Ectopic Insertion Research Articles

Cysts of the Lower Male Genitourinary Tract: Embryologic and Anatomic Considerations and Differential Diagnosis

Cysts of the lower male genitourinary tract are uncommon and usually benign. These cysts have different anatomic origins and may be associated with a variety of genitourinary abnormalities and symptoms. Various complications may be associated with these cysts, such as urinary tract infection, pain, postvoiding incontinence, recurrent epididymitis, prostatitis, and hematospermia, and they may cause infertility. Understanding the embryologic development and normal anatomy of the lower male genitourinary tract can be helpful in evaluating these cysts and in tailoring an approach for developing a differential diagnosis. There are two main groups of cysts of the lower male genitourinary tract: intraprostatic cysts and extraprostatic cysts. Intraprostatic cysts can be further classified into median cysts (prostatic utricle cysts, müllerian duct cysts), paramedian cysts (ejaculatory duct cysts), and lateral cysts (prostatic retention cysts, cystic degeneration of benign prostatic hypertrophy, cysts associated with tumors, prostatic abscess). Extraprostatic cysts include cysts of the seminal vesicle, vas deferens, and Cowper duct. A variety of pathologic conditions can mimic these types of cysts, including ureterocele, defect resulting from transurethral resection of the prostate gland, bladder diverticulum, and hydroureter and ectopic insertion of ureter. Accurate diagnosis depends mainly on the anatomic location of the cyst. Magnetic resonance imaging and transrectal ultrasonography (US) are excellent for detecting and characterizing the nature and exact anatomic origin of these cysts. In addition, transrectal US can play an important therapeutic role in the management of cyst drainage and aspiration, as in cases of prostatic abscess.

Écoulement urinaire chez la fille : quelle imagerie en 2012 ?

Continuous urinary leakage, despite normal deliberate voiding, must suggest the diagnosis of ectopic ureter, more specifically in girls. Ectopic ureter is usually associated with duplex kidney and complete ureteral duplication. The strategy of investigations has changed over the past few years, due to MRI development in the analysis of urinary tract malformations. We report the case of a 4-year-old girl who presented with these symptoms and had a suspicion of left duplex kidney on the prenatal ultrasonography (US). Two US examinations during the first months of life were compatible with a left duplex kidney without any complication. Another US at the age of 4 years was reported as normal. We completed the investigation with MR urography, which revealed a left duplex kidney with a poorly functioning dysplastic upper pole, and the orifice of the ureter of this upper pole inserting in the vagina. The surgical treatment, realized by celioscopy, was partial nephrectomy of the upper pole, removing most of the ectopic ureter. US is the first exam to investigate urinary tract malformations. However, duplex kidney with small dysplastic pole and ectopic insertion of a nondilated ureter may be difficult to see, and a normal US should never end the investigations. Intravenous urography and renal scintigraphy used to be the reference complementary exams, but are now replaced by MR urography. Without using ionizing radiation, MR urography can visualize duplex kidney and ectopic ureteral insertion with high resolution, and evaluates renal function of each kidney and each pole. These morphological and functional data are essential to determine the surgical treatment.

Unusual Presentation of Ectopic Insertion of Duplicated Collecting System in an Adult Male

Ectopic ureters are rare congenital mesonephric duct malformations with a higher prevalence in women than men. In women, ectopic ureters are often associated with a duplicated collecting system, whereas in men, ectopic ureters usually drain a single system and are associated with renal dysplasia and obstruction. Presentation and diagnosis generally occurs in the pediatric age group. Herein, we present an unusual case of delayed diagnosis of ectopic insertion of the upper pole ureter in a completely duplicated left kidney causing massive hydroureteronephrosis in an adult man.

Impact of Ectopic Insertion on Treatment Outcome of Primary Non-refluxing Megaureter

To investigate the characteristics of primary non-refluxing megaureter with ectopic insertion and its effects on renal function. Of 118 patients diagnosed with primary non-refluxing megaureter, we retrospectively studied 33 patients who underwent surgical treatment. Depending on the position of ureteral insertion, patients were classified as having either an ectopic or orthotopic megaureter; clinical characteristics and renal function, were analyzed. Among the 36 primary non-refluxing megaureters, 7 (19.4%) had ectopic megaureter. A total of 34.5% of the orthotopic megaureter and all ectopic megaureter cases were women (P = .003). The mean value of maximum ureteral diameter was significantly wider for ectopic than for orthotopic megaureter (16.3 vs 12.1 mm, respectively, P = .029). Mean preoperative differential renal function (DRF) were 36.4% and 43.0% for ectopic and orthotopic megaureters, respectively (P = .164). After surgery, the mean DRF of ectopic megaureter had decreased from 50% to 18.8%, whereas the mean DRF of orthotopic megaureter was 42.9% (P <.001). At the time of surgery, the mean age of patients was 4.6 months in the ectopic megaureter and 16.7 months in the orthotopic megaureter (P = .005). In our study, all the cases of an ectopic megaureter occurred in women, and the ureteral dilatation was comparatively more severe than in orthotopic megaureters. In addition, despite early surgical treatment, renal function deteriorated gradually. Further analyses are necessary to determine whether earlier surgical intervention for preventing deterioration of renal function is worthwhile or not.

