Left Ureter Research Articles

Tortuosed dilated ureter and urinary retention due to giant Gartner duct cyst

Gartner duct cyst (GDC) is a type of benign congenital vaginal cyst. It is rarely seen in girls and young women. It can also be observed in urological anomalies, and acquired urinary system diseases secondary to GDC have not been well defined. GDC is generally observed to be smaller than 2 cm and is asymptomatic. The larger GDC causes lower urinary tract complaints, sexual dysfunction and intestinal problems. GDC coming out of the vagina can also be perceived as vaginal organ prolapse. Pelvic Magnetic Resonance Imagınıng is the best radiological examination to identify GDC. Surgical treatment is applied to symptomatic due to GDC. There is no standardized surgical treatment method. In this study, we presented the case of a 74-year-old female patient who developed urinary retention and left tortuosed dilated ureter due to giant GDC. After the physical examination, abdominal ultrasonographyand whole abdominal computerized tomography were performed to the patient. Then, cystoscopy, üreterorenoscopy and vajinal marsupialization were applied. Acquired urologic disease due to giant GDC can be seen in elderly woman. Vaginal marsupialization can be applied to giant GDC that mimic vaginal organe prolapse.

Surgical treatment of a true diverticulum of the bladder in a patient with aplasia of the left kidney. Case report

A bladder diverticulum (BD) is a blindly terminating sac-like protrusion of the bladder wall with or without involvement of the muscular layer. BDs are categorized into true (congenital) and false (acquired), single and multiple. False diverticula are more common and develop in infravesical obstruction due to urethral stricture, prostate neoplasms, neurogenic disorders and other lower urinary tract diseases. Currently, there are no clear recommendations regarding the tactics of treatment of BD, so the choice of treatment method is based on the determination of the cause of BD, assessment of clinical manifestations and diagnostic results (localization, size, number, etc.), as well as the identification of concomitant anomalies and diseases of the upper urinary tract. The priority in the treatment of BD is surgical treatment. The article presents the observation of a patient with a developmental anomaly in the form of aplasia of the left kidney combined with a large congenital BD in the area of the missing mouth of the aplasic left ureter. The results of examination and treatment in the form of laparoscopic diverticulectomy are presented. A brief review of the literature on the problem of diverticulosis has been carried out.

Intravenous indocyanine green to evaluate distal ureteral vascularity during robot-assisted radical cystectomy with intracorporeal urinary diversion.

The aim of the present study is to assess the role of indocyanine green (ICG) to evaluate distal ureteral vascularity during robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion and its impact on the incidence of benign ureteroenteric strictures (UES). The study included patients who underwent RARC for bladder cancer between 2018 and 2023. All patients included underwent intracorporeal urinary diversion with ileal conduit or neobladder. Bricker technique was performed in all ureteroenteric anastomosis. ICG was employed during the study period to evaluate ureteral vascularity. We divided patients into 2 groups depending on the utilization of ICG during surgery and compared demographic, clinicopathological and perioperative outcomes, including benign UES rates. We identified 221 patients that underwent RARC with intracorporeal urinary diversion. Ileal conduit was performed in 173 (78.3%) patients and neobladder in 48 (21.7%) cases. A total of 142 (64.3%) and 79 (35.7%) patients were in the non-ICG and ICG group, respectively. With a median follow-up of the entire cohort of 21.1 months, there were no differences in the rate of benign UES after RARC between the non-ICG and the ICG group (p = 0.901). In the non-ICG group, 26 (18.3%) patients developed benign UES and in the ICG group 15 (19.0%) patients. Most of the strictures appeared in the left ureter in both groups (80.8% non-ICG vs. 66.7% ICG, p = 0.599). Median time to stricture diagnosis was 4 months (IQR 3-7.25) for the non-ICG and 3 months (IQR 2-5) for the ICG group (p = 0.091). The ICG group had a slightly greater length of ureter resected compared with the non-ICG group (1.5 vs. 1.3cm, p = 0.007). In our experience, choosing to use ICG intraoperatively to evaluate distal ureteral vascularity may not reduce the rate of benign UES after robot-assisted radical cystectomy with intracorporeal urinary diversion and Bricker ureteroileal anastomosis.

