Ureteral avulsion: a rare complication of ureteroscopy

A case of ureteral avulsion as a complication of ureteroscopy is presented. A 55-year-old woman was admitted to the hospital with the complaint of hematuria. The intravenous pyelography revealed a calculus measuring 16 x 12 mm located in the left upper ureter. Transurethral ureterolithotripsy was performed with 8 F rigid ureteroscopy. A safety guide wire was inserted and left ureteral olifice was dilated to 9 F. The ureteroscopy was smoothly introduced just under the stone. The stone was fragmentated with a pneumatic lithotripter. A part of the stone was pushed back to the renal pelvis, so the ureteroscope was passed to that stone and fragmentation was done as much as possible. The ureteroscopy was gently pulled out to the bladder, but the distal ureter was torn at the ureteral orifice and could be seen at the urethral orifice. Pelvis, upper ureter and middle ureter were intact, so open intervention for repair was not performed. A 6Fr double pigtail stent was placed over the safety guidewire. Cystscopy indicated a part of the distal ureter was protruded from the ureteral orifice. Eight weeks later, the protruded part of ureter was necrotic and calcified for ischemia. Transurethral resection of necrotic ureter was performed. Histologically, resected ureter changed necrotic tissue for ischema. Postoperatively intravenous pyelography did not reveal left hydronephrosis and cystoscopy indicated that the left ureteral orifice was almost normally repaired.     

A case of metastatic ureteral tumor

We report a case of metastatic ureteral tumor resulting from gastric cancer in a 56-year-old female. She had undergone distal gastrectomy for gastric cancer in our hospital 3 years earlier, on the histological diagnosis of poorly differentiated adenocarcinoma with absolute curative resection. In March, 1987, she visited our hospital complaining of microscopic hematuria and lumbago. Intravenous pyelography and left retrograde pyelography revealed the stenotic change of the left ureter and hydronephrosis. Endoscopic ureteral biopsy was performed, and the histological diagnosis was an inflammatory change of the ureter. But the hydronephrosis increased, so partial ureterectomy was performed. The histological examination confirmed adenocarcinoma in the left ureter resulting from gastric cancer. From the 340th postoperative day, she complained of general fatigue and vomiting, and gastroscopy revealed recurrent gastric cancer.     

Carcinoma of the ureter after long-term use of analgesic [phenacetin derivative]--report of the two cases (spouses)

Two cases (spouses) of carcinoma of the ureter possibly induced by long-term use of analgesic were presented. Case 1: A 66-year-old female with hematuria was diagnosed as a carcinoma of the ureter in January, 1985 and underwent resection of the left kidney and the ureter with partial resection of the urinary bladder. In December, 1988 she died due to recurrent cancer. Case 2: A 70-year-old male (a husband of case 1 patient) with hematuria was diagnosed as a carcinoma of the ureter in August, 1987 and underwent resection of the kidney and the ureter of the left side. In October, 1988 he died due to recurrent cancer. These two patients had used routinely phenacetin because of persistent headache for about 20 and 15 years, respectively and the presumed total dose was amounted to 4 and 2.5 kg, respectively.     

Case of mid-ureteral fibroepithelial polyps in a child

A 11-year-old boy showed gross hematuria and left flank pain. Ultrasonography and CT revealed left hydroureteronephrosis, and he was referred to us for the further evaluation. MRI revealed left hydroureteronephrosis with filling defect at the distal end of the dilated ureter suggesting ureteral polyp. Open surgery was performed with the diagnosis of mid-ureteral obstruction. In the operative findings, multiple stalks of ureteral polyps arose from the entire ureteral wall over 5 cm in length at the site of ureteral obstruction. Mid-ureter with polyps was completely resected, and end-to-end anastomosis was performed. The pathological diagnosis was fibroepithelial polyp of the ureter.     

Diagnostik und Behandlung einer ureteroarteriellen Fistel

Ureteroarterial fistulae are rare after vascular surgery with only 16 cases being reported in the literature. We report a 65-year-old woman who presented with massive gross hematuria following endostenting of an iliac aneurysm. Cystoscopy demonstrated ejaculation of blood from the left orifice and angiography revealed an ureteroiliac fistula between the left ureter and the common iliac artery. Following placement of a vascular endoprosthesis and a double J stent gross hematuria developed. This case highlights the diagnosis and therapeutic approach in patients with suspected ureteroarterial fistula.     

