Ureteroscopy in Pregnant Women for Ureteral Stone

Introduction: The occurrence of urolithiasis in pregnancy represents a challenge in both diagnosis and treatment of this condition, because it presents risks not only to the mother but also to the fetus. Surgical treatment may be indicated for patients with infection, persistent pain, and obstruction of a solitary kidney. We present our experience on the management of pregnant patients with ureteral calculi and a review of the literature.Materials and Methods: The charts of 19 pregnant patients with obstructive ureteral calculi were retrospectively reviewed. Gestational age ranged from 13 to 33 weeks. In all patients, ureteral stone was diagnosed on abdominal ultrasound. In regard to localization, 15 calculi were in the distal ureter, 3 in the proximal ureter, and 1 in the interior of an ureterocele. Calculi size ranged from 6 to 10 mm (mean, 8 mm). The following criteria were used to indicate ureteroscopy: persistent pain with no improvement after clinical treatment, increase in renal dilation, or presence of uterine contractions. Nine patients (47.3%) were submitted to ureteroscopy. All calculi (100%) were removed with a stone basket extractor under continuous endoscopic vision. None of the calculi demanded the use of a lithotriptor.Results: Nine patients (47.3%) treated with clinical measurements presented no obstetric complications and spontaneous elimination of the calculi. Nine patients (47.3%) submitted to ureteroscopy had no surgical complications. There was remission of pain in all cases after ureteroscopy and ureteral catheter placement.Conclusion: The diagnosis and treatment of ureteral lithiasis in pregnant women present potential risks for the fetus and the mother. Conservative management is the first option, but ureteroscopy may be performed with safety and high success rates.

Fatores associados à recorrência da infecção do trato urinário em crianças

OBJETIVOS: verificar a freqüência de infecção urinária recorrente (ITU) e avaliar os fatores associados à recorrência da ITU em crianças. MÉTODOS: estudo retrospectivo de 95 pacientes com seguimento de um ano (68 meninas e 27 meninos, mediana de idade três anos). As variáveis estudadas foram: sexo, idade, febre, constipação, tipo de bactéria, refluxo vésico-ureteral (RVU), anormalidades na cintilografia renal com ácido dimercaptosuccínico (DMSA). RESULTADOS: infecção urinária recorrente ocorreu em 49,5% crianças (19 com trato urinário normal, 19 com RVU e 9 com estenose da junção pielocalicial). Comparando o grupo com ITU recorrente com o grupo sem ITU recorrente não se encontrou diferença significativa entre sexos, presença de febre, constipação e anormalidades na cintilografia renal com DMSA. A ITU recorrente foi significativamente maior nas crianças com um ano ou menos, naquelas menores de dois anos com RVU, nas com bactéria diferente da Escherichia coli e sem profilaxia antibacteriana. Os fatores de risco significativos para a recorrência ITU foram idade < 2 anos (OR = 3,83) e refluxo vésico-ureteral (OR = 4,95). CONCLUSÕES: por causa da elevada freqüência de ITU recorrente é importante o seguimento regular de grupo de crianças com fatores de risco para ITU recorrente.

Laparoscopic management of iatrogenic lesions

Purpose: To present our series of patients who underwent laparoscopic correction of iatrogenic lesions and a review of the literature.Patients and Methods: We evaluated 23 patients who underwent laparoscopic correction of iatrogenic lesions. Thirteen patients had open surgery, 6 had an endoscopic procedure, and 4 had a laparoscopic approach as the first surgical procedure. Vesicovaginal fistulas (VVF) developed in seven patients after open abdominal hysterectomies, and 1 patient presented with a VVF after ureterolithotripsy. A urethral cutaneous fistula developed in one patient after a laparoscopic resection of endometriosis nodules, and 1 patient presented with a ureterovaginal fistula after a perineoplasty. Three patients presented with encrusted ureteral stents after ureterolithotripsy. Ureteral stenosis developed in seven patients: three after open abdominal surgery, three after ureteroscopy, and one after pyeloplasty. One patient had a ureteral injury during laparoscopic partial nephrectomy, and two patients had bowel injuries after a tension-free vaginal tape procedure and a laparoscopic radical prostatectomy.Results: All patients underwent laparoscopic correction of the iatrogenic injuries. One patient had an early recurrence of a VVF, and one patient had a recurrence of a ureteral stenosis. There was one conversion to open surgery because of technical difficulties and one major bleeding event that necessitated blood transfusion. A lower limb compartmental syndrome developed in one patient.Conclusion: Despite the small number of patients and different types of surgeries performed, laparoscopic management of iatrogenic lesions seems to be feasible and safe in experienced hands. Its precise role in the management of this stressful condition still needs to be determined.

POST-MORTEM LESIONS of UROLITHIASIS IN A LESSER SEED FINCH (Sporophila angolensis).

Urolithiasis is a disease that despite being a commonly observed problem in veterinary practice is uncommon in birds. Such disease was not reported in passeriforms to date. Accordingly, the aim of the present article is to describe a case of urolithiasis in an adult female lesser seed finch (Sporophila angolensis) pet bird which presented abdominal distension, respiratory distress, and apathy prior to death. The bird had history of being fed with a diet rich in protein. After the bird death, a necropsy was conducted in order to determine the cause of death. At necropsy, accentuated ascites, hydropericardium, and ureteral stones in the left ureter could be grossly observed. Additional tests related with viral and bacterial microbiological testing and with the determination of calculi composition could not be performed since the owner did not consent with the procedures because of the cost. Since the bird was fed on a high protein diet, a relationship between the ureteroliths and dietary imbalance was suggested with participation of protein in calculi development by providing the organic nuclei. Additionally, we conclude that the presence of calculi in the ureter resulted in urinary flow blockage, ascites, and consequent acute respiratory failure due to filling of air sacs with liquid.

