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

Bladder and ureteral injuries are associated with several types of hysterectomies performed laparoscopically. Subtotal hysterectomy is said to cause fewer complications and provide better pelvic support by preserving the uterosacral and cardinal ligaments, but there are also arguments against it. A new technique, total laparoscopic intrafascial hysterectomy (TLIH) has all the benefits of total and subtotal hysterectomies, but fewer complications. Conventionally, uterosacral ligaments are cut at or just below their junction with the cervix, and the remaining vagina and cardinal ligaments are cut at the same level. With TLIH, using a uterine manipulator and colpotomizer, the incision is made at a much higher level. The cervix is circumcised while preserving the entire uterosacral and cardinal ligaments and full length of the vagina, except in cases of malignancy or severe pelvic endometriosis. The ureter is mobilized farther from the cervix. A longer vagina and excellent pelvic support can be achieved with maximum preservation of the vagina and pelvic supporting structures. A modified McCall culdoplasty and reinforcement of the cardinal ligaments are done, and the vaginal cuff is closed with everted mattress sutures either vertically or transversely. Less granulation tissue is formed on the vaginal vault and postoperative leukorrhea or postcoital vaginal bleeding is reduced. Moschcowitz culdoplasty or high McCall culdoplasty can be done at the same time to correct or prevent an enterocele or prolapsed vagina.
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PMID:Total Laparoscopic Intrafascial Hysterectomy 907 61

Since its description in 1980, the Mitrofanoff principle has become a widely utilized and successful technique for the management of patients with a variety of urological disorders. We report our experience with this procedure in 12 patients (8 M, 4F). The age range was 3.5 years to 17 years (average 13y) and follow-up was from 6 months to 3 years (average 1.7y). Patients were classified in 2 groups: I. When this procedure was done because of the patient was unable to perform urethral catheterization (6p). II. Concomitant bladder neck transection and Mitrofanoff diversion (6p). The appendice was used in 8 p and ureter in 4. Bladder augmentation was performed with ureter in 2 p and colon sigmoid in 3. In 1p, ileocecal segment and in other colon + ileum, were used to replace the bladder. All patients catheterize the Mitrofanoff channel easily, there were no cases of stomal stenosis and the conduit was continent in all. We consider that Mitrofanoff principle is a very successful technique and it can be used as the primary continence mechanism or as an adjunct of major urinary tract reconstruction, to ensure complete bladder emptying, in patients unable to perform urethral catheterization.
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PMID:[The Mitrofanoff principle in the lower urinary tract reconstruction]. 913 61

Since its description in 1980, the Mitrofanoff principle has become a widely utilized and successful technique for the management of patients with a variety of urological disorders. We report our experience with this procedure in 14 patients (10 M, 4 F). The age range was 3.5 years to 17 years (average 12 y) and follow-up was from 6 months to 3 years (average 1.7 y). Patients were classified in 2 groups: I) When this procedure was done because of the patient was unable to perform urethral catheterization (8p). II) Concomitant bladder neck transection and Mitrofanoff diversion (6p). The appendice was used in 9p, ileum in 1 and ureter in 4. Bladder augmentation was performed with ureter in 2p and colon sigmoid in 4. In 1p, ileo-cecal segment and in other colon+ileum, were used to replace the bladder. All patients catheterize the Mitrofanoff channel easily, there were no case of stomal stenosis and the conduit was continent in all. We consider that Mitrofanoff principle is a very successful technique and it can be used as the primary continence mechanism or as an adjunct of major urinary tract reconstruction, to ensure complete bladder emptying, in patients unable to perform urethral catheterization.
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PMID:[The use of a continent urinary stoma in complex reconstructions of the lower urinary tract in children]. 921 8

