Hemangioma in Renal Pelvis

Hemangioma in the renal pelvis is a very rare benign tumor that may be mistaken for renal cell carcinoma. We present, herein, a case of a 59-year-old woman with a renal mass that was diagnosed as a cavernous hemangioma in the renal pelvis. The patient underwent intravenous pyelography, urine cytology, retrograde pyelography, kidney dynamic computed tomography (CT), and surgical excision.

Ureteral Dissection Is a Risky Factor for Ureteral Rupture, the First Case Report.

Backgroundureteral dissection（UD）is a rare condition which occurs when injury through the intima and occasionally the media allows entry of urine and separation of the inner and outer ureteral layers. Ureteral rupture (UR) is an urgent disease when ureter wall injures through entire layers, generally caused by ureteral calculus, frequent application of ureteral endoscope, trauma, oppression of tumors, iatrogenic injury and with urine flowing into peripheral space easily causes peritonitis, so patients usually present features of peritonitis prior to signs of urinary tract. Ureteral dissection found in ureteral rupture is the first report. Case presentation21-year-old male and 43-year-old female complained of left and right lumbago respectively with no obvious predisposing cause. Bilateral ureter dilation and contrast agent extravasation observed in imageological examination was the same point between the two patients. Delayed computed tomography (CT) and retrograde pyelography both show double lumen sign and damaged intima. All imaging results throw light on the nature of this disease, like formation of aortic dissection (AD). ConclusionThe emphasis of this study lies in imaging manifestations of UD to enable radiologist to find it accurately and rapidly, and also demonstrates that delayed CT and retrograde pyelography can effectively diagnose ureteral dissection with very high accuracy.

Retrograde Pyelography in the Presence of Urothelial Bladder Cancer Does Not Affect the Risk of Upper Tract Urothelial Cancer: A Retrospective Analysis of a Single-Centre Cohort

<b><i>Objective:</i></b> Patients with bladder cancer (BC) are at risk of developing upper tract urothelial carcinoma (UTUC). Therefore, CT urography is recommended for follow-up. To avoid intravenous contrast agents, retrograde pyelography (RPG) is an alternative. However, it is still unclear whether RPG increases the incidence of UTUC. The aim of this study was to investigate the impact of RPG in the presence of BC on the risk of developing UTUC. <b><i>Patients and Methods:</i></b> Retrospectively analysing a total of 3,680 RPGs between 2009 and 2016, all patients with simultaneous BC (group 1) and those without synchronous BC (group 2) during RPG were compared. All patients were risk stratified according to the EORTC bladder calculator. In patients without BC during RPG, risk stratification was based on the worst prior tumour characteristics. <b><i>Results:</i></b> A total of 145 patients with a history of BC were analysed. Of these, 112 patients underwent RPG with simultaneous BC. UTUC developed in 6 of 112 patients (5.4%) and 58.9% (66/112) had high-risk BC according to the EORTC bladder calculator. In the control group, one out of 33 (3%) patients with metachronous high-risk BC developed UTUC. <b><i>Conclusions:</i></b> Using RPG in the presence of BC did not increase the risk of UTUC. Due to the predominant number of high-risk/high-grade tumours, individual tumour biology appears to be the primary driver for the development of UTUC.

Congenital midureteral stenosis in children: a 13-year retrospective study based on data from a large pediatric medical center

