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

To determine the impact of prenatal detection on neonates with hydronephrosis of the upper pole of a duplex collecting system, we reviewed 40 such cases seen between June 1982 and April 1989. This six-per-year rate contrasts with fewer than one case per year that was seen at our hospital from 1947 to 1977. Nineteen patients had an ectopic ureterocele, and 21 had an ectopic ureter without a ureterocele. Thirty-three (83%) were girls. Thirty-three cases were discovered because of abnormal findings on a prenatal sonogram, and 20 of those infants were asymptomatic. In the 33 patients whose prenatal sonographic findings were abnormal, the sonogram was diagnostically precise for hydronephrosis of the upper pole of a duplex collecting system in only 39%. This imprecision did not adversely affect management or outcome. Postnatal sonography modified the prenatal diagnosis in 75% of these 33 patients. Voiding cystourethrography was the most sensitive and precise imaging technique for detecting both ureterocele and reflux. Lower pole reflux was almost twice as common when an ectopic ureterocele was present (63%) than when one was not (33%). Prenatal sonographic detection of hydronephrosis of the upper pole of a duplex collecting system decreased the proportion of neonates presenting with urinary tract infection and urosepsis because of prophylactic antibiotics initiated at birth and continued until surgical correction. Precise prenatal diagnosis was not needed for effective surgical treatment.
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PMID:Importance of prenatal detection of hydronephrosis of the upper pole. 211 33

A total of 17 patients with intestinal urinary diversion of enterocystoplasty underwent renal transplantation between 1970 and 1988. Patient age ranged from 4 to 35 years (mean age 20 years). The patients were divided into 2 groups. In group 1 (10 patients, 2 of whom required retransplantation) the ureter of the transplanted kidney was implanted into an ileal (7) or colonic (1) conduit or enterocystoplasty (2). In group 2 (7 patients, 1 of whom required a second transplant) the diversion was taken down and the transplanted ureter was implanted into the defunctionalized bladder. There were 14 living related and 6 cadaveric kidneys transplanted. Graft survival rates were 58 and 87% in groups 1 and 2, respectively, with an over-all rate of 70% (14 of 20 kidneys). There was no statistical difference in the graft survival rate between the 2 groups. The complications in group 1 included ureteroileal anastomotic leak (3 patients), ureteroileal stenosis (1), calculus formation (1), urosepsis (1), hyperchloremic metabolic acidosis (1), and wound infection and dehiscence (1). There were no complications in group 2. Renal transplantation into a pre-existing urinary intestinal conduit or augmented bladder does not statistically adversely affect patient or graft survival. However, the complication rate is much higher when the ureter is implanted into an intestinal segment. Therefore, it is preferable whenever possible to implant the ureter into the native bladder.
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PMID:Outcome of renal transplantation after urinary diversion and enterocystoplasty: a retrospective, controlled study. 223 23

Within the framework of a joint follow-up we report on the treatment of 57 infants with urethral valves (35 babies from Munich and 22 from Siegen) in the first year of life, studied between 1974 and 1986. In 16 newborn the diagnosis and initiation of treatment was effected during the first four weeks of life (Group I) and in 41 babies during the 2nd to 12th month (Group II). In three cases, diagnosis of suspected urethral valve was made prenatally. Primary management and the concept of further treatment are described. Primary therapy is determined by the general condition after birth, presence of urosepsis and the extent of any existing renal insufficiency. 2 children died, both from Risk Group I. 5 children are in a state of compensated renal insufficiency. In 2 newborn we were compelled to perform supravesical urinary drain and in 3 children a suprapubic drain. Secondary nephrectomy became necessary in 4 children, 3 of whom belonged to Risk Group I. In 23 of 57 children valve resection followed by transurethral drainage was the only therapy. In 22 of 57 children corrective surgery was performed subsequently (neo-implantation, with and without modellage, stenosis of the ureter exit). The article reports on the course in each case.
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PMID:[Diagnosis, therapy and follow-up of infants with urethral valves, treatment concept in the 1st year of life]. 232 21

During a 6-year period (1979-1985), 142 neonates with significant hydronephrosis were seen. Seventy-eight percent of the cases were discovered on fetal screening during obstetric sonography. Maternal/fetal intervention was virtually never indicated and most babies were asymptomatic. The most common conditions found were obstruction of the ureteropelvic junction (41%), obstruction of the distal ureter (usually primary megaureter) (23%), upper-pole hydronephrosis associated with duplex anomalies (13%), and posterior urethral valves (10%). Seventeen neonates with multicystic dysplastic kidney were seen (three per year or one for every eight with hydronephrosis). In comparison, during the 30-year period, 1947-1977, 146 neonates with significant hydronephrosis were seen. Most cases were discovered because the patients had signs and/or symptoms--either an abdominal mass (an enlarged kidney or bladder) or urosepsis. The three most common conditions were obstruction of the ureteropelvic junction (22%), posterior urethral valves (19%), and ectopic ureterocele (14%). During this period, 53 neonates with multicystic dysplastic kidney were discovered (two per year or one for every three with hydronephrosis). The dramatic increase in the number of neonates found to have hydronephrosis is primarily due to the widespread use of obstetric sonography and concomitant fetal screening. The pattern of causes before 1979 represented the incidence of symptomatic lesions. The current pattern more accurately reflects the true incidence of congenital anomalies of the urinary tract.
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PMID:Neonatal hydronephrosis in the era of sonography. 303 9

