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The challenging management of malignant ureteral obstruction:Analysis of a series of 188 cases

Current Urology 2024年第1期18卷 34-42页

作者： Alberto Artiles Medina Inés Laso García Fernando González Tello Sara Álvarez Rodríguez Manuel Hevia Palacios Marina Mata Alcaraz César Mínguez Ojeda Fernando Arias Funez Victoria Gómez Dos Santos Francisco Javier Burgos Revilla Department of Urology Hospital Universitario Ramón y CajalMadridSpain Department of Radiology Hospital Universitario Ramón y CajalMadridSpain

Background:Malignant ureteral obstruction(MUO)is a common condition that complicates the course of advanced *** aims of this study are to analyze the causes,management,and survival of patients with obstructive nephropathy due to malignant ureteric obstruction and to determine prognostic ***,we studied the complications and outcomes in patients who underwent urinary *** and methods:A retrospective study was conducted on patients with computed tomography-confirmed MUO between January 2016 and November ***,clinical,radiological,laboratory,and management data were *** curves were estimated using the Kaplan-Meier method,and univariate and multivariate Cox proportional hazards models were used to test the association between parameters and ***:A total of 188 patients were *** mean age was 69.01 years(SD,14.95 years),and the majority(54.8%)were *** most common mechanism leading to MUO was compression by a pelvic mass(36.9%),and the 3 most frequent tumors causing MUO were prostate(17.6%),bladder(16.5%),and rectal cancer(11.7%).Forty-seven patients(25%)underwent urinary diversion:23(48.9%)underwent double-J stenting and 21(44.7%)underwent percutaneous *** most common reason for urinary diversion was acute kidney injury(53.3%).Recovery of renal function was observed in 55.8%of the patients after urinary *** most frequently identified complications after urinary diversion were urinary tract infection(24.4%),hematuria(17.0%),and urinary sepsis(14.9%).The median survival after hydronephrosis diagnosis was 6.43 months(interquartile range,1.91-14.81 months).In patients who underwent urinary decompression,the median survival after urinary diversion was 8.67 months(interquartile range,2.99-17.28 months).In the multivariate analysis,a lower grade of hydronephrosis and cancer cachexia negatively impacted ***:Cancer patients with MUO have a poor pro

关键词： Hydronephrosis ureteral obstruction Neoplasms Urinary diversion Survival Prognosis

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Acute kidney injury due to bilateral malignant ureteral obstruction:Is there an optimal mode of drainage?

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World Journal of Nephrology 2022年第6期11卷 146-163页

作者： Rabea Ahmed Gadelkareem Ahmed Mahmoud Abdelraouf Ahmed Mohammed El-Taher Abdelfattah Ibrahim Ahmed Department of Urology Assiut Urology and Nephrology HospitalFaculty of MedicineAssiut UniversityAssiut 71515AssiutEgypt

There is a well-known relationship between malignancy and impairment of kidney functions,either in the form of acute kidney injury or chronic kidney *** the former,however,bilateral malignant ureteral obstruction is a surgically correctable factor of this complex *** warrants urgent drainage of the kidneys in emergency ***,there are multiple controversies and debates about the optimal mode of drainage of the bilaterally obstructed kidneys in these *** review addressed most of the concerns and provided a comprehensive presentation of this topic from the recent ***,we provided different perspectives on the management of the bilateral obstructed kidneys due to *** the frequent trials for improving the success rates and functions of ureteral stents,placement of a percutaneous nephrostomy tube remains the most recommended tool of drainage due to bilateral ureteral obstruction,especially in patients with advanced ***,the disturbance of the quality of life of those patients remains a major unresolved *** the unfavorable prognostic potential of the underlying malignancy and the various risk stratification models that have been proposed,the response of the kidney to initial drainage can be anticipated and evaluated by multiple renal prognostic factors,including increased urine output,serum creatinine trajectory,and time-to-nadir serum creatinine after drainage.