Background Midureteral stenosis is very rare in children and can cause congenital hydronephrosis. We report our experience treating children with congenital midureteral stenosis at our center, focusing on the differences in preoperative diagnosis and treatment compared with other congenital obstructive uropathies. Methods We retrospectively reviewed the medical records of 26 children diagnosed with congenital midureteral stenosis at our center between January 2007 and December 2020, such as preoperative examination methods, intraoperative conditions, and postoperative follow-up results. Results Of the 1625 children treated surgically for ureteral narrowing, only 26 (1.6%) were diagnosed with midureteral stenosis, including 15 infants and 11 children. Eighteen (69.2%) were boys, 13 (50%) were affected on the left side, and 23 (88.5%) had isolated ureteral stenosis. Overall, 13 (50%) of the children presented with prenatal hydronephrosis, and 13 (50%) presented with abdominal pain or a mass. All the children had undergone urinary ultrasound and intravenous urography preoperatively; the diagnostic rate of ultrasound was 92.3%. Only 7 (26.9%) children had undergone pyelography. All the children had undergone surgery. The ureteral stenotic segment was less than 1 cm long in 25 (96.2)% of the children. The mean follow-up duration was 22 months (range: 6–50 months). One child developed anastomotic strictures. Urinary tract obstruction was relieved in the other children without long-term complications. Conclusions Congenital midureteral stenosis is rare, accounting for 1.6% of all ureteral obstructions, and its diagnosis is crucial. Urinary ultrasound has a high diagnostic rate and should be the first choice for midureteral stenosis. Retrograde pyelography can be used when the diagnosis is difficult, but routine retrograde pyelography is not recommended. Congenital ureteral stenosis has a relatively short lesion range, largely within 1 cm. The treatment is mainly resection of the stenotic segment and end-to-end ureteral anastomosis, with a good prognosis.

Congenital Midureteral Stenosis in Children: A 13-year Retrospective Study based on Data from a Large Pediatric Medical Center

Background: Midureteral stenosis is very rare in children and can cause congenital hydronephrosis. We report our experience treating children with congenital midureteral stenosis at our center, focusing on the differences in preoperative diagnosis and treatment compared with other congenital obstructive uropathies.Methods: We retrospectively reviewed the medical records of 26 children diagnosed with congenital midureteral stenosis at our center between January 2007 and December 2020, including preoperative examination methods, intraoperative conditions, and postoperative follow-up results.Results: Of the 1625 children treated surgically for ureteral narrowing, only 26 (1.6%) were diagnosed with midureteral stenosis, including 15 infants and 11 children; 68% were boys; 48% were affected on the left side; and 88% had isolated ureteral stenosis. In all, 50% of the children presented with prenatal hydronephrosis, and 50% presented with abdominal pain or a mass. All children underwent urinary ultrasound and intravenous urography (IVU) preoperatively; the diagnostic rate of ultrasound was 92.3%. Only 7 (26.9%) children underwent pyelography. All children underwent surgery. The ureteral stenotic segment was less than 1 cm long in 96% of the children. The mean follow-up duration was 22 months (range: 6-50 months). One child developed anastomotic strictures. Urinary tract obstruction was relieved in the other children without long-term complications.Conclusions: Congenital midureteral stenosis is rare, accounting for 1.6% of all ureteral obstructions, and its diagnosis is very important. Urinary ultrasound has a high diagnostic rate and should be the first choice for midureteral stenosis. Retrograde pyelography can be used when diagnosis is difficult, but routine retrograde pyelography is not recommended. Congenital ureteral stenosis has a relatively short lesion range, largely within 1 cm. The treatment is mainly resection of the stenotic segment and end-to-end ureteral anastomosis, with a good prognosis.

Nephropleural fistula after supracostal approach for PCNL: report of two cases with review of literature

Nephropleural fistula is a rarely encountered complication of percutaneous nephrolithotomy (PCNL). Only 11 cases have been reported in literature to date. Often associated with supracostal punctures, the presentation is frequently delayed. Diagnosis is based on imaging, mainly X-rays and CT along with retrograde pyelography that establishes the fistulous connection. A difficult to diagnose condition, any patient with a supracostal access PCNL who presents with delayed symptoms of breathlessness and has leucocytosis with fluid in the lungs on chest imaging should be suspected to have a nephropleural fistula. The management involves intercostal tube thoracostomy to relieve symptoms and drainage of the operated kidney by double-J stent placement, if not placed already. Prompt recognition and management results in excellent recovery with no sequelae. We present our experience with two such cases and our aim was to familiarise the practising urologist regarding the diagnosis and management of this infrequent condition.

