BACKGROUND Varicocele embolization,a minimally invasive treatment for symptomatic varicoceles,carries a rare risk of complications like ureteral obstruction and hydronephrosis.This case report documents such a case to...BACKGROUND Varicocele embolization,a minimally invasive treatment for symptomatic varicoceles,carries a rare risk of complications like ureteral obstruction and hydronephrosis.This case report documents such a case to raise awareness of these potential complications and showcase minimally invasive surgical management as a successful solution.CASE SUMMARY A 35-year-old male presented with flank pain and hematuria following varicocele embolization.Imaging confirmed left ureteral obstruction and hydronephrosis.Laparoscopic ureterolysis successfully removed the embolization coil and repaired the ureter,resolving the patient's symptoms.Follow-up at six months and two years showed sustained improvement.CONCLUSION Minimally invasive surgery offers an effective treatment option for rare complications like ureteral obstruction arising from varicocele embolization.展开更多
Malignant ureteral obstruction can result in renal dysfunction or urosepsis and can limit the physician’s ability to treat the underlying cancer.There are multiple methods to deal with ureteral obstruction including ...Malignant ureteral obstruction can result in renal dysfunction or urosepsis and can limit the physician’s ability to treat the underlying cancer.There are multiple methods to deal with ureteral obstruction including regular polymeric double J stents(DJS),tandem DJS,nephrostomy tubes,and then more specialized products such as solid metal stents(e.g.,Resonance Stent,Cook Medical)and polyurethane stents reinforced with nickel-titanium(e.g.,UVENTA stents,TaeWoong Medical).In patients who require long-term stenting,a nephrostomy tube could be transformed subcutaneously into an extra-anatomic stent that is then inserted into the bladder subcutaneously.We outline the most recent developments published since 2012 and report on identifiable risk factors that predict for failure of urinary drainage.These failures are typically a sign of cancer progression and the natural history of the disease rather than the individual type of drainage device.Factors that were identified to predict drainage failure included low serum albumin,bilateral hydronephrosis,elevated C-reactive protein,and the presence of pleural effusion.Head-to-head studies show that metal stents are superior to polymeric DJS in terms of maintaining patency.Discussions with the patient should take into consideration the frequency that exchanges will be needed,the need for externalized hardware(with nephrostomy tubes),or severe urinary symptoms in the case of internal DJS.This review will highlight the current state of diversions in the setting of malignant ureteral obstruction.展开更多
The management options for ureteral obstruction are diverse, including retrograde ureteral stent insertion or antegrade nephrostomy placement, with or without eventual antegrade stent insertion. There is currently no ...The management options for ureteral obstruction are diverse, including retrograde ureteral stent insertion or antegrade nephrostomy placement, with or without eventual antegrade stent insertion. There is currently no consensus on the ideal treatment or treatment pathway for ureteral obstruction owing, in part, to the varied etiologies of obstruction and diversity of institutional practices. Additionally, different clinicians such as internists, urologists, oncologists and radiologists are often involved in the care of patients with ureteral obstruction and may have differing opinions concerning the best management strategy. The purpose of this manuscript was to review available literature that compares percutaneous nephrostomy placement vs ureteral stenting in the management of ureteral obstruction from both benign and malignant etiologies.展开更多
Objective:Complex ureteral obstruction is refractory to conventional urological intervention.This report describes a case of laparoscopic ureterolysis with simultaneous ureteroscopy and percutaneous nephroscopy for tr...Objective:Complex ureteral obstruction is refractory to conventional urological intervention.This report describes a case of laparoscopic ureterolysis with simultaneous ureteroscopy and percutaneous nephroscopy for treating complex ureteral obstruction.Methods:Right-side multiple ureteral stones and complicating ureteral obstruction failed an initial attempt of ureteroscopy lithotripsy with simultaneous percutaneous nephroscopy in a 23-year-old male.Laparoscopic ureterolysis with ureteroscopy and percutaneous nephroscopy was used simultaneously to dissect the periureteral adhesions with the patient placed in the Galdakao-modified supine Valdivia position.The ureter was incised to allow the insertion of a ureteral catheter through the twisted ureter,and a guide wire was advanced into the pelvis using ureteroscopy.A double-J stent was placed into the right-side ureter using antegrade percutaneous nephroscopy.Results:The laparoendoscopic procedure lasted 330 min with an estimated bleeding volume of 100 mL.The patient underwent an uneventful postoperative course,and postoperative followup radiography confirmed good positioning of the double-J stent.The double-J stent was removed 3 months after operation.The patient remained asymptomatic within a 13-month follow-up period.Conclusion:Laparoscopic ureterolysis with simultaneous ureteroscopy and percutaneous nephroscopy is an effective and safe treatment option for complex ureteral obstruction.展开更多
Renal tubulointerstitial fibrosis is the common ending of progressive renal disease. It is worth developing new ways to stop the progress of renal fibrosis. Peroxisome proliferator-activated receptor-γ（PPARγ） agon...Renal tubulointerstitial fibrosis is the common ending of progressive renal disease. It is worth developing new ways to stop the progress of renal fibrosis. Peroxisome proliferator-activated receptor-γ（PPARγ） agonists have been studied to treat diabetic nephropathy, cisplatin-induced acute renal injury, ischemia reperfusion injury and adriamycin nephropathy. In this study, unilateral ureteral obstruction（UUO） was used to establish a different renal fibrosis model. PPARγ agonist pioglitazone was administrated by oral gavage and saline was used as control. At 7th and 14 th day after the operation, mice were sacrificed for fibrosis test and T lymphocytes subsets test. Unexpectedly, through MASSON staining, immunohistochemistry for α-SMA, and Western blotting for α-SMA and PDGFR-β, we found that pioglitazone failed to attenuate renal fibrosis in UUO mice. However, flow cytometry showed that pioglitazone down-regulated Th1 cells, and up-regulated Th2 cells, Th17 cells and Treg cells. But the Th17/Treg ratio had no significant change by pioglitazone. Real-time PCR results showed that TGF-β and MCP-1 had no significant changes, at the same time, CD4＋ T cells associated cytokines were partially regulated by pioglitazone pretreatment. Taken together, pioglitazone failed to suppress renal fibrosis progression caused by UUO.展开更多
There is a well-known relationship between malignancy and impairment of kidney functions,either in the form of acute kidney injury or chronic kidney disease.In the former,however,bilateral malignant ureteral obstructi...There is a well-known relationship between malignancy and impairment of kidney functions,either in the form of acute kidney injury or chronic kidney disease.In the former,however,bilateral malignant ureteral obstruction is a surgically correctable factor of this complex pathology.It warrants urgent drainage of the kidneys in emergency settings.However,there are multiple controversies and debates about the optimal mode of drainage of the bilaterally obstructed kidneys in these patients.This review addressed most of the concerns and provided a comprehensive presentation of this topic from the recent literature.Also,we provided different perspectives on the management of the bilateral obstructed kidneys due to malignancy.Despite the frequent trials for improving the success rates and functions of ureteral stents,placement of a percutaneous nephrostomy tube remains the most recommended tool of drainage due to bilateral ureteral obstruction,especially in patients with advanced malignancy.However,the disturbance of the quality of life of those patients remains a major unresolved concern.Beside the unfavorable prognostic potential of the underlying malignancy and the various risk stratification models that have been proposed,the response of the kidney to initial drainage can be anticipated and evaluated by multiple renal prognostic factors,including increased urine output,serum creatinine trajectory,and time-to-nadir serum creatinine after drainage.展开更多
