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

There are a number of factors that affect ureteral dilatation in patients with posterior urethral valves. These include large urinary outputs, a noncompliant bladder, and distal ureteric fibrosis. Dilatation alone does not imply obstruction, and careful studies should be obtained to document obstruction prior to considering any surgery. Our prejudice leads us to avoid ureteric reconstruction in the period immediately after valve ablation. Our findings suggest that these patients have hypertonic bladders immediately after valve ablation period, so it could be hazardous to reimplant the ureter in such a bladder and thereby expose these kidneys to unnecessary high pressures. Each patient with persistent dilatation should be treated on an individual basis. Some will require no treatment, some reimplantation with or without tailoring, and some an augmentation cystoplasty. More conservative approaches include double and triple voiding regimens, intermittent catheterization, anticholinergics, alpha sympathomimetic blockers, and regimens to decrease urinary output. These same regimens also seem to have a role in improving the level of continence, as does the onset of adolescence. Fortunately, the majority of patients with posterior urethral valves can be treated with valve ablation alone. Unfortunately, a number of patients who have creatinines of less than 1.0 mg per dl following treatment in the first year of life will go onto renal failure years later. Rapid progression to renal failure usually does not ensue until the teenage period, when proteinuria and hypertension seem to be the hallmarks. The progressive renal failure that develops in these patients may be related to the hyperfiltration syndrome that Brenner and Levine reported in patients with a decreased number of nephrons. A role for decreased intake of protein may have some influence in preserving the function of patients with a reduced number of nephrons and hopefully will affect the ultimate prognosis. The author anxiously awaits the formation and results of studies that will employ such a dietary regimen for patients with a history of severe valves in the hope of preserving renal function. However, such reports are not likely to be forthcoming during this decade.
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PMID:Current issues regarding posterior urethral valves. 388 21

A series of 46 children treated by the author since January 1972 for congenital posterior urethral valves is presented: 22% were diagnosed at birth, 28% as neonates and 52% in the first 3 months of life. Ninety-three per cent had unilateral or bilateral dilatation of the upper urinary tract at the time the valves were diagnosed and 72% had ureteric reflux. Unilateral reflux occurred into the left ureter twice as often as the right. Renal failure was present at the time of diagnosis in 72% of all of the children but in 83% of those aged less than 3 months. Surface urinary diversion was used minimally during post-operative management and contributed little to the recovery of renal function. Reflux disappeared spontaneously in one-third of the refluxing ureters. Ureteric dilatation subsided spontaneously in 57% of dilated ureters. Surgery was performed mostly for reflux. Non-refluxing ureteric dilatation was made worse by surgery in a few instances and in others the dilatation improved with time rather than as a result of surgery. Renal function returned to normal in over 60% of the children who were in renal failure at diagnosis. Measurement of glomerular filtration rate was the most accurate method of predicting recovery of renal function: a value of less than 50% of normal for age at the time of diagnosis forecast persistent chronic renal failure with all its attendant complications.
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PMID:Management of congenital posterior urethral valves. 397 Nov 7

In obstructive renal failure in patients with terminal malignant tumors, we relieved the obstruction on only one side. As a result, it was found that the renal function of the other side also recovered (in five out of 19 patients 26.3%). Therefore, obstructive renal failure in these patients was caused not only by direct obstruction by the tumor, but also by renorenal reflex, humoral factors such as uremic toxius and edema of tissues around the ureter. It would be correct to assume that a reversible mechanism, such as ureteral stent insertion, percutaneous nephrostomy, etc. Should first be selected, rather than permanent urinary diversion.
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PMID:[Obstructive renal failure in patients with terminal malignant tumors--unilateral relief of ureteral obstruction and recovery of renal function on the opposite side]. 407 61

The authors report a case of bilateral retro-iliac ureter with renal failure. The transvascular segments of the ureters were eliminated, and the two ureters were reanastomosed in front of the iliac vessels.
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PMID:[Anuria due to bilateral ureteral blockage by the iliac pedicles (retro-iliac ureters)]. 408 45

Malignant tumors were responsible for 19 cases of urogenital fistula, including 10 ureterovaginal and 9 vesicovaginal fistulae, treated between 1974 and 1982. Details of the cases are reviewed and the therapeutic attitude to adopt towards urogenital fistulae of malignant tumor origin discussed. Recommended steps are: repeat plastic surgery as soon as possible after the postoperative appearance of the fistula, conservation of the kidney for as long as possible, and small intestine replacement of the ureter in selected cases. External as compared with internal urinary shunts are preferred in cases of advanced lesions with renal failure, tumor recurrence, or cobalt therapy. Cutaneous ureterostomy in Y with a single median or right lateral skin opening appears to be an excellent bypass procedure enabling a left colostomy to be performed, either primarily or secondary in case of rectal invasion.
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PMID:[Malignant tumorous urogenital fistula. Apropos of 19 cases]. 667 4

