1.Two cases of lupus cystitis and literature review.
Yisha LI ; Hui LUO ; Yanli XIE ; Xiaoxia ZUO
Journal of Central South University(Medical Sciences) 2011;36(8):813-816
OBJECTIVE:
To improve the understanding of lupus cystitis.
METHODS:
Clinical manifestations, laboratory Results , and image information of 2 cases of lupus cystitis were analysed retrospectively, and another 6 cases in the literature were reviewed.
RESULTS:
Two patients were female. The urinary symptoms followed the gastrointestinal symptoms. Ureterectasia and hydronephrosis were detected in both patients, and intestinal pseudo-obstruction was detected in one patient. In the 6 cases from the literature, ureterectasia and hydronephrosis were detected in all patients, and intestinal pseudo-obstruction was detected in 4.
CONCLUSION
The possibility of lupus cystitis should be considered when lupus patients complain of urinary or bowel symptoms. Glucocorticoid and immunodepressant are effective for lupus cystitis.
Adolescent
;
Adult
;
Cystitis
;
complications
;
diagnosis
;
Female
;
Humans
;
Hydronephrosis
;
etiology
;
Lupus Erythematosus, Systemic
;
complications
;
diagnosis
;
Ureter
;
pathology
2.Clinical features of hydronephrosis induced by retroperitoneal fibrosis: 17 cases reports.
Shi Bo LIU ; Hui GAO ; Yuan Chun FENG ; Jing LI ; Tong ZHANG ; Li WAN ; Yan Ying LIU ; Sheng Guang LI ; Cheng Hua LUO ; Xue Wu ZHANG
Journal of Peking University(Health Sciences) 2020;52(6):1069-1074
OBJECTIVE:
To investigate the clinical features and outcome of hydronephrosis induced by retroperitoneal fibrosis (RPF), and to evaluate the effect of corticosteroid based therapy combined with surgical intervention of ureteral obstruction.
METHODS:
A total of 17 RPF patients with hydronephrosis hospitalized in Peking University International Hospital from May 2016 to December 2019 were analyzed retrospectively.
RESULTS:
The median age was 56 (53, 65) years, the male to female ratio was 2.4 : 1, and the disease duration was 4.00 (0.83, 8.00) months. The initial symptoms included back pain (9 cases), abdominal pain (6 cases), oliguria (2 cases) and lower limb edema (3 cases). Eight patients presented left hydronephrosis, 1 right hydronephrosis and 8 bilateral hydronephrosis. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were both elevated in 13 patients (76.5%, n=17). Immunoglobin (Ig) G4 increased in 5 cases (29.4%, n=17). IgG, IgE and IgA increased in 4 cases (30.8%, n=13), 4 cases (30.8%, n=13) and 1 case (7.7%, n=13), respectively. Among 12 patients who underwent biopsy, 3 patients were diagnosed with IgG4-relate disease. The level of IgG4 in the tissues varied, 6 cases expressed less than 10 per high power field (HPF) or no expression (50.0%). Only 2 cases expressed 10-30/HPF (16.7%), and 4 cases revealed more than 30/HPF (33.3%). Among the 17 patients with ureteral obstruction, no urinary drainage procedure was needed in 4 patients who had mild ureteral obstruction, whereas, ureteral stenting was carried out in the other 13 cases before drug treatment. Time was too short to evaluate the effect of urinary drainage procedures in 4 patients. For the rest, ureterolysis had to be performed in 3 cases after failed ureteral stent insertion. Successful drain removal was accomplished in all of these 9 patients and the mean time to drain removal was (6.7±3.0) months. In addition, 10 patients had complete medical records after an average follow-up time of 5 (3-13) months. Levels of ESR, CRP, IgG4, IgG, IgE, IgA were 54.0 (36.3, 98.5) mm/h, 26.8 (8.7, 53.0) mg/L, 1.34 (0.55, 3.36) g/L, 16.3 (13.0, 21.1) g/L, 40.5 (31.4, 203.0) IU/mL, 2.51 (1.82, 3.25) g/L at baseline, which all decreased predominantly after treatment. ESR, CRP, IgG4, IgG, IgE and IgA dropped by 38.5 (23.5, 54.3) mm/h (P < 0.01), 23.0 (5.5, 52.0) mg/L (P < 0.05), 0.92 (0.40, 2.85) g/L (P < 0.01), 6.5 (1.7, 9.1) g/L (P < 0.05), 23.7 (4.8, 162.0) IU/mL (P < 0.05) and 0.77 (0.32, 1.26) g/L (P < 0.05), respectively. Size of mass measured by CT/MRI imaging became smaller significantly and hydronephrosis relieved.
