Left-sided Hydronephrosis Research Articles

LINDBLOM HERNIA: URETER INCARCERATION IN LEFT SCIATIC FORAMEN. LAPAROSCOPIC APPROACH

Abstract Background Sciatic hernias are thought to be secondary to a partial loss of pelvic fascia, atrophy of the piriformis, congenital deformity, or a combination of either. Hernia sac may contain small bowel, ureter, ovary, colon or bladder. Patients may have diverse symptoms and signs ranging from abdominal or pelvic pain or with complications due to incarceration of their contents such as ureteric or bowel obstruction. The Curlicue sign is described as ureteric obstruction with U-shaped tortuosity through the sciatic foramen which is pathognomonic of uretero-sciatic hernia. Various surgical approaches have been reported in the literature, from open laparotomy, abdominoperineal/trans-gluteal approach, to laparoscopy and minimally invasive approach to repair it. The defect can be repaired with a mesh, non-absorbable sutures, and reinforced with a peritoneal flap or epiplon. Method We describe a laparoscopic approach of a left-sided ureterosciatic hernia (Lindblom hernia) who associate an ipsilateral inguinal and obturator defect. Results 80-year-old female come to our center with left flank pain associated with a decline in renal function. A CT scan showed severe left-sided hydro-nephrosis, and the diagnosis of Lindblom hernia was made. A JJ tube was inserted, which relieved the obstruction and improved the renal function preoperatory. A laparoscopic approach via TAPP was perform and the patient was discharged without complications in 24 hours. Conclusion Sciatic hernia are a rare cause of chronic pelvic pain and various surgical approaches have been reported to repair it.

High-Throughput Genomics Identify Novel FBN1/2 Variants in Severe Neonatal Marfan Syndrome and Congenital Heart Defects.

Fibrillin-1 and fibrillin-2, encoded by FBN1 and FBN2, respectively, play significant roles in elastic fiber assembly, with pathogenic variants causing a diverse group of connective tissue disorders such as Marfan syndrome (MFS) and congenital contractural arachnodactyly (CCD). Different genomic variations may lead to heterogeneous phenotypic features and functional consequences. Recent high-throughput sequencing modalities have allowed detection of novel variants that may guide the care for patients and inform the genetic counseling for their families. We performed clinical phenotyping for two newborn infants with complex congenital heart defects. For genetic investigations, we employed next-generation sequencing strategies including whole-genome Single-Nucleotide Polymorphism (SNP) microarray for infant A with valvular insufficiency, aortic sinus dilatation, hydronephrosis, and dysmorphic features, and Trio whole-exome sequencing (WES) for infant B with dextro-transposition of the great arteries (D-TGA) and both parents. Infant A is a term male with neonatal marfanoid features, left-sided hydronephrosis, and complex congenital heart defects including tricuspid regurgitation, aortic sinus dilatation, patent foramen ovale, patent ductus arteriosus, mitral regurgitation, tricuspid regurgitation, aortic regurgitation, and pulmonary sinus dilatation. He developed severe persistent pulmonary hypertension and worsening acute hypercapnic hypoxemic respiratory failure, and subsequently expired on day of life (DOL) 10 after compassionate extubation. Cytogenomic whole-genome SNP microarray analysis revealed a deletion within the FBN1 gene spanning exons 7-30, which overlapped with the exon deletion hotspot region associated with neonatal Marfan syndrome. Infant B is a term male prenatally diagnosed with isolated D-TGA. He required balloon atrial septostomy on DOL 0 and subsequent atrial switch operation, atrial septal defect repair, and patent ductus arteriosus ligation on DOL 5. Trio-WES revealed compound heterozygous c.518C>T and c.8230T>G variants in the FBN2 gene. Zygosity analysis confirmed each of the variants was inherited from one of the parents who were healthy heterozygous carriers. Since his cardiac repair at birth, he has been growing and developing well without any further hospitalization. Our study highlights novel FBN1/FBN2 variants and signifies the phenotype-genotype association in two infants affected with complex congenital heart defects with and without dysmorphic features. These findings speak to the importance of next-generation high-throughput genomics for novel variant detection and the phenotypic variability associated with FBN1/FBN2 variants, particularly in the neonatal period, which may significantly impact clinical care and family counseling.