Ectopic insertion of the ureter into the seminal vesicle

We present a case of left ectopic ureter insertion into the left seminal vesicle which is a rare anomaly. The incidence of ectopic insertion of the ureter is more common in females and is usually associated with incontinence, leading to the diagnosis, while in males it is present with infection. Ectopic ureter is defined as abnormal insertion of the ureter, occurring in the posterior urethra in approximately 50% of cases in males. Other sites include the seminal vesicle (approximately one-third), vas deferens, bladder neck, prostate and epididymis, while the urethra and vagina are commonly affected in females. Management is usually addressed to the upper tract only; if there is incontinence it requires removal of the ureteric stump. Our case was initially diagnosed by magnetic resonance imaging and the diagnosis confirmed by computed tomography (CT) guided seminal vesiculography as transrectal guidance for seminal vesiculography was refused by the patient. CT guided seminal vesiculography is less painful and more tolerable than the transrectal route.

Non-Viral Generation of Neural Precursor-like Cells from Adult Human Fibroblasts

Recent studies have reported direct reprogramming of human fibroblasts to mature neurons by the introduction of defined neural genes. This technology has potential use in the areas of neurological disease modeling and drug development. However, use of induced neurons for large-scale drug screening and cell-based replacement strategies is limited due to their inability to expand once reprogrammed. We propose it would be more desirable to induce expandable neural precursor cells directly from human fibroblasts. To date several pluripotent and neural transcription factors have been shown to be capable of converting mouse fibroblasts to neural stem/precursor-like cells when delivered by viral vectors. Here we extend these findings and demonstrate that transient ectopic insertion of the transcription factors SOX2 and PAX6 to adult human fibroblasts through use of non-viral plasmid transfection or protein transduction allows the generation of induced neural precursor (iNP) colonies expressing a range of neural stem and pro-neural genes. Upon differentiation, iNP cells give rise to neurons exhibiting typical neuronal morphologies and expressing multiple neuronal markers including tyrosine hydroxylase and GAD65/67. Importantly, iNP-derived neurons demonstrate electrophysiological properties of functionally mature neurons with the capacity to generate action potentials. In addition, iNP cells are capable of differentiating into glial fibrillary acidic protein (GFAP)-expressing astrocytes. This study represents a novel virusfree approach for direct reprogramming of human fibroblasts to a neural precursor fate.

Minimally invasive surgical approach to excision of symptomatic ectopic inverted-Y ureteral duplications

Inverted-Y ureteral duplications are a rare duplication anomaly with few cases reported in the literature. We report a novel minimally invasive approach to managing inverted-Y duplications in two females who presented with continuous urinary incontinence and were found to have an ectopic insertion of the duplicated ureter. The ectopic segment was excised laparoscopically without complication in the outpatient setting with resultant cure of the continuous incontinence. This represents the first report of a laparoscopic approach to this rare anomaly.

562 Radiological Evaluation of Pediatric Congenital Urinary Tract Anomalies

PurposeTo illustrate a wide spectrum of congenital anomalies of the urinary tract in children.Materials and MethodsWe demonstrate radiological evaluation and its clinical significance of congenital anomalies of the urinary tract...

Static fluid magnetic resonance urography in evaluation of ureteral ectopia: Experience in 10 pediatric cases

