Normal Ureter Research Articles

Investigating cellular similarities and differences between upper tract urothelial carcinoma and bladder urothelial carcinoma using single-cell sequencing.

Upper tract urothelial carcinoma (UTUC) and bladder urothelial carcinoma (BLCA) both originate from uroepithelial tissue, sharing remarkably similar clinical manifestations and therapeutic modalities. However, emerging evidence suggests that identical treatment regimens may lead to less favorable outcomes in UTUC compared to BLCA. Therefore, it is imperative to explore molecular processes of UTUC and identify biological differences between UTUC and BLCA. In this study, we performed a comprehensive analysis using single-cell RNA sequencing (scRNA-seq) on three UTUC cases and four normal ureteral tissues. These data were combined with publicly available datasets from previous BLCA studies and RNA sequencing (RNA-seq) data for both cancer types. This pooled analysis allowed us to delineate the transcriptional differences among distinct cell subsets within the microenvironment, thus identifying critical factors contributing to UTUC progression and phenotypic differences between UTUC and BLCA. scRNA-seq analysis revealed seemingly similar but transcriptionally distinct cellular identities within the UTUC and BLCA ecosystems. Notably, we observed striking differences in acquired immunological landscapes and varied cellular functional phenotypes between these two cancers. In addition, we uncovered the immunomodulatory functions of vein endothelial cells (ECs) in UTUC, and intercellular network analysis demonstrated that fibroblasts play important roles in the microenvironment. Further intersection analysis showed that MARCKS promote UTUC progression, and immunohistochemistry (IHC) staining revealed that the diverse expression patterns of MARCKS in UTUC, BLCA and normal ureter tissues. This study expands our multidimensional understanding of the similarities and distinctions between UTUC and BLCA. Our findings lay the foundation for further investigations to develop diagnostic and therapeutic targets for UTUC.

Minimally invasive reconstruction of extensive mid-lower ureteral strictures using a bilateral Boari flap

ObjectiveTo describe and evaluate the technique using bilateral Boari flap ureteroneocystostomy (BBFUNC) for bilateral mid-lower ureteral strictures. MethodsWe retrospectively reviewed five patients who underwent minimally invasive BBFUNC in our institution (Union Hospital, Wuhan, China) between July 2019 and December 2021. The bilateral ureters were mobilized and transected above the stenotic segments. The bladder was isolated and incised longitudinally from the middle of the anterior wall. Then, an inverted U-shaped bladder flap was created on both sides, fixed onto the psoas tendon, and anastomosed to the ipsilateral distal normal ureter. Following double-J stenting, the Boari flaps were tubularized, and the bladder was closed with continuous sutures. The patients' perioperative data and follow-up outcomes were collected, and a descriptive statistical analysis was performed. ResultsNo case converted to open surgery, and no intraoperative complication occurred. The median surgical time was 230 (range 203–294) min. The median length of the bladder flaps was 6.2 (range 4.3–10.0) cm on the left and 5.5 (range 4.7–10.5) cm on the right side. All patients had not developed recurrent ureteral stenosis during the median follow-up time of 17 (range 16–45) months and had a normal maximum flow rate after surgery. The median post-void residual was 7 (range 0–19) mL. The maximal bladder capacity was decreased in one (20%) patient. ConclusionThe present study demonstrates that minimally invasive BBFUNC is feasible and safe in treating bilateral mid-lower ureteral strictures, and the impact on lower urinary tract function is limited.

Receiver operating characteristics of computed tomography (CT) compared to cystoscopy in diagnosis of canine ectopic ureters: Thirty-five cases.