S2343 Acute Diverticulitis Complicated by Left-Sided Hydronephrosis

S2343 Acute Diverticulitis Complicated by Left-Sided Hydronephrosis

Ureteroureteral Fistula as a Rare Complication of Ileal Conduit Urinary Diversion: a Case Report

Long-term studies on ileal conduit have shown a complication rate of up to 66%. Fistulas are a rare late complication of ileal conduit. To our knowledge, no data about ureteroureteral fistulas has been published yet. We present the case of a 73-year-old man with non-muscle invasive high-grade urothelial carcinoma of the bladder who failed to BCG due to intolerance and developed a cripple bladder. He underwent a cystoprostatectomy, pelvic lymphadenectomy, and an ileal conduit urinary diversion. Four months after the surgery, a raised creatinine level was discovered. Sonography revealed bilateral hydro-ureteronephrosis. Shortly after, the stomal urinary production became minimal, and a nephrostomy was introduced to the right kidney. As a result, the right- as well as the left-sided hydronephrosis diminished, as assessed by ultrasound. Through a loopogram and anterograde pyelography, a stenosis at the ureteroileal anastomosis as well as a connection between the two ureters was proven. As an endoscopic intervention to resolve the obstruction failed, a re-laparotomy to make a neo-anastomosis from the ureters to the ileal conduit was performed. We suspect that total obliteration of the oral end of the ileal conduit caused fistula formation of the ureters. We would like to address this rare phenomenon as a complication of ileal conduit to be mentioned in the differential diagnosis if the outcome of urine is in question. It is not a simple stenosis of the distal portion of the ureters and demands an adapted surgical reconstructing technique as well.

LBSAT61 Pure Aldosterone-secreting Adrenocortical Carcinoma Causing Resistant Hypertension In A Patient With Previously Controlled Longstanding Hypertension: A Case Report

Abstract Introduction Adrenocortical carcinoma is a rare endocrine malignancy that could be classified into functioning or non-functioning, depending on the tumor's ability to secret adrenocortical hormones. Pure aldosterone-secreting adrenocortical carcinoma is extremely rare, accounting for <7% of all functioning tumors that could present with primary aldosteronism and secondary hypertension. Case Presentation A 48-year-old man had a past medical history of longstanding hypertension that recently became resistant to multiple antihypertensive medications (thiazide, angiotensin receptor inhibitor, calcium channel blocker, hydralazine) despite medications compliance. He presented to the ER with left flank pain that was not associated with dysuria, nausea, or vomiting. On admission, his blood pressure was 223/135 mmHg. CT scan of the abdomen and pelvis showed mild left-sided hydronephrosis, hydroureter with a 2mm stone at the left ureterovesical junction, and a 7. 0×7. 0×6.4 cm left heterogeneous adrenal mass that was highly suspicious for malignancy. His laboratory workup revealed low serum potassium of 2.9 mmol/L (reference value 3.5-5.1 mmol/L), serum creatinine of 1.38 mg/dL (reference value 0.7-1.3 mg/dL), random cortisol of 21.8 mcg/dL (reference value 5-25 mcg/dL), ACTH of 5 pmol/L (reference value 10-60 pmol/L), serum levels of normetanephrine of 0.67 nmol/L (reference range 0-0.89 nmol/L), metanephrines of <0.10 nmol/L (reference range 0-0.49 nmol/L), and chromogranin A of 45 ng/mL (reference range 0-95 ng/mL). Further investigations showed high serum aldosterone of 28 ng/dL (reference range 2-9 ng/dL) and low plasma renin activity of 0.1 ng/mL per h (reference range 0.5-2.5 ng/mL per h) supported the diagnosis of primary aldosteronism. The patient underwent left adrenalectomy, and the diagnosis of pure aldosterone-secreting adrenocortical carcinoma was confirmed by histological examination. Conclusion Pure aldosterone-secreting adrenocortical carcinoma is an extremely rare adrenal tumor that could cause resistant hypertension. Re-evaluation of secondary causes of hypertension is essential in patients with a previously controlled longstanding hypertension, developing uncontrolled or resistant hypertension. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

