bladder" as cause of incontinence in many diseases of elderly people (apoplexia, M. Parkinson, diabetes etc.). Briefing of the therapeutic possibilities.
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PMID:[Urinary incontinence in the aged]. 648 83


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