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At least 19 recordsLinked to original sources

[The study on the function of the intramural portion of the ureter. The motion of the intramural portion of the ureter in dogs].

UNLABELLED: The present investigation was performed in order to clarify whether the motion of the intramural portion of the ureter is passive or active. In Experiment I, electromyograms of the extravesical and intramural portions of the ureter were recorded using bipolar suspended electrodes and bipolar needle electrodes for 52 ureters in 26 adult mongrel dogs to study the relationship between both portions of the ureters in the nondiuretic and diuretic state. In Experiment II, using 14 ureters in 10 adult mongrel dogs, electromyograms were recorded and the local forces of the ureteral walls of the extravesical and intramural portions were measured with a special needle electrode concurrently. RESULTS: (1) Experiment I demonstrated in the nondiuretic and diuretic state, 1. no significant differences in the ureteral discharge frequency between the extravesical and intramural portion of the ureters, and 2. a 1:1 correspondence in the extravesical and intramural action potentials. (2) Increases were observed in the local forces of the ureteral walls of the intramural portion of the ureters following action potentials. From these experimental results, it was suggested that the intramural portion of the ureter actively moves due to muscular excitation from the upper ureter and participates in urine transport.

Action Potentials↗

[Analysis of urinary tract injury during gynecological surgery performed with preoperative ureter catheterization or intraoperative ureter control].

DESIGN: To analyze urinary tract injuries during gynecological surgery performed with preoperative ureter catheterization or intraoperative ureter control. MATERIAL AND METHODS: Retrospective analysis of 1986 chosen gynecological operations performed between 1990-1998 in Dept. of Gynecological Surgery Polish Mother's Health Center Institute. RESULTS: The overall frequency of urinary injuries was 2.15%. It was less during gynecological surgery performed with ureter catheterization compared to intraoperative ureter control only (ureter: 0.30% vs. 0.55%, p = 0.22; urinary bladder: 0.40% vs. 0.90%, p < 0.05). CONCLUSION: 1/ urinary injury was twice as frequent during ureter control than during ureter catheterization, 2/ urinary injury was the most frequent complication during hysterectomy with adnexa, 3/ the results of our analysis should be treated as a vote "for" ureter catheterization before gynecological surgery.

Female↗

Valves of the ureter as a cause of primary obstruction of the ureter: anatomic, embryologic and clinical aspects.

The causes of obstruction of the ureter at the ureteropelvic and ureterovesical junctions are still controversial. In this study portions of obstructed ureters were excised at operation or autopsy and the suspected sites of obstruction were examined anatomically, radiographically and histologically. A valvular mechanism caused obstruction in 15 of 27 specimens. The valve lay at the junction of the dilated and undilated segments of the ureter. The internal anatomy of this site was hidden from external view by the fascia overlying the ureter and was demonstrated by contrast ureterograms. The axes of the lumina of the dilated and undilated segments were eccentric and the walls of the ureter overlapped at the site of obstruction to form a common wall, which created a valve effect. The valve flaps were visualized radiographically as a filling defect. The valve obstructed antegrade but not retrograde flow. Anatomic dissection or serial sections of blocks of the valve zone demonstrated that either a single or a double flap caused obstruction. The valve was coapted against the opposite wall of the distal segment by the pressure generated in the dilated ureter during antegrade flow. The muscle of the unobstructed segment of ureter distal to the valve appeared normal histologically, whereas the muscle of the obstructed proximal segment was hypertrophic.

Child↗

[A case of right duplex kidney with double ureters and left dysplastic kidney with bifid ureter].

During dissecting practice for students, a case of anomalous urinary tracts was found in a 81 year-old Japanese female cadaver which had an extraordinarily large right kidney with double ureters and a dwarf left kidney with a bifid ureter. The histological investigation on the left kidney revealed the renal dysplasia including thyroid gland-like widening of urinary tubules and the hyperplasia of interstitium. No renal corpuscles were observed besides very few primitive ones. Two ureters originating from the left kidney united each other in the proximal portions and the united ureter ran down the normal pathway to the urinary bladder. The left ureter was thin and underdeveloped but the circular and the oblique musculature were distinguished in the distal three quarters of the ureter. The right large kidney was shown to be a duplex kidney. Both the upper and the lower poles were well-developed and histologically normal except the compensatory hypertrophy of the cortex obviously resulting from the dysplasia of the left kidney. The upper and the lower pole ureters draining the duplex kidney never crossed each other and entered the bladder through adjoining two ureterovesical junctions at the normal position. The possible embryological basis for these anomalies was discussed.

