Perfusion pressure flow study in the upper urinary tract

Hydronephrosis with an undetermined pathology is a common condition detected in imaging studies. In urological clinical practice, it is a persistent dilemma to predict whether this condition will progress to result in the deterioration of renal function. Perfusion pressure flow study of the upper urinary tract, known as the Whitaker test, provides an alternative diagnostic tool for solving this condition. Perfusion pressure flow study has been criticized for its invasiveness, nonphysiological approach, and inconsistency in predicting outcomes. However, it continues to be used to evaluate difficult or equivocal cases and to provide an objective assessment of the upper urinary tract.     

经皮肾镜治疗>2 cm肾结石伴肾积水的疗效分析

目的分析经皮肾镜治疗>2 cm肾结石的疗效与肾积水程度的情况。方法选取2017年1月至2019年12月在十堰市人民医院泌尿外科应用经皮肾镜气压导弹碎石术治疗的105例肾结石>2 cm患者临床资料,根据肾结石伴不同程度的肾积水分为轻度积水组(A组)、中度积水组(B组)和重度积水组(C组),每组35例。比较并分析3组术中出血量、手术时长、术后住院时长及一次性清石率等情况。结果3组一次性清石率比较,差异无统计学意义(P>0.05)。3组术中出血量、手术时长及术后住院时长比较,差异有统计学意义(P<0.05)。A组术中出血量多于B组,且手术时长较B组长(P<0.05);A组手术时长较C组长,术后住院时长较C组短(P<0.05)。A组与C组术中出血量比较,差异无统计学意义(P>0.05)。B组术中出血量少于C组,且手术时长、术后住院时长较C组短(P<0.05)。结论经皮肾镜碎石取石术在>2 cm肾结石伴中度肾积水的治疗上较轻、重度积水具有一定的疗效优势。对于>2 cm肾结石伴轻、重度积水的治疗,经过了术前对患者情况及手术风险的充分评估。若术中术后出现大出血、肾功能减退等并发症多的患者,可考虑使用其他方法或联合其他方法碎石。     

The efficacy and safety of ureteral dilation and long-term type ureteral stent for patients with ureteral obstruction

ObjectiveThis study was conducted to investigate the efficacy and safety of ureteral dilation and placement of a long-term ureteral stent for patients with various types of ureteral obstructions.MethodsWe retrospectively reviewed the records of 39 patients presenting with ureteral obstruction secondary to malignant strictures (n = 9) or nonmalignant strictures (n = 30). The mean age of these patients was 55.8 ± 16.1 years (range, 13–87 years). All patients underwent retrograde ureteral balloon dilation and placement of one to three ureteral stents. Stent patency rate and complications including febrile urinary tract infection, stent encrustation, and stent fragmentation were recorded.ResultsA total of 117 ureteral stents were implanted during the 83 procedures. Three stents were placed in seven patients and two stents in 20 patients. The patency rate was 95.2% with a mean 75-day follow-up. There was no encrustation in 104 stents and Grade 1 in 13 stents. The patency rate was similar between the patients with malignant strictures and those with nonmalignant strictures (100% vs. 94.7%, p = 0.57). However, three episodes of febrile urinary tract infection were noted only in patients with malignant strictures. The improvement of hydronephrosis and complications were also comparable between those patients with ureteral stents indwelling for >90 days and those for <90 days. No stent fragmentation was found in any of the patients.ConclusionWe demonstrated that ureteral dilation and placement of a single or multiple ureteral stents was effective and safe for patients with ureteral obstruction.     

Evaluation and Outcome of Antenatal Hydronephrosis: A Prospective Study

Antenatal hydronephrosis (AHN), defined as dilatation of renal pelvis and/or calyces, is the most frequently detected antenatal abnormality. However, postnatal management of AHN is controversial. The purpose of this study was to describe the clinical outcomes of infants with AHN and to contribute to the definition of the postnatal evaluation of these patients. One hundred and thirty-six infants with AHN were prospectively followed up to 18 months. Patients were divided into two groups according to the degree of sonographic hydronephrosis (HN) on days 5–7: group I (n = 87, 64%) included patients who had grades 1 and 2 (64%) and group II (n = 49, 36%) included patients who had grade 3 and above HN. The grade of HN was found to be correlated with the increased risk of urologic pathologies. Frequency of vesicoureteral reflux was found to be significantly lower in patients with mild HN (6%) as compared to patients with severe AHN (29%) (p = 0.005). In addition, the risk of urinary tract infection increases with increasing grades of HN (10% vs. 29%, p = 0.006). The frequency of spontaneous resolution in patients with mild AHN (64%) was also significantly higher than in patients with severe HN (29%) (p < 0.001). The degree of AHN can be used for making decision about further diagnostic imaging and treatment. Our results strongly suggest that low-grade HN is a relatively self-limited condition and needs minimal investigation. In contrast, the outcome of more severe degrees of AHN needs clarification.     

Renal pelvis urothelial carcinoma of the upper moiety in complete right renal duplex: a case report

Urothelial carcinoma (UC) originated from renal pelvis is the common tumor of the urinary system, however, neoplasia of the renal pelvis in duplex kidneys is extremely rare, especially in the complete renal and ureteral duplex cases. We present the first case of renal pelvis UC of the upper moiety in a complete right renal duplex. This male patient has bilateral complete renal and ureteral duplex. To the best of our knowledge, this is the first reported case of renal pelvis UC in a complete renal duplex system. After this experience we feel that the diagnosis of renal pelvis UC in duplex kidneys is not so easy, and once the diagnosis is determined, the whole renal duplex units and bladder cuff or ectopic orifice should be excised radically.     

Stenosing ureteritis in Henoch–Schönlein purpura: Report of two cases

Stenosing ureteritis (SU), a rare complication of Henoch–Schönlein purpura (HSP), typically presents with severe symptoms. We report the cases of two HSP patients presenting with gross hematuria, blood clotting, and colicky flank pain, followed by purpura on the lower extremities. Early‐stage ultrasonography indicated hydronephrosis, thickened renal pelvic mucous membrane, and ureteral dilatation (UD), suggesting HSP complicated with SU. After early SU treatment with prednisolone, kidney function, thickened renal pelvic mucous membrane, and UD progressively normalized and the pain gradually disappeared. Regular ultrasonography of HSP patients from the onset of gross hematuria can be useful to detect early SU and facilitate conservative therapy with prednisolone. Diagnosis of SU can be easily missed by assuming HSP nephritis, particularly owing to the non‐specific symptoms. Common characteristics as well as treatment methods and prognosis of SU are given in the literature review.