关键词： Acute kidney injury Kidney Malignancy Percutaneous nephrostomy ureteral obstruction Ureter

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Laparoscopic ureterolysis with simultaneous ureteroscopy and percutaneous nephroscopy for treating complex ureteral obstruction after failed endoscopic intervention:A technical report

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Asian Journal of Urology 2015年第4期2卷 238-243页

作者： Zhixiang Wang Bing Liu Xiaofeng Gao Yi Bao Yang Wang Huamao Ye Yinghao Sun Linhui Wang Department of Urology Changzheng HospitalSecond Military Medical UniversityShanghaiChina Department of Urology Changhai HospitalSecond Military Medical UniversityShanghaiChina

Objective:Complex ureteral obstruction is refractory to conventional urological *** report describes a case of laparoscopic ureterolysis with simultaneous ureteroscopy and percutaneous nephroscopy for treating complex ureteral ***:Right-side multiple ureteral stones and complicating ureteral obstruction failed an initial attempt of ureteroscopy lithotripsy with simultaneous percutaneous nephroscopy in a 23-year-old *** ureterolysis with ureteroscopy and percutaneous nephroscopy was used simultaneously to dissect the periureteral adhesions with the patient placed in the Galdakao-modified supine Valdivia *** ureter was incised to allow the insertion of a ureteral catheter through the twisted ureter,and a guide wire was advanced into the pelvis using ureteroscopy.A double-J stent was placed into the right-side ureter using antegrade percutaneous ***:The laparoendoscopic procedure lasted 330 min with an estimated bleeding volume of 100 *** patient underwent an uneventful postoperative course,and postoperative followup radiography confirmed good positioning of the double-J *** double-J stent was removed 3 months after *** patient remained asymptomatic within a 13-month follow-up ***:Laparoscopic ureterolysis with simultaneous ureteroscopy and percutaneous nephroscopy is an effective and safe treatment option for complex ureteral obstruction.

关键词： ureteral obstruction Laparoscopic ureterolysis Ureteroscopy Percutaneous nephrostomy

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Huoxue Jiedu Huayu recipe(活血解毒化瘀方)alleviates contralateral renal fibrosis in unilateral ureteral obstruction rats by inhibiting the transformation of macrophages to myofibroblast

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Journal of Traditional Chinese Medicine 2023年第1期43卷 105-112页

作者： XIONG Yunzhao LIU Lingjin LIU Ziqian CHEN Gege HAO Juan GAO Xiaomeng QIANG Panpan WANG Zheng XU Qingyou Graduate School Hebei University of Chinese MedicineHebei Key Laboratory of Integrative Medicine on Liver-Kidney PatternsHebei University of Chinese MedicineHebei University of Chinese MedicineShijiazhuang 050091China Graduate School Hebei University of Chinese Medicine Hebei Key Laboratory of Integrative Medicine on Liver-Kidney PatternsHebei University of Chinese MedicineShijiazhuang 050091China Graduate School Hebei University of Chinese MedicineHebei Key Laboratory of Integrative Medicine on Liver-Kidney PatternsHebei University of Chinese MedicineDepartment of Internal MedicineHebei University of Chinese MedicineShijiazhuang 050091China

OBJECTIVE:To investigate the action and underlying mechanisms of Huoxue Jiedu Huayu recipe(活血解毒化瘀方,HJHR)against unilateral ureteral obstruction(UUO)-induced injury in the contralateral ***:Forty-eight male Sprague-Dawley rats weighing(200±10)g were used in this study and randomly assigned to 4 groups:a sham group,a UUO group,a UUO+eplerenone(EPL)group,and a UUO+HJHR *** contralateral kidneys were harvested for further study 180 d after *** analysis,immunohistochemistry and immunofluorescence were used to study the fibrosis of the contralateral kidneys obtained from UUO *** kidney damagerelated pathway proteins were detected by real-time polymerase chain reaction and Western blot ***:HJHR significantly inhibited fibrosis of the contralateral kidney in UUO rats by attenuating the UUOinduced macrophage-to-myofibroblast transition(MMT)in the contralateral ***,HJHR attenuated fibrosis in the contralateral kidney of UUO rats by preventing MMT through the aldosterone/mineralocorticoid receptor/serum/glucocorticoid regulated kinase 1 ***:Our findings suggest that HJHR may be a potential treatment for renal interstitial fibrosis of obstructive nephropathy.

