Advanced surgical techniques in minimally invasive surgery: multidisciplinary approach for silent obstructive uropathy in deep endometriosis.

Genitourinary prolapse is one of the major entity in urogynecology. It massively affects quality of life. Prolapse occurring with concomitant multiple vesicle calculi is not a very common occurrence. Only a few case reports have been reported in literature so far. Long-standing prolapse with chronic bladder infection can result in formation of bladder stones. These may result in large and multiple bladder calculi producing acute incarceration and obstructive uropathy. In this case series we aim to report three cases of multiple vesicle calculi in genitourinary prolapse. In first case there are two bladder stones in a postmenopausal patient. Second case describes multiple vesicle calculi in an incarcerated prolapse. In third case, there were multiple vesicle calculi in a vault prolapse patient.

Mowat-Wilson Syndrome (MWS) is an autosomal dominant genetic disorder caused by heterozygous mutations or deletions in the Zinc finger E-box-binding homeobox 2 (ZEB2) gene. Congenital anomalies of the kidney and urinary tract (CAKUT), including hydroureter and hydronephrosis, have been reported in patients with MWS. However, the role of the ZEB2 gene in urinary tract development and the cellular and molecular mechanisms underlying the CAKUT phenotypes in MWS remain unknown. In this study, we examined ZEB2 expression in the developing mouse ureter and generated Zeb2 ureteral mesenchyme-specific conditional knockout mice (Zeb2 cKO) by crossing Zeb2 floxed mice with Tbx18Cre mice. The urinary tract of Zeb2 cKO mice and their wild-type littermates was analyzed for morphological and histological changes. Our results show that ZEB2 is expressed in TBX18+ ureteral mesenchymal cells during mouse ureter development. Deleting Zeb2 in these cells caused hydroureter and hydronephrosis, indicating obstructive uropathy. Cellular and molecular marker analysis revealed that the TAGLN+ACTA2+ ureteral smooth muscle cell (SMC) layer was absent in Zeb2 cKO mice. In contrast, the tunica adventitia cell layer was significantly expanded compared to controls. At the molecular level, Zeb2 cKO mice had significantly decreased TBX18 expression but increased SOX9 expression in the developing ureter compared to wild-type controls. Our findings demonstrate that ZEB2 is crucial for normal ureteral SMC differentiation during ureter development. Additionally, our study suggests that MWS patients may have abnormal ureteral SMC development, which contributes to the abnormalities of the urinary tract.

Bladder herniation through the inguinal canal is a rare clinical entity. Moreover, prostate herniation has not been reported in the literature before, as it is a fixed extraperitoneal organ. We described a unique case of an 85-year-old man presenting with acute urinary retention and bilateral hydronephrosis secondary to herniation of the urinary bladder and prostate into the right inguinal canal. The patient was deemed unfit for surgical repair due to significant comorbidities and was successfully managed with long-term urethral catheterization. This case underscores the importance of maintaining a broad differential in elderly patients with atypical obstructive uropathy and highlights the role of imaging in diagnosis.

Globally, Chronic kidney disease(CKD) has emerged as one of the major public health concerns impacting 10 to 15% of the world population. However, relatively very few studies have presented the comprehensive data on burden of disease particularly in developing countries like Nepal. Chronic kidney disease leads to declining kidney function, often progressing to end stage renal disease or death, imposing significant economic burdens. We aim to describe the ethology of end stage renal disease patients undergoing maintenance haemodialysis. A cross-sectional, descriptive study was conducted at a dedicated transplant centre in Nepal to assess a comprehensive understanding of the causes of chronic kidney disease. Data was collected from the individual's undergoing haemodialysis at the Shahid Dharma Bhakta National Transplant Centre, approximately 175 individuals meeting the inclusion criteria. SPSS was used for descriptive and inferential statistics. Among 175 patients, the mean age was 47.2years (SD ± 14.97), with 115 (65.7%) males, and the majority were aged between 40 and 64years. Hypertensive nephropathy was the most common cause, accounting for 39.4%, followed by both hypertension and diabetes mellitus in 12.6% of cases, while isolated diabetes mellitus accounted for 10.9%. Chronic glomerulonephritis (9.1%), chronic pyelonephritis (8%), and obstructive uropathy (7.4%) were also major contributors, with smaller proportions linked to conditions like urate nephropathy, renal tuberculosis, systemic lupus erythematosus, preeclampsia, and solitary kidney. This study identified the primary causes of end stage renal disease in Nepal, where chronic kidney disease prevalence is increasing but under-researched. Hypertension and diabetes mellitus are key risk factors for chronic kidney disease, yet awareness of these conditions and their complications is often limited in Nepal. The etiological spectrum data is crucial for targeted screening programs for the general population and high-risk groups, follow-up and treatment, improving patient outcomes and reducing the economic burden of end stage renal disease.

