Moderate Bilateral Hydronephrosis Research Articles

Pyeloureteral Jonction upon a Horseshoe Kidney

The horseshoe kidney is the most common renal fusion anomaly, affecting around 0.25% of the general population. We report the rare case of a 14-year-old child with a horseshoe kidney, admitted to hospital for chronic abdominal pain and burning micturition. Physical examination revealed umbilical tenderness. Abdominal ultrasound showed a horseshoe kidney associated with moderate bilateral hydronephrosis. CT scan revealed fusion of the kidneys at their lower poles and obstruction of the ureteropelvic junction (UPJ).

Manejo não cirúrgico da obstrução da junção vesicoureteral: um relato de caso

Objective:To report the case of a pediatric patient with bilateral hydronephrosis due to vesicoureteral junction obstruction (VUJO) that was treated non-surgically and to discuss the approach of this anomaly.Case Description:A 25-month-old boy was referred without complaints for consultation due to prenatal ultrasound showing kidneys with cysts. He was under antibiotic prophylaxis. No family history of kidney disease and/or inherited disorders was reported. Renal ultrasound (RUS) at 2 days of life showed bilateral hydronephrosis, thus ruling out the possibility of kidney cystic disease. Dynamic renal scintigraphy (DTPA) showed marked retention of the marker in the pyelocaliceal system bilaterally, with little response to diuretic drug. He was maintained under antibiotic prophylaxis, when a new RUS showed bilateral ureteral dilatation, abrupt stenosis in the ureterovesical transition region (0.2 cm caliber), moderate bilateral hydronephrosis, and slight renal cortical thickness, confirming the diagnosis of VUJO. At 2 years and 10 months of age, DTPA showed hydronephrosis and ureteral stasis in both kidneys secondary to stenosis at the vesicoureteral junction (VUJ) level, with preservation of kidney function and slow degree of emptying. We opted for a non-surgical approach. RUS at 10 years of age showed significant improvement of all parameters, with ureteral transverse diameter of 9 mm, preserved VUJ, and age-appropriate bilateral kidney development.Comments:VUJO is a major cause of prenatal hydronephrosis and can trigger a deterioration of kidney function. Its treatment is still controversial but should take into account the importance of clinical follow-up and serial imaging evaluation.

Recurrent urinary tract infection due to large urinary bladder calculus in a 6-year-old child

Urinary bladder calculus is an uncommon presentation in the tropics, especially in children. Large (>2.5 cm) or giant bladder stones are rare and are more common in males due to higher incidence of lower urinary tract obstruction. Ultrasonography and plain radiography play an important role in the diagnosis of urinary bladder stone as well as evaluation for complications that may be associated with this condition. A 6-year-old boy presented with a 3-month history of abdominal pain and dysuria. He was treated with antibiotics on several occasions in a rural health center with no satisfactory improvement of his symptoms. Ultrasound and intravenous urography showed a huge oval urinary bladder calculus measuring 4.5 cm × 4.2 cm × 4.0 cm with moderate bilateral hydronephrosis. We presented a rare case of large bladder calculus in a 6-year-old boy with recurrent urinary tract infection highlighting the role of ultrasonography and excretory urography in the management.

