Ureterovesicular Junction Research Articles

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.

PMON88 A Rare Case of Composite Paraganglioma in the Bladder

Abstract Background Paragangliomas are neuroendocrine tumors that arise from embryonic neural crest cells; they are essentially extra-adrenal pheochromocytomas most frequently found in the head and neck. Composite tumors are rare and consist of the presence of two histologically distinct tissues within a single tumor. Additionally rare is the presence of a composite paraganglioma in the retroperitoneum and urinary bladder, of which there are few reported cases. Case Report We present a case of a 57 year old female who was found to have an incidental pelvic mass noted to progressively increase in size over the years on subsequent imaging. The patient had a cystoscopy and retrograde pyelogram that were both unremarkable. MRI Pelvis showed a 1.8×1.8×1.9 cm rounded, well-circumscribed lesion at the left posterior lateral bladder extending exophytically from the serosa at the ureterovesicular junction. As she had associated hypertension, palpitations, and anxiety, the patient was evaluated for pheochromocytoma.Laboratory workup showed elevated plasma levels of free Metanephrines at 130 (<57 pg/mL), free Normetanephrines at 247 (<148 pg/mL), and a free Total level at 377 (<205 pg/mL). 24-hour urine collection was consistent with mild elevation of Metanephrines at 330 (90-315 mcg/24 h), normal levels of Normetanephrines at 469 (122-676 mcg/24 h), and normal levels of Total urine Metanephrines of 799 (224-832 mcg/24 h). 24-hour urine free Catecholamines showed: Epinephrine of 6 (2-24 mcg/24 h), Norepinephrine of 77 (15-100 mcg/24 h), and a Total (Epi+NE) of 83 (26-121 mcg/24 h), with Dopamine of 220 (52-480 mcg/24 h).Due to mildly elevated metanephrine levels, the patient was started on the alpha-blocker doxazosin. She ultimately underwent a laparoscopic removal of the bladder mass, with pathology reports confirming presence of a composite paraganglioma with atypical features. Additionally, further immunohistochemistry was negative for the SDHB gene mutation in the tissue samples obtained. Conclusion Composite paragangliomas of the urinary bladder are very rare. Certain genetic pathologic variants carry an increased risk for malignancy and possible metastasis; therefore, these neuroendocrine tumors usually require targeted mutation testing. At this time, the pathogenesis of composite paragangliomas is still largely unknown, with little information available about treatment options and clinical outcomes. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

A case report of left sided ureteric calculus cured by lycopodium clavam in lm potency

Uretric calculus or stone in ureter is one of an acute abdominal condition, if it not managed properly it may transferred to fatal condition. Calculus of ureter mainly originates from kidney & passes down to ureter. While passing down it may stuck in to the narrowest constrictions in Ureteric lumens, leads to obstruction of ureter results in Uretric colic & hydonephrosis. A case of 25yrs old male patient with of Left sided ureteric calculus of 5.6mm at Uretero-vesicular junction with ipsilateral hydro-uretero nephrosis has been successfully treated by Lycopodium as a constitutional medicine at LM potency for a duration of 50 days.

Optimization of ultrasonographic ureteral jet detection and normal ureteral jet morphology in dogs.

Ureteral jets are visualized with ultrasound as echogenic streams extending from the ureterovesicular junction into the urinary bladder. In clinical practice, diuretics are sometimes administered to increase visibility of ureteral jets, however this has not been well described in the veterinary literature. The purpose of this prospective, crossover study was to describe the normal morphology of canine ureteral jets, determine an optimal protocol for diuretic administration to increase visibility of ureteral jets, and confirm in vitro the effect that differences in specific gravity and velocity have on visibility. Ultrasound of 10 normal dogs was performed at baseline and following 1mg/kg furosemide administered intravenously or subcutaneously. Increased numbers of ureteral jets were seen post-furosemide administration compared to baseline, with an overall increased number of ureteral jets identified following intravenous administration when compared to subcutaneous administration. Time to first ureteral jet was significantly shorter with intravenous compared to subcutaneous administration. Urine specific gravity significantly decreased following furosemide administration. For the in vitro study, saline solutions of varying specific gravities were infused into a bath of hypertonic saline with specific gravity of 1.037. There was good visibility in vitro with infusion of solutions of specific gravities of 1.010-1.025. Infusion of saline solution with a specific gravity of 1.030 had reduced visibility, while infusion of saline with equivalent specific gravity (1.037) was not visible with B-mode ultrasonography. Both intravenous and subcutaneous furosemide administration significantly increase ureteral jet detection with ultrasound secondary to differences in specific gravity, confirming results of prior studies.

