BACKGROUND Varicocele embolization,a minimally invasive treatment for symptomatic varicoceles,carries a rare risk of complications like ureteral obstruction and hydronephrosis.This case report documents such a case to...BACKGROUND Varicocele embolization,a minimally invasive treatment for symptomatic varicoceles,carries a rare risk of complications like ureteral obstruction and hydronephrosis.This case report documents such a case to raise awareness of these potential complications and showcase minimally invasive surgical management as a successful solution.CASE SUMMARY A 35-year-old male presented with flank pain and hematuria following varicocele embolization.Imaging confirmed left ureteral obstruction and hydronephrosis.Laparoscopic ureterolysis successfully removed the embolization coil and repaired the ureter,resolving the patient's symptoms.Follow-up at six months and two years showed sustained improvement.CONCLUSION Minimally invasive surgery offers an effective treatment option for rare complications like ureteral obstruction arising from varicocele embolization.展开更多
Dilated dysfunction involving multiple visceral organs has been reported in patients with systemic lupus erythematosus （SLE）. Chronic intestinal pseudoobstruction （CIPO） resulting from intestinal smooth muscle dam...Dilated dysfunction involving multiple visceral organs has been reported in patients with systemic lupus erythematosus （SLE）. Chronic intestinal pseudoobstruction （CIPO） resulting from intestinal smooth muscle damage has presented in conjunction with ureterohydronephrosis and, more rarely, biliary dilatation （megacholedochus）. While the molecular pathogenesis is largely unknown, observed histopathologic features include widespread myositis, myocyte necrosis in the intestinal muscularis propria with subsequent atrophy and fibrosis, preserved myenteric innervations and little vasculitis. High dose immunosuppression usually results in resolution of symptoms with recovery of smooth muscle function, indicative of an autoimmune etiology. We report a patient with SLE who presented with intestinal pseudo-obstruction, ureterohydronephrosis and megacholedochus, and present images that illustrate megaviscera simultaneously involving all 3 visceral organs. Since the co-manifestation of all 3 is unusual and has been reported only once previously, we have termed this rare clinical syndrome generalized megaviscera of lupus （GML）. Although the SLE disease-activity parameters responded to aggressive immunomodulative therapy in our patient, clinical evidence of peristaltic dysfunction persisted in all involved viscera. This is a variation from the favorable outcomes reported previously in SLE patients with GML and we attribute this poor clinical outcome to disease severity and, most importantly, delayed clinical presentation. Since inflammation followed by atrophy and fibrosis are key aspects in the pathogenesis and natural history of GML, the poor response in our patient who presented late in the clinical course may be the result of ＇burnt out＇ inflammation with irreversible end-stage fibrosis. Thus, early recognition and timely initiation of treatment may be the key to recover visceral peristaltic function in patients with GML.展开更多
Obstructive nephropathy ultimately leads to end-stage renal failure. Renovascular lesions are involved in various nephropathies, and most renal diseases have an ischemic component that underlies the resulting renal fi...Obstructive nephropathy ultimately leads to end-stage renal failure. Renovascular lesions are involved in various nephropathies, and most renal diseases have an ischemic component that underlies the resulting renal fibrosis. The aim of this study was to investigate whether morphological changes occur in the renal vasculature in hydronephrosis and the possible mechanisms involved. A model of complete unilateral ureteral obstruction（CUUO） was used. Experimental animals were divided into five groups： a normal control group（N） and groups of animals at 1st week（O1）, 2nd week（O2）, 4th week（O4） and 8th week（O8） after CUUO. Blood pressure was measured, renal arterial trees and glomeruli were assessed quantitatively, and renovascular three-dimensional reconstruction was performed on all groups. Glomerular ultrastructural changes were examined by transmission electron microscopy. The results showed that the systolic blood pressure was significantly increased in the obstructed groups（O1, O2, O4 and O8）. Three-dimensional reconstruction showed sparse arterial trees in the O8 group, and a tortuous and sometimes ruptured glomerular basement membrane was found in the O4 and O8 groups. Furthermore, epithelial media thickness and media/lumen ratio were increased, lumen diameters were decreased, and the cross-sectional area of the media was unaltered in the segmental renal artery, interlobar artery and afferent arterioles, respectively. In conclusion, renal arterial trees and glomeruli were dramatically altered following CUUO and the changes may be partially ascribed to vascular remodeling. Elucidation of the molecular mechanisms of renovascular morphological alterations will enable the development of potential therapeutic approaches for hydronephrosis.展开更多
Hydronephrosis and ureteral obstruction are rare sequelae of Crohn’s disease. Chronic obstruction can ultimately lead to dysfunction of the affected kidney, and atypical presenting symptoms create pitfalls in diagnos...Hydronephrosis and ureteral obstruction are rare sequelae of Crohn’s disease. Chronic obstruction can ultimately lead to dysfunction of the affected kidney, and atypical presenting symptoms create pitfalls in diagnosis. Few reviews in the literature focus on this process and are limited to isolated case reports and case reviews. We performed a PubMed search using such terms as “Hydronephrosis” AND “Crohn’s disease” AND/OR “ureteral obstruction.” References from selected papers were reviewed for relevance and used for information-gathering as well. Ureteral obstruction most commonly occurs on the right side, due to ileal involvement. Clinical diagnosis is difficult, as symptoms are notably not genitourinary in origin;rather they are more musculoskeletal in nature. Treatment centers on disease control and temporary drainage of the affected kidney. Though rare, hydronephrosis and ureteral obstruction may develop as a result of inflammatory bowel disease. Due to atypical presenting symptoms, a high clinical suspicion is needed to affirm the diagnosis and ensure proper treatment.展开更多