S2042 Hydronephrosis: An Unusual Complication of Diverticular Abscess

Introduction: Acute diverticulitis is inflammation due to microperforation of diverticulum in the colon. Ureteral complications from inflammatory bowel disease and colon cancer have been extensively documented, however, hydronephrosis as a complication of diverticulitis is rarely reported. We present a case of a patient with a diverticular abscess who developed left-sided hydronephrosis. Case Description/Methods: A 40-year-old man with a past medical history of laparoscopic cholecystectomy presented with left lower quadrant cramping abdominal pain for 2 weeks. He endorsed constipation for 3 months but denied other symptoms. His physical examination was significant for a palpable phlegmon in the left lower quadrant with mild tenderness to palpation. Laboratory values revealed hemoglobin of 11.4 g/dl, platelet count of 499 k/ul and unremarkable basic metabolic panel. Computed tomography (CT) scan of the abdomen with contrast revealed severe sigmoid diverticulitis and perisigmoid abscess measuring 6 x 2.6 cm (Figure A). It further revealed moderate left hydronephrosis with narrowing of the ureter, concerning for external ureteral compression by the diverticular abscess (Figure B). After multidisciplinary discussion with interventional radiology, urology, and surgery, recommendation was made to undergo surgical intervention after the resolution of acute diverticulitis. The patient was treated with intravenous antibiotics with symptomatic relief and discharged with plan for outpatient surgery. The patient was unfortunately lost to follow-up. He presented 3 months later with perforated diverticulitis, persistent hydronephrosis, colovesical and colocutaneous fistula requiring exploratory laparotomy and repair. His surgical pathology was negative for malignancy and revealed severe diverticulitis. Patient was discharged home in stable condition. Discussion: Ureteral complications in diverticulitis can occur due to the close anatomical location of the left ureter to the descending and sigmoid colon. Common urologic complications include the development of enterovesical fistulas and urinary calculi and obstruction. Physicians should be aware of this association to ensure a repeat CT scan is performed 4-6 weeks after acute diverticulitis to document resolution. Figure 1.: A. CT scan of the abdomen revealing 60.1 x 26.3 mm diverticular abscess. B. CT scan of the abdomen showing left hydronephrosis and dilation of the ureter.

Management of urolithiasis with individualised homoeopathy – A case report

Introduction: The population of the North-eastern region of India is prone to develop renal stones, and the prevalence and recurrence rate of renal stone disease is thus higher. A stone more than 0.5 cm diameter can cause painful ureteric obstruction. Stones of size more than 0.7 cm almost always require surgical intervention, as believed in conventional medicine. Repeated surgical interventions may remove obstruction but may not be a solution for altering the tendency for renal stone formation. Homoeopathy, an alternative system of medicine can offer holistic approach in treating such cases non-invasively. Case Summary: A 32 years old male patient presented with continuous severe pain in the left renal region for 15 days. A 1.0 × 0.4 cm calculus was found in the left distal ureter causing mild left-sided hydronephrosis as per computed tomography (CT) scan. According to symptoms similarity, homoeopathic medicine Tabacum was prescribed followed by Belladonna. Subsequently, the stone was expelled through urine. The pain was completely relieved, and the CT scan report showed no abnormality. On the basis of the patient’s constitution Calcarea carbonica was prescribed to remove the tendency to form the renal stone. This case of renal stone suggests that homoeopathic medicine can enable expulsion of a relatively bigger renal stones and check recurrence. However, more conclusive researches are required.

