Megaureter Research Articles

Robotic ureteroureterostomy for correction of a retrocaval ureter

Introduction: Retrocaval ureter is a rare condition identified in the adult patient usually revealing dilation of the proximal ureter as it passes posterior to the inferior vena cava. The presentation can vary from incidental radiographic findings to declining renal function secondary to hydronephrosis. Management of a retrocaval ureter typically involves surgery in patients who have symptoms or deterioration in renal function. Case Report: This case report explores the diagnosis and treatment of a retrocaval ureter in a 34-year-old male who was referred to Urology after the detection of right-sided hydronephrosis on computed tomography (CT). Further management included a confirmatory CT, diuretic renogram, and retrograde pyelogram before definitive treatment with robotic ureteroureterostomy. Conclusion: This case report explores the surgical steps to a robotic-assisted ureteroureterostomy to treat a retrocaval ureter that resulted in significant hydronephrosis and flank pain.

Spontaneous resolution of primary obstructive megaureter: Risk stratification and prediction based on early sonographic factors.

To describe and develop predictors for spontaneous resolution of primary obstructive megaureter (POM) from early ultrasound measures. Children referred to our institution between 2007 and 2023 for POM were reviewed. POM was defined as hydroureteronephrosis with ureteral dilatation >7mm. We excluded patients with other etiologies for upper tract dilatation. Resolution was defined as decrease in hydronephrosis to <10 mm anteroposterior diameter (APD) or SFU grade ≤ 2, or ≤7 mm in hydroureter. Patients were censored if they underwent surgical intervention or were lost-to-follow-up before documenting resolution. Kaplan-Meier curves were drawn to illustrate the cumulative resolution rate and determine univariate associations. Cox proportional hazards regression was performed to identify significant predictors for early resolution and concordance index (c-index) was calculated. A total of 159 patients were included, with a median index age of 2 months and a median follow-up of 30 months. Of these, 89 patients reached spontaneous resolution during monitoring and likelihood of surgical indication at 1-year from US was 30%. APD >15 mm, high-grade hydronephrosis, ureteral dilation >10 mm, and ureter tortuosity at presentation were associated with a lower likelihood of resolution for individual Kaplan-Meier curves. A Cox regression model trained on these predictors achieved an adjusted c-index of 0.68, and low APD remained associated with a higher likelihood of resolution. Early sonographic features in POM, specifically APD, are associated with the likelihood of spontaneous resolution. Patients with high-risk features at first ultrasound warrant closer follow-up.

Co-existing obstructed and refluxing lower moiety megaureter in a female without incontinence: a perplexing myriad in a duplex system with ectopic lower moiety ureter

Ectopic ureter is a rare congenital anomaly that predominantly affects females and typically manifests as urinary incontinence due to atypical ureteral openings in structures such as the vagina or cervix. This condition is estimated to occur in approximately 1 in 4000-10,000 female births. An exceptional variant, the intrasphincteric ectopic ureter, poses significant diagnostic challenges due to its atypical presentation, as it may cause dynamic obstruction and reflux phenomena without resulting in incontinence. A 28-year-old female presented with severe left flank pain, fever, and chills persisting for 10 days. Her medical history included intermittent dull, aching left flank pain over 7 years, exacerbated during voiding, but no urinary incontinence. Physical examination revealed marked tenderness in the left flank, and laboratory investigations showed elevated leukocyte count and normal serum creatinine levels. Computed tomography urography revealed a left duplex moiety with upper moiety infected hydronephrosis, necessitating percutaneous nephrostomy placement. Subsequent nephrostogram and micturating cystourethrogram identified a grossly dilated and tortuous upper moiety ureter with intrasphincteric ectopic ureteral opening, confirming the diagnosis of obstructed and refluxing megaureter. Following infection resolution, the patient underwent laparoscopic extravesical non-refluxing reimplantation of the upper moiety ectopic ureter with DJ stenting. The postoperative course was uneventful, and the patient reported no flank pain or fever upon stent removal. Periodic evaluations showed no increase in hydronephrosis, indicating a successful intervention. This case underscores the diagnostic complexity of intrasphincteric ectopic ureter, a rare anomaly presenting with obstructed and refluxing megaureter without incontinence. Heightened clinical vigilance and comprehensive radiological evaluation are imperative for timely diagnosis and intervention. Preservation of continence further complicates the clinical picture, necessitating early intervention to prevent renal function deterioration and improve long-term outcomes.