2732 Signet Ring Cell Carcinoma: A Rare Case Report Masquerading as Digital Infarction

INTRODUCTION: Signet Ring Cell Carcinoma (SRCC) is a mucin producing adenocarcinoma, commonly seen in the gastrointestinal tract, also rarely in the urinary bladder, pancreas, breast and gallbladder. Tumor embolism due to slowly evolving disseminated intravascular coagulation (DIC) can manifest as digital infarction and this report highlights its presentation in a case of SRCC. CASE DESCRIPTION/METHODS: An 82-year-old African American lady presented with 2 weeks of low back pain, hematuria and purplish discoloration of toes. Physical exam was significant for multiple gangrenous digits but palpable pulses. CT Abdomen and Pelvis revealed diffuse bony metastases and moderate bilateral hydronephrosis. Labs were significant for Hemoglobin of 6.6 gm/dl and Creatinine 1.8. Bone marrow biopsy was consistent with metastatic carcinoma of SRCC. Pathologic staining was positive for AE1/AE3, CK7, CK20, and CDX2, suggestive of gastric tract origin than urinary bladder. Further investigation for the location of the primary tumor was negative. Evaluation for peripheral arterial disease, vasculitis, thrombophilia, and endocarditis for digital infarction was negative. With elevated D-Dimer, prolonged PTT and normal fibrinogen suggestive of slowly evolving DIC, digital infarction from tumor embolism was diagnosed. Ureteral stent placement for hydronephrosis was attempted but was unsuccessful due to multiple clots in the bladder, likely owing to DIC and she further deteriorated to end stage renal disease. Goals of care were discussed with the patient and she was transitioned to hospice care. DISCUSSION: Slowly evolving DIC is seen in cancer (mostly adenocarcinoma), liver disease, aneurysm, hemangioma and rarely sepsis. It’s believed that the destruction and production of coagulation factors/platelets are balanced. Diagnostic labs indicate thrombocytopenia, normal to prolonged PT/PTT, normal to low fibrinogen level and elevated D-Dimer. Heparin is the treatment of choice when bleeding is not suspected. Unfortunately, heparin was contra-indicated in our patient who had hematuria. In conclusion, this case illustrates the aggressive presentation of SRCC, which can present as digital infarction. Identifying tumor embolism and slowly evolving DIC is important as it may indicate poor prognosis. This case is unique in its presentation and cancer should be ruled out in digital infarction when other common causes are not identified.

SUN-430 An Unusual Presentation of Hypopituitarism in the Setting of Metastatic Breast Carcinoma: A Case Report

Introduction: Metastasis to the pituitary gland (PM) are infrequent (1). Breast and lung cancer are the most common primary cancer of PM. We report an interesting case of metastatic breast cancer with pituitary gland involvement debuting with diabetes insipidus as the initial symptom. Clinical Case: A 59-year-old woman presented with symptoms of polydipsia, polyuria, unquantifiable weight loss, and generalized body weakness. Initial assessment showed evidence of panhypopituitarism as per: FT4 0.39 (0.60-1.32 ng/dL), TSH 1.39 (0.45-5.33 uIU/mL), Cortisol 1.8 (6.7-22.6 ug/dL), ACTH 13 (6-50 pg/mL), Prolactin 223.5 (2.74-19.64 ng/mL), Estradiol 222 (<= 31 pg/mL) while on estradiol pellets, LH 0.2 (10.87-58.64 mIU/mL), FSH 1.6 (16.74-113.59 mIU/mL), Na 146 mmol/L, Cl 112 mmol/L, and urine specific gravity 1.004. MRI of the brain reported a pituitary macroadenoma measuring 1.0x1.6x1.8 cm, extending posteriorly along the infundibulum. She was initially treated with hydrocortisone, levothyroxine, cabergoline, and desmopressin. Physical examination was remarkable for a right breast lump. Breast ultrasound showed a mass measuring 1.2x1.2 cm. A biopsy was performed reporting invasive lobular carcinoma, Nottingham histologic grade 2 [ER (85%) PR (61%) and HER2 negative with a KI67 of 2%]. Posteriorly, the patient underwent pituitary biopsy and trans sphenoidal resection with pathology report of metastatic breast carcinoma [ER 20% PR 2% HER2 negative by FISH]. Pituitary stains were negative for prolactin.Subsequent breast cancer staging with CT Abdomen/pelvis and 18F-FDG PET/CT revealed widely metastatic disease including right and left breast, bilateral axillary LAD, moderate bilateral hydronephrosis, and extensive bone disease in the axial and appendicular skeleton. Patient has been treated with 15 cycles of whole-brain radiation therapy, and the current treatment approach is no longer curative, focused on palliative chemotherapy and hormonal replacement therapy. Prolactin levels have normalized. Conclusion: Our case remarks the importance of working up pituitary macroadenomas with diabetes insipidus. Even though metastatic pituitary tumors are rare, awareness of clinical presentation is essential to keep in our differential that isolated pituitary tumors can be an initial presentation of the metastatic process, allowing early diagnosis and interventions. Keywords: Hypopituitarism, Pituitary Gland, Pituitary Metastasis