Aged↗

Extracorporeal shock wave lithotripsy: multicenter study of kidney and upper ureter versus middle and lower ureter treatments.

Six institutions throughout the United States participated in this study. Each center used a multifunctional flat table lithotriptor (Dornier MFL-5000) to treat 658 patients with kidney and upper ureteral stones (766 treatments) and 323 with middle and lower ureteral stones (391 treatments), for a total of 925 patients (1,157 treatments). Some patients received more than 1 treatment (that is the kidney and ureter), for a total of 981 patient events. Complete followup was available for 81% of the patients. The overall stone-free rate at followup of approximately 90 days was greater in the middle and lower ureter group (83%) than in the kidney and upper ureter group (67%). The proportion of single stones treated was greater for the former group (89.5%) than for the latter group (72%). A larger proportion (18%) of the middle and lower ureter group required 2 or more treatments to the targeted stone than did the kidney and upper ureter group (13%). Anesthesia was required or selected in only 26.7% of the kidney and upper ureteral stone patients and in 18.5% of those with middle and lower ureteral calculi, usually at the request of the patient or physician, or for performance of an adjunctive procedure. The relative safety of this treatment is demonstrated by a low overall rate of complications reported during and after treatment, including a ureteral obstruction rate of 2.1% for kidney and upper ureteral stones and 2.5% for middle and lower ureteral stones. There were no demonstrated trends in a review of laboratory data to suggest significant treatment side effects. The diastolic blood pressure increased to more than 95 mm. Hg after extracorporeal shock wave lithotripsy (ESWL*) in 6% of the kidney and upper ureteral and 4% of the middle and lower ureteral stone patients, while pretreatment hypertension resolved after ESWL in 11% of both groups. The results of this clinical evaluation indicate somewhat greater effectiveness for the specified indications of ESWL of stones in the ureter below the upper rim of the bony pelvis, as opposed to those in the kidney and upper ureter, with a low incidence of complications and side effects.

Adolescent↗

[Treatment,in girls, of ectopic ureters, due to duplication, using reimplantation of the single pathological ureter into the bladder].

Mostly the ectopic ureter belongs to the upper pole in urinary tract duplications. In the pelvis, the two ureters are clearly separated. The only dissection of the ectopic ureter is in no case dangerous for the ureter of the lower pole. Therefore the reimplantation of the ectopic ureter can be performed separately. This only reimplantation of the ectopic ureter has been performed 9 times, without any mortality nor morbidity. The scar is almost invisible and the child is cured without any risk for the upper pole and saving the whole of the renal parenchyma. If the upper pole is functional, which happened in 1/4 of the cases, this technique is the best way and the less dangerous to recovery.

Adolescent↗

Effects of metamizol on nociceptive responses to stimulation of the ureter and on ureter motility in anaesthetised rats.

In this study, we have examined the effects of metamizol (dipyrone), a non-opioid analgesic which is effective in relieving renal colic pain, on nociceptive responses evoked by stimulation of the ureter, on pyeloureteral motility and on intraureter pressure after ureter obstruction in anaesthetised rats. Metamizol (5- 50 mg/kg i.v.) dose-dependently inhibited reflex pressor responses evoked by distensions of the ureter to pressures of 30, 55 and 75 mmHg for 30 s (ID50 = 8 +/- 1 mg/kg). Metamizol also dose-dependently reduced intraureter pressure during total ureter occlusion (25 mg/kg produced a reduction of 25% in 10 min). However, metamizol at doses up to 50 mg/kg had no effect on pyleoureteric motility (contraction amplitude, rate or intraureter pressure) under normal pressure conditions. We conclude that metamizol has a direct antinociceptive action on pain of ureteric origin, and spasmolytic effects after ureter obstruction (but not under normal conditions) which may also contribute to pain relief.

Analgesics, Non-Narcotic↗

Ureterocele of the lower pole ureter and an ectopic upper pole ureter in a duplex system.

We report an unusual case of a ureterocele in a duplex system, which was associated with an ectopic (vulval) upper moiety ureter. This is the second case reported in the literature of a ureterocele arising from the lower pole ureter. Surgical treatment consisted of removal of the upper segment of the kidney and its ureter. The ureterocele was excised and the lower pole ureter was reimplanted in the bladder. At followup 14 years postoperatively the patient was cured and free of urinary infection.

Child, Preschool↗

Single unilateral ectopic bifid ureter with contralateral orthotopic quadrufid ureter--a rare combination.