The Course of Congenital Hydronephrosis in Infancy

Objective: The aim of our study is to examine the spontaneous resolution rates of congenital hydronephrosis from a recent perspective. Material and Methods: Sixty-nine pediatric patients (M/F=46/23) with congenital hydronephrosis were enrolled in this study. Results: The mean age at the first postnatal examination was 10.8±7.6 days, and the mean age at the time of the final examination was 9.5±3.2 months. Forty-eight patients’ renal anteroposterior diameters (APD) (69.5%) improved while 8 (11.6%) patients’ APDs worsened during the follow-up period. However, MAG3 of these 8 patients was normal. The remaining thirteen (18.9%) patients had congenital anomalies of the kidney and the urinary tract (8 vesicoureteral reflux, 5 cases of ureteropelvic junction obstruction). The mean baseline APD was 9.1±2.8 mm in the group with reduced APD, and 9.7±2.8 mm in the one with increased APD (p=0.461). The mean APD at the final visit was significantly lower in the group with reduced APD than that in the group with increased APD (5.1±1.8 mm vs 17.9±12.6 mm; p=0.001). The anteroposterior diameter of 26 (81.25%) patients with left-sided hydronephrosis and 10 (71.4%) patients with right-sided hydronephrosis regressed spontaneously. The rate of spontaneous resolution was relatively low in patients with bilateral hydronephrosis (n=13; 56.5%) compared to unilateral ones. Conclusion: Our study indicates that an initially mild hydronephrosis does not exclude a pathological course in cases of congenital hyronephrosis. Therefore, in such patients, routine ultrasonography should be done regularly.

Lung Adenocarcinoma Metastatic to the Cervix: Report of a Rare Case and Review of the Literature

Abstract Metastatic involvement of the cervix by nongynecologic malignancies is an extremely rare occurrence. We report a case of metastatic lung adenocarcinoma to the cervix. The patient is a 70-year-old woman who was admitted because of acute kidney injury. Imaging studies revealed left-sided hydronephrosis and a 3.2-cm heterogeneous pelvic mass involving the left pelvic wall. The patient underwent hysteroscopy with dilatation and curettage. Specimens labeled with endometrial and endocervical curettings were notable for tumor cells infiltrating the fibromuscular tissue. Immunohistochemical studies showed that the tumor cells were positive for CK7, napsin A, and TTF1, whereas they were negative for PAX8, p16, p40, p53, GATA3, and ER. This immunophenotype was consistent with a metastatic adenocarcinoma of the lung primary.

Сравнение функциональной магниторезонансной урографии и динамической нефросцинтиграфии в функциональной оценке обструкции пиелоуретерального сегмента у детей

PURPOSE In order to determine the role and significance of functional magnetic resonance urography (fMRU) in the diagnosis of ureteropelvic junction obstruction (UPJO), a comparative analysis of the results of fMRU and dynamic renal scintigraphy (DRS) was carried out. MATERIALS AND METHODS From January 2017 to December 2019, fMRU and diuretic DRS were performed in 36 patients (mean age 89+/-63 months). Boys - 26 (72.2%), girls - 10 (27.8%). Left-sided hydronephrosis was detected in 23 (63.9%) children, right-sided in 12 (33.3%) patients, and bilateral lesions in 1 (2.8%) patient (2 renal units (RU)). Antenatal hydronephrosis was detected in 9 (25%) patients, and postnatally in 27 (75%) patients. According to ultrasound data, grade II hydronephrosis occurred in 11 (29.8%) RU, grade III - in 21 RU (56.7%), and grade IV - in 5 RU (13.5%) according to the SFU classification. A diuretic test was performed in 26 patients. RESULTS Median and quartiles of differential renal function (DRF) according to fMRU data on the affected side were 37% [29; 43], and according to DRS - 46% [40;49]. When performing fMRU, a positive diuretic test was detected in 20 patients, 5 patients - negative and 1 patient - doubtful, and according to the DRS data, 12 patients had a positive test, 10 patients - negative and 4 patients - doubtful. Differences in DRF between fMRU and DRS varied between 0.7-33%. The average value of differences in DRF on the affected side was 11.3+/-8.5%. When comparing the results of DRF on the affected side, a moderate correlation was found on the Cheddock scale (r=0.59, p<0.05) between fMRU and DRS data. In comparison of the DRF using the Wilcoxon test, statistically significant differences were revealed (p<0,05). SUMMARY Our experience demonstrates the high potential of fMRU in terms of replacing the classical methods of diagnosis of UPJO in children, taking into account the high correlation coefficients between the results of fMRU and DRS. Standardization of the fMRU protocol will increase the diagnostic relevance of information and in the future will make fMRU the only necessary study to determine management tactics for patients with UPJO.