Based on 10 own cases during the past 12 years, and a review of the literature, the subject is divided into classification and correlations, morbidity, aetiology, traumatogenesis and pathomechanisms, pathological anatomy and physiology, diagnostical pathways, therapy and results. There are closed and open injuries of the ureter, isolated and combined ones, and among the latter, combined related and not related. This injury is rare in general; in overseas countries, more often the open and in Central Europe, mostly the closed trauma can be seen. The indirect rupture of the ureter happens by hyperlordosis, the direct rupture by wheel lesion. The prevalence of youth for the indirect mechanism of the injury is explained by the hyperextensibility of the lumbar region in juveniles. Usually, the rupture is located proximally, a distal rupture (pelvic fracture) is an exception. Criteria of the closed injury are urinoma within Gerota's fascia and local resorption, later infection or urosepsis. The open injury is marked additionally by abdominal resorption of urine, followed by uremia and peritonitis. Delayed diagnosis is common, as the trauma causes few symptoms initially. Further, it is often obscured by concomitant injuries. For therapy, the rupture must be closed operatively by suture and splint. The operative approach follows usually the lumbar, but in cases of concomitant abdominal injury the abdominal route. Loss of kidney occurs in 20% and lethal outcome in 10%.
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PMID:[Injuries of the ureter caused by external force]. 653 14

We describe 2 patients in whom histologically proved inflammatory strictures of the ureter developed after ureteroileal diversion. The dense impassable strictures were located proximal to the ureteroileal junction. The clinical onset was preceded by acute urosepsis and septicemia. Judicious use of percutaneous nephrostomy and antegrade studies is emphasized in establishing the diagnosis.
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PMID:Inflammatory ureteral strictures after ureteroileal diversion. 684 11

Nine patients with ectopic ureterocele, complete duplication, and nonvisualization of the upper renal segment are presented. All were managed with heminephrectomy and partial ureterectomy only. The procedure immediately controlled urosepsis, and ultimately was successful in the management of associated reflux. Excision of ureterocele and reimplantation of the ipsilateral ureter was unnecessary.
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PMID:Surgical management of ectopic ureterocele. 721 Mar 76

Percutaneous nephrostomy under ultrasonic guidance is a reliable method for suprapublic urinary diversion with a low complication rate. Indications are acute or chronic obstruction of the upper urinary tract from the intravesical ureter to the neck of renal calyx. Etiology of the obstruction may be a renal or ureteral calculus, an intrinsic or extrinsic (radiogenic, inflammatory, tumorous) stenosis of the ureter or a functional ureteral obstruction (megaureter, reflux). In the reported case of an ultrasonically guided percutaneous nephrostomy, the indication for urinary diversion was blocking renal calculus with urosepsis. Any operative procedure was contraindicated because of several internal disease. With sufficient urinary drainage, fever subsided and gradual dilatation of the nephrostomy channel with instrumental extraction of the calculus could be performed under local anesthesia. Percutaneous nephrostomy is recommended for urinary diversion in cases of blocking renal calculi with infection if an operation cannot be performed. This approach bears the option of a later cure by intrumental extraction, litholypaxy or chemical dissolution of the stone.
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PMID:[Case report: percutaneous nephrostomy and instrumental extraction of a blocking renal claculus under local anesthesia (author's transl)]. 742 82

Two hundred and twenty ureteric stones in 214 patients were fragmented intracorporeally by pneumatic lithotripsy under general/regional anaesthesia in a day care set-up. Patients were followed-up weekly and retreatment was done at 4 weeks where necessary. Majority (77%) of patients were in the age group 21-40 years with a male to female ratio of 2:1. Stone location was 86% in the lower third, 11% in the middle and 3% in the upper third ureter. Size of stones was less than 6 mm in 14%, 7-12 mm in 67% and more than 20 mm in 4% cases. All 81% stones of < 12 mm were fragmented in one treatment session while single treatment rate for stones 13-18 mm was 85% and 44% for more than 20 mm size. Overall non-fragmentation rate was 0.9%. Stone free state at four weeks was 95%. Complications were observed in 8.6% cases which included urosepsis, haematuria and perforations. Infrared spectroscopy (IR) in 45 stones showed majority (64%) to be composed of calcium oxalate. Our experience shows that PL is a safe and effective means of performing intracorporeal lithotripsy for both large and hard ureteric stones.
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PMID:Pneumatic lithotripsy: a new modality for treatment of ureteric stones. 773 Oct 87

Between September 1993 and December 1996, 138 patients underwent transurethral ureterolithotripsy (TUL) either as primary treatment or as a second-line therapy after extracorporeal shock wave lithotripsy. In all patients, a semirigid 6.0 F ureteroscope was used. Lithotripsy was performed using a pulsed-dye laser. The overall success rate was 82.6%. The success rates according to the location of stones were as follows, 76.9% for stones in the upper ureter (U1), 96.0% for those in the midureter (U2), and 86.2% for those in the distal ureter (U3). In 68 patients treated with TUL as primary therapy, the success rate was 88.2% and efficiency quotient, which was modified for TUL was 0.75. Complications were rare: no ureteral perforations and no major bleeding occurred, but urosepsis developed in 2 patients. In conclusion, transurethral ureterolithotripsy using a small caliber ureteroscope with pulsed-dye laser is recommended as the primary treatment for mid- and distal ureteral stones, because of its superior success rate. In addition, for upper ureteral stones, laser tripsy is recommended as a helpful auxiliary procedure.
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PMID:[Clinical results of transurethral ureterolithotripsy using pulsed-dye laser: primary ureteral stones versus secondary ureteral stones after ESWL]. 1002 29


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