Objective:To study the changes of the expression of bone morphogenetic protein-7(BMP-7) and its receptors(BMPR-Ⅱ,ALK2,ALK3 and ALK6) in the renal tubulointerstitial fibrosis induced with unilateral ureteral obstructi...Objective:To study the changes of the expression of bone morphogenetic protein-7(BMP-7) and its receptors(BMPR-Ⅱ,ALK2,ALK3 and ALK6) in the renal tubulointerstitial fibrosis induced with unilateral ureteral obstruction in rats. Methods: Sixty Wistar male rats were divided randomly into the normal control,sham-operation and unilateral ureteral obstruction(UUO) groups and the rats were killed on the 1st,3rd,7th and 14th postoperative days respectively.The mRNA level of BMP-7,BMPR-Ⅱ,ALK2,ALK3 and ALK6 was determined with RT-PCR.The site and level of protein expression of BMP-7 were observed with immunohistochemical staining. Results: The mRNA level of BMP-7,BMPR-Ⅱ,ALK2 and ALK3 was significantly decreased in the rats of UUO group than in those of the sham-operation group but the mRNA level of ALK6 showed no obvious changes in all the rats.Immunohistochemical staining revealed that the protein of BMP-7 was mainly expressed in the renal tubules and interstitial tissue of the kidneys in normal rats but it was decreased gradually along with the unilateral ureteral obstruction. Conclusion: It is found that the loss of BMP-7 and its receptors including BMPR-Ⅱ,ALK2 and ALK3 occurs in the early phase of renal tubulointerstitial fibrosis before the appearance of other pathological changes in the kidney and may play an important role in the occurrence and progress of renal tubulointerstitial fibrosis.展开更多
Objective: To explore the role of bone morphorgenetic protein-7 （BMP-7） in the renal tubulo-interstitial lesions induced by unilateral ureteral obstruction （UUO）. Methods: Sixty Wistar rats were equally and random...Objective: To explore the role of bone morphorgenetic protein-7 （BMP-7） in the renal tubulo-interstitial lesions induced by unilateral ureteral obstruction （UUO）. Methods: Sixty Wistar rats were equally and randomly divided into normal control, sham operation and UUO groups, and respectively sacrificed on the 1st, 3rd, 7th, 14th day after the time of UUO operation. The mRNA levels of BMP-7 and TGF-β1 in the renal tissues were examined by RT-PCR. The expression sites and levels of BMP-7 and TGF-β1 proteins were detected by immunohistochemistry staining. Results:Compared to control groups, the level of BMP-7 mRNA was significantly decreased, but that of TGF-β1 mRNA was significantly increased in UUO rats. Immunohistochemistry staining indicated that BMP-7 mainly expressed in the renal tubules and interstitum, rarely in the glomeruli. In UUO rats, the expression of BMP-7 protein was decreased, but that of TGF-β1 was increased in an obstruction dependent manner. Conclusion:The down- regulation of BMP-7 is observed in the early phase of fibrotic process of the renal interstitium, suggesting it may be involved in the formation and development of the tubulo-interstitial lesions.展开更多
Bilateral ureteral obstruction in children is a rare condition arising from several medical or surgical pictures.It needs to be promptly suspected in order to attempt a quick renal function recovery.In this paper we c...Bilateral ureteral obstruction in children is a rare condition arising from several medical or surgical pictures.It needs to be promptly suspected in order to attempt a quick renal function recovery.In this paper we concentrated on uncommon causes of obstruction,with the aim of giving a summary of such multiple,rare and heterogeneous conditions joint together by the common denominator of sudden bilateral ureteral obstruction,difficult to be suspected at times.Conversely,typical and well-known diseases have been just run over.We considered pediatric cases of ureteral obstruction presenting as bilateral,along with some cases which truly appeared as single-sided,because of their potential bilateral presentation.We performed a review of the literature by a search on Pub Med,Cross Ref Metadata Search,internet and reference lists of single articles updated to May 2014,with no time limits in the past.Given that we deal with rare conditions,we decided to include also papers in non-English languages,published with an English abstract.For the sake of clearness,we divided our research results into 8 categories:(1) urolithiasis;(2) congenital urinary tract malformations;(3) immuno-rheumatologic causes of ureteral obstruction;(4) ureteral localization of infections;(5) other systemic infective causes of ureteral obstructions;(6) neoplastic intrinsic ureteral obstructions;(7) extrinsic ureteralobstructions; and(8) iatrogenic trigonal obstruction or inflammation.Of course,different pathogenic mechanisms underlay those clinical pictures,partly wellknown and partly not completely understood.展开更多
OBJECTIVE:To elucidate the mechanism by which Huoxue Jiedu Huayu recipe(活血解毒化瘀方,HJHR)regulates angiogenesis in the contralateral kidney of unilateral ureteral obstruction(UUO)rats and the mechanism by which it ...OBJECTIVE:To elucidate the mechanism by which Huoxue Jiedu Huayu recipe(活血解毒化瘀方,HJHR)regulates angiogenesis in the contralateral kidney of unilateral ureteral obstruction(UUO)rats and the mechanism by which it reduces of renal fibrosis.METHODS:Male Wistar rats were randomly divided into 4 groups:the sham group,UUO group(180 d of left ureter ligation),UUO plus eplerenone(EPL)group,and UUO plus HJHR group.After 180 d of oral drug administration,blood and contralateral kidneys were collected for analysis.Angiogenesis-and fibrosis-related indexes were detected.RESULTS:HJHR and EPL improved structural damage and renal interstitial fibrosis in the contralateral kidney and reduced the protein expression levels ofα-smooth muscle actin(α-SMA),vimentin and collagen I.Moreover,these treatments could reduce the expression of vascular endothelial growth factor-A(VEGFA)by inhibiting the infiltration of macrophages.Furthermore,HJHR and EPL significantly reduced the expression of CD34 and CD105 by downregulating VEGFA production,which inhibited angiogenesis.Finally,the coexpressions of CD34,CD105 andα-SMA were decreased in the HJHR and EPL groups,indicating that endothelial-to-mesenchymal transition was inhibited.CONCLUSIONS:These findings confirm that HJHR alleviates contralateral renal fibrosis by inhibiting VEGFAinduced angiogenesis,encourage the use of HJHR against renal interstitial fibrosis and provide a theoretical basis for the clinical management of patients with CKD.展开更多
