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PubMed2002

Prospective evaluation of ureteral stent durability in patients with chronic ureteral obstruction.

OBJECTIVES: To prospectively evaluate the durability of ureteral stents in patients with chronic ureteral obstruction. METHODS: Twenty-nine renal units from 22 patients with known chronic ureteral obstruction treated with indwelling ureteral stents were studied at 3, 6, 9, and 12 months after initial stent placement (7 to 8F Percuflex) by abdominal x-ray, serum creatinine, and renal and bladder ultrasonography. Renal ultrasound scans were performed by a single senior radiologist with specific attention paid to any increase in hydronephrosis and to the presence of ureteral jets. The stent was changed when calcifications were seen along the stent on abdominal x-ray, if an increase in serum creatinine occurred, or if any increase in hydronephrosis or absence of ureteral jets was seen on ultrasonography. In addition, the stents were changed if new-onset flank pain and/or pyelonephritis developed. If none of the above occurred, the stents were changed after 12 months. RESULTS: Two patients died of metastatic cancer, leaving 25 renal units available for follow-up. The mean and median time to stent change were 6 months. At 3, 6, 9, and 12 months, the number of renal units that did not meet the criteria warranting stent change was 18 (72%), 12 (48%), 6 (24%), and 2 (8%), respectively. Only 2 (8%) of 25 renal units did not meet any exclusion criteria at 12 months. The most common reasons for requiring the stent to be changed were new-onset flank pain in 8 (35%), an increase in serum creatinine in 7 (30%), and new-onset or increased hydronephrosis in 7 (30%). No criteria were useful in predicting how long stents could be maintained in an individual patient. CONCLUSIONS: The stents were maintained for more than 6 months in 12 (48%) of 25 renal units. However, very few patients were able to maintain chronic ureteral stents for 12 months without requiring stent change based on our criteria.

Chronic Disease↗
PubMed1982

Retrospective study of ureteral obstruction following vascular bypass surgery.

Although several cases of ureteral obstruction after vascular bypass surgery for aortoiliac disease have been reported, the incidence of this potentially critical complication has not been established. In this study, 57 selected patients who had undergone vascular bypass surgery were examined with ultrasound for evidence of ureteral obstruction. Hydronephrosis was discovered in 1 of 57 patients (1.75 per cent) over-all (symptomatic and asymptomatic); no evidence of obstruction was found in the asymptomatic patients. These results fail to corroborate the impression of several investigators that undetected ureteral obstruction may be present in a significant number of patients after vascular bypass surgery.

Humans↗
PubMed1996

Rapidly reversible acute renal failure from ureteral obstruction in pregnancy.

We report a case of acute renal failure due to bilateral ureteral obstruction that rapidly resolved after delivery. Acute renal failure secondary to bilateral ureteral obstruction is rare; to our knowledge, only 18 cases have been reported in the English literature. Review of these cases reveals that twin pregnancies, polyhydramnios, and obstruction of the solitary kidney seem to increase the risk of obstructive renal failure. Measures including induced delivery, amniocentesis, and insertion of ureteral stents or nephrostomy tubes undertaken to relieve the ureteral obstruction usually lead to rapid improvement in urine flow and renal function. Acute renal failure secondary to bilateral ureteral obstruction is a rare but reversible complication of pregnancy.

Acute Kidney Injury↗
PubMed1979

Spontaneous extravasation of urine in chronic ureteric obstruction.

Two cases of spontaneous extravasation of urine in chronic ureteric obstruction are presented. In 1 case the long-standing partial ureteric obstruction was caused by enlarged lymphomatous glands, and extravasation was followed by a perinephric abscess. In the second case, believed to be unique, there was a moderate chronic ureteric obstruction post irradiation, and extravasation was induced by a sudden rise in intra-abdominal pressure due to vomiting.

Adult↗
PubMed2004

Cut-to-the-light technique and potassium titanyl phosphate laser ureterotomy for complete ureteral obstruction.

We describe a case of complete ureteral obstruction managed by endoscopic recanalization using a 'cut-to-the-light' technique followed by potassium titanyl phosphate (KTP) laser ureterotomy. A 53-year-old man developed a ureteral obstruction following the transurethral resection of a bladder tumor (TUR-Bt) at the left ureteral orifice. The length of the obstructed segment was estimated at 1 cm based on combined antegrade and retrograde contrast studies. Histopathological analysis indicated that the obstruction was caused by fibrosis. The 'cut-to-the-light' technique was used for recanalization, and KTP laser ureterotomy was performed to obtain an adequate ureteral lumen. A 14 F/7 F endoureterotomy stent was removed 6 weeks after the operation. No significant complications and no signs of stenosis were observed 24 months after endoscopic repair. Endoscopic recanalization is a safe, effective technique for the management of a completely obliterated ureteral segment, especially in combination with subsequent KTP laser ureterotomy.