The aim of the study was to determine receiver operating characteristics (ROC) of computed tomographic excretory urography (CTEU) in predicting cystoscopic findings of ureteral anatomy. Retrospective cohort study. Thirty-five client-owned dogs. The medical records of dogs referred for suspected ectopic ureters were reviewed. Inclusion criteria included CTEU findings reported by board-certified radiologists, followed by rigid cystoscopy with or without ureteral cystoscopic laser ablation (CLA). Data included signalment, urinary incontinence degree, body condition score, weight, degree of colon distension, CTEU and cystoscopy findings. ROC analysis was used to compare CT-predicted ureteral orthotopia/ectopia to cystoscopy findings. Additionally, ROC of CT predicted ureteral orifice locations was analyzed. Regression covariate analysis was performed to identify factors that may have influenced accuracy of diagnosis. The ability of CT to identify a normal and intra-or extramural ectopic ureters conclusively and correctly was 13/26 (50%) and 32/41(78%), respectively. Sensitivity and specificity of identifying extramural versus intramural ureters was 2/7 versus 30/46 (29 vs. 65%) and 61/63 versus 17/24 (97 vs. 71%), respectively. Ectopic orifice determination sensitivity and specificity varied widely depending on location from 0% to 76% and 67% to 97%, respectively. Covariate analysis failed to identify interfering factors. CT did not accurately predict anatomy of ureters; CT findings may need confirmation by cystoscopy and possibly intraoperative fluoroscopy prior to determining if CLA is indicated or not. Our results may be of importance for surgeons interpreting the CTEU findings. CTEU prediction of the location of the ureteral orifice shows low sensitivity especially in or close to the urethral sphincter area.

A novel in vivo model of ureteral fibrosis induced by calcium oxalate beads in C57BL/6J mice.

The global incidence of ureteroliths in humans is increasing, particularly posing a problem in developed countries. The most common stone type is calcium oxalate, which is associated with a high recurrence rate. In veterinary medicine, stones are the most common cause of ureteral obstruction in cats, accounting for 72-87% of cases. In cats, stones cause irreversible ureteral damage, necessitating stone treatment as well as ureteral therapy. However, the mechanisms underlying the ureteral damage caused by stones remain unclear. Therefore, this study aimed to create a mouse model suitable for studying the ureteral fibrosis caused by oxalate stones by artificially embedding calcium oxalate in the ureter. Pathological tissue analysis was used to compare normal ureters without ligation and ureters with sham or oxalate bead implantation. The ureters of the sham and oxalate bead groups showed granulation tissue formation, transitional epithelium exfoliation, and densely packed connective tissue in the proprietary and muscle layer regions. Particularly in the oxalate bead group, infiltration of degenerated neutrophils, presence of foreign body giant cells, and hyperplasia of the transitional epithelium were observed. The proportion of fibrosis was higher in the oxalate group than in the sham group. Overall, this mouse model created using oxalate bead implantation has the potential to efficiently induce ureteral obstruction. This mouse model is expected to be used for elucidating the molecular mechanisms of ureteral fibrosis and evaluating therapeutic drugs in future.

Congenital megacalice at Menontin Hospital in Benin: A case report and review of the literature

Background: Congenital megacalice of Puigvert is a rare congenital anomaly characterized by non-obstructive dilatation of the renal calyces with normal pelvis, ureter and bladder. Clinic Observation: We report the case of a left congenital megacaliceus without lithiasis or obstruction in a 36-year-old female patient discovered on uroscanner indicated for chronic abdominal pain. Conclusion: Congenital megacalice is a rare pathology, and only clinical and biological monitoring remains the basis of its management.

An Interesting Case Of A Horseshoe Kidney With Unilateral Single Ureter And Associated Anorectal Malformation

Horseshoe kidney (HSK) has an incidence of about 1 in 400 or 0.25% of the general population and is seen more commonly in males as compared to women in a ratio of 2:1. Usually, Horseshoe kidney would have two normal ureters each draining separately into the bladder. We present a rare and interesting case of Horseshoe kidney with unilateral single ureter and associated anorectal malformation.

