Hydronephrosis Of Left Kidney Research Articles

V01-06 ROBOT-ASSISTED PYELOPLASTY WITH THE NOVEL HUGO TM RAS SYSTEM: SURGICAL SETUP AT A HIGH VOLUME ROBOTIC CENTER

You have accessJournal of UrologyCME1 Apr 2023V01-06 ROBOT-ASSISTED PYELOPLASTY WITH THE NOVEL HUGOTM RAS SYSTEM: SURGICAL SETUP AT A HIGH VOLUME ROBOTIC CENTER Maria Peraire Lores, Carlo Bravi, Marco Paciotti, Luca Sarchi, Luigi Nocera, Adele Piro, Eleonora Balestrazzi, Angelo Mottaran, Federico Piramide, Rui Farinha, Geert De Naeyer, Alexandre Mottrie, and Ruben De Groote Maria Peraire LoresMaria Peraire Lores More articles by this author , Carlo BraviCarlo Bravi More articles by this author , Marco PaciottiMarco Paciotti More articles by this author , Luca SarchiLuca Sarchi More articles by this author , Luigi NoceraLuigi Nocera More articles by this author , Adele PiroAdele Piro More articles by this author , Eleonora BalestrazziEleonora Balestrazzi More articles by this author , Angelo MottaranAngelo Mottaran More articles by this author , Federico PiramideFederico Piramide More articles by this author , Rui FarinhaRui Farinha More articles by this author , Geert De NaeyerGeert De Naeyer More articles by this author , Alexandre MottrieAlexandre Mottrie More articles by this author , and Ruben De GrooteRuben De Groote More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003221.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: New surgical robots with various technical enhancements are gaining popularity in urology and may increase the use of robotics also in non-oncological fields. HUGO RAS system is a robotic platform with independent arm carts and an open console. Here, we presented our first robot-assisted pyeloplasty with HUGO RAS system with the aim to describe technical feasibility and surgical setup of this novel robotic platform for benign kidney surgery. METHODS: A 36-year-old male, without previous abdominal surgeries, was diagnosed with a left pyeloureteral junction stenosis. The CT scan showed a left kidney hydronephrosis with a pelvis diameter of 6 cm with a delayed urinary excretion. The MAG-3 scan showed left and right renal function of 27% and 73%, respectively. A robot-assisted left pyeloplasty was performed through a transperitoneal approach with the HUGO RAS system. With the patient in right lateral decubitus, a 12-mm Airseal trocar was placed 2 cm lateral to the umbilicus, on the left pararectal line. Other two 8-mm robotic ports and an 11-mm optic port were placed under vision in a diamond configuration (Figure 1), all of them 8 cm apart from each other and 2 cm away from bone prominences; lastly, an 8-mm port was placed in the left lower quadrant. In order to optimise working space, three arm carts (corresponding to surgeon’s left hand, optic and forth robotic arm, respectively) were positioned behind the operative bed, whereas one arm cart (i.e. surgeon’s right hand) was placed in front of the patient. RESULTS: The patient was classified as ASA 1 and had a preoperative creatinine of 1.16 mg/dl. Operative and console time were 95 and 70 minutes, respectively. No intraoperative complications occurred, and blood loss was <20 cc. No technical problems, instruments or arms clashes were reported. The patient was discharged the second postoperative day with a creatinine of 1.02 mg/dl. No perioperative complications were reported. CONCLUSIONS: Robot-assisted pyeloplasty using the new HUGO RAS system is safe, feasible and it guarantees optimal perioperative and early functional outcomes. Awaiting study with longer follow-up, our data showed that HUGO RAS might be considered a valuable treatment option for benign kidney surgery, providing relevant information for future adopters of this surgical platform. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e80 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maria Peraire Lores More articles by this author Carlo Bravi More articles by this author Marco Paciotti More articles by this author Luca Sarchi More articles by this author Luigi Nocera More articles by this author Adele Piro More articles by this author Eleonora Balestrazzi More articles by this author Angelo Mottaran More articles by this author Federico Piramide More articles by this author Rui Farinha More articles by this author Geert De Naeyer More articles by this author Alexandre Mottrie More articles by this author Ruben De Groote More articles by this author Expand All Advertisement PDF downloadLoading ...

Visual impression of the colon over giant hydronephrosis in a child: A case report.