CONCLUSION
Onset of RPF is insidious and lack of specific initial symptoms. Corticosteroid based therapy combined with surgical intervention of relieving obstruction is effective.
Aged
;
Female
;
Humans
;
Hydronephrosis/etiology*
;
Male
;
Retroperitoneal Fibrosis/complications*
;
Retrospective Studies
;
Ureter
;
Ureteral Obstruction
3.A Rare Cause of Ureteropelvic Junction Obstruction.
Korean Journal of Urology 2014;55(10):687-689
4.Masked Hydronephrosis.
Lae Young JUNG ; Kyung Pyo KANG ; Won KIM ; Sung Kwang PARK ; Sik LEE
The Korean Journal of Internal Medicine 2012;27(2):244-244
No abstract available.
Aged
;
Colitis, Ischemic/complications/*diagnosis/therapy
;
Cystitis/*diagnosis/etiology
;
Dehydration/etiology
;
Diarrhea/etiology
;
Female
;
Fluid Therapy
;
Humans
;
Hydronephrosis/*diagnosis/etiology
;
Oliguria/etiology
;
Predictive Value of Tests
;
Radiation Injuries/*diagnosis/etiology
;
Tomography, X-Ray Computed
5.Unilateral Hydronephrosis and Hydroureter by Foreign Body in Urinary Bladder: A Case Report.
Bum Sang CHO ; Kil Sun PARK ; Min Ho KANG ; Gi Seok HAN ; Seung Young LEE ; Sang Hoon CHA ; Sung Jin KIM
Journal of Korean Medical Science 2012;27(6):704-706
Foreign bodies inserted through the urethra are often found in the urinary bladder. We presently report the first case of hydronephrosis and hydroureter due to direct compression in the urinary bladder by silicon, which had been introduced by the patient himself 2 yr prior to presentation with severe right flank pain. Computed tomography indicated a convoluted, high-attenuation mass in the urinary bladder; unilateral hydronephrosis and hydroureter were also present due to direct compression by the mass. The foreign body was removed using a cystoscope. This foreign body was proven to be silicon.
Adult
;
Cystoscopy
;
Foreign Bodies/complications/*radiography/surgery
;
Humans
;
Hydronephrosis/*etiology
;
Male
;
Silicon
;
Tomography, X-Ray Computed
;
Urinary Bladder
6.Ureteral stenosis following hematopoietic stem cell transplantation: A case report.
Guan Peng HAN ; Yang Yang XU ; Zhi Hua LI ; Chang MENG ; Hong Jian ZHU ; Kun Lin YANG ; Li Qun ZHOU ; Xue Song LI
Journal of Peking University(Health Sciences) 2022;54(4):762-765
Ureteral stenosis is a comparatively rare complication following hematopoietic stem cell transplantation (HSCT). The etiology is still unclear and most believe that this may be due to the reactivation of BK virus in a state of immunodeficiency. In the later stages of ureteral stenosis with scarring, invasive interventions must be taken to relieve the hydronephrosis. Common treatments, such as D-J stent placement and permanent nephrostomy may not only entail the risk of infection, but also seriously affect the quality of life. Few cases of surgical intervention have been reported. In this article, a 25-year-old female was admitted to Peking University First Hospital suffering from recurrent flank pain. Seven years before, she developed hemorrhagic cystitis and bilateral urethritis 40 days after allogeneic HSCT. After continuous bladder irrigation and antiviral therapy, the left-sided hydronephrosis gradually alleviated while the right-sided one did not improve. D-J stents were used for urine drainage for 7 years before percuta-neous nephrostomy. Preoperative antegrade pyelography revealed significant hydronephrosis in the right kidney with long stricture of proximal-middle ureter. After comprehensive decision, she underwent ileal ureter replacement. The operation was successful. The segmental lesion was dissected and the scar tissue was removed. A 25 cm intestinal tube was isolated to connect the pelvis and bladder. An anti-reflux nipple was created at the distal end of ileal ureter to prevent the potential infection. The blood loss was minimal. After surgery, the drainage tube was removed in 2 weeks, the nephrostomy tube and the D-J stent was removed in 3 months. Follow-up mainly included clinical assessment, serologic testing, renal ultrasonography, blood gas analysis and radiological examination. During the follow-up of 6 years, she was symptom-free and no postoperative complications occurred. The serum creatinine level was stable. No hydronephrosis was observed under ultrasonography. Obvious peristaltic waves and ureteral jets of the ileal ureter was confirmed on cine magnetic resonance urography. To sum up, ureteral stenosis after HSCT is relatively rare. Obstruction caused by scarring is usually irreversible and surgical intervention should be designed according to the location and length of the lesion. Ileal ureter replacement can be a safe, feasible and effective method to solve this kind of complex stricture.