Unilateral Incomplete Bifid Ureter with UPJ Syndromes: A Case Report

Introduction: The ureters are muscular tubes that extend from the kidneys to the urinary bladder. The urine is propelled along the ureter by peristaltic contraction of the muscle coat, assisted by the filtration pressure of the glomeruli. Bifid ureter (BU) are rare congenital anomalies. Is a condition in which the ureter is duplicated, and it can be classified into complete (when they join separately at the urinary bladder) or incomplete –Y ureter- (When they fuse at some point in their trajectory). In the literature, the prevalence of duplicated ureter approximately 0.8%. Case: A 39-year-old woman was presented with history of chronic right-side flank pain and not associated with other urological symptoms. Physical examination revealed right flank tenderness and normal renal function test; urine culture was negative. Contrast- enhanced computed tomography showed right bifid ureters associated with moderate right hydronephrosis with a fine ureters evoking ureteropelvic junction syndromes (UPJ). Cystoscopy with retrograde pyelography revealed a right bifid ureter. The patient consented to open surgery by right mini-incision lombotomy (pyelotmy and anastomos peylo-ureteal latero-lateral) which is after a double-J ureteral stent was placed in the normal right ureter. The postoperative follow up was good. Conclusion: The BU with ureteropelvic junction syndromes are rare congenital anomalies. It is very important to diagnose urinary tract anomalies prior to interventions and supplementary evaluations should be considered. Retrograde pylogram can be a good tool than intravenous pylogram to detect such anomaly. The management can be open or laparoscopic.

The Rho-kinase inhibitor Y27632 promotes ureteral relaxation in an in vivo rat model for partial ureteral obstruction.

Aim of this study was to evaluate the effect of intravenous Y27632 (a ROK inhibitor) on intra-ureteral pressures and on blood pressure in an in vivo rat model for unilateral partial ureteral obstruction (PUO). 15 Male Sprague Dawley rats were used. Under isofluran anesthesia, saline was continuously infused via polyethylene (PE)-10 catheters inserted in the ureters beneath the kidney pelvis. Left psoas muscle was sutured around the distal left ureter to create a partial obstruction. Carotid artery and femoral vein were cannulated with PE catheters for registration of mean arterial blood pressure (MAP) and for administration of drugs. Left and right ureter pressures and MAP were simultaneously recorded. Y27632 (0.03 and 0.1mg/kg each n = 6-7) was given intravenously. T-test was used for comparisons. Spontaneous peristaltic pressure waves were recorded at baseline for both ureters. After the obstruction, Y27632 reduced maximum pressure (MaxP) by 10.5 ± 1.9% (0.03mg/kg; p = 0.004) and 29.1 ± 4.8% (0.1mg/kg; p < 0.001), minimum pressure (MinP) by 5.2 ± 2.3% (0.03mg/kg; p = 0.02) and 12.2 ± 3.4% (0.1mg/kg; p = 0.009), the area under the curve (AUC) by 7.8 ± 2.4% (0.03mg/kg; p = 0.008) and 16.5 ± 3.7% (0.1mg/kg;p = 0.007), the waves amplitude by 23.4 ± 11.3% (0.03mg/kg; p = 0.098) and 38.7 ± 7.5% (0.1mg/kg; p < 0.001), with no effect on contraction frequency. During simultaneous recordings from the normal ureter at the investigated doses, Y27632 reduced MaxP, MinP, AUC and waves amplitude by 1-7%. The MAP was reduced by 12.5 ± 5.3% (0.03mg/kg; p = 0.07) and 15.8 ± 1.8% (0.1mg/kg; p < 0.001). Y27632 decreased intra-ureteral pressures of a partially obstructed ureter with limited effect on blood pressure in an animal model of unilateral PUO.

Congenital venous anomalies associated with retrocaval ureter: evaluation using computed tomography.

Retrocaval ureter is a rare congenital anomaly resulting from anomalous development of inferior vena cava (IVC) and not from anomalous of the ureter. The anomaly always occurs on the right side due to regression of right supracardinal vein and persistence of right posterior cardinal vein. Retrocaval ureter tends to be associated with various vena cava anomalies because of the embryogenesis. We aimed to identify the prevalence of associated congenital venous anomalies (CVA) resulting from cardinal vein development in adults with retrocaval ureter using computed tomography (CT) images. The study included 22 adults with retrocaval ureter. We evaluated CT findings and determined the incidence of associated CVA using thin slice data sets from CT scanner with 64 or more detectors. We compared the prevalence of CVA in the retrocaval ureter group (mean age: 57 ± 19 years) and in the control group of 6189 adults with normal ureter (mean age: 66 ± 14 years). In the retrocaval ureter group, 4 (18.2%) adults had CVA including double IVC, right double IVC, preisthmic IVC with horseshoe kidney, and preaortic iliac confluence. One of 2 adults with preaortic iliac confluence had right double right IVC. In the control group, 49 (0.79%) adults had CVA including 37 double IVC, 11 left IVC, and 1 IVC interruption azygos continuation. Fifteen horseshow kidneys were found. The prevalence of associated CVA in the retrocaval ureter group was higher than that in the control group (p < 0.001). Retrocaval ureter is frequently associated with CVA. Various CVA with retrocaval ureter could happen because of abnormal development of not only the right posterior or supra cardinal vein but also other cardinal veins.

