PURPOSE: To evaluate 99mTc-mercaptoacetyltriglycine diuretic renograms for diagnosing stomal obstruction in tubeless cutaneous ureterostomy. MATERIALS AND METHODS: Cutaneous ureterostomy was performed in 29 patients (56 renal units) with a minimum follow-up period of 12 months. Stomal obstruction was evaluated with 99mTc-mercaptoacetyltriglycine diuretic renography 3 months after surgery. Regions of interest were drawn that completely encircled and snugly fit the kidney, renal pelvis, and ureter. The data analyses were performed with half-times to tracer clearance following furosemide (0.5 mg/kg) administration. RESULTS: The mean half-times to tracer clearance were 6.90+/-6.30, 5.25+/-4.29, and 8.75+/-7.63 minutes in the total, ipsilateral, and contralateral kidneys, respectively, in side relationships between the ureter and the stoma. There were significant differences between the ipsilateral and contralateral kidneys in the mean half-time to tracer clearance (p=0.038). Forty-eight renal units (85.7%) had a half-time to tracer clearance of less than 15 minutes, and all 48 renal units had no hydronephrosis. On the other hand, 5 renal units (8.9%) had a half-time to tracer clearance of more than 20 minutes, and these 5 renal units required the insertion of stent catheters or became atrophic. CONCLUSIONS: 99mTc-mercaptoacetyltriglycine diuretic renography was very useful for diagnosing stomal obstruction of tubeless cutaneous ureterostomy. The upper limit of the half-time to tracer clearance for unobstructed systems was 15 minutes, which allowed for the confident exclusion of stomal obstruction in tubeless cutaneous ureterostomy.
Catheters ; Follow-Up Studies ; Furosemide ; Hand ; Humans ; Hydronephrosis ; Kidney ; Kidney Pelvis ; Radioisotope Renography ; Statistics as Topic ; Stents ; Technetium Tc 99m Mertiatide ; Ureter ; Ureteral Obstruction ; Ureterostomy ; Urinary Bladder Neoplasms

PURPOSE: To investigate hydronephrosis after the establishment of tubeless cutaneous ureterostomy by using our definition of the tubeless condition and our indications for catheter insertion. MATERIALS AND METHODS: Twenty-eight (54 renal units) patients with both establishment of tubeless cutaneous ureterostomy 3 months after surgery and at least 12 months of follow-up were investigated in this study. The 4-grade system was used to evaluate the hydronephrosis. The definition of the tubeless condition in cutaneous ureterostomy was as follows: 1) the catheter stent is not placed in the renal pelvis through the stoma, 2) the grade of hydronephrosis is less than 3, and 3) the kidney is functioning. Indications for catheter insertion after the establishment of tubeless cutaneous ureterostomy were as follows: 1) difficulty in curing acute pyelonephritis by drug treatments, 2) flank pain due to hydronephrosis, or 3) increase in the grade of hydronephrosis. RESULTS: The follow-up period was 12 to 78 months (average, 40.5+/-22.1 months). After the establishment of tubeless cutaneous ureterostomy, 6 of 54 renal units (11.1%) were eligible for catheter insertion. The catheter insertion was performed in 4 renal units. Another 2 renal units were followed up without intervention, and they gradually became atrophic. The renal functions were preserved in the other 52 renal units. CONCLUSIONS: Our results suggest that our definition of the tubeless condition and our indications for catheter insertion would be useful for the evaluation and management of hydronephrosis after establishment of tubeless cutaneous ureterostomy.
Catheters ; Flank Pain ; Follow-Up Studies ; Humans ; Hydronephrosis ; Kidney ; Kidney Pelvis ; Pyelonephritis ; Stents ; Ureteral Obstruction ; Ureterostomy ; Urinary Bladder Neoplasms ; Urinary Diversion

Adult ; Humans ; Laparoscopy ; methods ; Male ; Retrocaval Ureter ; surgery ; Ureterostomy ; methods ; Young Adult