Endoscopy↗
PubMed2005

[Ureteral obstruction secondary to Rosai-Dorfman disease].

Ureteral obstruction can be secondary to a lot of reason. We present a uncommon case report of ureteral obstruction to Rosai-Dorfman disease. The form of clinic presentation is described, the diagnostic methods used and the therapeutic management.

Adult↗
PubMed1997

Partial ureteral obstruction: role of renal resistive index in stages of obstruction and release.

OBJECTIVES: To study the changes in renal resistive index (RI) and renal function before and after release of different grades of partial unilateral ureteral obstructions. METHODS: Ten dogs were subjected to right partial ureteral obstruction. Grade 1 (mild) obstruction was applied to 5 dogs (group A) and grade 3 (moderate and severe) obstruction was applied to the other 5 dogs (group B). Obstruction was maintained for 8 weeks, followed by release of obstruction. All dogs were subjected to excretory urography, technetium-99m mercaptoacetyltriglycine diuretic renography with calculation of half-time drainage (T1/2), and bilateral renal Doppler ultrasonography before the start of the experiment, after 8 weeks of obstruction, and every 2 weeks during the 8 weeks after release of obstruction. RESULTS: In both groups, after induction of right ureteral obstruction, there was a dramatic decrease of effective renal plasma flow (ERPF), increase of RI, and increase of T1/2 of the right kidney. Relief of obstruction was associated with normalization of T1/2, reversal of RI, and recovery of ERPF to near basal values. No correlation was found between ERPF at the end of the recovery period and the functional parameters (T1/2, RI, or ERPF) of the obstructed kidney before release of obstruction. CONCLUSIONS: (1) Unilateral partial ureteral obstruction produces an elevation of RI and T1/2 and a fall in ERPF of the corresponding kidney. (2) After relief of function is regained with associated reversal of RI. (3) Functional parameters (T1/2, RI, or ERPF) of the obstructed kidney do not predict the recovery of ERPF after release of obstruction. (4) Rapid reversal of a previously elevated RI is an early indicator of recoverability of renal function after relief of ureteral obstruction.

Animals↗
PubMed2003

Emergency extracorporeal shock wave lithotripsy (ESWL) for obstructing ureteral stones.

OBJECTIVE: To evaluate emergency treatment of obstructing ureteral stones by in situ extracorporeal shock wave lithotripsy (ESWL) during acute renal colic. PATIENTS AND METHODS: From January 1994 to February 2000, 200 patients (mean age: 42 years) were treated by ESWL (EDAP LT-02) for obstructing ureteral stones causing acute renal colic refractory to medical treatment or recurring within 24hours of such treatment. Stones were visualised by fluoroscopic imaging and/or ultrasound. Follow-up included radiological and/or ultrasound examinations and lasted three months. RESULTS: Mean stone size was 7mm (3-20mm). At three months, 164/200 (82%) patients were stone-free. This rate ranged from 79% to 83% according to the location of the stone, and from 75% to 86% according to the size of the stone. These differences in rate were not significant. Two or three ESWL sessions were required in 79 patients. ESWL was well tolerated in 90% of patients. The only complication was a case of pyelonephritis requiring the placement of a JJ stent, administration of antibiotics, and distant ureteroscopy. The 36 patients, in whom ESWL failed, underwent ureteroscopy (n=23) or lithotripsy with a Dornier machine (n=13). CONCLUSION: Non-deferred ESWL for acute renal colic secondary to obstructing ureteral stones has a satisfactory success rate and very low morbidity.

Acute Disease↗
PubMed2005

Ureteral obstruction caused by a duplicated anomaly of inferior vena cava.

Developmental anomalies of inferior vena cava are a rare cause of ureteral obstruction. We report a case that presented with right upper ureteral obstruction that radiologically simulated a retrocaval ureter. An aberrant vessel, which caused obstruction of the right ureter was identified at operation and surgical relief of ureteral obstruction was performed. Inferior venocavography was performed postoperatively and disclosed an unusual incomplete duplication of inferior vena cava. Our findings suggested that ureteral obstruction by incompletely duplicated anomaly of the inferior vena cava should be included in the differential diagnosis of extrinsic ureteral obstruction.

Adult↗
PubMed2001

Ureteral obstruction in a transplant kidney caused by an ovarian tumor.

Ureteral obstruction in the transplant recipient can provide a diagnostic challenge. We report a case of ureteral obstruction 5 years after cadaveric renal transplantation due to an ovarian tumor. Magnetic resonance imaging provided essential anatomic information that eventually led to the diagnosis. To our knowledge, this is the first reported case of ureteral obstruction in a transplant kidney caused by an ovarian tumor.

Adult↗
PubMed1993

Collagen studies in newborn rat kidneys with incomplete ureteric obstruction.