A rare case of early abdominal pregnancy (EAP)

Introduction: Abdominal pregnancy comprises 1% of ectopic pregnancies and is challenging to manage due to the associated significant morbidity and mortality. Abdominal pregnancy may be classified according to gestation and implantation site. Ultrasound imaging is the mainstay of diagnosis. Confirmatory tests include magnetic resonance imaging (MRI) and diagnostic laparoscopy. Case Report: A 36-year-old patient, amenorrheic for 9–10 weeks, presented to the early pregnancy unit complaining of a one-day history of abdominal pain associated with an episode of vomiting. She denied vaginal bleeding and examination revealed left lower quadrant tenderness. Ultrasound imaging demonstrated a live abdominal pregnancy around 12 weeks’ gestation implanted on the left uterine surface. Following appropriate counselling, she opted for surgical management and consented to the termination of pregnancy. She underwent diagnostic laparoscopy which confirmed that the gestational sac was arising from the left lateral uterine angle and was densely adherent to the omentum and bowel. The procedure was converted to laparotomy to enable safe adhesiolysis and excision of the entire gestational sac. Postoperatively, she represented on day 12 with abdominal pain, fever and bleeding. Computed tomography of abdomen and pelvis (CT-AP) suggested left ureteric injury and she underwent retrograde double J urethral stent (JJ stenting) of the left ureter. Fortunately, the same healed with conservative management. Conclusion: Abdominal pregnancy is rare and poses challenges in diagnosis and management. Once diagnosed, urgent surgical management is recommended given the high risk of complications including intra-abdominal bleeding and visceral injury. Therefore, each case requires a careful and considered treatment approach by a multi-disciplinary team.

Retroperitoneal Approach to D3-Lymph Node Dissection With Left Colic Artery Preservation in the Treatment of Sigmoid Cancer.

Laparoscopic approaches and robot-assisted operations are used for colorectal cancer surgery because of their minimal invasiveness.1 However, changes in intra-abdominal pressure during laparoscopy can lead to cardiovascular complications in compromised patients;2 obesity and intraabdominal adhesions may further interfere with laparoscopic procedures. The retroperitoneal approach may facilitate minimally invasive surgery, even in patients with comorbidities. The technique for high ligation of the inferior mesenteric artery has been described in left colonic surgeries.3 However, complete termination of the blood supply through this artery may lead to a higher frequency of anastomotic leakage.4. We present a novel retroperitoneal approach for D3-lymph node dissection with low ligation of the inferior mesenteric artery and preservation of the left colic artery. This method can reduce the duration of laparoscopic procedures for compromised patients and meet the standards for extended lymph node dissection with tumor-specific mesocolic excision.5,6. The procedure started with the installation of a paraumbilical optical trocar to introduce a 30-degree optical system. The SILS™ Port (Covidien, Medtronic) was inserted into the retroperitoneal space via a 4-cm incision, made 2 cm below and parallel to the anterior superior iliac spine in the left flank under the control of the optical system. The horizontal aspect of the duodenum served as the cranial landmark during interfascial dissection, with the dissection proceeding in a cranial and medial direction. During the dissection, the left ureter was the primary landmark, passing medial to the gonadal vessels and Gerota's fascia.The aorta was exposed medially and the inferior mesenteric artery was identified. The inferior mesenteric artery was skeletonized from its origin until the branching of the left colic artery and the sigmoid artery. The left colic artery was skeletonized until the passage of the inferior mesenteric vein, and the apical lymphatic nodes with mesocolic tissue were mobilized and excised. The inferior mesenteric artery was cut below the left colic artery.The final step was performed laparoscopically. The parietal fascia along Toldt's line was cut laterally to complete the mesocolon excision. The parietal fascia was cut along the right side of the aorta to free the mesocolonic medial border. The sigmoid mesocolon was dissected at the proximal and distal resection margins.Following mobilization, the colon was cut 10 cm distal to the tumor margin using a linear stapler. The specimen was then extracted using an SILS incision. The sigmorectal anastomosis was made. Atypical hepatic resection was performed using two additional trocars. The incidence of pain syndrome in the early postoperative period was low. Blood loss reached 100 mL. The duration of the surgery was 300 min. The retroperitoneal step took 63 min. Metastases were observed in 7 of the 41 harvested lymph nodes. The patient was discharged on the 8th postoperative day. The retroperitoneal technique can be safely performed. Anatomical structures are readily accessible and easily visualized with this approach after special training, enabling extended lymph node dissection.