Background:Malignant ureteral obstruction(MUO)is a common condition that complicates the course of advanced malignancies.The aims of this study are to analyze the causes,management,and survival of patients with obstru...Background:Malignant ureteral obstruction(MUO)is a common condition that complicates the course of advanced malignancies.The aims of this study are to analyze the causes,management,and survival of patients with obstructive nephropathy due to malignant ureteric obstruction and to determine prognostic factors.Furthermore,we studied the complications and outcomes in patients who underwent urinary diversion.Materials and methods:A retrospective study was conducted on patients with computed tomography-confirmed MUO between January 2016 and November 2020.Demographic,clinical,radiological,laboratory,and management data were collected.Survival curves were estimated using the Kaplan-Meier method,and univariate and multivariate Cox proportional hazards models were used to test the association between parameters and survival.Results:A total of 188 patients were included.The mean age was 69.01 years(SD,14.95 years),and the majority(54.8%)were male.The most common mechanism leading to MUO was compression by a pelvic mass(36.9%),and the 3 most frequent tumors causing MUO were prostate(17.6%),bladder(16.5%),and rectal cancer(11.7%).Forty-seven patients(25%)underwent urinary diversion:23(48.9%)underwent double-J stenting and 21(44.7%)underwent percutaneous nephrostomy.The most common reason for urinary diversion was acute kidney injury(53.3%).Recovery of renal function was observed in 55.8%of the patients after urinary diversion.The most frequently identified complications after urinary diversion were urinary tract infection(24.4%),hematuria(17.0%),and urinary sepsis(14.9%).The median survival after hydronephrosis diagnosis was 6.43 months(interquartile range,1.91-14.81 months).In patients who underwent urinary decompression,the median survival after urinary diversion was 8.67 months(interquartile range,2.99-17.28 months).In the multivariate analysis,a lower grade of hydronephrosis and cancer cachexia negatively impacted survival.Conclusions:Cancer patients with MUO have a poor prognosis;therefore,the risk-benefit ratio of urinary diversion should be carefully considered.Cachexia and hydronephrosis grade can be useful in selecting suitable candidates for urinary diversion.展开更多
OBJECTIVE:To investigate the action and underlying mechanisms of Huoxue Jiedu Huayu recipe(活血解毒化瘀方,HJHR)against unilateral ureteral obstruction(UUO)-induced injury in the contralateral kidney.METHODS:Forty-eigh...OBJECTIVE:To investigate the action and underlying mechanisms of Huoxue Jiedu Huayu recipe(活血解毒化瘀方,HJHR)against unilateral ureteral obstruction(UUO)-induced injury in the contralateral kidney.METHODS:Forty-eight male Sprague-Dawley rats weighing(200±10)g were used in this study and randomly assigned to 4 groups:a sham group,a UUO group,a UUO+eplerenone(EPL)group,and a UUO+HJHR group.The contralateral kidneys were harvested for further study 180 d after surgery.Histological analysis,immunohistochemistry and immunofluorescence were used to study the fibrosis of the contralateral kidneys obtained from UUO rats.Contralateral kidney damagerelated pathway proteins were detected by real-time polymerase chain reaction and Western blot analysis.RESULTS:HJHR significantly inhibited fibrosis of the contralateral kidney in UUO rats by attenuating the UUOinduced macrophage-to-myofibroblast transition(MMT)in the contralateral kidney.Moreover,HJHR attenuated fibrosis in the contralateral kidney of UUO rats by preventing MMT through the aldosterone/mineralocorticoid receptor/serum/glucocorticoid regulated kinase 1 pathway.CONCLUSIONS:Our findings suggest that HJHR may be a potential treatment for renal interstitial fibrosis of obstructive nephropathy.展开更多
Objective:To investigate the possible protective effect and mechanism of ginsenoside Rb1 against oxidative damage and renal interstitial fibrosis on rats with unilateral ureteral obstruction(UUO). Methods:In total,80 ...Objective:To investigate the possible protective effect and mechanism of ginsenoside Rb1 against oxidative damage and renal interstitial fibrosis on rats with unilateral ureteral obstruction(UUO). Methods:In total,80 male rats were randomly divided into 4 groups,20 in each group:the sham operated group (SOR),UUO group,UUO with ginsenoside Rb1 treatment group(treated with intraperitoneal injection of 50 mg/ kg daily) and UUO with Losartan treatment group(as the positive control,treated with 20 mg/kg by gastr...展开更多
Background Chronic kidney disease （CDK） is a worldwide health problem, but there is currently no effective treatment that can completely cure this disease. Recently, studies with mesenchymal stem cells （MSCs） on t...Background Chronic kidney disease （CDK） is a worldwide health problem, but there is currently no effective treatment that can completely cure this disease. Recently, studies with mesenchymal stem cells （MSCs） on treating various renal diseases have shown breakthroughs. This study is to observe the homing features of MSCs transplanted via kidney artery and effects on renal fibrosis in a reversible unilateral ureteral obstruction （R-UUO） model. Methods Thirty-six Balb/c mice were divided into UUO group, UUO-MSC group, and sham group randomly, with 12 mice in each group. The MSCs had been infected by a lentiviral vector to express stably the luciferase reporter gene and green fluorescence protein genes （Luc-GFP-MSC）. Homing of MSCs was tracked using in vivo imaging system （IVIS） 1, 3, 14, and 28 days after transplantation. Imaging results were verified by detecting GFP expression in frozen section under a fluorescence microscope. E-cadherin, α-SMA, TGF-β1, and TNF-α mRNA expression in all groups at 1 and 4 weeks after transplantation were analyzed by quantitative PCR. Results Transplanted Luc-GFP-MSCs showed increased Luciferase expression 3 days after transplantation. The expression decreased from 7 days, weakened thereafter and could not be detected 14 days after transplantation. Quantitative PCR results showed that all gene expressions in UUO group and UUO-MSC group at 1 week had no statistical difference, while at 4 weeks, except TGF-β expression （P〉0.05）, the expression of E-cadherin, α-SMA, and TNF-α in the above two groups have statistical difference （P〈0.01）. Conclusion IVIS enables fast, noninvasive, and intuitive tracking of MSC homing in vivo. MSCs can be taken home to kidney tissues of the diseased side in R-UUO model, and renal interstitial fibrosis can be improved as well.展开更多
OBJECTIVE:To investigate the effect of salvianolic acid A and C component molecules,which are involved in drug compatibility,on inflammatory cytokine expression that affects human chemokine ligand 5(CCL5) and chemokin...OBJECTIVE:To investigate the effect of salvianolic acid A and C component molecules,which are involved in drug compatibility,on inflammatory cytokine expression that affects human chemokine ligand 5(CCL5) and chemokine ligand 10(CXCL10)levels in rats with unilateral ureteral obstruction(UUO).METHODS:Fifty Sprague Dawley rats were randomly divided into five groups:normal,model,salvianolic acid A,salvianolic acid C and salvianolic acid A and C groups.The normal group was used as the control,and the other groups of rats had a UUO model established.The control group had free access to food and water,and the other groups received the corresponding drugs for 2 weeks.After the last administration,urine β_2-microglobulin(β_2-MG) and N-acetyl-β-D-glucosaminidase(NAG) levels were analyzed.After 24 h,all rats were sacrificed and the serum was analyzed for creatinine(Cr) and blood urea nitrogen(BUN) levels.Rat kidneys were removed,and CCL5 and CXCL10 inflammatory cytokine mRNA expression was measured using real-time fluorescent quantitative reverse transcription-polymerase chain reaction(RT-PCR).Kidney fibrosis was observed using hematoxylin-eosin(HE)staining and Masson trichrome staining.RESULTS:In the salvianolic acid A and salvianolic acid C treatment groups,serum Cr and urine NAG levels were significantly lower than in the model group(both P < 0.05).In all treatment groups,urine pYMG levels were significantly lower than in the model group(all P < 0.05).Compared with model group,the pathological changes and collagen deposition improved to varying degrees(both P <0.05).CCL5 and CXCL10 mRNA expression decreased to different degrees compared with the model group(both P < 0.05).CONCLUSION:Salvianolic acid A and C are component molecules of drug compatibility,and they may protect renal function and improve tubular function and renal pathology to a certain degree in UUO.This improvement may be related to a reduction in inflammatory cytokines CCL5 and CXCL10 secretion in the UUO rat kidney.展开更多
Retroperitoneal fibrosis (RPF) is a rare condition of unclear etiology. It can cause ureteral obstruction. We present the unique case of a 54 years old female, who initially presented with spontaneous perforation of t...Retroperitoneal fibrosis (RPF) is a rare condition of unclear etiology. It can cause ureteral obstruction. We present the unique case of a 54 years old female, who initially presented with spontaneous perforation of the cecum. Upon exploring the abdomen, the classical glistening white, unyielding retroperitoneal fibrosis was encountered. A right hemicolectomy was performed. Subsequently, the patient presented with bilateral ureteral obstruction, and later on with small bowel obstruction. Ureteral obstruction was treated with stents, and small bowel obstruction was treated with bypass. To our knowledge no case of idiopathic RPF presenting with features of both bilateral ureteral and small bowel obstruction has been reported in the literature.展开更多