A novel technique for distal ureterectomy and bladder cuff excision

IntroductionWe describe a novel endoscopic approach and provide a literature review for the “en bloc” dissection of the distal ureter and bladder cuff during laparoscopic radical nephroureterectomy using a transvesical single port approach under pneumovesicum.Materials and methodsThe procedure was performed in an 80-year old male with a history of gross hematuria due to left renal pelvic TCC and no history of prior bladder TCC. Laparoscopic radical nephroureterectomy was performed and the ureter was dissected down to the bladder and clipped. A single-port device was inserted transvesically and pneumovesicum established. A full thickness incision of the bladder around the ureter was performed with progressive intravesical mobilization of the distal ureter. Subsequently, a water-tight closure of the bladder defect was achieved. The distal ureter, together with the bladder cuff, was then delivered en bloc laparoscopically with the specimen.ResultsThe operating time (LESS radical nephroureterectomy, RPLND, and bladder cuff excision) was 6 hours and 15 minutes. The bladder cuff time was 45 minutes. There were no intra or postoperative complications and the catheter was removed after 6 days. Histopathological analysis showed kidney-invasive papillary urothelial cancer, pT3 pN0 (0/7) G3.ConclusionThe distal ureter and bladder cuff techniques have not yet been standardized. Management of the bladder cuff with a single port is feasible. Additional studies are needed to identify the best approach for management of the distal ureter at the time of laparoscopic nephroureterectomy.     

Ventricular pseudo-false aneurysm after myocardial infarction; report of a case

A 72-year-old man was admitted to our hospital with chest discomfort and syncope. The echocardiography showed the left ventricular aneurysm. The coronary arteriography revealed a complete occlusion at distal portion of the right coronary artery and anterior aneurysm of the left ventricle was demonstrated. We diagnosed that it was false aneurysm because of communicating with the left ventricle through a small orifice. Surgical repair was carried out after resection of the aneurysm of the left ventricle. The postoperative course was uneventful and discharged on the 33rd day after surgery. Pseudo-false ventricular aneurysm of the left ventricle was diagnosed by histological examination.     

Carcinosarcoma of the renal pelvis and ureter: a case report

We report a case of carcinosarcoma of the renal pelvis and ureter arising in an 89-year-old man who presented at our hospital with gross hematuria. Abdominal computed tomography, excretory pyelography, and retrograde pyelography demonstrated that left hydronephrosis was caused by an ureteral tumor. Left urine cytology indicated transitional cell carcinoma. The patient underwent chemotherapy and radiation therapy. However, gross hematuria recurred, and the patient underwent left nephroureterectomy. The surgical specimen showed carcinosarcoma in the renal pelvis and ureter histologically. He has been free of cancer for 1.5 years.     

False popliteal aneurysm caused by exostosis of the femur

A 45-year-old woman with a false aneurysm of the left popliteal artery caused by an exostosis of the femur is described. The patient had a tender swelling in the distal part of the thigh and a soft-tissue tumor was initially suspected. Diagnosis was made by ultrasonography, plain X-ray and angiography. The aneurysm and exostosis were resected. The literature regarding this condition is reviewed. Surgical treatment of popliteal aneurysm is recommended mainly because of the risk of occlusion of distal vessels by peripheral embolism.     

Massive hematuria due to iliac artery-ureteral fistula. Case report.

Massive hematuria in a 73-year-old man, who 17 years previously had undergone aorto-iliac-femoral thrombendarterectomy, was found to originate from an iliac artery-ureteral fistula due to a false aneurysm. Fistula formation should be kept in mind when investigating such hematuria in patients with a history of vascular surgery in the iliac segment.     

