Unilateral Nonfunctioning Kidney Research Articles

Case Report: Ureteral Obstruction at the Time of Hysterectomy after Uterine Artery Embolization

Study Objective To report ureteral obstruction at the time of hysterectomy following uterine artery embolization (UAE). Design Case report. Setting Clara Maass Medical Center. Patients or Participants 42 year-old African-American woman. Interventions Hysterectomy following UAE. Measurements and Main Results Patient presented for total laparoscopic hysterectomy (TLH) for abnormal uterine bleeding and dysmenorrhea. Patient had a history of UAE two years prior, which resolved her symptoms. MRI during UAE showed no kidney abnormalities. Preoperative TLH evaluation included bimanual exam and transvaginal ultrasound, which showed a globular uterus. TLH with bilateral salpingectomy, adhesiolysis, and minor endometriosis excision were performed uneventfully. A routine post-procedural cystoscopy showed no jet from the right ureter. A stent was attempted, but obstruction was noted at the mid-ureter, 6 cm from the vesicoureteral junction. Retroperitoneal dissection showed a dilated distal ureter but no injury noted. Urology was consulted and intraoperative retrograde pyelogram showed dilated distal ureter with complete obstruction. Ureteroscopy showed a complete obstruction at the level of pelvic brim. Postoperative CT with IV contrast showed severe right renal atrophy. Labs showed normal BUN and creatinine levels, but a renal scan showed a non-functioning right kidney. Nephrology concluded that no surgery was needed to resect the atrophic kidney, and the patient was discharged on postoperative day one. Conclusion Our experience is similar to a 2005 Canadian case report, in which a patient had complete ureteral obstruction following UAE, requiring nephrectomy. Although ureteral obstruction that results in unilateral non-functioning kidney following UAE is rare, it is likely an under-reported complication. As the uterine arteries supply the lower ureters, embolization could lead to segmental infarction of the ureter. Similarly, as leiomyoma necrose following UAE, peri-ureteral inflammation and infarction could occur. Physicians should be aware of these potential complications, and renal imaging may be indicated before hysterectomy in patients with prior UAE.

Laparoscopic nephrectomy in xanthogranulomatous pyelonephritis.

IntroductionThe aim of this article was to report our experience with laparoscopic and retroperitoneoscopic nephrectomy in patients with xanthogranulomatous (XPG) pyelonephritis.Material and methodsBetween November 2002 and September 2010, 27 patients, with a mean age of 61.1 years (range 43–85), underwent laparoscopic nephrectomy for a unilateral nonfunctioning kidney, because of xanthogranulomatous pyelonephritis. Patient's data was collected retrospectively and included patient age, gender, intraoperative conversion rate, operative time, estimated blood loss, length of hospital stay, perioperative transfusion rate, renal function pre- and postoperatively and postoperative complications.ResultsLaparoscopic nephrectomy was successful in 26 patients. It was transperitoneal in 15 patients, retroperitoneal in 11 patients and in one patient the operation was initiated as retroperitoneal and converted to transperitoneal. One conversion to open surgery was needed. The mean operative time was 193.6 minutes (range 123–340). The mean estimated blood loss was 223.5 ml (range 30–1000). The mean hospital stay was 4.8 days (range 3–12). The transfusion rate was 29.6%. Serum creatinine was 1.3 mg/dl the day before and the day after the operation. Major complications occurred in patients (11.1%).ConclusionsLaparoscopic nephrectomy should be considered as an initial approach for XGP. The indications for laparoscopic nephrectomy should be extended to these patients.

Retroperitoneoscopic nephrectomy for a nonfunctioning kidney

Background/Aim. The minimally invasive laparoscopic nephrectomy was first performed in 1991. The objective of this paper was to present the surgical technique of retroperitoneoscopic nephrectomy and to our experience with this procedure in removal of non-functioning kidneys. Methods. This retrospective study enrolled 55 patients who underwent retroperitoneoscopic nephrectomy at our institution during the period from January 2011 to November 2016. All patients had a unilateral non-functioning kidney confirmed by intravenous or computed tomography (CT)- urography and renal scintigram. Their medical records were analyzed for demographic data, duration of surgery, average blood loss, duration of hospital stay as well as time to return to normal life activities. Results. The mean age of patients was 43 years (range 23?78). Perioperative or early postoperative mortality was not recorded. Mean operative time was 82 minutes (range 45?210). The average blood loss was 90 mL (40?450). The average hospital stay was 4 days (3?7). Return to life activity was in average after 12 days (9?15). Conclusions. Retroperitoneoscopic nephrectomy for a non-functioning kidney is a feasible, safe, and effective minimally invasive method. The length of hospital stay and convalescence was shorter than after open nephrectomy.