With the increasing use of ultrasonography,congenital anomalies are often picked in utero.Antenatally detected hydronephrosis is amongst the most commonly detected abnormality.The management of this condition has rais...With the increasing use of ultrasonography,congenital anomalies are often picked in utero.Antenatally detected hydronephrosis is amongst the most commonly detected abnormality.The management of this condition has raised considerable debate amongst clinicians dealing with it.This article is written with an idea to provide comprehensive information regarding the postnatal management of antenatally detected hydronephrosis.A detailed review of the current literature on this topic is provided.Also,guidelines have been given to facilitate the management of this condition.展开更多
BACKGROUND Paraduodenal hernia(PDH)is a mesenteric-parietal hernia with retroperitoneal and retrocolic herniation of the small bowel into a sac,which is formed by a peritoneal fold located near the fourth portion of t...BACKGROUND Paraduodenal hernia(PDH)is a mesenteric-parietal hernia with retroperitoneal and retrocolic herniation of the small bowel into a sac,which is formed by a peritoneal fold located near the fourth portion of the duodenum.The present case revealed that PDH was a possible reason for hydronephrosis,and that the carful laparoscopic exploration surgery was necessary to find infrequent causes of hydronephrosis to avoid invalid Anderson–Hynes pyeloplasty surgery and its injury.CASE SUMMARY An 8-year-old boy presented to the pediatric department with a chief complaint of cryptorchidism.Afterwards,laparoscopy confirmed hydronephrosis secondary to left PDH with cryptorchid.Then,he received laparoscopic surgery,fixed operation for left PDH,release of the ureteropelvic junction obstruction,and treatment for hydronephrosis.It is necessary to perform secondary surgery for cryptorchidism and long-term follow-up.CONCLUSION The case revealed an extremely rare cause of hydronephrosis in children,suggesting a potential correlation between PDH and hydronephrosis.展开更多
A case of a 25 year old 2 alive Patient, with obstructed labour with fetal death and delivery of the fetus up to the trunk caused by congenital Bilateral Hydronephrosis is presented. Obstetric examination on admission...A case of a 25 year old 2 alive Patient, with obstructed labour with fetal death and delivery of the fetus up to the trunk caused by congenital Bilateral Hydronephrosis is presented. Obstetric examination on admission supported by Abdominal Ultrasound revealed Bilateral Hydronephrosis which was then drained per abdomen using needle and intravenous fluid giving set with eventual relief of the obstruction and vaginal delivery of the stillborn baby.展开更多
Giant Hydronephrosis (GH) is a rare condition in urology literature and defined as a pelvicalyceal system of kidney containing more of 1000 ml of urine. This condition is not so rare in our setting. We herein, reporte...Giant Hydronephrosis (GH) is a rare condition in urology literature and defined as a pelvicalyceal system of kidney containing more of 1000 ml of urine. This condition is not so rare in our setting. We herein, reported two cases of giant hydronephrosis, seen in two young patients respectively with 5 and 9 years old and their collecting system containing 4000 ml and 5000 ml of urines respectively. Only simple nephrectomy was performed for the two cases with renal function impairment and the post operative course was uneventful. Our purpose through these cases reports is to discuss diagnosis features and management of such condition in our setting, a context of low income countries as Burkina-Faso where diagnosis tool and further investigation are not always available.展开更多
Psoas muscle is a rare location for hydatid disease. Here we present a case of infected hydatid cyst left psoas muscle presenting as left flank pain, fever, local flank tenderness, and raised blood counts. Preoperativ...Psoas muscle is a rare location for hydatid disease. Here we present a case of infected hydatid cyst left psoas muscle presenting as left flank pain, fever, local flank tenderness, and raised blood counts. Preoperative diagnoses was made by Ultrasonography (USG) and Computed Tomography (CT) abdomen, although serology for hydatid disease was negative.展开更多
Objective: to study and explore the clinical effect of nursing intervention in the prevention of postoperative complications in children with hydronephrosis, and to analyze its application value. Methods: 30 cases of ...Objective: to study and explore the clinical effect of nursing intervention in the prevention of postoperative complications in children with hydronephrosis, and to analyze its application value. Methods: 30 cases of pediatric hydronephrosis patients admitted to our hospital last year were selected to carry out this study, which were divided into two groups, respectively, with different nursing intervention mode for nursing, after the end of nursing, its application effect and application value were analyzed. Results: in this study, the incidence of complications was significantly lower and the prevention effect was better after the end of nursing. In the comparison of this data, there was a statistically significant difference (P <0.05). Conclusion: according to the results of the study, it can be concluded that nursing intervention can promote the incidence of postoperative complications in children. This is a relatively effective way of nursing intervention, which can quickly promote the recovery of patients, and has won unanimous praise from the children and their families, and is worthy of promotion in clinical practice.展开更多
The authors report 4 different cases of giant hydronephrosis in the urology department of the national university healthcare, CNHU HKM of Cotonou. The frequency of the items, the etiologies and the different treatment...The authors report 4 different cases of giant hydronephrosis in the urology department of the national university healthcare, CNHU HKM of Cotonou. The frequency of the items, the etiologies and the different treatments carried out were elucidated. The patients were all females. The hydronephrosis affected the left kidney. The most frequent etiology was pyelouretral junction syndrome seconded by obstructive nephrolithiasis in the upper urinary tract. One of the last etiologies was lower pole vascular plexus. Three nephrectomies and one K?SS-HEYNES-ANDERSON pyeloplasty were carried out. Conclusion: Giant hydronephrosis is a rare condition. The etiologies were organic-based and malformed. The therapeutic attitude adopted shows the interest of an antenatal diagnosis for early care.展开更多
