Different Degrees Of Hydronephrosis Research Articles

Factors affecting the intraoperative calculi excretion during flexible ureteroscopy lithotripsy: an in vitro analysis.

To explore the parameters influencing intraoperative calculi excretion (ICE) during flexible ureteroscopy lithotripsy (fURL) using in vitro simulation experiments. 3D-printed human kidney models were used to simulate the elimination of gravel during fURL. The factors influencing the ICE during fURL were analyzed by comparing the effects of different degrees of hydronephrosis (mild, moderate, and severe), surgical positions (supine and lateral position), ratios of endoscope-sheath diameter (RESD) (0.625, 0.725, and 0.825), gravel sizes (0.50-1.00mm, 0.25-0.50mm, and 0.10-0.25mm), and ureteral access sheaths (UASs) (traditional UAS and negative-pressure UAS) on ICE. The impacts of various UAS, RESD, degree of hydronephrosis, surgical positions, and gravel sizes on ICE were all significant (p < 0.05). We found no evidence of multicollinearity for all the independent variables, and the linear regression equation fitted as (R2 = 0.569). Employing negative-pressure UAS, smaller RESD, milder hydronephrosis, lateral position, and smaller gravel size contribute to improved ICE during fURL. Among them, the adoption of negative-pressure UAS had the most substantial effects.

Combination of robot-assisted laparoscopy and ureteroscopy for the management of complex ureteral strictures

BackgroundTo summarize the efficacy of combined robot-assisted laparoscopy and ureteroscopy in treating complex ureteral strictures.MethodsEleven patients underwent combined robot-assisted laparoscopy and ureteroscopy for ureteral strictures between January 2020 and August 2022. Preoperative B-ultrasound, glomerular filtration rate measurement, and intravenous pyelography showed different degrees of hydronephrosis in the affected kidney and moderate to severe stenosis in the corresponding part of the ureter. During the operation, stricture segment resection and end-to-end anastomosis were performed using the da Vinci robot to find the stricture point under the guidance of a ureteroscopic light source in the lateral or supine lithotomy position.ResultsAll the patients underwent robot-assisted laparoscopy and ureteroscopy combined with end-to-end ureterostenosis. There were no conversions to open surgery or intraoperative complications. Significant ureteral stricture segments were found in all patients intraoperatively; however, stricture length was not significantly different from the imaging findings. Patients were followed up for 3–27 months. Two months postoperatively, the double-J stent was removed, a ureteroscopy was performed, the ureteral mucosa at the end-to-end anastomosis grew well, and the lumen was patent in all patients. Furthermore, imaging examination showed that hydronephrosis was significantly improved in all patients, with grade I hydronephrosis in three cases and grade 0 hydronephrosis in eight cases. No recurrence of ureteral stricture was observed in patients followed up for > 1 year.ConclusionRobot-assisted laparoscopy combined with ureteroscopy is an effective method for treating complex ureteral strictures and can achieve accurate localization of the structured segment.

Total tubeless percutaneous nephrolithotomy without artificial hydronephrosis in preschool children: Three case reports.

Indwelling ureteral catheter, double J tube, or nephrostomy tube are routine procedures for percutaneous nephrolithotomy (PCNL) in children. There are a few cases in which PCNL has been performed in children without any additional instruments being left in place. In this study, 3 children were treated for hematuria and complicated with different degrees of urinary tract infection. All of them were diagnosed as upper urinary tract calculi by abdominal computed tomography. Three preschoolers were diagnosed with upper urinary tract calculi before surgery, one with no hydronephrosis and the other 2 with different degrees of hydronephrosis. After preoperative evaluation, all the children successfully completed PCNL without indwelling ureteral catheter, double J tube, or nephrostomy tube. The operation was successful and there were no residual stones observed during postoperative review. The operating times for the children were 33 minutes, 17 minutes, and 20 minutes, and the intraoperative bleeding volumes were 1 mL, 2 mL, and 2 mL. The catheter was removed on the second day after the operation, the postoperative review of the abdominal computed tomography or ultrasound did not indicate any stone residue, and there were no fever, bleeding, and other related complications after the operation. We believe that total tubeless PCNL without artificial hydronephrosis can be achieved in the preschool population.