Retroperitoneal laparoscopic nephroureterectomy with distal and intramural ureter resection for a tuberculous non - functional kidney.

ABSTRACTObjective:To evaluate the safety and feasibility of total retroperitoneal laparoscopic nephroureterectomy with urinary-bladder junction resection for a tuberculous nonfunctional kidney.Materials and Methods:A total of 27 individuals diagnosed with unilateral nonfunctional kidney secondary to tuberculosis were treated between June 2011 and June 2015. All patients had normal renal function on the contralateral side and underwent the standard four-drug anti-tuberculosis treatment for at least four weeks before surgery. Total retroperitoneal laparoscopic nephroureterectomy was performed in all patients, and the urinary-bladder junction of distal ureter was managed using different auto-suture techniques.Results:Nineteen male and 8 female patients with an average age of 47.3 years (range, 36-64 years) underwent surgery. All the operations were successfully performed without conversion. The median operative time was 109.3 min (range, 75-138 min), the median blood loss was 157.5 mL (range, 70-250 mL), and the median hospitalization time was 3.7 days (range, 3-6 days). No serious perioperative complications occurred. Anti-tuberculosis chemotherapy was prescribed to all patients, with the entire course of treatment lasting six months. No recurrence of tuberculosis of the bladder or the contralateral kidney was observed during the median follow-up period of 26.7 months (range, 6-54 months).Conclusion:Retroperitoneal laparoscopic nephroureterectomy with urinary-bladder junction resection is a safe and feasible approach for the treatment of tuberculous non-functional kidneys.

Sonographic and 99m Tc DTPA Renal Scan changes in Pre and Post Percutaneous Nephrostomy in Unilateral Hydronephrotic on U/S and Non-Functioning on IVU kidneys

15 patients who presented with unilateral non-functioning kidney on IVU and with age range 21-69 years with mean of 45 were studied. 11 patients (70.35%) were male and 4 patients (29.70%) were female with 2.31:1 ratio. 3,5,4,2, and 1 patients were from 21-30,31-40, 41-50, 51-60 and above 61 years age group respectively. 11 (73.73%) had some disease, 3 (20%) PUJ obstruction and 1 (6.6%) ureteric stricture as cause. 11 (73.3%) had no hydronephrosis and 4 had minimal hydronephrosis after PCN. Total mean GFR was 94.2, 94.4,97.3 and 98.5 ml/min in pre PCN, 2 weeks, 4 weeks and 65 weeks respectively, showing significant improvement. Final results in obstructive kidney showed no improvement in 4 (26.6%) mild (<25%) in 1 (6.6%), good (<50%) in 2 (13.3%) and excellent (<50%) in 8 (53.3%) patients. Both ultrasound and 99m Tc DTPA renal scan can play a vital role not only in diagnosing Hydronephrotic and non functioning kidney but also saving 11 (73.3%) patients from emotional as well as physical trauma of nephrectomy

False-Positive Cystoscopic Diagnosis of Ureteral Obstruction After Hysterectomy Due to a Nonfunctional Kidney.

An estimated 0.2% of the population may have a unilateral nonfunctional kidney. This pre-existing condition may lead to the mistaken presumption that a ureteral injury has occurred when performing cystoscopy after hysterectomy. Two cases are presented in which cystoscopy to confirm ureteral patency after hysterectomy was performed in patients with pre-existing unknown nonfunctional kidneys. These false-positive findings resulted in additional operative time, additional cost, and unnecessary surgical exploration. Cystoscopy to confirm ureteral patency after hysterectomy may lead to an incorrect presumption of a ureteral injury in patients with a pre-existing nonfunctional kidney.