Acute renal insufficiency, secondary to the advanced pelvic organ prolapse and its resolution

The hydronephrosis associated with advanced pelvic organ prolapse is known in rare cases it causes severe acute or chronic renal failure We present the case of a year old patient who consulted for emergencies due to drowsiness and fatigue symptoms associated with acute renal failure At the physical examination of evidenced prolapse of pelvic organs Grade IV complementary tests report moderate bilateral hydronephrosis acute renal failure and urinary sepsis The diagnosis and reduction of urogenital prolapse through surgical treatment demonstrates the resolution of the clinical picture with adequate functional aesthetic and social recovery in the patient

Abnormal Contour Huge Uterine Fibroids

Uterine fibroids represent the most common large solid benign tumor of the female genital tract. This 35 years old lady, mother of one child represented to our clinic with a history of progressive abdominal swelling that had rapidly increased in the last two years. There were associated abdominal pain, easy fatigability, heavy menstrual loss and prolong secondary subfertility of about ten years. On examination abdomen was enlarged and the mass measuring about 25cm from xiphisternum, firm, irregular and fairly mobile. Pelvic ultrasound scan revealed features of huge multiple uterine fibroids and the size of the largest one was about 20x25cm,moderate bilateral hydro-nephrosis. Intraoperative findings were moderate pelvic adhesions, huge multiple fibroids and the largest measuring about 18x20cm. Total abdominal hysterectomy with preservation of both ovaries were done. Histopathological report confirmed benign leiomyoma with no evidence of malignancy.Medicine Today 2015 Vol.27(2): 49-50

A Rare case of Aphallia

. Aphallia (total absence of penis) is an extremely rare abnormality that can be part of the urorectal septum malformation sequence. We are reporting a 40-day-old boy who was referred to our nephrology clinic due to the absence of the penis and urinating through the rectum. He was born to a 17-year-old mother and a 24-year-old father, and was delivered term via normal vaginal delivery. The pregnancy was uncomplicated with no maternal toxin or medication exposure. Both parents were healthy and there was no family history of congenital abnormality. The parents were also unrelated. Physical examination revealed agenesis of the penis, a normal scrotum, and bilateral normally positioned testises. Moreover, the heart, lungs, abdomen, head and neck, and spinal column were all normal on examination. The karyotype was 46XY and the gender was male. Initial ultrasonography one week after birth revealed moderate bilateral hydronephrosis but the last ultrasonography 45 days later revealed only mild fullness of both kidneys. Keywords: Aphallia; Gender; penile agenesis.

Warfarin-induced bilateral renal hematoma causing acute renal failure

Acute renal failure due to bilateral hematoma is a rare complication of anticoagulant warfarin therapy. A 43-year-old man presented with complaints of hematuria and abdominal pain. He had been receiving warfarin for six years, after placement of an aortic valve prosthesis. One week prior to admission, he sustained a urinary tract infection which was treated with third-generation cephalosporin and indomethacin. His serum creatinine level was 1.8 mg/dl with an INR of 15. Three days later, he developed anuria and was treated with hemodialysis. Renal ultrasonography disclosed moderate bilateral hydronephrosis. Computed tomography without contrast enhancement showed bilateral extensive hyperdense thickening of the renal and ureteral walls and high-attenuation areas. Conservative treatment was preferred and diuresis resumed spontaneously, lumbar pain disappeared, and serum creatinine level returned to normal. One month later, renal computed tomography was found normal.