Objective:Secondary pyeloplasty for recurrent ureteropelvic junction obstructions may be a safe and feasible surgical option for patients.This study aimed to demonstrate outcomes of utilizing a non-transecting buccal ...Objective:Secondary pyeloplasty for recurrent ureteropelvic junction obstructions may be a safe and feasible surgical option for patients.This study aimed to demonstrate outcomes of utilizing a non-transecting buccal mucosa graft ureteroplasty for management of recurrent ureteropelvic junction obstruction after prior failed pyeloplasty.Methods:We performed a retrospective review of our Collaborative of Reconstructive Robotic Ureteral Surgery database for all consecutive patients who underwent buccal mucosa graft ureteroplasty between April 2012 and June 2022 for management of recurrent ureteropelvic junction obstructions after prior failed pyeloplasty.The primary outcome included surgical success which was defined as the absence of flank pain and no obstruction on imaging.Results:Overall,ten patients were included in our analysis.The median stricture length was 2.5(interquartile range[IQR]1.8-4.0)cm.The median operative time was 230.5(IQR 199.5-287.0)min and median estimated blood loss was 50.0(IQR 28.8-102.5)mL.At a median follow-up of 10.3(IQR 6.2-14.8)months,80%of patients were surgically successful and there were no major(ClavieneDindo Grade>2)complications.Conclusion:Buccal mucosa graft ureteroplasty is a valuable non-transecting surgical option for patients with recurrent ureteropelvic junction obstructions who failed prior pyeloplasty and has comparable outcomes to the literature regarding standard transecting techniques.展开更多
When compared with maintenance dialysis,renal transplantation affords patients with end-stage renal disease better long-term survival and a better quality of life.Approximately 9% of patients will develop a major urol...When compared with maintenance dialysis,renal transplantation affords patients with end-stage renal disease better long-term survival and a better quality of life.Approximately 9% of patients will develop a major urologic complication following kidney transplantation.Ureteral complications are most common and include obstruction(intrinsic and extrinsic),urine leak and vesicoureteral reflux.Ureterovesical anastomotic strictures result from technical error or ureteral ischemia.Balloon dilation or endoureterotomy may be considered for short,low-grade strictures,but open reconstruction is associated with higher success rates.Urine leak usually occurs in the early postoperative period.Nearly 60% of patients can be successfully managed with a pelvic drain and urinary decompression(nephrostomy tube,ureteral stent,and indwelling bladder catheter).Proximal,large-volume,or leaks that persist despite urinary diversion,require open repair.Vesicoureteral reflux is common following transplantation.Patients with recurrent pyelonephritis despite antimicrobial prophylaxis require surgical treatment.Deflux injection may be considered in recipients with low-grade disease.Grade IV and V reflux are best managed with open reconstruction.展开更多
Objective:To determine the feasibility of decellularized small intestinal submu-cosa(5IS)matrix in repairing ureteral strictures.Methods:Two patients with ureteral stenoses underwent ureteral reconstruction with SIS m...Objective:To determine the feasibility of decellularized small intestinal submu-cosa(5IS)matrix in repairing ureteral strictures.Methods:Two patients with ureteral stenoses underwent ureteral reconstruction with SIS ma-trix at the Zhejiang Provincial Corps Hospital of Chinese People's Armed Forces between June 2014 and June 2016.The ureteral stenoses were repaired with a semi-tubular SIS matrix and the postoperative recoveries were observed.Results:Both operations were successfully completed.The average operative time was 90 min and the average length of hospital stay was 15 days.No fevers,incision infections,intestinal obstruction,graft rejection,or other serious complications were noted.After 2 months,ure-teroscopic examinations showed that the surfaces of the original patches were covered by mu-Cosa and there were no apparent stenoses in the lumens.The ureteral stents were replaced every 2 months postoperatively and removed 12 months postoperatively.No infections or uri-nary leakage occurred after removal of the stents.Intravenous urography was performed 6 and 12 months postoperatively.The results showed that the ureters were not obstructed and there was no apparent stenosis at the anastomosis sites.The average follow-up time was>12 months.Long-term follow-up is still ongoing,and computed tomography examin ations of the urinary tract have been conducted in the outpatient department of our hospital 1,3,and 6 months after removal of the double-J stents,suggesting the absence of hydronephrosis.The serum creatinine levels remained stable during the follow-up.Conclusion:SIS matrix reconstruction is a feasible method to repair ureters stenosis.展开更多
BACKGROUND Retroperitoneal fibrosis is an exceptionally rare disease characterized by proliferation of fibrous tissue and inflammation in the retroperitoneum.It features many symptoms in the kidneys and in other organ...BACKGROUND Retroperitoneal fibrosis is an exceptionally rare disease characterized by proliferation of fibrous tissue and inflammation in the retroperitoneum.It features many symptoms in the kidneys and in other organs and usually leads to ureteral obstruction.CASE SUMMARY Here we present 9 consecutive cases of idiopathic retroperitoneal fibrosis(IRPF)in patients who presented to the Department of Nephrology or Department of Rheumatology,Xuanwu Hospital,Capital Medical University,Beijing,China,between January 2012 and June 2017 with ureteral obstruction due to external compression of the ureter that led to hydronephrosis and kidney dysfunction.Computed tomography imaging was used to identify hydronephrosis and ureteral obstruction and to evaluate kidney function.Each patient was diagnosed with IRPF based on clinical observation and computed tomography examination results.To restore kidney function,a retrograde metallic stent was placed in the ureter under X-ray guidance 2 d after each patient’s admission.No perioperative complications occurred in any patient,but postoperative complications occurred in two patients as follows:Patient 2 had stent migration and repeated metallic stent infections that resolved with treatment;and patient 4 had postoperative hematuria because he resumed normal activities too soon after stent placement(contrary to instruction).Placement of the metallic ureteral stents provided relief from ureteral obstruction and restored kidney function in all patients.CONCLUSION Our 9-case series underscores the utility and efficacy of applying the Resonance®metallic ureteral stent to treat ureteral obstruction in patients with IRPF.For all retroperitoneal fibrosis cases in our series,ureteral stents provided effective relief and were shown to reduce the incidence rate of perioperative and postoperative complications.展开更多
文摘BACKGROUND Varicocele embolization,a minimally invasive treatment for symptomatic varicoceles,carries a rare risk of complications like ureteral obstruction and hydronephrosis.This case report documents such a case to raise awareness of these potential complications and showcase minimally invasive surgical management as a successful solution.CASE SUMMARY A 35-year-old male presented with flank pain and hematuria following varicocele embolization.Imaging confirmed left ureteral obstruction and hydronephrosis.Laparoscopic ureterolysis successfully removed the embolization coil and repaired the ureter,resolving the patient's symptoms.Follow-up at six months and two years showed sustained improvement.CONCLUSION Minimally invasive surgery offers an effective treatment option for rare complications like ureteral obstruction arising from varicocele embolization.