Successful endourological treatment for a rare case of atazanavir-induced urinary stones.

Atazanavir, an anti-HIV drug, induces urinary stone formation. We herein report a case of atazanavir-induced bilateral ureteral stones treated with endourological procedures. A 47-year-old male patient on atazanavir was admitted with right flank pain. The patient's serum creatinine level was 3.60 mg/dL. Plain computed tomography showed bilateral hydronephrosis. The left upper ureter was obstructed by a 13 × 12 × 9-mm mass, which had very low CT attenuation values. The lower part of the right ureter was obstructed, but no mass was observed. Given his medical history, we suspected bilateral ureteral obstruction caused by drug-induced stones. A ureteral stent was successfully inserted on the right side, but not on the left side. Thereafter, a bilateral ureteroscopic lithotripsy was performed. Infrared spectrophotometry revealed that the stone component was atazanavir. Understanding the characteristics of these rare drug-induced stones will aid in the proper early diagnosis and treatment.

Deep-learning-based method for the segmentation of ureter and renal pelvis on non-enhanced CT scans

This study aimed to develop a deep-learning (DL) based method for three-dimensional (3D) segmentation of the upper urinary tract (UUT), including ureter and renal pelvis, on non-enhanced computed tomography (NECT) scans. A total of 150 NECT scans with normal appearance of the left UUT were chosen for this study. The dataset was divided into training (n = 130) and validation sets (n = 20). The test set contained 29 randomly chosen cases with computed tomography urography (CTU) and NECT scans, all with normal appearance of the left UUT. An experienced radiologist marked out the left renal pelvis and ureter on each scan. Two types of frameworks (entire and sectional) with three types of DL models (basic UNet, UNet3 + and ViT-UNet) were developed, and evaluated. The sectional framework with basic UNet model achieved the highest mean precision (85.5%) and mean recall (71.9%) on the test set compared to all other tested methods. Compared with CTU scans, this method had higher axial UUT recall than CTU (82.5% vs 69.1%, P < 0.01). This method achieved similar or better visualization of UUT than CTU in many cases, however, in some cases, it exhibited a non-ignorable false-positive rate. The proposed DL method demonstrates promising potential in automated 3D UUT segmentation on NECT scans. The proposed DL models could remarkably improve the efficiency of UUT reconstruction, and have the potential to save many patients from invasive examinations such as CTU. DL models could also serve as a valuable complement to CTU.

Mechanistic study on lncRNA XIST/miR-124-3p/ITGB1 axis in renal fibrosis in obstructive nephropathy

ObjectiveThe purpose of this study was to investigate the role and possible mechanism of lncRNA XIST in renal fibrosis and to provide potential endogenous targets for renal fibrosis in obstructive nephropathy (ON). MethodsThe study included 50 cases of ON with renal fibrosis (samples taken from patients undergoing nephrectomy due to ON) and 50 cases of normal renal tissue (samples taken from patients undergoing total or partial nephrectomy due to accidental injury, congenital malformations, and benign tumors). Treatment of human proximal renal tubular epithelium (HK-2) cells with TGF-β1 simulated renal fibrosis in vitro. Cell viability and proliferation were measured by CCK-8 and EdU, and cell migration was measured by transwell. XIST, miR-124-3p, ITGB1, and epithelial-mesenchymal transition (EMT)-related proteins (E-cadherin, α-SMA, and fibronectin) were detected by PCR and immunoblot. The targeting relationship between miR-124-3p and XIST or ITGB1 was verified by starBase and dual luciferase reporter gene experiments. In addition, The left ureter was ligated in mice as a model of unilateral ureteral obstruction (UUO), and the renal histopathology was observed by HE staining and Masson staining. ResultsON patients with renal fibrosis had elevated XIST and ITGB1 levels and reduced miR-124-3p levels. The administration of TGF-β1 exhibited a dose-dependent promotion of HK-2 cell viability, proliferation, migration, and EMT. Conversely, depleting XIST or enhancing miR-124-3p hindered HK-2 cell viability, proliferation, migration, and EMT in TGF-β1-damaged HK-2 cells HK-2 cells. XIST functioned as a miR-124-3p sponge. Additionally, miR-124-3p negatively regulated ITGB1 expression. Elevating ITGB1 weakened the impact of XIST depletion on TGF-β1-damaged HK-2 cells. Down-regulating XIST improved renal fibrosis in UUO mice. ConclusionXIST promotes renal fibrosis in ON by elevating miR-124-3p and reducing ITGB1 expressions.