Diagnostic efficacy of combined high- and low-frequency ultrasound in post-hematopoietic stem cell transplantation ureteral obstruction in leukemia patients.

The objective of this study was to evaluate the diagnostic efficacy of high- and low-frequency ultrasound (H&LFUS) in the imaging of post-hematopoietic stem cell transplantation (post-HSCT) ureteral obstruction in leukemia patients. A total of 103 patients who received HSCT for leukemia were included in this retrospective study. Patients underwent examinations using high-frequency ultrasound (HFUS), low-frequency ultrasound (LFUS), and the combined use of H&LFUS approach. Baseline data, clinical laboratory parameters, and clinical parameters were compared among the groups. Ultrasound findings and diagnostic sensitivity, specificity and accuracy were also analyzed to assess the diagnostic value of the imaging modalities. The investigation demonstrated no statistically significant distinctions in demographic, baseline, and clinical parameters among the HFUS group, LFUS group, and H&LFUS group. Nonetheless, notable differences emerged in the detection rates of specific ultrasound abnormalities, encompassing ureteral dilatation, wall thickening, urine flow obstruction, hydronephrosis, bladder wall thickening, andrenal masses. Regarding diagnostic performance metrics, H&LFUS approach exhibited superior efficacy across sensitivity, specificity, and overall accuracy, registering rates of 91.43%, 88.57%, and 90%, respectively, surpassing those of the individual HFUS and LFUS methodologies. The amalgamation of H&LFUS techniques manifests as a formidable diagnostic modality, characterized by heightened sensitivity, specificity, and diagnostic accuracy.

Clinical characteristics of urinary system symptoms in 11 patients with neuronal intranuclear inclusion disease

To summarize the characteristics of urinary system symptoms in 11 patients with neuronal intranuclear inclusion disease (NIID), in order to improve the understanding of the disease. A retrospective analysis was performed on 15 patients with NIID of the First Affiliated Hospital of Zhengzhou University, which were enrolled between January, 2020 and December, 2022. All of them were confirmed by NOTCH2NLC gene and pathology. GGC repeated expansion mutationof NOTCH2NLC gene, the pathogenic gene of NIID, was detected by gene test, and eosinophilic intranuclear inclusions were detected by skin pathological biopsy. 4/15 patients started with urinary symptoms, 11/15 patients with NIID combined with different degrees of urinary system symptoms, manifested as frequent urination, weak urination, incontinence and other neurogenic bladder symptoms, and the serious patients due to long-term urinary retention, secondary ureteral dilation, hydronephrosis, even renal failure, some patients with urinary system symptoms may be earlier than other systems.

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

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

Effect of preoperative Silodosin on facilitating access sheath placement in retrograde intrarenal surgery. A randomized controlled studys

ABSTRACT Introduction to evaluate the effect of preoperative Silodosin on ureteric dilatation to facilitate ureteral access sheath (UAS) placement and reduction of ureteral wall injury in retrograde intrarenal surgery (RIRS). Methods one hundred and twenty patients with renal or ureteric stones were randomly allocated into 2 equal groups. Group A represents patients who received a 7-day preoperative single dose Silodosin before RIRS while Group B represents patients who received a placebo for the same regimen. Our primary outcome was to assess the success rate of (UAS) placement. Our secondary outcomes were to evaluate the perioperative complication rate, stone-free rate, hospital stay, and cost analysis. Results In our study, Silodosin showed a higher success rate for (UAS) insertion compared to placebo with a statistically significant difference (p-value = 0.04). Spontaneous UAS insertion in the Silodosin group was 58.3%, which was increased with active ureteric dilatation to 98.3%. Preoperative Silodosin led to less postoperative pain and analgesics requirements without impacting postoperative hospital stay or stone-free rate. There was less ureteric injury incidence in the Silodosin group compared to placebo with a statistically significant difference (p-value = 0.002). Conclusion Preoperative Silodosin facilitates UAS insertion with a protective role against ureteric injury compared to placebo.

