Ureteroscopic manipulation of stones in the ureter: four years experience

Our experience of 223 ureteroscopies and stone manipulations is reported. Stone removal was successful in 82% of the cases whereof the stones were pushed back into the renal pelvis and subsequently managed with percutaneous nephrolithotomy or extracorporeal shock wave lithotripsy in 24%. For distal stones the success rate was 88%. Reasons for failure were acute obstruction of the ureter and previous surgery or irradiation to the pelvis. In six cases (4%) strictures requiring treatment developed secondary to ureteroscopy. Ureteroscopy can be a tedious and difficult procedure with a considerable learning time. In experienced hands the rate of serious complications is low and the procedure is an alternative in the treatment of ureteric stones, especially in the distal part of the ureter.     

Treatment of ureteral obstruction and urinary fistulas after kidney transplantation]

In 285 renal transplantations, performed during the years 1967-1978, 6 ureteral obstructions (2,1%) and 15 urinary fistulas (5,3%) were observed. Ureteral obstructions occurred in the late phase after transplantation and were caused by strictures at the uretero-vesical anastomosis (two patients), compression of the ureter by enlarged kidney during rejection (one patient) resp. lymphocele (one patient) and strictures at the pyelo-ureteral junction (two patients). Satisfactory results were achieved by surgical treatment in all patients. Urinary fistulas occurred in the early postoperative phase. Two vesical, 12 vesico-ureteral and one calyceal fistula were observed. 7 fistulas (1 vesical, 6 vesico-ureteral) closed spontaneously after temporary drainage of the bladder. 8 fistulas were repaired surgically. While satisfactory results were obtained in 13 patients, two patients died due to infection and sepsis after reoccurrence of fistulas.     

Open dismembered tubularized flap pyeloplasty: an effective and simple operation for treatment of ureteropelvic junction obstruction

OBJECTIVE: To evaluate the success rate of dismembered tubularized flap pyeloplasty (DTFP) in the treatment of ureteropelvic junction obstruction (UPJO). PATIENTS AND METHODS: In a prospective study from August 2002 to September 2004, 15 patients with a mean age of 21 years (range 2-47) in whom UPJO had been diagnosed by sonography, excretory urography or diuretic renography and who had a large extrarenal pelvis, underwent operation via flank intercostal incision. The proximal ureter and renal pelvis were dissected and mobilized retroperitoneally, the site of UPJO was excised and the site of insertion of the ureter on the renal pelvis was closed with a stitch. A wide based renal pelvic flap was created and tubularized to bridge the upper ureteral defect. After insertion of a nephrostomy tube, a double-J tube was inserted as an internal ureteral stent and anastomosis of the tubularized flap to the spatulated upper ureter was done and the renal pelvis window was closed. Patients were followed 3, 6 and 12 months postoperatively. RESULTS: Mean operation time was 1 h and mean hospital stay was 3 days. The ureteral stent was removed 4 weeks after operation and at the same time a nephrostogram was done that showed a widely patent ureteropelvic junction with good renal pelvis drainage in 12 ( approximately 80%) of the cases, but in 3 cases (approximately 20%) passage of contrast materials was not seen. In these patients, methylene blue was injected via a nephrostomy tube and in 2 patients (14%) urine color turned blue 20 min later, but in 1 patient (7%) this test was also negative. The latter patient underwent percutaneous endopyelotomy later. Mean patient follow-up was 14 months. Follow-up excretory urography confirmed patent and unobstructed ureteropelvic junction in all patients. The overall success rate of DTFP was 93%. CONCLUSION: DTFP is a simple and effective procedure for patients with UPJO who have long or multiple upper ureteral strictures and a large extrarenal pelvis.     

输尿管软镜在治疗输尿管上段漂移结石中的应用

目的 探讨输尿管软镜下钬激光碎石治疗输尿管上段漂移结石的疗效和安全性.方法 2004年11月～2012年11月,在输尿管硬镜钬激光治疗输尿管上段结石中有63例结石或＞5 mm残余结石漂入肾盂,在输尿管扩张鞘或Flexor输尿管导入鞘帮助下置入输尿管软镜62例,因输尿管细沿导丝置入输尿管软镜1例,应用钬激光碎石治疗.结果 输尿管软镜下钬激光同期碎石成功率81.0％ (51/63).败血症1例,肾周包膜下血肿1例,无大出血、输尿管撕脱或断裂.结论 输尿管软镜下钬激光碎石是在输尿管硬镜碎石时对漂入肾盂内结石或残余结石的安全、有效的治疗手段.     