Retroperitoneal fibrosis is a disease which causes renal failure by obstruction of the ureters. The fibrosis may be benign or secondary to malignant disease. The clinical and radiological features of 30 cases have been reviewed. The symptoms are non-specific and diagnosis is often difficult. The most important features are back pain associated with a high ESR. Urography is diagnostic; the well known features are obvious dilatation of the pelvicalyceal system and ureter above the level of the obstruction. However, there is a spectrum of appearances corresponding to the duration of the disease and there may be only minimal dilatation of the pelvicalyceal system or no pelvicalyceal opacification at all. The progress of the disease is variable. Slow progress leads to chronic obstruction and chronic ill health. With more rapid progression, the patient may present with acute obstruction in anuria and, in such cases, urgent ureterolysis is necessary to conserve nephrons. Benign and malignant retroperitoneal fibrosis are often indistinguishable, clinically and radiologically, and laparotomy with biopsy is essential for diagnosis.
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PMID:The urographic appearances in acute and chronic retroperitoneal fibrosis. 669 Jan 82

Liver cells were prepared from untreated controls, rats with various models of acute uraemia (uranyl nitrate-treated, bilaterally nephrectomised and ureter-ligated rats, rats with acute ischaemic renal failure) and sham-operated animals. Hepatocyte glucose output, pyruvate utilisation and lactate production were determined in the presence of Krebs-Ringer bicarbonate buffer with different pH values (7.1, 7.4, 7.6) using pyruvate, dihydroxyacetone, serine and fructose as substrates. In the presence of pyruvate and dihydroxyacetone a significant increase of glucose production in hepatocytes from bilaterally nephrectomised and ureter-ligated rats was observed. However, pyruvate-generated glucose production in the hepatocytes of uranyl nitrate-treated animals was unchanged, while a diminished glucose output was seen in the presence of dihydroxyacetone. A marked increase in glucose and lactate production in the presence of serine was observed in the hepatocytes of uranyl nitrate-treated, ureter-ligated and binephrectomised rats. However, lactate production from dihydroxyacetone in the liver cells of uranyl nitrate-treated animals was inhibited. In contrast to other types of uraemia, in acute ischaemic renal failure there is significantly lower hepatocyte glucose production using pyruvate as a substrate, but unchanged glucose generation from dihydroxyacetone or serine.
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PMID:The gluconeogenetic ability of hepatocytes in various types of acute uraemia. 681 Jan 92

Diagnostic puncture of the renal pelvis with a fine-gauge needle inserted under radiological and ultrasound control, has been performed in more than 100 cases. The method is safe, easy to perform for those trained in imaging modalities, and causes little discomfort. Pyelography and pressure flow studies can be made and urine specimens obtained from the upper urinary tract. Skinny needle pyelography is indicated in unilateral non-visualization of the ureter on intravenous pyelography, in acute oliguric renal failure when ultrasound reveals dilated ureters, and when retrograde pyelography is not feasible. The method is cost-effective, as it can be performed on outpatients as a follow-on procedure after intravenous pyelography or renal ultrasound scanning.
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PMID:Skinny needle pyelography. An advance in uroradiology. 702 95

The investigation was designed to determine the effect of experimental renal failure on the retention of free (inorganic) sulfate and on the pharmacokinetics of acetaminophen in rats. Adult male Sprague-Dawley rats with renal failure produced by uranyl nitrate treatment or ligation of ureters had much higher serum free sulfate concentrations (about 2 and 5 mM, respectively) than normal animals (about 1 mM). The time-averaged total clearance of a 100-mg/kg dose of acetaminophen was higher in animals with renal failure than in normal rats and was positively correlated with serum free sulfate concentration (r = 0.76, P less than .001). Renal failure had no effect on the total clearance of a 15-mg/kg dose of acetaminophen, apparently because free sulfate was not appreciably depleted by this small dose. A 6-hr infusion of acetaminophen, at 36 mg/kg/hr, produced steady-state plasma concentrations of about 20 micrograms/ml within 2 hr in renal failure (ureter-ligated) animals, whereas in normal animals the plasma concentrations increased continuously to about 100 micrograms/ml at 6 hr. Free sulfate concentrations in serum at the end of the infusion were about 0.2 mM in normal animals and generally greater than 1 mM in the renal failure animals. The rats with renal failure converted most of the administered dose to acetaminophen sulfate, whereas normal animals metabolized much of the drug to acetaminophen glucuronide. These observations demonstrate the important effect of the endogenous free sulfate level in the body on the elimination kinetics and metabolic fate of a drug that is subject to conjugation with sulfate.
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PMID:Effect of experimental renal failure on sulfate retention and acetaminophen pharmacokinetics in rats. 706 93

Sixty-eight children (ages ranging from 5 months to 16 years) with urolithiasis were treated between 1966 and 1979. There were 36 females (53%) and 32 males (47%). Sixteen children (24%) had associated urinary tract infection; 4 out of these (6%) presented with urinary tract malformation. Fifty-five calculi (89%) were found in the upper urinary tract (kidney and ureter); 24 of the chemically studied calculi (80%) were made of calcium salts. In 30 children, metabolic investigations were carried out, leading to the discovery of hypercalciuria in 17 (57%). In one patient, important vesico-ureteral reflux associated with urolithiasis led to renal failure.
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PMID:[Urolithiasis in Isreali children (author's transl)]. 723 27


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