Adult
;
Cicatrix
;
Constriction, Pathologic/etiology*
;
Female
;
Hematopoietic Stem Cell Transplantation/adverse effects*
;
Humans
;
Hydronephrosis/surgery*
;
Quality of Life
;
Ureter/surgery*
;
Ureteral Obstruction/surgery*
7.Congenital Nephrogenic Diabetes Insipidus with Bilateal Hydronephrosis: Indomethacin in Treatment of Nephrogenic Diabetes Insipidus.
Young Mo SOHN ; Chul LEE ; Pyung Kil KIM ; Duk Jin YUN
Yonsei Medical Journal 1980;21(2):116-122
A 13-year-old boy was diagnosed as having primary nephrogenic diabetes insipidus, and symptoms developed at 3 years of age. Subsequently he developed bilateral hydronephrosis and a neurogenic bladder. His pedigree could be explored back 5 generations and represented an inheritance as an X-linked recessive transmission factor. He was treated with indomethacin 2 mg/kg/day plus chlorothiazide 500 mg/day and this new treatment showed a markedly decreased urine output and increased urine osmolarity. (Nephrogenic diabetes insipidus, Hydronephrosis, Indomethacin)
Adolescent
;
Bladder, Neurogenic/etiology
;
Chlorothiazide/therapeutic use
;
Diabetes Insipidus/complications
;
Diabetes Insipidus/congenital*
;
Diabetes Insipidus/drug therapy
;
Diabetes Insipidus/genetics
;
Drug Therapy, Combination
;
Human
;
Hydronephrosis/etiology*
;
Indomethacin/therapeutic use*
;
Male
8.Postoperative ureteral obstruction after endoscopic treatment for vesicoureteral reflux.
Jae Min CHUNG ; Chang Soo PARK ; Sang Don LEE
Korean Journal of Urology 2015;56(7):533-539
PURPOSE: We undertook this study to evaluate the incidence, risk factors, management, and outcome of postoperative ureteral obstruction after endoscopic treatment for vesicoureteral reflux (VUR). MATERIALS AND METHODS: Ninety patients undergoing endoscopic treatment for VUR were retrospectively reviewed and classified into two groups according to ureteral obstruction: the nonobstruction group (83 cases, 122 ureters; mean age, 7.0+/-2.8 years) and the obstruction group (7 cases, 10 ureters; mean age, 6.2+/-8.1 years). We analyzed the following factors: age, sex, injection material, laterality, voiding dysfunction, constipation, renal scarring, preoperative and postoperative ultrasound findings, endoscopic findings, injection number, and injection volume. Additionally, we reviewed the clinical manifestations, natural course, management, and outcome of ureteral obstruction after endoscopic treatment. RESULTS: The incidence of ureteral obstruction after endoscopic treatment was 7.6% (10/132 ureters). The type of bulking agent used and injection volume tended to be associated with ureteral obstruction. However, no significant risk factors for obstruction were identified between the two groups. Three patients showed no symptoms or signs after the onset of ureteral obstruction. Most of the patients with ureteral obstruction experienced spontaneous resolution within 1 month with conservative therapy. Two patients required temporary ureteral stents to release the ureteral obstruction. CONCLUSIONS: In our experience, the incidence of ureteral obstruction was slightly higher than in previous reports. Our study identified no predictive risk factors for developing ureteral obstruction after endoscopic treatment. Although most of the ureteral obstructions resolved spontaneously within 1 month, some cases required drainage to relieve symptoms or to prevent renal function deterioration.
Adolescent
;
Child
;
Child, Preschool
;
Cystoscopy/*adverse effects
;
Drainage
;
Female
;
Humans
;
Hydronephrosis/etiology
;
Male
;
Postoperative Period
;
Prognosis
;
Remission, Spontaneous
;
Retrospective Studies
;
Risk Factors
;
Stents
;
Ureteral Obstruction/*etiology/pathology/therapy
;
Vesico-Ureteral Reflux/*surgery
9.Role of Urinary Levels of Endothelin-1, Monocyte Chemotactic Peptide-1, and N-Acetyl Glucosaminidase in Predicting the Severity of Obstruction in Hydronephrotic Neonates.
