Blind-ending Ureter Research Articles

Obstructed hemivagina and ipsilateral renal agenesis: magnetic resonance imaging findings in young Nepali females - a report of four cases.

The cases presented describe the imaging (ultrasound and MRI) findings of four young females who presented with dysmenorrhea and urinary complaints. All of them had solitary kidneys with a didelphic uterus and unilateral hematometrocolpos. A proximally blind-ending ureter with distal ectopic insertion, transverse vaginal septum, and left-sided endometrioma was seen. OHVIRA syndrome is associated with duplicated uterovaginal structure with OHVIRA. Ultrasound is the first line of investigation; however, MRI better delineates the anatomy and assists in preoperative planning. This report highlights that earlier clinical suspicion and imaging diagnosis of OHVIRA is crucial to prevent adverse outcomes and treating complications.

UNILATERAL RENAL AGENESIS AND PROXIMAL BLIND-ENDING URETER WITH URETERIC ATRESIA

Renal agenesis associated with proximal blind-ending ureter, ureteric atresia, and fusiform dilatation of distal ureter which is an extremely rare occurrence and has not been described in the literature. We report a case of unilateral renal agenesis and ipsilateral proximal blind-ending ureter with ureteric atresia in an 11-year-old boy which was dealt surgically with good outcomes.

Ureteral Sextuplication With a Blind-ending Ureter Originating From the Upper Pole in a Boy: A Case Report

We experienced an extremely rare case of ureteral sextuplication with a blind-ending ureter originating from the upper pole. The patient had 6 separate ureters and 6 renal pelvises with 1 ureteral orifice on the left. The left kidney was hypoplastic and its differential function was 6.5%. The patient underwent definitive surgical treatment to repair the anomaly (ureteroureterostomy and reimplantation of the formed ureter). The surgery was successful and the postoperative course was uneventful. We herein report the first such case in the English-language literature and discuss the etiology of this ureteral anomaly, the method of diagnostic imaging, and the treatment.

Proximal ureteral atresia in a duplex kidney with preserved renal function: A case report and review of literature

Ureteral atresia is a rare congenital anomaly and is usually associated with renal dysplasia. Distal atresia is more common and other associated urinary anomalies are rare. We report a case of an eight year old boy who presented with left flank pain and vomiting. Ultrasound abdomen and pelvis and renal scinitigraphy were suggestive of hydro-ureteronephrosis with obstructed drainage. He was suspected to have ureteric stricture and taken up for surgery. Cystoscopy and retrograde pyelogram revealed an incomplete duplication with lower moiety ureter ending blindly. Exploration of left renal fossa showed a duplex anomaly with normal upper moiety and hydronephrosis of lower moiety with an ureteric stump. Ureteropelvic anastomosis was done between the dilated renal pelvis and the blind ending ureter. Patient was doing well post operatively with good function in both moieties. Review of literature shows only two previously reported cases of proximal ureteric atresia. Preservation of renal function in an older child has also been reported only once. Ureteral atresia is usually diagnosed intra-operatively and various reconstruction options are available in patients with preserved function.

Renal agenesis, blind ending ureteral remnant, and ectopic ureterocele

We wish to highlight the importance of multi-modality imaging in patients with renal agenesis who may present with lower urinary tract obstruction symptoms. Our case features a rare entity comprising three associated urinary tract anomalies, namely, a blind ending ureter, ectopic uretrocele, and ipsilateral renal agenesis, in a 20-year-old male patient.

Multicystic dysplastic kidney with twice duplicated distal ureter having ectopic blind endings

Congenital abnormalities of the kidneys, urinary collecting system, and bladder come at an incidence of roughly 1% of total live births. These urinary abnormalities form a major problem in urological studies both of interest to the surgeons and anatomists, of which inverted “Y” shaped ureter, ectopic ureter, blind ending ureter, and multicystic kidney are a very rare spectrum of anomalies. Coexistence of such a complex spectrum of anomalies in the same individual is of immense surgical importance.During dissection, retro peritoneum of intra uterine dead (IUD) male fetus of 28 weeks gestation a combination of multicystic dysplastic kidney with a rare ureteral anomaly that is not seen frequently was observed. The normal left renal anatomy was completely distorted. Ureter divided twice in an inverted “Y” branching pattern, the two left limbs entered the wall of rectum and urinary bladder of same side respectively and right limb opened ectopically into urinary bladder. The gross and microscopic features were in favor of Multicystic Dysplastic Kidney and Ureter. Congenital renal dysplasia may be explained by an abnormal induction of metanephric blastema by migrating ureteric bud. The embryological basis of inverted “Y” shaped ureter is not clearly understood, we suggest that it is due to longitudinal splitting of ureteric bud. This type of anomaly of the ureter may represent real traps in the interpretation of abdominal imaging, particularly in CT scanning.

