输尿管膀胱连接处梗阻的诊断与治疗

目的 探讨输尿管膀胱连接处梗阻的诊治方法.方法 回顾性分析我院2006年1月至2011年12月,10例输尿管膀胱连接处梗阻(UVJO)接受手术治疗患者的临床资料.男6例,女4例.间断腹痛和反复泌尿系感染.B超、IVU及排泄性膀胱尿道造影(VCU)诊断为UVJO.行横向膀胱黏膜下隧道膀胱输尿管再吻合术(Cohen术式).结果 10例术后恢复顺利,10～14 d出院.10例获随访,随访时间平均2.5(0.5 ～3.5)年.IVU示肾输尿管积水明显减轻8例,好转2例.并发泌尿系感染1例,抗感染治疗后好转;症状完全消失9例.结论 腹痛、泌尿系感染等临床症状或肾输尿管积水进行性加重为UVJO手术指征,Cohen式术式效果满意.积水较轻或无临床症状患者可动态观察.     

Extravesical correction of the ureterovesical junction

In correction of the ureterovesical junction, the pathology can be corrected using an extravesical or intravesical technique. We performed an extravesical antireflux procedure with the dismembered or non-dismembered technique in 117 ureters between March 1991 and March 1996 at our Department of Pediatric Urology. The success rate was 94.9 % (111 renal units). Postoperative morbidity and complications were minimal, hematuria and bladder spasms were not seen. Associated pathology like paraostial diverticula, megaureter with the necessity for modeling and ureter duplex do not compromise the success rate.     

输尿管镜技术治疗输尿管膀胱壁间段结石的疗效观察

目的 探讨输尿管镜技术治疗输尿管膀胱壁间段结石安全性和有效性.方法 回顾性分析我院近10年采取输尿管镜技术治疗的输尿管膀胱壁问段结石患者86例.结果 全部患者成功碎石并留置双J管,术后4周拔除.术后6个月复查超声与尿常规未见同侧肾积水、输尿管开口狭窄和尿路感染.结论 输尿管镜技术治疗输尿管壁间段结石安全有效,具有创伤小、安全性高、疗效确切等优点,具有很强的实用性及可操作性.     

Extravesical correction of the ureterovesical junction

In correction of the ureterovesical junction, the pathology can be corrected using an extravesical or intravesical technique. We performed an extravesical antireflux procedure with the dismembered or non-dismembered technique in 117 ureters between March 1991 and March 1996 at our Department of Pediatric Urology. The success rate was 94.9% (111 renal units). Postoperative morbidity and complications were minimal, hematuria and bladder spasms were not seen. Associated pathology like paraostial diverticula, megaureter with the necessity for modeling and ureter duplex do not compromise the success rate.     

Vesicoureteric reflux and ureterovesical obstruction

The unusual combination of reflux and obstruction as seen in 8 o f a series of 40 unduplicated ureters reimplanted for refux is presented, with particular reference to the mechanical obstructing factors which can be demonstrated. These involve the extravesical rather than the intravesical ureter so that separate pathologic mechanisms for obstruction and refux must be postulated. This unusual obstruction/reflux combination appears to be more common than is generally recognized, and the need for its early recognition and surgical correction contrasts with the less urgent indications for operative intervention in ureteric reflux alone.     

One-stage operation of ureteropelvic junction and ureterovesical junction stricture

One-stage surgical management for ureteropelvic (UP) and ureterovesical (UV) strictures is reported. A 3-year-old boy with UP and UV strictures on left side, underwent nephrostomy at 4 months old. The plastic operations which were Anderson-Hynes method for UP stricture and submucosal tunnel method with tailoring of dilated ureter for UV stricture were performed at the same time. The post-operative intravesical pyelogram and renal scintigraphy showed the improvement of hydronephrosis. Many authors have described two-stage operations for such cases. Our findings revealed that one-stage operation, carefully preserving the blood supply to the ureter, would be an alternative surgical management for UP and UV strictures.     

A case of combination with proliferative cystitis and pelvic lipomatosis causing bilateral hydronephrosis

A 70-year-old man consulted our hospital complaining of gross hematuria and bilateral hydronephrosis. Cystoscopic findings suggested non-papillary sessile tumor at the bladder neck. CT findings revealed bilateral hydronephrosis caused by the stricture of lower ureters. Tumorous structure existed between bladder and prostate. Abundant fatty tissue was observed around bladder and rectum, the shape of the bladder was distorted to inverted tear-drop and the bladder was transferred anteriorly, showing findings of pelvic lipomatosis. Urethrocystography revealed elongation of prostatic urethra and anterior displacement of the bladder. Transurethral tumor resection was performed under spinal anesthesia. Pathological diagnosis was proliferative cystitis and no malignant cells were observed. Transperineal tumor biopsy also revealed no malignant cells. The patient was followed under administration of "Saireitou" (chinese medicine) and cetirizine hydrochloride, followed by antibiotics and anti-inflammatory enzyme preparations.     

Nitroxergic innervation of the human ureterovesical junction

Nitric oxide synthase (NOS) immunohistochemistry and nicotinamide adenine dinucleotide phosphate diaphorase (NADPH-d) histochemistry were used to investigate the distribution of nitroxergic, i.e., nitric oxide-synthesizing, neuronal perikarya and processes in the human ureterovesical junction (UVJ). Tissue specimens obtained from two cadaver kidney donors and two patients undergoing radical cystectomy for bladder cancer were examined. Clusters of NOS-immunoreactive neurons were localized in extramural ureterovesical ganglia. NOS-containing nerve fibers traveled within large extramural nerve trunks and marched among smooth muscle bundles. Extramural and intramural blood vessels were encircled by varicose NOS-positive axonal processes. The distribution of NOS immunoreactivity paralleled the staining pattern for NADPH-d activity. Urothelium stained strongly for NADPH-d activity but showed no NOS immunolabeling. Specimens from all four patients investigated showed similar staining patterns. Our results suggest that nitric oxide, a potent smooth-muscle-relaxing neurotransmitter in the autonomic nervous system, plays a physiologic role in opening the human UVJ.     