Controversy exists about the timing of surgery in neonates and infants with congenital anomalies such as refluxing and/or obstructing megaureters and ectopic ureteroceles. Discussion acuminates to the fact whether or not early reconstruction causes irreversible damage to the urodynamic properties of the bladder. Between 1986 and 1992, 49 neonates and infants with obstructing or refluxing megaureters and 23 neonates and infants with ectopic ureteroceles have been operated in our hospital with a mean follow-up of 7.3 years. Reimplant surgery consisted of a modified Politano Leadbetter procedure, ureterocele surgery consisted of complete excision of the ureterocele, including the urethral part, with reconstruction of the urethra, bladder neck and bladder base combined with ureteral reimplants. Urodynamically no unexpected changes or deteriorisation have been seen in any of the patients. Bladder capacity for age, especially in the reflux group, averages 200%. Two of the ureterocele patients needed clean intermittent catheterisation for several years. Results of reflux cure in megaureter surgery were disappointing in ureters with a flat diameter between 6 and 9 mm's that were not recalibrated leading to the conclusion that in young children recalibration of the distal ureter should be done from 6 mm's upwards. No post-operative ureteral obstruction was observed in any of the cases. The conclusion is that early major reconstructions of the lower urinary tract causes no specific harm to the urodynamic properties of the bladder and pelvic floor, provided that the surgery is performed by specialised pediatric urological surgeons. The reported urodynamic problems in this patient group are probably related to lack of experience to deal with dysfunctional voiding habits that are quite common in these children, also after successful surgery. These micturation problems are not related to the surgical procedures, they are the result of pre-existing urodynamic changes of bladder function in these children.
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PMID:Treatment of the neonatal and infant megaureter in reflux, obstruction and complex congenital anomalies. 928 34

To investigate the role of injecting cultured fetal-bladder tissue into the region of the vesicoureteric orifice (VUO) to correct surgically produced vesicoureteric reflux (VUR), 12 Coopworth ewe lambs were studied. Four weeks after incising the intravesical segment of ureter, VUR was demonstrated by micturating cystourethrography. Bladder tissue was obtained from a fetal Coopworth lamb at 10 weeks' gestation, cultured in RPMI 1640, and injected into the region of the VUO of 1 ureter of each lamb using an open surgical approach. The lambs were killed between 1 and 6 months after the injection. Smooth-muscle cells from the cultured fetal bladder tissue were identified by the monoclonal antibodies HHF-35 for muscle alpha-actin and D33 for muscle desmin, and by electron microscopy. One lamb died of a gastrointestinal infection at 8 weeks of age. Of the remaining 11 animals, the injection of fetal-bladder tissue corrected the reflux in 7, while it was reduced in degree in 3 and persisted unchanged in 1. The reflux on the contralateral control side was also corrected in 6 ureters and improved in 2. Using histochemical techniques, grafted fetal-bladder tissue could not be differentiated from host tissue in the region of the VUO. Histopathological studies failed to show any injected tissue in distant organs. This study has shown that surgically-induced VUR in lambs was corrected or improved by the injection of cultured fetal-bladder tissue into the submucosa adjacent to the VUO.
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PMID:Treatment of vesicoureteric reflux in a sheep model using subureteric injection of cultured fetal-bladder tissue. 939 Dec 1

Bladder malignancy in the renal transplant recipient is an infrequent occurrence. The 11 previously reported cases reflect an aggressive tumor growth with invasion, requiring partial or complete cystectomy with or without conduit diversion. We report an additional case in a 40-yr-old woman with a living related renal transplant, who experienced rapid progression of her tumor over 3 wk from initial hematuria to a pelvic mass involving the anterior bladder. Her allograft ureter and native ureters, as well as her left iliac vein, became obstructed with tumor in another 2 wk. Biopsy showed poorly differentiated, invasive transitional carcinoma. Attempted resection was abandoned because of finding tumor involvement in most of the pelvis. Chemotherapy was not attempted. She died 2 wk after her attempted resection from tumor burden. Our report presents a collective review of these previously reported 11 cases plus our case. These bladder tumors demonstrate a rapid progression of invasive disease and respond poorly to chemotherapy. There is a possible association of bladder tumors with cyclophosphamide immunosuppression. An aggressive surgical approach should be followed, especially since these tumors present in a younger age group.
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PMID:Carcinoma of the bladder in renal transplant patients. A case report and collective review of cases. 954 25

