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Genito-Urinary Tract Anomalies
Published in Asim Kurjak, CRC Handbook of Ultrasound in Obstetrics and Gynecology, 2019
The uretero-pelvic junction is the most common site of congenital urinary obstruction above the level of the bladder. The resulting hydronephrosis may be unilateral or bilateral. The level of obstruction may also be at the ureterovesicle junction, in which case there is hydronephrosis as well as dilated ureters. The distinction between the two is very difficult.
Prune belly syndrome, bladder and cloacal exstrophy
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
Kate H Kraft, Howard M Snyder III
Recurrent upper urinary tract infections or deterioration of renal function mandates urinary tract diversion. In this case, the findings are consistent with bilateral ureteropelvic junction obstruction with worsening nephropathy. Upper tract diversion can be achieved with bilateral cutaneous pyelostomy or bilateral percutaneous nephrostomy tube placement.
Upper urinary tract obstructions
Published in Prem Puri, Newborn Surgery, 2017
Intrinsic obstruction results from failure of transmission of the peristaltic waves across the PUJ with failure of urine to be propulsed from the renal pelvis into the ureter, which results in multiple ineffective peristaltic waves that eventually causes hydronephrosis by incompletely emptying the pelvic contents.8–11 Tainio et al.12 have shown the abnormalities of peptidergic innervation with dense innervation of neuropeptide Y and vasoactive intestinal polypeptide, and proposed that these may have a role in intrinsic obstruction. Absence or reduction of smooth muscle with replacement by collagen fibers has been demonstrated histologically.13,14 Some researchers proposed that downregulation of Cajal cells is responsible for the development of PUJ obstruction.15 Extrinsic mechanical factors include aberrant renal vessels, bands, adventitial tissues, and adhesions that cause angulation, kinking, or compression of the PUJ. Extrinsic obstruction may occur alone but usually coexists with intrinsic ureteropelvic junction pathology. Secondary PUJ obstruction may develop as a consequence of severe VUR in which a tortuous ureter may kink proximately.16 Previous reports have described VUR in 9%–15% of children who have PUJ obstruction, although the fractions that are secondary to reflux are difficult to determine.9,16
Grooved vs smooth ureteric stent before extracorporeal shockwave lithotripsy: Single-blind randomised clinical trial
Published in Arab Journal of Urology, 2022
Abdulqadir Alobaidy, Tarek Ibrahim, Walid El Ansari, Hosam Tawfik, Abdulla Al-Naimi, Salam Hussain, Abdulla Al-Ansari
None of the recruited patients had a significant reduction of renal size or parenchymal thickness of the ipsilateral kidney compared to the other kidney and none had compensatory renal hypertrophy of the contralateral kidney. All the patients had ureteric stones that were indicated for stenting. Of the 96 patients, 77 patients had upper ureteric stones close to the ureteropelvic junction causing intolerable pain, of whom 43 were associated with severe hydronephrosis and impairment of renal function, and 19 patients presented with UTI drained by insertion of ureteric stents. Upon stent insertion, 22 stones migrated to the kidneys. The indications of stenting and the stone location during ESWL in each group are shown in Table 2. Table 2 also shows that there were no statistically significant differences in the baseline renal and stone characteristics of both stent groups.
Telocytes, c-Kit positive cells, Smooth muscles, and collagen in the ureter of pediatric patients with congenital primary obstructive megaureter: elucidation of etiopathology
Published in Ultrastructural Pathology, 2021
Mohamed Wishahi, Ehab Hafiz, A M K Wishahy, Mohamed Badawy
Many theories were postulated to explain the etiology of congenital POM, Primary megaureter could be attributed to a segmental developmental delay of the terminal ureter with a possible pathogenetic involvement of autocrine TGF-beta overexpression.5 The ultrastructure of the narrow segment of POM showed that the muscle cells are normal in appearance, their connections with each other are present in normal form, there were a great increase in the amount of collagen fibers in the submucosa and the muscle coat that were responsible for the poor drainage of the ureter and its consequent dilatation.6 Friedrich et al studied resected parts of ureter in ten children with obstructive megaureter. The functionless narrow ureteral segment is characterized by dissociation of muscle cells with interposition of fibrous tissue. It was postulated that in congenital megaureter, there were disturbances in the electric syncytium occur in connection with nexus injury.7 It was hypothesized that ureteral peristalsis is a maturational event that includes the maturational and development of interstitial cells of Cajal-like cells (ICC) as ureteral peristalsis loss in patients with refluxing megaureters result from increased myocyte apoptosis in the obstructive megaureter and by the decreased number of ICC and smooth muscle content.8,9 This lesion is like that demonstrated in the narrow pelvi‐ureteric segment of idiopathic hydronephrosis and in ureteropelvic junction obstruction.10,11
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
Ureteropelvic junction obstruction (UPJO) is less common than ureteral duplication and is characterized by obstruction of urine flow at the level of the renal pelvis. This obstruction can be extrinsic due to crossing vessels or intrinsic due to scarring of ureteral valves or even ureter hypoplasia. Histologically, there is no clear evidence of the difference between the two types but it is reported that having higher grades of muscular hypertrophy is more indicative of an extrinsic crossing vessel [7]. Our case is different than the UPJO or primary obstructive megaureter that can affect the lower moiety [8, 9] because our stenosis is more caudal than UPJ.