文摘Malignant ureteral obstruction can result in renal dysfunction or urosepsis and can limit the physician’s ability to treat the underlying cancer.There are multiple methods to deal with ureteral obstruction including regular polymeric double J stents(DJS),tandem DJS,nephrostomy tubes,and then more specialized products such as solid metal stents(e.g.,Resonance Stent,Cook Medical)and polyurethane stents reinforced with nickel-titanium(e.g.,UVENTA stents,TaeWoong Medical).In patients who require long-term stenting,a nephrostomy tube could be transformed subcutaneously into an extra-anatomic stent that is then inserted into the bladder subcutaneously.We outline the most recent developments published since 2012 and report on identifiable risk factors that predict for failure of urinary drainage.These failures are typically a sign of cancer progression and the natural history of the disease rather than the individual type of drainage device.Factors that were identified to predict drainage failure included low serum albumin,bilateral hydronephrosis,elevated C-reactive protein,and the presence of pleural effusion.Head-to-head studies show that metal stents are superior to polymeric DJS in terms of maintaining patency.Discussions with the patient should take into consideration the frequency that exchanges will be needed,the need for externalized hardware(with nephrostomy tubes),or severe urinary symptoms in the case of internal DJS.This review will highlight the current state of diversions in the setting of malignant ureteral obstruction.
文摘The management options for ureteral obstruction are diverse, including retrograde ureteral stent insertion or antegrade nephrostomy placement, with or without eventual antegrade stent insertion. There is currently no consensus on the ideal treatment or treatment pathway for ureteral obstruction owing, in part, to the varied etiologies of obstruction and diversity of institutional practices. Additionally, different clinicians such as internists, urologists, oncologists and radiologists are often involved in the care of patients with ureteral obstruction and may have differing opinions concerning the best management strategy. The purpose of this manuscript was to review available literature that compares percutaneous nephrostomy placement vs ureteral stenting in the management of ureteral obstruction from both benign and malignant etiologies.
基金supported by grants from the Shanghai Municipal Hospitals’Project for Emerging and Frontier Technology(No.SHDC12010115)Chinese Military Major Project for Clinical High-tech and Innovative Technology(No.2010gxjs057)the Project for the Key Discipline of Shanghai(No.2013046).
文摘Objective:Complex ureteral obstruction is refractory to conventional urological intervention.This report describes a case of laparoscopic ureterolysis with simultaneous ureteroscopy and percutaneous nephroscopy for treating complex ureteral obstruction.Methods:Right-side multiple ureteral stones and complicating ureteral obstruction failed an initial attempt of ureteroscopy lithotripsy with simultaneous percutaneous nephroscopy in a 23-year-old male.Laparoscopic ureterolysis with ureteroscopy and percutaneous nephroscopy was used simultaneously to dissect the periureteral adhesions with the patient placed in the Galdakao-modified supine Valdivia position.The ureter was incised to allow the insertion of a ureteral catheter through the twisted ureter,and a guide wire was advanced into the pelvis using ureteroscopy.A double-J stent was placed into the right-side ureter using antegrade percutaneous nephroscopy.Results:The laparoendoscopic procedure lasted 330 min with an estimated bleeding volume of 100 mL.The patient underwent an uneventful postoperative course,and postoperative followup radiography confirmed good positioning of the double-J stent.The double-J stent was removed 3 months after operation.The patient remained asymptomatic within a 13-month follow-up period.Conclusion:Laparoscopic ureterolysis with simultaneous ureteroscopy and percutaneous nephroscopy is an effective and safe treatment option for complex ureteral obstruction.
基金financially supported by grants from the National Natural Science Foundation of China(No.81470948,No.81270770,and No.81300575)Hubei Provincial Health and Family Planning Youth Project of China(No.WJ2015Q007)
文摘Renal tubulointerstitial fibrosis is the common ending of progressive renal disease. It is worth developing new ways to stop the progress of renal fibrosis. Peroxisome proliferator-activated receptor-γ（PPARγ） agonists have been studied to treat diabetic nephropathy, cisplatin-induced acute renal injury, ischemia reperfusion injury and adriamycin nephropathy. In this study, unilateral ureteral obstruction（UUO） was used to establish a different renal fibrosis model. PPARγ agonist pioglitazone was administrated by oral gavage and saline was used as control. At 7th and 14 th day after the operation, mice were sacrificed for fibrosis test and T lymphocytes subsets test. Unexpectedly, through MASSON staining, immunohistochemistry for α-SMA, and Western blotting for α-SMA and PDGFR-β, we found that pioglitazone failed to attenuate renal fibrosis in UUO mice. However, flow cytometry showed that pioglitazone down-regulated Th1 cells, and up-regulated Th2 cells, Th17 cells and Treg cells. But the Th17/Treg ratio had no significant change by pioglitazone. Real-time PCR results showed that TGF-β and MCP-1 had no significant changes, at the same time, CD4＋ T cells associated cytokines were partially regulated by pioglitazone pretreatment. Taken together, pioglitazone failed to suppress renal fibrosis progression caused by UUO.
文摘There is a well-known relationship between malignancy and impairment of kidney functions,either in the form of acute kidney injury or chronic kidney disease.In the former,however,bilateral malignant ureteral obstruction is a surgically correctable factor of this complex pathology.It warrants urgent drainage of the kidneys in emergency settings.However,there are multiple controversies and debates about the optimal mode of drainage of the bilaterally obstructed kidneys in these patients.This review addressed most of the concerns and provided a comprehensive presentation of this topic from the recent literature.Also,we provided different perspectives on the management of the bilateral obstructed kidneys due to malignancy.Despite the frequent trials for improving the success rates and functions of ureteral stents,placement of a percutaneous nephrostomy tube remains the most recommended tool of drainage due to bilateral ureteral obstruction,especially in patients with advanced malignancy.However,the disturbance of the quality of life of those patients remains a major unresolved concern.Beside the unfavorable prognostic potential of the underlying malignancy and the various risk stratification models that have been proposed,the response of the kidney to initial drainage can be anticipated and evaluated by multiple renal prognostic factors,including increased urine output,serum creatinine trajectory,and time-to-nadir serum creatinine after drainage.
