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

Ureteral injuries are uncommon but serious complications of laparoscopic pelvic surgery. When unrecognized, patients experience fever, abdominal pain, signs of peritonitis, and leukocytosis usually 48 to 72 hours after the surgical procedure. A 48-year-old woman underwent laparoscopic-assisted vaginal hysterectomy, bilateral salpingo-oophorectomy, and anterior and posterior colporrhapy due to a large, symptomatic uterine myoma. Postoperatively, she suffered from progressive left lower quadrant pain, with drainage of yellowish fluid from the subumbilical puncture wound 5 days after the operation. Significant urinary ascites was present. Intravenous pyelogram revealed injury to the lower third of the left ureter about 3 cm away from the ureterovesical junction. Left-sided percutaneous nephrostomy was performed after transurethral placement of a ureteral stent failed. Reanastomosis of the ureter was performed successfully 3 months later, and the patient fully recovered without compromise of the genitourinary tract.
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PMID:Ureteral injury after laparoscopic surgery. 922 89

This study was undertaken to evaluate the various gynecologic endoscopic surgical techniques including resectoscopic myomectomy, laparoscopic myomectomy, and laparoscopy assisted vaginal hysterectomy (LAVH) used in the treatment of uterine myomas. The medical records of 136 cases of uterine myomas treated using one or more of the gynecologic endoscopic surgical techniques in the Department of Obstetrics and Gynecology at Yonsei University were retrospectively reviewed from March 1997 to September 1998. Of the 136 cases reviewed, there were 40 submucosal myomas and 96 intramural and subserosal myomas. For statistical analysis, Student's t-test was used. Submucosal myomectomy using the resectosope was performed in 35 cases (mean age: 39 +/- 1.5 years), laparoscopic myomecotmy in 35 cases (mean age: 36 +/- 1.9 years), and LAVH in 66 cases (mean age: 42 +/- 1.1 years). In cases of huge myomas, the GnRH agonist was used prior to surgery, and in cases of heavy uterine bleeding, angioblock of the uterine artery was undertaken before the endoscopic procedures. The mean operating time was significantly shorter in resectoscopic myomectomy (41 +/- 12 min), followed by laparoscopic myomectomy (85.0 +/- 10.3 min) and LAVH (123 +/- 5.3 min). The mean hospital stay for resectoscopic myomectomy, laparoscopic myomectomy, and LAVH was 1.9 +/- 0.5, 2.5 +/- 0.5, and 3.4 +/- 0.8 days (p < 0.001), respectively. There were 3 cases of complications including pulmonary edema and uterine perforation in the resectoscopic myomectomy group, and 4 cases of complications including bladder, ureter, and epigastric vessel injury in the LAVH group. In conclusion, the therapeutic effect of various gynecologic endoscopic surgical techniques can be maximized in terms of shorter operation time, shorter hospital stay, faster recovery, and less blood loss by the appropriate management of uterine myoma in well-chosen patients.
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PMID:Endoscopic management of uterine myoma. 1066 Oct 36

We conducted a retrospective study of all hysterectomies performed in our setting over a two year period (1995-1996). The objective was double: define the indications and precise the outcome. A total of 141 cases were recorded. The main characteristics of the patients were the following: a mean age of 38 years, mean gravidity and parity of 5 and an average number of living children of 3. Hysterectomy was performed by the abdominal route in 86.52% of the cases. The main indications were: uterine rupture (39.71%), uterine myoma (25.53%), genital prolapse (19.89%) and cervix cancer (7.09%). Adnexectomy was associated in 51 cases and it was bilateral in 22 cases. The following complications occurred: 5 deaths, 8 wound abcess, 2 bladder injury, 1 ureter injury and 1 case of post-operative hemorragea.
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PMID:[Hysterectomies in tropical zones: experience of one African maternal health service. 141 cases in Burkina Faso]. 1133 44

A 42-year-old woman was referred to our hospital because of abdominal fullness and a large abdominal mass. Computed tomography (CT) demonstrated bilateral ovarian tumors, uterine myoma and left hydronephrosis. On excretory urography the left kidney was not visualized and retrograde pyelography (RP) revealed left hydronephrosis and a filling defect in the left lower ureter. Based on the diagnoses of endometriosis of bilateral ovaries, uterine myoma and a left ureteral tumor, abdominal total hysterectomy, right salpingo-oophorectomy and partial ureterectomy were performed. Pathologically, in the uterus, both leiomyoma and adenomyosis, and endometriosis of the right ovary and ureter were diagnosed. Medication with buserelin acetate was started.
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PMID:Ureteral endometriosis: a case report and a review of the Japanese literature. 1157 99

We examined the relationships between the incidence of noncancer diseases and atomic bomb radiation dose using the longitudinal data for about 10,000 Adult Health Study (AHS) participants during 1958-1998. The current report updates the analysis we presented in 1993 with 12 additional years of follow-up. In addition to the statistically significant positive linear dose-response relationships detected previously for the incidence of thyroid disease (P < 0.0001), chronic liver disease and cirrhosis (P = 0.001), and uterine myoma (P < 0.00001), we also found a significant positive dose response for cataract (P = 0.026), a negative linear dose-response relationship for glaucoma (P = 0.025), and significant quadratic dose-response relationships for hypertension (P = 0.028) and for myocardial infarction among survivors exposed at less than 40 years of age (P = 0.049). Significant radiation effects for calculus of the kidney and ureter were evident for men but not for women (test of heterogeneity by sex: P = 0.007). Accounting for smoking and drinking did not alter the results. Radiation effects for cataract, glaucoma, hypertension, and calculus of the kidney and ureter in men are new findings. These results attest to the need for continued follow-up of the aging A-bomb survivors to fully elucidate the effects of radiation exposure on the occurrence of noncancer diseases.
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PMID:Noncancer disease incidence in atomic bomb survivors, 1958-1998. 1516 58