This is a report a case with a unilateral single ectopic ureter associated with ipsilateral incomplete duplication of upper third of the ureter, contralateral quadrufid ureter and L3 hemivertebra. These findings provide further evidence of a generalised mesenchymal or epithelial defect, which would explain a defective ureteral bud and metanephric development, besides associated anomalies.

Child, Preschool↗

Is the pediatric ureter as efficient as the adult ureter in transporting fragments following extracorporeal shock wave lithotripsy for renal calculi larger than 10 mm.?

PURPOSE: We determined whether the thin ureter of the young child transports stone fragments after extracorporeal shockwave lithotripsy (ESWL) as efficiently as the adult ureter does. This determination was done by comparing the outcome after lithotripsy of renal stones greater than 10 mm. between young children and adults. MATERIALS AND METHODS: Our study group consisted of 38 children 6 months to 6 years old (median 3 years) with renal stones greater than 10 mm. in diameter. This group was further divided into 3 subgroups according to the longest stone diameter on plain abdominal film. There were 21 children with a renal stone diameter of 10 to 15 mm. (subgroup 1), 8, 16 to 20 mm. (subgroup 2) and 9 greater than 20 mm. (subgroup 3). The control group consisted of 38 adults older than 20 years randomly selected from the local ESWL registry. Each adult was matched with a child regarding stone diameter and localization. The control group was similarly divided into subgroups 1a, 2a and 3a. ESWL was performed with the unmodified Dornier HM-3 lithotriptor (Dornier Medical Systems, Inc., Marietta, Georgia). The stone-free rate, complication rate, and need for tubes, including stent or nephrostomy, and greater than 1 ESWL session were compared. RESULTS: The stone-free rate was 95% in the study and 78.9% in the control group (p = 0.086). Stone-free rates were 95%, 100% and 89% in subgroups 1, 2 and 3, and 95%, 65% and 56% in subgroups 1a, 2a and 3a, respectively. There were 10 children and 4 adults who underwent greater than 1 ESWL session (p = 0.14). Then there were 10 children and 6 adults who required a tube before ESWL (p = 0.04), and almost all of them were included in subgroups 3 and 3a. Early complications were rare in both the study and control groups. Late complications had included 2 cases of Steinstrasse in the control and none in the study group. CONCLUSIONS: The stone-free rate after ESWL for large renal stones is higher in young children compared to adults with matching stone size. Renal stones greater than 20 mm. often require more than 1 ESWL session. The pediatric ureter is at least as efficient as the adult for transporting stone fragments after ESWL.

Child↗

Inverted papilloma of the ureter with malignant transformation: a case report and review of the literature. The importance of the recognition of the inverted papillary tumor of the ureter.

Inverted papilloma of the ureter is a rare tumor generally considered to be a benign lesion. We present a case of ureteral inverted papilloma with malignant transformation and review the literature. Ten cases of ureteral inverted papillary tumors in Japan and 13 cases of inverted papillary tumors associated with malignancy in the urinary tract in the world literature have been analyzed to define their features. Inverted papillary tumors of the ureter have distinct clinicopathological features, but most are discovered retrospectively after nephroureterectomy. From the standpoint of clinicopathological features, inverted papillary tumor of the ureter should be distinguished from its exophytic counterpart with respect to the treatment. If the tumor can be diagnosed macro- and microscopically during surgery as inverted papilloma or malignant inverted papillary tumor without invasion, partial ureterectomy including the lesion may be recommended. Furthermore, we propose the hypothesis that inverted papillary tumor could be a neoplasm of basal cell origin in the transitional epithelium, termed 'basal cell urothelioma'.

Aged↗

Experimental partial unilateral ureter obstruction. I. Pressure flow relationship in a rat model with mild and severe acute ureter obstruction.

PURPOSE: To create an animal model with mild and severe partial unilateral ureter obstruction in young rats using a modified Ulm and Miller technique and to characterize the model by acute renal pelvic pressure measurements. MATERIAL AND METHODS: During anesthesia the upper fourth (n = 15) or the upper two-thirds of the left ureter (n = 15) was embedded into the psoas muscle causing either a mild or severe partial obstruction. Sham-operated control rats were prepared in parallel (n = 20). The baseline pelvic pressure, the perfusion pelvic pressure (perfusion rates: 0.2 to 1.0 ml. per minute) and peristaltic waves were recorded after a resting period. RESULTS: Mean baseline pelvic pressure and perfusion pelvic pressure were significantly higher in obstructed kidneys than in non-obstructed kidneys, and significantly higher in severely obstructed kidneys than in mildly obstructed kidneys (p < 0.05). A fair linear relationship existed between the increase in pelvic pressure and the increase in perfusion rates in all groups. In the severely obstructed kidneys, baseline pelvic pressure was 16.9 +/- 2.3 cm. H2O and the perfusion pelvic pressure increased significantly from 41.7 +/- 3.3 cm. H2O to 68.6 +/- 6.3 cm. H2O. The pelvic peristaltic amplitude increased significantly following the increase in perfusion rate and there was a significant difference in the amplitude between severely obstructed and non-obstructed kidneys when the perfusion rate exceeded 0.4 ml. per minute (p < 0.05). CONCLUSION: Embedding either the upper fourth or the upper two-thirds of the ureter into the psoas muscle produced a mild or a severe partial obstruction. In the latter model a significant increase in pelvic pressure and amplitude was observed, indicating the existence of severe obstruction.