Wilms tumor extending into the dilated renal pelvis as a mold

A case of Wilms tumor associated with hydronephrosis is reported. The tumor extended into the dilated renal pelvis but there was no invasion in the mucosa of the ureter or renal pelvis.     

肾移植术后尿瘘分类标准的建立

目的 建立肾移植术后尿瘘分类方法与标准.方法 1993年12月至2009年2月行肾移植术1313例,发生尿瘘102例(7.8%).根据尿道损伤分类原理,按照尿瘘病因、部位、数量及病变程度等分为单纯性和复杂性2类.结果 102例中单纯性尿瘘81例,占79.4%.其中输尿管末端坏死76例、输尿管膀胱吻合口缝合不严4例,伤口感染致吻合口愈合不良1例.复杂性尿瘘21例,占20.6%.其中瘘口部位于肾盂2例、输尿管2例、输尿管膀胱吻合口11例、输尿管坏死段>2 cm 6例.保守疗法治愈34例(33.3%),手术治愈68例(66.7%).死亡3例,占2.9%,死亡原因为尿瘘导致重症肺部感染.结论 建立肾移植术后尿瘘诊治"五步流程"制度,将其分为单纯性和复杂性两类,可使尿瘘诊断更加细致及规范化,有利于选择最佳治疗方案.     

Duplication of the renal pelvis and blind-ending bifid ureter in twins

Blind-ending bifid ureter in a woman with urinary tract infection and a duplicated renal pelvis in her twin sister are reported. The blind-ending bifid ureter terminated as a fibrous cord with a terminal mass of immature renal tissue. This type of ureter may be a transitional form between histologically blind-ending bifid ureter and duplication of the renal pelvis and/or kidneys. Findings in twins support this opinion.     

The anatomy of the kidney and ureter

The kidneys are placed retroperitoneally on the posterior abdominal wall, the right lower than the left. At the renal hilum are found, from before back, the renal vein, artery, pelvis of the ureter and a small posterior artery branch. There are also lymphatics and sympathetic fibres (T12–L1), which account for referred renal pain to the lower abdominal wall and external genitalia. The pelvis of the ureter divides into two or three major calyces, which divide into minor calyces, each indented by a renal papilla, onto which discharge the renal tubules. The three fascial layers are: the capsule, which is easily stripped from the healthy kidney; the perinephric fat; and the investing renal fascia, which adheres to the structures at the hilum and usually tamponades a closed rupture of the kidney, which can thus be treated conservatively. The ureter is 25 cm long, comprising the pelvis and an abdominal, pelvic and vesical portion; the last acting as a sphincter. The ureter is crossed by the gonadal vessels and may be injured here in gynaecological surgery. The ureter can be identified as it constantly crosses the common iliac artery at its bifurcation and then lies on the anterior aspect of the internal iliac artery.     

肾移植术后尿瘘分类标准的建立

目的 建立肾移植术后尿瘘分类方法与标准.方法 1993年12月至2009年2月行肾移植术1313例,发生尿瘘102例(7.8%).根据尿道损伤分类原理,按照尿瘘病因、部位、数量及病变程度等分为单纯性和复杂性2类.结果 102例中单纯性尿瘘81例,占79.4%.其中输尿管末端坏死76例、输尿管膀胱吻合口缝合不严4例,伤口感染致吻合口愈合不良1例.复杂性尿瘘21例,占20.6%.其中瘘口部位于肾盂2例、输尿管2例、输尿管膀胱吻合口11例、输尿管坏死段>2 cm 6例.保守疗法治愈34例(33.3%),手术治愈68例(66.7%).死亡3例,占2.9%,死亡原因为尿瘘导致重症肺部感染.结论 建立肾移植术后尿瘘诊治"五步流程"制度,将其分为单纯性和复杂性两类,可使尿瘘诊断更加细致及规范化,有利于选择最佳治疗方案.     