PURPOSE: Unilateral low loop cutaneous ureterostomy (LLCU) has been offered as the preferred method of temporary urinary diversion in cases of massively dilated and refluxing ureters. We sought to explore whether LLCU is effective in preserving urinary bladder function in the long term. MATERIALS AND METHODS: The charts of all patients who had undergone temporary unilateral LLCU as newborns in the presence of massive vesico-ureteric reflux were retrospectively reviewed. Demographic data, follow-up length, and presence of incontinence were recorded. Patients were interviewed regarding lower urinary tract symptoms (LUTS), and their urination patterns were recorded by using uroflow and post-void residual (PVR) measurements. RESULTS: Between 1972 and 2003, a total of 24 patients underwent unilateral LLCU in the presence of massively refluxing ureters. Eight patients were included in the final analysis. The median age at diversion was 12 days, the median time to closure was 22.5 months, and the median follow-up was 12.5 years. Urinary bladders showed normal contour, normal capacities, and minimal PVRs in most cases. None of the patients required augmentation cystoplasty. One patient suffered from urinary leakage and few demonstrated minimal LUTS. CONCLUSIONS: Unilateral refluxing LLCU is an effective method of urinary diversion that preserves urinary bladder function for the long term. Larger studies are required to confirm this finding.
Follow-Up Studies ; Humans ; Infant, Newborn ; Lower Urinary Tract Symptoms ; Retrospective Studies ; Ureter ; Ureterostomy ; Urinary Bladder ; Urinary Diversion ; Urination

It is known that many renal transplantation candidates with end stage renal disease have bladder dysfunction. Before 1966, these patients were considered poor candidates for renal transplantation because of their many bladder problems. But it has recently been reported that renal transplantation with an ileal conduit could solve these problems. Herein, we report on a patient with Hinman's syndrome and this patient underwent renal transplantation using a pre-existing cutaneous ureterostomy.
Humans ; Kidney Failure, Chronic ; Kidney Transplantation ; Ureterostomy ; Urinary Bladder ; Urinary Diversion

Significant surgical complications occur in about half of patients after simultaneous pancreas kidney transplantation (SPK) with bladder drainage. Urologic complications are very common in bladder-drained pancreas transplants. Urinary obstruction occurs in either the early or the late period following transplantation. Predictors of urological complications after transplantation have not been well established. Early obstruction is usually diagnosed by an increment of serum creatinine or through imaging studies, such as ultrasound and antegrade pyelogram. Surgical management is inevitable when conservative managements fails. If the length of the donor ureter is sufficient, it is possible to redo the ureteroneocystostomy. However, if this is not the case or the stricture is at a high level, a native ureterotransplant ureterostomy may be the procedure of choice. SPK was performed on a 36 year old male patient with insulin dependent diabetes mellitus and diabetic nephropathy. The pancreatic exocrine secretion was drained by duodenocystostomy. The patient developed an obstruction in upper ureter on the postoperative 16th day. On the postoperative 32nd day, a native ureterotransplant ureterostomy with a double J stent was performed. The postoperative course was uneventful. The double J stent was removed on postoperative 112nd day by cystoscope. A subsequent follow up showed excellent pancreatic and renal function.
Adult ; Constriction, Pathologic ; Creatinine ; Cystoscopes ; Diabetes Mellitus ; Diabetic Nephropathies ; Drainage ; Follow-Up Studies ; Humans ; Insulin ; Kidney Transplantation* ; Kidney* ; Male ; Pancreas* ; Stents ; Tissue Donors ; Ultrasonography ; Ureter* ; Ureteral Obstruction* ; Ureterostomy* ; Urinary Bladder

OBJECTIVE: The purpose of our study was to evaluate the postnatal outcome of fetal pyelectasia and to assess the cut-off value for prediction of renal pathologic processes and surgical intervention. MATERIALS AND METHODS: Seventy-seven cases of pyelectasia were identified during the study period (1996 through 2000). Fetuses with antero-posterior pelvic diameter (APPD) >or=7 mm after 28 weeks were included. Postnatal evaluation included renal sonogram, voiding cystourethrogram, and renal flow and function studies. RESULTS: Renal pathologic processes after birth were found in 38 of 77 cases (49%). Ureteropelvic junction obstruction (19 cases, 50%) was the most common, followed by 4 cases of duplicated kidney, 3 cases of ureterovesical junction obstruction, 2 cases of primary vesicoureteral reflux, dysplastic kidney, extrarenal pelvis respectively and 1 case of ureterocele. Surgical intervention was performed in 21 cases (55%); pyeloplasty (13), nephrectomy (including partial) (3), transurethral incision of ureterocele (2), uretero- ureterostomy (1), uretero-cystostomy (2). Using cut-off value derived from receiver operating characteristic (ROC) curve, renal APPD >or=10.5 mm, >or=13.6 mm after 28 weeks gestation could predict the fetuses who would have renal pathologic processes and need surgical intervention, with sensitivity and specificity of 77.5%, 79.4% and 90.5%, 89.3%, respectively. CONCLUSION: It is possible to predict the fetuses who would require appropriate urologic evaluation and surgical intervention after birth, with determining the renal pelvic diameter in the third trimester of pregnancy.
Female ; Fetus ; Humans ; Kidney ; Nephrectomy ; Parturition ; Pathologic Processes ; Pelvis ; Pregnancy ; Pregnancy Trimester, Third ; ROC Curve ; Sensitivity and Specificity ; Ureterocele ; Ureterostomy ; Vesico-Ureteral Reflux