Background:Hypertension secondary to giant hydronephrosis(GH)is a rare but treatable renal condition mediated by the renin-angiotensin-aldosterone system and tubuloglomerular feedback.In adults,GH is often diagnosed l...Background:Hypertension secondary to giant hydronephrosis(GH)is a rare but treatable renal condition mediated by the renin-angiotensin-aldosterone system and tubuloglomerular feedback.In adults,GH is often diagnosed late due to nonspecific abdominal symptoms that may not manifest until advanced stages.Early identification is crucial,as failure to diagnose can lead to significant complications.Case Presentation:A 60-year-old hypertensive female presented with vague right-sided abdominal pain for two weeks.Contrast enhanced computed tomography of abdomen and pelvis revealed a grossly hydronephrotic right kidney with severe pelvicaliectasis crossing the midline with thinned out parenchyma,due to ureteropelvic junction obstruction(UPJO).A renogram confirmed a non-functioning right kidney.She underwent right nephrectomy,during which 2.5 L of hemorrhagic fluid were drained.Histopathology confirmed hydronephrosis with chronic pyelonephritis.Postoperatively,her hypertension resolved,and antihypertensive medication was discontinued.At 1-and 3-month follow-ups,her blood pressure remained stable,underscoring the connection between GH and secondary hypertension.Conclusion:GH in adults is a rare but treatable cause of secondary hypertension.Clinicians should consider renal imaging for patients presenting with unexplained hypertension to rule out hydronephrosis,ensuring timely diagnosis and management.展开更多
Objective To evaluate postoperative renal function in children with congenital moderate or severe hydronephrosis. Methods 99m Tc-labeled diethylenetriaminepenta-acetic acid scintigraphy was performed in 50 chi...Objective To evaluate postoperative renal function in children with congenital moderate or severe hydronephrosis. Methods 99m Tc-labeled diethylenetriaminepenta-acetic acid scintigraphy was performed in 50 children with unilateral moderate or severe hydronephrosis to determine postoperative renal function. We also analyzed the factors influencing renal function recovery. Results Average postoperative renal function in 50 cases was 40.62%±10.09%. Among them, 32% of patients had nearly normal renal function and differentiated renal function reached up to 45%. Average preoperative and postoperative renal function in 25 cases was 23.89%±11.65% and 39.33%±8.59% respectively and the increase of renal function was about 15.44%±11.18% (P=0.0003). Renal parenchyma thickness was negatively correlated with postoperative renal function (r=-0.62, P=0.0009). The follow-up period was positively correlated with postoperative renal function (r=0.58, P=0.0026). The patients’age had no correlation with renal function recovery (r=-0.05, P=0.80). Recovery of renal function in hydronephrosis with extrarenal pelvis was greater than that in hydronephrosis with intrarenal pelvis (P=0.016). Conclusions Postoperative renal function in children with moderate or severe hydronephrosis can recover to normal. Recovery of renal function was more obvious in hydronephrosis with thinner renal parenchyma, longer follow-up period and extrarenal pelvis.展开更多
Objective To assess apoptosis in congenital hydronephrosis and discuss its clinical significance. Methods Apoptosis was detected in 15 kidneys from children with congenital hydronephrosis (5 mild hydronephrosis, 5 mod...Objective To assess apoptosis in congenital hydronephrosis and discuss its clinical significance. Methods Apoptosis was detected in 15 kidneys from children with congenital hydronephrosis (5 mild hydronephrosis, 5 moderate hydronephrosis and 5 severe hydronephrosis) using the electronmicroscope, in situ gap labeling of fragmented nuclear DNA and DNA fragmentation analysis.Results Apoptosis was seen in kidneys from children with congenital hydronephrosis. Margination of nuclear chrornatin was identified and rounded apoptotic bodies were seen. The mean apoptotic index was 0.0941 + 0.017 in severe hydronephrosis, 0.0325 + 0.0169 in moderate hydronephrosis, and 0.0021 +0.0031 in mild hydronephrosis. There was a significant difference between severe and moderate hydronephrosis (P=0.0005), as well as between moderate and mild hydronephrosis ( P = 0.0154).Moreover, with an increasing degree of hydronephrosis, the number of apoptotic cells also increased. Five kidneys with severe hydronephrosis and one kidney with moderate hydronephrosis showed typical apoptotic bands.Conclusion Apoptosis might participate in damaging kidneys in children with congenital hydronephrosis.展开更多
In their retrospective study of 298 diabetic patients with renal/ureteral calculi,Zhou et al identified critical predictors for urosepsis using multivariate logisticregression.Key findings revealed female gender(OR=2....In their retrospective study of 298 diabetic patients with renal/ureteral calculi,Zhou et al identified critical predictors for urosepsis using multivariate logisticregression.Key findings revealed female gender(OR=2.237,P=0.03),advancedage(OR=1.05/year,P=0.002),fever(OR=2.999,P=0.015),severe hydronephrosis(OR=6.129,P=0.011),and elevated urinary markers-particularly urineleukocytes(U-LEU+++:OR=66.0,P<0.001)and glucose(U-GLU+++:OR=7.248,P=0.005)as independent risk factors.These readily accessible clinicalparameters offer significant potential for early risk stratification in high-riskpopulations.While this STROBE-adherent study provides actionable insights,limitations include its single-center design and unaddressed antibiotic protocols.Future multicenter validation should assess residual stone impacts and optimizeintervention thresholds.This work establishes a foundation for targeted surveillanceprotocols in diabetic urolithiasis management.展开更多