Complications and surgical results of stone-directed antegrade pyelography compared to the retrograde pyelographic access method in percutaneous nephrolithotomy using ‘bull’s eye’ technique: A randomized clinical trial

Objectives: This study aimed to evaluate the differences in outcomes and complications in stone-directed antegrade pyelography using the ‘bull’s eye’ technique in patients with renal stones versus the conventional method of percutaneous nephrolithotomy (PCNL). Although conventional PCNL access using retrograde pyelography is useful, it is time-consuming and may cause postoperative discomfort. Herein, we report our experience in the application of this new technique. Methods: Between January 2017 and June 2018, 100 patients participated in this randomized clinical trial. Stone-directed antegrade pyelography using the ‘bull’s eye’ technique under fluoroscopic guidance was used for percutaneous access in the intervention group. The second group, consisting of those who had undergone conventional PCNL using retrograde pyelography and ‘bull’s eye’ technique in the same period, were considered as the controls. Pre- and postoperative laboratory examinations, surgical results and complications were recorded and compared between the two groups. Results: A single calyceal puncture in partial staghorn and staghorn stone patients was sufficient in 72.2% of the antegrade group and in 78.9% of the retrograde group ( p=0.69). The double-puncture technique was necessary for 71.9% of renal pelvis stones in the antegrade group and for 9.4% in the retrograde group ( p<0.001). The antegrade approach reduced the mean operative time and analgesic requirement significantly ( p<0.001). No statistically significant difference, however, was found between the two groups regarding stone migration to the ureter, radiation time and postoperative complications. Conclusions: The stone-directed antegrade approach using the ‘bull’s eye’ technique is a safe and accurate method in PCNL access in patients with radiopaque and semi-opaque renal stones.

Ureteral Dissection is a Transient Process Before Ureteral Rupture: A Case Report

Background: Ureteral dissection（UD）is a rare condition which occurs when injury through the intima and occasionally the media allows entry of urine and separation of the inner and medial ureteral layer just like the formation of aortic dissection. Ureteral rupture (UR) is generally caused by ureteral calculus, operation of ureteral endoscope, trauma, tumors, iatrogenic injury and easy to cause peritonitis, so patients usually show symptoms of peritonitis prior to signs of urinary tract. Ureteral rupture caused by ureteral dissection is rarely reported. Case presentation:21-year-old male and 43-year-old female were both admitted into hospital because of abdominal pain. Enhanced CT and retrograde pyelography showed “double lumen sign” in the right proximal ureter and contrast extravasation in the perinephric gap. The male is dead due to serious condition but the female is in good condition without complication after correct and timely therapy. Conclusions: UD is a transient process viewed by enhanced CT or retrograde pyelography offering a warning sign of UR in order to improve prognosis.

Case – Reflex anuria: A rare complication of retrograde pyelography

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Double trouble: diagnostic dilemma in a rare association of proximal ureteric valve with orthotopic ureterocele—case report

Background Association of the ureterocele and proximal ureteral valve is a rare congenital anomaly which can lead to quick detoriation of renal function due to double obstruction. Though ureteral valves have been associated with other ureteral anomalies, this specific association is extremely rare. Case presentation A 7-month-old boy was referred to us for antenatally detected hydronephrosis. Provisional diagnosis of orthotopic ureterocele with pelviureteric junction (PUJ) obstruction was made based on preoperative imaging. Endoscopic incision of ureterocele was done and retrograde pyelography showed tight obstruction at PUJ which necessitated a pyeloplasty. Examination of resected specimen confirmed a ureteral valve. Postoperatively, the patient had good improvement in kidney function. Conclusion To conclude, congenital ureteral valves are a rare cause of ureteric obstruction and its association with ureterocele is rarer still. Identification of an ureterocele should not deter us from searching for an associated pathology like a ureteric valve when imaging shows more severe hydronephrosis suggestive of more proximal obstruction.