Single center experience in patients with unilateral multicystic dysplastic kidney
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Multicystic dysplastic kidney
Megaureter
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Nephrology
No AccessJournal of UrologyClinical prize finalist1 Oct 2007Endoscopic Treatment of Vesicoureteral Reflux Associated With Ureterocele Boris Chertin, Nochiparambil Mohanan, Amicur Farkas, and Prem Puri Boris ChertinBoris Chertin , Nochiparambil MohananNochiparambil Mohanan , Amicur FarkasAmicur Farkas , and Prem PuriPrem Puri View All Author Informationhttps://doi.org/10.1016/j.juro.2007.03.170AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We determined the value of endoscopic treatment for vesicoureteral reflux associated with ureterocele. Materials and Methods: From 1984 to 2005, 109 children with a median age of 6 months underwent endoscopic ureterocele puncture. Ureterocele presented as a part of a duplex system in 97 of patients (89%) and as part of a single system in 12 (11%). Vesicoureteral reflux was seen to the lower ipsilateral moiety in 53 patients and in 32 contralateral kidneys (85 refluxing renal units). Puncture was performed with a 3Fr Bugbee electrode. High grade vesicoureteral reflux or breakthrough infection while on antibiotic prophylaxis served as the indication for the surgical correction of vesicoureteral reflux. Median followup after endoscopic correction was 10 years (range 1 to 21). Results: Spontaneous vesicoureteral reflux resolution following successful ureterocele puncture was seen in 36 of the 85 refluxing renal units (42%) and in 5 (6%) reflux was downgraded. The latter patients were withdrawn from antibiotic prophylaxis and they did well. A total of 33 refluxing renal units with vesicoureteral reflux into the lower moiety of the ureterocele kidney and 11 contralateral refluxing renal units underwent endoscopic correction. Reflux was corrected in 31 of the 44 refluxing renal units (70%) after a single injection and it resolved after a second injection in another 9 (21%). In 4 refluxing renal units (9%) endoscopic correction failed and open reimplantation was done. Of the 109 patients (13%) 14 had vesicoureteral reflux to the ureterocele moiety following endoscopic puncture. Of those patients endoscopic correction resolved reflux in 3, reflux resolved spontaneously in 5 and upper pole partial nephrectomy was performed in 4 due to a nonfunctioning moiety. The remaining 2 patients did well without antibiotic prophylaxis. Conclusions: Our data show that endoscopic treatment of vesicoureteral reflux associated with ureterocele is a simple, long-term effective and safe procedure, avoiding the need for open surgery in the majority of patients following endoscopic puncture of ureterocele. References 1 : Ureteral duplication, ectopy, and ureteroceles. In: Pediatric Urology. Edited by . Philadelphia: WB Saunders Co2001: 430. Google Scholar 2 : Endoscopic puncture of ureterocele as a minimally invasive and effective long-term procedure in children. Eur Urol2001; 39: 332. Google Scholar 3 : Is primary endoscopic puncture of ureterocele a long-term effective procedure?. J Pediatr Surg2003; 38: 116. Google Scholar 4 : Controversies in the management of ectopic ureteroceles. Urology2000; 56: 665. Google Scholar 5 Medical versus surgical treatment of primary vesicoureteral reflux: report of the International Reflux Study Committee. International Reflux Study Committee. Pediatrics1981; 67: 392. Google Scholar 6 : Endoscopic correction of vesicoureteral reflux—our experience with 115 ureters. J Urol1990; 144: 534. Link, Google Scholar 7 : Endoscopic correction of vesicoureteral reflux in duplex systems. Eur Urol1983; 24: 111. Google Scholar 8 : Endoscopic treatment of primary grades IV and V vesicoureteral reflux in children with subureteral injection of polytetrafluoroethylene. J Urol2003; 169: 