Inverted papilloma of the ureter

Two cases of ureteral inverted papilloma are reported. Case 1: A 48-year-old male had asymptomatic gross hematuria and filling defect of left middle ureter on intravenous pyelography. Segmental resection of ureter was performed. The specimen was a 1 cm polypoid lesion with histologic features resembling "multifocal bud-like proliferation", which was reported as the initial stage of the inverted urothelial tumor by Kunze et al. Case 2: A 64-year-old female with asymptomatic gross hematuria and complete obstruction of left middle ureter on ante- and retrograde pyelograms. Total nephroureterectomy was performed. A 4 cm lobulated and pedunculated lesion with histologic features of typical inverted urothelial papilloma was resected. Twenty-one cases of ureteral inverted papilloma in the literature, including our cases, are analyzed.     

Reoperation for femoral anastomotic false aneurysm. A 15-year experience.

An experience on the surgical treatment of anastomotic false aneurysms during the last 15 years was reviewed. Fifty-nine were femoral anastomoses complicated by false aneurysm appearance requiring surgical excision. They represented 2.9% of all femoral anastomoses performed, whereas they represented 3.3% when considering reconstruction in which the femoral artery was the distal anastomosis. Reconstructions with distal anastomosis performed on the femoral artery were primarily involved (58 of 59), whereas grafts with "take off" from the femoral artery were rarely affected (p less than 0.05). A higher incidence of false aneurysm formation was demonstrated in hypertensive patients (p less than 0.05) as well as those who previously had femoral thromboendarterectomy (p less than 0.01). Infection was considered a causative factor even if it developed before (6-14 months) false aneurysm appearance. When a false aneurysm was resected, the best hemodynamic reconstruction, to avoid recurrence, was considered a bypass with distal anastomosis performed end-to-end on the femoral artery (p less than 0.05). The surgical treatment of choice was false aneurysm resection and graft interposition. However, a reanastomosis in the presence of small false aneurysms, when technically possible, has been successfully performed. Both treatments allowed good long-term results.     

Traumatic false aneurysm of the radial artery

A patient was referred to the hand service for treatment of a ganglion of his left distal volar forearm. History and examination revealed the mass to be an aneurysm of the left radial artery. At surgery, a false aneurysm was resected and a vein graft interposed. This case illustrates arterial aneurysms, although uncommon, must be included in the differential diagnosis of masses about the hand and wrist.     

The evaluation of pre and intraoperative factors influencing the false lumen after graft replacement surgery to the extended dissecting aneurysm]

We evaluated the residual false lumen of type I and IIIb dissecting aneurysm by CT, MRI and angiography postoperatively. The 19 patients with type I dissecting aneurysm were included eleven men and eight women, the average age was 55.8 +/- 10.2 years old. The 20 patients with type IIIb dissecting aneurysm were included sixteen men and four women, the average age was 56.2 +/- 8.5 years old. The rate of distal patent false lumen was 52.6% of type I and 35% of type IIIb dissecting aneurysm after graft replacement surgery. In type I dissecting aneurysm, the rate of distal patent false lumen was 40% of acute stage vs 66.7% of chronic stage, 66.7% of ascending and partial arch replacement vs 46.2% of ascending and total arch replacement, and 90% of graft inclusion technique vs 11.1% of graft exclusion technique. The distal patent false lumen was the lowest (12.5%) with type I dissecting aneurysm of ascending and total arch replacement using graft exclusion technique. In type IIIb dissecting aneurysm, the rate of patent false lumen was 66.7% of acute stage vs 29.4% of chronic stage, 30% of graft exclusion technique vs 40% of graft inclusion technique. The size of false lumen preoperatively were larger (11.1 +/- 4.5 cm2) in patients with distal patent false lumen than that (6.7 +/- 3.2 cm2) of in patients with distal occlusive false lumen.(ABSTRACT TRUNCATED AT 250 WORDS)     

Distal anterior inferior cerebellar artery aneurysm occult on magnetic resonance angiography one month prior to rupture--case report

A 77-year-old man suffered subarachnoid hemorrhage due to a ruptured aneurysm of the distal anterior inferior cerebellar artery (AICA). He had a history of hearing disturbance in the left ear for more than 3 years. Computed tomography on three separate occasions had found no abnormalities. One month before the hemorrhage, he came to our outpatient service complaining of vertigo. Magnetic resonance (MR) imaging and MR angiography detected no abnormality. Conventional angiography demonstrated an aneurysm of 8 mm diameter in the distal AICA region after the hemorrhage. Filling and wash out of the aneurysm sac by contrast medium was markedly delayed, which suggested that MR imaging had failed to detect the flow void because of the slow blood flow in the dome. The aneurysm was clipped successfully. He was discharged with mild dysarthria on the 33rd postoperative day. MR angiography has limitations in detecting unruptured aneurysms and there is certainly a high risk group of false negatives, including aneurysms located in the distal region of the main trunk.     