A Rare Case of Retroperitoneal Schwannoma in an Adult Male

Objective. This study aims to illustrate a rare case of retroperitoneal schwannoma by presenting the clinical, imaging, and histological parameters. Case Report. A 36-year-old patient visited the outpatient clinic because of back pain experienced over the previous two months. There were no complaints regarding the nervous system or urinary system. Thorough imaging evaluation, including magnetic resonance for the lumbar spine, abdominal computed tomography, and positron emission tomography was conducted. An encapsulated mass was found in the retroperitoneal area, positioned in front of the O4 vertebra and in close proximity to the left psoas muscle, the left common iliac artery, and the left ureter. The lesion exhibited FDG radioisotope uptake, and a CT-guided biopsy confirmed a benign peripheral nerve tumor. The patient underwent laparotomy surgery, where the tumor was removed. The histological investigation, along with immunohistochemistry, confirmed the presence of a retroperitoneal schwannoma. Conclusion. Schwannoma is a rare type of retroperitoneal tumor, with nonspecific clinical and radiological characteristics that make diagnosis difficult. Surgical resection is the primary treatment for symptomatic patients, with a favorable prognosis. Long-term follow-up is advised to reduce the chance of late recurrence.

A Rare Cause of Macroscopic Hematuria: Ureteral Fibroepithelial Polyp: A Case Report

Fibroepithelial polyps are rare, benign, non-epithelial tumors of the urinary system. They can occur throughout the entire urinary system, including the renal pelvis, ureter, bladder, and urethra, which are lined with urothelium. These polyps originate from the stromal structure, formed by the combination of mesodermal and urothelial cells. The most common clinical complaint of patients with fibroepithelial polyps is unilateral flank pain. In some cases, this pain may be accompanied by hematuria, dysuria, and pollakiuria, which are irritative lower urinary tract symptoms. In this case report, a case of a giant ureteral fibroepithelial polyp in a patient who was admitted to our clinic with macroscopic hematuria and left flank pain was presented. Following the diagnosis of a giant polyp in the left ureter, we treated the patient with endoscopic ablation using a Holmium-YAG laser device under ureteroscopy guidance.

Laparoscopic ureteroureterostomy for benign non-passable upper ureteric stricture – A case report with review of literature

Ureteral stricture (US) is not a very common condition. The etiology of US could be either benign or malignant. It is mostly due to long-standing ischemia causing inflammation and fibrosis that ultimately leads to stricture formation. In most cases, diagnosis is made incidentally under direct visualization at the time of the ureteroscopic procedure. Surgery for ureteral reconstruction aims to achieve adequate vascular supply, a tension-free anastomosis with mucosal apposition, and to ensure complete excision of stricture-laden ureteral segments. We herein present the case of a 42-year-old male patient who presented with a complaint of acute pain in his left flank, radiating from the loin to the front, for 10 days. The workup investigations revealed a tight stricture in the left upper ureter, a 2-mm calculus in the left upper ureter proximal to the stricture, and left proximal hydroureteronephrosis. The patient was successfully managed by laparoscopic ureteroureterostomy.