MP70-04 URETERAL PERISTALSIS LONGITUDINAL MOTION MINIMIZES REFLUX

You have accessJournal of UrologyCME1 Apr 2023MP70-04 URETERAL PERISTALSIS LONGITUDINAL MOTION MINIMIZES REFLUX Kourosh Kalayeh, Haotian Xie, J. Brian Fowlkes, William W. Schultz, and Bryan S. Sack Kourosh KalayehKourosh Kalayeh More articles by this author , Haotian XieHaotian Xie More articles by this author , J. Brian FowlkesJ. Brian Fowlkes More articles by this author , William W. SchultzWilliam W. Schultz More articles by this author , and Bryan S. SackBryan S. Sack More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003338.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Lack of sufficient ureteral peristalsis is theorized as one of the mechanisms contributing to ureteral dilation in vesicoureteral reflux (VUR) and non-obstructing megaureters. To help understand the phathophysiologic mechanism for these disorders, we first need to understand the dynamics of normal ureteral peristalsis, which results in near complete clearance of urine from the ureter (i.e., non-dilated). We hypothesize that the clinically observed ureteral wall longitudinal motion is crucial to prevent and/or limit peristaltic reflux (i.e., retrograde flow of urine during an episode of peristalsis). METHODS: To examine this hypothesis, based on the lubrication theory in fluid mechanics, we modeled ureteral peristalsis mathematically as an infinite train of sinusoidal waves and analyzed the antegrade and retrograde flows in the ureter. In doing so, we accounted for ureteral wall longitudinal motion by imposing a periodic Gaussian longitudinal velocity on the wall, Figure 1 (a) and (b), inspired by videos of ureteral operations. RESULTS: Effects of wall longitudinal motion on peristaltic reflux and performance are shown in Figure 1 (c) & (d), and Figure 2 (a) & (b), respectively. The results are shown as an example for a typical clinical case with discharge rate of 1.62 mL/min and peristaltic amplitude of 80 % of lumen diameter. As shown, by considering wall longitudinal motion, the range of urine flow rates resulting in peristaltic reflux drops substantially. The minimum required flow rate to prevent peristaltic reflux drops by 50% when including the wall longitudinal motion effect, Figure 2 (a). Similarly, the required flow rate to limit the reflux volume fraction below a critical value of 2% (chosen as an example, based on clinical expertise) drops by 70%, Figure 2 (b). CONCLUSIONS: This computational model is the first to include longitudinal wall motion, which aligns with our hypothesis that it is important for minimizing peristaltic reflux. This supports the clinical observation of normal ureters having high emptying ability and helps direct further investigations to understand ureteral disorders. Source of Funding: This research has been partially supported by grants from the Michigan Institute for Clinical and Health Research (MICHR), and the Departments of Urology and Radiology at the University of Michigan © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1004 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kourosh Kalayeh More articles by this author Haotian Xie More articles by this author J. Brian Fowlkes More articles by this author William W. Schultz More articles by this author Bryan S. Sack More articles by this author Expand All Advertisement PDF downloadLoading ...

