[Ureteral duplication and ectopic ureterocele].
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Abstract:
An ectopic ureterocele and unilateral ureteral duplication in a young women is reported. It is a rare congenital malformation of the urinary tract. In this typical case, the aspecific symptomatology and diagnostic imaging are discussed. The pathology was not diagnosed preoperatively. The excretory urography, sonography and CT scanning did not show neither the duplication and the ureterocele, and diagnosis of retroperitoneal mass was made. The data of literature are analyzed and the importance of surgical therapy is underlined.Keywords:
Ureterocele
Pyelogram
Ectopic ureter
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Objective:To evaluate the value and limit of MR urography in urinary tract obstruction and hydronephrosis Methods:38 patients with urinary tract obstruction and hydronephrosis were examined with heavily T2 weighted fast spinecho sequence All the patients were proved by operation Results:MR urography can show the level and degree of urinary tract obstruction in all the patients with a high accurace of 100%,especially in those who were not visualized or not satisfactory by IVU Conclusion:MR urography is a safe and non invasion examination method which does not require iodinated contrast material It is helpful in diagnosis of urinary tract obstruction
Pyelogram
Urinary tract obstruction
Intravenous urography
Ureterocele
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(Background and Methods) we performed renal ultrasonographic screening on 3799 healthy 3-month-old infants, who showed up for the routine health check up in Nobeoka City, for congenital malformations of the urinary tract.(Results) Urinary tract disorders were suspected in 139 (3.7%). Almost all ultrasonographic abnormalities of these were dissociation of CEC (Central Echo Complex). Thirty-three (24.4%) of the 135, which was 0.9% of the original 3799, were diagnosed as having significant congenital anomalies in urinary tract, such as vesicoureteral reflux (VUR) in 17, hydronephrosis in 10, unilateral renal agenesis in 2, unilateral small kidney in 2 and each case of horseshoe kidney, simple ureterocele, ectopic ureterocele, megaureter and mild dilated ureter. Minor or mild renal pelvis enlargement without the dilatation of calyx was found in 78 cases. Fiftythree of the 78 were followed more than 3 months, and complete or partial reduction of the pelvic enlargement was noted in 39 (74%), while enlarged pelvis remained unchanged in 14. There was no progressive hydronephrosis among these patients during the follow-up. Urinary tract infections were found in 6 cases (5 in VUR and 1 in ectopic ureterocele). Eleven ureters in 9 children of VUR (44%) were cured spontaneously (follow-up period: 3 months-6 months and 2 years). Surgical correction was required in 6 cases, antireflux surgery for VUR in 4, heminephroureterectomy for ectopic ureterocele in 1 and endoscopic incision of ureterocele for simple ureterocele in 1.(Conclusion) Our result indicate that infant ultrasonographic screening is a useful and valuable method of detecting urinary tract malformations.
Congenital malformations
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An ectopic ureterocele and unilateral ureteral duplication in a young women is reported. It is a rare congenital malformation of the urinary tract. In this typical case, the aspecific symptomatology and diagnostic imaging are discussed. The pathology was not diagnosed preoperatively. The excretory urography, sonography and CT scanning did not show neither the duplication and the ureterocele, and diagnosis of retroperitoneal mass was made. The data of literature are analyzed and the importance of surgical therapy is underlined.
Ureterocele
Pyelogram
Ectopic ureter
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Urinary collecting system duplication is a congenital anomaly and can associate various types of urinary tract pathologies. Authors will illustrate by cases some of associated anomalies such as ureterocele, extravesical ectopic ureter, vesicoureteral reflux or reflux nephropathy; one case presented an association between posterior urethral valve and bilateral collecting system duplication.
Ureterocele
Ectopic ureter
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Purpose:To evaluate the diagnosis and treatment in duplex kidney.Methods:53 cases of duplication of kidney and ureter were reported.Results:Single side abnormality noted in 50 cases and two side abnormalities noted in 3 cases, ectopic opening of ureter in 6 cases, ureterocele in 11 cases, moderate or severe hydronephrosis of the upper kidney in thirty cases. The diagnosistic value of symptoms, IVU, ultrosonography and CT , MRU was revealed respectively. Conclusions:Ultrasonography played the most important role in the diagnosis. Surgical management should be individualized. Usually, upper nephroureterectomy is performed for a nonfunctioning moiety. Ureteric replantation can be considered for functioning segment.
Ectopic ureter
Ureterocele
Abnormality
Pyelogram
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Sonographic and Ct examinations were performed prospectively on 14 patients with advanced urinary tract tuberculosis who had undergone serial urography. Sonography and CT showed abnormalities in the affected kidney in each patient. Detailed morphologic information (patterns of calcification and hydronephrosis) and functional status (nephrogram and urogram) were better shown by CT than by urography; sonography showed the fewest morphologic details. CT is probably at least as accurate as urography in detecting advanced urinary tuberculosis; sonography appears to be less accurate than either CT or urography.
