Endoscopic Ureteral Dilation Balloon Catheter for a Difficult Ureter: A New Novel Approach

<b><i>Objectives:</i></b> This study aims to assess the safety and efficacy of INNOVEX^TM ureteral dilation balloon catheter to promote the likelihood of passing the ureter to complete primary ureteroscopy (URS). <b><i>Methods:</i></b> This was a prospective case series of patients during URS between August 2018 and January 2020 at the Pudong New District People’s Hospital. A 12-Fr INNOVEX^TM ureteral dilation balloon catheter was used to dilate the ureter when a 5° Wolf 6.0/7.5-Fr ureteroscope encounters an unpredictable hindrance to retrograde access for ureteral stones. Patients with documented ureteral strictures, radiation therapy, or urothelial cancer were excluded from the analysis. The primary outcomes were to characterize the use, safety, and efficacy of ureteral dilation balloon catheter to promote stone treatment during URS. <b><i>Results:</i></b> Eight hundred and sixty-two patients underwent primary URS of ureteral stones over the study period. The use of a ureteral dilation balloon catheter to promote ureteral access was performed in 65 (7.54%) cases and effectively allowed completion of the procedure in 58 (89.23%) cases. No ureteral perforation and access loss occurred during the operation. Seven patients required ureteral stent placement for passive ureteral dilation, with definitive stone treatment later. Postoperative radiographic follow-up was available for 63 (96.92%) cases, and no ureteral stenosis was observed after balloon dilation. <b><i>Conclusion:</i></b> The use of a new ureteral dilation balloon catheter before endoscopic treatment of ureteral stones was associated with a high success rate and few complications. The convenient use method under direct vision at the whole process may increase the willingness of doctors to use it. In addition, it may reduce the need for secondary procedures for patients undergoing URS to manage ureteral stones.

Renal pelvic and ureteral ultrasonographic characteristics of cats with chronic kidney disease in comparison with normal cats, and cats with pyelonephritis or ureteral obstruction

Objectives The objective was to describe ultrasonographic characteristics of cats with stable chronic kidney disease (CKD) and determine if these were significantly different from cats with pyelonephritis (Pyelo) and ureteral obstruction (UO), to aid in clinical assessment during uremic crisis. Methods Sixty-six cats with stable CKD were prospectively enrolled, as well as normal control cats (n = 10), cats with a clinical diagnosis of Pyelo (n = 13) and cats with UO confirmed by surgical resolution (n = 11). Renal ultrasound was performed and routine still images and cine loops were obtained. Analysis included degree of pelvic dilation, and presence and degree of ureteral dilation. Measurements were compared between groups using non-parametric one-way ANOVA with Dunn’s post-hoc analysis. Results In total, 66.6% of CKD cats had measurable renal pelvic dilation compared with 30.0% of normal cats, 84.6% of Pyelo cats and 100% of UO cats. There was no statistically significant difference in renal pelvic widths between CKD cats and normal cats, or CKD cats and Pyelo cats. On almost all measurement categories, UO cats had significantly greater renal pelvic widths compared with CKD cats and normal cats ( P <0.05) but not Pyelo cats. Six percent of stable CKD cats had measurable proximal ureteral dilation on one or both sides vs 46.2% of Pyelo cats and 81.8% of UO cats. There was no statistically significant difference in proximal ureteral width between normal and CKD cats, or between Pyelo and UO cats. There was a statistically significant difference in proximal ureteral width between CKD and Pyelo cats, CKD and UO cats, normal and UO cats, and normal and Pyelo cats. Conclusions and relevance No significant difference in renal pelvic widths between CKD cats and Pyelo cats was seen. These data suggest CKD cats should have a baseline ultrasonography performed so that abnormalities documented during a uremic crisis can be better interpreted.

Urolithiasis in adults with congenital megaureter

The primary presentation of congenital megaureter in adults israre. Development of urolithiasis may lead to this unusual underlyingdiagnosis. Urinary tract stones can form either within thedilated ureteral segment or in a part of the upper urinary tractproximal to the abnormal ureteral segment. We report two casesof nephrolithiasis that occurred in adults found to have segmentalmegaureter. The first case is that of a 58-year-old man whopresented with left lower quadrant pain. Computed tomographyscan revealed a 2-cm stone in the distal left ureter within an areaof isolated segmental distal ureteral dilation. The second case isa 48-year-old man who developed recurrent renal urolithiasisassociated with isolated distal megaureter.Although a rare condition in adults, congenital megauretermay present when kidney stones develop as a result of the ureteralabnormality. Typically, stones will develop within the dilatedsegment of ureter. Atypically, stones may develop away from thesite of the underlying abnormality. Congenital megaureter is adiagnosis that urologists and radiologists need to consider in thesetting of isolated distal ureteral dilation, as the diagnosis of adultmegaureter may require more involved surgical measures to preventrecurrence of adverse symptoms.