Collagen studies in newborn rats with incomplete ureteric obstruction were performed to describe and quantify changes in collagen deposition resulting from urinary tract obstruction at an early developmental age. Incomplete ureteric obstruction was created in three-day-old rats by placing the left ureter in a tunnel formed by the psoas muscle, and sham-operated controls underwent a laparotomy. The rats were sacrificed at 10, 17, 24 or 31 days. Collagen types I, III, IV, and V were localized by indirect immunofluorescence microscopy, the total collagen content of the kidney was quantitated using hydroxyproline analysis, and collagen types I and III were quantitated using cyanogen bromide (CNBr) peptide analysis. Increased immunofluorescent staining for all of the collagens was found in the diffusely widened medullary interstitium of the obstructed kidney, and more focally in the cortical interstitium. Collagen types I, III and V, but not collagen type IV, were also found in bands in the interstitium at the junction of the cortex with the medulla. Increased staining for collagen type IV was found in thickened and tortuous tubular basement membranes (TBM) of the obstructed kidneys. The total collagen content of the obstructed kidney was significantly increased compared to the amounts in both the contralateral kidneys and in the kidneys from sham-operated controls at 24 and 31 days of age (P < 0.01 in each case, Wilcoxon matched pairs rank sum test and Mann Whitney U-test, respectively). The amount of collagen in the kidneys correlated with the degree of hydronephrosis (Spearman correlation test, r = 0.78, P < 0.02). CNBr peptide analysis demonstrated that over 50% of the collagen in the normal neonatal rat kidney was collagen type I and approximately 25% was collagen type III. In the obstructed kidneys most of the collagen was also collagen type I and collagen type III, although the proportion of total collagen comprised by these collagen types was decreased compared with the controls. The amount of collagen type III in the contralateral kidneys was reduced compared to that in the controls. Thus, the neonatal renal response to obstruction resulted in increased amounts of a range of collagens in the interstitium and TBM, and the extent of this response was partially related to the degree of hydronephrosis.

Animals↗
PubMed1987

Nonoperative urinary diversion for malignant ureteral obstruction.

The management of malignant ureteral obstruction (MUO) has undergone major changes due to the availability of percutaneous drainage techniques and new ureteral stents for endoscopic insertion. These procedures are less morbid than conventional surgical techniques so that the indications for urinary diversion due to untreated or relapsing malignancy have to be reconsidered. During the period of technological change from 1978 to 1984, 135 patients with unilateral (37) or bilateral (98) MUO were managed. Open nephrostomy is now almost never necessary. Initial retrograde ureteral stenting (RS) was successful under local anaesthesia in 41% of patients. Forty-seven had percutaneous nephrostomy (PN), nine of whom underwent antegrade ureteral stenting (AS) and elimination of external appliances. Twenty-nine patients underwent miscellaneous open procedures mostly in the earlier years, with a 57% morbidity rate compared to the minimal morbidity associated with the newer techniques. The overall mean survival post diversion was 9.9 months, which is significantly longer than that reported using open procedures. MUO can now be successfully relieved with little morbidity and frequently without the use of external urine collection devices. The relative ease of diversion can complicate decision making in patients with progressive renal failure due to bilateral MUO.

Dilatation↗
PubMedDate not supplied

[Ureteral obstruction after radiotherapy in patients with cancer].

Diagnosis and treatment of postradiation ureteral obstruction is a problem of utmost importance, whose resolution will make it possible to prolong survival of many postcancer patients. A review of 58 cases of ureteral compression as a result of radiation and combined treatment for cervical, uterine and vesical cancer is presented. Upper urinary tract changes were shown to range from moderately dilated calycopelvic system to bilateral ureterohydronephrosis and a nonfunctional kidney. The fact that postradiation urethral compression remains asymptomatic for a long period of time makes the diagnosis still more difficult. Mean interval between radiotherapy and the detection of ureteral obstruction was 5.6 years. Ureteral affection was either isolated or combined with vesicovaginal fistulas and radiation cystitis. Short ureteral strictures were detected in 37 (68.9%) patients, and long strictures, in 16 (31.1%), mostly in cases of combined treatment. Urinary infection and pelvic inflammation are major contributing factors to postradiation ureteral obstruction. Surgical treatment was performed in 34 (64.2%) patients with postradiation ureteral stenosis; the operation was limited to nephrectomy of urine collection because of the patient's grave condition in 25 (73.5%) of those.

Adult↗
PubMed1988

Extratubular Tamm-Horsfall protein deposits induced by ureteral obstruction in mice.