Renal Subcapsular Hematoma Formation Due to Hydronephrosis Caused by Recurrent Uterine Cervical Cancer

Most non-traumatic renal subcapsular hematomas are found in the presence of primary or metastatic renal tumors, or in the presence of vascular disease of the renal blood vessels. We managed an asymptomatic renal subcapsular hematoma that formed due to uterine cervical cancer that metastasized to the left common iliac lymph nodes. A 48-year-old woman with stage IB1 cervical cancer underwent neoadjuvant chemotherapy and concurrent chemoradiation following a radical hysterectomy. Six months after the completion of her first treatment, she developed left-sided hydronephrosis, a left subcapsular hematoma and left common iliac lymph nodes enlargement as demonstrated with contrast-enhanced computed tomography. Although a renal subcapsular hematoma is rarely a symptom of cervical cancer recurrence, it should be considered if other neoplastic or vascular diseases are ruled out. J Med Cases. 2021;12(3):126-129 doi: https://doi.org/10.14740/jmc3640

Correction to: A Nautilus kidney.

In the original publication of the article, the second sentence under the heading, Case presentation appears incorrectly as A computed tomographic (CT) scan demonstrated left-sided hydronephrosis (Fig.1).

Short Term Outcome of Antenatal Hydronephrosis: A Single Center Experience

Background Fetal hydronephrosis is a common urinary tract anomaly that may result in renal parenchyma damage. Ultrasound is considered a simple, noninvasive procedure to diagnose and track antenatal hydronephrosis. Our aim was to study the clinical course of fetal hydronephrosis in fetuses. Materials and Methods In this prospective study, 60 fetuses in Imam Reza Hospital in Kermanshah, Iran, which were diagnosed with prenatal hydronephrosis in the third trimester of pregnancy, were grouped into three categories according to the anteroposterior diameter of the renal pelvis: mild (7-9 mm), moderate (9-15 mm), and severe (> 15 mm). The groups were followed for two months after birth with ultrasonography to investigate the clinical course and spontaneous resolution. Results: The severity of the left-side hydronephrosis at the antenatal ultrasound was mild in 27 (45%), moderate in 19 (31.7%), and severe in 3 (18.30%) fetuses. At the follow-up, 30 patients had normal renal pelvis. Severe hydronephrosis, however, remained in three patients after 6 to 8 weeks of follow-up. The severity of the right-side hydronephrosis at the antenatal ultrasound was mild in 15 (25%), moderate in 10 (16.7%), and severe in 1 (1.7%) fetuses. At six to eight weeks after birth, 15 patients had normal renal pelvis. In 10 patients (16.7%), improvement in hydronephrosis was observed after 6-8 weeks. In the first evaluation, 45 patients (75%) had unilateral hydronephrosis and 15 patients (25%) had bilateral hydronephrosis. After six to eight weeks, these decreased to 22 (36.7%), and 6 (10%) cases, respectively. Conclusion The use of antenatal and postnatal ultrasound for imaging follow-up of neonates with fetal hydronephrosis showed that a significant number of cases improved after 6-8 weeks.

Significance of third trimester ultrasound in detecting congenital abnormalities of kidney and urinary tract—a prospective study

Antenatal hydronephrosis is defined as dilatation of the renal pelvis with or without dilatation of calyces in the developing fetus. Although second trimester scan is more sensitive in detecting congenital abnormalities of kidney and urinary tract (CAKUT), it has been suggested that the third trimester scan is more predictive of postnatal outcome. This study aims to determine the incidence of antenatal hydronephrosis at our institution and the significance of third trimester scan in detecting CAKUT postnatally. It is a prospective observational study. During the 3-year study period from June 2013 to May 2016, all cases of antenatal hydronephrosis, defined as renal pelvic diameter (RPD) ≥4mm in the second trimester and ≥7mm in the third trimester scan, diagnosed in the fetal medicine unit of our hospital, were included and were followed up postnatally for 6 months. In the fetal medicine unit, 32,443 women were screened for anomalies, and hydronephrosis was detected in 269 cases. Incidence of antenatal hydronephrosis was observed to be 0.83% in our institution. In second trimester scan, of 80 cases with the left hydronephrosis, only 22 (27.5%) had postnatal CAKUT and of 70 cases with the right hydronephrosis, 18 (25.7%) had CAKUT. In the third trimester scan, it was observed that with RPD >10mm, on the left side hydronephrosis, 87% had CAKUT on postnatal scan, and 85% with the right hydronephrosis had CAKUT. Sixty percent cases of hydronephrosis detected in the second trimester scan resolve in utero. In the third trimester scan with RPD <10mm, the possibility of postnatal CAKUT is 23%, whereas if RPD is>10mm, then the possibility of postnatal CAKUT is 86%.