Ergonomic principles and techniques in facilitating advanced laparoendoscopic single site (LESS) urinary tract reconstruction with conventional laparoscopic instruments

The technical and ergonomic details of laparoendoscopic single site (LESS) reconstruction have not been reported. In this study, we explored the feasibility and safety of performing advanced LESS upper urinary tract reconstruction with conventional laparoscopic instruments. Between September 2010 and March 2011, we retrospectively reviewed prospectively collected data from five patients who underwent LESS urinary tract reconstruction. The LESS reconstruction included pyeloureterostomy (N = 1), dismembered pyeloplasty (N = 2), ureteroneocystostomy (N = 1), and ureteroplasty for bifid blind ending ureter (N = 1). The perioperative and postoperative parameters were collected for analysis. The ergonomic principles and techniques are detailed. All reconstructive LESS procedures were completed successfully without open conversion or laparoscopic conversion. Ancillary ports or ancillary instruments were not applied in any of the patients. The mean patient age was 40.4 years. The mean operative time was 213 ± 69 minutes, the estimated blood loss ranged from minimal to 50 mL, and the mean hospital stay was 4.4 ± 4 days. No operation-related complication occurred. Based on our ergonomic principles and suturing/knotting techniques, conventional laparoscopic instruments are feasible and safe for LESS urinary reconstructive procedures.

Radiological seminal vesicle stones may actually be in the ureter

Calculi in blind-ending ureters are uncommon. We describe a rare case of calculi in the diverticulum of a blind-ending ureter associated with ipsilateral renal agenesis, which masqueraded as seminal vesicle calculi.

Letter to the editor Distal blind-ending branch of a bifid ureter

Ureteral duplication is a common congenital anomaly of the urinary system observed in 0.8% of autopsy series [1]. However, bifid ureter with a blind branch is a rare condition. It is three times more prevalent in women than men and is observed twice as often on the right side as on the left side [2]. It does not generally give any clinical symptoms. However, in the literature, symptomatic cases with haematuria, flank pain, urinary infection, stone, vesicoureteral reflux and abdominal mass have been reported [3, 4]. We report a case on which ureteroscopy was performed to the right ureteral duplication with a blind-ending branch and left distal-end ureteral stone. A 40-year-old woman was admitted to our clinic with acute left renal colic, dysuria and frequency micturition. She had no previous history of urinary tract symptoms. Laboratory tests showed normal renal function. Urine analysis and culture showed haematuria without infection. In the direct urinary system graphy (DUSG) and ultrasonography (US) a left distal ureteral stone was detected; hence excretory urography (EU) was also performed on the patient. The EU showed a distal ureteral stone on the left side and two radio-opaque shadows in the region of the distal right ureter (Figures 1, ​,2).2). Surgery for the ureter stone and diagnostic ureteroscopy (DU) on the ureter with anomaly were planned to be performed in the same session. Ureteroscopic stone removal was performed on the left sided distal ureteral stone. In same session, DU was performed and distal blind-ending branch of bifid ureter 7 cm long was confirmed at the position 5 cm from the beginning of the ureterovesical junction (Figure 3). Figure 1 A schematic drawing of the blind-ending ureter Figure 2 Right duplicated system with bifid blind-ending ureter on excretory urography Figure 3 Normal and blind-ending ureter lumen orifice on diagnostic ureteroscopy No pathology was determined in the lumen of the blind-ending branch. The images were recorded on DU. The patient was discharged from the hospital the day following the operation. Since no complication related to ureter anomaly developed in the post-operative follow-up, blind-ending ureter was not intervened. Blind-ending bifid ureter is a rare congenital anomaly of the ureter which has three sub-types according to the localization. These are proximal, distal, and middle according to their frequencies [2]. Our case was a distal blind-ending ureter, which is less frequent than the proximal and more frequent than the middle blind-ending bifid ureter. Many blind-ending ureters are clinically insignificant and do not give any symptoms because of this. Patients who develop symptoms generally have complaints about abdominal pain, dysuria, frequency micturition, and haematuria. These complaints might depend on stone formation, vesicoureteric reflux or ureteral tumour [3–6]. Our patient did not have any symptoms or complications related to blind-ending bifid ureter. It was detected incidentally during the EU performed because of her complaints regarding the other ureter with stone. Conventional approaches such as EU and retrograde ureterography in diagnosis of ureteral anomalies can be sufficient [2]. Our patient was easily diagnosed since she had a ureteroureteral reflux (yo-yo ureteric peristalsis) between the normal ureter and blind-ending branch detected in EU. Voiding cystouretrography may help diagnosis in patients with vesicoureteric reflux [5]. Multidetector computed tomography (CT) imaging urography [5, 7] and magnetic resonance urography can be useful for diagnosis as alternative new advanced imaging methods [8]. However, these methods, being expensive, and multidetector CT having ionizing radiation, are disadvantageous. Another method for diagnosis of blind-ending bifid ureter may be ureteroscopy. This method is expensive and invasive but could be used in patients with planned surgery or in the presence of haematuria for the confirmation of diagnosis and evaluation of ureter lumen. We applied ureteroscopy in order to exclude other ureteral pathologies, and confirm the diagnosis. We recommend that the use of ureteroscopy is beneficial for such patients. Treatment of symptomatic patients must be planned according to the complication. In our patient, as there was no complication following the treatment of the stone in the normal ureter, no surgery was performed on the ureter with the anomaly and the patient was placed in follow-up. In conclusion, blind-ending bifid ureter is a rare entity, and unexpected complications during the surgery can be prevented if its probability is kept in mind, and it is visualized by diagnostic imaging methods and DU.