A 15-mm urinary calculus expelled with homoeopathic medicine - A case report

Introduction: Renal or ureteric colic is an acute and severe pain caused by obstruction in the ureter. It usually occurs in the narrower areas of the ureter. It can be associated with severe pain, nausea, vomiting, urinary infections, haematuria, hydronephrosis, etc. Case Summary: A case of 15-mm calculus, lodged at the right ureterovesicular junction, presented with severe cutting pain extending downwards from the right lumbar region to the right groin area. The patient had severe pain at the conclusion of urination. Another calculus of size 10 mm in the lower calyx of the left kidney and 3.4-mm concretion in the right kidney was also detected. The homoeopathic medicine Sarsaparilla was given on the basis of totality of symptoms for 3 days. The pain reduced in 3 days and subsequent to an acute colicky pain and some bleeding, on the 11th day, the stone was expelled. This case report shows the potential of Homoeopathy in cases of large urinary calculi.

RETROPERITONEAL FIBROSIS PRESENTING AS URETERAL OBSTRUCTION SECONDARY TO SARCOIDOSIS

SESSION TITLE: Fellows Disorders of the Mediastinum Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Sarcoidosis is a multi-organ system granulomatous disease of unknown etiology and, although it commonly affects the lungs, may be highly variable in its presentation. We will describe here a case of retroperitoneal fibrosis and ureteral obstruction secondary to sarcoidosis. CASE PRESENTATION: A 69 year old male with a history of prior episodes of nephrolithiasis presented with recurrent flank pain and nausea. Computed tomography (CT) of the abdomen revealed a new 4 mm stone at the left ureterovesicular junction with periureteral stranding. Cystoscopy was significant for distal left ureteral extramural compression. Subsequent magnetic resonance imaging (MRI) of the abdomen showed infiltrative soft tissue encasing the distal left ureter and iliac vessels. Patient underwent CT guided biopsy with pathology showing inflammatory myofibroblastic tumor. Initially, only observation was advised. The patient later developed recurrent urethral obstruction requiring new cystoscopy and stent placement. Subsequent MRI showed progressive infiltrative soft tissue throughout the retroperitoneum encasing the infrarenal aorta, IVC, and bilateral ureters. Multiple enlarged lymph nodes were also partially visualized in the chest, then dedicated CT chest showed diffuse nonspecific mediastinal and bilateral hilar lymphadenopathy. Endobronchial ultrasound guided fine needle aspiration of the mediastinal lymph nodes, stations 7, 11R, 4R and 4L revealed non-necrotizing granulomas consistent with sarcoidosis, without evidence of infection, malignancy or any additional inflammatory process as an explanation for the pathologic findings. DISCUSSION: Retroperitoneal fibrosis is a rare fibro-inflammatory disorder comprising the periabdominal aorta which expands to involve the retroperitoneum and frequently causes ureteral obstruction. It is an extremely rear manifestation of sarcoidosis, and always other more common etiologies such as immunoglobulin G4-related disease (IgG4-RD), malignancy, connective tissue disease, abdominal aortic aneurysm, and medications such as ergots, beta blockers, and non-steroidal anti-inflammatory drugs need to be ruled out. Symptoms are non-specific and include a dull low back, flank, or abdominal pain as well as constipation, fatigue, and weight loss. The diagnosis can be made with CT or MRI and biopsy is used to exclude malignancy and diagnose IgG4-RD. First line therapy is corticosteroids. CONCLUSIONS: Although experience with retroperitoneal fibrosis as a manifestation of sarcoidosis is lacking, treatment may help to reduce inflammation especially in the case of recurrent ureteral obstruction. Reference #1: Runowska M, Majewski D, Puszczewicz M. Retroperitoneal fibrosis – the state-of-the-art. Reumatologia 2016; 54, 5: 256–263. Reference #2: Spagnolo P, Rossi G, Trisolini R, et al. Pulmonary sarcoidosis. Lancet Respir Med 2018; 6: 389–402. DISCLOSURES: no disclosure on file for David Abia Trujillo; no disclosure on file for Isabel Mira-Avendano; No relevant relationships by Murat Tatari, source=Web Response

Ureteral Anomalies in Gynecologic Surgery

A 30-year-old woman with recurrent endometriosis presented for definitive surgical management with a hysterectomy. Her surgical history included 4 laparoscopic excisions of endometriosis including bilateral ovarian cystectomies and an appendectomy. Given her surgical history, the retroperitoneum was opened to definitively identify the course of her ureters. Exploration of the right retroperitoneum revealed 2 right ureters that fused 2 cm proximal to the ureterovesicular junction (Figs. 1 and 2).