Suspected encrusting cystitis in a domestic ferret (Mustela putorius furo)

BackgroundEncrusting cystitis diagnosis and medical management in domestic ferrets (Mustela putorius furo) has never been documented. Case descriptionA client-owned, 6.5-year-old, neutered, male domestic ferret was presented for lethargy, abdominal pain, straining to urinate for 12 days, and red, purulent urine. On physical examination, the ferret was quiet, alert, and responsive, had a distended and inexpressible bladder, large and firm kidneys, and was displaying signs of severe pain including vocalization on abdominal palpation and when attempting to urinate. Sonographic evaluation showed an irregular, layered, hyperechoic mass lesion present in the lumen of the urinary bladder with extensions of the layered luminal material into the urethra, and severely dilated renal pelves and ureters. These severe, urinary bladder changes were consistent with pseudomembranous, encrusting cystitis. Following a discussion with the owner about options for humane euthanasia versus exploratory surgery, euthanasia was elected. The remains were taken home with the owner and a necropsy was not performed. Conclusion and case relevanceTo the author’s knowledge, this paper reports the first known case of suspected encrusting cystitis in a domestic ferret including radiologic and ultrasonographic findings.

Prevalence of and factors associated with Na + /K + imbalances in a population of children hospitalized with febrile urinary tract infection

We aimed to assess the prevalence of and factors associated with Na + /K + imbalances in children hospitalized for febrile urinary tract infection (fUTI). This retrospective Italian multicenter study included children aged 18 years or younger (median age = 0.5 years) who were discharged with a primary diagnosis of fUTI. Na + /K + imbalances were classified as hyponatremia (sodium < 135 mEq/L), hypernatremia (sodium > 145 mEq/L), hypokalemia (potassium < 3.5 mEq/L), hyperkalemia (potassium > 5.5 mEq/L), and concurrent hyponatremia and hyperkalemia, in the absence of evidence of hemolyzed blood samples. Among the 849 enrolled children, 23% had hyponatremia, 6.4% had hyperkalemia, 2.9% had concurrent hyponatremia and hyperkalemia, 0.7% had hypokalemia, and 0.4% had hypernatremia. In the multiple logistic regression analysis, after applying the Bonferroni correction, only C-reactive protein (C-RP) levels were significantly associated with hyponatremia (OR = 1.04; 95% CI: 1.02–1.06; p < 0.001), only age was significantly associated with hyperkalemia (OR = 1.7; 95% CI: 1.1–2.7; p = 0.01), and only CAKUT was significantly associated with concurrent hyponatremia and hyperkalemia (OR = 4.3; 95% CI: 1.7–10.8; p = 0.002). Even after adjusting for the presence of kidney hypoplasia, abnormal renal echogenicity, pelvi-caliceal dilation, ureteral dilation, uroepithelial thickening of the renal pelvis, bladder abnormalities, pathogen other than E. coli, concurrent hyponatremia and hyperkalemia persisted significantly associated with CAKUT (OR = 3.6; 95% CI: 1.2–10.9; p = 0.02).Conclusion: Hyponatremia was the most common Na + /K + imbalance in children hospitalized for fUTI, followed by hyperkalemia and concurrent hyponatremia and hyperkalemia. C-RP levels were most strongly associated with hyponatremia, age with hyperkalemia, and CAKUT with concurrent hyponatremia and hyperkalemia (suggestive of transient secondary pseudo-hypoaldosteronism). Therefore, in children who develop concurrent hyponatremia and hyperkalemia during the course of a fUTI, an underlying CAKUT could be suspected.What is known:• Na+ and K+ abnormalities can occur in patients hospitalized for febrile urinary tract infection (fUTI).• Concurrent hyponatremia and hyperkalemia during fUTI may suggest transient secondary pseudo-hypoaldosteronism (TPHA), for which limited data on prevalence are available.What is new:• The most common Na+/K+ imbalance in children hospitalized with fUTI was hyponatremia (23%), followed by hyperkalemia (6.4%), concurrent hyponatremia and hyperkalemia (2.9%), hypokalemia (0.7%), and hypernatremia (0.4%).• Concurrent hyponatremia and hyperkalemia were mainly associated with CAKUT, while hyponatremia alone correlated with high C-reactive protein and hyperkalemia alone with younger age. In cases of concurrent hyponatremia and hyperkalemia during fUTI, an underlying CAKUT should be suspected.