Urothelial carcinoma associated with a blind-ending bifid ureter

We report a case of urothelial carcinoma (UC) associated with a blind-ending bifid ureter. A 76-year-old man presented with asymptomatic, intermittent gross hematuria. Computed tomography revealed a mass in the left middle ureter at the level of the pelvic rim, which appeared to be the cause of hydronephrosis. A pouch of the ureter was also detected, and it was closely associated with the dilated main ureter along its entire length. Retroperitoneoscopic nephroureterectomy with open excision of the bladder cuff was performed. Pathological examination of the surgical specimen revealed two papillary UCs. The main tumor of dimension 30 × 15 × 15 mm was mainly located at the proximal end of the blind-ending branch and a solitary daughter tumor of dimension 5 × 5 × 5 mm was within the pouch. The main tumor was thought to originate from the blind-ending ureter and invade the adjacent main ureter, thereby causing the dilatations of the main and blind-ending bifid ureter. This is the second reported case of UC associated with a blind-ending bifid ureter. A long-term adverse effect of the blind-ending branch on the urothelial microenvironment may have important implications in the pathogenesis of malignancy.

Letter to the editor: Blind-ending branch of bifid ureter: multidetector CT imaging findings

Free AccessCorrespondenceLetter to the editor: Blind-ending branch of bifid ureter: multidetector CT imaging findingsP K GuptaP K GuptaSearch for more papers by this authorPublished Online:28 Jan 2014https://doi.org/10.1259/bjr/31163090SectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail AboutThe Editor,I read the case report published in the British Journal of Radiology 2011; 84(998):38–40, on “Blind-ending branch of bifid ureter: multidetector CT imaging findings” by E Chang et al, with academic interest. In the present era of imaging, CT is the modality of choice in patients presenting with microscopic haematuria especially when no other sign or symptom is evident. It is appreciable that the learned authors have presented this appropriately as a rare case of such urinary anomaly on MDCT. However, intravenous urography, a conventional approach, could have also given good diagnostic results for surgical management in such cases. It could be an economical and easily available modality with much less radiation to the patient compared with MDCT. We diagnose cases of renal and ureteric duplication and other urinary anomalies on intravenous urography for proper management of patient and relief of their symptoms. One such male patient of 35-years-old presented with right side uretric colic at our hospital and was diagnosed on intravenous urography as ureteric duplication with blind ending.The authors have very rightly described that bifid ureters with blind ending have ureterouretral reflux with asynchronous peristaltic waves (yo-yo ureteric peristalsis). In such cases the contrast should have not been seen at the most cephalad part of the blind ending ureter, instead the filling of this duplicated ureter must be from the caudal to cephalad part as shown in our case (Figure 1). The cephalic segment of this bifid blind ending ureter, in the presented case, must not have been filled completely in 10 min; however, if we look at the images a contrast track can be seen along the right side of the orthotopic right ureter suggest the filling of ureter from caudal to cephalad part of bifid ureter.Figure 1 (a) Right-side bifid ureter filling from caudal to cephalic section, (b) right-side bifid ureter with blind ending. Download Figure The letter is written with the aim that readers of the BJR can appreciate the diagnostic values of IVU, a state of the art modality in radiodiagnosis. This art of conventional radiology, we are losing fast in the era of imaging.Yours etc., Previous article Next article FiguresReferencesRelatedDetails Volume 84, Issue 1004August 2011Pages: 677-e168 2011 The British Institute of Radiology History ReceivedFebruary 16,2011AcceptedMarch 16,2011Published onlineJanuary 28,2014 Metrics Download PDF