IntroductionGiant hydronephrosis is a rare manifestation of upper urinary tract obstruction. On clinical examination, a colonic band of resonance is appreciated on percussion due to presence of transverse colon anterior to the renal lump. However, visualizing the colon on inspection is not reported in the literature.Presentation of caseA 13-year-old girl presented with abdomen distension for a duration of two years. On clinical examination, the abdomen was grossly distended, with left side of abdomen more prominent. On inspection, the colonic impression was visualized. There was large cystic lump, above which, the colonic impression was observed. With percussion we could elicit the colonic band of resonance as well. Imaging and radionuclide scan revealed giant hydronephrosis of left kidney with poor function. Patient underwent a laparoscopic nephrectomy. Patient was discharged after 3 days.ConclusionGiant hydronephrosis can present as gross abdomen distension. The presence of colon anterior to the renal lump can be appreciated by inspection during the clinical examination.

Laparoscopic ureteral reconstruction in infant with congenital mid ureteric valve

Congenital mid ureteric valve (MUV) stenosis is a very rare cause of ureteric obstruction and hydronephrosis (HN) in children. We describe how we manage laparoscopically one case of a patient with congenital MUV. We describe a 6-month-old boy born with antenatal left HN, with an anteroposterior diameter (APD) of 1,5cm. Follow-up renal ultrasound at 3 months of age showed an increase in left kidney HN, approximately 2.5cm below the PUJ associated with distal stenosis. Renal scintigraphy with DTPA showed an obstructive pattern. Urography scan showed an abrupt reduction in the caliber of the mid left ureter Based on a preoperative diagnosis of MUV stenosis, we performed a laparoscopic left ureteroplasty. Abrupt tapering of the left ureter at 3cm from the PUJ was identified. Proximal ureter repair was performed before the resection of the narrowing segment. The two edges of the ureter were spatulated and continuous anastomosis was performed without tension. An antegrade JJ stent was inserted after the posterior part of the anastomosis was done. Patient made an uneventful recovery and was discharged on the first postoperative day. Laparoscopic ureteroplasty is a complex but feasible option to treat patients with congenital MUV stenosis.

Surgical management of retroperitoneal schwannoma complicated with severe hydronephrosis

Rationale:Schwannomas are usually benign tumors arising from well-differentiated schwann cells, which rarely occur in the retroperitoneal space. The lack of specific signs and radiologic imaging characteristics makes preoperative diagnosis rather difficult. Most retroperitoneal schwannomas are benign and the primary treatment choice for retroperitoneal schwannomas is surgical excision, however, the involvement of the urinary system is scarcely reported.Patient concerns:A 34-year-old woman presented with progressive left abdominal pain and rebound abdominal mass at the left lower quadrant for 1 month. Radiological imaging suggested capsulated solid mass with cystic and necrotic areas in the retroperitoneum accompanied by severe left kidney hydronephrosis and preoperative biopsy result was inconclusive.Diagnoses:We believe this is a rare case of retroperitoneal schwannoma complicated with severe hydronephrosis.Interventions:After preparation, the patient underwent laparoscopy exploration and converted to open surgical exploration. The patient accepted complete surgical excision of the retroperitoneal tumor and left kidney. Postoperative pathology diagnosis of the mass was proven to be benign retroperitoneal schwannoma.Outcomes:Postoperative course of the patient was uneventful and the left abdominal pain was greatly improved. After 12-month follow up, no evidence of recurrence or any other complication including renal failure was observed.Lessons:Preoperative imaging and preoperative ultrasound-guided biopsy are helpful to make accurate diagnosis. The final diagnosis is based on postoperative histological and immunohistochemical findings. The primary treatment option is complete surgical resection of the retroperitoneal schwannoma and the involved upper urinary system when severe hydronephrosis occured. Local recurrence and overall survival are closely correlated with negative resection margins and pathology types.

Squamous Cell Carcinoma of the Renal Pelvis: Rare Case Report

Primary squamous cell carcinoma (SCC) of the kidney is an extremely rare entity representing only 0.5-15% of all urothelial cancers. Herein, we reported a rare case of renal cell carcinoma with SCC extended to the pelvis. A 56 year-old female patient referred to the oncology clinic with complaints of pain in the right flank. The CT showed a hypodense renal mass of size approximately 2 × 2.1 cm in the upper pole of the right kidney. High grade urothelial carcinoma and squamous cell carcinoma extended to renal capsule, but not pass to perirenal fat. Vascular invasion was present, but perineural invasion was not seen. Ureteral margin was free of tumor. Biopsy showed one hilar lymph node involved with tumor in the near right kidney. A few slightly stones smaller than normal 0.4 × 0.9 cm can be seen in the calyx of the asymptomatic hydronephrosis of left kidney. SCC is one of the rare histological tissues in the kidney and hydronephrosis is the most common complaints in more patients with this malignancy.