Ureterocystoplasty in pediatric patients with unilateral nonfunctioning kidney

Bladder augmentation with uroepithelium lined material yields an absence of mucus production, with reduced possibility of urinary infection and lithiasis. The utilization of the ureter in augmentation cystoplasty results in a uroepithelium-lined neobladder with all of the appropriate histologic layers. The purpose of this study was to assess the efficacy and safety of ureterocystoplasty in children with a small bladder capacity and low bladder compliance. Between January 1992 and August 2011, six females and eight males who were 3 to 13 years old (median age 6 years) and had a low-capacity, poorly compliant bladder underwent augmentation cystoplasty using dilated ureters. Unilateral non-functioning renal moiety draining into a massively dilated ureter was present in every patient. The etiology of hydroureteronephrosis was a neurogenic bladder secondary to meningomyelocele in five patients, a posterior urethral valve in four patients, an obstructive megaureter in three patients and ectopic obstructive ureterocele in two patients. Mean age was 6 years (3-13 y). Clinical improvement regarding the resolution of reflux, a better bladder capacity and improved compliance was achieved in every patient. The increase in bladder capacity ranged from 84 cc (30 to 200) to 235 cc (150 to 420), with a mean increase of 318% (210 to 500). Marked improvement in compliance was also observed (from 1.2 to 5.1 mL/cm H2O, mean 2.4, to 22 to 50 mL/cm H2O, mean 41). No uninhibited bladder contractions were detected during a urodynamic study at 12 months postoperatively. In patients with a low-capacity, poorly compliant bladder, augmentation cystoplasty using the ureter seems to be a viable alternative. Ureterocystoplasty results in a large-capacity, high-compliance bladder, without metabolic and infective complications, compared with other techniques of augmentation cystoplasty.

Laparoscopic nephrectomy for xanthogranulomatous pyelonephritis – Are there predictive factors for success?

OBJECTIVES:Laparoscopic nephrectomy for xanthogranulomatous pyelonephritis is currently associated with great operative difficulty and surgical complications. Herein, we report on our single-center experience and describe predictive factors for successfully accomplishing this procedure.METHOD:Between March 1998 and April 2010, 66 patients (27 men and 39 women) underwent laparoscopic nephrectomy for the treatment of a unilateral nonfunctioning kidney. These patients had previous diagnoses of renal chronic inflammation associated with calculi and previous pyonephrosis. All of the nephrectomies were performed using the transperitoneal approach, and a similar technique was used for radical nephrectomy.RESULTS:Laparoscopic nephrectomy for the treatment of renal chronic inflammation was successful in 58/66 cases (87.9%). Eight cases were converted to the open technique because of difficulty in progression, which was related to the discovery of dense adhesions in the hilar or perirenal region. One major (colonic lesion) and two minor (wound infection) complications occurred in the conversion group. A diagnosis of xanthogranulomatous pyelonephritis was confirmed pathologically for all of the specimens. Of the factors examined, a longitudinal renal length greater than 12 cm (laparoscopy group - 7.2±1.8 cm, versus open group - 13.6±1.5 cm; p<0.05) and time to access the renal vessels (laparoscopy group - 32±18 min, versus open group - 91±11 min; p<0.05) were associated with a higher conversion rate. Although the number of patients in the conversion group was small, the majority of these patients received right-sided nephrectomy.CONCLUSIONS:Laparoscopic nephrectomy for the treatment of xanthogranulomatous pyelonephritis is feasible and associated with low levels of morbidity. Factors including the time required to control the renal vessels, renal length and right-sided nephrectomy were associated with higher chances of conversion into an open procedure.

Ureterocystoplasty in a Boy with Myelomeningocele

Introduction In the rare case of a decompensated neurogenic bladder combined with a unilateral hydronephrosis and hydroureter, ureterocystoplasty is a feasible and elegant technique for bladder augmentation. In contrast to augmentation using bowel segments, the use of urothelial-lined tissue avoids the common problems caused by mucus development and electrolyte disturbance. Prerequisite is a unilateral non-functional kidney and a severe dilation of the ureter. Patients The patient presented in this case report is an 11-year old boy with myelomeningocele. Due to a decompensated neurogenic low-compliance bladder with high-degree reflux, the left kidney was hydronephrotic and afunctional, urodynamic revealed a maximum bladder capacity of 70ccl, therefore unilateral nephrectomy and ureterocystoplasty were performed. Results Three years after surgery the patient is continent day and night. Urodynamic evaluation shows a normal compliance, bladder capacity is 440cc. The boy empties his bladder 4-6 times a day by means of clean intermittent catheterization. Conclusions In selected cases ureterocystoplasty is a safe and feasible technique for bladder augmentation.