文摘Objective:To study the changes of the expression of bone morphogenetic protein-7(BMP-7) and its receptors(BMPR-Ⅱ,ALK2,ALK3 and ALK6) in the renal tubulointerstitial fibrosis induced with unilateral ureteral obstruction in rats. Methods: Sixty Wistar male rats were divided randomly into the normal control,sham-operation and unilateral ureteral obstruction(UUO) groups and the rats were killed on the 1st,3rd,7th and 14th postoperative days respectively.The mRNA level of BMP-7,BMPR-Ⅱ,ALK2,ALK3 and ALK6 was determined with RT-PCR.The site and level of protein expression of BMP-7 were observed with immunohistochemical staining. Results: The mRNA level of BMP-7,BMPR-Ⅱ,ALK2 and ALK3 was significantly decreased in the rats of UUO group than in those of the sham-operation group but the mRNA level of ALK6 showed no obvious changes in all the rats.Immunohistochemical staining revealed that the protein of BMP-7 was mainly expressed in the renal tubules and interstitial tissue of the kidneys in normal rats but it was decreased gradually along with the unilateral ureteral obstruction. Conclusion: It is found that the loss of BMP-7 and its receptors including BMPR-Ⅱ,ALK2 and ALK3 occurs in the early phase of renal tubulointerstitial fibrosis before the appearance of other pathological changes in the kidney and may play an important role in the occurrence and progress of renal tubulointerstitial fibrosis.
文摘Objective: To explore the role of bone morphorgenetic protein-7 （BMP-7） in the renal tubulo-interstitial lesions induced by unilateral ureteral obstruction （UUO）. Methods: Sixty Wistar rats were equally and randomly divided into normal control, sham operation and UUO groups, and respectively sacrificed on the 1st, 3rd, 7th, 14th day after the time of UUO operation. The mRNA levels of BMP-7 and TGF-β1 in the renal tissues were examined by RT-PCR. The expression sites and levels of BMP-7 and TGF-β1 proteins were detected by immunohistochemistry staining. Results:Compared to control groups, the level of BMP-7 mRNA was significantly decreased, but that of TGF-β1 mRNA was significantly increased in UUO rats. Immunohistochemistry staining indicated that BMP-7 mainly expressed in the renal tubules and interstitum, rarely in the glomeruli. In UUO rats, the expression of BMP-7 protein was decreased, but that of TGF-β1 was increased in an obstruction dependent manner. Conclusion:The down- regulation of BMP-7 is observed in the early phase of fibrotic process of the renal interstitium, suggesting it may be involved in the formation and development of the tubulo-interstitial lesions.
文摘Bilateral ureteral obstruction in children is a rare condition arising from several medical or surgical pictures.It needs to be promptly suspected in order to attempt a quick renal function recovery.In this paper we concentrated on uncommon causes of obstruction,with the aim of giving a summary of such multiple,rare and heterogeneous conditions joint together by the common denominator of sudden bilateral ureteral obstruction,difficult to be suspected at times.Conversely,typical and well-known diseases have been just run over.We considered pediatric cases of ureteral obstruction presenting as bilateral,along with some cases which truly appeared as single-sided,because of their potential bilateral presentation.We performed a review of the literature by a search on Pub Med,Cross Ref Metadata Search,internet and reference lists of single articles updated to May 2014,with no time limits in the past.Given that we deal with rare conditions,we decided to include also papers in non-English languages,published with an English abstract.For the sake of clearness,we divided our research results into 8 categories:(1) urolithiasis;(2) congenital urinary tract malformations;(3) immuno-rheumatologic causes of ureteral obstruction;(4) ureteral localization of infections;(5) other systemic infective causes of ureteral obstructions;(6) neoplastic intrinsic ureteral obstructions;(7) extrinsic ureteralobstructions; and(8) iatrogenic trigonal obstruction or inflammation.Of course,different pathogenic mechanisms underlay those clinical pictures,partly wellknown and partly not completely understood.
基金Natural Science Foundation-funded Project:Effect of Macrophage-to-Myofibroblast Transition in Contralateral Kidney of Unilateral Ureteral Obstruction Rats Through the Aldosterone/MR/SGK1 Pathway and Inhibition of Chinese Herbs(No.81873251)Natural Science Foundation-funded Project:Aldosterone Stimulates MR Activation to Induce Lymphangiogenesis in the Contralateral Kidney of UUO Rats and the Protective Effect of Yiqi Jiedu Huayu Herbs(No.82174317)+1 种基金Hebei Provincial Postgraduate Innovative Ability Cultivation Funding Project:Aldosterone Induced Macrophages to Secrete VEGFA to Participate in Renal Angiogenesis and the Protective Effect of Huoxue Jiedu Huayu Recipe(CXZZBS2023140)Construction Program of New Research and Development Platform and Institution,Hebei Province Innovation Ability Promotion Plan under Grant No.20567624H。
文摘OBJECTIVE:To elucidate the mechanism by which Huoxue Jiedu Huayu recipe(活血解毒化瘀方,HJHR)regulates angiogenesis in the contralateral kidney of unilateral ureteral obstruction(UUO)rats and the mechanism by which it reduces of renal fibrosis.METHODS:Male Wistar rats were randomly divided into 4 groups:the sham group,UUO group(180 d of left ureter ligation),UUO plus eplerenone(EPL)group,and UUO plus HJHR group.After 180 d of oral drug administration,blood and contralateral kidneys were collected for analysis.Angiogenesis-and fibrosis-related indexes were detected.RESULTS:HJHR and EPL improved structural damage and renal interstitial fibrosis in the contralateral kidney and reduced the protein expression levels ofα-smooth muscle actin(α-SMA),vimentin and collagen I.Moreover,these treatments could reduce the expression of vascular endothelial growth factor-A(VEGFA)by inhibiting the infiltration of macrophages.Furthermore,HJHR and EPL significantly reduced the expression of CD34 and CD105 by downregulating VEGFA production,which inhibited angiogenesis.Finally,the coexpressions of CD34,CD105 andα-SMA were decreased in the HJHR and EPL groups,indicating that endothelial-to-mesenchymal transition was inhibited.CONCLUSIONS:These findings confirm that HJHR alleviates contralateral renal fibrosis by inhibiting VEGFAinduced angiogenesis,encourage the use of HJHR against renal interstitial fibrosis and provide a theoretical basis for the clinical management of patients with CKD.