Bilateral Ectopic Ureters with Vaginal Insertion in a Duplex Collecting System: A Case Report of a Rare Case

Abstract The usual opening of the ureters is in the trigone of the bladder. However, it may open in an infrasphincteric location causing urinary incontinence with normal voiding. This is more commonly associated with a duplex collecting system in females, albeit, a bilateral occurrence of ectopic ureters with drainage into the vagina is rare. We report a rare case of bilateral occurrence of a duplex collecting system with drainage into the vagina. She was a 3-year-old girl with a complaint of continuous dripping of urine despite normal voiding. There was no history of fever, difficulty with micturition, fecal soiling, back swelling, or pelvic surgery in the past. She had normal female external genitalia with two openings in the vestibule. A computerized tomography urography showed a bilateral duplex collecting system with prompt and symmetric excretion of contrast, and dilated ureters of the upper renal moiety draining into the vagina bilaterally. We reimplanted the ectopic ureters with a resolution of urinary incontinence.

Endoscopic balloon dilatation of primary obstructive megaureter: An effective first line management in children

This study evaluates outcomes of endoscopic balloon dilatation (EBD) in the management of primary obstructive megaureter (POM) in children. Retrospective data between 2013 and 2023 from two tertiary paediatric surgical centres in the UK were reviewed. Pre and post-operative clinical and imaging parameters of children managed with EBD were assessed. Failure of procedure was defined as requiring further intervention due to persistent/recurrent symptoms, upper tract dilatation and/or obstruction on MAG3 over the follow up period. 55 children with 61 renal units were evaluated. Median age at treatment was 18 months with a median follow up of 24 months. There was significant reduction in upper tract ultrasound measurements following balloon dilatation but there was no significant difference between the pre and post-operative renal function on MAG3. No significance difference was demonstrated when the outcomes of cutting and non-cutting balloons were compared. No significant difference was shown when outcomes after EBD were compared between infants vs older children as well as ureteric dilatation less than or over 25mm (p=0.841). 87% were successfully treated with a single dilatation and this increased to 95% after second dilatation. The remaining 5% had ureteric re-implantation. Although a retrospective study, the patient population is relatively large. 87% success rate shown after EBD is comparable to similar studies. It has been suggested that children less than 12months and those with severe ureteric dilatation (>25mm) may not be suitable for EBD. No significant difference was demonstrated when the outcomes of these categories of children were compared to other children with POM. All of the patients that had repeat balloon dilatation required no further intervention, a finding that has so far not been well evaluated in available literature. This study demonstrates 87% success rate after single EBD in children with POM and this outcome increased to 95% following a second dilatation. EBD is shown to be an effective definitive surgical management option of POM. It can be safely offered as first line management in all patient groups and repeated if no initial response.

Megaureter in adults: a review of the current literature.