BACKGROUND Urosepsis is a life-threatening condition frequently associated with renal and ureteral calculi(RUC)and diabetes mellitus(DM),a combination that exacerbates susceptibility to infection due to urinary obstru...BACKGROUND Urosepsis is a life-threatening condition frequently associated with renal and ureteral calculi(RUC)and diabetes mellitus(DM),a combination that exacerbates susceptibility to infection due to urinary obstruction and impaired immune response.AIM To identify the risk factors for urosepsis in patients with RUC complicated by DM to enhance early detection and intervention strategies.METHODS This retrospective observational study included 298 patients with RUC and DM admitted between January 2020 and June 2024.Patients were divided into an observation group(n=32)with urosepsis and a control group(n=266)without urosepsis.Comprehensive clinical,laboratory,and imaging data were collected and analyzed using univariate and multivariate logistic regression models to identify factors associated with urosepsis.The study adhered to the STROBE guidelines and received ethical approval.RESULTS Multivariate analysis identified several independent risk factors for urosepsis.Female sex(OR=2.237,95%CI:1.086-4.605,P=0.03),advanced age(OR=1.05,95%CI:1.018-1.084,P=0.002),and fever(OR=2.999,95%CI:1.283-7.015,P=0.015)significantly increased the risk.Laboratory findings such as elevated urine leukocyte(U-LEU)(+++,OR=66.0,95%CI:7.031–580.125,P<0.001)and glucose(U-GLU)(+++,OR=7.248,95%CI:1.862-28.211,P=0.005)levels were strongly associated with urosepsis.Severe hydronephrosis also emerged as a significant predictor(OR=6.129,95%CI:3.027-9.623,P=0.011).Other factors,such as gross hematuria,stone laterality,and mild to moderate hydronephrosis,were not significantly associated with urosepsis.CONCLUSION This study identifies key demographic,clinical,laboratory,and imaging factors associated with urosepsis risk in patients with RUC and DM.Early identification of female patients,elderly individuals,those presenting with fever,severe hydronephrosis,and elevated U-LEU and U-GLU levels may facilitate timely intervention.These findings highlight the importance of comprehensive assessment and targeted management in the care of high-risk patients.展开更多
Obstructive uropathy represents a major risk of acute kidney injury.From an epidemiological point of view,it is responsible for 5%to 10%of cases of acute renal failure and 4%of cases of end-stage kidney disease.Althou...Obstructive uropathy represents a major risk of acute kidney injury.From an epidemiological point of view,it is responsible for 5%to 10%of cases of acute renal failure and 4%of cases of end-stage kidney disease.Although obstructive uropathy is a recognized disease,there is a significant lack of detailed research on this topic from both a nephrological and urological perspective.The majority of published research focuses on the pathophysiology of the topic and neglects a comprehensive analysis of diagnostic and treatment approaches supported by current data.In this context,it is crucial to assess the overall hemodynamic status,especially in the presence of urosepsis.Once clinical stability is assured,it is important to focus on symptom management,usually by controlling pain.Ultimately,it is crucial to decide immediately whether the patient should receive a prompt urinary diversion.Urinary diversion is an essential part of the treatment of obstructive uropathy and should be initiated promptly and without unnece-ssary delay once the diagnosis has been confirmed.Functional recovery of the obstructed kidney after decompression of the urinary tract depends on the degree of obstruction,the duration of the obstruction and the presence of a concomitant urinary tract infection.The timing and proper treatment of this condition determines the recovery of kidney function after an obstruction and prevents the development of chronic kidney disease.In this editorial,we emphasized the pathophysiological role and clinical significance of obstructive uropathy in the context of acute kidney injury.展开更多
Aim:The aim of this study was to investigate the factors affecting treatment success in children that got either pyeloplasty or J stent placement in ureteropelvic junction obstruction(UPJO).Patients and Methods:The st...Aim:The aim of this study was to investigate the factors affecting treatment success in children that got either pyeloplasty or J stent placement in ureteropelvic junction obstruction(UPJO).Patients and Methods:The study comprised 126 patients who either J stent placement or pyeloplasty performed by the same physician for UPJO from 2012 to 2022.The criteria for surgical intervention adhered to the European Association of Urology(EAU)recommendations.Symptomatic patients with verified obstruction,with a split renal function(SRF)over 40%,low-grade hydronephrosis(Society of Fetal Urology grade 2),and an obstructive segment measuring less than 1 cm,had Double-J stent placement.Furthermore,in infants exhibiting poor health or development retardation,a J stent was inserted as a temporary measure to alleviate obstruction and maintain renal function,notwithstanding the recommendation for pyeloplasty.Results:The treatment success rate was 43.9%in the J stent group and 88.4%in the pyeloplasty group,with a statistically significant difference(p<0.001).The kind of procedure(pyeloplasty vs.stent)was the sole independent prognostic factor predicting treatment success(HR:4.77,p<0.001)in the multiple logistic regression analysis.No statistically significant change was observed in preoperative and postoperative SRF(48%vs.48.5%,p=0.923)among patients with stent failure,confirming a transient preservation of functional advantage.Conclusion:The placement of a stent may have restricted success rates in specific patients with UPJO.Preserving renal function may be advantageous until definitive surgery,particularly in cases where there are hazards associated with anesthesia and invasive procedures.展开更多
Objective:This study aimed to explore the global,prevalence,and risk factors of fever after percutaneous nephrolithotomy(PCNL)by conducting a systematic review and meta-analysis.Methods:The high-sensitivity searching ...Objective:This study aimed to explore the global,prevalence,and risk factors of fever after percutaneous nephrolithotomy(PCNL)by conducting a systematic review and meta-analysis.Methods:The high-sensitivity searching was conducted without time limitation until December 30,2020 in Web of Sciences,Scopus,and PubMed based on inclusion and exclusion criteria.Results:The prevalence rates of fever and sepsis among patient undergoing PCNL were estimated 9.5%(95%confidence interval[CI]:9.3%-9.7%),and 4.5%(95%CI:4.2%-4.8%),respectively.Nephrostomy tube was used in 9.96%(95%CI:9.94%-9.97%)of patients.The mean preoperative white blood cells of patients were 6.401×109/L;18.3%and 4.55%of patients were considered as the positive urinary culture and pyuria,respectively.About 20.4%of patients suffered from residual stones.The odds ratios(ORs)of fever in patients who suffering from diabetes mellitus,hydronephrosis,staghorn stones,and blood transfusion were 4.62(95%CI:2.95-7.26),1.04(95%CI:0.81-1.34),2.57(95%CI:0.93-7.11),and 2.65(95%CI:1.62-4.35),respectively.Patients who underwent PCNL in prone position were more likely to develop fever(OR:1.23;95%CI:0.75-2.00)than patients in supine position.Conclusion:The current study showed that patients who suffer from diabetes mellitus,hydronephrosis,staghorn stones,nephrostomy tube or double-J stent,blood transfusion,and also patients who underwent PCNL in prone position surgery are more likely to develop a postoperative fever after PCNL.展开更多