Unusual presentation of duplex kidney with poor functioning upper moiety in an adult patient a case report

Renal duplexing (also known as a duplicate collection system) occurs in about 1% of children and does not usually require medical attention. The condition results in two tubes rather than the normal single ureter tube for each kidney. Medical problems that warrant attention are obstruction of urine flow or the backflow of urine into the kidney (reflux). These double ureter tubes can join in a "y" shape before reaching the bladder (partial duplex) and combining their urine delivery. In other cases, each duplicate ureter empties into the bladder on its own (complete duplex). There is cause for concern when a duplex kidney is associated with urological conditions requiring treatment. Renal duplexing can cause urine to reflux into the kidney (vesicoureteral reflux) rather than going into the bladder and can cause subsequent Urinary Tract Infection (UTI). This can result in serious consequences like the loss of renal parenchyma (reflux nephropathy) and sometimes death in acute infections if not attended to in a timely manner. Weigert-Meyer postulated that rule i-e in a complete duplex system is mostly associated with reflux in lower moiety and obstruction in upper moiety with ectopic insertion and ureterocele. Ureteroceles may require simple management of symptoms or surgery, depending on the size of the ballooning, the functioning of the kidney and bladder and the degree of urine obstruction. An ectopic ureter is when the ureter opens and drains urine outside the bladder rather than inside.

Lectin-Based Study Reveals the Presence of Disease-Relevant Glycoepitopes in Bladder Cancer Cells and Ectosomes.

Bladder cancer is a malignancy that remains a therapeutic challenge and requires the identification of new biomarkers and mechanisms of progression. Several studies showed that extracellular vesicles promote angiogenesis, migration and metastasis, and inhibit apoptosis in bladder cancer. This effect may depend on their glycosylation status. Thus, the aim of this study was to compare glycosylation profiles of T-24 urothelial bladder cancer cells, HCV-29 normal ureter epithelial cells, and ectosomes released by both cell lines using lectin blotting and flow cytometry. Ectosomes displayed distinct total and surface glycosylation profiles with abundance of β-1,6-branched glycans and sialilated structures. Then, it was investigated whether the glycosylation status of the T-24 and HCV-29 cells is responsible for the effect exerted by ectosomes on the proliferation and migration of recipient cells. Stronger proproliferative and promigratory activity of T-24-derived ectosomes was observed in comparison to ectosomes from HCV-29 cells. When ectosomes were isolated from DMJ-treated cells, the aforementioned effects were diminished, suggesting that glycans carried by ectosomes were involved in modulation of recipient cell function. HCV-29- and T-24-derived ectosomes also increased the viability and motility of endothelial HUVEC cells and Hs27 fibroblasts. This supports the hypothesis that ectosomes can modulate the function of various cells present in the tumor microenvironment.

Normative values for ureteral diameter in children.

Assessment of the ureter is a fundamental part of the radiologic evaluation of the urinary tract. Abnormal ureteral dilation warrants further investigation to assess the etiology, which includes obstruction and/or reflux. Despite this fundamental need, there are no established normative values in children based on imaging. To provide normative values for ureteral diameter in pediatric patients with age-related ranges. We retrospectively reviewed all magnetic resonance (MR) urography studies and chose only normal ureters for assessment. The images were analyzed on commercially available software to assess maximum internal diameter. Manual measurements were done in cases where the images were below the resolution for automated assessment. Maximum intraluminal ureteral diameters were measured in upper, mid and lower thirds and the average of the three maximum ureteral diameters was used to obtain the average widest internal ureteral diameter. Multivariable linear regression was performed to test the association between the calculated diameter and gender. Differences in sizes between the left and right ureter were assessed using paired Wilcoxon signed rank test. One hundred twenty-one MR urography studies were selected, which included 160 ureter units. The diameter increases progressively with age, ranging from 3.2mm during infancy to 5.0mm in patients older than 16years of age. After 9years of age, the average widest internal ureteral diameter is slightly larger in males compared to females (odds ratio [OR]=1.91, 95% confidence interval [CI] [1.63, 2.25], P<0.0001). The right ureter was slightly larger than the left (3.9mm vs. 3.7mm, P=0.004) among 39 patients in whom both right and left ureter units were included. The average mid ureteral diameter is widest, followed by the distal third then proximal third. We present the normative values for the average widest internal ureteral diameter based on laterality and different segments. In the pediatric population, 3.8mm should be considered the average widest internal ureteral diameter.