Rationale:Benign prostatic hyperplasia (BPH) is a common, typically nonlethal condition in middle-aged and older men. However, its complications can lead to fatal outcomes if untreated. This report presents a rare fatal case of obstructive uropathy and renal failure resulting from neglected BPH.Patient concerns:A 54-year-old reclusive male with no known medical interventions was found deceased at home after being unresponsive to contact for several days.Diagnoses:Postmortem examination revealed marked bladder distension (2500 mL), hemorrhagic cystitis, prostatic enlargement (45 g) with urethral obstruction, bilateral hydronephrosis, and renal cortical cysts. Histopathology confirmed obstructive nephropathy and renal failure. Extreme elevations in postmortem serum creatinine (879 μmol/L) and urea (153.4 mmol/L) supported the diagnosis of terminal uremia. Toxicological screening was negative.Interventions:No medical interventions were undertaken prior to death.Outcomes:The patient died due to complications of BPH, specifically urinary retention leading to obstructive nephropathy, renal failure (uremia), and subsequent multi-organ dysfunction syndrome.Lessons:This case underscores the potentially lethal consequences of untreated bladder outlet obstruction from BPH. It highlights the importance of clinical vigilance, early intervention, and patient education, particularly for at-risk individuals such as those living alone or with limited healthcare access.

To assess the prognostic value of serum cystatin C for predicting 10-year major adverse kidney events (MAKE) in pediatric patients with urologic malformations (UTMs). This retrospective cohort study used the TriNetX global federated research network of electronic health records. Children aged 0-18 years with UTMs (including congenital urinary tract anomalies, vesicoureteral reflux, obstructive uropathy, neurogenic bladder, and spina bifida) and available serum cystatin C measurements were included. The primary outcome was MAKE, defined as the first occurrence of dialysis initiation, kidney transplantation, chronic kidney disease, albuminuria, or an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m² within 10 years. Secondary outcomes were the individual components of MAKE. After 1:1 propensity score matching, 2062 patients were analyzed (mean follow-up 1025 days). Elevated cystatin C (≥1.3 mg/L) was associated with higher MAKE incidence (39.3% vs 29.2%; HR 2.5, 95% CI 2.00-3.12, p < 0.001). Significant risks were observed for CKD (HR 3.55), dialysis (HR 9.09), and albuminuria (HR 1.83). No significant differences were found for renal transplantation (HR 0.52) or eGFR decline <60 (HR 1.48). High cystatin C independently predicts MAKE and CKD in children with UTMs. Routine testing may enable early risk stratification and guide long-term renal surveillance. Pediatric patients with urologic malformations have increased chronic kidney disease risk, often requiring dialysis with a significant healthcare and quality-of-life burden. Traditional markers like serum creatinine and eGFR have limitations in detecting early renal impairment in growing children. Serum cystatin C, unaffected by muscle mass or growth, offers superior kidney function assessment but has not been evaluated for predicting long-term outcomes in pediatric urinary tract malformations. This study is the first to evaluate cystatin C's prognostic value for Major Adverse Kidney Events in this population. Incorporating cystatin C into routine monitoring may improve early risk stratification and guide surveillance strategies.

Obstructive uropathy (OU) during fetal development induces a fetal cystic dysplastic kidney. The mechanisms of cyst formation and the onset of renal dysfunction remain unclear. Determining whether nephrogenic potential persists during fetal life may suggest whether early intervention could preserve renal development. We aimed to evaluate residual nephrogenic activity in fetal cystic dysplastic kidneys using β-catenin and CD10 immunostaining, and to assess whether the site of obstruction influences cystogenesis. After appropriate approval, 20 timed-gestation fetal lambs had OU created at 60 days. Males underwent urethral and urachal ligation (n = 8, 3 lost), and females underwent unilateral ureteric ligation (n = 8, 1 lost). Fetuses were sacrificed at 80 days (n = 6) and 140 days (term, n = 10), comparing kidneys with normal controls of the same gestational age using immunohistochemical staining for β-catenin and CD10. Developing fetal cystic dysplastic kidneys were identified at 80 days. β-catenin staining showed the absence of granular cytoplasmic expression in cystic regions, indicating arrested nephrogenesis. In male models, cysts originated exclusively from proximal tubules. Female models exhibited mixed proximal and distal tubular involvement. CD10 staining confirmed the loss of proximal tubular markers. Renal development remained arrested at term. Cyst formation disrupts renal development early in gestation, which persists until term. Differences in cystogenesis between the models suggest that the site of obstruction influences pathogenic mechanisms.