Diagnostic Value of DCE-MRI and Tofts Model in Children with Unilateral Hydronephrosis.

Hydronephrosis is a common condition, and the correct diagnosis of hydronephrosis is necessary to improve the early diagnosis rates of pediatric hydronephrosis. The objective of this study is to explore and analyze the diagnostic value of dynamic contrast- enhanced magnetic resonance imaging (DCE-MRI) analyzed using the Tofts model in children with unilateral hydronephrosis. We retrospectively selected data from 88 children with unilateral hydronephrosis treated in our hospital from September 2018 to October 2020. Routine and DCE-MR renal image indexes were collected and their pharmacokinetic variables were calculated based on the Tofts model to compare kinetic parameters of affected and normal kidney. We compared the renal parenchymal thickness and other renal function indexes in children with different degrees of hydronephrosis, and drew receiver operating characteristic (ROC) curves to evaluate the diagnostic value of this approach in children with hydronephrosis. The Ktrans, Kep, and Ve values in the diseased kidneys were lower than those in the normal ones (P<0.05). The thickness of the healthy renal parenchyma in children with severe hydronephrosis was higher than in children with moderate and mild hydronephrosis, but the renal parenchyma thickness and the thickness ratio of renal parenchyma on the affected side were lower than those in children with moderate and mild hydronephrosis (P<0.05). Sensitivity, specificity and accuracy of DCE-MRI and Tofts model in the diagnosis of hydronephrosis in children were higher than those of a single DCE-MRI (P<0.05). The area under the ROC curve for the DCE-MRI and Tofts model approach for the diagnosis of hydronephrosis in children was 0.789 (95% CI, 0.72-0.859), and the sensitivity and specificity were 86.36% and 71.59%, respectively. DCE-MRI and Tofts model can provide a clear picture of renal morphology, and renal function evaluation parameters. They have high sensitivity and specificity in the diagnosis of hydronephrosis in children.

Serum and Urinary Neutrophil Gelatinase-Associated Lipocalin Levels as Early Markers of the Renal Function in Patients With Urinary Stone-Induced Hydronephrosis.

IntroductionUrinary stones cause hydronephrosis, which leads to kidney function impairment. The serum creatinine level is frequently used as a marker of kidney function. However, in some patients with hydronephrosis, it does not reflect the kidney function changes in the early stages of kidney stone disease. Neutrophil gelatinase-associated lipocalin (NGAL) is a novel indicator of the kidney function. Previous NGAL-related research has focused on its role in acute kidney injury. This study aimed to determine the usefulness of NGAL as an early marker of the kidney function in patients with urinary stones and hydronephrosis.MethodsEighty-five patients with urinary stones who were admitted to the Shanghai Tenth People's Hospital (USP group) and 65 healthy volunteers (NC group) were recruited. Blood and urine samples collected from the study participants were evaluated using an enzyme-linked immunosorbent assay to determine the NGAL concentration. Data on the height, weight, age, medical history, and blood and urine findings were collected. Computed tomography data were collected from the USP group.ResultsCompared to in the NC group, NGAL levels were significantly elevated in the USP group (P < 0.001). However, no significant differences in the NGAL levels were observed among the USP group members with different degrees of hydronephrosis. Furthermore, no significant between-group differences in the creatinine level or the estimated glomerular filtration rate were observed. The areas under the receiver operating characteristic curves for the serum and urinary NGAL levels with hydronephrosis were 92.03 and 99.54%, respectively. The areas under the receiver operating characteristic curves for the serum and urinary NGAL levels with kidney stones were 85.05 and 91.89%, respectively.ConclusionNGAL is a sensitive indicator of hydronephrosis secondary to urinary stones.

Does the degree of stone-induced hydronephrosis affect the outcome of shock-wave lithotripsy in patients with proximal ureteral stones?

