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Ureteric Obstruction (ureteric + obstruction)
Selected AbstractsJoaquin Maria Albarran Y Dominguez: Microbiologist, histologist, and urologist,a lifetime from orphan in Cuba to Nobel nomineeINTERNATIONAL JOURNAL OF UROLOGY, Issue 9 2006ROWAN G CASEY Abstract, Joaquin Albarran was an extraordinary late 19th century urologist. His early career was in the field of microbiology and histopathology in Paris at a time of great medical developments and innovations. His later contributions to urology included the Albarran lever, Albarrans sign, Albarran,Ormond syndrome and seminal works on testicular and renal tumors. He also wrote treatizes on the pathophysiology of acute urinary retention, nephritis and calculus ureteric obstruction. He died at the young age of 52 from the effects of tuberculosis and in this same year was nominated for the Nobel prize in medicine. [source] Unique pattern of urinary tract calculi in Australian Aboriginal childrenJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 5 2003PJ Carson Abstract Young Aboriginal children in remote regions of tropical and desert Australia are at risk of developing urate stones in their upper urinary tract from an early age. These radiolucent calculi were only recognized with the availability of ultrasound diagnosis and are not associated with anatomic anomalies or abnormal uric acid production/metabolism. Although these stones appear to resolve spontaneously after the weaning period, some result in ureteric obstruction and infection which may lead to renal damage. This pattern of urolithiasis differs from the usual global urolithiasis pattern of either endemic bladder stones in young children in developing countries or predominantly calcium-based stones in upper tracts of older children and adults in affluent industrialized countries, where upper tract urate stones account for only a minority of childhood urinary tract stones. Risk factors for urate stones are low urine output and acidic urine. An association between urolithiasis and carbohydrate intolerance leading to chronic acidosis has been suggested for Aboriginal children, but existing limited evidence does not support this as a major aetiological factor. Although further studies on the epidemiology, natural history and management of these urate stones are needed, we believe the focus should be on improving the known social and environmental risk factors of remote Aboriginal children during the weaning period which contribute to the unacceptably high prevalence of failure to thrive, diarrhoeal disease, environmental enteropathy, iron deficiency and urolithiasis. [source] Extracellular signal-regulated kinase-dependent interstitial macrophage proliferation in the obstructed mouse kidneyNEPHROLOGY, Issue 5 2008YINGJIE HAN SUMMARY: Aim: A number of growth factors have been shown to induce proliferation of renal cell types in animal models of kidney disease. In vitro studies suggest that many such growth factors induce renal cell proliferation through the extracellular signal-regulated kinase (ERK) pathway. The aim of this study was to determine the functional role of ERK signalling in cell proliferation in the obstructed kidney. Methods: Unilateral ureteric obstruction was induced in C57BL/6J mice which then received an ERK inhibitor drug (U0126 100 mg/kg t.i.d.), vehicle (DMSO) or no treatment, starting at day 2 after unilateral ureteric obstruction surgery and continuing until animals were killed on day 5. Cell proliferation was assessed by uptake of bromodeoxyuridine (BrdU). Results: In normal mice, phosphorylation (activation) of ERK (p-ERK) was restricted to collecting ducts. Western blotting identified a marked increase in p-ERK in the obstructed kidney in the no-treatment and vehicle-treated groups. Immunostaining showed strong p-ERK staining in many tubules and in interstitial cells. U0126 treatment inhibited ERK phosphorylation as assessed by western blot and immunostaining. The number of BrdU+ cortical tubular cells was reduced by vehicle treatment but was not further changed by U0126 treatment. In contrast, interstitial cell proliferation in the obstructed kidney was unaltered by vehicle treatment, but this was significantly inhibited by U0126. This was associated with a reduction in interstitial macrophage accumulation, but no effect was seen upon interstitial accumulation of ,-SMA+ myofibroblasts. Renal fibrosis, as assessed by collagen deposition, was unaffected by U0126 or vehicle treatment. Conclusion: These studies show that accumulation of interstitial macrophages in the obstructed kidney is, in part, dependent upon the ERK signalling pathway. [source] Gynaecological presentation of retroperitoneal tumoursBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 2 2000Andrew J. Spillane Fellow (Surgical Oncology) Objective To illustrate the problems associated with mistaken pre-operative diagnosis following gynaecological presentation of patients with retroperitoneal tumours. Design A case series of five referrals. Results