IntroductionEctopic ureters are often very difficult to diagnose with conventional imaging modalities especially in children. Magnetic resonance urography (MRU) has been recently investigated as a problem-solving tool for the evaluation of various congenital urogenital anomalies with favorable results. Aim of the workTo assess the value of static fluid MRU in diagnosing ectopic ureters in childhood. Patients and methodsTen out of 14 pediatric patients with suspected ureteral ectopia (as suggested by clinical or conventional imaging techniques) were included in this study and prospectively studied by MRU aiming to confirm the suspected diagnosis. The examinations were done on 1.5T machines using static fluid T2W-MRU sequences. Ultrasound examinations were done for all patients. Voiding cystourethrogram (VCUG) was done for 8 patients to exclude vesico-ureteric reflux or urethral anomalies. ResultsAll studied patients had dilated collecting systems. Static fluid MRU was able to detect the site of ectopic ureteric insertion in all 10 patients. It was superior to ultrasound in evaluation of 8 cases with complex duplex systems. In one patient with multiple congenital anomalies, MRU clearly demonstrated the urinary and extra-urinary anomalies. The final diagnosis was confirmed by surgical or endoscopic data in all patients. ConclusionsIn dilated collecting systems, static fluid MRU can provide detailed assessment of the collecting systems and ureters as well as adequately detect ureteral ectopia. MRU should be recommended whenever a ureteric insertion anomaly is suspected.

A Beta-Herpesvirus with Fluorescent Capsids to Study Transport in Living Cells

Fluorescent tagging of viral particles by genetic means enables the study of virus dynamics in living cells. However, the study of beta-herpesvirus entry and morphogenesis by this method is currently limited. This is due to the lack of replication competent, capsid-tagged fluorescent viruses. Here, we report on viable recombinant MCMVs carrying ectopic insertions of the small capsid protein (SCP) fused to fluorescent proteins (FPs). The FPs were inserted into an internal position which allowed the production of viable, fluorescently labeled cytomegaloviruses, which replicated with wild type kinetics in cell culture. Fluorescent particles were readily detectable by several methods. Moreover, in a spread assay, labeled capsids accumulated around the nucleus of the newly infected cells without any detectable viral gene expression suggesting normal entry and particle trafficking. These recombinants were used to record particle dynamics by live-cell microscopy during MCMV egress with high spatial as well as temporal resolution. From the resulting tracks we obtained not only mean track velocities but also their mean square displacements and diffusion coefficients. With this key information, we were able to describe particle behavior at high detail and discriminate between particle tracks exhibiting directed movement and tracks in which particles exhibited free or anomalous diffusion.

The Skp1 Protein from Toxoplasma Is Modified by a Cytoplasmic Prolyl 4-Hydroxylase Associated with Oxygen Sensing in the Social Amoeba Dictyostelium

In diverse types of organisms, cellular hypoxic responses are mediated by prolyl 4-hydroxylases that use O(2) and α-ketoglutarate as substrates to hydroxylate conserved proline residues in target proteins. Whereas in metazoans these enzymes control the stability of the HIFα family of transcription factor subunits, the Dictyostelium enzyme (DdPhyA) contributes to O(2) regulation of development by a divergent mechanism involving hydroxylation and subsequent glycosylation of DdSkp1, an adaptor subunit in E3(SCF) ubiquitin ligases. Sequences related to DdPhyA, DdSkp1, and the glycosyltransferases that cap Skp1 hydroxyproline occur also in the genomes of Toxoplasma and other protists, suggesting that this O(2) sensing mechanism may be widespread. Here we show by disruption of the TgphyA locus that this enzyme is required for Skp1 glycosylation in Toxoplasma and that disrupted parasites grow slowly at physiological O(2) levels. Conservation of cellular function was tested by expression of TgPhyA in DdphyA-null cells. Simple gene replacement did not rescue Skp1 glycosylation, whereas overexpression not only corrected Skp1 modification but also restored the O(2) requirement to a level comparable to that of overexpressed DdPhyA. Bacterially expressed TgPhyA protein can prolyl hydroxylate both Toxoplasma and Dictyostelium Skp1s. Kinetic analyses showed that TgPhyA has similar properties to DdPhyA, including a superimposable dependence on the concentration of its co-substrate α-ketoglutarate. Remarkably, however, TgPhyA had a significantly higher apparent affinity for O(2). The findings suggest that Skp1 hydroxylation by PhyA is a conserved process among protists and that this biochemical pathway may indirectly sense O(2) by detecting the levels of O(2)-regulated metabolites such as α-ketoglutarate.

