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

Ureteral strictures are serious and frequent complications of chronic bilharziasis of the urinary tract are seen. To determine which corrective surgical procedures are most successful, we compared the results of those most commonly done. We retrospectively analyzed our experience with mucosa to mucosa ureterovesical anastomosis (68 ureters), transvesical ureteral meatotomy (30 ureters) are submucosal tunnel ureteroneocystostomy, (UNC; 10 ureters). Complete follow-up data are available for 102 patients (108 ureters); half of these cases were followed for 4 years or even more. It is to be noted that, in our series, only 10 ureters were suitable for submucosal tunnel anastomosis: bilharzial ureters are usually fibrotic, noncompressible, and the vesical mucosa is adherent to the muscular layer - which renders creation of a tunnel difficult or impossible. However, this procedure produced the best results. The conclusion was reached that, whenever possible, antireflux procedures suitable for the bilharzial bladder and ureter should be attempted. Based on this analysis, a prospective clinical trial was carried out, which compared Boari flap UNC (30 ureters), triangular flap ureterovesicoplasty of Girgis et al. (30 ureters), and ileal loop replacement of the pathologic segment (30 ureters). The average period of follow-up was 20 months. Triangular flap and Boari flap were found to be superior to ileal replacement. Ileal replacement is consistently followed by vesicoileal reflux and commonly by persistent urinary tract infection. In consequence, the latter operation must be reserved for cases with extensive ureteral loss or destruction. Antireflux procedures still remain the most desirable methods whenever technically possible.
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PMID:Management of bilharzial strictures of the lower ureter. 711 57

Advances in surgical techniques have dramatically altered the management of patients with symptomatic urolithiasis requiring intervention. Extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy, and ureteroscopy allow virtually any stone to be removed from the upper urinary tract without resorting to open surgical techniques. Extracorporeal shock wave lithotripsy is the preferred initial treatment for approximately 80% to 85% of calculi. Percutaneous nephrolithotomy is the preferred approach when dealing with more voluminous stone material (ie, > 2 cm). Ureteroscopy is generally reserved for distal ureteral calculi, although the recent advent of small flexible ureteroscopes have extended ureteroscopic techniques effectively into the proximal ureter and even the kidney. Staghorn stones are usually best managed initially with percutaneous nephrolithotomy followed by the addition of extracorporeal shock wave lithotripsy, if necessary. The relative advantages, disadvantages, and complications of extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy, and ureteroscopy will be reviewed.
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PMID:Lithotripsy and surgery. 889 Apr 3

Renal scanning is one of the imaging techniques used to investigate the upper urinary tract. In the present examination, the principles of performing renal scanning in the dog and car are described. Eleven animals with healthy kidneys (six dogs and five cats) were included in the study for the determination of normal scintigraphic findings as well as eight animals (seven dogs and one cat) with renal damage. The following nephropathies were investigated scintigraphically: nephrolithiasis, hydronephrosis, polycystic renal degeneration, renal aplasia, renal hypoplasia, obstruction of the ureter and renal trauma. Renal scanning proved to be easy to perform with acceptable effort in the dog and cat. It allows the simultaneous assessment of renal function on both sides during the phases of renal perfusion and tubular se- and excretion and represents a valuable adjunct to the morphologically orientated radio- and sonography. The nephrogram curves are comparable to those found in man, although the time until reaching the maximum of the curves and elimination half times are shorter. Also, the sequential scintigrams can be divided into the corresponding phases as in man. Through permanent technical development, today there are gamma processors at disposal that allow a faster, comprehensive and sophisticated evaluation. In the present investigation, this was demonstrated by a comparison of two different calculators. However, due to the financial and technical expenditures and the special radiological safety precautions required, renal scanning will be a technique reserved to larger clinics.
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PMID:[Kidney scintigraphy in dogs and cats using 99mTc-MAG3]. 896 43

In 58 patients with acute recurrent or persistent flank pain, straight x-ray (kidney, ureter, bladder region) detected stones in the urinary tract in 50 cases (86.2%), whereas ultrasonography detected stones in the urinary tract in 55 patients (94.8%). Ultrasound also detected unilateral hydronephrosis in 20 patients (34.48%). The presence of calculus was subsequently proved by intravenous urography/surgery or spontaneous passage. Ultrasonography is safe, quick, reliable and most effective diagnostic tool in such cases in rural areas. Intravenous urogram should be reserved for cases which need surgical intervention.
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PMID:Ultrasonography in acute flank pain. 914 63

The advent of "minimal invasive surgery" with the development of new endoscopic techniques modified many therapeutical concepts in urology as in other fields. The treatment of the ureteropelvic junction obstruction reserved in the past to open surgery can nowadays be successfully realized with endopelvic or endoureteral techniques under visual or fluoroscopic guidance. The authors present their experience with two new techniques: antegrade endopyelotomy under visual control or retrograde fluoroscopic endopyelotomy. Based on experimental and clinical studies which demonstrated the extraordinary capacity of the incised ureter to regenerate and regain a peristaltic activity, these treatments offer a cure rate nearly as high as open pyeloplasty.
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PMID:[Endoscopic treatment of pyelo-ureteral junction disease]. 944 75