关键词： ureteral obstruction renal fibrosis aldosterone receptors,mineralocorticoid macrophages myofibroblast Huoxue Jiedu Huayu recipe

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Migration of varicocele coil leading to ureteral obstruction and hydronephrosis:A case report

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World Journal of Clinical Cases 2024年第16期12卷 2856-2861页

作者： Abdulaziz Alamri Department of Surgery College of MedicineKing Khalid UniversityAbhaAlfaraa 61421Saudi Arabia

BACKGROUND Varicocele embolization,a minimally invasive treatment for symptomatic varicoceles,carries a rare risk of complications like ureteral obstruction and *** case report documents such a case to raise awareness of these potential complications and showcase minimally invasive surgical management as a successful *** SUMMARY A 35-year-old male presented with flank pain and hematuria following varicocele *** confirmed left ureteral obstruction and *** ureterolysis successfully removed the embolization coil and repaired the ureter,resolving the patient's ***-up at six months and two years showed sustained *** Minimally invasive surgery offers an effective treatment option for rare complications like ureteral obstruction arising from varicocele embolization.

关键词： Varicocele embolization ureteral obstruction Hydronephrosis Iatrogenic ureteral injury Laparoscopic ureterolysis Minimally invasive surgery Case report

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Use of percutaneous nephrostomy and ureteral stenting in management of ureteral obstruction

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World Journal of Nephrology 2016年第2期5卷 172-181页

作者： Linda Hsu Hanhan Li Daniel Pucheril Moritz Hansen Raymond Littleton James Peabody Jesse Sammon Vattikuti Urology Institute Henry Ford Health System Center for Outcomes Research and Evaluation Maine Medical Center

The management options for ureteral obstruction are diverse, including retrograde ureteral stent insertion or antegrade nephrostomy placement, with or without eventual antegrade stent insertion. There is currently no consensus on the ideal treatment or treatment pathway for ureteral obstruction owing, in part, to the varied etiologies of obstruction and diversity of institutional practices. Additionally, different clinicians such as internists, urologists, oncologists and radiologists are often involved in the care of patients with ureteral obstruction and may have differing opinions concerning the best management strategy. The purpose of this manuscript was to review available literature that compares percutaneous nephrostomy placement vs ureteral stenting in the management of ureteral obstruction from both benign and malignant etiologies.

关键词： Percutaneous nephrostomy Urinary diversion ureteral obstruction Quality of life ureteral stents Pelvic malignancy Urinary drainage

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Retroperitoneal fibrosis: A rare cause of both ureteral and small bowel obstruction

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World Journal of Gastroenterology 2006年第43期12卷 7061-7063页

作者： Faisal Aziz Srinivasulu Conjeevaram Than Phan Department of Surgery New York Medical College Valhallah NY 10595 United States Department of Surgery. North Oakland Medical Centers MI 48341 United States Attending Physician Department of Surgery North Oakland Medical Centers MI 48341 United States

Retroperitoneal fibrosis (RPF) is a rare condition of unclear etiology. It can cause ureteral obstruction. We present the unique case of a 54 years old female, who initially presented with spontaneous perforation of the cecum. Upon exploring the abdomen, the classical glistening white, unyielding retroperitoneal fibrosis was encountered. A right hemicolectomy was performed. Subsequently, the patient presented with bilateral ureteral obstruction, and later on with small bowel obstruction. ureteral obstruction was treated with stents, and small bowel obstruction was treated with bypass. To our knowledge no case of idiopathic RPF presenting with features of both bilateral ureteral and small bowel obstruction has been reported in the literature.

关键词： Retroperitoneal fibrosis ureteral obstruction Small bowel obstruction Surgery for retroperitonealfibrosis

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Yishen Huoxue decoction(益肾活血方) attenuates unilateral ureteric obstruction-induced renal fibrosis and hypoxia-induced reactive oxygen species generation via adenosine monophosphate-activated protein kinase/peroxisome proliferator-activated receptor coa

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Journal of Traditional Chinese Medicine 2021年第6期41卷 875-882页

作者： ZHONG Jian FANG Guiyu WANG Zixia CHEN Ping LU Dengyong SHI Xiaodong Department of Nephrology the First Affiliated Hospital of Guangxi University of traditional Chinese MedicineNanning 530023China