Duplicaciones del tracto urinario

ObjectivesReview the clinical and radiological characteristics of the different kinds of urinary tract duplications, assessing the outcome of the cases and the incidence of renal parenchymal injury. Material and methodsA retrospective study was performed including 301 children diagnosed of renal duplication by urological ultrasound, voiding cystourethrogram (VCUG) and 99-technetium renal scintigraphy (DMSA). ResultsThey were classified in four groups. The first consisted of 166 (55.1%) cases that had complete ureteral duplication without an obstructive component (CD). The cases that had an upper system obstruction due to an ectopic ureter (EU), 19 (6.3%), or an ureterocele (UTC), 35 (11.6%), were divided into two different groups. The fourth group 81 (26.9%) had incomplete ureteral duplication. The nephro-urological study was performed in 181/301 after a urinary tract infection; in 100/301 after a prenatal finding of hydronephrosis. It was a casual diagnosis in 20/301.The percentage upper kidney dilation in the diagnostic ultrasound was significantly higher in those with EU 16/19 (84%) and in those with UTC 33/35 (94%), compared with the upper pole dilations found in the CD 35/166 (21%) and ID 21/81 (25%).Surgery was performed in 96/166 (41%) of the CD, 7/81 of the ID, 16/19 (84%) of the EU, and 34/35 (97%) of the UTC. Three cases with EU and 8 with UTC needed a second surgery, and 3 a third one. No scintigraphy changes were observed in 58% of the patients in the CD group, 87% in the ID group, 29% in the EU group, and 5% in the UTC group.As regards the renal duplications who did not have surgery, it was found that there were 98 refluxing units in the CD, and 74 in the ID. The spontaneous resolution of the vesicoureteral reflux (VUR) was 80% in the CD, and 90% in the ID (McNemar test P<.001). The average healing time ranged from 1 year to 5 years (Mean: 3 years and 3 months). ConclusionThe patients with higher risk of having renal injury are those who presented with a duplication with upper kidney obstruction due to ectopic insertion of the ureter, particularly due to an ureterocele.

Chronic Epididymitis with Scrotal Vasocutaneous Urinary Fistula

Chronic Epididymitis is a relatively rare problem in boys and is often enigmatic in its etiology. It is often associated with urinary tract abnormalities in infants and prepubertal children. This report describes a rare and unusual case of a chronic epididymitis with acquired scrotal vasocutaneous urinary fistula in an 8-mo-old boy who was found to have a large prostatic utricular cyst and ectopic vas insertion. The authors discuss embryology, pathophysiology, diagnostic dilemma and different treatment options.

Using Conventional Instruments to Perform Single Incision Laparoscopic Heminephroureterectomy in Children with Duplex Kidneys and Megaureters: The Crossed-Instruments (“Chopsticks”) Technique

Abstract Introduction: Poorly functioning dysplastic upper moiety in duplex kidney associated with ectopic ureteric insertion is a rare cause for urinary dribbling in children and upper moiety hemi...

Meiotic silencing by unpaired DNA is expressed more strongly in the early than the late perithecia of crosses involving most wild-isolated Neurospora crassa strains and in self-crosses of N. tetrasperma

Meiotic silencing by unpaired DNA is a presumed RNAi-mediated elimination of the transcripts of any gene that is not properly paired with a homolog in meiosis. Eighty wild-isolated strains of Neurospora crassa were classified into three types based on the apparent strength of meiotic silencing of the bml (β- tubulin) and mei-3 genes in crosses with the ::Bml r and ::mei-3 tester strains. “OR” and “Sad” type wild-isolates, respectively, did or did not silence both the genes, whereas the “Esm” type (68 strains) silenced bml but not mei-3 +, suggesting an intermediate strength of silencing. Many wild strains, especially of the Esm type, gave fertile crosses with strains bearing the 148 kbp chromosome segment duplication Dp( EB4) but their crosses with the 405 kbp Dp( IBj5) were barren. Larger Dps might include more genes whose sensitivity to silencing is comparable with that of bml, consequently their crosses with the OR and Esm type strains would be about equally barren, whereas small Dps, with presumably few or no bml-like genes suffer little gene silencing in crosses with Esm and Sad strains and thus remain fertile. Using lollipop-shaped asci as indicators of silencing in crosses of the ::act tester with Esm type strains, and white-spored asci in Neurospora tetrasperma self-crosses heterozygous for an ectopic insertion of the asm-1 gene, we found that meiotic silencing was expressed more strongly in the early but not in the late perithecia of these crosses.