Giant hydronephrosis of kidney mimicking ascites: A case report

The giant hydronephrosis can rarely be large enough to mimicks as ascites. A patient was received with distended abdomen and was diagnosed clinically as ascites in which paracentesis revealed clear fluid and subsequently ultrasonological evaluation revealed a giant hydronephrosis of left kidney occupying almost whole abdomen. Such presentation of giant hydronephrosis is uncommon, So, we present this case in which percutaneous nephrostomy was done as initial treatment to savage the kidney function.

Bilateral ureteral calcification with left kidney hydronephrosis in systemic lupus erythematosus

A 23-year-old woman with systemic lupus erythematosus (SLE) was admitted for evaluation of anemia. She was diagnosed with SLE 2 years earlier after visiting our hospital with swelling and pain in both proximal interphalangeal joints several years in duration. Although symptoms improved while taking prednisolone and hydroxychloroquine, these medications were discontinued after 10 months because of pregnancy. Eight months before admission, she was treated with prednisolone for SLE flare with thrombocytopenia, elevated liver function, and pulmonary congestion after giving birth. After recovery, hydroxychloroquine and mycophenolate mofetil were added, and she has been stable since then. She was hospitalized because of asymptomatic hemoglobin decrease. However, she complained of left flank pain after admission. Physical examination showed no costovertebral angle tenderness. Urinalysis revealed 2+ albumin, many red blood cells per high power field, and many white blood cells per high power field. Laboratory examination revealed hemoglobin 7.3 mg/dL, creatinine 1.3 mg/dL, total calcium 9.0 mg/dL, inorganic phosphate 2.8 mg/dL, parathyroid hormone 77.8 pg/dL, and C-reactive protein 0.04 mg/dL. Computed tomography of the abdomen showed bilateral ureteral calcification and stones with hydronephrosis of the left kidney (Fig. 1). Figure 1 Abdominal CT. (A) Curved multiplanar reconstruction imaging shows bilateral ureter calcification (arrows) with hydronephrosis of the left kidney. (B) Precontrast axial imaging shows left ureter calcification with central lucency (arrow). SLE is a chronic systemic inflammatory autoimmune disease affecting various organ systems. Calcinosis occurs in damaged tissues, and calcification has been reported primarily in the musculoskeletal, cerebral, and vascular systems of SLE patients. Bilateral calcification of the ureters is quite rare; however, when flank pain, hematuria, or azotemia develops in SLE patients, ureteral calcification and obstruction should be considered.

Hidronefroz ile Birlikteliği olan İzole Rüptüre Dev İliak Arter Anevrizması: Olgu Sunumu

We report a 51year-old male patient admitted to our emergency department because of sudden abdominal pain, hypotension, and dyspnea. On physical examination, abdominal tenderness was observed, primarily in the lower abdomen. Hemoglobin was 8.5g/dl and hematocrit was 26%. Renal function was within normal limits. Ruptured giant left IIIAA ( diameter 11 cm ) with massive hematoma on the left side of retroperitoneal space and extensive left kidney ( diameter 26x18x20 cm ) hydronephrosis ( Figure 1a,1b ) was detected with contrast-enhanced computed tomography (CT). The patient been consulted to the urology department at the same time and decided left nephrectomy for left kidney hydronephrosis. The patient was immediately taken to operation room due to hemodynamic instability. Proximal control was obtained by percutaneous endoaortic balloon occlusion catheter. The aneurismal sac was reached after midline laparotomy (figure 2). Ligation was performed to both the proximal and distal neck of aneurismal sac. After this procedure aneursimal sac was opened and drained. Concomitantly nephrectomy was performed. The postoperative follow up was uneventful. Symptoms of ischemic colon and claudicating were not observed and renal function tests were impaired. The patient was discharged on day 7 postoperatively. At 6 months postoperative, the patient remained well.

The First Case of Eggerthella lenta Bacteremia in Korea

The First Case of <i>Eggerthella lenta</i> Bacteremia in Korea

Testicular Inflammation as a New Manifestation of IgG4-associated Disease

IgG4-related disease has properties of a systemic disorder but simultaneously is associated with a growing list of organ-specific manifestations including autoimmune pancreatitis, IgG4-associated cholangitis, IgG4-related kidney disease, and IgG4-associated prostatitis. In this study, we present, to the best of our knowledge, the first case of a patient with multiorgan IgG4-related disease who lost his testes because of IgG4-related testicular inflammation. We postulate that IgG4-related disease in the urogenital tract is not restricted to IgG4-related kidney disease and prostatitis, but that this rare disorder may also affect the testis.