Vesicoureteral Reflux in Conjunction With Posterior Urethral Valves

We evaluated the link between primary kidney function and vesicoureteral reflux in patients with posterior urethral valves. We also analyzed the timing of the resolution of reflux after release of urethral obstruction. We retrospectively analyzed records and x-ray results for 200 patients with posterior urethral valves treated at our institution between 1953 and 2003. Of these patients 197 were evaluated for vesicoureteral reflux. Bilateral vesicoureteral reflux was present in 73 patients (37%) and unilateral reflux in 54 (27%). Of 99 cases of posterior urethral valves diagnosed postnatally the diagnosis was made at a younger age when reflux was present (p <0.001). Patients with reflux (especially bilateral) had significantly higher serum creatinine levels at presentation and 6 and 12 months postoperatively compared to patients without reflux. In unilateral cases the split functions of refluxing kidneys were significantly decreased. Reflux resolved spontaneously at a median of 1.28 years (range 0.04 to 15.16) after treatment of posterior urethral valves, resolving more rapidly in patients with unilateral disease. Among 200 poorly functioning kidneys 35 with reflux (18%) were removed. In patients with posterior urethral valves vesicoureteral reflux is often associated with poorly functioning kidneys. Accordingly patients with bilateral reflux have decreased overall kidney function. Reflux resolves in half of ureters within 2 years after valve ablation. Reflux resolves more rapidly in unilateral cases.

Epidemiology of urogenital tuberculosis worldwide

To characterize the epidemiology of urogenital tuberculosis worldwide and to compare the features of patients from developing countries to those from developed countries. A comprehensive search of articles published up to April 2008 using a combination of the terms 'tuberculosis', 'genitourinary', 'renal' and 'urogenital' was performed. Urogenital tuberculosis affects more men than women (2:1), with a mean age of 40.7 years (range 5-90). In 26.9% of cases there is a non-functioning unilateral kidney and in 7.4%, renal failure. Patients from developing countries are more likely to have a delayed diagnosis with a higher frequency of renal failure, unilateral non-functioning kidney, ablative surgery and contracted bladder. Urogenital tuberculosis is a worldwide disease with more destructive behavior in developing countries where urgent strategies for early detection are particularly warranted.

Analgesic nephropathy selectively affecting a unilateral non-functioning hypoplastic kidney

Analgesic nephropathy results from chronic abuse of non-narcotic analgesics, most frequently with the use of phenacetin and mixed analgesic preparations. Renal papillary necrosis and chronic interstitial nephritis with progressive scarring are characteristic of the histopathology of analgesic nephropathy. Typically, papillary necrosis in these patients is bilateral and affects almost all renal papillae. This report describes a case of severe analgesic nephropathy that discriminantly affected a unilateral non-functioning kidney and spared the contralateral normally developed kidney. The patient herein consumed therapeutic doses of acetaminophen and naproxen daily and for several years. We estimated the cumulative doses of acetaminophen and naproxen used by the patient during that period to be approximately 1.0 and 0.4 kg, respectively. The cumulative dose of acetaminophen is at the threshold of doses that were traditionally associated with an increased risk for end-stage kidney failure. Simultaneous intake of both analgesics could have had a synergetic adverse effect on renal function. This case also demonstrates that preexisting renal insufficiency is prerequisite to the development of analgesic nephropathy. Conversely, kidneys with normal function are resistant to the chronic nephrotoxicity associated with habitual analgesic use.