The effects of unilateral ureteral obstruction were studied in mice. Obstruction for 24 hr led to the formation of extratubular Tamm-Horsfall protein (TH) aggregates within the renal interstitium and at the base of distal convoluted tubular (DCT) cells. These DCT deposits were shown by ultrastructural analysis to be entirely extracellular. They had the fibrillar substructure characteristic of TH and had not been seen after urinary obstruction in other species. As a consequence of retrograde flow of urine to glomeruli, obstruction also caused TH aggregates to form within Bowman's spaces. These glomerular casts of TH were detected throughout the 3-week period of study after the release of unilateral obstruction. High serum titers of IgG antibodies to TH developed in mice intradermally immunized with TH but were not observed after obstruction alone. Circulating anti-TH antibodies combined with TH present on the basal surfaces of the thick ascending limb of the loop of Henle cells and DCT cells to form immune complexes in situ. Interstitial inflammation in the areas surrounding subepithelial tubular immune deposits was not present in the kidneys of immunized mice and was not selectively induced by temporary obstruction. However, foci of inflammation were seen in all obstructed kidneys. At later times, inflammatory foci in previously obstructed kidneys were associated with progressive scarring, primarily in polar regions. The location and severity of these changes within kidneys produced by obstruction in immunized mice did not differ from those in unimmunized mice. The titers of anti-TH antibodies in immunized mice were not enhanced or depressed as a consequence of unilateral ureteral obstruction. These studies demonstrate that complete obstruction of urinary flow in the mouse for periods as short as 24 hr may lead to progressive segmental renal scarring. These studies further indicate that increasing the quantities of extracellular TH by obstruction does not facilitate inflammatory responses to TH immune complexes formed in situ. While exposure of renal tissue to highly toxic components of extravasated urine may play a crucial role in inflammatory responses, autoimmunity to TH was not implicated as a contributing factor by the present studies in mice.

Animals↗
PubMed1995

Results of radiotherapy on ureteric obstruction in muscle-invasive bladder cancer.

OBJECTIVE: To evaluate the effect of radiotherapy on ureteric obstruction due to muscle-invasive bladder cancer. PATIENTS AND METHODS: Retrospective evaluation of the records of 574 patients with muscle-invasive bladder cancer revealed 90 patients (16%) with ureteric obstruction; the obstruction was bilateral in 24%. The effect of radiotherapy was assessed in 55 patients with 68 obstructed kidneys. Six patients with eight obstructed kidneys required percutaneous nephrostomy or ureteric catheters in addition to radiotherapy. RESULTS: Drainage improved in 20% of kidneys and the diverting catheter was withdrawn permanently in one (17%) of the diverted patients. The median survival was 11 months. Irradiation was followed by significant complications in 37 patients (67%). CONCLUSION: The results of this study raise doubts about the assumed beneficial effect of irradiation on ureteric obstruction due to muscle-invasive bladder cancer. The short median survival of 11 months confirms that ureteric obstruction is a poor prognostic factor in muscle-invasive bladder cancer.

Adenocarcinoma↗
PubMed1994

Clinically significant ureteral obstruction caused by inflammatory complications of severe pancreatitis.

Clinically significant ureteral obstruction caused by the inflammatory complications of severe pancreatitis is rare with only eight previously reported cases. We present two additional cases and review the world literature. Clinically significant ureteral obstruction can affect either or both ureters and present simultaneously with an episode of pancreatitis or months later. If symptomatic ureteral obstruction is present, prompt urologic drainage is recommended. Definitive correction of the obstruction is frequently required and depends on the obstructive mechanism.

Adult↗
PubMed1996

Endourological management of ureteral obstruction after renal transplantation.

PURPOSE: We evaluated endourological treatment of ureteral obstruction after renal transplantation. MATERIALS AND METHODS: Between January 1986 and December 1993, 582 kidney transplantations were performed at our center, and ureteral obstruction was suspected in 31 cases (5.3%). RESULTS: Initial treatment consisted of retrograde placement of an internal stent in 6 patients and percutaneous nephrostomy in 25. Due to upper tract dilatation obstruction could not be diagnosed in 3 patients, and rejection was the cause of decreasing renal function. Obstruction was temporary in 8 of the remaining 28 patients, including 6 in whom a Double-J stent was introduced in a retrograde manner without anesthesia. In the other 2 patients was well as the 20 with definitive obstruction, cannulation of the transplant orifice without anesthesia was unsuccessful and percutaneous nephrostomy drainage was necessary. Even with general anesthesia a guide wire could not be passed along the stricture in a retrograde or antegrade fashion in 7 of the 20 patients with definitive obstruction and open surgery was performed. The remaining 13 patients underwent dilation with (9) or without (4) diathermic incision. All 4 patients treated with dilation only had recurrent obstruction, while 9 treated with dilation and incision had no recurrence after a minimum followup of 27 months (mean 58). CONCLUSIONS: Modern endourological procedures have replaced open reconstructive surgery in the majority of patients with ureteral obstruction after renal transplantation.

Adolescent↗