Tratamento cirúrgico das rupturas ureterais por ureterocoloanastomose

A implantação do ureter no cólon descendente advém da impossibilidade de reimplantá-lo na vesícula urinária, devido a perdas substanciais do tecido ureteral. O presente trabalho avaliou as alterações macroscópicas, microscópicas e laboratoriais em cães submetidos à ureterocoloanastomose esquerda. Foram utilizados 8 cães adultos, hígidos, de ambos os sexos. A técnica operatória consistiu na ligadura do coto distal do ureter próximo à bexiga e na implantação de um curto seg- mento do coto proximal, através de um túnel submucoso, na face antimesentérica do cólon. Realizou-se dosagens séricas de uréia, creatinina, sódio e potássio no pré-operatório, 2, 7, 15 e 30 dias após a cirurgia. Um total de 6 animais foram observados por 30 dias, e outros dois foram observados durante 7 e 180 dias, res- pectivamente. Todos apresentaram fezes moles durante o decorrer do experimento. Ao exame macroscópico, todos os animais apresentaram dilatação ureteral e pielonefrites. Azotemia transitória e hidronefrose foram observadas no animal mantido por 7 dias, e em mais quatro animais, mantidos por 30 dias, também se observou hidronefrose. O animal mantido por 180 dias demonstrou hidronefrose ao exame ultrasono gráfico aos 30 dias de evolução, mas a mesma não foi observada quando se realizou a necropsia. em um animal, mantido por 30 dias , houve um aumento nos níveis de creatinina nos dias 7, 15 e 30, entretanto estes permaneceram dentro dos limites fisiológicos. Nenhuma alteração foi observada no exame histológico da mucosa intestinal exposta à drenagem de urina. As poucas alterações encontradas nas análises laboratoriais não comprometeram a saúde dos animais, e, considerando que não foram encontradas lesões na mucosa intestinal analisada, é possível concluir que a ureterocoloanastomose é um procedimento viável para ser usada por um curto período de tempo.

Pressure evaluation of the antireflux ability of the rat ureterovesical junction

The bladder pressure necessary to cause vesicoureteral reflux (VUR) was measured in 16 female rats. Under general anesthesia, the ureters were exposed via an abdominal incission and a pressure catheter was placed near the uterovesical junction. Values of bladder distension and bladder pressure increase to cause VUR were obtained by injecting isotonic saline in one ureter until VUR in the opposite ureter was detected as a sudden pressure increase. After 5 min the same procedure was done on the contralateral side. This procedure was repeated eight times in each rat with a 15-min intermission. The bladder pressure at which VUR occurred was measured through a uretral catheter. Two groups were studied: G1, control, and G2, administration of intravenous metoclopramide (0.007 mg/100 g body weight) four times.

Spontaneous resolution rates of vesicoureteral reflux in Brazilian children: A 30-year experience

Objective: We evaluated clinical characteristics of primary vesicoureteral reflux (VLJR) in infants in a 30-year period in Brazil with special reference to the relation of renal parenchymal damage to urinary tract infection and gender. Materials and Methods: From 1975 through 2005, 417 girls (81.6%) and 94 boys (18.4%) with all grades of reflux were retrospectively reviewed. Patients were categorized by the worst grade of reflux, maintained on antibiotic prophylaxis and underwent yearly voiding cystourethrography until the reflux was resolved. VUR was considered resolved when a follow-up cystogram demonstrated no reflux. Surgical correction was recommended for those who fail medical therapy, severe renal scarring or persistent VUR. Results: Grades I to V VUR resolved in 87.5%, 77.6%, 52.8%, 12.2% and 4.3%, respectively. Renal scars were present at presentation in 98 patients (19.2%). Neither gender nor bilaterality versus unilaterality was a helpful predictor of resolution. The significant difference was found among the curves using the log rank (p < 0.001) or Wilcoxon (p < 0.001) test. Conclusion: Despite the current use of screening prenatal ultrasound, many infants are still diagnosed as having vesicoureteral reflux only after the occurrence of urinary tract infection in our country. Scarring may be associated to any reflux grade and it may be initially diagnosed at any age but half of the scars are noted with higher grades of reflux (IV and V). The incidence of reflux related morbidity in children has significantly diminished over the last three decades.

Carcinoma de células transicionales en perros: Un informe de dos casos, madre e hija

The transitional cell carcinoma is usually located in the trigone region of the bladder, and shows nonspecific clinical signs of the lower urinary tract such as hematuria, strangury, pollakiuria and urinary incontinence. The urethral and ureteral obstructions occur in some cases. Etiological factors such as endogenous and iatrogenic have been listed as the cause of disease. The objective of this report is to describe the process and treatment of two cases of transitional cell carcinoma presented simultaneously in two dogs, mother and daughter, that showed hematuria and post-renal azotemia, both with tumor in the trigone of bladder. After partial cystectomy ureteroneocistostomia, the diagnosis of transitional cell carcinoma was confirmed by histopathological analysis of bladder tissue. Patients received firocoxib as adjuvant to surgery. It is concluded that the surgical procedure associated with the use of specific anti-inflammatory COX-2 provided a better quality of life in both patients.

Avaliação das alterações funcionais e histológicas na isquemia renal, comparando-se duas técnicas de hipotermia: estudo experimental em suínos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Diagnóstico e tratamento do refluxo vesicoureteral na infância: experiência de 30 anos em instituição brasileira não universitária

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Ureterostomias cutânea e colônica em suínos: avaliação da exequibilidade das técnicas e complicações pós-operatórias

Pós-graduação em Medicina Veterinária - FCAV