Malignant ureteral obstruction can result in renal dysfunction or urosepsis and can limit the physician’s ability to treat the underlying cancer.There are multiple methods to deal with ureteral obstruction including ...Malignant ureteral obstruction can result in renal dysfunction or urosepsis and can limit the physician’s ability to treat the underlying cancer.There are multiple methods to deal with ureteral obstruction including regular polymeric double J stents(DJS),tandem DJS,nephrostomy tubes,and then more specialized products such as solid metal stents(e.g.,Resonance Stent,Cook Medical)and polyurethane stents reinforced with nickel-titanium(e.g.,UVENTA stents,TaeWoong Medical).In patients who require long-term stenting,a nephrostomy tube could be transformed subcutaneously into an extra-anatomic stent that is then inserted into the bladder subcutaneously.We outline the most recent developments published since 2012 and report on identifiable risk factors that predict for failure of urinary drainage.These failures are typically a sign of cancer progression and the natural history of the disease rather than the individual type of drainage device.Factors that were identified to predict drainage failure included low serum albumin,bilateral hydronephrosis,elevated C-reactive protein,and the presence of pleural effusion.Head-to-head studies show that metal stents are superior to polymeric DJS in terms of maintaining patency.Discussions with the patient should take into consideration the frequency that exchanges will be needed,the need for externalized hardware(with nephrostomy tubes),or severe urinary symptoms in the case of internal DJS.This review will highlight the current state of diversions in the setting of malignant ureteral obstruction.展开更多
文摘BACKGROUND Varicocele embolization,a minimally invasive treatment for symptomatic varicoceles,carries a rare risk of complications like ureteral obstruction and hydronephrosis.This case report documents such a case to raise awareness of these potential complications and showcase minimally invasive surgical management as a successful solution.CASE SUMMARY A 35-year-old male presented with flank pain and hematuria following varicocele embolization.Imaging confirmed left ureteral obstruction and hydronephrosis.Laparoscopic ureterolysis successfully removed the embolization coil and repaired the ureter,resolving the patient's symptoms.Follow-up at six months and two years showed sustained improvement.CONCLUSION Minimally invasive surgery offers an effective treatment option for rare complications like ureteral obstruction arising from varicocele embolization.
基金Supported by NIH/T32 DK07202 (Ghosh P and Park FD)Ghosh P was additionally supported by the Research Scholar Award (American Gastroenterology Association FDN)the UCSD Digestive Diseases Research Development Center, U.S. PHS grant DK080506
文摘Dilated dysfunction involving multiple visceral organs has been reported in patients with systemic lupus erythematosus （SLE）. Chronic intestinal pseudoobstruction （CIPO） resulting from intestinal smooth muscle damage has presented in conjunction with ureterohydronephrosis and, more rarely, biliary dilatation （megacholedochus）. While the molecular pathogenesis is largely unknown, observed histopathologic features include widespread myositis, myocyte necrosis in the intestinal muscularis propria with subsequent atrophy and fibrosis, preserved myenteric innervations and little vasculitis. High dose immunosuppression usually results in resolution of symptoms with recovery of smooth muscle function, indicative of an autoimmune etiology. We report a patient with SLE who presented with intestinal pseudo-obstruction, ureterohydronephrosis and megacholedochus, and present images that illustrate megaviscera simultaneously involving all 3 visceral organs. Since the co-manifestation of all 3 is unusual and has been reported only once previously, we have termed this rare clinical syndrome generalized megaviscera of lupus （GML）. Although the SLE disease-activity parameters responded to aggressive immunomodulative therapy in our patient, clinical evidence of peristaltic dysfunction persisted in all involved viscera. This is a variation from the favorable outcomes reported previously in SLE patients with GML and we attribute this poor clinical outcome to disease severity and, most importantly, delayed clinical presentation. Since inflammation followed by atrophy and fibrosis are key aspects in the pathogenesis and natural history of GML, the poor response in our patient who presented late in the clinical course may be the result of ＇burnt out＇ inflammation with irreversible end-stage fibrosis. Thus, early recognition and timely initiation of treatment may be the key to recover visceral peristaltic function in patients with GML.
基金supported by the Natural Science Foundation of Hubei Province,China(No.2008CDA054)
文摘Obstructive nephropathy ultimately leads to end-stage renal failure. Renovascular lesions are involved in various nephropathies, and most renal diseases have an ischemic component that underlies the resulting renal fibrosis. The aim of this study was to investigate whether morphological changes occur in the renal vasculature in hydronephrosis and the possible mechanisms involved. A model of complete unilateral ureteral obstruction（CUUO） was used. Experimental animals were divided into five groups： a normal control group（N） and groups of animals at 1st week（O1）, 2nd week（O2）, 4th week（O4） and 8th week（O8） after CUUO. Blood pressure was measured, renal arterial trees and glomeruli were assessed quantitatively, and renovascular three-dimensional reconstruction was performed on all groups. Glomerular ultrastructural changes were examined by transmission electron microscopy. The results showed that the systolic blood pressure was significantly increased in the obstructed groups（O1, O2, O4 and O8）. Three-dimensional reconstruction showed sparse arterial trees in the O8 group, and a tortuous and sometimes ruptured glomerular basement membrane was found in the O4 and O8 groups. Furthermore, epithelial media thickness and media/lumen ratio were increased, lumen diameters were decreased, and the cross-sectional area of the media was unaltered in the segmental renal artery, interlobar artery and afferent arterioles, respectively. In conclusion, renal arterial trees and glomeruli were dramatically altered following CUUO and the changes may be partially ascribed to vascular remodeling. Elucidation of the molecular mechanisms of renovascular morphological alterations will enable the development of potential therapeutic approaches for hydronephrosis.
