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a: KUB x-ray, b and c: IVP, d: Post endoscopic intervention KUB x-ray.
Contexts in source publication
Context 1
... of left pyelocaliceal system with 12 mm calculus in lower calyx, 10 and 12 mm calculi in the proximal ureters in the distance of 44 mm from left renal pelvis and moderate hydronephrosis on upper and lower poles of left kidney reported. The patient undergone intravenous pyelography (IVP) that left kidney duplex system demonstrated obviously (Fig. 1, a, b and c). The excretion of the left kidney in comparison to right, and upper pole of left kidney in comparison to the lower pole had definitely delay. Two opaque densities with the same size reported on sonography observed in the proximity of L3 vertebral body and upper edge of the L4 vertebral body on the left side conforming with ...
Context 2
... b and c). The excretion of the left kidney in comparison to right, and upper pole of left kidney in comparison to the lower pole had definitely delay. Two opaque densities with the same size reported on sonography observed in the proximity of L3 vertebral body and upper edge of the L4 vertebral body on the left side conforming with left ureters (Fig. 1, a). Pyelocaliceal system dilation on both upper and lower poles of left kidney observed (Fig. 1, b and c). Due to the size and location of the ureteral stones, the time of patient's sign and symptoms and absence of urinary infection, ESWL selected as first therapeutic intervention and the patient undergone ESWL two times during one month. ...
Context 3
... in comparison to the lower pole had definitely delay. Two opaque densities with the same size reported on sonography observed in the proximity of L3 vertebral body and upper edge of the L4 vertebral body on the left side conforming with left ureters (Fig. 1, a). Pyelocaliceal system dilation on both upper and lower poles of left kidney observed (Fig. 1, b and c). Due to the size and location of the ureteral stones, the time of patient's sign and symptoms and absence of urinary infection, ESWL selected as first therapeutic intervention and the patient undergone ESWL two times during one month. Un- fortunately, the ESWL failed to break the calculi as they were remained intact on following ...
Context 4
... then the stone broke completely by pneumatic lithotripter without pushing back any particles of the stone and finally a double J ureteral catheter (4.8 Fr, 28 cm) inserted and placed. The same steps are done for lower ureteral stone at the same session. The KUB x-ray showed proper placement of double J catheters and successful litho- tripsy ( Fig. 1, d). The patient discharged and following 2 weeks the double J catheters removed after KUB x-ray and sonography con- ...
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Citations
... 9 Ureteral duplication is usually asymptomatic and diagnosed incidentally; however, it can be associated with ureteric calculi, urinary tract infections, vesicoureteral reflux, ureteral varices, and other congenital complications. 10 Herein, we report a parenchymal renal rupture due to an obstructive ureteric calculus in an incompletely duplicated renal pelvis and ureter. ...
Introduction
Parenchymal renal rupture due to a ureteric calculus is extremely rare and an emergency.
Case presentation
A 54‐year‐old man was brought to the emergency room with left back pain without trauma. Computed tomography showed left parenchymal renal rupture with an incompletely duplicated renal pelvis, ureter, and an 11‐mm ureteric calculus in the ureterovesical junction. A ureteral stent was placed, and the patient was treated conservatively as his vital signs were stable. We performed transurethral lithotripsy after resolution of the perirenal hematoma.
Conclusion
To best of our knowledge, this report is the first to present a case of parenchymal renal rupture due to a ureteric calculus in an incompletely duplicated renal pelvis and ureter. Ureteric calculus within an incompletely duplicated renal pelvis and ureter is at risk of parenchymal renal rupture. Therefore, the aggressive treatment of ureteric calculus could be important.
... Furthermore, a few cases have been reported possessing calculi in a single limb of the duplicated ureter [7][8][9]. In addition, some cases have been reported with an impacted stone in both limbs of one side of the duplicate [10,11]. Occasional cases have been reported involving the detection of calculi in all limbs of the duplicate [12]. ...
... We searched the existing literature for articles describing impacted calculi in a single limb or in both limbs of complete ureteric duplication; some of this literature reported that some of the treated patients subsequently required a definitive surgical intervention [10][11][12]17]. This may prolong hospital stay and increase the patient co-morbidity that is usually associated with a substantial clinical and financial burden. ...