Radiographic distribution of ureteral stones in 78 cats.

To document the distribution of ureteral stones in cats. Retrospective case series. Seventy-eight cats. Abdominal radiographs with ureteral stones were reviewed. The location of stones was categorized as proximal ureter (PU), midureter (MU), or ureterovesicular junction (UVJ). The number, size, and location of stones were recorded by using the kidneys and vertebral bodies as landmarks. Stone location in cats with 1 versus multiple stones was assessed. Descriptive statistics were used to describe the incidence of ureteral stone location. Among cats with a single stone (44%, 34/78), 44% (15/34) had a stone in the PU, 41% (14/34) had a stone in the MU, and 15% (5/34) had a stone at the UVJ. When multiple stones were present, 61% (27/44) of cats had at least 1 stone located in the PU, 70% (31/44) had at least 1 stone located in the MU, and 34% (15/44) had at least 1 stone located at the UVJ. The L4 vertebral body most commonly marked stone location in cats with 1 stone and the most distal stone in cats with multiple stones. Stones located at the UVJ site were more common in male (37%) than in female (12%) cats (P = 0.004). Larger stone size was associated with a more proximal location (P = 0.04). Ureteral stones were more commonly located in the PU and the MU than in the UVJ. UVJ stones were more common in male than in female cats, and larger stones had a more proximal location. This study enhances our understanding of feline ureteral stone location and identifies a correlation between stone location and stone size.

Vesicoureteral reflux in infants: what do we know about the gender prevalence by age?

Vesicoureteral reflux (VUR) affects up to 1% of Caucasian children. Primary VUR is characterized by failure of the ureterovesicular junction to prevent urine from traveling in a retrograde fashion from the bladder to the ureters and the kidneys. Several reports in the literature describe the prevalence of this condition in pediatric patients; overall, VUR affects more males during infancy and with higher grades. However, a thorough consideration of these articles reveals important contradictions regarding the prevalence by gender and age. We analyzed those contradictions and suggested a possible explanation based on our single center experience with this patient group. In particular, for the age interval 0-2 years: we have found that (1) VUR mostly affects boys; (2) the male/female ratio steadily declines over time; (3) the unequal prevalence between males and females essentially disappears when children reach the age of two years. The natural history of VUR in infant boys differs from that of infant girls, and therefore requires a gender-specific approach. Available data support the need to redefine the categorization and clinical guidelines for this disease.

Sensitivity, specificity and accuracy of diagnostic imaging methods for the diagnosis of ectopic ureters in the dog

The clinical records of dogs with urinary incontinence, examined at the Queen Mother Hospital for animals between November 1995 and January 2006, were reviewed. Only dogs that had at least one contrast radiographic study, ultrasonographic examination of the ureters and surgical diagnosis were included. All the cases were examined on an individual ureter basis and on a case basis. The sensitivity, specificity and accuracy were calculated for intravenous urography, retrograde urethrography or retrograde vaginourethrography and ultrasonographic examination of the ureterovescicular junctions. Ultrasonographic examination of the ureterovescicular junctions had the higher sensitivity, specificity and accuracy from the imaging methods with only intravenous urography having mildly higher sensitivity when examined on a ureter base. The main failure of ultrasonographic examination of the ureterovescicular junctions was the identification of the correct side of ectopia. When evaluated on a case basis ultrasonographic examination of the ureterovescicular junctions had perfect sensitivity, specificity and accuracy. The lower mainly specificity and accuracy of intravenous urography and retrograde urethrography or retrograde vaginourethrography were probably related to the difficulty in identifying the location of the ureterovesicular junction.