OBJECTIVE:To investigate the effeicacy of Yishen Huoxue decoction(YSHX)on renal fibrosis induced by unilateral ureteric obstruction(UUO),and on reactive oxygen species(ROS)homeostasis in human umbilical vein endothelial cells(HUVECs).METHODS:Forty male mice were randomly divided into six groups,sham group,UUO group,UUO+resveratrol(RSV)(15 mg/kg)group,UUO+YSHX20 mg/kg group(UUO+YSHX-L),UUO+YSHX 40 mg/kg group(UUO+YSHX-M),UUO+YSHX 80 mg/kg group(UUO+YSHX-H).Western blotting was used to measure protein expression *** transcription-quantitative polymerase chain reaction was used to measure the m RNA *** was used to examine the histopathological changes of kidney tissue *** apoptosis was measured by Annexin V/PI *** viability was measured using CCK-8/WST-8 ***:YSHX treatment reducedα-SMA and Col-4 expressions,and increased CD31 and VE-cadherin expressions in UUO model *** vitro,YSHX increased cell viability and decreased apoptosis of HUVECs under hypoxic *** inhibited ROS generation by activating adenosine monophosphate-activated protein kinase(AMPK)/peroxisome proliferator-activated receptor coactivator-1α(PGC-1α)/silent mating-type information regulation2 homolog 3(Sirt3)***:YSHX treatment reduced 109 KJ UUO-induced renal injury and ***,YSHX treatment attenuated hypoxia-induced oxidative stress by regulating AMPK/PGC-1α/Sirt3 signaling.

关键词： renal fibrosis ureteral obstruction Sirtuin 3 reactive oxygen species hypoxia Yishen Huoxue decoction

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Magnetic resonance urography in the diagnosis of urinary tract obstruction after renal transplantation

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Chinese Medical Journal 2002年第4期115卷 540-542页

作者：李响韩志友王玮张愚高居忠北京朝阳医院泌尿外科北京100020

OBJECTIVE: To evaluate magnetic resonance urography (MRU) in the diagnosis of urinary tract obstruction after renal transplantation. METHODS: A total of 31 patients with suspected urinary tract obstruction after renal transplantation were examined, and the results were compared with those from surgery and B-ultrasound examination. RESULTS: The urinary tract after renal transplantation was clearly shown using MRU, and all patients were clearly diagnosed by MRU. Imaging results were consistent with those from surgery. CONCLUSIONS: MRU is suitable for detecting urinary tract obstruction after renal transplantation. It is a alternative method for IVP and CT in patients with renal function impairment and uremia.

关键词： Kidney Transplantation Humans Magnetic Resonance Imaging ureteral obstruction Urinary Tract Urography

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Metallic ureteral stent in restoring kidney function: Nine case reports

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World Journal of Clinical Cases 2020年第13期8卷 2841-2848页

作者： Wei Gao Tong-Wen Ou Xin Cui Jiang-Tao Wu Bo Cui Department of Urology Xuanwu HospitalCapital Medical UniversityBeijing 100053China

BACKGROUND Retroperitoneal fibrosis is an exceptionally rare disease characterized by proliferation of fibrous tissue and inflammation in the *** features many symptoms in the kidneys and in other organs and usually leads to ureteral *** SUMMARY Here we present 9 consecutive cases of idiopathic retroperitoneal fibrosis(IRPF)in patients who presented to the Department of Nephrology or Department of Rheumatology,Xuanwu Hospital,Capital Medical University,Beijing,China,between January 2012 and June 2017 with ureteral obstruction due to external compression of the ureter that led to hydronephrosis and kidney *** tomography imaging was used to identify hydronephrosis and ureteral obstruction and to evaluate kidney *** patient was diagnosed with IRPF based on clinical observation and computed tomography examination *** restore kidney function,a retrograde metallic stent was placed in the ureter under X-ray guidance 2 d after each patient’s *** perioperative complications occurred in any patient,but postoperative complications occurred in two patients as follows:Patient 2 had stent migration and repeated metallic stent infections that resolved with treatment;and patient 4 had postoperative hematuria because he resumed normal activities too soon after stent placement(contrary to instruction).Placement of the metallic ureteral stents provided relief from ureteral obstruction and restored kidney function in all *** Our 9-case series underscores the utility and efficacy of applying the Resonance®metallic ureteral stent to treat ureteral obstruction in patients with *** all retroperitoneal fibrosis cases in our series,ureteral stents provided effective relief and were shown to reduce the incidence rate of perioperative and postoperative complications.

关键词： Retroperitoneal fibrosis Metallic ureteral stent ureteral obstruction Computed tomography Kidney function Plastic stent Case report

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