Bilateral multiple ureteral polyps causing intermittent hydronephrosis: a case report

We report an unusual case of bilateral ureteral polyps causing intermittent hydronephrosis, which developed extensively in the upper part of ureters. The patient was an 8-year-old male. He had several episodes of gross hematuria with right flank pain. Ultrasonography of the kidney showed mild bilateral hydronephrosis, while this finding was markedly aggravated in association with the onset of pain. Intravenous pyelogram and retrograde pyelogram revealed multiple filling defects in both upper parts of ureters. Since the diseased part of the ureter was wide (about 7 cm in length), a segmental resection of the right ureter with mobilization of the right kidney was performed, followed by end-to-end ureteral anastomosis. The pathological diagnosis was fibroepithelial polyps. Regarding the disease of contralateral ureter, no surgical treatment was performed because he had no clinical symptoms. Six years after the surgery, he again developed gross hematuria with left flank pain. Marked dilatation of the left renal pelvis was shown by ultrasonography, which suggested left intermittent hydronephrosis caused by ureteral polyps. He underwent a partial ureterectomy with mobilization of the left kidney for the left ureteral disease. No recurrence of polyps has been observed in the urinary tract since this surgery.     

Arterio-intestinal fistula as a complication following insertion of an aorto-iliac bifurcation graft. A case report

A patient who had been treated with insertion of an aorto-iliac bifurcation dacron prosthesis for atherosclerosis 6 years previously, developed a fistulous communication between a false aneurysm at the distal anastomosis to the left iliac artery and an ileal loop. Intestinal haemorrhage and signs of infection were the main symptoms. Successful surgical treatment consisted of suturing the intestinal defect, removal of the left limb of the graft and vascular reconstruction by means of a subcutaneous femorofemoral vein bypass.     

Rupture of false aneurysm of the femoral artery caused by blunt trauma

The successful surgical repair of a ruptured false aneurysm of the left femoral artery in a 44-years-old male is presented. He was admitted to this hospital with the chief compliant of marked swelling accompanied with severe pain of the left thigh and the past history of a blunt trauma 7 years ago on the left groin? He had also severe anemia with hb 4.4 g/dl. An aneurysm measuring 15 by 8 cm was detected on the arteriogram. The aneurysm was treated by resection and implantation of Gore-Tex graft with good result. The pathological findings strikingly suggested that the false aneurysm was caused by the old blunt trauma. A false aneurysm of femoral artery caused by a blunt trauma is very rare and it's complications include acute arterial occlusion, subsequent ischemic change of lower limb and massive bleeding by the rupture. In conclusion, early diagnosis and surgical treatment are essential for a false aneurysm of femoral artery.     

Infected false aneurysm due to methicillin-resistant staphylococcus aureus after proximal aortic grafting

A 70-year-old man developed meticillin-resistant staphylococcus aureus (MRSA) mediastinitis after prosthetic graft replacement of the ascending aorta. The sternal wound was reexplored and a single-stage procedure of irrigation, debridement, and omental transposition was performed. Ten months after the first operation, he suffered recurrence of pyrexia and the presence of false aneurysm originated from the distal suture line was diagnosed by the chest computed tomography (CT) scan. Re-replacement of the ascending aorta and proximal hemiarch with rifampicin soaked Gelseal was successfully performed. Hypothermic perfusion with circulatory arrest through peripheral cannulation and left ventricular venting via a left anterior thoracotomy was useful to obtain safe reentry in the operation of retrosternal false aneurysm.     

Migration of left hip pin with involvement of left ureter

This patient had hematuria and a history of hip fusion many years before. It was found that a left hip pin had broken, and its sharpened portion had migrated through the head of the femur into the adventitia of the left ureter. During exploratory surgery, a bonecutter was employed to cut off the tip of the pin flush with the pelvic wall. The patient has had no recurrence of hematuria. Review of the literature disclosed no report of a similar case.