... The duplications were not visualized initially but became evident during cystoscopy, at which point the bilateral duplicate was clearly visible (Figs. 6,7,8,9,10). ...
The ureter is commonly the subject of congenital anatomical variations involving either complete or incomplete duplication. Complete ureter duplication may not produce symptoms and therefore does not become apparent until later in life. This condition is most encountered incidentally during the extraction of impacted ureteric stones. This type of anomaly is more common in females. However, this condition is not the extremely rare incident as previously thought. Herein, we present our second case of bilateral complete ureter duplication. This aberration was encountered during the extraction of an impacted calculus which was found close to the vesico-ureteric junction of the medial limb of the right complete duplicated ureter. We also present a review of the related English literature. It is essential to emphasize the importance of our basic knowledge relating to most possible renal and ureteric surgical aberrations. A particular consideration prior to any procedure is the meticulous analysis of related radiological images. This clinical practice is a key priority if we are to avoid unpleasant surgical pitfalls. The in-depth diagnosis of an aberration basically remains a radiological entity. This case study provides learning points to complement our daily practice in the management of impacted ureteric calculi.
... We searched through the databases of PubMed, Scopus, and Google Scholar and to the best of our knowledge this is the fourth case of patient with complete ureteral duplication concomitant with calculi obstruction of both limbs. [6,9,10] This occurrence may hinder the stenting of the obstructed orifices which are often inflammatory. In such complicated cases combined with suspected pyelonephritis or severe hydronephrosis, the option of an urgent lithotripsy should be considered. ...
Duplication of the ureter is a common congenital malformation, which unfortunately may be accompanied by unpleasant and challenging pathologies. Hereby, a rare case of a patient with obstructive urolithiasis secondary to undiagnosed complete ureteral duplication is presented. A single large calculus in the vesicoureteral junction was obstructing both duplicated ureters. The aim of this article was to discuss both the challenges arising from this clinical entity and the diagnostic approaches. In such complicated cases combined with suspected pyelonephritis or severe hydronephrosis, the option of an urgent lithotripsy should be considered. The obstructed orifices are often inflammatory, hindering their stenting. Asymptomatic and undiagnosed patients with completely duplicated ureters are prone to severe complications. Thus, early screening of these patients is an imperative need for the clinician.
... The highest prevalence has been reported in Caucasian females [4,5]. Duplication of the ureter may be incomplete (bifid ureter) or complete in which each limb of the duplicate open separately in the bladder and this is a rare anomaly [6,7].The VUJ orifice of the limb which drain the upper renal moiety (the first limb of the duplicate) has ectopic insertion usually medial and inferior to the lower pole moiety ureter (the second limb of the duplicate) which has orthotopic insertion in the bladder (Weigert-Mayer law) [1]. The complete duplication is present in approximately in 1 from 125 individual [6].It is more common in females than males with a ratio of 2:1 [5].In the English literature few cases of calculi found in one limb or in the two limbs of the duplicated ureter [8,9]. ...
... More few cases reported with bilateral ureteric duplication in which stones were found in all of the limbs of the duplicate [10]. Some cases of ureteral duplication with ureterocele stone have been reported [5,7].A similar cases of duplex were also detected in a research study and another seen during a routine dissection of a cadaver [6,11]. Generally speaking most of the aberrations detected incidentally during URS surgery for obstructing stone or during other pelvic organ surgery [5]. ...
... Ureteral duplication usually is asymptomatic and its diagnosis is incidental. It can be associated with urinary tract infection, vesicoureteric reflux, ureterocele, stone formation, obstructive uropathy, ectopic ureter and other congenital complications [3,5,7]. In such cases renal morphology, ureteral condition and renal function warranted to be evaluated.The initial evaluation of a patient with a suspected obstructive stone usually occur in the emergency room (ER). ...
The ureter is a common site of congenital anomalies which may be associated with a considerable morbidity particularly among young patient. The congenital anomalies of the ureter coexist with multitude of other urinary tract anomalies but it may occur independently. It is more common in females. The complete duplication of the ureter may not produce symptoms which would suggest the presence of malformation. Therefore, such anomaly may not become apparent until later in life. Further, this anomaly might not be recognized prior to the surgery and hence, missing of the stone is highly possible. Herein we present a case of complete ureter duplicate with an obstructive stone located close to VUJ of one limb of the duplicate. A sound knowledge of the surgical anatomy and of the congenital ureter anomalies is essential for correct diagnosis and appropriate management.