Acute Disease↗

Double ureter and congenital diverticulum of the ureter.

The ureteral duplication is a relatively common malformation and usually has no pathologic consequences. On the contrary, congenital diverticula of the ureter are rare and often give rise to urinary complications. A double malformation combining left ureteral duplication and a congenital diverticulum of the right ureter is reported and discussed. This rare case illustrates one and the same malformational process arrested at different stages of development.

Diverticulum↗

Response of the renal pelvis and ureter to distension of the contralateral renal pelvis and ureter: identification of the reno-renal pelvic reflex.

For the study of the relationship of the pelviureteric system of one kidney to that of the contralateral one, bilateral cutaneous ureterostomy was performed in 14 dogs. The renal pelvis (RP) and ureter (U) of one side were distended separately with a balloon filled with saline in increments of 1 and 0.25 ml, respectively, and the pressure response of the contralateral RP and U was recorded. The test was repeated after anesthetization of the RP and U. RP distension with 1 ml of saline effected a pressure rise (P < 0.05) in the ipsilateral RP but no pressure response in the ipsilateral U or the contralateral RP or U (P > 0.05). RP distension with 2, 3, and 4 ml of saline induced a significant pressure rise in the ipsi- and contralateral RP but not in the ureters. Ureteric distension produced a pressure elevation (P < 0.05) on the ipsilateral U but had no effect on the contralateral U (P > 0.05) or on either of the renal pelves (P > 0.05). Distension of the anesthetized RP or U effected no pressure response in any of the ipsi- or contralateral RPs or Us. In conclusion, distension of the RP with large volumes led to an increase in pressure in the contralateral RP but not in the U. A reflex relationship is postulated to exist between the two renal pelves and to be mediated through a reflex we call the reno-renal pelvic reflex. It seems that this reflex acts to allow either of the kidneys to share an extra load of the other one by increasing the contractile activity of the RP, thus assumedly assisting the regulation of urine flow.

Animals↗

Potassium-induced contractions in pig ureter strips. Consequences for helical muscle-fiber model of ureter.

Contractions were chemically induced in vitro in pig uterus segments by a high potassium concentration in a metabolic solution. Slow contractions were found mainly in the transverse direction. The near absence of contractions in the longitudinal direction is ascribed to a nearly circular orientation of the muscle fibers. (In terms of the helical muscle-fiber model of the ureter, our findings would correspond to a pitch of 3 to 5 degrees for the helix.) It is further postulated that the coupling structure of fibers in the transverse direction, determining an annular contraction mode, differs from that in the longitudinal direction, determining the longitudinal propagation of the annular contraction mode. The over-all conclusions on the basis of our results is that the helical muscle-fiber model now generally assumed for the ureter must be greatly modified to correlate with the experimental facts that its continued use is misleading and undesirable.

Animals↗

Replacement of the ureter by small intestine: clinical application and results of the ileal ureter in 89 patients.

Partial or total replacement of the ureter by small intestine was performed at the University of California/Los Angeles Hospital and affiliated hospitals 94 times in 92 patients from 1954 to 1978. Indications included recurrent calculi, ureteral stricture, fistula, congenital obstruction of the ureter and ureteral carcinoma with a solitary kidney. A special use has been for undiversion of an ileal conduit. Followup evaluation was possible in 95% of the patients and ranged from 6 months to 23 years. Thirty-six patients were followed for more than 5 years. The operation was judged successful in 81% of the cases. Serum creatinine was unchanged or decreased in 75.7% and the pyelogram was unchanged or showed decreased dilatation in 84.6% of the patients. Although reflux was seen in 40 of 55 patients who had cystograms 39 (97.5%) were considered to be treated successfully. Indications for and results of the operation are discussed. The procedure is recommended as optimal therapy for carefully selected situations when the normal urinary tract cannot be used.

Child↗