A surprising case of bilateral ureteric stones causing acute renal failure and anuria

Introduction: We present a case of bilateral ureteric colic that causes anuric acute renal failure. Bilateral ureteric colic causing acute renal failure is not a new presentation. However, the patient had only 3 mm calculi, making our case unique. Background: Bilateral renal calculi are an uncommon cause of acute kidney injury (AKI). Obstructing ureteroliths rarely lead to AKI without any underlying renal disease or anatomic abnormalities, such as a solitary kidney or horseshoe kidney. The literature has reported the incidence of a unilateral ureterovesicular junction obstruction secondary to a stone as 20%. However, there are a very few case reports in the literature of urology, nephrology or emergency medicine regarding the incidence of bilateral ureteric calculi. Cases of bilateral ureteric calculi are rare, and cases with AKI and anuria are very rare. Case presentation: A 30-year-old male presented with bilateral colicky flank pain for 4 days and started to develop macroscopic haematuria. After proper pain management in the Emergency Department, the patient was found to have a raised serum creatinine level (152 μmol/L). A CT scan was performed showing two 3 mm calculi in the left and right proximal ureters. Ultrasound showed moderate left and mild right hydroureteronephrosis. Due to the relatively small size of the stones, and the clinical image of the patient, he was planned for medical expulsive therapy. Surprisingly, the patient developed complete anuria for 2 days and presented to the ED with a serum creatinine level of 843 μmol/L. Bilateral double J stents were placed and urgent ureteroscopy was done. Following treatment, the patient's condition significantly improved and his renal function returned to normal within 4 days. Conclusion: Even small bilateral stones can result in acute kidney injury.

Nephrolithiasis

The term nephrolithiasis, often used synonymously with urolithiasis, refers to the formation of solid concretions consisting of both protein and crystalline materials in the lumen of the urinary tract. These calculi, or “stones,” become symptomatic when they cause acute obstruction, and as such, there are an unknown but probably large number of individuals with nephrolithiasis who are subclinical, without signs or symptoms. This review covers the pathophysiology, stabilization and assessment, diagnosis, and treatment of nephrolithiasis. Figures show ultrasound images of a stone with shadowing, a stone with a twinkling artifact, hydronephrosis, and a stone with shadowing at the ureterovesicular junction and a computed tomographic (CT) image showing a renal calculus at the ureterovesicular junction. Tables list drug-induced renal calculi, the proportion of stones spontaneously passing depending on size category as identified on CT, diagnostic test characteristics for renal colic diagnosis, the clinical prediction rule for the risk of renal stones, an example of the theoretical probability of stone disease using Moore and colleagues’ risk stratification, pooled test characteristics, bayesian analysis, and important pathology diagnosed on CT scan in the investigation of flank pain in four studies. Key words: kidney stone, nephrolithiasis, renal calculus, renal stone, urolithiasis This review contains 5 highly rendered figures, 6 tables, and 75 references.

Use of the bolus tracking technique for the tomographic evaluation of the uretero-vesicular junction in dogs and assessment of dose records.

BackgroundThe aim of the work is the application of a bolus tracking technique for tomographic evaluation of the uretero-vesicular junction in dogs. Ten adult dogs (8–14 years) with variable body weight (2,8–32 kg) were enrolled in the prospective study. The patients were placed in sternal recumbency with a 10° elevated pelvis and the visualization of the uretero-vesicular junction was obtained with the bolus tracking technique after intravenous administration of non-ionic contrast medium. In the post-contrast late phase a region of interest was placed within the lumen of the distal ureters and the density values were monitored before starting the helical scan.ResultsThe uretero-vesicular junction was clearly visible in 100 % of patients with the visualization of the endoluminal ureteral contrast enhancement and bladder washout. At the end of the tomographic study an evaluation of the dose records was performed and compared to human exposures reported in literature for the pelvic region. The effective dose estimated for each patient (37,5–138 mSv) proved to be elevated, when compared to those reported in human patients.ConclusionThe bolus tracking technique could be applied for the visualization of the uretero-vesicular junction in non-pathological patients, placing the region of interest in the distal ureters. The high effective doses recorded in our study support the need of specific thresholds for veterinary patients, pointing out the attention for paediatric patient’s exposure also in veterinary imaging.

Computed tomographic excretory urography features of intramural ectopic ureters in 10 dogs.

To describe the morphologic and morphometric computed tomographic excretory urography features of intramural ectopic ureters in dogs. Retrospective evaluation of computed tomographic excretory urography studies in 10 dogs with surgical and/or cystoscopically confirmed intramural ectopic ureters. All studies were assessed for ureteral ectopia, dilatation, tortuosity, ureterovesicular junction morphology and ureteral orifice location. A total of 14 intramural ectopic ureters were confirmed at surgery/cystoscopy with reviewers correctly identifying 100% (14/14). Abnormalities on computed tomographic excretory urography included ureteral dilatation (7), ureteral tortuosity (3), lack of a normal ureterovesicular junction (14), urethral ureteral orifice location (14) and lack of ureteral divergence (14). Lack of a normal ureterovesicular junction, a urethral-ureteral orifice location and lack of ureteral divergence are common computed tomographic excretory urography findings in dogs with intramural ectopic ureters. This technique requires further investigation to determine whether it might allow differentiation of intramural and extramural ectopic ureters.