... 10,11 Moreover, the diagnostic iconography related to these conditions has been obtained through urography examinations or patients showed calculosis along the regular ureteral structure (not at the junction of the two ureters, as in our clinical case). 4,[12][13][14] There is no standard approach for patients affected by obstruction of the ureteropelvic junction. Therefore, the treatment should be identified on the basis of clinical evidence, detailed anatomy and obstruction severity. ...
... 10,11 Peraltro, l'iconografia diagnostica relativa a tali condizioni è stata tratta da esami urografici oppure presentavano calcolosi lungo il regolare decorso degli ureteri (non alla giunzione dei due ureteri, come nel nostro caso clinico). 4,[12][13][14] Non esiste un approccio standard per i pazienti affetti da ostruzione della giunzione ureteropelvica. Il trattamento dovrebbe essere pertanto individuato a seconda della presentazione clinica, dell'anatomia dettagliata e della gravità dell'occlusione. ...
Several congenital anomalies of the urinary tract are reported in the literature. Ureteral duplication is among the most frequent and may be either complete or incomplete. Here we describe the case of a 35-year-old male patient who presented with an acute urinary retention. Ultrasound examination showed significant hydronephrosis, and it was followed by a multidetector computed tomography (MDCT) without contrast medium. This examination showed the evidence of an incomplete double ureter upstream dilated, due to a calculus that occluded both ureters at the junction, arranging itself over them ("saddle" calculus). MDCT is a highly-sensitive examination technique for the detection and grading evaluation of urinary diseases. Riassunto Nella letteratura sono state rinvenute diverse anomalie congenite delle vie urinarie. Tra le più frequenti si annovera la duplicazione ureterale, la quale può essere completa o incompleta. Descriviamo il caso di un paziente maschio di 35 anni che giunge in Pronto Soccorso per ritenzione acuta d'urina. L'esame ecografico dimostrava un'im-portante idronefrosi, successivamente integrato con esame TC in condizioni basali. In tale esame si evidenziava la presenza di un doppio uretere incompleto dilatato a monte per la presenza di una formazione calcolotica che occludeva entrambi gli ureteri alla giunzione, disponendosi a cavaliere tra questi (calcolo "a sella"). La tomografia computerizzata si conferma esame altamente sensibile per la detezione e la valutazione del grading delle patologie delle vie urinarie. Parole chiave: Calcolosi; Calcoli nelle vie urinarie; Idronefrosi; Tomografia computerizzata; Disturbi delle vie urinarie.
Objective
To retrospectively review a cohort of adult patients with single ectopic ureter, a rare congenital abnormality where one ureter terminates in an abnormal position outside of the trigone of the bladder.
Methods
We identified 5 patients diagnosed with a single ectopic ureter over a single surgeon’s career over 35 years and 2 institutions. Clinical symptoms, medical history, interventions, available radiologic imaging, and urodynamic features were analyzed.
Results
Median age at diagnosis was 53 years (range 18–85 years). The majority were male (80%). All patients were noted to have a solitary functioning kidney. A diminutive contralateral kidney and ureter was found in 1 (20%) patient. All patients were symptomatic, with the most common presenting symptoms being chronic dysuria (60%) and chronic prostatitis (40%). Physical examination findings were identified in 3 (60%) patients. Interventions were principally dependent upon the type and severity of each patient’s symptoms, and included observation, drainage of ectopic structures, vaginal marsupialization, and laparoscopic nephroureterectomy. The 3 (60%) patients that underwent intervention remained symptom free and the 2 (40%) patients that decided on observation were minimally symptomatic.
Conclusions
Single ectopic ureter is a complex embryological abnormality that can result in a wide array of anatomic variations and clinical findings in both men and women. Given the rarity of this entity in adult patients, a high index of suspicion must be held by the clinician for this diagnosis. Ultimately, treatment options for these patients will be dependent upon symptom severity, anatomic presentation, and patient quality of life.