The effectiveness of cysto-urethroscopy for the staging of cervical cancer was evaluated in a review of 412 cases of advanced squamous cell carcinoma referred to Kasturba Medical College Hospital (Manipal, India) in 1985-93. These cases were classified as follows: stage 3a (growth involving the lower third of the vagina without invasion of the pelvic wall), n = 19; stage 3b (invasion to the pelvic wall), n = 359; stage 4a (extension of disease to an adjacent organ), n = 17; and stage 4b (distal spread), n = 7. However, only 10 of the 378 stage-3 cases and 19 of the 24 stage-4 cases had histopathologically confirmed vesical mucosal involvement. All women underwent radiotherapy, regardless of the cystoscopic finding. Overall, this review suggests that cysto-urethroscopy is an unnecessary, cost-ineffective, invasive procedure that facilitates neither diagnosis nor treatment planning. Transvaginal sonography may be a preferable technique for evaluating vesical invasion, with use of cystoscopy reserved for endoscopic decompression of the obstructed ureter.
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PMID:Cystoscopic staging of carcinoma uterine cervix, revisited. 956 87

Laparoscopic pyeloplasty is one of several minimally invasive treatment options for UPJ obstruction. In fact, several endoscopically and fluoroscopically controlled methods of incising the obstructed UPJ are now available that are significantly less invasive and less morbid in comparison with open pyeloplasty. However, the long-term success rates of these incisional techniques are less than the rates reported for open pyeloplasty. Several causes of obstruction may be present in the primarily obstructed UPJ, including kinking or compression related to crossing vessels or intrinsic narrowing at the UPJ. One potential reason for the inferior success rates of incisional methods in comparison with open pyeloplasty is that the former techniques address the intrinsically narrowed UPJ but may not address extrinsic problems such as kinking of the ureter associated with fibrotic bands or compression from crossing vessels. Laparoscopic pyeloplasty addresses all potential causes of obstruction. Any fibrotic bands kinking the ureter are divided, and the ureter is spatulated through the level of the UPJ prior to completion of the anastomosis. If a crossing vessel is encountered, a dismembered pyeloplasty is performed, the ureter and renal pelvis are transposed to the opposite side of the vessels, and the anastomosis is completed. An additional disadvantage of incisional techniques is the significant risk of hemorrhage following incision of the UPJ, with as many as 3% to 11% of patients requiring blood transfusion. Hemorrhage may occur owing to an errant anterior incision, the presence of a crossing vessel, incision into the renal parenchyma adjacent to the UPJ, or as the result of bleeding from the percutaneous access site. In contrast, mean estimated blood loss in the authors' series of 57 laparoscopic pyeloplasties was 139 mL, and none of the patients required blood transfusion. Although it is more morbid in comparison with retrograde or fluoroscopically controlled endopyelotomy, laparoscopic pyeloplasty seems at least comparable to antegrade percutaneous endopyelotomy in terms of the length of hospitalization and patient convalescence. Laparoscopic pyeloplasty, however, offers a higher success rate than with incisional techniques, not only from a radiographic standpoint but from a subjective standpoint as determined by the results of the analogue pain and activity questionnaire. The major disadvantage of laparoscopic pyeloplasty is the need for proficiency in laparoscopic techniques and for a longer operative time. As a result, the literature on laparoscopic pyeloplasty consists primarily of small series. Janetschek and co-workers reported on a series of 17 patients who underwent laparoscopic pyeloplasty, including 14 via a transperitoneal approach and 3 via a retroperitoneal approach. Procedures performed included ureterolysis alone, dismembered pyeloplasty, and nondismembered (Fenger) pyeloplasty. "Fenger-plasty" is similar to Y-V pyeloplasty and is performed by incising the UPJ longitudinally and closing the incision transversely in a Heineke-Mikulicz fashion. Janetschek and colleagues reported a 100% success in the eight patients who underwent dismembered pyeloplasty but believed that this technique was too cumbersome and should be reserved for patients with long stenoses, dorsally crossing vessels, or large renal pelvis. Because two of the four patients undergoing ureterolysis alone failed treatment, Janetschek and colleagues have abandoned this technique. They now prefer the Fenger-plasty technique, even in the setting of ventrally crossing vessels, because the technique can be performed quickly with one to three sutures, and the anastomosis can be sealed with fibrin glue and a flap of Gerota's fascia. Their experience with this technique, however, remains relatively limited. Technologic advances such as the Endostitch device have facilitated reconstructive laparoscopic procedures such as pyeloplasty. (ABSTRACT TRUNCATED)
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PMID:Laparoscopic pyeloplasty. Indications, technique, and long-term outcome. 963 88