Double pigtail ureteral stenting and renal pelvic lavage for renal-sparing treatment of obstructive pyonephrosis in dogs: 13 cases (2008-2012).

To describe the technical aspects and clinical outcome of endoscopic- and fluoroscopic-guided ureteropelvic lavage and ureteral stent placement for treatment of obstructive pyonephrosis in dogs. Retrospective case series. 13 client-owned dogs (14 obstructed ureters). All patients with obstructive pyonephrosis were treated with a ureteral stent. Medical records were reviewed for history, clinical signs, pre- and postprocedural clinical and imaging data, and short- and long-term outcomes. 13 dogs (14 ureters) had unilateral or bilateral ureteral obstructions and pyonephrosis due to ureterolithiasis (n = 13) or a suspected ureteral stricture (1). Eleven dogs had positive results of bacteriologic culture of urine obtained from the bladder, renal pelvis, or both. Ten were thrombocytopenic, and 8 were azotemic. Stents were placed fluoroscopically with endoscopic (n = 11) or surgical (3) assistance. Median hospitalization time was 48 hours (range, 6 to 260 hours). Median follow-up time was 480 days (range, 2 to 1,460 days). Intraoperative complications occurred in 2 patients (stent occlusion from shearing of a guide wire, and wire penetration of the ureter at the location of a stone). Short-term complications included a bladder hematoma (n = 1) and transient dysuria (1). Long-term complications included stent encrustation (n = 1), stent migration (1), and tissue proliferation at the ureterovesicular junction (5), which had no clinical implications. Recurrent urinary tract infections were documented in 7 dogs. Ureteral stenting was a successful renal-sparing treatment for obstructive pyonephrosis in dogs and could often be performed in a minimally invasive manner. There were few major complications. This technique may be considered as an effective treatment option for this condition in dogs.

315-POS

Objectives Eclampsia results from the “cooperation” of three distinct implacable forces: molecular, hydraulic, and gravitational, superimposed upon an anatomically defective uretero-vesicular junction (u.v.j.). Renin is the kidney’s implacable molecule dictating elevated blood pressure (b.p.) to maintain constant filtration pressure. Hydraulic principles within the ”renal excretory compartment” (r.e.c.), Bowman’s capsule to the bladder’s interior, implacably signal renin secreting cells of the juxta-glomerular-apparatus (JGA) to elevate b.p. whenever bladder pressure increases. Gravity acts implacably through the defective u.v.j. to force increased renin release in the third trimester as the baby’s head pounds against the bladder whenever the mother walks. Avoid seizures and premature Caesarian sections; achieve natural birth after nine months gestation. Methods Flawless logic, evaluating contributing factors, like Sir William Harvey’s recirculation of the blood. Eclampsia is worse in developing countries because pregnant poor women work/walk longer during the third trimester, carrying heavy items on their heads; and resting/toileting using squatting positions; greatly exacerbating hydraulic pressure transmission from bladder to JGA. Dissect the JGA to comprehend the pathophysiology of “normal” hypertension: Macula Densa Cells (MDC) of the distal convoluted tubule, where it passes between the glomerular arteries, exist at the mid pressure point of the r.e.c., comparing proximal glomerular pressure to distal bladder pressure. As the bladder fills, MDC direct the JGA’s hormone secreting cells to release renin. Results Table 1. Correlation between systolic blood pressure and subjective sense of bladder urgency as +1., +2., +3., and +4. with this author as the subject. The defective u.v.j. may be either a microscopic gap or merely a weakness in a membrane. No compensation is possible for the molecular and hydraulic forces. Bed rest as compensation for exacerbation by gravity is common in developed counties but difficult for poor women. Conclusions Ironic, incredible, ingenious, imaginative, and intuitive is the conclusion; this condition, “The Disease of Theories,” is solvable with one simple procedure. To defy gravity, the pregnant woman must ambulate on four extremities during the third trimester! Disclosure N. deVera: None.

The ROKS nomogram for predicting a second symptomatic stone episode.

