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Aims. The aim of the study is to present our experience with the management of ureteral avulsions following semirigid ureteroscopy for ureteral stones. This is one of the largest series reported so far. Methods and Materials. It is a retrospective and observational study done at Sri Ramachandra Institute of Higher Education and Research over the last 18 years. Results. There were seven cases of ureteral avulsion following semirigid ureteroscopy. All patients were males with a mean age of 35.7 years. All had impacted stones, with proximal ureteric location in 6 patients and distal ureteric location in 1 patient. Five cases had two-point avulsions with loss of entire ureter. Two cases had one-point avulsion: one distal ureteric and the other mid-ureteric. Of the five cases with whole length ureteral avulsion, four were managed by classical ileal replacement of ureter and the the fifth case was managed by ileal replacement of ureter by the Yang–Monti technique. Of the two cases with one-point avulsion, one was managed by uretero-neocystostomy and the other by uretero-ureterostomy. All the patients had successful outcome. Conclusions. Even though rare, ureteral avulsion can potentially happen especially when dealing with impacted ureteric stones. Being conscious of the possible occurrence of this serious complication during any difficult ureteroscopy and exercising utmost care during the procedure are important preventive measures. However, this catastrophe can be successfully managed by either immediate definitive repair or in a staged manner.

Purpose: To develop a standardized technique to assess delineation of the whole ureter for the evaluation of symptomatizing urologic patients. Method and materials: 2500 patients are examined using 64-MDCT. Examinations were performed with oral hydration Group I (n = 834), Group II which received IV diuretics (n = 847), or Group III which received nothing (n = 819). Curved planar reformatted images were obtained manually to obtain the entire ureter in a single coronal oblique image. The ureter was divided into 3 anatomic segments for estimating the degree of its delineation where if the segment is assessed along its whole length it is graded as satisfactory delineation, otherwise it is graded as non-proper delineation. Delineation degrees for each ureteric segment were compared. Results: Satisfactory delineation obtained with group II (51.3%) was statistically higher than other groups with p value

Objectives: To evaluate our experiences with ureteroscopic treatment of ureteral calculi in pregnancy. Patients and methods: Between April 2006 and October 2013, 41 pregnant women with persistent renal colics and/or hematuria refractory to conservative measures were treated with ureteroscopy. The patients’ mean age was 23 (range 19–37) years. Most of the patients (56.1%) presented in the 2nd trimester. Loin pain and colic were the most common presenting symptoms (90.2%). Twenty-seven patients (65.9%) had an obstruction on the right side. All patients underwent ureteroscopy under epidural anesthesia. Results: Ureteroscopy revealed the presence of ureteric stones in 36 of the 41 cases. The stone size ranged from 5 to 16 (mean 8.9) mm. Distal ureteric stones were found in 29 patients. The pneumatic lithoclast was used for stone fragmentation in 22 of them (75.9%), while the stone was directly extracted in 4 patients. In 3 patients the stone migrated proximally and was not accessible any more. Proximal ureteric stones were detected in 7 of the remaining 12 cases. When attempting to manipulate these stones, they migrated more proximally and became unreachable. In the last 5 patients the entire ureter was free of stones; they only had edema at the ureteric orifice. A long lasting JJ stent was left until the end of the pregnancy in all cases with migrated inaccessible stones. In all patients successfully treated, a JJ stent with dangle extraction strings was left for two weeks. Minor urologic complications were encountered in the form of mild dysuria in 12 cases (29.2%) and mild hematuria in 5 cases (12.2%). All patients completed their pregnancy until full term without any serious obstetric complications requiring intervention. Conclusion: Ureteroscopy is a safe and effective therapeutic option for the treatment of obstructing ureteral stones in pregnancy with stone-free and complication rates comparable to the non-pregnant population. Keywords: Stones; Ureteroscopy; Pregnancy

A case of antenatally diagnosed hydronephrosis (later known to be PUJO complicated with urinoma and associated with hypoplasia of entire ureter) was treated using vermiform appendix as replacement.

or many years, “open” procedures were the treatment of choice for almost all calF culi too large to be expelled spontaneously. Extracorporeal shock wave lithotripsy (ESWL), which fragments calculi without incisions, and endoscopic procedures such as percutaneous nep hros toli thot rip s y and rig id ureteroscopy with ultrasonic lithotripsy gradually have made open procedures obsolete.’ Endoscopy continues to be a viable treatment alternative for fragmenting calculi because of the advances in flexible ureteroscopic technology. Many of the recent advances involve newer, smaller accessory instruments (eg, fulgurating probes as small as 1.6 Fr) for use with endoscopes. One of these accessory instruments is the small, “hair-like’’ fiber of the pulsed dye laser, which often is used in conjunction with flexible endoscopes. Additionally, baskets, graspers, and snares now come in a myriad of shapes and in sizes as small as 1.7 Fr. Flexible ureteroscopes also have evolved and now have increased deflecting capabilities that allow urologists to inspect the entire ureter

The role of retrograde ureterography in the management of pelviureteric junction (PUJ) obstruction remains controversial and it has recently been reiterated that visualisation of the entire ureter on the affected side is mandatory owing to the high incidence of other ureteric abnormalities. In a review of 119 consecutive adult pyeloplasties carried out over a 9-year period, only 2 ureteric abnormalities were found in association with PUJ obstruction (duplex ureter/3-cm proximal stricture). Other anatomical abnormalities included aberrant vessels, fascial bands and renal anomalies. Most secondary abnormalities were undiagnosed prior to surgery and all were easily dealt with per-operatively.