Background Shock-wave lithotripsy (SWL) is an effective, well-established approach for treating ureteral calculi. Some studies have shown that patients with collecting system obstruction and ureteral stones had lower stone-free rates after SWL than patients with nonobstructed stones. In contrast, other studies acknowledge that stone-induced urinary obstruction does not decrease success with SWL for ureteral stones. The purpose of this study was to assess whether the degree of stone-induced hydronephrosis in patients with solitary proximal ureteral stones influences the outcome and clearance rates after SWL. Patients and methods This prospective study included 30 patients, with solitary proximal ureteric stones and different degrees of hydronephrosis, who were treated with SWL. Patients were divided into three groups according to the degree of stone-induced hydronephrosis. Group 1 (33.33%) had mild dilation, group 2 (33.33%) had moderate dilation, and group 3 (33.33%) had severe dilation. The Dornier MFL 5000 lithotripter was used to treat the patient groups. The results were compared in terms of stone-free rates, number of shock waves, number of sessions, incidence of complications, number of secondary interventions, and time to stone clearance. Results The average stone size was between 8 and 18 mm. The overall success rate was found to be 80% in patients with severe back pressure compared with 90 and 86.6% success rate in moderate and mild hydronephrosis groups, respectively (P=0.749). Furthermore, there was no statistical significance between the three studied groups regarding clearance time (P=0.721). Conclusions The degree of hydronephrosis secondary to proximal ureteral stones of between 6 and 20 mm has shown not to affect the duration till stone clearance or overall treatment success following SWL treatment.

Acute Kidney Injury Induced by Pneumoperitoneum Pressure Via a Mitochondrial Injury-dependent Mechanism in a Rabbit Model of Different Degrees of Hydronephrosis

OBJECTIVETo clarify the effect of mitochondrial injury during laparoscopic surgery of the kidney in different degrees of hydronephrosis in rabbit model. METHODSA total of 90 rabbits were randomly allocated into 3 groups (groups PN, PM, and PS, ie, rabbits without, with mild and with severe hydronephrosis, respectively). The rabbits in the PM group (n = 30) and PS group (n = 30) underwent surgical procedures that induced mild and severe left hydronephrosis, respectively. The rabbits in all the groups were then allocated into 5 subgroups and were subjected to intra-abdominal pressures of 0, 6, 9, 12, and 15 mmHg. Changes in the mitochondrial membrane potential and mitochondrial electron microstructure were observed. The apoptosis proteins cytochrome C, apoptosis-inducing factor, caspase-3, and caspase-9 were measured by western blot analysis. RESULTSAs the degrees of hydronephrosis increased, histopathological changes such as the decrease in mitochondrial membrane potential and mitochondrial vacuolization along with increased expression of apoptosis proteins, cytochrome C, apoptosis-inducing factor, caspase-3 gained statistically significance at lower intra-abdominal pressures (In PN and PM groups at 15 mmHg, and in PS group at 9 mmHg; for all P <.01). CONCLUSIONMitochondrial injury plays an important role during acute kidney injury induced by pneumoperitoneal pressure in different degrees of hydronephrosis in the rabbit model.

Colour Doppler and Biomarkers Utility for Renal Damage due to Congenital Hydronephrosis.

To determine colour doppler and serum biomarkers spectrum in children with congenital hydronephrosis. An observational study. Department of Pediatric Nephrology, West China 2nd University Hospital of Sichuan University and Key Laboratory of Birth Defects and Related Disease of Women and Children (Sichuan University), China, from January to December 2017. A total of 95 children with hydronephrosis were selected as case group. According to the degree of hydronephrosis, the patients were divided into mild hydronephrosis group, moderate hydronephrosis group, and severe hydronephrosis group. Forty children with normal renal function were selected as normal comparison group. Peak systolic velocity (Vmax), end diastolic velocity (Vmin), resistance index (RI), pulsatility index (PI), and serum cystatin C (CysC), β2-microglobulin (β2-MG), and 1-microglobulin (β1-MG) of all subjects in both groups were recorded and compared. The Vmax, Vmax of main renal artery (MRA) and interlobar renal artery (IRA) in case group were lower than those of normal group (all p<0.001). RI of MRA and IRA in case group were higher than those of normal control group (both p<0.001). There were no significant differences in the PI of MRA and IRA between the two groups (p=0.700, and 0.250 respectively). The levels of serum CysC, β2-MG and α1-MG in normal control group, mild hydronephrosis group, moderate hydronephrosis group, and severe hydronephrosis group were significantly different (all p<0.001), and the levels of serum CysC, β2-MG, α1-MG were also different in children with different degrees of hydronephrosis. Combined detection of colour doppler and serum biomarkers CysC, β2-MG and α1-MG in the diagnosis of renal damage in congenital hydronephrosis is feasible and reliable.