Robot-Assisted Laparoscopic Excision of Symptomatic Retrovesical Cysts in Boys and Young Adults

We review our surgical experience with the management of retrovesical cystic anomalies using robot-assisted laparoscopic techniques. We retrospectively reviewed the presentation, diagnosis and treatment of 6 patients 28 months to 22 years old with retrovesical cystic anomalies who underwent robot-assisted laparoscopic excision at our hospital between January 2006 and November 2010. Presenting signs and symptoms included urinary retention, lower urinary tract symptoms, abdominal pain and repeated epididymitis. Associated anomalies consisted of hypospadias, vesicoureteral reflux, renal agenesis, 5alpha-reductase deficiency, premature adrenarche and cryptorchidism. Cystic anomalies ranged from 3 to 6 cm long. The final diagnoses were prostatic utricular cyst, müllerian duct cyst and seminal vesicle cyst. Ectopic insertion of vas into the cyst was found in 4 cases, requiring ligation of the affected vas in 3. Mean ± SD operative time including cystoscopy was 198 ± 23.8 minutes, and estimated blood loss ranged from 5 to 10 ml. Mean ± SD hospital stay was 1.33 ± 0.52 days. All patients had resumed their regular activities within 2 weeks postoperatively. De novo contralateral epididymitis developed 2 months postoperatively in 1 patient. Otherwise, there was no recurrence of cystic mass or presenting signs or symptoms during followup of 3 to 56 months. In the management of retrovesical cystic anomalies robot-assisted laparoscopic excision affords a natural extension of conventional laparoscopy with the additional advantages of 3-dimensional vision and ease of instrument control.

Overproduction of Bacillus amyloliquefaciens extracellular glutamyl-endopeptidase as a result of ectopic multi-copy insertion of an efficiently-expressed mpr gene into the Bacillus subtilis chromosome

BackgroundPlasmid-less, engineered Bacillus strains have several advantages over plasmid-carrier variants. Specifically, their stability and potential ecological safety make them of use in industrial applications. As a rule, however, it is necessary to incorporate many copies of a key gene into a chromosome to achieve strain performance that is comparable to that of cells carrying multiple copies of a recombinant plasmid.ResultsA plasmid-less B. subtilis JE852-based strain secreting glutamyl-specific protease (GSP-the protein product of the mpr gene from B. amyloliquefaciens) was constructed that exhibits decreased levels of other extracellular proteases. Ten copies of an mprB.amy cassette in which the GSP gene was placed between the promoter of the B. amyloliquefaciens rplU-rpmA genes and the Rho-independent transcription terminator were ectopically inserted into designated (3 copies) and random (7 copies) points in the recipient chromosome. The resulting strain produced approximately 0.5 g/L of secreted GSP after bacterial cultivation in flasks with starch-containing media, and its performance was comparable to an analogous strain in which the mprB.amy cassette was carried on a multi-copy plasmid.ConclusionA novel strategy for ectopically integrating a cassette into multiple random locations in the B. subtilis chromosome was developed. This new method is based on the construction of DNA fragments in which the desired gene, marked by antibiotic resistance, is sandwiched between "front" and "back" portions of random chromosomal DNA restriction fragments. These fragments were subsequently inserted into the targeted sites of the chromosome using double-cross recombination. The construction of a marker-free strain was achieved by gene conversion between the integrated marked gene and a marker-less variant carried by plasmid DNA, which was later removed from the cells.

Arterial Injury Complicating Subclavian Central Venous Catheter Insertion

n i a a g n c INADEQUATE PLACEMENT of a subclavian venous catheter in the subclavian artery is a well-known complication.1,2 Three cases of accidental arterial puncture occurred with the implantation of subclavian venous catheters, 2 of which involved the subclavian artery leading to percutaneous treatment; and the other involved the aortic arch, resulting in surgical management, are described.

Magnetic resonance urography in duplex kidney with ectopic ureteral insertion

This is a report on the use of magnetic resonance urography (MRU) in a 6-year-old girl who presented with urinary incontinence. She had a left duplex kidney with poorly functioning upper moiety and ectopic insertion of the dilated upper pole ureter. MRU has been shown to be superior to conventional imaging techniques in delineating poorly functioning moieties of duplex kidneys and ectopic ureters.

Suite of novel vectors for ectopic insertion of GFP, CFP and IYFP transcriptional fusions in single copy at the amyE and bglS loci in Bacillus subtilis

We report the development of a suite of six integrative vectors for construction of single copy transcriptional fusions with the gfpmut3, cfp and iyfp reporter genes in Bacillus subtilis. The promoter fusions are constructed using the highly efficient ligation-independent cloning (LIC) technique making them suitable for high-throughput applications. The plasmids insert into the chromosome by a double cross-over event at the amyE or bglS loci and integration at each site can be verified by a plate-based screening assay. The vectors allow expression of two different promoters to be determined in the same strain using the cfp and iyfp reporter genes since CFP and iYFP are spectrally distinct and have comparable half-lives of approximately 2 h in exponentially growing B. subtilis cells. We demonstrate the versatility of these vectors by measuring expression of the tuaA and phoA operons singularly and in combination, during growth in phosphate limiting conditions.