文摘Background:Malignant ureteral obstruction(MUO)is a common condition that complicates the course of advanced malignancies.The aims of this study are to analyze the causes,management,and survival of patients with obstructive nephropathy due to malignant ureteric obstruction and to determine prognostic factors.Furthermore,we studied the complications and outcomes in patients who underwent urinary diversion.Materials and methods:A retrospective study was conducted on patients with computed tomography-confirmed MUO between January 2016 and November 2020.Demographic,clinical,radiological,laboratory,and management data were collected.Survival curves were estimated using the Kaplan-Meier method,and univariate and multivariate Cox proportional hazards models were used to test the association between parameters and survival.Results:A total of 188 patients were included.The mean age was 69.01 years(SD,14.95 years),and the majority(54.8%)were male.The most common mechanism leading to MUO was compression by a pelvic mass(36.9%),and the 3 most frequent tumors causing MUO were prostate(17.6%),bladder(16.5%),and rectal cancer(11.7%).Forty-seven patients(25%)underwent urinary diversion:23(48.9%)underwent double-J stenting and 21(44.7%)underwent percutaneous nephrostomy.The most common reason for urinary diversion was acute kidney injury(53.3%).Recovery of renal function was observed in 55.8%of the patients after urinary diversion.The most frequently identified complications after urinary diversion were urinary tract infection(24.4%),hematuria(17.0%),and urinary sepsis(14.9%).The median survival after hydronephrosis diagnosis was 6.43 months(interquartile range,1.91-14.81 months).In patients who underwent urinary decompression,the median survival after urinary diversion was 8.67 months(interquartile range,2.99-17.28 months).In the multivariate analysis,a lower grade of hydronephrosis and cancer cachexia negatively impacted survival.Conclusions:Cancer patients with MUO have a poor prognosis;therefore,the risk-benefit ratio of urinary diversion should be carefully considered.Cachexia and hydronephrosis grade can be useful in selecting suitable candidates for urinary diversion.
基金Supported by Natural Science Foundation-funded Project:Effect of Macrophage-to-Myofibroblast Transition in Contralateral Kidney of Unilateral Ureteral Obstruction Rats Through the Aldosterone/MR/SGK1 Pathway and Inhibition of Chinese Herbs(No.81873251)Natural Science Foundation-funded Project:Aldosterone-induced Macrophage Polarization-lymphatic Endothelial Cell-like Transformation Involved in Renal Fibrosis and the Protective Effect of Yiqi Jiedu Huayu Herbs(No.82205006)Youth Top Talent Project of Hebei Provincial Department of Education:Mechanism of Renal Fibrosis Induced by NF-kB/IL-8 Induced MMT in UUO Rats(BJK2022004)。
文摘OBJECTIVE:To investigate the action and underlying mechanisms of Huoxue Jiedu Huayu recipe(活血解毒化瘀方,HJHR)against unilateral ureteral obstruction(UUO)-induced injury in the contralateral kidney.METHODS:Forty-eight male Sprague-Dawley rats weighing(200±10)g were used in this study and randomly assigned to 4 groups:a sham group,a UUO group,a UUO+eplerenone(EPL)group,and a UUO+HJHR group.The contralateral kidneys were harvested for further study 180 d after surgery.Histological analysis,immunohistochemistry and immunofluorescence were used to study the fibrosis of the contralateral kidneys obtained from UUO rats.Contralateral kidney damagerelated pathway proteins were detected by real-time polymerase chain reaction and Western blot analysis.RESULTS:HJHR significantly inhibited fibrosis of the contralateral kidney in UUO rats by attenuating the UUOinduced macrophage-to-myofibroblast transition(MMT)in the contralateral kidney.Moreover,HJHR attenuated fibrosis in the contralateral kidney of UUO rats by preventing MMT through the aldosterone/mineralocorticoid receptor/serum/glucocorticoid regulated kinase 1 pathway.CONCLUSIONS:Our findings suggest that HJHR may be a potential treatment for renal interstitial fibrosis of obstructive nephropathy.
文摘Objective:To investigate the possible protective effect and mechanism of ginsenoside Rb1 against oxidative damage and renal interstitial fibrosis on rats with unilateral ureteral obstruction(UUO). Methods:In total,80 male rats were randomly divided into 4 groups,20 in each group:the sham operated group (SOR),UUO group,UUO with ginsenoside Rb1 treatment group(treated with intraperitoneal injection of 50 mg/ kg daily) and UUO with Losartan treatment group(as the positive control,treated with 20 mg/kg by gastr...
文摘Background Chronic kidney disease （CDK） is a worldwide health problem, but there is currently no effective treatment that can completely cure this disease. Recently, studies with mesenchymal stem cells （MSCs） on treating various renal diseases have shown breakthroughs. This study is to observe the homing features of MSCs transplanted via kidney artery and effects on renal fibrosis in a reversible unilateral ureteral obstruction （R-UUO） model. Methods Thirty-six Balb/c mice were divided into UUO group, UUO-MSC group, and sham group randomly, with 12 mice in each group. The MSCs had been infected by a lentiviral vector to express stably the luciferase reporter gene and green fluorescence protein genes （Luc-GFP-MSC）. Homing of MSCs was tracked using in vivo imaging system （IVIS） 1, 3, 14, and 28 days after transplantation. Imaging results were verified by detecting GFP expression in frozen section under a fluorescence microscope. E-cadherin, α-SMA, TGF-β1, and TNF-α mRNA expression in all groups at 1 and 4 weeks after transplantation were analyzed by quantitative PCR. Results Transplanted Luc-GFP-MSCs showed increased Luciferase expression 3 days after transplantation. The expression decreased from 7 days, weakened thereafter and could not be detected 14 days after transplantation. Quantitative PCR results showed that all gene expressions in UUO group and UUO-MSC group at 1 week had no statistical difference, while at 4 weeks, except TGF-β expression （P〉0.05）, the expression of E-cadherin, α-SMA, and TNF-α in the above two groups have statistical difference （P〈0.01）. Conclusion IVIS enables fast, noninvasive, and intuitive tracking of MSC homing in vivo. MSCs can be taken home to kidney tissues of the diseased side in R-UUO model, and renal interstitial fibrosis can be improved as well.
基金Supported by the National Natural Science Foundation of China(Intervention Effect of Compatibility of Salvianolic Acid A,B,C on PDGF-C/PDGFR-A Signaling Pathway in Renal Fibrosis,No.81260603)
文摘OBJECTIVE:To investigate the effect of salvianolic acid A and C component molecules,which are involved in drug compatibility,on inflammatory cytokine expression that affects human chemokine ligand 5(CCL5) and chemokine ligand 10(CXCL10)levels in rats with unilateral ureteral obstruction(UUO).METHODS:Fifty Sprague Dawley rats were randomly divided into five groups:normal,model,salvianolic acid A,salvianolic acid C and salvianolic acid A and C groups.The normal group was used as the control,and the other groups of rats had a UUO model established.The control group had free access to food and water,and the other groups received the corresponding drugs for 2 weeks.After the last administration,urine β_2-microglobulin(β_2-MG) and N-acetyl-β-D-glucosaminidase(NAG) levels were analyzed.After 24 h,all rats were sacrificed and the serum was analyzed for creatinine(Cr) and blood urea nitrogen(BUN) levels.Rat kidneys were removed,and CCL5 and CXCL10 inflammatory cytokine mRNA expression was measured using real-time fluorescent quantitative reverse transcription-polymerase chain reaction(RT-PCR).Kidney fibrosis was observed using hematoxylin-eosin(HE)staining and Masson trichrome staining.RESULTS:In the salvianolic acid A and salvianolic acid C treatment groups,serum Cr and urine NAG levels were significantly lower than in the model group(both P < 0.05).In all treatment groups,urine pYMG levels were significantly lower than in the model group(all P < 0.05).Compared with model group,the pathological changes and collagen deposition improved to varying degrees(both P <0.05).CCL5 and CXCL10 mRNA expression decreased to different degrees compared with the model group(both P < 0.05).CONCLUSION:Salvianolic acid A and C are component molecules of drug compatibility,and they may protect renal function and improve tubular function and renal pathology to a certain degree in UUO.This improvement may be related to a reduction in inflammatory cytokines CCL5 and CXCL10 secretion in the UUO rat kidney.