Obstructive uropathy is a very common pathology of the genitourinary system which, if untreated, leads to renal impairment, end-stage renal failure and death. Particularly in the case of acute obstructive uropathy, urgent decompression is necessary to prevent compression-mediated ischaemia of the renal parenchyma and the development of irreversible renal failure. Percutaneous nephrostomy is a well-established and relatively safe image-guided procedure used to obtain access to the renal collecting system and is the procedure of choice for the infected obstructed kidney, minimising the risk of septic shock and possible death. Subsequent internalisation via antegrade ureteric stenting is frequently employed to relieve obstruction at the level of the causative lesion. CIRSE Standards of Practice documents recommend a reasonable approach to, and best practices for, performing procedures, in this instance, Nephrostomy and Ureteric Stent Placement and Exchange. The writing group, established by the CIRSE Standards of Practice Committee, consisted of five clinicians with internationally recognised expertise in this topic, and one research assistant (I.I.). The writing group reviewed the existing literature, performing a pragmatic evidence search using PubMed to search for publications in English relating to human subjects from 2001 to 2025. Relevant older primary sources were included where the data have not been updated. A document was produced, making recommendations for practice based on currently available evidence in a range of clinical scenarios.

Infants with severe hyponatremia (Na < 120) and an abdominal mass require an astute clinical evaluation and often represent a medical emergency. We report a case of a 2‐month‐old White female, born full term, presenting with a two‐day history of decreased oral intake and urinary output, who was found to have severe hyponatremia with notable abdominal distention. Abdominal imaging revealed the presence of a pelvic mass causing obstructive uropathy. Further imaging and urogenital examination revealed a hydrometrocolpos. This rare entity required urgent surgical intervention and standard supportive care in the PICU. She had a subsequent significant improvement in symptoms and prevention of further deleterious complications.

A 6-year retrospective cost-effectiveness analysis of Memokath ureteric stents vs double-J stents – single-centre assessment

To study the antenatal follow-up of fetal urinary tract dilation (UTD) and its post-natal outcomes using the standard "UTD Classification System." In this prospective observational study, fetuses diagnosed with urinary tract dilatation were classified based on the multidisciplinary "UTD Classification System" and were followed up throughout the pregnancy and postnatally for 1 year. We excluded fetuses with additional structural abnormalities, genetic disorders, or intrauterine fetal death. During the study period, 46 108 antenatal scans were conducted; according to the eligibility criteria, 593 fetuses were included for analysis, with 81% belonging to the A1 group and 19% to the A2-3 group. The rate of antenatal resolution was significantly higher in the A1 group (64%) compared to the A2-3 group (3%) (p < 0.05). The female gender was protective and had higher spontaneous prenatal resolution among UTD A1 fetuses. However, post-natal persistence at 1 year (49% vs. 0.2%) and the need for surgery (32% vs. 1%) were higher in the A2-3 group. Higher maximum anteroposterior renal pelvic diameter (APRPD) and ureteric abnormalities in the last scan were independent predictors for surgery. Ours is one of the largest prospective studies on UTD classification. Key points noted in this study are that most of the resolving UTDs were from UTD A1, and obstructive uropathies were from the UTD A2-3 group. Higher maximum APRPD and ureteric abnormalities were independent predictors for surgery in the UTD A2-3 group.

Ureteric squamous cell carcinoma in a duplex collecting system presenting with chronic obstructive uropathy: a rare case report

The safety data on zolbetuximab, a new CLDN18.2-targeting antibody for advanced gastric cancer (AGC), are still exiguous. We report herein a 75-year-old, male patient with CLDN18.2-positive, HER2-negative AGC with weight loss, massive nodal disease, and peritoneal carcinomatosis-related obstructive uropathy. First-line zolbetuximab plus mFOLFOX6 triggered grade 2 nausea, which was followed on day 3 by tumor lysis syndrome (TLS) and 5-fluorouracil (5-FU)-induced hyperammonemic encephalopathy. Discontinuation of 5-FU and supportive care consisting of hydration and rasburicase led to rapid clinical improvement. Chemotherapy, which was resumed after a dosage adjustment, achieved tumor shrinkage and resolved the hydronephrosis. To the best of our knowledge, the present study is the first to describe concurrent TLS and 5-FU-induced encephalopathy during the administration of a zolbetuximab-based regimen and highlights the need for proactive prophylaxis against TLS and for controlling nausea in AGC patients with a high tumor burden, baseline renal impairment, and cachexia.