Non-gynaecological tumours were not suspected in each case and hence there was a failure to undertake further pre-operative investigation and referral to a specialised soft tissue sarcoma service. This resulted in four of the patients having an unnecessary laparotomy with an inappropriate transperitoneal biopsy undertaken when the retroperitoneal tumour was discovered. The mistaken diagnosis of ovarian malignancy lead to increased morbidity, compromise of potential for a long disease free interval and/or possibly lessened the chance of cure in each case. Conclusions Misinterpretation of clinical signs and an over-reliance on ultrasound diagnosis were the commonest causes of inappropriate management of these patients. Gynaecologists should consider more frequently the other, less common differential diagnoses of a pelvic mass. This is especially true in circumstances with a predominantly solid tumour, where there are clinical signs of vascular or rectal displacement, or where there is ultrasound evidence of ureteric obstruction. The more frequent utilisation of a computerised tomography scan with intravenous and oral contrast with referral before inappropriate transperitoneal biopsy are recommended as complete en bloc surgical excision at the first laparotomy is the treatment of choice in virtually all primary retroperitoneal tumours. [source] Current status of metal stents for managing malignant ureteric obstructionBJU INTERNATIONAL, Issue 8 2010Petros Sountoulides Obstruction of the ureters caused by extrinsic compression from a primary tumour or retroperitoneal lymph node masses is not unusual in the course of advanced pelvic malignancies. Most of the cases are of gynaecological or gastrointestinal origin, and the situation can be aggravated by peri-ureteric fibrosis, a long-term adverse event of previous chemotherapy or radiotherapy. Undoubtedly upper urinary tract decompression and maintenance of ureteric patency, even as a palliative measure, is important in managing these patients. Options for upper tract decompression include percutaneous nephrostomy, retrograde stenting and open urinary diversion. Plastic stents have long been used for managing malignant ureteric obstruction, but their overall success remains limited. Plastic stents often fail to be placed correctly, require regular exchange, and are faced with a high incidence of encrustation and migration. For these reasons plastic stents have been unsuccessful for long-term maintenance of ureteric patency. To overcome these limitations metal stents were introduced and recently developed in an effort to ensure better long-term patency of the obstructed ureter, fewer hospital admissions for stent change and better overall quality of life. In the present review the clinical applications of different types of metal stents are discussed, with a specific focus on the latest advances and the future options for managing malignant ureteric obstruction. [source] Modified ureterosigmoidostomy (Mainz Pouch II): a nonrefluxing stented vs unstented laparoscopic porcine modelBJU INTERNATIONAL, Issue 2 2008Mitchell R. Humphreys OBJECTIVE To describe a rapid and reproducible pure laparoscopic cystectomy and nonrefluxing modified continent urinary diversion (Mainz Pouch II), and to determine whether ureteric stenting decreases ureteric obstruction after surgery. MATERIALS AND METHODS After institutional review and approval, six female pigs (51,55 kg) had a laparoscopic cystectomy and urinary diversion using a modified Mainz Pouch II. Imbricating bowel over the extra-intestinal ureteric segment created the nonrefluxing mechanism. All pigs had the same bowel preparation before a standard four-port transperitoneal laparoscopic procedure, but three pigs received bilateral J ureteric stents and three did not. Body weights, radiographic imaging, serum electrolytes and renal function were monitored during the 6-week survival period. RESULTS One stented pig developed bilateral pyelonephritis, renal obstruction and was killed. Including this pig, four of 12 renal units were obstructed, occurring more often in the stented pigs. There were no significant differences between the serum electrolytes before and after surgery or between the stented or unstented pigs. The surgery was quicker as experience increased. No pig developed hyperchloraemic metabolic acidosis. The nonrefluxing modification appeared to be effective, as reflux was only present in one renal unit. CONCLUSIONS Laparoscopic ureterosigmoidostomy, specifically the modified Mainz Pouch II, represents a viable and reasonable continent urinary diversion. The results suggest that there was no benefit in stenting in this pig model. [source] A multi-institutional studyof orthotopic neobladders: functional results in men and womenBJU INTERNATIONAL, Issue 6 2004R. Carrion Multi-institutional studies are extremely valuable whena new surgical technique is being introduced. The Confederationof American Urology conducted such a study into the functional results inmales and females of the orthotopic