文摘Retroperitoneal fibrosis (RPF) is a rare condition of unclear etiology. It can cause ureteral obstruction. We present the unique case of a 54 years old female, who initially presented with spontaneous perforation of the cecum. Upon exploring the abdomen, the classical glistening white, unyielding retroperitoneal fibrosis was encountered. A right hemicolectomy was performed. Subsequently, the patient presented with bilateral ureteral obstruction, and later on with small bowel obstruction. Ureteral obstruction was treated with stents, and small bowel obstruction was treated with bypass. To our knowledge no case of idiopathic RPF presenting with features of both bilateral ureteral and small bowel obstruction has been reported in the literature.
文摘Objective:Secondary pyeloplasty for recurrent ureteropelvic junction obstructions may be a safe and feasible surgical option for patients.This study aimed to demonstrate outcomes of utilizing a non-transecting buccal mucosa graft ureteroplasty for management of recurrent ureteropelvic junction obstruction after prior failed pyeloplasty.Methods:We performed a retrospective review of our Collaborative of Reconstructive Robotic Ureteral Surgery database for all consecutive patients who underwent buccal mucosa graft ureteroplasty between April 2012 and June 2022 for management of recurrent ureteropelvic junction obstructions after prior failed pyeloplasty.The primary outcome included surgical success which was defined as the absence of flank pain and no obstruction on imaging.Results:Overall,ten patients were included in our analysis.The median stricture length was 2.5(interquartile range[IQR]1.8-4.0)cm.The median operative time was 230.5(IQR 199.5-287.0)min and median estimated blood loss was 50.0(IQR 28.8-102.5)mL.At a median follow-up of 10.3(IQR 6.2-14.8)months,80%of patients were surgically successful and there were no major(ClavieneDindo Grade>2)complications.Conclusion:Buccal mucosa graft ureteroplasty is a valuable non-transecting surgical option for patients with recurrent ureteropelvic junction obstructions who failed prior pyeloplasty and has comparable outcomes to the literature regarding standard transecting techniques.
文摘When compared with maintenance dialysis,renal transplantation affords patients with end-stage renal disease better long-term survival and a better quality of life.Approximately 9% of patients will develop a major urologic complication following kidney transplantation.Ureteral complications are most common and include obstruction(intrinsic and extrinsic),urine leak and vesicoureteral reflux.Ureterovesical anastomotic strictures result from technical error or ureteral ischemia.Balloon dilation or endoureterotomy may be considered for short,low-grade strictures,but open reconstruction is associated with higher success rates.Urine leak usually occurs in the early postoperative period.Nearly 60% of patients can be successfully managed with a pelvic drain and urinary decompression(nephrostomy tube,ureteral stent,and indwelling bladder catheter).Proximal,large-volume,or leaks that persist despite urinary diversion,require open repair.Vesicoureteral reflux is common following transplantation.Patients with recurrent pyelonephritis despite antimicrobial prophylaxis require surgical treatment.Deflux injection may be considered in recipients with low-grade disease.Grade IV and V reflux are best managed with open reconstruction.
基金the Fund of Jiaxing Science and Technology Bureau(2014AY21034-2).
文摘Objective:To determine the feasibility of decellularized small intestinal submu-cosa(5IS)matrix in repairing ureteral strictures.Methods:Two patients with ureteral stenoses underwent ureteral reconstruction with SIS ma-trix at the Zhejiang Provincial Corps Hospital of Chinese People's Armed Forces between June 2014 and June 2016.The ureteral stenoses were repaired with a semi-tubular SIS matrix and the postoperative recoveries were observed.Results:Both operations were successfully completed.The average operative time was 90 min and the average length of hospital stay was 15 days.No fevers,incision infections,intestinal obstruction,graft rejection,or other serious complications were noted.After 2 months,ure-teroscopic examinations showed that the surfaces of the original patches were covered by mu-Cosa and there were no apparent stenoses in the lumens.The ureteral stents were replaced every 2 months postoperatively and removed 12 months postoperatively.No infections or uri-nary leakage occurred after removal of the stents.Intravenous urography was performed 6 and 12 months postoperatively.The results showed that the ureters were not obstructed and there was no apparent stenosis at the anastomosis sites.The average follow-up time was>12 months.Long-term follow-up is still ongoing,and computed tomography examin ations of the urinary tract have been conducted in the outpatient department of our hospital 1,3,and 6 months after removal of the double-J stents,suggesting the absence of hydronephrosis.The serum creatinine levels remained stable during the follow-up.Conclusion:SIS matrix reconstruction is a feasible method to repair ureters stenosis.
文摘BACKGROUND Retroperitoneal fibrosis is an exceptionally rare disease characterized by proliferation of fibrous tissue and inflammation in the retroperitoneum.It features many symptoms in the kidneys and in other organs and usually leads to ureteral obstruction.CASE SUMMARY Here we present 9 consecutive cases of idiopathic retroperitoneal fibrosis(IRPF)in patients who presented to the Department of Nephrology or Department of Rheumatology,Xuanwu Hospital,Capital Medical University,Beijing,China,between January 2012 and June 2017 with ureteral obstruction due to external compression of the ureter that led to hydronephrosis and kidney dysfunction.Computed tomography imaging was used to identify hydronephrosis and ureteral obstruction and to evaluate kidney function.Each patient was diagnosed with IRPF based on clinical observation and computed tomography examination results.To restore kidney function,a retrograde metallic stent was placed in the ureter under X-ray guidance 2 d after each patient’s admission.No perioperative complications occurred in any patient,but postoperative complications occurred in two patients as follows:Patient 2 had stent migration and repeated metallic stent infections that resolved with treatment;and patient 4 had postoperative hematuria because he resumed normal activities too soon after stent placement(contrary to instruction).Placement of the metallic ureteral stents provided relief from ureteral obstruction and restored kidney function in all patients.CONCLUSION Our 9-case series underscores the utility and efficacy of applying the Resonance®metallic ureteral stent to treat ureteral obstruction in patients with IRPF.For all retroperitoneal fibrosis cases in our series,ureteral stents provided effective relief and were shown to reduce the incidence rate of perioperative and postoperative complications.