Hamid MOHAMMADJAFARI ; Alireza RAFIEI ; Seyed Abdollah MOUSAVI ; Abdulrasool ALAEE ; Yalda YEGANEH
Korean Journal of Urology 2014;55(10):670-676
PURPOSE: Antenatal hydronephrosis (AH) is found in 0.5%-1% of neonates. The aim of the study was to assess the urinary concentrations of 3 biomarkers, endothelin-1 (ET-1), monocyte chemotactic peptide-1 (MCP-1), and N-acetyl-glucosaminidase (NAG) in severely hydronephrotic neonates. MATERIALS AND METHODS: Neonates with a history of prenatal hydronephrosis were enrolled in the prospective study in 2 groups. Group 1 included neonates with severe forms of obstruction requiring surgical intervention and group 2 included neonates with milder forms of obstruction without any functional impairment. Fresh voided urinary levels of ET-1, MCP-1, and NAG were measured and their ratios to urinary Cr were calculated. RESULTS: Fourty-two neonates were enrolled into the 2 groups: group 1, 24 patients (21 male, 3 female); group 2, 18 neonates (16 male, 2 female). There were no statistically significant differences between urinary ET-1, NAG, MCP-1 values, and ET-1/Cr and NAG/Cr ratios in groups 1 and 2. The urinary MCP-1/Cr ratio was significantly higher in group 1 than in group 2. For comparison of groups 1 and 2, the cut-off values were measured as 0.5709 ng/mg (sensitivity, 75%; specificity, 67%; positive predictive value [PPV], 71%; negative predictive value [NPV], 71%), 0.927 ng/mg (sensitivity, 77%; specificity, 72%; PPV, 77%; NPV, 72%), and 1.1913 IU/mg (sensitivity, 62%; specificity, 67%; PPV, 68%; NPV, 60%) for ET-1/Cr, MCP-1/Cr, and NAG/Cr ratios, respectively. CONCLUSIONS: The urinary MCP-1/Cr ratio is significantly elevated in neonates with severe obstruction requiring surgical intervention. Based upon these results, urinary MCP-1/Cr may be useful in identification of severe obstructive hydronephrosis in neonates.
Acetylglucosaminidase/*urine
;
Biological Markers/urine
;
Chemokine CCL2/*urine
;
Endothelin-1/*urine
;
Female
;
Humans
;
Hydronephrosis/*congenital/etiology/surgery/ultrasonography
;
Infant, Newborn
;
Male
;
Predictive Value of Tests
;
Prospective Studies
;
Sensitivity and Specificity
;
Ureteral Obstruction/complications/*diagnosis/surgery
10.Diagnosis and treatment of ureteropelvic junction obstruction caused by renal crossing vessels:an analysis of 24 cases.
Min QIU ; Hongzhang WU ; Lulin MA ; Jian LU ; Yi HUANG ; Gang LI ; Ye YAN ; Hang LI
Chinese Journal of Surgery 2014;52(9):702-705
OBJECTIVETo investigate the diagnosis, treatment and surgical outcomes of ureteropelvic junction obstruction (UPJO) caused by renal crossing vessels.
METHODSThe case records of 24 patients discharged from Peking University Third Hospital between June 2001 and September 2011 with the diagnosis of UPJO caused by renal crossing vessels were reviewed .Of the 24 patients, 17 were male and 7 were female patients. The mean age was 28 years (range, 2-63 years). The mean disease duration was 22.3 months (range, 7 days to 180 months). Of which, 4 patients underwent open surgery, and the other 20 patients were treated with laparoscopic surgery. Surgical approach was decided by operative conditions: adhesion release technique, dismembered pyeloplasty or Y-V anastomosisor, with or without cut off the crossing vessels. The kind of crossing vessels was recorded, and the effect of surgery was evaluated by follow-up.
RESULTSFifteen cases were caused by oppressed renal crossing artery, 8 cases by renal crossing vein, and 1 case by 2 renal crossing arteries and 1 renal crossing vein. Among them, 11 cases were followed up successfully. Average follow-up time was 48.2 months (range, 13-120 months). Eight cases (8/11) were relieved, and 1 case (1/11) had no obvious improvement, another 2 cases (2/11) were aggravating. Among those 6 cases underwent adhesion release technique, 3 cases were relieved, 1 case had no obvious improvement, and 2 cases were aggravating. Five cases who underwent dismembered pyeloplasty was relieved significantly.
CONCLUSIONSRenal crossing artery is one of the main causes of UPJO, the crossing artery should be retained as far as possible. Crossing vessel oppression is not the only pathological cause of UPJO, so the treatment of UPJ constriction is also very important. Dismembered pyeloplasty seems to be the most efficacies treatment procedure for UPJO caused by repressed vessels, and the remission rate of adhesion release technique seems limited.
Adolescent ; Adult ; Arteries ; surgery ; Child ; Child, Preschool ; Female ; Humans ; Hydronephrosis ; congenital ; etiology ; surgery ; Kidney ; blood supply ; Kidney Pelvis ; blood supply ; Laparoscopy ; methods ; Male ; Middle Aged ; Multicystic Dysplastic Kidney ; etiology ; surgery ; Renal Artery ; abnormalities ; Treatment Outcome ; Ureteral Obstruction ; etiology ; surgery ; Young Adult