OBJECTIVE: To describe the sonographic visualization of fetal micturition and its role in the diagnosis of posterior urethral valves and hypospadias. METHODS: This was a prospective study of 25 male fetuses (21 with bilateral pyelectasis, one whose bladder was being studied because of ureterocele and three with hypospadias), and five female fetuses (with bilateral pyelectasis). A midline sagittal scan of the fetal pelvis, perineum and external genitalia was obtained and observed continuously during fetal micturition. RESULTS: In 19 of the 21 male fetuses and the five female fetuses with bilateral pyelectasis micturition was normal, with visualization of urinary bladder contraction, slight fluid distention of the urethra and a urinary stream from the external urethral meatus. In three male fetuses, two with bilateral pyelectasis and the one with ureterocele, the posterior urethra was normal at rest and it ballooned out during micturition, diagnostic of posterior urethral valves. In the three male fetuses with hypospadias the ventral jet of the urinary stream was visualized. CONCLUSION: Fetal micturition can be visualized on sonography. It may be of value in the diagnosis of posterior urethral valves and hypospadias. (+info)
Simplified upper pole nephrectomy: initial experience.
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OBJECTIVE: To assess the results of an upper pole nephrectomy technique on 5 children. MATERIALS AND METHODS: Upper pole nephrectomy was performed on 5 children, including 4 females and 1 male. Age ranged from 3 to 6 years old. The technique was performed without initial dissection of the renal pedicle. The upper pole is incised and removed. Upon its complete dissection, the segment that drains the upper pole is easily identified, clamped and sectioned. RESULTS: Three children with ureterocele and 2 with ectopic ureter underwent this procedure. There was no intra- or postoperative complication with this technique. DSMA scintigraphy showed no decrease in renal function in the remaining kidney following the procedure. CONCLUSION: The polar nephrectomy technique is simple, and has the advantage of not approaching the renal hilum, which makes surgery less laborious and prevents risk of renal damage, hemorrhage and decreased function in the remaining renal portion. (+info)
Familial ureteroceles: an evidence for genetic background?
(3/14)
In the pediatric population, ureteroceles may present with different clinical pictures, and the severity of the renal damage is greater than in adults. Ureterocele, an anomaly of ureteric budding, is likely a component of a spectrum of anomalies including vesicoureteral reflux and ureteral duplications. Both have been confirmed to have a genetic and familial basis. We document the largest series of familial cases of ureteroceles, giving evidence for genetic background. We retrospectively reviewed the charts of patients with familial ureteroceles seen between 1992 and 2002. Coexisting ureteral anomalies and features of the cases were documented and compared to sporadic cases and all familial cases within the literature. This is the largest series of familial ureterocele patients in the literature. The review of the literature revealed seven publications with seven ureterocele families (15 affected patients) between 1936 and 2002. Comparing sex, ureterocele location, and single versus duplex systems, familial series are similar to other sporadic cases. Three of the families have twin siblings with ureteroceles. Familial cases, despite their rarity, raise the issue of the genetic origin of uretereoceles. Family members of ureterocele cases should be informed and followed carefully, especially twins. Increased reporting and genetic analysis of familial ureteroceles may prove to link the genetic mouse models of abnormal ureteric budding to the human conditions. (+info)
Orthotopic ureterocele masquerading as a bladder tumor in a woman with pelvic pain.
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Single system orthotopic ureteroceles often present in adulthood are associated with characteristic radiographic findings. We present the case of a 54 year old woman with 8 months of urgency/frequency and pelvic pain that has the cystoscopic appearance of a bladder tumor. Cystoscopic images, radiographs and intraoperative photos demonstrate the work-up, evaluation, and treatment of this unique single system orthotopic ureterocele containing a calculus. This patient demonstrates the need for cystoscopy accompanied by upper tract imaging in patients with new onset pelvic pain, urgency/frequency, and frequent urinary tract infections. (+info)
Prolapsing ectopic ureterocele presenting as a vulval mass in a newborn girl.
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Prolapse of the ureterocele and its presentation as a vulval mass is an extremely rare condition. There are no detailed imaging findings of such cases in the literature. We present voiding cystourethrography and MRI findings of a newborn girl with a ureterocele extending through the urethra. (+info)
Postnatal evaluation of infants with an abnormal antenatal renal sonogram.
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PURPOSE OF REVIEW: Antenatally detected renal abnormalities are frequently encountered. Recommended postnatal evaluation of these infants has evolved to minimize invasive testing while maximizing detection of significant abnormalities. RECENT FINDINGS: There is a low rate of detectable renal abnormalities in infants with a normal postnatal sonogram at 4-6 weeks of age. Routine prophylactic antibiotics are not indicated in infants with isolated antenatal hydronephrosis. Infants with a multicystic dysplastic kidney and a normal contralateral kidney on renal ultrasound do not require further evaluation. Parents of these children should be counseled on symptoms of urinary tract infections to allow prompt diagnosis. SUMMARY: All infants with abnormalities on antenatal sonogram should undergo postnatal evaluation with a sonogram after birth and at 4-6 weeks of age. Further evaluation can be safely limited when the postnatal sonogram is normal at 6 weeks of age. (+info)
The safety and efficacy of endoscopic incision of orthotopic ureterocele in adult.
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Endoscopic incision is a good management option for orthotopic ureterocele. But most of the literature has shown its efficacy only in children. We have done this retrospective study to evaluate the safety and efficacy of endoscopic incision of orthotopic ureterocele in adults. From March 2004 to January 2008, at our center, 26 adults underwent transurethral, transverse incision of an ureterocele. The perioperative data of these patients were retrospectively analyzed. The literature was reviewed to identify all the reported options for management of this relatively rare condition in adults. Unilateral ureterocele was present in 24 patients and two patients had bilateral ureterocele. One patient had associated upper tract stones. Three patients had associated stones in ureterocele. Transurethral, transverse incision of ureterocele was given in all patients. The mean postoperative hospital stay was 50.5 h. Twenty-three patients were available for follow-up at three, six and 12 months. All patients were symptom free. At three months ultrasound and intravenous urography revealed no residual ureterocele but four patients showed residual hydronephrosis, but with a decrease in the grade indicating decompression. Micturating cystourethrography revealed vesico-ureteral reflux (VUR) in two patients and the reflux persisted in one patient even at 6 months. We conclude that in adults, management with endoscopic incision of orthotopic ureterocele is safe and effective. VUR may occur in a few cases. (+info)
Ureterocele containing a stone in a duplex system.
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The formation of calcified stone in the ureterocele, a frequent event in adults, is very uncommon in a pediatric age. We present a case of a ureterocele containing a calcified stone in an 8-year-old girl. The diagnosis was made with radiological investigations (intravenous pyelogram, ultrasonography and, eventually, voiding cystourethrogram). Meatostomy and calculus extraction, or open surgery in more complicated cases, are the treatments of choice. (+info)