文摘Hydronephrosis and ureteral obstruction are rare sequelae of Crohn’s disease. Chronic obstruction can ultimately lead to dysfunction of the affected kidney, and atypical presenting symptoms create pitfalls in diagnosis. Few reviews in the literature focus on this process and are limited to isolated case reports and case reviews. We performed a PubMed search using such terms as “Hydronephrosis” AND “Crohn’s disease” AND/OR “ureteral obstruction.” References from selected papers were reviewed for relevance and used for information-gathering as well. Ureteral obstruction most commonly occurs on the right side, due to ileal involvement. Clinical diagnosis is difficult, as symptoms are notably not genitourinary in origin;rather they are more musculoskeletal in nature. Treatment centers on disease control and temporary drainage of the affected kidney. Though rare, hydronephrosis and ureteral obstruction may develop as a result of inflammatory bowel disease. Due to atypical presenting symptoms, a high clinical suspicion is needed to affirm the diagnosis and ensure proper treatment.
文摘With the increasing use of ultrasonography,congenital anomalies are often picked in utero.Antenatally detected hydronephrosis is amongst the most commonly detected abnormality.The management of this condition has raised considerable debate amongst clinicians dealing with it.This article is written with an idea to provide comprehensive information regarding the postnatal management of antenatally detected hydronephrosis.A detailed review of the current literature on this topic is provided.Also,guidelines have been given to facilitate the management of this condition.
文摘BACKGROUND Paraduodenal hernia(PDH)is a mesenteric-parietal hernia with retroperitoneal and retrocolic herniation of the small bowel into a sac,which is formed by a peritoneal fold located near the fourth portion of the duodenum.The present case revealed that PDH was a possible reason for hydronephrosis,and that the carful laparoscopic exploration surgery was necessary to find infrequent causes of hydronephrosis to avoid invalid Anderson–Hynes pyeloplasty surgery and its injury.CASE SUMMARY An 8-year-old boy presented to the pediatric department with a chief complaint of cryptorchidism.Afterwards,laparoscopy confirmed hydronephrosis secondary to left PDH with cryptorchid.Then,he received laparoscopic surgery,fixed operation for left PDH,release of the ureteropelvic junction obstruction,and treatment for hydronephrosis.It is necessary to perform secondary surgery for cryptorchidism and long-term follow-up.CONCLUSION The case revealed an extremely rare cause of hydronephrosis in children,suggesting a potential correlation between PDH and hydronephrosis.
文摘A case of a 25 year old 2 alive Patient, with obstructed labour with fetal death and delivery of the fetus up to the trunk caused by congenital Bilateral Hydronephrosis is presented. Obstetric examination on admission supported by Abdominal Ultrasound revealed Bilateral Hydronephrosis which was then drained per abdomen using needle and intravenous fluid giving set with eventual relief of the obstruction and vaginal delivery of the stillborn baby.
文摘Giant Hydronephrosis (GH) is a rare condition in urology literature and defined as a pelvicalyceal system of kidney containing more of 1000 ml of urine. This condition is not so rare in our setting. We herein, reported two cases of giant hydronephrosis, seen in two young patients respectively with 5 and 9 years old and their collecting system containing 4000 ml and 5000 ml of urines respectively. Only simple nephrectomy was performed for the two cases with renal function impairment and the post operative course was uneventful. Our purpose through these cases reports is to discuss diagnosis features and management of such condition in our setting, a context of low income countries as Burkina-Faso where diagnosis tool and further investigation are not always available.
文摘Psoas muscle is a rare location for hydatid disease. Here we present a case of infected hydatid cyst left psoas muscle presenting as left flank pain, fever, local flank tenderness, and raised blood counts. Preoperative diagnoses was made by Ultrasonography (USG) and Computed Tomography (CT) abdomen, although serology for hydatid disease was negative.
文摘Objective: to study and explore the clinical effect of nursing intervention in the prevention of postoperative complications in children with hydronephrosis, and to analyze its application value. Methods: 30 cases of pediatric hydronephrosis patients admitted to our hospital last year were selected to carry out this study, which were divided into two groups, respectively, with different nursing intervention mode for nursing, after the end of nursing, its application effect and application value were analyzed. Results: in this study, the incidence of complications was significantly lower and the prevention effect was better after the end of nursing. In the comparison of this data, there was a statistically significant difference (P <0.05). Conclusion: according to the results of the study, it can be concluded that nursing intervention can promote the incidence of postoperative complications in children. This is a relatively effective way of nursing intervention, which can quickly promote the recovery of patients, and has won unanimous praise from the children and their families, and is worthy of promotion in clinical practice.
文摘The authors report 4 different cases of giant hydronephrosis in the urology department of the national university healthcare, CNHU HKM of Cotonou. The frequency of the items, the etiologies and the different treatments carried out were elucidated. The patients were all females. The hydronephrosis affected the left kidney. The most frequent etiology was pyelouretral junction syndrome seconded by obstructive nephrolithiasis in the upper urinary tract. One of the last etiologies was lower pole vascular plexus. Three nephrectomies and one K?SS-HEYNES-ANDERSON pyeloplasty were carried out. Conclusion: Giant hydronephrosis is a rare condition. The etiologies were organic-based and malformed. The therapeutic attitude adopted shows the interest of an antenatal diagnosis for early care.