Prenatal diagnosis of urinary tract dilation: Comparative prognostic value of APDRP and UTD grading systems.

Background: Obstructive uropathy is a critical condition that requires prompt diagnosis, with imaging techniques like ultrasound and multidetector CT playing essential roles in evaluating urinary tract obstruction. The purpose of this study is to assess the effectiveness of CT urogram and ultrasonogram (USG) in diagnosing calculus obstructive uropathy. The aim of the study was to evaluate the effectiveness of CT USG in diagnosing calculus obstructive uropathy. Methods: This cross-sectional study was conducted at the Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from January to December 2018. It included 45 adult patients with clinically suspected calculus obstructive uropathy referred for USG and CT urogram. Imaging findings, including stone size, location, and hydronephrosis, were recorded, with CT urogram as the reference standard. Data were analyzed using SPSS to assess diagnostic accuracy, sensitivity, specificity, and predictive values. Results: The study of 45 patients, mostly male with a mean age of 35.8 years, found CT more effective than USG in diagnosing calculus obstructive uropathy. CT detected stones in 75% of patients with a sensitivity of 93.75% and specificity of 100%, whereas USG detected stones in 57.5% with a sensitivity of 61.29% and specificity of 88.88%. CT demonstrated superior diagnostic accuracy compared to USG. Conclusions: Unenhanced CT KUB shows higher diagnostic accuracy than USG in evaluating calculus obstructive uropathy, providing essential information for timely and accurate management.

A bstract Sertoli-Leydig cell tumor (SLCT) is a rare sex cord-stromal tumor accounting for &lt;0.5% of all primary ovarian neoplasms. It occurs in all age groups, with majority occurring in the reproductive age group, mostly in the second and third decades. It is the most common virilizing ovarian tumor, autonomously secreting testosterone, leading to androgenic manifestations. A 17-year-old single nulliparous female presented with a 2-year history of oligomenorrhea, followed by amenorrhea, abdominal swelling, and features of virilism. A computed tomographic scan diagnosed a right complex ovarian mass with obstructive uropathy. She underwent a right salpingo-oophorectomy and omentectomy for a stage 1A tumor. Histopathological examination confirmed the diagnosis of poorly differentiated SLCT with a predominance of heterologous mesenchymal elements. The postoperative period was uneventful, with resumption of menstruation and regression of the androgenic signs and symptoms. Unfortunately, symptoms recurred 5 months after the initial surgery, and patient succumbed.

Abstract Posterior urethral valves (PUVs) are abnormal folds or membranes occurring at different levels of the posterior urethra, almost exclusively in males, and causing obstructive uropathy. Early prenatal diagnosis is important to prevent impaired renal function. The case of a 7-year-old boy with complications of obstructive uropathy arising from late presentation of PUV is presented. The benefits of abdominal ultrasound and micturating cystourethrography in diagnosis and management options for the patient were highlighted, which prompted surgical intervention, which appeared successful.

Introduction: Chronic kidney disease (CKD) is a catastrophic condition and a public health problem in Ecuador. The present study aims to determine the prevalence of etiologies of stage 5 chronic kidney disease among patients in the city of Cuenca's public dialysis network in March 2018. Materials and methods: A cross-sectional multicenter study was conducted. Data were collected from 458 patients using a questionnaire. Tabulation and statistical analysis were performed in Microsoft Office Excel 2016. The results were presented in simple distribution tables. Results: The distribution according to sex was 50.44% men and 49.46% women. The mean age was 58.47 ±13.59 years. The etiologies were: Diabetes Mellitus (41.92%), Arterial Hypertension (34.06%), Unknown Etiology (11.57%), Unrelated Glomerulopathies (3.06%), Obstructive Uropathy (2.4%), and the remaining pathologies (6.99%). Conclusions: The main etiologies of stage 5 CKD were Diabetes Mellitus and Arterial Hypertension.

We present a novel salvage technique for managing a completely occluded percutaneous nephrostomy catheter in a patient with metastatic cervical cancer and bilateral obstructive uropathy. While the left nephrostomy catheter was exchanged uneventfully, the right was entirely blocked, preventing standard guidewire passage. Using the Accustick II Introducer System (Boston Scientific, Spencer, IN, USA), a 21-gauge needle was advanced through the cut percutaneous nephrostomy lumen to traverse the obstruction, penetrating the catheter sidewall and access the renal collecting system. This allowed sequential guidewire and sheath introduction, enabling successful percutaneous nephrostomy replacement through the existing tract. Termed the Sharp Urologic Recanalization technique, this method modernizes traditional sharp recanalization strategies and offers a less invasive alternative when conventional techniques fail.