Distal Third Of Ureter Research Articles

Prevention of Ureteric Injury & Laparoscopic Uretero-Neo-Cystostomy

Video Objective To elucidate the precautions involved in preventing ureteric injury in laparoscopy. To demonstrate management of ureteric injury and technique of ureteric re-implantation in diseased distal third of ureter Setting 39 yr old female with dysmenorrhoea & dyspareunia, diagnosed as having advanced endometriosis with recto-vaginal and ureteric involvement at our Tertiary Care University recognised Endoscopy Referral Unit Interventions Uretero - Neo - Cystostomy with Psoas Hitch to excise diseased distal third of ureter. Double cystotomy technique to draw in the ureter and suture internally to the bladder mucosa after achieving adequate mobilisation of the bladder and ureter in a tension free manner Conclusion Precautions and pre-operative planning and imaging can help avert injuries to vital structures. Ureteric injury, if encountered, can be handled laparoscopically if correct principles are followed, with a urologist standby for medico-legal purposes

Ureteric Injuries during Laparoscopic Gynecological Operations

Objective: To review the literature regarding ureteral injuries that occured during laparoscopic gynecological operations and determinepreventive methods.Material and methods: We have evaluated all the articles related with ureteral injuries of laparoscopic operations between the years 2000and 2010, and selected 14 of them.Results: The rate of injury is 0.093 to 1.1%. Most of the injuries occured at distal third of ureter due to close proximity to uterine artery.Unfortunately, most of the injuries were diagnosed postoperatively. The most common injury type was thermal injury, and the treatmentof choice was often by laparotomy, particularly ureteroneocystostomy.The best way to prevent injury is a through knowledge of pelvicanatomy and principles of electrosurgery together with enough expertise.Conclusion: Ureteric injury prevention and if occured, timely diagnosis is prudent to prevent serious morbidities.

Uso de alfuzosina para la expulsión de cálculos del tercio distal del uréter

Introduction Ureteral stones occur in approximately 12% of the population worldwide, and their incidence has significantly increased in recent years in Western countries. Seventy percent of ureteral stones are located in the distal third of the ureter. Several factors have a strong influence on spontaneous passage of ureteral stones, including stone size, shape, and location. Alpha blockers are currently attributed a potential role in rapid expulsion of stones in the distal third of the ureter. Materials and methods Thirty patients diagnosed of stones in the distal third of ureter of sizes ranging from 4 mm and 10 mm were divided into two groups. The first group was given Buscopan 10 mg plus ketorolac 10 mg every 8 hours, while the second group received alfuzosin 10 mg every 24 hours. Results In group 1, mean stone size was 6.4 mm. Stone expulsion occurred in only 4 patients after a mean of 11.4 days. In group 2, mean stone size was 5.8 mm, and stone expulsion occurred in 13 patients after a mean of 3.3 days. The two stones that were not passed where the biggest ones (9 mm and 10 mm). Conclusions Use of alpha-adrenergic blockers for ureteral distal third stones has been shown to be effective for increasing the stone expulsion rate and even the number of stones passed, and for faster symptom relief.

Extracorporeal Shock Wave Lithotripsy in the Treatment of Ureteric Stones: Experience from Tawam Hospital, United Arab Emirates

The optimal treatment of ureteric stones, especially the lower ureteric stone, remains controversial. The purpose of this study was to evaluate the role of extracorporeal shock wave lithotripsy (ESWL) in the management of ureteric stones. A total of 99 patients with ureteric stones at different levels were treated with ESWL from 1994 through 1998 at our hospital. All patients were treated using Siemen Lithostar-II Plus Lithotripter. Of the 99 patients, 20 were excluded from the study because they had no follow-up records of their stone-free status. The clearance rates for ureteric stones of the other 79 patients treated were stratified according to the site, size, and number of treatment sessions required per stone. The stone size was determined by the widest diameters. Based on stone size, the patients were divided into two groups: A (< or =10 mm) and B (11-20 mm). The overall clearance rate for ureteric stones treated with ESWL, irrespective of its site and size, was 78.5%. The overall clearance rate for size A (< or =10 mm) stones was 82% and size B (11-20 mm) was 58% regardless of the site of the stone in the ureter. A total of 17 upper ureteric stones were treated with ESWL. The overall clearance rate for upper ureteric stones was 94%. Thirteen patients with mid-ureteric stones were treated with ESWL. The overall clearance rate for the mid-ureteric stones was 92.3%. Forty-nine patients had lower ureteric stones. The overall clearance rate for the lower ureteric stones was 69.3%. ESWL is safe, effective, noninvasive and a convenient way of treatment for all ureteric stones. The clearance rate for stones in the upper and mid-ureter is above 90%. ESWL being an outpatient procedure without any need for anesthesia or any pretreatment intervention, it should be considered as the first line of treatment for all stones in the upper and mid-ureter. The clearance rate for small stones (< or =10mm) in the lower third of the ureter was 73.8% in our study and for these, ESWL may be considered as a primary therapy. For stones larger than 10 mm in the distal third of ureter, the clearance rate was low with a high retreatment rate, and ureteroscopy as primary treatment modality would be more preferable.