PURPOSE: To characterize the course of treatment for nonmonosymptomatic enuresis with overactive bladder (OAB) in a real clinical setting. METHODS: Data from 111 OAB patients with moderate to severe enuresis were analyzed. The baseline analysis included a questionnaire, voiding diary, uroflowmetry with postvoid residual urine measurement, and plain abdominal radiography of the kidneys, ureters, and bladder (KUB). Following standard urotherapy for 1 month, anticholinergic medication was administered with or without laxatives. Desmopressin was added if there was a partial response to OAB. Patients were followed every 3 months to evaluate the status of OAB and enuresis. Multivariate analysis was performed to identify predictors associated with the lack of complete response (CR) in enuresis at 12 months. RESULTS: Following 12 months of treatment, 64% and 88% of patients experienced at least partial response in enuresis and OAB, respectively. Urgency improved more quickly than enuresis, supporting the need to address daytime symptoms before enuresis. Seventy-nine patients (71%) had fecal impaction on KUB and/or subjective constipation. The combination of anticholinergics with either laxatives or desmopressin fared better than anticholinergics alone. Daytime incontinence and anticholinergics-only treatment were associated with a lack of CR during 12 months of treatment. CONCLUSIONS: The data confirmed the validity of addressing OAB before treating enuresis. The results of this study also highlight the need to address fecal impaction. Patients should be counseled about the need for a prolonged course of treatment before starting treatment. Anticholinergics should be accompanied with either desmopressin or laxatives for better control of enuresis.
Cholinergic Antagonists ; Constipation ; Deamino Arginine Vasopressin ; Enuresis* ; Fecal Impaction ; Humans ; Kidney ; Laxatives ; Multivariate Analysis ; Radiography, Abdominal ; Ureter ; Urinary Bladder ; Urinary Bladder, Overactive*

A knotted ureteral stent is an extremely rare condition, with fewer than 20 cases reported in the literature; however, it is difficult to treat. We report a case in which a folded Terumo guidewire was successfully used to remove a knotted stent percutaneously without anesthesia. We also review the current literature on predisposing factors and management strategies for knotted ureteral stents.
Anti-Bacterial Agents/therapeutic use ; Humans ; Kidney Calculi/*radiography/*therapy ; Lithotripsy ; Male ; Middle Aged ; Stents/*adverse effects ; Ureter

PURPOSE: Temporary drainage of the upper urinary tract by use of internal ureteral stents is a common procedure that is often associated with a variety of symptoms. The role of intravesical stent position in associated morbidity is controversial. MATERIALS AND METHODS: The German version of the ureteral stent symptom questionnaire (USSQ) was completed by 73 patients with an indwelling ureteral stent the day before stent removal. Intravesical stent position was classified into 3 categories by x-ray before stent removal. The influence of intravesical stent position on USSQ score was analyzed, including subscores and single items. RESULTS: Intravesical stent position showed no significant influence on associated morbidity. The median USSQ total score in all patients was 77.5 (range, 30-147). Patients with ipsilateral stents (69.0; range, 30-122) tended to have lower total scores than did those with tangential (86.5; range, 30-122) or contralateral (77.0; range, 31-147) stents, but the differences were not statistically significant (p=0.35). The USSQ subscores for urinary symptoms (p=0.80), body pain (p=0.80), general health (p=0.16), work performance (p=0.07), additional problems (p=0.81), and all of the USSQ single items of interest in the context of stent length also did not differ significantly between the three groups. CONCLUSIONS: Intravesical stent position did not significantly influence associated morbidity in our study. An appropriate stent length should be chosen to avoid dislocation. However, complex calculations of optimum stent length, time-consuming manipulations, and costly stock holding of various stent sizes to obtain the perfect stent position do not seem worthwhile.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Lower Urinary Tract Symptoms/*etiology ; Male ; Middle Aged ; *Morbidity ; Pain ; Prognosis ; Quality of Life ; Stents/*adverse effects ; Surveys and Questionnaires ; Ureter/*radiography ; Young Adult

A patient with a complete right ureteral triplication presented with recurrent pyelonephritis and flank pain that was refractory to medical management. Evaluation showed that the atrophic upper-most renal moiety had been chronically obstructed and was associated with a dilated ureter. Intraureteral and intravenous indocyanine green (ICG) were used as real-time contrast agents intraoperatively to facilitate right robotic partial nephroureterectomy of the diseased system. Intraureteral ICG was used to accurately distinguish the pathologic ureter and associated renal pelvis from its normal counterparts. Intravenous ICG was used to assess perfusion in the right kidney and delineate the margins of diseased renal parenchyma.
Administration, Topical ; Adult ; Coloring Agents/administration & dosage ; Female ; Humans ; Indocyanine Green/*administration & dosage ; Infusions, Intravenous ; Nephrectomy/*methods ; Pyelonephritis/surgery ; Robotic Surgical Procedures/*methods ; Tomography, X-Ray Computed ; Ureter/*abnormalities/radiography/*surgery