肾移植术后尿瘘分类标准的建立

目的 建立肾移植术后尿瘘分类方法与标准.方法 1993年12月至2009年2月行肾移植术1313例,发生尿瘘102例(7.8%).根据尿道损伤分类原理,按照尿瘘病因、部位、数量及病变程度等分为单纯性和复杂性2类.结果 102例中单纯性尿瘘81例,占79.4%.其中输尿管末端坏死76例、输尿管膀胱吻合口缝合不严4例,伤口感染致吻合口愈合不良1例.复杂性尿瘘21例,占20.6%.其中瘘口部位于肾盂2例、输尿管2例、输尿管膀胱吻合口11例、输尿管坏死段>2 cm 6例.保守疗法治愈34例(33.3%),手术治愈68例(66.7%).死亡3例,占2.9%,死亡原因为尿瘘导致重症肺部感染.结论 建立肾移植术后尿瘘诊治"五步流程"制度,将其分为单纯性和复杂性两类,可使尿瘘诊断更加细致及规范化,有利于选择最佳治疗方案.     

肾移植术后尿瘘分类标准的建立

目的 建立肾移植术后尿瘘分类方法与标准.方法 1993年12月至2009年2月行肾移植术1313例,发生尿瘘102例(7.8%).根据尿道损伤分类原理,按照尿瘘病因、部位、数量及病变程度等分为单纯性和复杂性2类.结果 102例中单纯性尿瘘81例,占79.4%.其中输尿管末端坏死76例、输尿管膀胱吻合口缝合不严4例,伤口感染致吻合口愈合不良1例.复杂性尿瘘21例,占20.6%.其中瘘口部位于肾盂2例、输尿管2例、输尿管膀胱吻合口11例、输尿管坏死段>2 cm 6例.保守疗法治愈34例(33.3%),手术治愈68例(66.7%).死亡3例,占2.9%,死亡原因为尿瘘导致重症肺部感染.结论 建立肾移植术后尿瘘诊治"五步流程"制度,将其分为单纯性和复杂性两类,可使尿瘘诊断更加细致及规范化,有利于选择最佳治疗方案.     

肾移植术后尿瘘分类标准的建立

目的 建立肾移植术后尿瘘分类方法与标准.方法 1993年12月至2009年2月行肾移植术1313例,发生尿瘘102例(7.8%).根据尿道损伤分类原理,按照尿瘘病因、部位、数量及病变程度等分为单纯性和复杂性2类.结果 102例中单纯性尿瘘81例,占79.4%.其中输尿管末端坏死76例、输尿管膀胱吻合口缝合不严4例,伤口感染致吻合口愈合不良1例.复杂性尿瘘21例,占20.6%.其中瘘口部位于肾盂2例、输尿管2例、输尿管膀胱吻合口11例、输尿管坏死段>2 cm 6例.保守疗法治愈34例(33.3%),手术治愈68例(66.7%).死亡3例,占2.9%,死亡原因为尿瘘导致重症肺部感染.结论 建立肾移植术后尿瘘诊治"五步流程"制度,将其分为单纯性和复杂性两类,可使尿瘘诊断更加细致及规范化,有利于选择最佳治疗方案.     

肾移植术后尿瘘分类标准的建立

目的 建立肾移植术后尿瘘分类方法与标准.方法 1993年12月至2009年2月行肾移植术1313例,发生尿瘘102例(7.8%).根据尿道损伤分类原理,按照尿瘘病因、部位、数量及病变程度等分为单纯性和复杂性2类.结果 102例中单纯性尿瘘81例,占79.4%.其中输尿管末端坏死76例、输尿管膀胱吻合口缝合不严4例,伤口感染致吻合口愈合不良1例.复杂性尿瘘21例,占20.6%.其中瘘口部位于肾盂2例、输尿管2例、输尿管膀胱吻合口11例、输尿管坏死段>2 cm 6例.保守疗法治愈34例(33.3%),手术治愈68例(66.7%).死亡3例,占2.9%,死亡原因为尿瘘导致重症肺部感染.结论 建立肾移植术后尿瘘诊治"五步流程"制度,将其分为单纯性和复杂性两类,可使尿瘘诊断更加细致及规范化,有利于选择最佳治疗方案.     