In a study of 115 ureters showing chronic bilharzial changes, 4 main patterns of ureteropathy are defined. Type A is benign, shows mild fusiform dilatation localised to the distal ureteric segment and requires no surgery. Type B presents with distal ureteric stricture, without extensive fibrosis, is rare, and shows good results following resection and ureterovesical reimplantation. Type C shows extensive bilharzial changes without stricture and is difficult to evaluate unless fluoroscopy is added to standard urographic investigation. If peristaltic dysfunction is severe, these ureters will require placement with an ileal segment. Type D ureteropathy presents with fixed tortuosity, mainly in the upper ureteric segment, and conservative surgery, involving freeing and straightening the entire ureter, has shown good results. Staging the presenting ureteropathy has proved valuable in evaluation and follow-up.

Summary— A technique is described for removing the entire ureter in children by intussuscepting the ureter into the bladder. The technique has been successfully used in the orthotopic refluxing ureter and in the ectopic ureter.

Two cases are presented of reflux into a residual ureter causing recurrent urinary tract infection. A voiding cysto-urethrogram should be included in the investigative routines when nephrectomy for unilateral chronic pyelonephritis is planned. If severe reflux is seen, the entire ureter should be removed along with the kidney.

We review the complications and failures in our first 64 patients who underwent endopyelotomy. There were 2 intraoperative complications (3.1 per cent) necessitating an open operation. Postoperative complications included leakage around the stent or irritative bladder symptoms, which were treated by repositioning the stent, and 2 instances of ureterovesical stenosis, which have led us to stent the entire ureter in recent cases. There were 7 failures, 4 in patients who in retrospect were not suitable candidates for the percutaneous operation (long stenotic segment and redundant renal pelvis) and 3 for which there was no obvious cause. All failures were apparent soon after removal of the stent that was inserted at the end of the procedure.

A small isolated segment of ileum was used to replace a portion of the ureter in 3 patients with the distal anastomosis being performed to the intact ureteral stump. The ileal interposition rather than replacement of the entire ureter, takes advantage of the presence of a normal, non-refluxing ureterovesical junction and serves to diminish any potential problems with electrolyte disturbances.

It has been shown that there are large variations in the velocity of the front end of a urine bolus travelling down the ureter (Durben and Gerlach 1979). Since the velocity of this front end may be influenced by passive viscoelastic properties of the ureteral wall (Griffiths and Notschaele 1983), it should be possible to detect variations in these viscoelastic properties along the entire ureter. The purpose of this study was to investigate this hypothesis and also to obtain objective data on the viscoelasticity of the ureter. The variation in viscoelastic parameters along the entire ureter was measured. The isotropy of the ureter was investigated by comparing transverse and longitudinal sections, and the influence of metabolism on the viscoelasticity was evaluated.

The function of the male renal sex segment secretions in the adder, Vipera berus, was studied. Renal sex segments in male adders were hypertrophied immediately before and during the mating period. Simultaneously, renal secretion was found in the entire ureter and coprodeum. Newly mated females have long, slightly convoluted, and hard posterior uteri, while females prior to mating, and nonreproductive ones, have weakly contracted or flaccid uteri. Uteri in newly mated females had a contracted sphincter muscle with reduced and compressed folded lumen. Uteri in an estrous female supplied with vital stained renal secretion became hard posteriorly. The stained secretion reached the entrance of the uteri, where the hard parts started. Estrous females artificially supplied with male sex secretion showed a significant decrease in acceptance of male courtship. Administration of renal sex secretion also interfered with reproduction.

Four cases of primary ureteral tumour are presented. The significance of cytologic examination of the urine and complete visualization of the entire ureter by either intravenous or retrograde urography is stressed.

Since the introduction thirty-four years ago of intravenous urography as a means of visualizing the urinary tract, the limitations imposed by the usual form of the examination have become evident and better methods have been sought (5, 8, 11–13). Until recently the 20 ml dose of contrast medium administered to a dehydrated patient has remained the accepted routine for all pyelographic examinations. In an effort to improve the quality of the examination, prolong the nephrogram, and consistently visualize the entire ureter by increasing the radiographic density of the opacified urine, Schencker in 1964 introduced drip infusion urography. This led to a re-evaluation of the low-dosage dehydration method (3,4, 7, 9). Although higher doses of contrast medium do not seem to increase the hazard to the patient, because of the risk and expense smaller doses would be desirable if comparable results could be achieved. Also, the routine use of drip infusion pyelography is precluded by the cost of a disposable infusion...

Combining the bladder-psoas hitch Boari-flap technique makes it possible to replace the entire ureter. The operation was used successfully in one patient with an extensive proximal ureter lesion. This method can be used in patients with reduced renal function, since the continuity of the urinary tract is preserved; it requires a normal bladder wall and bladder capacity exceeding 400 ml.

Although the entire ureter and renal collecting system are accessible for endoscopic treatment with a neodymium:YAG, (Nd:YAG) laser, specifications for safe laser application within the ureter are not established. After various doses of Nd:YAG laser energy were delivered, the midureters of six mongrel dogs were studied to determine tissue effects. Doses which are appropriate within the bladder (35 watts X 2 seconds) resulted in perforation and urine leak from the ureters. Higher doses (60-65 watts) of short duration were tolerated without problems and nonstrictured healing ensued. Further studies are necessary before Nd:YAG laser treatment of mid-ureteral tumors is recommended.