Obstructive nephropathy and kidney injury associated with ketamine abuse

A 26-year-old man presented to the emergency department in a state of collapse. One month prior to the current admission he was seen by a urologist with frank haematuria associated with colicky abdominal pain, increased urinary frequency and dysuria. Although he was initially treated for a urinary tract infection a CT abdomen demonstrated moderate bilateral hydronephrosis. No cause for the hydronephrosis was seen, in particular no calculi. Common bile duct (CBD) was measured at 8 mm. Cystoscopy revealed a diffusely inflamed bladder with marked reduction in capacity (150 cc) but no obstruction at the ureteric orifices. The bladder biopsy showed inflammatory change but no dysplasia or malignancy. No firm diagnosis was reached and the patient was discharged with outpatient follow-up. For 4 days prior to the current admission the patient had been unwell with increasing flank pain, but had become drowsy and short of breath. On arrival, blood pressure was low at 95/60 mmHg with an associated tachycardia (140 bpm, sinus rhythm) and tachypnoea (60 breaths/min). The Glasgow coma scale was 13/15 with no localizing neurological signs. Initial investigations revealed severe metabolic acidosis (pH 7.2, bicarbonate 6.4 mmol/l, pO2 39.3 kPa, pCO2 2.0 kPa) and acute renal failure (serum potassium 5.4 mmol/l, urea 36.7 mmol/l, creatinine 851 μmol/l). Liver function tests were abnormal with an obstructive pattern (serum bilirubin 58 μmol/l, alkaline phosphatase 294 IU/l, alanine transaminase 106 IU/l, γGT 1045 IU/l). Further history revealed that the patient was a regular user of street ketamine intra-nasally for the past 2 years.

Prenatally diagnosed patent urachus with bladder prolapse

We report 2 cases of patent urachus with bladder prolapse, which has a characteristic finding of "disappearance of cyst" antenatally. In the first case, a 34-year-old woman presented at 14 weeks gestation for evaluation of a cyst. Prenatal ultrasonography revealed a cystic mass at the base of the umbilical cord, communicating with the bladder. At 26 weeks gestation, the cyst had disappeared, and a solid mass bulged out inferior to the umbilical cord. At term, the patient delivered a male infant. Examination of the neonate demonstrated mucosal protrusion inferior to the umbilical cord. Catheterization confirmed communication with the bladder. We diagnosed patent urachus with bladder prolapse. In the second case, a 36-year-old woman presented at 19 weeks gestation for evaluation of moderate bilateral hydronephrosis and an abdominal cyst. Prenatal ultrasonography revealed a cystic mass at the base of the umbilical cord, communicating with the bladder. At 26 weeks gestation, the cyst had disappeared. At term, the patient delivered a male infant displaying patent urachus with bladder prolapse. Understanding of the development of urachus is important for prenatal diagnosis, which in turn allows surgery immediately after birth. We showed bladder function after surgery remains good at school age.