Background: Most abdominal surgery can be done by laparoscopic method. For urologic surgery, laparoscopic surgery is used to cut the kidney, prostate, seminal vesicles and get urinary stones, including the ureter stones.\r\n', u'Objectives: Contribute to improving treatment effects ureter stones by lapasoscopy tranperitoneal ureterolithotomy\r\n', u'Subjects and method: Laparoscopic transperitoneal ureterolithotomy was attempted in 90 patients (50 men and 34 women) with an age range of 22 \ufffd?75 years (mean 43.60+ 11.97 years). Learn characteristics of ureteral calculi (X-ray, ultrasound, urinary map vein) and surgical methods.\r\n', u'Results:The results showed that: Most ureterolith at L3 vertebral level (55.6%) and L4 (40.0%). The stone size ranged from 8 to 22mm (mean 13.87+ 3.25mm) and an average width 4 to 12mm (mean 6.96 + 1.82mm). Most cases of ureteral calculi with the situation fluid in the kidney level 2 (76.7%). The stone has impacted in the upper and mid ureter. Two 10-mm and one 5mm trocars were used. Most cases of stage 2 nasal. The mean operative time was 57.22 + 15.51 minutes (30-90 minutes). \r\n', u'Conclusion: The authors conclude that laparoscopic ureterolithotomy by the transperitoneal approach is a safe and reliable minimally invasive procedure. For large, hard, long-standing and impacted ureteric calculi, one laparoscopicureterolithotomy is an initial therapy\r\n', u'
Ureterostomy ; Laparoscopy

Two examples of the rare case of complete duplicated collecting system with lower pole ureteropelvic junction obstruction are described. Ureteropelvic junction obstruction (UPJO) and duplicated collecting systems seldom occur in combination. Complete duplication of the ureter may be asymptomatic or recognized when complications develop as a result of reflux into the lower pole ureter or obstruction of the upper pole with an ectopic ureterocele. It is difficult to choose an optimal therapy due to the high variability in function, degree of obstruction, damage and potential for regeneration in growing kidneys. The diagnosis and management of UPJO of the lower pole in complete duplicated collecting systems are discussed.
Case Report ; Female ; Human ; Infant ; Infant, Newborn ; *Kidney Pelvis ; Kidney Tubules, Collecting/*abnormalities/surgery ; Male ; *Ureteral Obstruction/*complications/diagnosis/surgery ; Ureterostomy

A 62-year-old diabetic male was presented with abdominal pain. Six years ago, he had been performed cystectomy with both cutaneous ureterostomy for bladder cancer. After admission, high fever was developed and radiologic findings revealed a calcification occupying the whole left pelvocalyceal system with gas accumulation in parenchyme. We started the intensive cares with fluid therapy, broad-spectrum antibiotics and insulin therapy, but he failed to improve with supportive management. For the decompression we placed initially double-J stent through the left cutaneous ureterostomy instead of percutaneous nephrostomy or nephrectomy. After stenting, postobstructive diuresis was occurred and followed by marked improvement in general condition including vital sign, mental status and laboratory findings. Herein, we report a case of emphysematous pyelonephritis recoverd by ureteral stenting through the cutaneous ureterostomy in a diabetic patient with contralateral atrophic kidney.
Abdominal Pain ; Anti-Bacterial Agents ; Cystectomy ; Decompression ; Diuresis ; Fever ; Fluid Therapy ; Humans ; Insulin ; Kidney ; Male ; Middle Aged ; Nephrectomy ; Nephrostomy, Percutaneous ; Pyelonephritis* ; Stents* ; Ureter* ; Ureterostomy ; Urinary Bladder Neoplasms ; Vital Signs