Commentary on "A Case of Erdheim-Chester Disease with Asymptomatic Renal Involvement"

We read with interest the article written by Dr. Lee et al. [1] on renal involvement in Erdheim-Chester disease (ECD). We agree with the authors on the long asymptomatic period of obstructive nephropathy that occurs in ECD. In our experience, a 60-year-old female, suffering from diabetes mellitus, who was treated with metformin, was admitted for fever, abdominal pain, diarrhoea, and acute renal failure (creatinine, 19 mg/dL). For two years, she had suffered from ECD, diagnosed in another medical ward. She had undergone interferon therapy with stability of her clinical status. Since the diagnosis, she had bilateral hydronephrosis, however, she had never suffered from impaired renal function. At admission, laboratory examinations showed: leukocytes, 21,500/µL; platelet, 54,000/µL; Hb, 11 g/dL; pH, 7.05; HCO3-, 9 mEq/L; serum lactates, 6 mEq/L. Findings on other routine laboratory examinations were within the normal range. Renal ultrasound showed a bilateral hydronephrosis, more to the right side. A percutaneous nephrostomy was placed to the right side; the patient received antibiotic and saline solution therapy with progressive improvement of her clinical status (remission of fever, recovery of diuresis; normalization of renal function and acid-base balance); blood and urine cultures were negative for bacterial growth. We diagnosed intestinal discomfort and lactic acidosis metformin associated with acute renal failure secondary to dehydration. Upon the complete normalization of renal function (creatinine, 1.16 mg/dL), it was possible to perform a computed tomography scan with contrast, which showed a slight hydronephrosis on the right side (Fig. 1) and a marked hydronephrosis on the left side (Fig. 2). We decided to remove the percutaneous nephrostomy, and, as in the case reported by Dr. Lee et al. [1], we counseled a wait-and-see policy in the outpatient clinic. We counseled ureteral stenting in cases of hydronephrosis or deterioration of renal function. Fig. 1 Computed tomography abdomen scan: slight hydronephrosis of right kidney with percutaneous nephrostomy. Fig. 2 Computed tomography abdomed scan: marked hydronephrosis of left kidney.

Multiple-stage correction of caudal duplication syndrome: a case report

Caudal duplication syndrome is a very rare congenital deformity. A 13-year-old boy was born with duplicated colon-rectum and anus, diphallus, hydronephrosis of left kidney with megaureter, double bladders and urethras, and vertebral abnormalities. Multiple-stage correction was performed to remove the duplicated colon and the mucosa of the duplicated rectum. A new colon was reconstructed. The left kidney and megaureter were excised. The septum in the bladders was removed to convert the double bladders into a single bladder. The double phalluses were fused into a single penis. After these staged procedures, the boy is now living a normal life.

Long-term nephrostomy in an adult male spinal cord injury patient who had normal upper urinary tracts but developed bilateral hydronephrosis following penile sheath drainage: pyeloplasty and balloon dilatation of ureteropelvic junction proved futile: a case report

IntroductionThe consequences of spinal cord injury upon urinary bladder are readily recognised by patients and health care professionals, since neuropathic bladder manifests itself as urinary incontinence, or retention of urine. But health care professionals and persons with spinal cord injury may not be conversant with neuropathic dysmotility affecting the ureter and renal pelvis. We report an adult male patient with spinal cord injury, who developed bilateral hydronephrosis after he started managing neuropathic bladder by penile sheath drainage.Case presentationA male patient, born in 1971, sustained spinal cord injury following a motorbike accident in September 1988. In November 1988, intravenous urography showed normal upper tracts. He was advised spontaneous voiding with 2-3 catheterisations a day. In February 1995, this patient developed fever, chills and vomiting. Blood urea: 23.7 mmol/L; creatinine: 334 umol/L. Ultrasound revealed marked hydronephrosis of right kidney and mild hydronephrosis of left kidney. Bilateral nephrostomy was performed in March 1995. Right pyeloplasty was performed in May 1998. In July 2005, this patient developed urine infection and was admitted to a local hospital with fever and rigors. He developed septicaemia and required ventilation. Ultrasound examination of abdomen revealed bilateral hydronephrosis and multiple stones in left kidney. Percutaneous nephrostomy was performed on both sides. Subsequently, extracorporeal shock wave lithotripsy of left renal calculi was carried out. Right nephrostomy tube slipped out in January 2006; percutaneous nephrostomy was performed again. In June 2006, left ureteric antegrade stenting was performed and nephrostomy tube was removed. Currently, right kidney is drained by percutaneous nephrostomy and left kidney is drained by ureteric stent. This patient has indwelling urethral catheter.ConclusionIt is possible that regular intermittent catheterisations along with anticholinergic medication right from the time of rehabilitation after this patient sustained paraplegia might have prevented the series of urological complications. Key components to successful management of external drainage of kidney in this patient are: [1] use of size 14 French pigtail catheter for long-term nephrostomy, [2] anchoring the catheter to skin to with Percufix catheter cuff to prevent accidental tug [3], replacing the nephrostomy dressing once a week by the same team in order to provide continuity of care, and [4] changing nephrostomy catheter every six months by a senior radiologist.