Circumcaval Ureter: An Extremely Rare Vascular Anomaly Causing Hdroureteronephrosis: Case Report

Circumcaval (retrocaval) ureter is a very rare vascular (venous) anomaly caused by an error in the embryonic development of the inferior vena cava in which an embryologically normal ureter becomes entrapped behind the inferior vena cava causing varying degrees of upper urinary tract hydronephrosis. Herein, the current study presents a case report of a 19-year-old Libyan male, single patient, who presented with right flank pain and dysuria of one-year duration. On abdominal examination, he had tenderness on the right renal angle. His laboratory investigations (Hematological and biochemical) were within normal limits. Urine analysis showed Escherichia coli infection, which was treated with antibiotics. His workup, including abdominal ultrasonography, showed a moderate degree of hydronephsis. Intravenous urogram showed typical reverse "J" Shaped (fish-hook) deformity and dilatation of the proximal ureter and hydronephrosis on the right side. He underwent the right ureteroureterostomy through a conventional midline approach. He passed an uneventful post-operative course and had a good outcome.

Doppler-Assessed Ureteric Jet Frequency: A Valuable Predictor of Ureteric Obstruction.

Objectives: To compare ureterovesical jet frequency in non-obstructed versus obstructed ureter secondary to ureteric stone using ultrasonography in patients presenting with ureteral stones.Study design: Cross-sectional prospective study.Place of study and duration: Urology Department, The Kidney Centre Post Graduate Training Institute from May 16 to November 15, 2019.Methods: This study included 97 patients having presented in the emergency department with acute renal colic and were diagnosed as having ureteral stones on a non-contrast-enhanced computed tomography (NCCT). The ureteric jet frequency was measured by Doppler ultrasonography by our radiologist with the Hitachi Aloka F-37 ultrasound machine after they underwent CT. Patients were asked to drink 750-1000 ml of liquids 15-20 minutes before their ultrasonographic examination of both kidneys, ureters, and urinary bladder. The kidney size (length and width) and presence/absence of hydronephrosis were evaluated by grayscale ultrasound. Then, with the help of color Doppler ultrasonography, the frequency of the ureteric jet was recorded.Results: The patient's mean age was 46.66 ± 3.21 years ranging from 37 to 56 years. There were 58 (59.8%) male and 39 (40.2%) female cases. The mean cumulative stone size was 9.77 ± 2.65 mm. According to stone location, 44 (45.4%) cases had upper ureteric, 24 (24.7%) cases had mid ureteric, and 29 (29.9%) cases had lower ureteric stone. The mean obstructive side jet frequency was 0.70/min ± 0.49, and the non-obstructive side jet frequency was 2.89/min ± 1.29 (P < 0.05).Conclusions: The mean obstructive side jet frequency was 0.70 ± 0.49/min, which, if we compare to the non-obstructed normal ureter, is significantly less. Hence, color Doppler ultrasonography can be helpful to patients who were previously diagnosed with ureteral stones on NCCT to see if their stone has passed. This can be a very cost-effective modality especially in resource-poor countries where repeat CT can be very expensive. The results from this study can also be used in a specific population (i.e., pregnancy) where the use of imaging modalities that involve ionizing radiation is prohibited.