Letter to the editor: Blind-ending branch of a bifid ureter: multidetector CT imaging findings

Author's reply The Editor, We appreciate your feedback to our case. We acknowledge and agree that conventional intravenous urography (IVU) could have been used to make the diagnosis, as prior reports indicate. Our institution reflects the general trend and unfortunately the valuable IVU has become under used. The effectiveness of IVU has been proven over time, both in regards to cost and radiation dose to the patient. Often the finding of a blind-ending bifid ureter is noted incidentally and primary pathologies that clinicians are assessing include calculi and neoplasms. Clearly, MDCT has an important role for evaluation of these diseases and has been demonstrated to be far more sensitive. Regarding the asynchronous peristaltic waves that the ureter demonstrates, we believe that contrast was initially seen most cephalad in the blind-ending ureter because one or more cycles of retrograde-antegrade peristalsis had already occurred prior to the imaging at 10 min. It is possible that some portion of the blind-ending ureter was dyskinetic or minimally extrinsically compressed leading to residual contrast remaining at the cephalad-most portion after antegrade peristalsis. Again we appreciate your comments. Yours etc.,

A blind-ending ureter with infection due to vesicoureteric reflux with associated renal agenesis: A rare cause of pain abdomen

We report a 12-year-old male child with an unusual cause of abdominal pain, i.e. a blind-ending ureter with vesicoureteral reflux. The pain improved with antibiotic therapy, implying infection as the cause of pain. This entity is difficult to diagnose clinically, thereby affecting management. Usually, a blind-ending ureter is not filled on intravenous urography (IVU) and the diagnosis is confirmed by retrograde pyelography, which is an invasive procedure. We illustrate the contribution of IVU and computerized tomographic cystography, which has not been reported earlier, in the evaluation of such cases.

First report of an unexpected blind-ending duplication of the ureter as a rare pitfall in kidney transplantation

We report on the case of an unexpected blind-ending ureter in a kidney transplant. To our knowledge, this is the first report of a blind-ending ureter in kidney transplantation. The recipient was a 60-year-old woman, with a 6-year history of chronic haemodialysis. During the performance of ureterocystostomy, the ureteric stent could not be placed in the renal pelvis as the ureter, surprisingly, was found as blind-ending in the ureteral sheath. Dissecting the ureteral sheath a second shorter ureter was found and used for ureterocystostomy. The histology reported a normal ureter, which led to a thread of connective tissue. The patient had an uneventful recovery; the creatinine was 1.07 mg/dl at discharge from the hospital. It is mandatory for the transplanting surgeon to be aware of the ureteral variations and the surgeon should be trained in the surgical management of these variations. Accuracy should be ensured when exploring the exact anatomy of the donor organ.

Blind-ending ureteral duplication with calculi

or reflux. 3 Because of non-filling of the blind ureter on intravenous urography (IVU), the diagnosis of blind-ending ureteral duplication is best made with the help of retrograde pyelography. However, a blind-ending bifid ureter can be opacified on IVU if uretero-ureteral reflux is present. The anomaly can also be seen on computerized tomography. 4 We report a case featuring a long, blind-ending ureteral duplication complicated by stone formation. Case Report A 45-year old male was admitted with right loin pain, dysuria and frequency of micturition of 3 months duration. He reported passing stones in urine in the past, but had no history of fever or recurrent urinary tract infection (UTI). The patient had presented to another hospital with the same complaints 6 weeks before reporting to our unit. Cystoscopy at that hospital showed a normal bladder with no calculus in the bladder or the ureters. He came to our unit because of persistent pain. Laboratory investigations showed normal renal function. Urine microscopy and culture showed red blood cells in the urine, but no bacterial growth. Plain radiograph of the kidneys, ureters and bladder (KUB) revealed two radio-opaque shadows in the region of the lower third of the right ureter (Figure 1). However, IVU showed patent ureters with no calculus seen in either ureter (Figure 2). A pre-operative CT scan showed grossly normal kidneys and ureters with 2 extravesical masses in the pelvis. Cystoscopy in our unit revealed an edematous mass just caudal and medial to the right ureteric orifice. A guide wire introduced into the right ureter under fluoroscopic control showed that the radio-opaque shadows seen on KUB were extraureteral and extravesical. Right retrograde pyelography showed a patent ureter with opacification of a normal pelvicalyceal system. Transurethral resection of the bullous, edematous mass revealed another ureteric orifice. Retrograde pyelography through the other ureteric orifice revealed multiple filling defects and a long blind-ending ureter, with no opacification of the pelvi-calyceal system (Figure 3). Ureteroscopy through the second ureteric orifice confirmed the presence of 2 calculi, which were removed using a Dormia basket. Post-operatively the patient became pain free. Postoperative micturating cystourethrogram (MCUG) performed 3 months after calculus extraction from the duplicated ureter, showed no vesicoureteric reflux (VUR).