HYPERBARIC OXYGEN THERAPY FOR CYCLOPHOSPHAMIDE INDUCED REFRACTORY HEMORRHAGIC CYSTITIS IN A CHILD

No AccessJournal of UrologyPediatric Urology1 Aug 2004HYPERBARIC OXYGEN THERAPY FOR CYCLOPHOSPHAMIDE INDUCED REFRACTORY HEMORRHAGIC CYSTITIS IN A CHILD K.S. BRATSAS, A.A. STEPHANIDES, E. SPYROPOULOS, B.P. ZACHARIADES, and P.A. ANDROULAKAKIS K.S. BRATSASK.S. BRATSAS More articles by this author , A.A. STEPHANIDESA.A. STEPHANIDES More articles by this author , E. SPYROPOULOSE. SPYROPOULOS More articles by this author , B.P. ZACHARIADESB.P. ZACHARIADES More articles by this author , and P.A. ANDROULAKAKISP.A. ANDROULAKAKIS More articles by this author View All Author Informationhttps://doi.org/10.1097/01.ju.0000129267.31060.9dAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "HYPERBARIC OXYGEN THERAPY FOR CYCLOPHOSPHAMIDE INDUCED REFRACTORY HEMORRHAGIC CYSTITIS IN A CHILD." The Journal of Urology, 172(2), p. 679 References 1 : Urological complications of cyclophosphamide. J Urol1989; 141: 1063. Link, Google Scholar 2 : Comparison of the uroprotective efficacy of mesna and HBO treatments in cyclophosphamide-induced hemorrhagic cystitis. J Urol1997; 158: 2296. Link, Google Scholar 3 : Hyperbaric oxygen therapy for pediatric hemorrhagic cystitis. J Urol1999; 161: 1596. Abstract, Google Scholar From the Department of Pediatric Urology, Aghia Sophia Children’s Hospital (KSB, AAS, PAA) and Departments of Urology (ES) and Hyperbaric Medicine (BPZ), Athens Naval Hospital, Athens, Greece© 2004 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 172Issue 2August 2004Page: 679 Advertisement Copyright & Permissions© 2004 by American Urological Association, Inc.Keywordscystitiscyclophosphamidehyperbaric oxygenationiatrogenic diseasebladderMetricsAuthor Information K.S. BRATSAS More articles by this author A.A. STEPHANIDES More articles by this author E. SPYROPOULOS More articles by this author B.P. ZACHARIADES More articles by this author P.A. ANDROULAKAKIS More articles by this author Expand All Advertisement PDF downloadLoading ...

AN ALTERNATIVE URETEROILEAL REIMPLANTATION USED IN AUGMENTATION CYSTOPLASTY FOR NEUROGENIC BLADDER WITH BILATERAL VESICOURETERAL REFLUX

Purpose We describe the use of a serous lined extramural tunnel for ureteral reimplantation during augmentation of a neurogenic bladder to prevent reflux. Materials and Methods A 46-year-old male C6 spinal cord injury patient presented with a high pressure bladder, detrusor-sphincter dyssynergia and bilateral grade II/III vesicoureteral reflux. Despite maximal anticholinergic therapy and intermittent catheterization, detrussor pressures were between 80 and 100 cm. water at volumes of 100 to 150 cc with consistent leakage between catheterizations. Preoperative ultrasound and voiding cystourethrogram demonstrated moderate bilateral hydronephrosis and a heavily trabeculated bladder. Augmentation cystoplasty with the formation of 3 cm. extramural ureteral tunnels as described by Ghoneim was performed. The serosa of the adjacent limbs of the ileal segment were opposed to form the back wall of a serosal lined tunnel. Results At 3 weeks postoperatively a cystogram demonstrated no extravasation or reflux. At 8 weeks an excretory urogram showed prompt function and excretion bilaterally with marked improvement of preoperative hydronephrosis. Conclusions Subserosal ureteral tunnels can be used as an alternative antireflux technique during augmentation cystoplasty when ureteral reimplantation is required. Two advantages of this technique include the elimination of staples and avoidance of ischemic problems associated with an afferent intussuscepted nipple valve.

The influence of hydration and bladder distension on the sonographic diagnosis of hydronephrosis.

Renal sonography is frequently employed to exclude obstructive uropathy in patients with uremia. Sonographic findings of moderate bilateral hydronephrosis were encountered in a dehydrated patient undergoing rehydration. Subsequent excretory urography and a follow-up renal sonogram were normal. To investigate the possibility that hydration and bladder distension in an otherwise normal and unobstructed collecting system could result in hydronephrosis detectable by ultrasound, 23 apparently normal volunteers underwent renal sonography in the hydrated and basal states. The filled urinary bladder in a patient undergoing hydration frequently results in the sonographic appearance of hydronephrosis.