Subcutaneous ureteral bypass for treatment of bilateral ureteral obstruction in a cat with retroperitoneal paraganglioma

CASE DESCRIPTION A 7-year-old female domestic shorthair cat was referred for evaluation of azotemia and unilateral hydronephrosis. CLINICAL FINDINGS Abdominal ultrasonography revealed right-sided hydronephrosis and dilation of the proximal aspect of the ureter; the left kidney was small with irregular margins. A highly vascular, irregular retroperitoneal mass, not clearly associated with the ureteral obstruction, was also visualized. Surgical exploration confirmed a retroperitoneal mass involving the caudal mesenteric artery and both ureters, with hydroureter on the right side. TREATMENT AND OUTCOME A subcutaneous ureteral bypass (SUB) device was surgically implanted to treat right ureteral obstruction, and the mass was biopsied. Shortly after surgery, progressive azotemia and hyperkalemia were detected; ultrasonographic examination revealed left-sided hydronephrosis and hydroureter, which was suspected secondary to inflammation of the mass causing a left-sided ureteral obstruction. A second surgery was performed to place an SUB device for the left kidney and remove the retroperitoneal mass; both ureters were ligated at the mid- and distal aspects and then transected and removed with the mass. A neuroendocrine paraganglioma was identified by histopathologic evaluation of the mass. Hydronephrosis improved (right kidney) or resolved (left kidney) after surgery, and azotemia improved. Chemotherapeutic intervention was declined. Markers of renal function were static during the 14-month follow-up period. At the last follow-up evaluation, the patient was reportedly doing well, and both SUB devices were patent. CLINICAL RELEVANCE This was the first report of retroperitoneal paraganglioma in a domestic cat causing bilateral ureteral obstruction. Bilateral SUB device placement enabled en bloc mass resection and provided long-term relief of ureteral obstruction.

Endovascular Treatment of Duplicated Inferior Vena Cava Compression From Retroperitoneal Fibrosis

Retroperitoneal fibrosis (RPF) is a rare condition that can affect the iliocaval veins, leading to treatment of this condition. We report a unique case of RPF causing symptomatic compression of a duplicated inferior vena cava treated successfully with stenting. A 68-year-old African American man presented for evaluation of severe debilitating venous claudication and bilateral lower extremity swelling. He reported chronic and progressive symptoms of venous insufficiency that became lifestyle limiting a few months before presentation. His past medical history was significant for hypertension, anemia, and idiopathic RPF with mild renal insufficiency. His surgical history was significant for retroperitoneal exploration and ureterolysis for left-sided hydronephrosis as well as bilateral hydrocele resection. On physical examination, he had normal pulses and severe edema, right worse than left, but no varicosities. Duplex ultrasound was negative for deep venous thrombosis or reflux but demonstrated blunting of respiratory variations in the bilateral external iliac veins. Computed tomography scan showed near obliteration of the venous structures in the pelvis (Fig 1, A). The patient was fitted for compression stockings but could not get relief. Venography was performed and demonstrated a duplicated inferior vena cava with severe bilateral stenosis of the iliocaval vasculature (Fig 2). Intravascular ultrasound was performed to confirm the sites of stenosis and for sizing. Bilateral balloon angioplasty and iliocaval stenting were performed using two 16-mm Wallstents (Boston Scientific, Marlborough, Mass) on the right and two 14-mm Wallstents on the left. The completion venogram showed excellent flow bilaterally (Fig 3). Intravascular ultrasound confirmed complete resolution of all areas of stenosis. The patient was started on clopidogrel and was discharged the next day. The edema cleared within a week, and he experienced excellent relief of symptoms. After 1 year, he was switched to aspirin, and he continues to have minimal symptoms with no recurrence. On his latest follow up, 33 months after intervention, computed tomography scan demonstrated patent stents in the duplicated cava and no venous stenosis (Fig 1, B). Iliocaval compression from RPF is rare but can be debilitating. Endovascular stenting seems to be an effective and durable treatment.Fig 2Pelvic venogram demonstrating severe stenosis in the right (A; arrow) and left (B; arrow) iliocaval systems.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig 3Completion venogram after iliocaval stenting showing brisk flow and resolution of areas of stenosis on the right (A) and left (B).View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Correlation of ultrasonographical findings of hydronephrosis/atrophy with 99m technetium-dimercaptosuccinic acid in childhood: A single-center experience from Turkey.