Most patients with first-time kidney stones undergo limited evaluations, and few receive preventive therapy. A prediction tool for the risk of a second kidney stone episode is needed to optimize treatment strategies. We identified adult first-time symptomatic stone formers residing in Olmsted County, Minnesota, from 1984 to 2003 and manually reviewed their linked comprehensive medical records through the Rochester Epidemiology Project. Clinical characteristics in the medical record before or up to 90 days after the first stone episode were evaluated as predictors for symptomatic recurrence. A nomogram was developed from a multivariable model based on these characteristics. There were 2239 first-time adult kidney stone formers with evidence of a passed, obstructing, or infected stone causing pain or gross hematuria. Symptomatic recurrence occurred in 707 of these stone formers through 2012 (recurrence rates at 2, 5, 10, and 15 years were 11%, 20%, 31%, and 39%, respectively). A parsimonious model had the following risk factors for recurrence: younger age, male sex, white race, family history of stones, prior asymptomatic stone on imaging, prior suspected stone episode, gross hematuria, nonobstructing (asymptomatic) stone on imaging, symptomatic renal pelvic or lower-pole stone on imaging, no ureterovesicular junction stone on imaging, and uric acid stone composition. Ten-year recurrence rates varied from 12% to 56% between the first and fifth quintiles of nomogram score. The Recurrence of Kidney Stone nomogram identifies kidney stone formers at greatest risk for a second symptomatic episode. Such individuals may benefit from medical intervention and be good candidates for prevention trials.

Endoscopic-guided sclerotherapy for renal-sparing treatment of idiopathic renal hematuria in dogs: 6 cases (2010–2012)

To describe the use of sclerotherapy for the renal-sparing treatment of idiopathic renal hematuria (IRH) in dogs and report clinical outcomes. Retrospective case series. 6 dogs (8 renal pelvises) with IRH. Medical records of dogs that underwent sclerotherapy were reviewed. Each ureterovesicular junction was identified cystoscopically to determine the side of bleeding, and a retrograde ureteropyelogram was performed with endoscopic and fluoroscopic guidance. A ureteropelvic junction balloon was used for ureteral occlusion, and pelvis filling volumes were recorded. A povidone iodine mixture, followed by a sterile silver nitrate solution, was infused into the renal pelvis. A double-pigtail ureteral stent was placed after the procedure. Information on preprocedure and postprocedure biochemical changes, imaging parameters, and clinical outcomes was obtained. 6 dogs (5 males and 1 female) had sclerotherapy for unilateral (4) or bilateral (2) bleeding. Five were right-sided and 3 were left-sided. The median age and weight of dogs were 3 years and 42.4 kg (93.28 lb), respectively. Median procedure time was 150 minutes. One dog that did not have a ureteral stent placed following the procedure developed short-term signs of renal pain and pyelectasis. Cessation of macroscopic hematuria occurred in 4 of 6 dogs (median, 6 hours). Two additional dogs improved moderately. Median follow-up time was 8 months (range, 3.5 to 20.5 months). Topical sclerotherapy for IRH was safe and effective. Local sclerotherapy for IRH in dogs could be considered a valuable and minimally invasive renal-sparing treatment over ureteronephrectomy.

Twinkle twinkle little stone: utilizing color Doppler in emergency ultrasound diagnosis of a ureterovesicular stone

Abstract Case report A case of a 43-year-old woman presenting with acute left flank pain is reported. Method and result Point-of-care ultrasound utilizing color Doppler revealed a twinkling artifact at the left ureterovesicular junction, consistent with a ureterovesicular stone. The sonographic findings and significance of the twinkling artifact are described.

Impact of obesity on urologic complications among unrelated living donor kidney transplants

Although obesity has been associated with improved survival on dialysis, its effects on renal transplantation outcomes remain unclear. Herein we aimed to evaluate the effect of obesity on posttransplantation complications. A retrospective analysis of consecutive renal transplant recpients from un related living donors was undertaken from 2006 to 2008. We included 180 patients, 34 (18%) were obese (body mass index >30 kg/m(2)) and 146 were lean. Obese patients were more likely to develope renal artery stenosis (17.6% vs 2.8%, p < 0.001), hematoma (47.9% vs 17.6, p = 0.009), wound complications (64.7% vs 9.6%, P < 0.001) and renal vein thrombosis(2% vs 0%, p < 0.001). Urologic complications consisting ureteral, ureteropelvic and ureterovesicular junction stenosis, wound bleeding, urinary leakage and renal artery thrombosis and also hospitalization time were found similar between the two groups. 2 year patiets and graft survival were not statististically different. Renal transplantation could be performed with reasonable urologic complications in obese patients.