Megaureter (MU) is an uncommon condition in adults. The aim is to present a review of the current literature. A literature search was conducted to explore the current literature including case reports on MU in adults in the period 2003-2023. Each case was characterised in terms of the eight categories: sex, age, etiology, location, symptoms, diagnostic tool used, type of treatment and follow-up. There was no meta-analysis but two reviews. Total, 39 case reports were included based on 35 articles. The most common observations for the first four categories were male (sex), age below 40 (age), obstructed MU (etiology) and left-sided MU (location). Almost every patient appeared with symptoms, most frequently flank pain, abdominal pain and recurrent urinary tract infections. CT scan and transabdominal ultrasonography are the most commonly used diagnostic tools. Most cases underwent either laparoscopic or open surgical treatment with ureteral reimplantation as the most performed surgical procedure. A majority of the patients had an uneventful follow-up. MU in adults is a rare condition presenting with heterogeneous symptoms. CT scan and transabdominal ultrasonography should be used as diagnostic tools. Nearly all patients underwent surgical treatment with an uneventful follow-up. Complications such as stone formation and altered function of the affected kidney are common. Surgical treatment is recommended and is determined by consideration of age, symptoms, ureteral extension and progressive loss of renal function.

Comparison of Clinical Response to D-Mannose with Behavioral Modifications Versus Behavioral Modifications Alone in Asymptomatic Pyuria During Pregnancy

The physiological and structural changes during pregnancy cause ureteral dilatation and urine stasis, which can lead to asymptomatic and symptomatic infections. Objective: To compare the clinical response between d-mannose with behavioral modifications versus behavioral modifications alone in asymptomatic pyuria during pregnancy. Methods: A quasi experimental study was conducted from April to September 2021, in the Department of Gynecology and Obstetrics Maternal and Child Health Center unit-1, PIMS, Islamabad. A total of 130 women with diagnoses of asymptomatic pyuria matching the inclusion criteria were recruited during study period and assigned to two groups by consecutive non-probability sampling method. Patients with urinary tract abnormalities, GDM, and antibiotic-treated symptomatic UTIs were excluded. Group A was instructed to take 1 g of D-mannose twice daily and follow the advises about behavioral changes.The group B was instrcucted to follow behavioral change only. pus cells in urine R.E.reports were used to evaluate response of treatments. Results: According to the study, the mean age of patients in group A was 27.69 ± 4.04 years, whereas group B had a mean age of 28.85 ± 4.12 years. The majority of patients (61.54%) were aged 15-30. Patients in group A had a mean gestational age of 23.72 ± 3.19 weeks, whereas group B had 24.26 ± 3.23 weeks. Patients had a mean BMI of 29.65 ± 3.55 kg/m2. In group A; 23 (35.18%) and in group B 11 (16.92%) cases of asymptomatic pyuria achieved reolution.Conclusions: This study found that D-mannose with behavioral adjustments resolves asymptomatic pyuria during pregnancy better than behavioral modifications alone.

Novel anti-reflux ureteral skirt: proof of concept in a Yorkshire-Landrace pig model.

Stents with anti-reflux properties have been previously described in various studies but not widely adopted. We designed, constructed and tested a novel umbrella-looking anti-reflux skirt on a double J stent at the level of the ureteral orifice in a previous ex-vivo study. This study serves as a proof of concept of testing this prototype in a porcine model. 3 Yorkshire-Landrace pigs were put under general anaesthesia. Conventional bilateral retrograde stenting with white-colored double-J stents were performed. Deployment of anti-reflux skirt was performed unilaterally. Capsaicin mixed with methylene blue and saline were instilled in the bladder. Both stents were removed and methylene blue stain were inspected to assess the level of reflux. Bilateral stenting was performed again and stents/skirt prototype were left in-situ for 1 week. The procedure was repeated on Day 7 to re-test the anti-reflux property of the prototype after ureteral dilatation. Intraluminal reflux was evident, with methylene blue stain seen on the inner surface of the stents. Extraluminal reflux was proved with blue stain seen on the outer surface of the stents, both in undilated and dilated ureters. Study also proved the anti-reflux property of the skirt as the blue stain didn't go beyond the skirt, whereas the contralateral stent was stained up to proximal ureter. In this porcine in-vivo study, we elucidated that reflux occurred were both intraluminal and extraluminally. As a proof of concept, it also showed the anti-reflux property of a novel ureteral skirt.