文摘Background:Hypertension secondary to giant hydronephrosis(GH)is a rare but treatable renal condition mediated by the renin-angiotensin-aldosterone system and tubuloglomerular feedback.In adults,GH is often diagnosed late due to nonspecific abdominal symptoms that may not manifest until advanced stages.Early identification is crucial,as failure to diagnose can lead to significant complications.Case Presentation:A 60-year-old hypertensive female presented with vague right-sided abdominal pain for two weeks.Contrast enhanced computed tomography of abdomen and pelvis revealed a grossly hydronephrotic right kidney with severe pelvicaliectasis crossing the midline with thinned out parenchyma,due to ureteropelvic junction obstruction(UPJO).A renogram confirmed a non-functioning right kidney.She underwent right nephrectomy,during which 2.5 L of hemorrhagic fluid were drained.Histopathology confirmed hydronephrosis with chronic pyelonephritis.Postoperatively,her hypertension resolved,and antihypertensive medication was discontinued.At 1-and 3-month follow-ups,her blood pressure remained stable,underscoring the connection between GH and secondary hypertension.Conclusion:GH in adults is a rare but treatable cause of secondary hypertension.Clinicians should consider renal imaging for patients presenting with unexplained hypertension to rule out hydronephrosis,ensuring timely diagnosis and management.
文摘Objective To evaluate postoperative renal function in children with congenital moderate or severe hydronephrosis. Methods 99m Tc-labeled diethylenetriaminepenta-acetic acid scintigraphy was performed in 50 children with unilateral moderate or severe hydronephrosis to determine postoperative renal function. We also analyzed the factors influencing renal function recovery. Results Average postoperative renal function in 50 cases was 40.62%±10.09%. Among them, 32% of patients had nearly normal renal function and differentiated renal function reached up to 45%. Average preoperative and postoperative renal function in 25 cases was 23.89%±11.65% and 39.33%±8.59% respectively and the increase of renal function was about 15.44%±11.18% (P=0.0003). Renal parenchyma thickness was negatively correlated with postoperative renal function (r=-0.62, P=0.0009). The follow-up period was positively correlated with postoperative renal function (r=0.58, P=0.0026). The patients’age had no correlation with renal function recovery (r=-0.05, P=0.80). Recovery of renal function in hydronephrosis with extrarenal pelvis was greater than that in hydronephrosis with intrarenal pelvis (P=0.016). Conclusions Postoperative renal function in children with moderate or severe hydronephrosis can recover to normal. Recovery of renal function was more obvious in hydronephrosis with thinner renal parenchyma, longer follow-up period and extrarenal pelvis.
文摘Objective To assess apoptosis in congenital hydronephrosis and discuss its clinical significance. Methods Apoptosis was detected in 15 kidneys from children with congenital hydronephrosis (5 mild hydronephrosis, 5 moderate hydronephrosis and 5 severe hydronephrosis) using the electronmicroscope, in situ gap labeling of fragmented nuclear DNA and DNA fragmentation analysis.Results Apoptosis was seen in kidneys from children with congenital hydronephrosis. Margination of nuclear chrornatin was identified and rounded apoptotic bodies were seen. The mean apoptotic index was 0.0941 + 0.017 in severe hydronephrosis, 0.0325 + 0.0169 in moderate hydronephrosis, and 0.0021 +0.0031 in mild hydronephrosis. There was a significant difference between severe and moderate hydronephrosis (P=0.0005), as well as between moderate and mild hydronephrosis ( P = 0.0154).Moreover, with an increasing degree of hydronephrosis, the number of apoptotic cells also increased. Five kidneys with severe hydronephrosis and one kidney with moderate hydronephrosis showed typical apoptotic bands.Conclusion Apoptosis might participate in damaging kidneys in children with congenital hydronephrosis.
基金Supported by National Natural Science Foundation of China,No.82300780Natural Science Foundation of Jiangsu Province,No.BK20220306Yancheng Key Research and Development Plan(Social Development)Project,No.YCBE202214.
文摘In their retrospective study of 298 diabetic patients with renal/ureteral calculi,Zhou et al identified critical predictors for urosepsis using multivariate logisticregression.Key findings revealed female gender(OR=2.237,P=0.03),advancedage(OR=1.05/year,P=0.002),fever(OR=2.999,P=0.015),severe hydronephrosis(OR=6.129,P=0.011),and elevated urinary markers-particularly urineleukocytes(U-LEU+++:OR=66.0,P<0.001)and glucose(U-GLU+++:OR=7.248,P=0.005)as independent risk factors.These readily accessible clinicalparameters offer significant potential for early risk stratification in high-riskpopulations.While this STROBE-adherent study provides actionable insights,limitations include its single-center design and unaddressed antibiotic protocols.Future multicenter validation should assess residual stone impacts and optimizeintervention thresholds.This work establishes a foundation for targeted surveillanceprotocols in diabetic urolithiasis management.
文摘BACKGROUND Urosepsis is a life-threatening condition frequently associated with renal and ureteral calculi(RUC)and diabetes mellitus(DM),a combination that exacerbates susceptibility to infection due to urinary obstruction and impaired immune response.AIM To identify the risk factors for urosepsis in patients with RUC complicated by DM to enhance early detection and intervention strategies.METHODS This retrospective observational study included 298 patients with RUC and DM admitted between January 2020 and June 2024.Patients were divided into an observation group(n=32)with urosepsis and a control group(n=266)without urosepsis.Comprehensive clinical,laboratory,and imaging data were collected and analyzed using univariate and multivariate logistic regression models to identify factors associated with urosepsis.The study adhered to the STROBE guidelines and received ethical approval.RESULTS Multivariate analysis identified several independent risk factors for urosepsis.Female sex(OR=2.237,95%CI:1.086-4.605,P=0.03),advanced age(OR=1.05,95%CI:1.018-1.084,P=0.002),and fever(OR=2.999,95%CI:1.283-7.015,P=0.015)significantly increased the risk.Laboratory findings such as elevated urine leukocyte(U-LEU)(+++,OR=66.0,95%CI:7.031–580.125,P<0.001)and glucose(U-GLU)(+++,OR=7.248,95%CI:1.862-28.211,P=0.005)levels were strongly associated with urosepsis.Severe hydronephrosis also emerged as a significant predictor(OR=6.129,95%CI:3.027-9.623,P=0.011).Other factors,such as gross hematuria,stone laterality,and mild to moderate hydronephrosis,were not significantly associated with urosepsis.CONCLUSION This study identifies key demographic,clinical,laboratory,and imaging factors associated with urosepsis risk in patients with RUC and DM.Early identification of female patients,elderly individuals,those presenting with fever,severe hydronephrosis,and elevated U-LEU and U-GLU levels may facilitate timely intervention.These findings highlight the importance of comprehensive assessment and targeted management in the care of high-risk patients.