Pyelogram
Intravenous urography
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Five children (three girls and two boys) who had a duplex collecting system with an ectopic ureter or a ureterocele that was not detected with either imaging or cystoscopy were seen during a 10-year period. Four had urinary tract infection. The fifth was noted to have hydronephrosis when CT scanning of the abdomen was done for trauma. In each case, voiding cystourethrography showed reflux into what was thought to be a single (nonduplex) collecting system, but was found during surgery to be the lower pole of a duplex system. Excretory urography in four patients, sonography in two, and CT scanning in one did not show signs of duplication on the affected side. In each case cystoscopy failed to show a duplex system on the affected side. The diagnosis of duplication of the collecting system with ectopic ureter or ureterocele was made in each case only when the bladder was opened to reimplant the ureter. Direct opacification of the previously unsuspected upper pole ureter in each case showed it to be bind-ending and terminating at the level of the kidney. Radiologists and surgeons should be aware that duplex systems may not always be visible on urography and sonography.
Ureterocele
Ectopic ureter
Pyelogram
Duplex (building)
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Objective:To evaluate the ability of dynamic intravenous urography (DIVU) in the evaluation of the upper urinary tract by comparing with intravenous urography (IVU).Methods:158 cases suspected with upper urinary tract disease were imaged by DIVU,other 120 cases underwent IVU for comparison. Opacification scores for the two groups (normal and abnormal cases) of urinary tracts were then compared. Ability of DIVU and IVU was compared in the diagnosis of upper urinary tract disease.Results:The score of DIVU was higher than that of IVU for lower ureters(P=0.000). The score of DIVU was higher than that of IVU for pelvis of the abnormal urinary tracts,the differences in scores were statistically significant(P=0.001).The score of DIVU was higher than that of IVU for upper, middle and lower ureters(P= 0.001). The accuracy rate of DIVU in diagnosing renal duplication and hydronephrosis was 100%, which was higher than that of IVU. DIVU was also more reliable in detecting the ectopic ureteral orifice and ureterocele than IVU.Conclusion:DIVU is a reliable technique for the diagnosis of urinary tract diseases. In patients suspected with congenital anomaly,hydronephrosis etc, DIVU could be selected as the first choice.
Pyelogram
Intravenous urography
Ureterocele
Upper urinary tract
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Eight infants and children (six girls) were seen over a 13-year period with duplex collecting systems and ectopic ureteroceles. In each, there was striking dissimilarity in size between the large ureterocele and its diminutive ureter and calyces. The upper moiety did not function and, except for the ureterocele, the indirect urographic and direct sonographic signs of duplication were absent or subtle. We call this entity ureterocele disproportion. Seven patients presented with urinary infection and one was found to have hydronephrosis of a dilated lower moiety in utero. Five had ipsilateral lower-pole reflux, which ranged in degree from 3 to 5 (on a scale of 1-5). Two had bilateral duplication; one of these had a typical contralateral ectopic ureterocele. The diagnosis of ureterocele disproportion was strongly suggested by urography and sonography and was confirmed at cystoscopy by direct puncture of the ureterocele and opacification of the upper moiety. All had surgery. The approach varied and depended on the status of the lower moiety and the contralateral kidney. One had incision of the ureterocele only. Five with lower-pole reflux had excision of the ureterocele and ipsilateral common-sheath reimplantation.
Ureterocele
Ectopic ureter
Pyelogram
Cystography
Intravenous urography
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Citations (41)
A growing body of evidence suggests that it is safe to ligate the ureter of poorly functioning renal moieties during renal transplantation. We present clinical outcomes and data on hydronephrosis progression in pediatric cases associated with ectopic ureters and obstructive ureteroceles.We prospectively collected data for 35 consecutive patients (23 females and 12 males) who underwent ureteral clipping between February 2011 and August 2016. Patients were divided into 4 groups consisting of 1) duplex system with ectopic ureter (45.7%), 2) duplex system with a large ureterocele (11.4%), 3) other duplex system (8.6%) and 4) single system kidneys (34.3%). Patients were followed for clinical outcomes and hydronephrosis trends. Comparisons included preoperative and postoperative anteroposterior diameter, maximal ureteral diameter and ureterocele size.Median age at surgery was 59 months (IQR 11 to 120, range 5 to 216). Median ± SD operative time was 108.9 ± 31.1 minutes (range 20 to 180) and median length of stay was 7.5 hours (IQR 6 to 19, range 5 to 336). Immediate resolution of urinary incontinence was observed in all 16 ectopic ureter cases. After a median ± SD followup of 20.8 ± 13.8 months (IQR 8.5 to 30, range 6 to 50) 97.2% of the patients remained asymptomatic. No significant differences were observed between initial and last anteroposterior diameter measurements except in group 1 (p = 0.001). All ureteroceles demonstrated a significant decrease in median ± SD size after clipping (from 2.7 ± 0.41 to 0.53 ± 0.92 cm, p = 0.003). Pyonephrosis developed in 1 patient, who underwent laparoscopic nephrectomy.Ureteral clipping appears to be a reasonable, safe and effective option for pediatric patients in the reported settings, with the potential to be simpler and quicker than extirpative or reconstructive procedures.
Ectopic ureter
Ureterocele
Pyonephrosis
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