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Vesicoureteric reflux: Open and minimally invasive treatment
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Aurelien Scalabre, Delphine Demède, Pierre Mouriquand
The child is usually hospitalized for 5 days. The ureteric stent is removed after 2 days (or 10 days if the ureter has been remodeled). The bladder catheter is removed on the fifth postoperative day. Both suction drains are usually removed on the second day. Bladder spasms are common, and administration of oxybutinin can be useful to reduce the discomfort. Antibiotic prophylaxis is a possible option with trimethoprim with or without sulfamethoxazole (co-trimoxazole).
Surgical considerations including haemorrhage and transfusion
Published in Sheila Broderick, Ruth Cochrane, Trauma and Birth, 2020
Sheila Broderick, Ruth Cochrane
Ureteric injury may not be recognised at the time of the CS, and only become apparent when the patient presents with a pyrexia or flank pain. Treatment will require a stent and possibly a temporary nephrostomy while the repaired ureter heals.
Extrapulmonary Tuberculosis
Published in Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies, Clinical Tuberculosis, 2020
A 6-month regimen is recommended for patients with drug-susceptible urogenital TB36 based on limited observational studies.217–219 Dose adjustment may be required in patients with coexistent renal failure. TB recurrence occurs in 6% of patients with very low recurrence after nephrectomy. Nephrectomy should be considered when there is a nonfunctioning or poorly functioning kidney, particularly in the setting of hypertension, as this can be cured in most patients in this setting.220,221 If ureteral obstruction occurs, procedures to relieve the obstruction are indicated. In cases of hydronephrosis and progressive renal insufficiency due to obstruction, renal drainage by stenting or percutaneous nephrostomy is advised. In one study of 77 patients with ureteral stricture, the rate of nephrectomy was higher (73% vs. 34%) in those who did not undergo ureteral stenting or nephrostomy in addition to anti-TB therapy.222 TB of the female or male genital tract responds well to standard chemotherapy, although surgery may be indicated for residual, large, tubo-ovarian abscesses. Unfortunately, infertility is common even after successful treatment.
Incomplete Renal Duplex System with Lower Moiety Hydroureteronephrosis Due to Aberrant Blood Vessel
Published in Fetal and Pediatric Pathology, 2022
Hassan Alhellani, Fabio Beretta, Michele Corroppolo, Federica Fati, Giosuè Mazzero, Elisa Pani, Clara Revetria, Hamid Reza Sadri, Enrico Ciardini
A ureter receives blood supply from different vessels; abdominal ureter gets ramifications of renal, gonadal and even abdominal aorta. The pelvic ureter receives blood from a variety of adjacent arteries. Generally, abdominal ureter gets its blood supply from medial sources while pelvic ureter from lateral sources. Such vessels tend to have anastomosis over the course of the ureter creating a longitudinal plexus in its adventitia, which allows safe ureteral mobilization during surgery [4]. Venous and lymphatic drainage tend to follow the course of arterial vessels [5]. Duplicated systems have wide vascular variations [6] which makes it even harder to follow the course of each supplying vessel. The aim is to preserve connection between ureters when operating on duplicated systems to avoid vascular lesions and consequent ischemia of certain segments.
Retroperitoneal fibrosis requiring prompt nephrostomy in a case with immunoglobulin A vasculitis
Published in Scandinavian Journal of Rheumatology, 2022
Y Ishihama, K Fukumoto, R Watanabe, S Nakatani, A Tsuda, T Otoshi, K Yamada, S Yamada, N Negoro, M Emoto, M Hashimoto
Skin biopsy demonstrated leucocytoclastic vasculitis (Figure 1B). IgA deposition was not detected. Whole-body computed tomography (CT) revealed bilateral hydronephrosis caused by a retroperitoneal mass (Figure 1C), which showed mild uptake on 18F-fluorodeoxyglucose positron emission tomography (Figure 1D). Bilateral ureteral catheterization failed to release urinary retention, which subsequently required percutaneous nephrostomy for the right kidney (Figure 1E). Oral prednisolone (1 mg/kg per day) and concomitant antibiotics led to rapid improvement in the laboratory results and dermatological symptoms. Follow-up CT demonstrated resolution of the ureteral obstruction. Kidney biopsy showed slight mesangial expansion with IgA deposition (Figure 1F), which confirmed the diagnosis of IgA vasculitis. IgG4-positive plasma cell infiltration was not observed. After 2 months, repeated CT showed marked regression of the retroperitoneal mass.
Revascularized Pyelo-Uretero-Cystoplasty in Patients with Chronic Bladder Outlet Obstruction Due to Ectopic Ureterocele: A Safe Surgical Technique with Superior Continence Outcomes
Published in Journal of Investigative Surgery, 2022
Asal Hojjat, Shabnam Sabetkish, Abdol-Mohammad Kajbafzadeh
The ureter is an appropriate substance for bladder augmentation which imitates the normal bladder wall without the metabolic and infective disadvantages associated with intestinal segments such as extreme mucus production, metabolic disturbances, and a slightly higher risk of carcinoma arose from heterotopic heterotopic epithelium.6,7 Although ureter has been considered as an excellent source for augmentation cystoplasty; the techniques of ureterocystoplasty were criticized due to several reports of multiple failures, ureteral tissue shortage, inadequate blood supply, and the need for re-augmentation.8 To overcome the related drawbacks, we attempt to assess the efficacy of an alternative reconstructive procedure to identify if these types of patients with end-stage bladder disease would be best suited for this technique. Several reported data suggested that entire reconstruction can be carefully applied in infantile without any side effect on continence. Therefore, we reported our experience with revascularized pyelo-uretero-cystoplasty (RPUC) in conjunction with ureterocele unroofing, in eight children with duplex systems and ureterocele who developed end-stage bladder disease due to long-lasting ectopic obstructive ureterocele.