文摘Obstructive uropathy represents a major risk of acute kidney injury.From an epidemiological point of view,it is responsible for 5%to 10%of cases of acute renal failure and 4%of cases of end-stage kidney disease.Although obstructive uropathy is a recognized disease,there is a significant lack of detailed research on this topic from both a nephrological and urological perspective.The majority of published research focuses on the pathophysiology of the topic and neglects a comprehensive analysis of diagnostic and treatment approaches supported by current data.In this context,it is crucial to assess the overall hemodynamic status,especially in the presence of urosepsis.Once clinical stability is assured,it is important to focus on symptom management,usually by controlling pain.Ultimately,it is crucial to decide immediately whether the patient should receive a prompt urinary diversion.Urinary diversion is an essential part of the treatment of obstructive uropathy and should be initiated promptly and without unnece-ssary delay once the diagnosis has been confirmed.Functional recovery of the obstructed kidney after decompression of the urinary tract depends on the degree of obstruction,the duration of the obstruction and the presence of a concomitant urinary tract infection.The timing and proper treatment of this condition determines the recovery of kidney function after an obstruction and prevents the development of chronic kidney disease.In this editorial,we emphasized the pathophysiological role and clinical significance of obstructive uropathy in the context of acute kidney injury.
文摘Aim:The aim of this study was to investigate the factors affecting treatment success in children that got either pyeloplasty or J stent placement in ureteropelvic junction obstruction(UPJO).Patients and Methods:The study comprised 126 patients who either J stent placement or pyeloplasty performed by the same physician for UPJO from 2012 to 2022.The criteria for surgical intervention adhered to the European Association of Urology(EAU)recommendations.Symptomatic patients with verified obstruction,with a split renal function(SRF)over 40%,low-grade hydronephrosis(Society of Fetal Urology grade 2),and an obstructive segment measuring less than 1 cm,had Double-J stent placement.Furthermore,in infants exhibiting poor health or development retardation,a J stent was inserted as a temporary measure to alleviate obstruction and maintain renal function,notwithstanding the recommendation for pyeloplasty.Results:The treatment success rate was 43.9%in the J stent group and 88.4%in the pyeloplasty group,with a statistically significant difference(p<0.001).The kind of procedure(pyeloplasty vs.stent)was the sole independent prognostic factor predicting treatment success(HR:4.77,p<0.001)in the multiple logistic regression analysis.No statistically significant change was observed in preoperative and postoperative SRF(48%vs.48.5%,p=0.923)among patients with stent failure,confirming a transient preservation of functional advantage.Conclusion:The placement of a stent may have restricted success rates in specific patients with UPJO.Preserving renal function may be advantageous until definitive surgery,particularly in cases where there are hazards associated with anesthesia and invasive procedures.
文摘Objective:This study aimed to explore the global,prevalence,and risk factors of fever after percutaneous nephrolithotomy(PCNL)by conducting a systematic review and meta-analysis.Methods:The high-sensitivity searching was conducted without time limitation until December 30,2020 in Web of Sciences,Scopus,and PubMed based on inclusion and exclusion criteria.Results:The prevalence rates of fever and sepsis among patient undergoing PCNL were estimated 9.5%(95%confidence interval[CI]:9.3%-9.7%),and 4.5%(95%CI:4.2%-4.8%),respectively.Nephrostomy tube was used in 9.96%(95%CI:9.94%-9.97%)of patients.The mean preoperative white blood cells of patients were 6.401×109/L;18.3%and 4.55%of patients were considered as the positive urinary culture and pyuria,respectively.About 20.4%of patients suffered from residual stones.The odds ratios(ORs)of fever in patients who suffering from diabetes mellitus,hydronephrosis,staghorn stones,and blood transfusion were 4.62(95%CI:2.95-7.26),1.04(95%CI:0.81-1.34),2.57(95%CI:0.93-7.11),and 2.65(95%CI:1.62-4.35),respectively.Patients who underwent PCNL in prone position were more likely to develop fever(OR:1.23;95%CI:0.75-2.00)than patients in supine position.Conclusion:The current study showed that patients who suffer from diabetes mellitus,hydronephrosis,staghorn stones,nephrostomy tube or double-J stent,blood transfusion,and also patients who underwent PCNL in prone position surgery are more likely to develop a postoperative fever after PCNL.
文摘Malignant ureteral obstruction can result in renal dysfunction or urosepsis and can limit the physician’s ability to treat the underlying cancer.There are multiple methods to deal with ureteral obstruction including regular polymeric double J stents(DJS),tandem DJS,nephrostomy tubes,and then more specialized products such as solid metal stents(e.g.,Resonance Stent,Cook Medical)and polyurethane stents reinforced with nickel-titanium(e.g.,UVENTA stents,TaeWoong Medical).In patients who require long-term stenting,a nephrostomy tube could be transformed subcutaneously into an extra-anatomic stent that is then inserted into the bladder subcutaneously.We outline the most recent developments published since 2012 and report on identifiable risk factors that predict for failure of urinary drainage.These failures are typically a sign of cancer progression and the natural history of the disease rather than the individual type of drainage device.Factors that were identified to predict drainage failure included low serum albumin,bilateral hydronephrosis,elevated C-reactive protein,and the presence of pleural effusion.Head-to-head studies show that metal stents are superior to polymeric DJS in terms of maintaining patency.Discussions with the patient should take into consideration the frequency that exchanges will be needed,the need for externalized hardware(with nephrostomy tubes),or severe urinary symptoms in the case of internal DJS.This review will highlight the current state of diversions in the setting of malignant ureteral obstruction.