Pelvis peristalsis of hydronephrosis in children and its correlation with prognosis

Objective To analyze the frequency of pelvis peristalsis in children with hydronephrosis and its correlation with postoperative percentage of improvement in anteroposterior diameter (PI-APD). Methods From October 2015 to September 2017, the data of the children with unilateral ureteropelvic junction obstruction (UPJO) hydronephrosis who underwent laparoscopic pyeloplasty were collected, and their pelvis peristalsis frequencies of 2 min were recorded after exposing the pelvis, while the APD and PI-APD were followed 1 year posto-peratively.The degrees of hydronephrosis were divided into mild, moderate and severe according to the Society of Fetal Urology(SFU)classification system.ANOVA was used to compare the pelvis peristalsis frequency and postoperative PI-APD between different degrees of hydronephrosis.Spearman analysis was used to analyze the correlation between pelvis peristalsis frequency and degree of hydronephrosis.Meanwhile, Pearson test was used to analyze the correlation between pelvis peristalsis frequency, hydronephrosis degree and PI-APD. Results A total of 50 children were included, of which 36 patients got follow-up for 1 year postoperatively.Pelvis 2 min peristalsis frequency between different degrees of hydronephrosis [mild: (8.1±3.3) times; moderate: (6.3±3.5) times; severe: (7.8±3.9) times] had no significant difference (F=0.65, P=0.527); no statistical correlation was observed between pelvis peristalsis frequency and degree of hydronephrosis or PI-APD (all P>0.05). Preoperative hydronephrosis degree was positively correlated with PI-APD (r=0.54, P=0.001). PI-APD in severe hydronephrosis (0.48±0.29) was significantly higher than that of mild hydronephrosis (0.21±0.20)(P=0.001). Conclusions For children with different degrees of hydronephrosis caused by UPJO, there was no significant difference in the pelvis peristalsis frequency recorded during laparoscopic pyeloplasty.Pelvis peristalsis frequency recorded during surgery was not correlated with PI-APD, but preoperative hydronephrosis degree was positively correlated with postoperative PI-APD. Key words: Hydronephrosis; Unilateral ureteropelvic junction obstruction; Pelvis peristalsis frequency; Anteroposterior diameter

Effect of ultrasonic kidney depth correction on glomerular filtration rate measured by renal dynamic imaging in patients with hydronephrosis

Objective To compare the glomerular filtration rate (GFR) measured by Gates method based on renal dynamic imaging before and after ultrasonic depth correction in patients with different degrees of hydronephrosis. Methods Renal dynamic images of 113 patients (65 males, 48 females; average age: (45.7±10.3) years) with hydronephrosis from October 2015 to October 2016 were retrospectively analyzed. The GFR was also determined with cystatinC (CysC) method within 1 week. According to the degree of hydronephrosis, patients were divided into mild, moderate, severe hydronephrosis groups. The GFR (total GFR, GFR of the impaired kidney, GFR of the normal kidney) was determined by Gates method, and was measured again after the kidney depth being corrected by ultrasound. One-way analysis of variance analysis, the least significant difference t test, and paired t test were used. Results In severe hydronephrosis group (n=55), GFRs (ml·min-1·1.73 m-2) of the impaired kidney before and after the depth correction were significant different (14.9±6.2 vs 9.6±5.8; t=4.63, P 0.05). Conclusion Ultrasonic depth correction may have greater clinical significance in GFR measurement by renal dynamic imaging for patients with severe hydronephrosis. Key words: Hydronephrosis; Radionuclide imaging; Glomerular filtration rate; Ultrasonography; Technetium Tc 99m pentetate

Management of ureteral endometriosis with hydronephrosis: Experience from a tertiary medical center.