V03-06 ZINNER SYNDROME, ROBOTIC MANAGEMENT IN PEDIATRIC PATIENTS WITH SEMINAL VESICLE CYSTS

You have accessJournal of UrologyPediatrics (V03)1 Sep 2021V03-06 ZINNER SYNDROME, ROBOTIC MANAGEMENT IN PEDIATRIC PATIENTS WITH SEMINAL VESICLE CYSTS Igor Voznesensky, Thomas Shelton, Joseph Allen, Ihor Yosypiv, Erik Castle, and Aaron Martin Igor VoznesenskyIgor Voznesensky More articles by this author , Thomas SheltonThomas Shelton More articles by this author , Joseph AllenJoseph Allen More articles by this author , Ihor YosypivIhor Yosypiv More articles by this author , Erik CastleErik Castle More articles by this author , and Aaron MartinAaron Martin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001991.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Zinner Syndrome is a rare congenital abnormality of the mesonephric (Wolffian) duct consisting of the triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst and ipsilateral ejaculatory duct obstruction. While most patients with this anomaly are asymptomatic until the second or third decade of life, some may report nonspecific symptoms such as urinary urgency, dysuria, painful ejaculation, and perineal discomfort. Surgical resection of the cyst and the seminal vesicle is often necessitated because of the high rate of recurrence after conservative treatment. METHODS: Using the DaVinci robotic surgical system, we performed minimally invasive surgical management for two Zinner Syndrome patients, aged 14 and 17. For both procedures, cystoscopy was first utilized to identify the large posterior extravesical cystic masses and to cannulate the normal healthy contralateral ureter with a safety wire. We then incised the peritoneum, identifying and mobilizing the remnant distal ureteral stump and tracing towards the vas deferens. Once the seminal vesicle cyst was identified and mobilized from surrounding tissues, we proceeded to excise the SV cyst in its entirety. Due to the thin walled nature of the seminal vesical cyst in both patients, a small cystotomy was necessitated to facilitate complete excision. The cystotomy was then closed in standard fashion with pre-placed sensor wire used to facilitate identification and preservation of normal contralateral ureter. Lastly, the peritoneum was then reapproximated with running absorbable suture. RESULTS: Both patients were sent home the day following surgery. Post op imaging showed resolution of the seminal vesicle cysts and the patients reported symptomatic relief. Pathology demonstrated benign urothelium and underlying fibromuscular stromal tissue along with a portion of benign ureter. CONCLUSIONS: Using technology such as the DaVinci robot we can offer pediatric patients a minimally invasive approach for management even in the setting of rare pelvic pathology and clinical presentations. Source of Funding: n/a © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e224-e224 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Igor Voznesensky More articles by this author Thomas Shelton More articles by this author Joseph Allen More articles by this author Ihor Yosypiv More articles by this author Erik Castle More articles by this author Aaron Martin More articles by this author Expand All Advertisement Loading ...

V03-05 ROBOT-ASSISTED LAPAROSCOPIC PYELOPLASTY FOR URETEROPELVIC JUNCTION OBSTRUCTION IN A Y-TYPE DUPLICATED COLLECTING SYSTEM

You have accessJournal of UrologyPediatrics (V03)1 Sep 2021V03-05 ROBOT-ASSISTED LAPAROSCOPIC PYELOPLASTY FOR URETEROPELVIC JUNCTION OBSTRUCTION IN A Y-TYPE DUPLICATED COLLECTING SYSTEM Zoe Gan, Katherine Fischer, and Aseem Shukla Zoe GanZoe Gan More articles by this author , Katherine FischerKatherine Fischer More articles by this author , and Aseem ShuklaAseem Shukla More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001991.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Renal duplication anomalies may present with a ureteropelvic junction obstruction (UPJO) affecting the lower moiety. A proximal partial ureteral duplication (Y-type ureter) is a rare associated finding and can render surgical repair more challenging. We present our technique for robot-assisted left lower pole pyeloplasty in the setting of a Y-type ureter demonstrating the anatomical considerations relevant for the adjacent upper pole ureter. METHODS: Cystoscopy and retrograde pyelogram were performed, and an open-ended catheter was placed across the lower pole UPJO for identification. The daVinci® robot platform was docked. The left colon and renal pelvis were mobilized medially to visualize the Y-type duplication and dilated lower pole. The lower pole ureter was dismembered and spatulated past the area of obstruction until unaffected normal ureter was reached. A stent was placed antegrade into the lower pole ureter, the anastomosis between the lower pole ureter and renal pelvis was performed, and excess renal pelvis was trimmed. A feeding tube was passed retrograde to identify and protect the upper pole ureter during the anastamosis, and minor spatulation was performed on the upper pole ureter to avoid compromising the insertion of the upper pole ureter into the renal pelvis. RESULTS: The patient was discharged on postoperative day 1. One month postoperatively, a renal bladder ultrasound showed resolved dilation of the lower pole, and the upper pole remained non-dilated. The stent was removed 2 months postoperatively. CONCLUSIONS: A lower pole UPJO in a Y-type duplex system may be repaired with a modified Anderson Hines dismembered pyeloplasty using a robot surgery platform. Additional consideration is given to maintain the patency and continuity of the adjacent unobstructed ureter. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e223-e223 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zoe Gan More articles by this author Katherine Fischer More articles by this author Aseem Shukla More articles by this author Expand All Advertisement Loading ...