Ureteral endometriosis: MR imaging appearance for predicting complex procedures

Rationale and objectivesTo describe MRI characteristics of ureteral endometriosis (UE) in identifying intrinsic involvement of the ureteric wall and predicting complex procedures. MethodsThirty-three UE lesions in 30 patients treated for UE over a 20-year period were reviewed. A systematic analysis of 13 MRI (ureteric wall thickening, circumference, T1 signal, T2 signal, ureterectasis, lateral parametrial endometriosis (LPE), rectal endometriosis, the foregoing three-characteristic diameter, ovarian endometriomas, adenomyosis, paraurethral endometriosis) and 5 clinical (age, BMI, CA125, creatinine and rAFS stage) characteristics was performed. MRI results were compared to histology and surgical procedure performed (simple versus complex ureteral procedures). ResultsTwenty-five extrinsic and 8 intrinsic UE were pathologically identified. Twenty lesions underwent a simple procedure, and 12 underwent a complex procedure, with 1 ureteroscopic biopsy. There were significant differences in the characteristics of ureteric wall thickening, the diameter of dilated ureter and LPE, rectal endometriosis and adenomyosis between extrinsic and intrinsic UE (p < 0.05). UE was associated with LPE (p = 0.033). The criteria of ureteral wall thickening more accurately predicted intrinsic UE than circumference, but the AUC was not significant difference (AUC, 0.806 and 0.639; 95 % CI, [0.594, 0.937] and [0.419, 0.823], respectively; p = 0.350). There were significant differences in creatinine, thickening and adenomyosis between the simple and complex procedures (p < 0.05). In 11 lesions with the absence of ureterectasis, 4 lesions with hydronephrosis and thickening were intrinsic and underwent complex procedures, while 7 lesions extrinsic and simple. ConclusionsUreteric wall thickening as a analytical criterion may accurately predict intrinsic UE and complex ureteric procedures.

Evaluation of the Role of Preoperative Pharmacological Ureteral Dilatation in Ureteroscopic Stone Surgery

Abstract Background Urinary stone disease is very common, with an estimated prevalence among the general population of 2% to 3% and an estimated lifetime risk of 1 in 8 for white males and 5% to 6% for white females, with men forming stones three times as often as women. Aim of the Work To compare the effectiveness of antispasmodics (hyoscine-N- butylbromide), α-blockers (tamsulosin), placebo as control (in the form of multivitamins), as preoperative medications for ureteral dilatation prior to semirigid ureteroscopic stone surgery. Patients and Methods This prospective randomized control clinical study conducted on 90 patients admitted from Urology department, Faculty of Medicine, Ain Shams University hospitals in a period of 6 months starting from March 2022 till September 2022; they were randomized into 3 groups 30 patients per group: Group (A) received Tamsulosin 0.4 mg once daily for 7 days, Group (B) received Hyoscine-N- butylbromide 10 mg three times per day for 7 days, Group (C) received Placebo. Results The operation time and the need of double J stent insertion significantly decrease with Tasmulosin or Hyoscine-N-butylbromide versus Placebo. Operative and postoperative complications significantly decrease while using Tamsulosin or Hyoscine- N-butylbromide versus Placebo. Conclusion The administration of adjunctive alpha-blockers and/or antispasmodics prior to ureteroscopic management of lower ureteric stones seems to be associated with better advancing of the ureteroscope to access the stone, shorter procedure time, higher stone-free rate, lower incidence of intra- and postoperative complications and lesser need for postoperative analgesia.