Bilateral Complete Ureteral Duplication with Obstructing Stones in Both Left Ureters: A Case Report and a Review of Literature

Congenital anomalies like duplex renal collecting systems are rare developmental conditions. Among these anomalies, ureteral duplication is rarely observed, with partial ureteral duplication comprising a majority of cases. Bilateral ureteral complete duplication, where fully duplicated ureters drain separately into the bladder via separate orifices, is extremely rare, making it a seldom-documented anomaly in the medical literature. A case of bilateral complete ureteral duplication complicated by calculi in both the upper and lower moieties of the left kidney presented to the urology outpatient department with complaints of left flank pain for one month. His computed tomography-urogram revealed complete duplication of bilateral collecting systems with bilateral double ureters with an 8.2×5.9 mm2 sized stone in the pelvi-ureteric junction of the left upper moiety and 11.9×5.6 mm2 sized stone in the proximal ureter of left lower moiety causing hydronephrosis of both upper and lower moiety pelvicalyceal system. Calculi in both the upper and lower moieties were cleared in a single setting using a Ureteroscopic Lithotripsy. Duplex renal systems, while often asymptomatic, are linked to a higher occurrence of treatable conditions like stones and renal reflux diseases. The duplicated structure may lead to stagnant urine, causing obstructions and consequently infections. Stones that obstruct the ureter for a prolonged period can cause renal impairment and require active intervention. Currently, flexible or semirigid ureteroscopy with laser lithotripsy is the standard procedure. Even in this case, both stones were effectively managed in a single session using a standard procedure.

Construction and validation of a rat model of acute necrotizing pancreatitis-associated intestinal injury.

Acute pancreatitis (AP) is an acute inflammatory reaction of the pancreatic tissue, which involves auto-digestion, edema, hemorrhage, and necrosis. AP can be categorized into mild, moderately severe, and severe AP, with severe pancreatitis also referred to as acute necrotizing pancreatitis (ANP). ANP is characterized by the accumulation of necrotic material in the peritoneal cavity. This can result in intestinal injury. However, the mechanism of ANP-associated intestinal injury remains unclear. We established an ANP-associated intestinal injury rat model (ANP-IR model) by injecting pancreatitis-associated ascites fluid (PAAF) and necrotic pancreatic tissue at various proportions into the triangular area formed by the left renal artery and ureter. The feasibility of the ANP-IR model was verified by comparing the similar changes in indicators of intestinal inflammation and barrier function between the two rat models. In addition, we detected changes in apoptosis levels and YAP protein expression in the ileal tissues of rats in each group and validated them in vitro in rat epithelial crypt cells (IEC-6) to further explore the potential injury mechanisms of ANP-associated intestinal injury. We also collected clinical data from patients with ANP to validate the effects of PAAF and pancreatic necrosis on intestinal injury. Our findings offer a theoretical basis for restricting the buildup of peritoneal necrosis in individuals with ANP, thus promoting the restoration of intestinal function and enhancing treatment efficacy. The use of the ANP-IR model in further studies can help us better understand the mechanism and treatment of ANP-associated intestinal injury.NEW & NOTEWORTHY We constructed a rat model of acute necrotizing pancreatitis-associated intestinal injury and verified its feasibility. In addition, we identified the mechanism by which necrotic pancreatic tissue and pancreatitis-associated ascites fluid (PAAF) cause intestinal injury through the HIPPO signaling pathway.

Vesicovaginal Fistula Secondary to Left Ectopic Ureter in a 3-Year-Old Female with Left Ureter-Duplication in Tamale Teaching Hospital, Ghana: A Case Report

Purpose: Vesicovaginal fistula (VVF) is a pathological connection between the bladder and vagina, primarily caused by gynaecological surgery, obstructed labour, and cesarean section. VVF significantly impairs quality of life and is prevalent in developing countries, with Africa seeing up to 130,000 new cases annually. Surgical repair, especially transvaginal approaches, remains the primary treatment. Paediatric cases of VVF, often linked to congenital anomalies like ectopic ureter, are rare and complex to manage. Methodology: We report a case of a 3-year-old female with continuous urinary leakage since birth, initially flagged for renal anomalies via prenatal imaging. Clinical examination was normal with no distress or developmental issues. Diagnostic assessments, including abdominal ultrasound and micturating cystourethrogram (MCUG), revealed left hydronephrosis, hydroureter, and a definitive vesicovaginal fistula. A CT Urogram confirmed the diagnosis, showing contrast leakage into the vagina. Findings: Diagnostic cystoscopy revealed a normally positioned right ureteric orifice, while the left was aberrantly positioned near the bladder neck. Culposcopy identified a ureterocele in the posterior fornix of the vagina. During laparotomy, a dilated left distal ureter was observed entering the vagina, indicating true ureter duplication. The surgical intervention involved left ureteric reimplantation using the antireflux method, successfully resolving the anomaly. Post-operative recovery was smooth, with significant improvement in urinary symptoms and no recurrence or complications noted during follow-up. Unique contribution to theory, policy and practice: VVF secondary to ectopic ureter in paediatric patients is rare but manageable with early diagnosis and tailored surgical intervention. Our case underscores the importance of a multidisciplinary approach and the efficacy of ureteral reimplantation in treating complex congenital anomalies, leading to favourable outcomes and symptom resolution.

