微创治疗方法在输尿管上段结石中应用进展

输尿管上段结石为临床中常见泌尿系结石类型之一,如不能及时诊治,可引起重度积水、泌尿系感染,甚至脓毒血症,对患者肾功能、健康造成严重影响。随着微创治疗技术在泌尿系结石中应用,微创治疗方法能降低对患者造成治疗性创伤,降低相关并发症发生率,促进患者康复,了解临床中微创治疗输尿管上段结石方法,对临床中合理治疗输尿管上段结石有重要价值。     

Ureteral carcinoid tumor

Most ureteral tumors are transitional cell neoplasms. Neuroendocrine tumors of the genitourinary tract are extremely rare. To our knowledge, only one ureteral carcinoid tumor has been reported before. We report a second case of ureteral carcinoid tumor found in a 70-year-old female.     

Obstructive Uropathy Secondary to Ureteral Herniation in a Pediatric En Bloc Renal Graft

Ureteral herniation is a rare entity. We report the first case of extraperitoneal ureteral herniation in a pediatric en bloc renal graft causing obstructive uropathy. A 70-year-old, obese patient with an en bloc renal transplant was found to have ureterohydronephrosis in the right renal graft on magnetic resonance imaging. Nephrostomy with insertion of a double-J catheter confirmed the presence of a ureteral loop within the inguinal tract. Surgery confirmed herniation of the ureter through the internal inguinal ring, crossing over the spermatic cord. We performed release, resection, ureteral reimplantation and hernioplasty. Four months later, renal function was normal and urinary tract dilation had diminished. This case illustrates an unusual cause of obstructive uropathy in a transplanted kidney. Apart from obesity, two other factors may have contributed to its development: presence of a redundant ureter, and the fact that the ureter had been placed over, rather than under, the spermatic cord.     

Acute renal failure as a result of bilateral ureteral obstruction by Candida albicans fungus balls

A 73-year-old male with a history of diabetes mellitus was admitted to our hospital for acute renal failure. An ultrasonogram revealed bilateral hydronephrosis, which worsened despite insertion of a bladder catheter. Nephrostomy catheters were positioned bilaterally, and Candida albicans was found in the urine culture. The patient was successfully treated with intermittent direct irrigation and i.v. antifungal agent therapy. Since 1977, approximately 50 cases of fungus balls or fungal bezoars in the urinary tract have been reported, but the majority of these cases have been characterized by unilateral ureteral or bladder involvement. Herein, we report a case of acute renal failure as a result of bilateral ureteral obstruction by Candida albicans fungus balls.     

Is cytomegalovirus a cause of ureteral stricture in renal transplant recipients?

Cytomegalovirus (CMV) is regarded as a predominant infectious agent in solid organ transplants. CMV disease has highly protean clinical manifestations. Nevertheless, urinary tract involvement seems to be very rare during CMV infection. We report two cases of renal transplant recipients in whom ureteral stricture developed in the course of CMV disease. Histologic data were available for them and were consistent with CMV infection. We discuss previous case reports and propose physiopathologic mechanisms. Received: 3 October 1996 Received after revision: 13 February 1997 Accepted: 17 February 1997     

医源性输尿管损伤临床分析

目的探讨医源性输尿管损伤的原因、类型、处理和预防.方法回顾性分析1994年5月～2003年11月13例14侧医源性榆尿管损伤临床资料.结果 1例输尿管内支架管引流、2例输尿管端端吻合内支架管引流、2例松解部分结扎及内支架管引流、7例8侧输尿管膀胱再植术,输尿管均通畅,肾功能均恢复正常,6例尿瘘治愈;1例肾切除.结论规范化操作及输尿管逆行插管对预防医源性输尿管损伤和早期发现输尿管损伤有决定性的作用和帮助;早期与后期诊断有所不同;治疗的目的是恢复输尿管通畅和保护肾功能;后期诊断病例应考虑一次性恢复输尿管通畅,尽可能不作尿流改道.     

原发性输尿管癌31例临床分析

目的：提高原发性输尿管癌的术前诊断水平。方法：对南京医科大学第一附属医院1989-2002年间收治的31例原发性输尿管癌的临床资料进行回顾性分析。结果：31例中，肉眼血尿22例(71．0％)，腰痛11例(35，5％)。B超、静脉肾盂造影(IVU)、CT和逆行造影检查的阳性率分别为输尿管腔内占位4例(13．0％)、输尿管腔内占位3例(11．5％)、膀胱或合并膀胱占位8例(36．4％)，输尿管充盈缺损6例(40．0％)。29例患者经手术治疗，其中13例行患侧肾、输尿管、膀胱袖状切除。结论：老年患者反复发作的腰痛及血尿应考虑原发性输尿管癌的可能，造影诊断对本病有较高价值，应作CT及MRU无创检查。     

体外冲击波碎石术后石街的处理(附41例报告)

目的总结体外冲击波碎石(ESWL)术后石街的处理经验。方法回顾性分析2001年8月至2006年3月我院41例上尿路结石行ESWL术后形成石街患者的临床资料。结果9例石街采用逆行引流体位后自行排净,25例再次行ESWL术后石街排净,5例改行输尿管镜碎石术,2例行开放手术。结论采用患侧卧位的逆行引流体位,再次行ESWL术和输尿管镜碎石术等方法处理,能有效提高石街的排净率。     

诱导型一氧化氮合酶在单侧输尿管梗阻大鼠肾脏的表达

目的:探讨诱导型一氧化氮合酶(iNOS)在单侧输尿管梗阻(UUO)大鼠术侧肾脏的表达.方法:建立左侧输尿管梗阻模型(UUO组),设假手术组为对照.3 d后应用逆转录-聚合酶链反应(RT-PCR)检测iNOS的mRNA水平.结果:与对照组相比,UUO组大鼠肾脏出现明显病理变化,并且其iNOS mRNA表达明显增加.结论:iNOS参与UUO的发生和发展的病理过程.     

Late Ureteral Stenosis Following Renal Transplantation: Risk Factors and Impact on Patient and Graft Survival

The aim of this retrospective study of a cohort of 1787 consecutive kidney transplantations was to analyze the risk factors associated with the occurrence of ureteral stenosis and the impact of ureteral stenosis on graft and patient survival. Between January 1990 and December 2002, 1787 renal transplantations were performed at our center. Only stenosis observed after the first month, were considered. Among the parameters studied were: donor age and serum creatinine before procurement; recipient age, cold ischemia time, delayed graft function (DGF), number of arteries and the presence of a double J stent. The follow-up parameters were the number and timing of acute rejection episodes, cytomegalovirus (CMV) infection, acute pyelonephritis, renal function and death. Ureteral stenosis occurred in 4.1% of patients and was correlated with donor age > 65 years (p = 0.001), kidneys with more than 2 arteries (p = 0.009) and DGF (p = 0.016). Ureteral stenosis did not affect 10-year patient and graft survival rates, which were respectively 90% and 64% for the stenosis group, 86% and 63% for the no-stenosis group (p = NS). These data suggest an important role for donor age, number of renal arteries and DGF for the occurrence of ureteral stenosis following renal transplantation.