Ultrasonography Analysis and Incidence of Urinary Schistosomiasis among some Selected Junior Secondary School Students in Rigachikun, Igabi Local Government Area, Kaduna State, Nigeria

Study’s Excerpt/Novelty This study assesses urinary schistosomiasis prevalence and associated ultrasonographic abnormalities among school-aged children in Rigachikun, Igabi Local Government Area of Kaduna State. By combining urine sample analysis and ultrasound examination, the research identifies a significant infection rate (5.00%) and highlights the presence of urinary tract abnormalities in 70% of infected subjects. The findings underscore the ongoing disease burden of schistosomiasis in the region and advocate for expanded research on adult populations and snail intermediate hosts to inform targeted intervention strategies. Full Abstract This study evaluated urinary schistosomiasis and ultrasonography incidence among school-aged children in Rigachikun, Igabi Local Government Area of Kaduna State. Three hundred urine samples were collected from students within 5-16 years from 3 selected schools. The samples were tested for urinary schistosomiasis, and information was gathered using a standardized questionnaire. The weight and height of the samples were measured using an electronic scale (9201 SV3R) and a portable stadiometer (ADE MZ10042). 5.29% of males and 3.70% of females tested positive for urinary schistosomiasis. Ultrasound examination was performed on ten positive and one negative subjects for confirmation. The mean age was 11.00±5.72 years. Seven out of ten (70%) subjects showed urinary tract abnormalities. The ultrasound findings revealed two out of ten (20%) had bladder wall thickening, four out of ten (40%) had an irregular shape of the bladder wall, and ureteric dilatation was observed in one out of ten (10%) among the subjects. Ultrasound is a useful tool for identifying the morbidity of S. haematobium. Schistosomiasis infection amongst schools in Rigachikun was established at 5.00%. This has confirmed that schistosomiasis is still a disease burden amongst school-aged students in Rigachikun and, by extension, all the study area's inhabitants. It can be recommended that further studies need to be carried out on adults and snail intermediate hosts.

Endoscopic diagnosis of an obstructive fungal ball in the urethra of a dog

AbstractA 1‐year‐old, male, neutered German shepherd dog was presented for a chronic atraumatic non‐healing fracture of the right accessory carpal bone, stranguria and polyuria/polydipsia. Biochemistry and urinalysis showed azotaemia. Ultrasound and computed tomography of the abdomen both demonstrated bilateral renal infarcts with pyelectasia, bilateral ureteral dilation and bladder distension. Cystoscopy of the bladder identified a fungal ball obstructing the pelvic urethral sphincter, which was adhered to the bladder mucosa in the region of the ureterovesicular junction. The obstruction was traversed endoscopically, but could not be removed transurethrally. The combination of elevated serum galactomannan titres (6.4) and Aspergillus terreus cultured from urine, confirmed a diagnosis of disseminated aspergillosis. The dog was euthanased due to poor quality of life, guarded prognosis and lengthy timeframe before an expected medical response. This is the first case report describing Aspergillus fungal balls in a dog causing partial urethral and bilateral ureteral obstruction, identified using cystoscopy.

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

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

18F-FDG PET/CT findings in nevoid basal cell carcinoma syndrome: a systematic review and a new case report

BackgroundTo demonstrate and analyze the 18F-FDG positron emission tomography/computed tomography (PET/CT) findings in this rare nevoid basal cell carcinoma syndrome (NBCCS).Case presentationA 71-year-old woman with the left invasive breast cancer was treated with hormone therapy for six months and underwent the 18F-FDG PET/CT examination for efficacy evaluation. 18F-FDG PET/CT revealed the improvement after treatment and other unexpected findings, including multiple nodules on the skin with 18F-FDG uptake, bone expansion of cystic lesions in the bilateral ribs, ectopic calcifications and dilated right ureter. She had no known family history. Then, the patient underwent surgical excision of the all skin nodules and the postoperative pathology were multiple basal cell carcinomas. Finally, the comprehensive diagnosis of NBCCS was made. The patient was still in follow-up. Additionally, we have summarized the reported cases (n = 3) with 18F-FDG PET/CT from the literature.ConclusionsIt is important to recognize this syndrome on 18F-FDG PET/CT because of different diagnoses and therapeutic consequences.