肾移植术后尿瘘分类标准的建立

目的 建立肾移植术后尿瘘分类方法与标准.方法 1993年12月至2009年2月行肾移植术1313例,发生尿瘘102例(7.8%).根据尿道损伤分类原理,按照尿瘘病因、部位、数量及病变程度等分为单纯性和复杂性2类.结果 102例中单纯性尿瘘81例,占79.4%.其中输尿管末端坏死76例、输尿管膀胱吻合口缝合不严4例,伤口感染致吻合口愈合不良1例.复杂性尿瘘21例,占20.6%.其中瘘口部位于肾盂2例、输尿管2例、输尿管膀胱吻合口11例、输尿管坏死段>2 cm 6例.保守疗法治愈34例(33.3%),手术治愈68例(66.7%).死亡3例,占2.9%,死亡原因为尿瘘导致重症肺部感染.结论 建立肾移植术后尿瘘诊治"五步流程"制度,将其分为单纯性和复杂性两类,可使尿瘘诊断更加细致及规范化,有利于选择最佳治疗方案.     

肾移植术后尿瘘分类标准的建立

目的 建立肾移植术后尿瘘分类方法与标准.方法 1993年12月至2009年2月行肾移植术1313例,发生尿瘘102例(7.8%).根据尿道损伤分类原理,按照尿瘘病因、部位、数量及病变程度等分为单纯性和复杂性2类.结果 102例中单纯性尿瘘81例,占79.4%.其中输尿管末端坏死76例、输尿管膀胱吻合口缝合不严4例,伤口感染致吻合口愈合不良1例.复杂性尿瘘21例,占20.6%.其中瘘口部位于肾盂2例、输尿管2例、输尿管膀胱吻合口11例、输尿管坏死段>2 cm 6例.保守疗法治愈34例(33.3%),手术治愈68例(66.7%).死亡3例,占2.9%,死亡原因为尿瘘导致重症肺部感染.结论 建立肾移植术后尿瘘诊治"五步流程"制度,将其分为单纯性和复杂性两类,可使尿瘘诊断更加细致及规范化,有利于选择最佳治疗方案.     

肾移植术后尿瘘分类标准的建立

目的 建立肾移植术后尿瘘分类方法与标准.方法 1993年12月至2009年2月行肾移植术1313例,发生尿瘘102例(7.8%).根据尿道损伤分类原理,按照尿瘘病因、部位、数量及病变程度等分为单纯性和复杂性2类.结果 102例中单纯性尿瘘81例,占79.4%.其中输尿管末端坏死76例、输尿管膀胱吻合口缝合不严4例,伤口感染致吻合口愈合不良1例.复杂性尿瘘21例,占20.6%.其中瘘口部位于肾盂2例、输尿管2例、输尿管膀胱吻合口11例、输尿管坏死段>2 cm 6例.保守疗法治愈34例(33.3%),手术治愈68例(66.7%).死亡3例,占2.9%,死亡原因为尿瘘导致重症肺部感染.结论 建立肾移植术后尿瘘诊治"五步流程"制度,将其分为单纯性和复杂性两类,可使尿瘘诊断更加细致及规范化,有利于选择最佳治疗方案.     

肾移植术后尿瘘分类标准的建立

目的 建立肾移植术后尿瘘分类方法与标准.方法 1993年12月至2009年2月行肾移植术1313例,发生尿瘘102例(7.8%).根据尿道损伤分类原理,按照尿瘘病因、部位、数量及病变程度等分为单纯性和复杂性2类.结果 102例中单纯性尿瘘81例,占79.4%.其中输尿管末端坏死76例、输尿管膀胱吻合口缝合不严4例,伤口感染致吻合口愈合不良1例.复杂性尿瘘21例,占20.6%.其中瘘口部位于肾盂2例、输尿管2例、输尿管膀胱吻合口11例、输尿管坏死段>2 cm 6例.保守疗法治愈34例(33.3%),手术治愈68例(66.7%).死亡3例,占2.9%,死亡原因为尿瘘导致重症肺部感染.结论 建立肾移植术后尿瘘诊治"五步流程"制度,将其分为单纯性和复杂性两类,可使尿瘘诊断更加细致及规范化,有利于选择最佳治疗方案.     