We report the clinical characteristics and experience of the surgical management of ureteral endometriosis in our institution. We retrospectively reviewed the data of patients with hydronephrosis resulting from ureteral endometriosis. Forty-six patients with different degrees of hydronephrosis were included in the study; 35% had urinary tract symptoms. Concomitant involvement of the ipsilateral ovary occurred in more than two-thirds of the patients. Four patients had nephrectomy, one of which involved ureterolysis because of hydronephrosis recurrence six months later. Hydronephrosis may be caused by uncommon reasons, such as ureteral endometriosis, which can even cause silent loss of renal function. Routine ultrasound scanning of the upper urinary tract for severe stages of endometriosis is very important in order to detect any potential ureteral lesions. Ureterolysis should be considered as the first surgical step, not only to avoid iatrogenic ureteral injuries but also to better evaluate ureter involvement for further procedures. To warrant tension-free and lesion-free anastomosis, it is wise to perform ureteroneocystostomy for long-term sound results.

Does maternal hydronephrosis have an impact on urinary neutrophil gelatinase-associated lipocalin (uNGAL) levels?

Objective: To determine urinary neutrophil gelatinase-associated lipocalin (uNGAL) levels and creatinine clearance values in women with different degrees of asymptomatic hydronephrosis during pregnancy.Methods: A total of 44 pregnant women with different degrees of hydronephrosis and 46 without hydronephrosis were consecutively enrolled in this prospective study. Basic serum and urine parameters, uNGAL levels, and creatinine clearance values were evaluated. All results were compared between the two groups. Regression analysis was used to determine independent predictors, which were mostly related to hydronephrosis.Results: Demographic data, basal laboratory parameters, and creatinine clearance values were similar, whereas significantly higher uNGAL levels were detected in women with hydronephrosis compared to those without hydronephrosis (45.3 versus 33.2 ng/mL, respectively) (p = 0.004). An increasing trend in uNGAL levels was detected with increasing degrees of hydronephrosis; as it was not statistically significant (p = 0.163). Linear regression analysis revealed that the parameter of “pelvic diameter” was found as a significant independent factor influencing uNGAL concentrations (β = 0.289; 95% CI: 0.522–3.061; p = 0.006). Other independent variables were not found to influence uNGAL concentrations (p > 0.05).Conclusion: The results obtained from this study indicate a significant increase of urinary concentration of NGAL in the presence of asymptomatic maternal hydronephrosis. This impact is likely to be more profound in those with severe hydronephrosis although this has not been specifically investigated. This theory needs to be validated in larger populations.

Percutaneous Nephrostomy Versus Indwelling Ureteral Stent in the Management of Gynecological Malignancies

The aims of this study were to evaluate the efficacy of retrograde ureteral stenting and to identify the predictive factors for potential failure of this technique in women with advanced gynecologic malignancies. From 2006 to 2010, a retrospective analysis was performed on a total of 75 patients with ureteral obstruction due to gynecologic malignancies. This population was divided into group 1 (n = 50) in which retrograde stent placement was successful, and group 2 (n = 25) in which stent placement failed and subsequent percutaneous nephrostomy tube placement was required. Multivariate analysis was done to identify predictors of the failure of ureteral stent insertion. Multivariate analysis revealed that mean preprocedureal serum cystanin C greater than 2.5 mg/L and length of the ureteral obstruction greater than 3 cm were significant predictors of stent failure. Neither the causes nor location of obstruction predicted the need for percutaneous nephrostomy (PCN). No statistical significance was detected among the subgroups of patients with different degrees of hydronephrosis. Statistical significant differences were found between the 2 groups in procedural time, average cost, and mean interval of stent/catheter replacement. However, no statistically significant difference was found in the median survival time and overall stent-related or catheter-related complications between the 2 groups. Retrograde ureteral stenting is a first-line option for managing ureteral obstruction caused by gynecologic malignancies. However, in cases where the preprocedureal mean serum cystanin C is greater than 2.5 mg/L and the length of the ureteral obstruction segment is greater than 3 cm, these patients may be better served by percutaneous drainage.