P04.38: Fetal renal dilatation: a poor predictor for high grade vesicoureteric reflux

systolic velocity (Vmax) of the RA and DA using color Doppler. Measurements were made five times from the 20th to the 40th week, in both the control and the renal disease group. Results: In the fetuses with PCK (Potter’s syndrome) that died postpartum from non-functional kidneys, the Vmax of the RA and DA in the 35th week were 13 cm/sec and 25.4 cm/sec, respectively. In the fetus with PCK (Trisomy 9) that died due to nonfunctional kidneys in the 34th week, the values were 13.3 cm/sec and 29.6 cm/sec, respectively. These values were well below those of the normal group: more than 1.5 SD below the mean. In two fetuses from the nine with hydronephrosis that had a unilateral nonfunctional kidney, the RA did not clearly show identifiable blood flow. Conclusions: The Vmax of the RA and DA in fetuses with renal disease correlates with fetal kidney function, particularly the RA Vmax. Vmax of 1.5 SD below the mean should be the lower normal limit.

Hemodynamics of the renal artery and descending aorta in fetuses with renal disease using color Doppler ultrasound – longitudinal comparison to normal fetuses

To examine the hemodynamic values of the renal artery (RA) and descending aorta (DA) in normal fetuses, and to compare these values to those of fetuses with renal disease, thus evaluating the usefulness of hemodynamic analysis for the diagnosis of fetal renal disease. We examined 46 normal fetuses and 15 fetuses with renal disease (six cases of polycystic kidney (PCK) and nine cases of hydronephrosis). We measured the maximum systolic velocity (Vmax ) of the RA and DA using color Doppler. Measurements were made five times, from the 20th to the 40th week, in both the control and the renal disease group. In the fetuses with PCK (Potter's syndrome) that died postpartum from non-functional kidneys, the Vmax of the RA and DA in the 35th week were 13 cm/s and 25.4 cm/s, respectively. In the fetus with PCK (Trisomy 9) that died due to non-functional kidneys in the 34th week, the values were 13.3 cm/s and 29.6 cm/s, respectively. These values were well below those of the normal group: more than 1.5 SD below the mean. In two fetuses from the nine with hydronephrosis that had a unilateral non-functional kidney, the RA did not clearly show identifiable blood flow. The V max of the RA and DA in fetuses with renal disease correlates with fetal kidney function, particularly the RA Vmax.Vmax of 1.5 SD below the mean should be the lower normal limit.

Poor predictability of prenatal ultrasonography for a nonfunctional kidney

We present 2 cases in which the diagnosis of a unilateral nonfunctioning kidney was not anticipated. The first case appeared to be simple, antenatally diagnosed, unilateral hydronephrosis with adequate parenchyma. However, at 3 months postnatally, it was found to be nonfunctional, most likely secondary to early high-grade obstruction. The second case presented prenatally as a left hydronephrotic kidney with parenchymal cysts, and the right kidney showed only mild parenchymal cystic changes. By 6 months, however, the right kidney was nonfunctional. These cases emphasize the need for coordinated prenatal and postnatal care. The sonographic appearance of renal dysplasia is variable (in size, number of cysts, and degree of hydronephrosis), depending on the point at which it is evaluated during the disease course. Subtle signs of dysplasia, such as increased echogenicity, may be the only warning sign of a nonfunctioning kidney, for which one should have a high index of suspicion.

Retroperitoneoscopic extirpation for adult multicystic calcified dysplastic kidneys with contralateral ureteral abnormalities mimicking genitourinary tuberculosis.

To identify adult multicystic calcified dysplastic kidneys (AMCDK) with contralateral ureteral abnormalities mimicking urinary tuberculosis and to evaluate the feasibility and efficacy of retroperitoneoscopic extirpation in their management. We retrospectively identified a group of adult patients who were referred to us as having unilateral nonfunctioning kidney containing calcified cystic masses with a contralateral normally functioning kidney along with segmental dilation of ureter. Two patients had histories of treatment elsewhere with antitubercular drugs on the basis of imaging studies, before being referred to our center for retroperitoneoscopic nephrectomy with a diagnosis of nonfunctioning left kidneys and urinary tuberculosis. The other two cases with similar findings on imaging studies were detected incidentally while the patients were undergoing investigations for vague abdominal symptoms. All these patients had AMCDK on the left side and a contralateral normally functioning kidney with ureteral abnormality. Retroperitoneoscopic extirpation of the nonfunctioning left renal unit was carried out uneventfully with a mean operating time, blood loss, and hospital stay of 124 minutes, 80 mL, and 3 days, respectively. There were no complications. The dissection in these cases was difficult, as the dysplastic calcified kidney was plastered in the retroperitoneum. Unilateral AMCDK with contralateral segmental dilation of the ureter may be separate entity or a coincidental finding, and it should not be confused with urinary tuberculosis unless there is microbiological and radiologic or histopathologic evidence of infection. Minimally invasive surgery in the form of retroperitoneoscopic extirpation is feasible, safe, and effective in such cases, although difficult, and it requires skills as well as experience.

