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Ultrasound Guided Procedures in Small-For-Gestation
Published in Asim Kurjak, John M. Beazley, Fetal Growth Retardation: Diagnosis and Treatment, 2020
R. J. Bradley, K. H. Nicolaides
The finding of severe oligo- or anhydramnios in the mid-trimester presents a difficult diagnostic problem. This may be due to three causes: (1) ruptured membranes, (2) fetal renal agenesis or urinary tract malformation, or (3) uteroplacental insufficiency. It is usually possible to exclude leakage of liquor by taking a careful history. An obstructive uropathy can be reliably diagnosed by ultrasound examination. The main difficulty lies in differentiating renal agenesis from intrauterine growth retardation (IUGR), as fetuses with renal agenesis are often small for gestational age8 and the absence of liquor makes the identification of fetal kidneys difficult. Doppler ultrasound is proving to be a useful tool in this situation, as in renal agenesis the uteroplacental and fetal blood flow velocity waveforms are usually normal, in contrast to the findings in uteroplacental insufficiency.9 Alternatively, the ultrasonographic image can be improved by the instillation of normal saline either into the amniotic cavity or the fetal peritoneal cavity.
Obstructive uropathy
Published in Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan, Take Charge! General Surgery and Urology, 2020
Obstructive uropathy (urinary tract obstruction) is when urine cannot flow freely within the urinary tract. It may be structural or functional in nature and lead to renal impairment. It can be caused by a lesion at any level in the urinary tract. Urinary tract obstruction occurs most commonly in the young and old. In children (usually boys), it is due to anatomic abnormalities including posterior urethral valves or stenosis at the pelviureteric junction (PUJ). In young adults, it is most commonly due to calculi. In older men, it is most commonly due to benign prostatic hyperplasia (BPH). In women, urinary tract obstruction tends to be caused by pelvic tumours, pregnancy or prolapse of pelvic structures.
Infectious Diseases
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Vas Novelli, Delane Shingadia, Huda Al-Ansari
The early manifestations in children infected with S haematobium are frequency, dysuria and terminal hematuria. Symptoms of obstructive uropathy (straining, dribbling, incomplete emptying of the bladder and constant urge to urinate) occur in advanced infection. End-stage disease results in hydronephrosis (Fig. 3.57) and uraemia. CNS involvement is occasionally seen.
Acute abdominal pain in non-pregnant endometriotic patients: not just dysmenorrhoea. A systematic review
Published in Journal of Obstetrics and Gynaecology, 2021
Mohamed Mabrouk, Giulia Borghese, Eugenia Degli Esposti, Diego Raimondo, Valentino Remorgida, Alessandro Arena, Errico Zupi, Giulia Mattioli, Marco Ambrosio, Renato Seracchioli
Acute onset of urinary tract endometriosis is extremely rare. In the literature, we found three cases of acute kidney injury due to acute obstructive uropathy, which presented with acute abdominal pain (Table 3). Two out of three patients had a history of previous surgery for endometriosis, a bicornuate uterus and a solitary kidney (Gagnon et al. 2001; Pant et al. 2016). In all the cases, laboratory exams revealed acute renal failure, and imaging demonstrated mono or bilateral distal ureteral obstruction and hydroureter with hydronephrosis. Surgical exploration showed dense fibrosis and pelvic adhesions that constricted the single ureter or both ureters and that required double-J ureteral stenting or/and nephrostomy. After surgical debulking due to pelvic endometriosis, the three women had a regular recovery with normal renal function at a median follow-up of twelve months (range 3–24 months).
Curcumin attenuates renal interstitial fibrosis of obstructive nephropathy by suppressing epithelial-mesenchymal transition through inhibition of the TLR4/NF-кB and PI3K/AKT signalling pathways
Published in Pharmaceutical Biology, 2020
Zhaohui Wang, Zhi Chen, Bingsheng Li, Bo Zhang, Yongchao Du, Yuhang Liu, Yao He, Xiang Chen
Obstructive nephropathy and obstructive uropathy are two frequently-used terms to describe a renal disease that induces hydronephrosis due to the anatomy or an injury, which can occur throughout the urinary tract from the renal tubules to the urethral meatus (Klahr 2000; Bascands and Schanstra 2005). A result of an obstructive uropathy is a renal interstitial fibrosis (RIF), which features several major pathophysiologic changes, including an inflammatory response, oxidative stress, cytokine release (including interleukin (IL)-6, IL-1β and tumour-necrosis factor (TNF)-α), an epithelial-mesenchymal transition (EMT), and deposition of fibroblasts and the extracellular matrix (ECM), which leads to fibrogenesis (Wang et al. 2014; Chuang et al. 2015). EMT is the key mechanism involved in RIF progression, and is an important biological process whereby epithelial cells lose their cell adhesion and cell polarity characteristics and develop several mesenchymal characteristics, such as migration and invasion (Kalluri and Weinberg 2009; Liao and Yang 2017).
Urological approach for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in a clinical care center
Published in Acta Chirurgica Belgica, 2018
Carlos Gustavo Trujillo, Cristina Domínguez, Daniela Robledo, Juan Ignacio Caicedo, Alejandra Bravo-Balado, Juan Guillermo Cataño, Natalia Cortés, Lina Parra, Wilson Riaño, Eduardo Londoño-Schimmer, Jorge Otero, Gabriel Herrera, Fernando Arias, Mauricio Plata
Also, ureteral catheterization has been associated with urothelial trauma secondary to manipulation and decreased ureteral peristalsis that may lead to obstructive uropathy [18]. However, obstructive uropathy can't be attributed neither to catheter placement nor to surgery alone; it is probably of multifactorial origin, combining internal and external trauma from manipulation of the ureters, and tissue edema from intensive fluid reanimation. In our study, postoperative urological complications were classified according to the Clavien–Dindo Scale, where 23 (74.2%) and 8 (25.8%) patients developed complications grade II and IIIb, respectively. Four patients developed acute obstructive uropathy after removal of the ureteral catheters and were successfully treated with double-J stenting. All 99 (96.1%) patients that underwent instrumentation of the UT presented with non-symptomatic macroscopic hematuria, which was not considered a complication of the procedure. Management was expectant for all cases. It is important that none of the four patients without prophylactic ureteral catheterization developed gross hematuria or any complication, including UTI.