Embryology, Anatomy, and Physiology of the Kidneys and Ureters
Karl H. Pang, Nadir I. Osman, James W.F. Catto, Christopher R. Chapple in Basic Urological Sciences, 2021
A ureterocoele results from failure of the Chwalla’s membrane to rupture. As the collecting system forms, the bifurcating ureteric bud secretes growth factors. The loss of function of any of the inductive factors involved in this process can lead to hypoplasia or agenesis. Renal agenesis - failure of the ureteric bud to arise from the mesonephric duct. The upper pole is larger and positioned more medial and posterior than the smaller lower pole. The kidneys are enclosed: in a fibrous capsule surrounded in perirenal fat and Gerota’s fascia, surrounded in pararenal fat. The anterior fascia is thinner and adherent to the peritoneum. The lungs and diaphragm are closely related to the kidneys. Diaphragm covers posterior part of the upper third of both kidneys. The 12th rib, with its invested pleura, crosses the kidneys just inferior to the diaphragm.
The kidneys, urinary tract and prostate
Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas in Browse’s Introduction to the Symptoms & Signs of Surgical Disease, 2014
It is very important to obtain an exact history of the symptoms of renal and urinary tract disease because the kidney, ureter and bladder are not readily accessible for physical examination. When asked to show you the site of renal pain, the patient usually spreads a hand around his waist with fingers covering the renal angle and thumb above the anterior superior iliac spine. In most cases, the pain starts in the loin and then radiates downwards, around the waist, obliquely across the abdomen just above the inguinal ligament, and to the base of the penis, the testes or the labia. Blood may be noticed during or after micturition. Modest bleeding may not affect the colour of the urine, or may make it look darker than usual. With heavy bleeding, the urine may be bright red. Old blood or clot in the bladder is usually very dark.
Kidney and Urinary Bladder
Victor A. Bernstam in Pocket Guide to GENE LEVEL DIAGNOSTICS in Clinical Practice, 2019
Autosomal dominant polycystic kidney disease (PKD) is most commonly caused by a mutation on chromosome 16p13. Genetic markers on chromosome 16 can be used for prenatal and presymptomatic diagnosis of PKD. The presence of a high concentration of epidermal growth factor receptor is correlated with poor differentiation and invasiveness of human bladder carcinomas and, therefore, with poor prognosis. Flow cytometry (FCM) of bladder irrigation specimens allows the differentiation of urothelial cells from granulocytes and squamous cells. Absolute nuclear fluorescence intensity of individual acridine orange-stained cells was able to detect recurrent and precancerous bladder lesions as well as kidney, ureter, and prostate lesions. Differential staining of blood and urothelial cells in FCM analysis of bladder irrigation specimens, using propidium iodide staining for deoxyribonucleic acid, can mimic aneuploidy or contribute to an increased hyperdiploid fraction. In laboratory animals, elevated and potentially abnormal c-myc expression was implicated in the pathogenesis of PKD.
Ureteroscopic Holmium:YAG laser lithotripsy is effective for ureteral steinstrasse post-SWL
Published in Minimally Invasive Therapy & Allied Technologies, 2013
Chenchen Feng, Zhong Wu, Haowen Jiang, Qiang Ding, Peng Gao
Objective: To evaluate the efficacy of Holmium: YAG laser lithotripsy for ureteral steinstrasse after extracorporeal shock lithotripsy (SWL). Material and methods: Holmium: YAG laser lithotripsy was performed on 21 patients who had developed ureteral steinstrasse post-SWL. Results: Nineteen cases had successful treatment. The ureteral steinstrasse was cleared within one month after the treatment (success rate of 90.48%). Upper ureteral steinstrasse shifted to the renal pelvis was noted in one patient, who underwent a second SWL treatment. Another patient had a severely kinking ureter and underwent open surgery after ureteroscopy failed. Conclusion: Holmium: YAG laser lithotripsy of ureteral steinstrasse post-SWL is an effective clinical modality due to its high success rate, short lithotripsy time, high safety and reliability, and easy feasibility.
A two way fully coupled fluid structure simulation of human ureter peristalsis
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2018
Ahmed Tasnub Takaddus, Abhilash J. Chandy
Numerical simulations of ureter peristalsis have been carried out in the past to understand both the flow field and ureter wall mechanics. The main objective of the current investigations is to have a better understanding of the urine transport due to the peristalsis in the ureter, thus making the information helpful for a better treatment and diagnosis of ureteral complications like urine reflux. In the current study, a numerical simulation is performed using a finite-element-based solver with a two-way fully coupled fluid structure interaction approach between the ureter wall and urine. For the first time, the ureter wall is modeled as an anisotropic hyper-elastic material based on experiments performed in previous literature on the human ureter. Peristalsis in the ureter is modeled as a series of isolated boluses. By observing the flow field it is clear that the peristalsis mechanism has a natural tendency to create a backflow as the isolated bolus moves forward. As a result, the urine can flow back from the bladder to the ureter at the ureterovesical (ureter-bladder) junctions, if the one-way valve starts to malfunction.
Robotic correction of iatrogenic ureteral stricture: preliminary experience from a tertiary referral centre
Published in Scandinavian Journal of Urology, 2019
L. Masieri, S. Sforza, F. Di Maida, Antonio Andrea Grosso, A. Mari, Emma Maria Rosi, R. Tellini, M. Carini, A. Minervini
Objective: Iatrogenic stenosis is a relatively common complication and it could happen after urological procedures in the entire course of the ureter. The aim of this study is to report the surgical outcomes of 36 consecutive patients (period April 2013–November 2018) submitted to robot-assisted correction of benign stricture with previous urological surgery in a tertiary referral center. Methods: Elective criteria were to have had a benign ureteral stricture development after at least one urological procedure. Patients were classified as failures in the event of post-operative ultrasound demonstrating persistent hydronephrosis with or without symptoms or persistent symptoms with renal scan evidence of obstruction or redo procedures. Results: Eighteen patients (50%) were treated for calculosis, seven (19.4%) patients were submitted to double J ureteral stenting and previous pyeloplasty was performed in 11 (30.5%) patients. Overall median operative time was 160 min (IQR = 120–180). Five (13.8%) complications with three (8.3%) surgical post-operative complications occurred. Length of stay was 6 (IQR = 5–7) days. At last follow-up, ranging between 7–60 months, the overall success rate was 86.1% (31/36): three of them (8.3%) were submitted to retrograde holmium laser endopyelotomy, while two (5.5%) underwent a redo robot-assisted correction. Conclusions: Robot-assisted correction procedures can be done safely with good perioperative outcomes and a high post-operative success rate in a tertiary referral center. Further randomized clinical trials are mandatory to confirm the safety of this procedure.
Related Knowledge Centers
- Kidney Pelvis
- Urinary Bladder
- Urinary Tract
- Urine
- Kidney
- Urethra
- Bladder Ureters