Curable hypertension: Usefulness of renal vein renin ratio

A case of severe hypertension in an adolescent male is presented. Initial evaluation of hypertension revealed a unilateral nonfunctioning kidney with no lateralization of renal vein renin ratio. Following 10 months of medical therapy, lateralization of renal vein renin was demonstrated, with subsequent cure of hypertension following nephrectomy.

Accuracy of Ultrasound in the Diagnosis of Nonfunctioning Kidneys

The accuracy and reliability of ultrasound were assessed in 246 patients with 338 radiologically nonfunctioning renal units. The causes of nonfunction included hydronephrosis, pyonephrosis, renal parenchymal disease, renal agenesis, renal neoplasm and polycystic disease. Obstruction was proved in 158 patients, with an accuracy of 98.1 per cent. Retrograde pyelography was avoided.The diagnosis of a small end stage kidney was correct in 42 patients. In 9 patients with a unilateral nonfunctioning kidney less than 9cm. long a thin coarsely textured cortex with dilatation of 1 or more calices was found. To our knowledge the presence of dilated calices in a small kidney, suggestive of chronic pyelonephritic changes, has not been described previously by ultrasound. Nonvisualization occurred in 16 cases (4.7 per cent) despite the anatomical presence of a kidney. An advanced degree of pyonephrosis with thick inspissated pus sometimes may mimic the ultrasonic appearance of a renal neoplasm.

Role of Nephrectomy in the Treatment of Non-Functioning or Very Poorly Functioning Unilateral Tuberculous Kidney

We reviewed 300 consecutive cases of genitourinary tuberculosis at Wrightington Hospital from 1961 to 1978. There were 73 patients with non-functioning or poorly functioning kidneys who underwent nephrectomy after at least 6 weeks of intensive chemotherapy with 3 antituberculous drugs. Three of 4 patients with unilateral non-functioning kidneys who did not have a primary nephrectomy had delayed complications. Late complications of in situ non-functioning tuberculous kidneys included draining flank sinuses, abscesses and hypertension. These complications can occur years after completion of chemotherapy, even in sterile organs. The incidence of hypertension in this series was 11.3 per cent. The incidence of hypertension in patients with unilateral nonfunctioning or poorly functioning tuberculous kidneys was 23.2 per cent (p <0.005). Two-thirds of the hypertensive patients with severe unilateral tuberculous nephropathy benefited by a decrease in blood pressure after nephrectomy. Removal of these kidneys does not cause a significant loss of renal function. The perioperative morbidity and mortality of the procedure should be minimal in a generally younger population. It is concluded that primary nephrectomy is an important adjunct in the comprehensive management of the unilateral non-functioning kidney.

Computed tomography in the evaluation of the solitary or unilateral nonfunctioning kidney.

Computed tomography (CT) using the EMI CT5000/5005 scanner was performed on 14 patients with a solitary functioning kidney demonstrated by other radiological investigations. Examinations before and after intravenous injection of contrast material have been undertaken. In the majority of cases, the patients were referred as a "nonfunctioning kidney" following excretion urography. Other referrals included previous nephrectomy or solitary kidneys. In all cases, the CT scan made possible the definitive diagnosis. The diagnosis included unsuspected hydronephrosis, vestigial kidney, contracted kidney secondary to chronic pyelonephritis and calculus, recurrence of a hypernephroma, and lymphomatous infiltration. Valuable information was obtained about the vascular pedicle, the renal collecting systems, the perinephric space, and the retroperitoneal space including the paraaortic lymph nodes. Furthermore, the increased sensitivity of the technique in detecting lower concentrations of iodine provided information regarding renal function. It is concluded that the noninvasive nature of CT makes it a valuable adjunct in the further investigation of such patients.