Renal Fornix Rupture Due To Acute Ureteral Obstruction

Background: Renal fornix rupture with fluid extravasation is a rare complication in cases of ureteral obstruction, which is usually caused by obstructive ureterolithiasis. The symptoms of renal fornix rupture are not very specific and can easily go unnoticed due to their underlying cause. Case representation: The present article reports a case of a patient of a 70-year-old, male, who was diagnosed with a ruptured renal fornix due to acute ureteral obstruction, following clinical assessment and a non-contrast CT scan. The proposed course of action was the endoscopic placement of a double J ureteral catheter. Conclusion: In the case described, the conservative treatment that was chosen by passing a double J catheter through the left ureter, for the patient proved to be an alternative to surgical treatment in the acute event, reducing the risk of possible complications from the operation. It was possible to conclude that although renal fornix rupture is a rare emergency with multiple etiologies, conservative treatment with urinary diversion using a double J ureteral stent was effective in solving the patient's acute condition.

Huoxue Jiedu Huayu recipe inhibits macrophage-secreted vascular endothelial growth factor-a on angiogenesis and alleviates renal fibrosis in the contralateral kidneys of unilateral ureteral obstruction rats.

Male Wistar rats were randomly divided into 4 groups: the sham group, UUO group (180 d of left ureter ligation), UUO plus eplerenone (EPL) group, and UUO plus HJHR group. After 180 d of oral drug administration, blood and contralateral kidneys were collected for analysis. Angiogenesis- and fibrosis-related indexes were detected. HJHR and EPL improved structural damage and renal interstitial fibrosis in the contralateral kidney and reduced the protein expression levels of α-smooth muscle actin (α-SMA), vimentin and collagen I. Moreover, these treatments could reduce the expression of vascular endothelial growth factor-A (VEGFA) by inhibiting the infiltration of macrophages. Furthermore, HJHR and EPL significantly reduced the expression of CD34 and CD105 by downregulating VEGFA production, which inhibited angiogenesis. Finally, the coexpressions of CD34, CD105 and α-SMA were decreased in the HJHR and EPL groups, indicating that endothelial-to-mesenchymal transition was inhibited. These findings confirm that HJHR alleviates contralateral renal fibrosis by inhibiting VEGFA-induced angiogenesis, encourage the use of HJHR against renal interstitial fibrosis and provide a theoretical basis for the clinical management of patients with CKD.

Ureteroenteric strictures after cystectomy: Side-specific risk factors and radiological assessment.

To evaluate risk factors contributing to side-specific benign ureteroenteric strictures following radical cystectomy with an ileal conduit. Data obtained from patients with bladder cancer who underwent radical cystectomy with ileal conduit surgery between 2015 and 2018 were retrospectively analysed. Imaging prior to surgery was analysed, regarding calcifications in the aorta, sarcopenia and postoperatively for length of remaining left ureter. Descriptive analyses were performed on preoperative and perioperative data, comparing patients who developed unilateral left- or right-sided strictures, bilateral strictures, to those who remained free of strictures. COX regression analysis was employed to calculate crude and adjusted hazard ratio for side-specific strictures. The study included 395 patients. Strictures developed in 19% (75/395) of the patients, within a median period of 9months: 57% (43/75) unilateral left sided, 20% (15/75) unilateral right sided and 23% (17/75) bilateral. Unilateral left-sided stricture was associated with higher body mass index (p = 0.077) and hypercholesterolemia (p = 0.007). Right-sided stricture was associated with a history of prior abdominal surgery (p = 0.029) and postoperative leakage (p = 0.004). Bilateral stricture was associated with smoking (p = 0.006) and high BMI (p = 0.015). The adjusted HR comparing patients with and without previous abdominal surgery was only significantly higher for right-sided ureteroenteric strictures (HR 3.18 [95% CI: 1.11; 9.05]) compared with patients without strictures. No association was identified between strictures and preoperative aortic calcification of the abdominal aorta or sarcopenia as estimated from imaging. The aetiology of ureteroenteric strictures appears multifactorial. Our findings suggest that development of left-sided stricture is influenced by factors associated with metabolic syndrome, indicating a potential role of distal ureteric ischemia. On the other hand, right-sided stricture was more frequent in patients with previous abdominal surgery and postoperative leakage.