Laparoscopic retroperitoneal resection of blind-ending bifid ureter in patient with recurrent urinary tract infections

Blind-ending bifid ureters are rare congenital anomalies. Symptomatic patients require surgical resection of the blind-ending ureter. Traditionally, open resection of the blind-ending segment has been performed. We describe a laparoscopic retroperitoneal three-port approach for resection of blind-ending bifid ureters. We believe this is a viable and less-invasive alternative to traditional open surgical resection of a blind-ending segment.

Uréter con terminación ciega frente a divertículo ureteral

Our aim is to establish that the blind-ending ureter and ureteral diverticulum are two different manifestations of the same entity as their embryological origins, tissular compositions and resulting pathologies are the same, their being different only in their digitiform or ovoid morphology, respectively.We present the innovation of echographically describing the blind-ending ureter. In our case, the imaging study is completed with an intravenous urography.

Surgical and endoscopic treatment of ureterocele: Case reports

— Ureterocele is a cystic dilatation of the ureter, often associated with urinary tract infection and vesico-ureteral reflux. Treatment should aim at preserving renal function. Eight patients with ureterocele were included in this study. Three of them underwent surgery hemiureteronephrectomy with ureterocystoneostomy was performed in two, while a supernumerary blind-ending ureter in the third was resected and the complementary ureter reimplanted. Endoscopic incision of the ureterocele was carried out in five patients, of whom four were children. Endoscopic incision was possible in all patients and hospital stay was considerably shortened. In two cases endoscopic incision was followed by UCNS of both ureters Our results agree with data reported in recent literature (93% successful endoscopic procedures).

Ureteric Cyst: An Unusual Abdominal Mass

Abdominal cystic masses in childhood are rare and despite improved imaging techniques continue to present diagnostic confusion. Typically such cystic lesions are mesenteric or intestinal in origin. However, rarer causes include cystic dilatation of a blind ending ureter. To date over 100 cases of blind ending ureters have been reported and their management described. We report on a case of non-communicating ureteric cyst associated with a blind ending ureter that recurred following percutaneous drainage and required operative resection. Although percutaneous drainage techniques have been advocated for a variety of abdominal cystic lesions, the experience gained from this case suggests that operative excision is the treatment of choice.

Unilateral Renal Agenesis May Result From in Utero Regression of Multicystic Renal Dysplasia

Renal agenesis is generally thought to result from a lack of induction of the metanephric blastema by the ureteral bud, which may be secondary to ureteral bud maldevelopment and/or to a problem with the formation of the mesonephric duct. Multicystic dysplasia is thought to result from early ureteral obstruction as evidenced by the high frequency of associated proximal ureteral atresia. The recent obstetrical practice of large scale screening of large numbers of fetuses with sonography has resulted in a significant increase in the detection of this and other genitourinary anomalies. These findings have contributed to our understanding of the natural history of many of these malformations, resulting in ongoing reassessment and refinement of current management modalities. Thus, it is now well established that a significant number of multicystic dysplastic kidneys, initially detected in utero and followed postnatally, involute and disappear with time.We report the unequivocal presence of unilateral multicystic dysplasia detected during maternal sonography in 3 fetuses, which could not be seen on subsequent studies during the fetal or immediate postnatal period. To our knowledge, these cases constitute the first report of complete in utero regression of multicystic kidneys. This novel observation indicates that some cases of unilateral renal agenesis result from in utero regression of multicystic dysplastic kidneys. This phenomenon may explain the presence of an ipsilateral blind ending ureter found in some patients with unilateral renal agenesis. However, this infrequent observation does not explain all cases of renal agenesis. Thus, the etiology of renal agenesis remains multifactorial.