Ureteroscopy is frequently indicated in the treatment of stones of the pelvic ureter. Access to the lumbar ureter is associated with a higher complication rate: wounds, ureteric rupture, haemorrhage, or more serious lesions such as avulsions of the ureter. We present 4 cases of avulsion of the ureter seen in our department, corresponding to 4 men with stones of the lumbar ureter treated by ureteroscopy, 2 of them after failure of in situ extracorporeal lithotripsy (ESWL) and an attempt to "flush" the stone and the other two because ESWL was not available. The ureteric lesion was related to a Dormia catheter in 2 cases and the ureteroscope in 2 cases. The lesion was diagnosed and treated immediately in 2 patients and after a delay in the other 2 cases. Repair consisted of ureteric reimplantation on a Boari flap (1 case), implantation onto a psoas bladder (1 case), ureteroileoplasty (1 case) and autologous transplantation (1 case). Ureteric lesions prevented uretero-ureterostomy. Ureteric reimplantation on psoas bladder and/or Boari flap appears to be the simplest method, but it cannot always be performed. In the case of avulsion of the ureteropelvic junction with a large defect, autologous transplantation is a method of choice in young subjects. Ureteroileoplasty appears to be reserved for elderly patients.
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PMID:[Hazards of lumbar ureteroscopy: apropos of 4 cases of avulsion of the ureter]. 968 67

Since its introduction in 1980, extracorporeal shockwave lithotripsy (SWL) has become the first therapeutic option in most cases of upper-tract urolithiasis, and the technique has been used for pediatric renal stones since the first report of success in 1986. Lithotripter effectiveness depends on the power expressed at the focal point. Closely correlated with the power is the pain produced by the shockwaves. By reducing the dimensions of the focus, it becomes possible to treat the patient without anesthesia or analgesia but at the cost of a higher re-treatment rate. Older children often tolerate SWL under intravenous sedation, and minimal anesthesia is applicable for most patients treated with second- and third-generation lithotripters. Ureteral stenting before SWL has been controversial. Current data suggest that preoperative stent placement should be reserved for a few specific cases. Stone-free rates in pediatric SWL exceed 70% at 3 months, with the rate reaching 100% in many series. Even the low-birth-weight infant can be treated with a stone-free as high as 100%. How can one explain the good results? Possible explanations include the lesser length of the child's ureter, which partially compensates for the narrower lumen. Moreover, the pediatric ureter is more elastic and distensible, which facilitates passage of stone fragments and prevents impaction. Another factor is shockwave reproduction in the body: there is a 10% to 20% damping of shockwave energy as it travels through 6 cm of body tissue, so the small body volume of the child allows the shockwaves to be transmitted with little loss of energy. There are several concerns regarding the possible detrimental effect of shockwaves on growing kidneys. Various renal injures have been documented with all type of lithotripters. On the other hand, several studies have not shown adverse effects. In general, SWL is considered to be the method of choice for managing the majority of urinary stones in children of all ages. Re-treatments improve the stone-free rate, often raising it to 100%. Among the predictors of success, stone size seems to be the most important. In the absence of guidelines, selecting the appropriate treatment modality for each child requires planning and depends on instrument availability and local expertise.
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PMID:Extracorporeal shockwave lithotripsy in pediatrics. 1817 37

Transitional cell carcinoma of the upper urinary tract (UUT-TCC) is relatively uncommon, accounting for 2-5% of all urothelial tumors. Its incidence appears to be increasing as a result of progress in imaging, endoscopy, and improved survival from bladder cancer. Renal pelvis tumors represent 10% of all renal cancers. Pyelic neoplasms occur at a rate twice to four times the incidence of tumors in the ureter, where the common site is the distal tract (about 70%). One third of UUT-TCC ore multifocal, and about 1% are simultaneous and bilateral. The introduction of lasers represented a big step in the diagnosis and endoscopic treatment of upper urinary tract tumors. A successful laser treatment is defined by the careful selection of the patients affected by urinary tract lesions. Usually, only patients affected by low grade and papillary lesion should be treated endoscopically with laser. Patients with high grade and invasive lesions should rather be submitted to surgical procedure. Actually, the urologist has a wide choice in laser technology (Holmium laser, Thulium laser). For a correct and safe treatment of ureteral and pyelic lesions with lasers it is mandatory to respect some technical advises. First of all, an adequate access for a good vision of ureter and renal pelvis is imperative. In fact, the urologist should always work in safety, with an optimal control of the instrumentation. Then, it is important to define the laser type and its energy level. The development in laser technology (i.e. small and flexible laser fibers) allows also a radical, safe and minimally invasive treatment of urothelial lesions using flexible ureteroscopes. Of course it is mandatory to evaluate the grade and stage of the tumors by means of the ureteroscopic biopsies: invasive tumors must be treated by immediate nephroureterectomy while the endoscopic treatment should be reserved to those patients with a solitary kidney, renal failure, bilateral tumors, severe comorbities or affected by a solitary tumors with <15 mm in diameter and of low-grade/stage.
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PMID:Treatment of the pyelocalyceal tumors with laser. 1914 May 90


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