1804. Link, Google Scholar 9 : Treatment of vesicoureteral reflux by endoscopic injection of Teflon. Br Med J1984; 289: 79. Google Scholar 10 : Endoscopic treatment of vesicoureteral reflux with dextranomer/hyaluronic acid copolymer is effective in either double ureters or a small kidney. J Urol2003; 170: 1551. Link, Google Scholar 11 : Endoscopic treatment dextranomer/hyaluronic acid for complex cases of vesicoureteral reflux. J Urol2004; 172: 1614. Link, Google Scholar 12 : Reflux following endoscopic puncture of ureteroceles: A new approach using subureteric Teflon injections. Br J Urol1987; 71: 279. Google Scholar 13 : Endoscopic treatment of ureterocele in a duplex system. Br J Urol1993; 71: 105. Google Scholar 14 : Does prenatal diagnosis influence the morbidity associated with left in situ nonfunctioning or poorly functioning renal moiety after endoscopic puncture of ureterocele?. J Urol2005; 173: 1349. Link, Google Scholar Departments of Urology, Shaare Zedek Medical Centre, Jerusalem and Ben-Gurion University of Negev, Be'er Sheva, Israel, and Children's Research Centre, Our Lady's Hospital for Sick Children, University College Dublin (NM, PP), Dublin, Ireland© 2007 by American Urological AssociationFiguresReferencesRelatedDetailsCited ByCastagnetti M (2018) Re: Outcomes of Endoscopic Incision for the Treatment of Ureterocele in Children at a Single InstitutionJournal of Urology, VOL. 194, NO. 4, (1171-1172), Online publication date: 1-Oct-2015.Palmer B, Greger H, Mannas D, Kropp B and Frimberger D (2011) Comparison of Endoscopic Ureterocele Decompression Techniques. Preliminary Experience—Is the Watering Can Puncture Superior?Journal of Urology, VOL. 186, NO. 4S, (1700-1704), Online publication date: 1-Oct-2011.Merguerian P, Taenzer A, Knoerlein K, McQuiston L and Herz D (2010) Variation in Management of Duplex System Intravesical Ureteroceles: A Survey of Pediatric UrologistsJournal of Urology, VOL. 184, NO. 4S, (1625-1630), Online publication date: 1-Oct-2010.Renzo D, Ellsworth P, Caldamone A and Chiesa P (2010) Transurethral Puncture for Ureterocele—Which Factors Dictate Outcomes?Journal of Urology, VOL. 184, NO. 4S, (1620-1624), Online publication date: 1-Oct-2010. Volume 178Issue 4SOctober 2007Page: 1594-1597 Advertisement Copyright & Permissions© 2007 by American Urological AssociationKeywordsendoscopyvesico-ureteral refluxureteroceleureterhyaluronic acidMetricsAuthor Information Boris Chertin More articles by this author Nochiparambil Mohanan More articles by this author Amicur Farkas More articles by this author Prem Puri More articles by this author Expand All Advertisement PDF DownloadLoading ...
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To evaluate the feasibility of retroperitoneoscopic heminephroureterectomy for children with duplex anomaly.Retroperitoneoscopic heminephroureterectomy was performed in five children (four girls and one boy) with complete duplication of the ureter, of whom four (age range 1-5 years; mean age 3.3 years) had upper pole ectopic megaureters and one (3 years old) had an upper pole megaureter with ureterocele. In the patient with ureterocele, distal ureterectomy and ureterocelectomy were performed by Pfannenstiel incision.The mean operation time was 346 min (range 270-450 min) in the four patients with ectopic megaureter and 420 min (330 min for heminephroureterectomy) in the patient with ureterocele. The mean estimated blood loss was 43 mL (range 5-100 mL) in the four patients with ectopic megaureter and 40 mL in the patient with ureterocele. No postoperative complications were observed. Postoperative intravenous pyelography showed normal pyelogram and renal function of the preserved lower pole in all cases.Retroperitoneoscopic heminephroureterectomy for children is feasible, safe and has good postoperative results, including cosmetic results. However, the operation time needs to be reduced.