PURPOSE: To evaluate the distribution of ureteral stones and to determine their characteristics and expulsion rate based on their location. MATERIALS AND METHODS: We retrospectively reviewed computed tomography (CT) findings of 246 patients who visited our Emergency Department (ED) for renal colic caused by unilateral ureteral stones between January 2013 and April 2014. Histograms were constructed to plot the distribution of stones based on initial CT findings. Data from 144 of the 246 patients who underwent medical expulsive therapy (MET) for 2 weeks were analyzed to evaluate the factors responsible for the stone distribution and expulsion. RESULTS: The upper ureter and ureterovesical junction (UVJ) were 2 peak locations at which stones initially lodged. Stones lodged at the upper ureter and ureteropelvic junction (group A) had a larger longitudinal diameter (4.21 mm vs. 3.56 mm, p=0.004) compared to those lodged at the lower ureter and UVJ (group B). The expulsion rate was 75.6% and 94.9% in groups A and B, respectively. There was no significant difference in the time interval from initiation of renal colic to arrival at the ED between groups A and B (p=0.422). Stone diameter was a significant predictor of MET failure (odds ratio [OR], 1.795; p=0.005) but the initial stone location was not (OR, 0.299; p=0.082). CONCLUSIONS: The upper ureter and UVJ are 2 peak sites at which stones lodge. For stone size 10 mm or less, initial stone lodge site is not a significant predictor of MET failure in patients who have no previous history of active stone treatment in the ureter.
Adult ; Female ; Humans ; Kidney Pelvis/pathology ; Male ; Middle Aged ; Renal Colic/drug therapy/*pathology/radiography ; Retrospective Studies ; Sulfonamides/therapeutic use ; Tomography, X-Ray Computed ; Treatment Failure ; Ureter/pathology ; Ureteral Calculi/drug therapy/*pathology/radiography ; Urological Agents/therapeutic use

Crossed renal ectopia is a condition in which a kidney is located on the side opposite of its ureteral insertion. Ninety percent of crossed ectopic kidneys are fused to their ipsilateral uncrossed renal unit. Crossed renal ectopia without fusion is rare, with only 62 patients reported in the literature to date. These kidneys may suffer iatrogenic injury during an unrelated surgical intervention. The injury, unless self-limiting, may necessitate the removal of the ectopic kidney. We present a unique case of a dual injury, renal as well as ureteric, in a crossed ectopic kidney without fusion that was successfully managed without surgical excision.
Adult ; Choristoma/radiography/*therapy ; Humans ; *Iatrogenic Disease ; Kidney/*abnormalities/injuries/radiography ; Male ; Stents ; Tomography, X-Ray Computed ; Ureter/abnormalities/injuries/radiography

Adult ; Foreign Bodies ; diagnostic imaging ; Humans ; Male ; Radiography ; Stents ; adverse effects ; Ureter

Abnormalities, Multiple ; diagnostic imaging ; Adult ; Female ; Humans ; Kidney Calculi ; diagnostic imaging ; Radiography ; Ureter ; abnormalities ; diagnostic imaging

Humans ; Male ; Middle Aged ; Radiography ; Rupture, Spontaneous ; diagnostic imaging ; etiology ; physiopathology ; Ureter ; injuries ; Urolithiasis ; complications ; diagnosis ; diagnostic imaging

Purpose: The aim of this study was to compare the efficacy, safety and compliance of ureteroscopic stone removal (URS) patients who were treated with extracorporeal shock wave lithotripsy (ESWL) for large (>10mm) proximal ureteral stones. Materials and Methods: We reviewed 123 patients who were treated for upper ureteral stones (>10mm) between January 2000 and March 2005. URS and ESWL were performed in 51 and 72 patients, respectively. Success was defined as the patients achieving a stone-free status on radiography at 1 month after treatment. We analyzed the success rates of stone removal, the reasons for failure and the complication rates of each procedure. Results: The overall success rate of URS was 90.2%. For the ESWL treatments, the overall success rates after the first, second, third and more sessions were 47.2%, 61.1%, 76.4% and 81.9%, respectively. Notably, the stone free rate of the URS group was better than that of the 1st, 2nd and 3rd session ESWL group (p<0.05). The complication rate of URS was 24.0% and that of ESWL was 22.2%; the difference was not statistically significant (p<0.05). Conclusions: In this study, URS achieved an excellent stone free rate and a similar complication rate to that of ESWL for treating large (>10mm) upper ureteral calculi. Thus, this procedure should be considered as first line therapy for large (>10mm) upper ureteral stones. In addition, for the proper selection of patients for ESWL and URS, analysis of the cost effectiveness, compliance and recurrence rates of the two groups should be done in the future.
Compliance ; Cost-Benefit Analysis ; Humans ; Lithotripsy* ; Radiography ; Recurrence ; Shock* ; Ureter* ; Ureteral Calculi ; Ureteroscopes