A case of ureteral triplication associated with ureteropelvic junction obstruction

Ureteral triplication is one of the rarest malformations of the upper urinary tract. The association of ureteral triplication and obstruction is even rarer. We report a case of ureteral triplication associated with hydronephrosis due to ureteropelvic junction (UPJ) obstruction at the middle pole ureter. To our knowledge, such a malformation has not been described previously.     

Dynamics of the ureterovesical junction: interaction between diuresis and detrusor instability at the ureterovesical junction in pigs

In pigs under general anesthesia, the mutual relation between ureterovesical flow and detrusor activity was evaluated with juxtavesical ureteral perfusion pressure measurements and cystometry. At constant bladder filling volume ureterovesical perfusion could provoke detrusor activity, which was positively related to the perfusion rate, and which disappeared after perfusion was stopped. During such involuntary detrusor activity ureterovesical perfusion pressure might increase significantly more than intravesical pressure. It is concluded that ureterovesical flow causes distension of detrusor muscle bundles around the ureteric hiatus, which may trigger local and general detrusor activity in an unstable bladder. During such detrusor activity, due to forces in the bladder wall, resistance to outflow from the upper urinary tract could be significantly more impaired than is reflected by the increase of intravesical pressure at cystometry. The clinical implications are discussed.     

An unusual case of pelviureteric junction obstruction.

We describe an unusual case of pelviureteric junction obstruction in a child due to a benign ureteric polyp. Benign neoplasms of the ureter are uncommon in adults and extremely rare in children.     

A case of proliferative cystits forming a tumorous lesion associated with male infertility

A 41-year-old man was referred for infertility to our hospital. Retrograde ejaculation was suspected on several semen analyses. Retrograde cystourethrography showed irregular filling-defect at the base of bladder. Cystoscopic examination revealed a broad-based non-papillary bladder tumor, which was located mainly on the trigone of bladder. Transurethral resection was performed, and histological examination showed proliferative cystitis. Proliferative cystitis is not so rare, but there was no case report of proliferative cystitis associated with male infertility.     

A case of ureterovesical malacoplakia that manifested hydronephrosis

A 70-year-old woman visited a nearby physician with a chief complaint of fever and was admitted to a hospital with a diagnosis of acute pyelonephritis. After discharge, pyuria persisted and examination revealed an intravesical solid tumor. The patient was referred to this department for close examination and treatment. The right kidney was hydronephrotic. The intravesical tumor that was resected was solid yellowish-white and ranged from the neck of the uterus to both ureteral orifices. In addition, a grain-sized tumoral lesion, was found in the lower part of the ureter and was also resected. There was sclerotic thickening localized to the right intramural ureter, which had a slightly edematous interior. This was considered to be the cause of the hydronephrosis and a ureteral stent was put in place. Pathological diagnosis was given as malacoplakia. With this case, placement of a ureteral stent was chosen based on the findings of a minimal ureteral lesion, a narrow area of scarring in the intramural ureter as a probable cause of hydronephrosis, and a judgement of mild obstruction. A stent is less invasive for patients, but consideration should be given to urinary infection due to long-term placement recurrence of malacoplakia due to the increased risk of infection, and trouble with periodical exchanging of catheters due to aggravated scarring. Absence of pyuria or signs of recurrence after seven months' placement suggests that use of the stent was the best method.     

Prenatal and postnatal neuromuscular development of the ureterovesical junction

PURPOSE: The mechanisms underlying functional maturation of the ureterovesical junction during infancy are still not fully understood. We analyzed the development of smooth muscle components of the ureterovesical junction and their nerve supply in the fetal, newborn and adolescent pig. MATERIALS AND METHODS: Bladder specimens were obtained from porcine fetuses at gestational ages 60 days (5) and 90 days (5), newborn piglets (5) and 6-month-old pigs (4). Serial sections of the ureterovesical junction were investigated by Masson's trichrome, and hematoxylin and eosin histological staining, enzyme immunohistochemistry for alpha-smooth muscle actin and desmin, as well as double immunofluorescence staining using the neuronal marker peripherin and smooth muscle actin. RESULTS: At day 60 the detrusor muscle already consisted of distinctive muscle bundles with rich innervation, while the smooth muscle coat of the extravesical ureter and subsequently the intravesical ureter had only started to differentiate. At day 60 innervation of the extravesical ureteral smooth muscle was well developed, while the innervation of the intramural part did not mature until birth. Muscle fibers of the periureteral sheath were well distinguishable at day 60 but innervation of these fibers was sparse during fetal life and showed a remarkable increase during the postnatal period. All smooth muscle components showed a striking increase in muscle bulk between the neonatal and adolescent stages. CONCLUSIONS: Our findings show that the smooth muscle components and innervation of the ureterovesical junction continue to mature during the postnatal period. This may have implications for managing ureterovesical junction disorders.     

A case of lupus cystitis

A case of lupus cystitis in a 23-year-old male is reported. The patient began to complain of diarrhea and vomiting in October, 1985. When the diagnosis of systemic lupus erythematosus (SLE) was established at the Department of Internal Medicine in our hospital, he was referred to our clinic for examination of pollakisuria on November 22. DIP revealed a loss of bladder distensibility, and bilateral hydronephrosis and hydroureter. Transurethral cold cup biopsies revealed subcutaneous edema. A diagnosis of lupus cystitis was made and he was treated with steroids, which resulted in symptomatic and radiographic improvement.