Etiology of Hydronephrosis in adults and children: Ultrasonographic Assessment in 233 patients

Objectives: Hydronephrosis (HN) is dilatation of the collecting system of the kidney due to obstruction of urine outflow. This study intended firstly, to investigate the efficacy of ultrasound (US) imaging to determine the cause of HN, and secondly, to list the causes of HN. Methods: In this retrospective study, 233 patients with HN were scanned to determine the cause of the HN in the period from 1st January 2016 to 31st October 2017. Categorical results were written as frequencies and percentages. Results: Out of 233, 91.41% were adults and 8.58% were children (P<0.001), 66.10% were male and 33.90% were female (P<0.001). In 55.36%, HN was in the right kidney and 44.64% was in the left (P=0.116). Exactly 58% of patients were suffering from grade-2, 21.5% grade-3, 11.6% grade-1, and 8.2% grade-4 HN. US imaging can determine the cause of HN in 70.4% of patients. Kidney or ureteric calculi were the cause of HN in 54.1% of cases, reflux was in 7.3%, and pelviureteric junction (PUJ) stenosis was in 3.9%. In cases of calculi induced HN, 25.3% of the calculi were in the vesicoureteric junction (VUJ), 21.5% were in the renal pelvis, 6.4% were in the PUJ or upper ureter, and only 0.9% were in the middle ureter. Conclusion: Ultrasound imaging can determine the cause of HN in more than two thirds of patients. Calculi are the most common cause of HN even in children and are most common in the VUJ. Abbreviations:HN: Hydronephrosis, US: Ultrasound, PUJ: Pelviureteric Junction,VUJ: Vesicoureteric Junction, SFU: Society of Fetal Urology,MHz: Megahertz, SPSS: Statistical Package for the Social sciences,IBM: International Business Machines, NY: New York, CI: confidence interval. doi: https://doi.org/10.12669/pjms.37.5.3951 How to cite this:Alshoabi SA, Alhamodi DS, Alhammadi MA, Alshamrani AF. Etiology of Hydronephrosis in adults and children: Ultrasonographic Assessment in 233 patients. Pak J Med Sci. 2021;37(5):---------. doi: https://doi.org/10.12669/pjms.37.5.3951 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Florid cystitis cystica et glandularis causing irreversible renal injury

Cystitis cystica et glandularis (CCEG) is widely believed to be innocuous and self-limiting. We report a case of a 32-year-old male patient who was found to have gross bilateral hydroureter and hydronephrosis and an estimated glomerular filtration rate of 3 ml/min/1.73 m2. Cystoscopy revealed extensive cystic and nodular lesions involving most of the bladder urothelium, which proved to be CCEG on histopathological analysis. Retrograde and anterograde stents could not be inserted due to obstruction of the ureters at the level of the vesicoureteric junction. Percutaneous nephrostomies were subsequently inserted. Although there was evidence of improvement of the CCEG on follow-up cystoscopy, no improvement of renal function, despite decompression with percutaneous nephrostomies, was seen. He was subsequently placed on the waiting list for a renal transplant. We believe this to be the only known case reported of florid CCEG obstructing the upper urinary tracts bilaterally, causing irreversible renal injury.

Tubercular Stricture at Lower End of Ureter Causing Vesicoureteric Junction Obstruction: Our Experience in Rangpur Medical College

Objective: To determine the outcome of ureteroneocystostomy for vesicoureteric junction obstruction due to tubercular stricture. Patients and Method: Twelve patients age from 19 years to 47 years were underwant uretroneocystostomy with ifilateral D-J stanting for vecicoureteric junction obstruction (VUJO) with proximal hydroureteronephrosis tissue from the lower of the ureter shows granunation lesion complatable with tuberculosis. D-J stant were remove and patients were put into antitubercular chemotherapy Results: Patients were symptom free and follow up IVU at six months interval shows free passage of contrast at 10 minutes film. Conclusion: Vesicoureteric junction obstruction (VUJO) due to lower ureteric stricture by tuberculus lesion, though rare, should be searched, because if not treated properly may lead to damage of ipsilateral renal unit. Bangladesh Journal of Urology, Vol. 19, No. 1, Jan 2016 p.13-17

Obstructive uropathy in the context of ureteroinguinal hernia: experience of challenges in surgical management of an unwell patient

This case exemplifies an unusual anatomical variation of a common presentation and highlights the importance of perioperative diagnosis and planning in complex surgical patients. A 72-year-old comorbid man presented to the emergency department with an infected obstructed right kidney secondary to an obstructing 12 mm vesicoureteric junction calculi. However, imaging also showed concurrent ureteroinguinal hernia associated with a 130 cm-long ureter, too long for conventional treatment with a ureteric stent. Acutely, the patient’s collecting system was decompressed via nephrostomy, but due to the rarity of this anatomical variation, definitive treatment had to be rethought to help reduce the risk of iatrogenic damage and the associated long-term complications.