Cases are presented to illustrate pitfalls in radiologic and histopathologic diagnosis in urology. In a 73-year-old woman, ultrasound revealed calcification in an irregular mass arising from the left wall of the bladder. Bladder biopsy reported the mass as papillary transitional cell carcinoma. Histologically, the specimen showed marked hyperplasia of the urothelium with formation of Brunn's nests and no evidence of dysplasia or malignancy. A review of medical images showed that the mass was a calcified uterine fibroid. In a 36-year-old man, a calcified opacity in the pelvis was reported as a ureteric calculus, and the patient underwent ureteroscopy. No stone was found. A review of an intravenous urogram showed that the radio-opaque shadow appeared outside the left ureter. A 41-year-old man with tetraplegia developed hydronephrosis as the result of a calculus in the renal pelvis. Ureteric stenting was performed, followed by shock wave lithotripsy. A follow-up x-ray of the abdomen showed a small radioopacity that projected over the line of the left ureter at the L-3 level-probably a ureteric calculus. A review of a computed tomography scan revealed that the calculus, noted on plain film at the level of L-3, had become extruded and was lying posterior to the ureter. A 59-year-old man underwent nephrectomy for a 5-cm solid lesion in the mid pole of the left kidney. Histology showed multiple synchronous renal cell carcinomas and angiomyolipomas. The patient underwent further investigation for von Hippel-Lindau disease and tuberous sclerosis. A review of tissue blocks from the nephrectomy specimen, however, showed no evidence of angiomyolipoma. What was interpreted as renal angiomyolipoma was actually simple distorted blood vessels in areas of renal scarring. To prevent mistakes in diagnosis and to detect medical errors without delay, the authors recommend that physicians set aside time to reflect upon their clinical practice, regularly participate in honest and informal case discussions, and seek a second opinion when in doubt.
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PMID:Pitfalls in radiologic and histopathologic diagnosis of urologic disease--report of 4 cases. 1727 70

Obstruction of the ureter as a cause of acute or chronic kidney injury in the transplanted kidney is unusual beyond the perioperative period. We present a case of ureteric obstruction, infection and septicemia caused by a large uterine leiomyoma in a patient 8 years post transplantation. Initial treatment comprised of intravenous fluid and antibiotics followed by urgent drainage of the collecting system. Subsequent hysterectomy resolved the obstruction with resolution of renal failure. In young female kidney transplant recipients, gynecologic causes, although rare, need to be considered as possible etiologies of urinary obstruction and renal dysfunction.
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PMID:Uterine leiomyoma causing urinary obstruction of the transplanted kidney. 2035 40

We report 2 patients with ureteral injury after a simple total laparoscopic hysterectomy for uterine myoma with a complete resection of the distal ureter. One patient had unilateral injury and the other 2 patients had bilateral injury. The surgical laparoscopic repair procedure was carried out 3 to 5 days after the injury. Surgery involved intramural dissection of the distal ureteral stump to expose at least 1 cm of the ureter, percutaneous ureteral stent placement, elimination of tension between the proximal ureter and the dissected distal stump, end-to-end anastomosis, and reinsertion of the distal ureter into the bladder muscle layer, which was previously dissected for the anastomosis.
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PMID:Laparoscopic dissection of the intramural ureter to repair a complete transection of the distal ureter: Initial experience with a new minimally invasive technique that preserves the anatomy of the urinary tract. 2494 Apr 68

Iatrogenic ureteral injury is a well-recognized complication of abdominal total hysterectomy. We report a case of a 57-year-old female who underwent abdominal total hysterectomy for a uterine myoma and experienced severe right flank pain postoperatively. The imaging study displayed an obstruction of the right distal ureter. Under ureteroscopy, an extraluminal ligature was released with a holmium:yttrium-aluminum-garnet laser. The stenotic segment was immediately relieved. Two months later, the intravenous urogram illustrated patency of the distal ureter with regression of right hydronephrosis. There was no recurrent hydronephrosis during 1 year of follow-up.
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PMID:Endoluminal release of ureteral ligature after hysterectomy. 2524 Dec 86

Endometriosis is defined as the presence of endometrial-like tissue outside the uterus. Deposits are commonly distributed on the ovaries, uterosacral ligaments, pouch of Douglas, rectum and sigmoid colon, bladder and ureter. Endometriosis is common, affecting 10% of the female adult population and up to 50% of women with infertility. Risk factors include early menarche, late menopause, delayed childbearing, vaginal outflow obstruction and a first-degree relative affected. Women commonly present to their GP with pelvic pain, painful intercourse or subfertility. Classically the pain starts several days before the period which is extremely painful. After the period, symptoms tend to improve until mid-cycle when the pattern repeats again. Patients also complain of fatigue. Abdominal palpation, bimanual and speculum examination are important to identify signs of endometriosis, but also to exclude alternative diagnoses such as fibroid uterus, infection or pregnancy. However, a normal examination does not exclude a diagnosis of endometriosis. Serum CA125 can be raised in endometriosis but is not specific or sensitive for the condition and is therefore not recommended as a screening test. A normal pelvic ultrasound scan does not exclude a diagnosis of endometriosis. The gold standard investigation for endometriosis is laparoscopy and biopsy with histological confirmation. Referral should be considered if pain is not controlled with simple analgesia or the diagnosis is suspected in a woman who is actively trying to conceive. Early referral should be considered in women with abnormal examination findings, or an abnormal ultrasound result.
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PMID:GPs have key role in early diagnosis of endometriosis. 2606 68


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