肾移植术后尿瘘分类标准的建立

目的 建立肾移植术后尿瘘分类方法与标准.方法 1993年12月至2009年2月行肾移植术1313例,发生尿瘘102例(7.8%).根据尿道损伤分类原理,按照尿瘘病因、部位、数量及病变程度等分为单纯性和复杂性2类.结果 102例中单纯性尿瘘81例,占79.4%.其中输尿管末端坏死76例、输尿管膀胱吻合口缝合不严4例,伤口感染致吻合口愈合不良1例.复杂性尿瘘21例,占20.6%.其中瘘口部位于肾盂2例、输尿管2例、输尿管膀胱吻合口11例、输尿管坏死段>2 cm 6例.保守疗法治愈34例(33.3%),手术治愈68例(66.7%).死亡3例,占2.9%,死亡原因为尿瘘导致重症肺部感染.结论 建立肾移植术后尿瘘诊治"五步流程"制度,将其分为单纯性和复杂性两类,可使尿瘘诊断更加细致及规范化,有利于选择最佳治疗方案.     

The anatomy of the kidney and ureter

The kidneys are placed retroperitoneally on the posterior abdominal wall, the right lower than the left. At the renal hilum are found, from before back, the renal vein, artery, pelvis of the ureter and a small posterior artery branch. There are also lymphatics and sympathetic fibres (T12–L1), which account for referred renal pain to the lower abdominal wall and external genitalia. The pelvis of the ureter divides into two or three major calyces, which divide into minor calyces, each indented by a renal papilla, onto which discharge the renal tubules. The three fascial layers are: the capsule, which is easily stripped from the healthy kidney; the perinephric fat; and the investing renal fascia, which adheres to the structures at the hilum and usually tamponades a closed rupture of the kidney, which can thus be treated conservatively. The ureter is 25 cm long, comprising the pelvis and an abdominal, pelvic and vesical portion; the last acting as a sphincter. The ureter is crossed by the gonadal vessels and may be injured here in gynaecological surgery. The ureter can be identified as it constantly crosses the common iliac artery at its bifurcation and then lies on the anterior aspect of the internal iliac artery.     

Renal pelvis cuff pyeloplasty for ureteropelvic junction obstruction for the high inserting ureter: an initial experience

PURPOSE: Ureteropelvic junction (UPJ) obstruction can result from a high inserting ureter without intrinsic ureteral obstruction. We describe our initial experience using a renal pelvis cuff pyeloplasty technique to treat this cause of UPJ obstruction. MATERIALS AND METHODS: We reviewed our experience regarding all children who underwent renal pelvis cuff pyeloplasty. All patients had Society for Fetal Urology grade 3 to 4 hydronephrosis on ultrasonography and radiographic confirmation of UPJ obstruction by diuretic mercaptoacetyltriglycine renography. Pyeloplasty was performed through a flank incision. A circumferential incision was made of the renal pelvis proximal to the insertion site of the ureter into the renal pelvis. Next, a catheter was passed through the UPJ to ensure uniform patency. The cuff of pelvis with the attached ureter was then sutured to the dependent portion of the pelvis. Postoperative resolution of the obstruction was evaluated by ultrasonography and mercaptoacetyltriglycine renography. RESULTS: A total of 11 children (6 boys and 5 girls) underwent renal cuff pyeloplasty for UPJ obstruction due to a high inserting ureter. Median patient age was 6 months (range 2.5 months to 2.4 years) and median followup was 11 months (8 months to 3.4 years). All patients were discharged home within 2 days postoperatively. No intraoperative or postoperative complications were noted. All patients exhibited resolution of UPJ obstruction on followup radiographs. CONCLUSIONS: Renal pelvis cuff pyeloplasty is a surgical technique for UPJ obstruction resulting from a high inserting ureter without intrinsic ureteral obstruction. The procedure was straightforward with good results and without complications in this initial experience.