Introduction:To assess the association of frequently detected abnormalities (hydronephrosis and/or atrophy) on renal ultrasound with dimercaptosuccinic acid (DMSA) scan and the impact of vesicoureteral reflux (VUR) on these abnormalities to find new perspectives in pediatric age group.Materials and Methods:We retrospectively reviewed the DMSA, ultrasonography (US), micturating cystourethrography (MCUG) findings, and medical records of pediatric patients with hydronephrosis and/or atrophy who were at follow-up between January 2013 and December 2016 in our center which is located in the southeast region of Turkey.Results:Among 148 pediatric patients (male/female = 60/88), 66 had hydronephrosis, 72 had atrophy, and 10 patients had both. MCUG study detected VUR in 66 patients. Patients with atrophy were significantly older than patients with hydronephrosis (77.8 ± 58.6 vs. 39.3 ± 38.9 months, P = 0.002). Only 19.4% of our patients with atrophy had VUR. The rate of VUR was higher in the high-grade group than the mild-to-moderate-grade group although the difference was not statistically significant (80% vs. 61%, P = 0.199). Patients with high-grade hydronephrosis had more severe DMSA findings (73% vs. 39%). On the other side, 79% of the patients with high-grade VUR had severe DMSA findings. A total of 10 patients had both atrophy and hydronephrosis all affecting the left side. Six of them had VUR. Severe DMSA findings were more likely in toddlers (age 24–72 months) (48%). This finding was abruptly lowered after 72 months of age.Conclusions:The presence of atrophy and cases of left-sided hydronephrosis should be closely monitored, and DMSA may not be necessary in cases with high-grade hydronephrosis before MCUG.

Успішна лапароскопічна нефректомія в дитини раннього віку з лівобічним термінальним гідронефрозом

Успішна лапароскопічна нефректомія в дитини раннього віку з лівобічним термінальним гідронефрозом

Hydronephrosis Secondary to an Ectopic Decidual Reaction in the Urinary Bladder

A 28-year-old pregnant woman at 19 weeks gestation presented with dysuria as well as lower abdominal and left flank pain. Imaging revealed left-sided hydronephrosis and a mass invading the posterior bladder wall. Management included placement of a left nephrostomy tube and transurethral resection of ~25% of the mass. Microscopy showed an ectopic decidual reaction within the muscularis propria. The patient improved symptomatically and continued prenatal care. Complete resolution of her ureteral obstruction was demonstrated during the postpartum period. Ectopic decidual reactions involving the urinary bladder are extremely rare, and ureteral obstruction secondary to this phenomenon has not yet been reported.

Case Presentation: Vesicovaginal Fistula Following a Total Abdominal Hysterectomy

2405-4569/# 2016 Published by Elsevier B.V. on behalf of European Associ A 43-yr-old woman underwent a total abdominal hysterectomy for benign disease. The procedure appeared to be straightforward, although heavy bleeding around the left ovarian vascular pedicle was encountered. This needed additional sutures for control. Postoperatively the patient developed left loin pain and was found to have new-onset left-sided hydronephrosis on an abdominal ultrasound scan. A percutaneous nephrostomy was inserted into the left kidney and renal pelvis, and 2 d later this was followed by percutaneous antegrade ureteric stenting. The patient then developed continuous urinary leakage per vagina despite a period of catheterisation. A vesicovaginal fistula was diagnosed and she was referred to our specialist centre for repair. We performed a cystogram (Fig. 1) and upper tract imaging via a computed tomography urogram. We then performed an examination under anaesthesia, including cystoscopy with bilateral retrograde studies (Fig. 2).