The effects of KRN2391 (N-cyano-N'-(nitroxyethyl)-3-pyridine carboximidamide methane-sulfonate), which possesses ATP-sensitive potassium (K+) channel opening (KCO) activity and nitrate activity; Ki1769 (N-cyano-N'-(phenylethyl)-3-pyridinecarboximidamide methanesulfonate), which possesses only KCO activity; and nitroglycerin (NG) were determined on the motility of the ureter, urinary bladder and urethra of rats. Bladder contraction was induced by infusion of fluid into the bladder of conscious rats and recorded on a cystometrogram. KRN2391 and Ki1769 (both 0.3 mg/kg, i.v.) prolonged the micturition interval immediately after the injection, but NG (5 mg/kg, i.v.) did not. Peristaltic movement of the ureter, recorded in anesthetized rats, was inhibited by i.v. injection of KRN2391 and Ki1769 (both 0.03 mg/kg). However, when NG, NaNO2, N-nitro L-arginine methylester and methylene blue were applied directly to the ureter, no change in movement of the ureter was detected. KRN2391 (0.03 mg/kg, i.v.) and Ki1769 (0.3 mg/kg, i.v.) reduced the resistance to fluid infusion through the urethral lumen in anesthetized rats, whereas NG (0.5 mg/kg, i.v.) only reduced this resistance transiently. These results indicate that KCO activity had an inhibitory effect on the motility of the ureter, bladder and urethra. On the other hand, nitrate activity had an inhibitory effect on urethral tonus, corresponding to that induced by KCO activity.
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PMID:Effect of K+ channel openers, KRN2391 and Ki1769, and nitroglycerin on the urinary tract of rats in vivo. 1044 May 33

Bladder augmentation with intestinal or urinary segments has virtually replaced other treatments in the management of both neuropathic and no neuropathic bladder dysfunction that has not responded to pharmacotherapy nor other intervention. We present herein our experience in 55 patients who underwent augmentation cystoplasty. Their mean age were 12.2 years (range 2.5-22.8) and the mean follow-up time was 4 years (1-13.1). They were divided in three groups according to the diagnosis: vesical or cloacal exstrophy (14 patients), neuropathic bladder (36) and posterior urethral valves (5 patients). Indications were: 1) to get a low pressure, high volume reservoir and avoid upper urinary tract damage in low-compliance bladders (41 patients); 2) as an undiversion (8 patients), and 3) prior to renal transplantation. Cystoplasty was performed with bowel segments in 47 cases and ureter in 8, adding some other urological procedures in 22 patients. Mean bladder capacity after 1 year was 400 ml versus 112 as previous value. 52 out of the 55 patients are continent after augmentation. There was no impairment of the renal function in the 5 patients with prior renal failure who underwent cystoplasty. Vesicoureteral reflux disappeared in 78.6% of the patients after cystoplasty. The complications were urinary stones in 5 cases, upper urinary tract infections in 3, and spontaneous bladder perforation in 1 patient. Augmentation cystoplasty is the best choice to achieve a low pressure reservoir, to assure contingency and to avoid progressive damage of the upper urinary tract in neuropathic or no neuropathic pediatric bladder dysfunctions.
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PMID:[Bladder augmentation in reconstruction of the urinary tract (1985-1997)]. 1057 Aug 65

Children who develop end-stage renal disease (ESRD) as a result of obstructive uropathies require evaluation and treatment of associated bladder dysfunction to ensure a good outcome following renal transplantation. Bladder dynamics can often be optimized medically, although surgical intervention is occasionally necessary. For those patients who require bladder augmentation, the use of a dilated native ureter (ureterocystoplasty) is preferred to the more commonly used intestine or stomach (enterocystoplasty), which carry a higher risk of complications. Unfortunately, most patients do not have a suitable anatomy for ureterocystoplasty and, by necessity, intestine or stomach has to be utilized. Herein, we describe the successful application of ureterocystoplasty in the presence of ESRD and a solitary kidney prior to renal transplantation. We believe that owing to the many advantages of native urothelium, every effort should be made to use ureter and avoid the use of intestine.
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PMID:Ureterocystoplasty (bladder augmentation) with a solitary kidney. 1210 May 10

An 86-year-old Caucasian female presented with two weeks history of discomfort discharging urine, occasional hematuria, and suprapubic pain. The patient had a history of left salpingo-oophorectomy for an ovarian tumor, performed four years earlier. Ultrasound showed a solid mass surrounding the orifice of the left ureter. Bladder washing cytology yielded single, loosely cohesive syncytial aggregates of rather uniform cells. A few discretely grooved nuclei ("coffee bean nuclei") were seen. Histologic examination revealed muscular tissue infiltrated by oval to round cells, arranged in solid and follicular structures. The tumor cells were immunoreactive for estrogen receptor, inhibin, vimentin, and calretinin. The use of antibodies to pancytokeratin, inhibin, estrogen receptor, S-100, calretinin, and chromagranin could help confirm granulosa cell tumor. To my knowledge, there was no previous report on bladder washing cytology of metastatic granulosa cell tumor.
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PMID:Bladder-washing cytology of metastatic ovarian granulosa cell tumor. 1211 30


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