A Turn for the Better – The Benefit of Doing A Limited Prone Rescan to Confirm the Exact Location of an Equivocal Vesicoureteric Junction Calculus Detected on Supine Abdominopelvic CT Scan

Background: In this case report, a calculus was seen at the vesicoureteric junction (VUJ) on computed tomography (CT), in an equivocal location. The subsequent urological management is based on the precise location of the calculus (ureteric orifice at the VUJ versus urinary bladder lumen). A simple manoeuvre of doing a limited prone CT rescan of the urinary bladder confirmed the location of the calculus within the urinary bladder, thus allowing conservative management. Case Presentation: A middle-aged male with known urolithiasis presented with right sided abdominal pain, nausea and vomiting. Differentials included a right ureteric calculus and appendicitis. A CT scan of the abdomen and pelvis in the supine position revealed a 0.4 cm calculus at the right VUJ with mild right hydronephrosis. It was not certain whether this calculus was impacted at the VUJ or within the bladder lumen. A limited prone CT re-scan of the pelvis was performed, which confirmed that the calculus was within the urinary bladder, as it migrated to a dependent position in the lumen of the bladder when in the prone position. Patient was managed conservatively and passed the calculus via the urethra the next day. Conclusion: Prone CT is the gold standard for the evaluation of stone disease and can differentiate a vesical calculus from a vesicoureteric junction calculus. In cases where a supine abdominopelvic CT is performed (e.g. in institutions which do not routinely scan in prone position or in cases where a supine scan is done to exclude other pathologies), an additional limited prone CT is needed in equivocal cases for a suspected VUJ calculus. This additional limited prone CT can prevent unnecessary urologic intervention.

Experience of Managing Ureterovaginal Fistulas following Obstetric and Gynecological Surgeries

Aims: Iatrogenic ureteric injuries leading to fistula are rare but devastating complications of obstetric and gynecological surgeries.The aim of the study is to review the demography of ureterovaginal fistula (UVF) and its surgical outcome in the starting phase of fistula surgery. Methods: This is a retrospective review of 15 patients of ureterovaginal fistula who were referred to department of Obstetrics and Gynaecology of Kathmandu Model Hospital from Feb 2014 to Sept 2017. The study reviewed the demography, causes and surgical outcome of ureterovaginal fistula (UVF). Ten patients who had complete blind end at the distal ureter undergone Lich-Gregoir extravesicalur enteroneocystostomy. In other 5 patients, guide wire was successfully negotiated beyond the fistula site, however retrograde double J stenting could be done in only 4 patients. Results: All the patients had distal ureteric injury close to vesicoureteric junction leading to ureterovaginal fistula. Among them, majority were due to post hysterectomy 60% (n=9) followed by obstetrics procedures (caesarean section) 40% (n=6). Fourteen patients (93%) had successful closure of the fistula with complete preservation of renal function till date. Retrograde double J stenting was possible in patients who were referred earlier within two weeks of the onset of injury. Conclusions: In our short review, iatrogenic injury to the distal ureter during Obstetrics/Gynaecologic surgery was found to be the leading cause for the formation of ureterovaginal fistula. Endoscopic management with ureteric stents is still possible if the patients are referred earlier following primary surgery.

Urinary tract obstruction

The urinary tract can become obstructed by various disease processes, including tumours. Obstruction at any level of the urinary tract can impair the free flow of urine and may be partial or complete, and unilateral or bilateral. Bilateral obstruction usually occurs at the level of the bladder or lower. Retroperitoneal fibrosis and extrinsic compression of both ureters by a malignancy are exceptions. Children are affected by congenital vesicoureteric junction obstruction or pelvi-ureteric junction obstruction. Young adults suffer stone disease. The elderly are prone to urothelial cancers, and older men to bladder outflow obstruction. Retroperitoneal fibrosis is an inflammatory condition that typically affects men over 50 years of age. Diagnosis should be confirmed by biopsy to exclude a lymphoma or malignancy.

Managing Ureterovaginal Fistulas following Obstetric and Gynecological Surgeries

Background: Iatrogenic ureteric injuries leading to fistula are rare but devastating complications of obstetric and gynecological surgeries. The aim of the study was to review the demography of ureterovaginal fistula (UVF) and its surgical outcome in Kathmandu Model Hospital.Methods: This is a review of 15 patients of ureterovaginal fistula who were referred to department of Obstetrics and Gynaecology of Kathmandu Model Hospital from Feb 2014 to Sept 2017. We reviewed the demography, causesand surgical outcome of ureterovaginal fistula (UVF). Ten patients who had complete blind end at the distal ureter, underwent Lich-Gregoir extravesical ureteroneocystostomy. In other five patients, guide wire was successfully negotiated beyond the fistula site, however retrograde double J stenting could be done in only four patients.Results: All the patients had distal ureteric injury close to vesicoureteric junction leading to ureterovaginal fistula. Among them, majority were due to post-hysterectomy in 60% (n=9) followed by obstetrical procedures in 40% (n=6). Fourteen patients (93%) had successful closure of the fistula with complete preservation of renal function. Retrograde double J stenting was possible in patients who were referred earlier within two weeks of the onset of injury.Conclusions: Iatrogenic injury to the distal ureter during surgery was the leading cause for the ureterovaginal fistula. Endoscopic management with ureteric stents was still possible if the patients were referred earlier following primary surgery.