High bifurcation of abdominal aorta upon horseshoe kidney at the level of upper L2 vertebral body: a rare case report

A high-positioned bifurcation of abdominal aorta upon a horseshoe kidney at the level of upper L2 vertebral body was detected during contrast enhanced abdominal computed tomography scan. The isthmus was clamped between the two elevated and extended common iliac arteries. The right renal artery arose from right common iliac artery supplying the superior and medium segments of right kidney. The left renal artery originated from right common iliac artery and branched off into three main arteries supplying the medium segment of right kidney, the inferior segment of right kidney and the lower half part of left kidney, respectively. The left accessory renal artery arose from abdominal aorta supplying the upper half part of left kidney. The inferior mesenteric artery arose from right common iliac artery. Lumbarization anomaly, scoliolosis, asymmetric pelvis and serious hydronephrosis of left kidney were also found. We describe this rare case of variations and discuss the possible embryonic development mechanism.

Prenatal diagnosis of deletion of chromosome 6p presenting with hydrops fetalis

To report the first known case of 6p deletion presenting in utero with hydrops fetalis and multiple anomalies in the second trimester of pregnancy. A thirty-year-old woman (gravida 3 para 1 abortion 1) was referred to our hospital at 18 weeks of gestation because of suspicion of fetal anomaly on routine ultrasound examination. A detailed anomaly scan revealed a single viable fetus with marked skin edema, marked ascites, pleural effusion, hydronephrosis of left kidney, absence of right kidney, cardiac anomaly and oligohydramnios. The fetal face was not visible due to the fetal position. Fetal karyotyping revealed 46,XX,del(6)(p21.3). The couple opted to terminate the pregnancy. A hydropic female fetus was aborted and the autopsy revealed hydrops fetalis with bilateral cleft lips, hydronephrosis of left kidney, absence of right kidney, spleen, and thymus gland, truncus arteriosus, and single umbilical artery. Cord blood and tissue culture confirmed that the fetus had deletion of chromosome 6p. Deletion of short arm of chromosome 6 can result in hydrops fetalis in early pregnancy.

An autopsy case of testicular tumor forming a widespread metastatic tumors in a 6 years boy

This report deals with a male patient of 6 years, succumbed to testicular tumor origeniating in the left testis with widespread metastatic tumors in the whole body after extirpation.1. Gross findings1) Operative specimem : Hen's egg sized, soft, covered with thick white capsules and divided into many nodules by a small amoumt of connective tissues.2) Metastatic tumor formations around the abdominal aorta and pelvic space having sizes of an infant's head and a fist, respectively.3) Swelling of liver with numerous metastatic lesions.4) Numerous metastatic lesions of omentum, diaphragm and lymphonodules around the gastric wall.5) A pea-sized metastatic tumor formation in upper lobe of right lung.6) In addition, cerebral swelling, hydronephrosis of left kidney and dilatation of left ureter were main findings.2. Microscopic findingsMicroscopicallg the tumor consisted of two types of cells. One had wide acidophilic cytoplasm with ovoid nucleus poor in chromatin and often showed large acidophilic inclusions bodies. The other had obscure cytoplasm with ovoid, chromatinrich nucleus and distinct nucleolus. Polymorphisms were dominant in a latter cell group. The former showed less polymorphisms and inclined to form cell masses or giant cell formation.The tumor was rich in blood vessels and in some part showed radial arrangement around the vessel wall. But as a rule the tumor tissue had less resemblance to the mature tissues.It is considered that this tumor belongs to a type of embryonal carcinoma on account of the above mentioned histological pictures.

Hydronephrosis of Left Kidney Due to Stricture of Pelvi-Ureteral Junction

Hydronephrosis of Left Kidney Due to Stricture of Pelvi-Ureteral Junction