bladder. In a series of 138patients they found many interesting outcomes, which they presenthere. Authors from Sheffield describe their experience in developing tissue-engineeredbuccal mucosa for use in urethral reconstruction. They describetheir technique and report the successful culture of full-thicknessbuccal mucosa, which they found to be robust and safe for clinicaluse. OBJECTIVES To analyse the incidence of diurnal incontinence (DI) and nocturnalincontinence (NI), the need for intermittent catheterization (IC),and the rate of ureteric obstruction (UO) among a group of men andwomen with ileal and colonic orthotopic neobladders in four countries. PATIENTS AND METHODS In all, 138 patients (113 men and 25 women) had an orthotopicneobladder constructed after radical cystectomy for carcinoma. The mean(range) age was 61.3 (28,76) years and thefollow-up 41 (6,144) months. All patients underwentsurgery by experienced surgeons associated with the Confederationof American Urology. A retrospective evaluation was designed toreview the functional results and the incidence of UO. The techniqueof orthotopic neobladder construction was at each surgeon's discretion. Various detubularized bowelsegments were used, including ileum, colon or sigmoid. Patients werefollowed by chart reviews and personal interviews at 1, 3 and 6 monthsafter surgery and then every 6 months, and were evaluated bya physical examination, urine analysis, cytology and renal ultrasonography. RESULTS An ileal or colonic neobladder was constructed in 74 and 64 patients, respectively. Five (7%), 23 (31%), 10 (14%) and 14(9.6%) with an ileal neobladder developed DI, NI, IC andUO, respectively; the respective values for patients with a colonicneobladder were eight (12%), 19 (30%), seven (11%)and 15 (12%). Statistical analysis by Fisher'sexact test showed no significant differences between the ileal andcolonic neobladder groups or with gender. CONCLUSIONS Using this specific protocol for evaluating many men and womenwith ileal and colonic orthotopic neobladders showed no significant differencesin the incidence of DI, NI, IC or UO. Neobladders constructed fromdetubularized bowel, irrespective of bowel segment(s) used, canprovide satisfactory diurnal results. A moderate incidence of NIand UO continue to be a problem. [source] Association between leptin receptor gene polymorphisms and early-onset prostate cancerBJU INTERNATIONAL, Issue 1 2003Z. Kote-Jarai Significant tissue loss is a consistent feature of ureteric obstruction with, most studies showing increased programmed cell death or apoptosis of kidney epithelial cells. The study by Chuang et al. showed that there is also muscular damage during obstruction, specifically of the ureteric myocytes. More importantly they show for the first time that this induction of cell death is associated with the increased expression of cytochrome c and the caspases, key proteins that drive the induction of apoptosis. Admittedly they do not show whether cytochrome c is released from the mitochondria or that the caspases are truly activated, important events in the cell death pathway, but an increase in their expression does indicate their role in this process. Understanding the pathways leading to tissue loss during ureteric obstruction has important implications in the development of novel treatments for this condition. OBJECTIVE To report a case-control study examining the relationship between polymorphisms in the leptin receptor (OBR) gene and the development of young-onset prostate cancer, because epidemiological studies report that prostate cancer risk is associated with animal fat intake, and thus we investigated if this association occurs via this genetic mechanism. PATIENTS, SUBJECTS AND METHODS The Lys109Arg (OBR1) and Gln223Arg (OBR2) polymorphisms in the coding region of OBR were studied in blood DNA from 271 patients with prostate cancer aged < 56 years at diagnosis and 277 geographically matched control subjects. Cases were collected through the Cancer Research UK/British Prostate Group Familial Prostate Cancer Study. Blood DNA was genotyped using the polymerase chain reaction and a restriction enzyme digest. RESULTS There was no statistically significant association between the OBR genotype and prostate cancer risk; men homozygous for 109Arg genotype had a slightly increased risk for prostate cancer, with a relative risk (95% confidence interval) of 1.36 (0.65,2.85), and those homozygous for the 223Arg allele had some reduction in prostate cancer risk, at 0.82 (0.58,1.26), but neither was statistically significant. CONCLUSION This case-control study showed no significant association between leptin receptor gene polymorphisms and the risk of young-onset prostate cancer, suggesting that genetic variations in OBR are unlikely to have a major role in the development of early-onset prostate cancer in the UK. [source] Lower ureteric obstruction: a complication of tailed ureteric stentsBJU INTERNATIONAL, Issue 6 2003M.F. Bultitude No abstract is available for this article. [source] | ||||||||||