Urinary incontinence in a dog with a duplex renal system and extramural ectopic ureter

A 1-year-old female spayed French Bulldog was referred to the Interventional Radiology and Endoscopy Service for evaluation of urinary incontinence with partial response to medical management (phenylpropanolamine). Cystourethroscopy and retrograde ureteropyelogram were performed and revealed multiple congenital abnormalities including; a duplex renal system of the left kidney with one normal ureter with an intravesicular ureteral orifice and one extramural ectopic ureter with an associated branching and ureteral diverticulum. A dual vagina was also noted. Left neoureterocystostomy of the extramural ectopic ureter was performed and a temporary ureteral stent was concurrently placed and removed cystoscopically one month later, leaving the patient with two patent left ureters. Thirty-four months later the patient is mildly incontinent with no other comorbidities.

Modified vaginal hysterectomy for chronic non-puerperal complete uterine inversion: video presentation.

Chronic non-puerperal complete uterine inversion is a relatively rare condition. Abdominal Haultain's operation is the usual management. We present such a case with fundal fibroids managed by modified vaginal hysterectomy. Preoperative computerized tomography enhanced intravenous urogram depicted normal ureters and bladder. Diluted vasopressin (10 U in 100 ml normal saline) was infiltrated at the base of the myoma and a myomectomy was performed. The fundal raw area was pierced to reach the formed space between the anterior and posterior uterine serosa. The bilateral round ligaments were clamped, cut, and ligated. Diluted vasopressin was injected into the fundal anterior uterine wall and about 1 cm was excised. Then, the bilateral utero-ovarian ligaments were clamped, cut, and ligated. In the same way another 1 cm of anterior uterine wall was excised and the bilateral uterine vessels were clamped, cut, and ligated. The rest of the uterine wall area was infiltrated with diluted vasopressin circumferentially. An incision at the vesico-cervical junction was made and the bladder pushed up. The posterior fornix area was incised and the Pouch of Douglas (POD) opened. Vesico-uterine pouch opened under finger guidance placed through POD. The rest of the anterior uterine wall was excised. Exposed bilateral cardinal-uterosacral ligament complexes (CULCs) were clamped, cut, and ligated. The remaining vaginal attachments ligated hemostatically and the vault was closed. For vault prolapse prevention, vault closure suture ends were tied with ipsilateral CULC suture end, brought outside the vagina at vault angle. A follow-up visit up to 1 year found no complications. This novel reverse vaginal hysterectomy combining the principles of both abdominal and vaginal hysterectomy can successfully manage chronic non-puerperal complete uterine inversion.

Proteomic Profiling of Ectosomes Derived from Paired Urothelial Bladder Cancer and Normal Cells Reveals the Presence of Biologically-Relevant Molecules.

Protein content of extracellular vesicles (EVs) can modulate different processes during carcinogenesis. Novel proteomic strategies have been applied several times to profile proteins present in exosomes released by urothelial bladder cancer (UBC) cells. However, similar studies have not been conducted so far on another population of EVs, i.e., ectosomes. In the present study we used a shotgun nanoLC–MS/MS proteomic approach to investigate the protein content of ectosomes released in vitro by T-24 UBC cells and HCV-29 normal ureter epithelial cells. In addition, cancer-promoting effects exerted by UBC-derived ectosomes on non-invasive cells in terms of cell proliferation and migratory properties were assessed. In total, 1158 proteins were identified in T-24-derived ectosomes, while HCV-29-derived ectosomes contained a lower number of 259 identified proteins. Qualitative analysis revealed 938 proteins present uniquely in T-24-derived ectosomes, suggesting their potential applications in bladder cancer management as diagnostic and prognostic biomarkers. In addition, T-24-derived ectosomes increased proliferation and motility of recipient cells, likely due to the ectosomal transfer of the identified cancer-promoting molecules. The present study provided a focused identification of biologically relevant proteins in UBC-derived ectosomes, confirming their role in UBC development and progression, and their applicability for further biomarker-oriented studies in preclinical or clinical settings.