Is Open Ureterolithotomy Finished? : A Case of Giant Ureteral Stone and Screening of the Literature

INTRODUCTION: Open surgery is an old method of urology in the treatment of ureteral stones. With the development of new technologies; Indications for open surgery in the treatment of stone disease have decreased to 1-5.4 %. In this case, we aimed to remove 4 stones with a diameter of 22 mm at the lower end of the left ureter by open ureterolithotomy and to report similar cases in the literature. CASE: In the direct urinary system X-ray and abdominal computed tomography of the patient who applied to us with the complaint of left flank pain, 4 stones with a diameter of 22 mm in the lower end of the left ureter, grade 4 hydroureteronephrosis in the left ureter and kidney were observed. Left open ureterolithotomy was planned. The patient's stones were removed using the left Gibson incision technique, and the ureteral incision area was sutured by placing a 6f double j catheter into the ureter. A drain was placed in the left ureteral tracing and the procedure was terminated by suturing the Gibson incision. The patient's foley catheter was removed on the 1st day and the drain was removed on the 2nd day, and he was discharged. No postoperative complications were encountered. Six weeks later, the patient's 6f double j catheter was removed and the surgical procedure was completed. DISCUSSION: Ureteral stones usually form in the primary kidney and then descend into the ureter. Ureteral stones usually pass spontaneously, but stones larger than 1 cm have fewer spontaneous passages. Ureteral stones are usually single and smaller than 2 cm. For stones larger than 5 cm, the term giant ureteral stone is used. Paik et al. reported a mean blood loss of 144 cc and a mean hospital stay of 6.5 days in seven patients with open ureterolithotomy. All patients in the series were stone-free and had no complications. In another study, open ureterolithotomy was performed in 56 patients, and 46.4% of the patients had stones in the distalureter. While the hospital stay was 4.2 days, no complications were encountered. CONCLUSION: Open ureterolithotomy has lost its status as the gold standard with the development of ureterorenoscopy, but as in our case, it is a surgical technique that should be considered in large ureteral stones.

Distal renal tubular acidosis as a rare complication of vesicoureteral reflux in children: a case report and literature review.

Distal renal tubular acidosis (dRTA) is a clinical picture of hyperchloremic hypokalemic metabolic acidosis with a normal anion gap. It can be caused by a variety of conditions including obstructive uropathy such as vesicoureteral reflux (VUR). We report a rare case of dRTA secondary to VUR in a 4-year-old girl with a history of meningomyelocele, neurogenic bladder and recurrent urinary tract infections. She was admitted to the hospital with complaints of polydipsia, polyuria, and inability to gain weight for the last 1year. She was on prophylactic antibiotic treatment with clean intermittent catheterization and anticholinergic drug. She had a history of subureteral injection of various agents and botulin toxin injection into the bladder. Her voiding cystourethrogram revealed grade 5 VUR in the left kidney, tortuosity in the left ureter, and the bladder had a dome-like appearance and was trabeculated. When all laboratory values of the patient since birth were examined, it was observed that urine pH was high despite hypokalemic hyperchloremic metabolic acidosis for the last year; these abnormalities became more severe in the last few months. In conclusion, the development of hypokalemia and nephrolithiasis/nephrocalcinosis along with metabolic acidosis in a patient diagnosed with VUR should be considered as an indicator of impaired tubular functions. Also, the possibility of an underlying VUR in the presence of recurrent urinary tract infection in a patient diagnosed with dRTA should not be ignored.

Unilateral incomplete duplication of the left ureter: a case report

Unilateral incomplete duplication of the left ureter: a case report