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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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Introduction Multicystic dysplastic kidney (MCDK) is a rare congenital anomaly that usually presents as neonatal abdominal mass. It presents as a unilateral disorder and ipsilateral ureter is atretic. Its presentation in adults is even rarer due to its involution during initial years of life. In present case, an adult patient presented with renal MCDK with ipsilateral obstructed megaureter that led to pyelonephritis. Case Report A 55-year-old male presented with loin pain of one month duration. Imaging studies revealed non functioning right kidney with ipsilateral megaureter. The patient underwent right nephroureterectomy and on histopathology, the diagnosis of MCDK with pyelonephritis was made. Conclusion MCDK associated with ipsilateral obstructed megaureter is an extremely unusual presentation in adult patients. Association of pyelonephritis with MCDK is even rarer. Keyword Multicystic dysplastic kidney, pyelonephritis, megaureter, adult.
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Objective To analyze the common causes of missed diagnosis and misdiagnosis of ureterocele by ultrasound.Methods The sonograms of 53 ureterocele patients were retrospectively analyzed.All cases were proved by cystoscopic or operative pathology.The patients with well-filled bladders were examined by routine urinary ultrasound.During examination,gain adjustment and multi-plane scan had been done to find the cyst at the ureteral end with regular expansion and contraction,and to obseve its position,size,opening and movement.Color Doppler flow imaging(CDFI) could real-time display the urinary jet from ureteric orifice into the cyst.Results There were 53 ureterocele cases in this study including 30 left lesions,17 right lesions,and 6 bilateral lesions.And concomitant abnormalities included 3 cystic stones,3 duplex kidneys,2 renal aplasia,1 solitary kidney combined with megaureter,and 1 horseshoe kidney.In addition,abnormal renal function and urinary infection were found in 21 and 9 patients respectively.2D-ultrasound could directly display the position,shape,size,and movement of ureterocele.CDFI could real-time display the urinary jet of ureteric orifice.Four cases which were missed diagnosed by ultrasonography at the first time got diagnosed by follow-up.And there were 4 additional cases misdiagnosed as prolapse of the ureteral orifice,bladder calculus,ureteral calculus and ovarian cyst respectively.Conclusions Ultrasound is the first-choice imaging modality for ureterocele.Inappropriate instrument setting and insufficient understanding of sonographic appearance of ureterocele are the primary causes for missed diagnosis and misdiagnosing.The missed diagnosis and misdiagnosis of this disease could be reduced by proper adjustment,real time observation,and sufficient knowledge of this and related disease.
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The authors analyze their experience in the treatment of 59 children aged 3 months--14 years with ureterocele of the single (22 patients) and double ureter (37 patients). Examination and surgical data showed that ureterocele in the operated on children was congenital and became a component of a complicated malformation of the distal ureter. Structural changes varied from minimal to total dysplasia reflected in the degree of the ureteral dilatation. These changes were characteristic for both normal and double ureters and served the base for treatment policy decision. In normal megaureter the authors performed resection of the distal ureter as well as ureterocele, modelling and neoplantation of the proximal segment according to the antireflux technique. Minor dilatation of the pelvic ureter (up to 1.0-1.5 cm dependent on the patient's age) indicated that structural alterations of its wall are confined to the submucosal segment. In view of this, surgical intervention involved only endovesicular electroperforation of ureterocele. The policy in the double ureter ureterocele was based on the same criteria.
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Correction of primary non-reflux megaureter (153 ureters) was made in 136 patients aged 3 months to 14 years. Bilateral disease was in 17 patients. Non-reflux non-obstructive megaureter was in 113 cases, obstructive in 40 cases including association with ureterocele in 23 cases. Resection of distal ureter with its neoimplantation into the urinary bladder according to the antireflux technique was made in 146 patients, endovesical electroperforation and resection of ureterocele were made in 5 and 2 patients, respectively. Good results were obtained in 88.3% (135 ureters), satisfactory in 2.6% (4 ureters), unsatisfactory in 9.1% (14 ureters). After effective correction of megaureter, the treatment should be focused on adequate therapy of pyelonephritis present in 90% examinees, on improvement of urodynamics and stabilization of sclerotic process in renal parenchyma. The patients need long-term follow-up and more effective treatment.
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