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At least 91 records · Page 5Linked to original sources
PubMed2003

Histological study of fetal kidney with urethral obstruction and vesicoureteral reflux: a consideration on the etiology of congenital reflux nephropathy.

PURPOSE: A recent subject of interest regarding reflux nephropathy is the presence of renal abnormalities in neonates and infants who have no history of urinary tract infections. Debates have centered on the etiology of this renal abnormality - congenital reflux nephropathy; regarding whether it is the result of abnormal ureteral budding or of back pressure effect from sterile reflux. We examined the renal pathology of fetuses with urethral obstruction and vesicoureteral reflux, and we suggest herein a possible etiology of congenital reflux nephropathy. METHODS: The renal pathology of seven autopsied fetuses with vesicoureteral reflux was studied. Reflux was demonstrated at autopsy by slow injection of contrast medium into the bladder. Severe urethral obstruction, either atresia or urethral valves, was evident in six of the subjects. RESULTS: In six subjects, abnormality of the urinary tracts was detected by prenatal ultrasonography. Of these six subjects, three revealed characteristics of prune belly syndrome. Reflux was graded as moderate in five subjects, and severe in two. In three subjects autopsied at 21 weeks gestation or earlier, the kidneys were well-developed with normal corticomedullary configuration, and nephrogenesis was retained. In three cases autopsied at over 25 weeks of gestation, the kidneys were grossly cystic, and the nephrogenic zone was completely absent. Contrast medium was observed not only in the dilated ducts and tubules, but also in the subcapsular cysts. Extravasation of the contrast medium was seen in the peritubular space. In the last subject with normal lower urinary tract, abnormal segments among normal cortical structures were observed. CONCLUSION: Our findings of renal pathology in fetuses with reflux are quite similar to those seen in fetal hydronephrosis. Back pressure from reflux probably damages the developing kidney leading to a degeneration of the ampullae and a reduction in the number of nephrons. Both dilatation of the collecting ducts and tubules, and extravasation of the urine may result in interstitial fibrosis. We postulate that one of the important etiologies of congenital reflux nephropathy may be the result of back pressure from sterile reflux.

Cadaver↗
PubMed2001

The clinical and radiological findings in boys with endoscopically severe congenital posterior urethral obstruction.

OBJECTIVE: To assess the clinical and radiological spectrum in boys with endoscopically severe posterior urethral obstruction, as there is a broad clinical spectrum which does not always correlate with the cystoscopic findings. PATIENTS AND METHODS: Between December 1990 and July 2000, 39 boys (newborn to 12 years old) underwent cystoscopy to investigate a urethral anomaly and were found to have a severe obstructing posterior urethral membrane. Their voiding cystograms, video-recorded cystoscopy and presenting signs were reviewed. RESULTS: Of the 39 boys assessed, a voiding cystogram and presenting signs were available in 36. Of these 36 boys, three cystograms were initially reported as normal, eight showed posterior urethral dilatation as the only feature, and the remainder had more severe bladder and upper tract changes. Fourteen were diagnosed after identifying antenatal hydronephrosis, four presented with voiding dysfunction, one with haematuria and 17 were found after investigation of a urinary tract infection. CONCLUSIONS: This study shows that a congenital posterior urethral membrane that has only a small posterior defect endoscopically can have a wide clinical and radiological spectrum. The difference in outcome may be caused by variations in the response of the bladder to the obstruction, resulting in a different effect on the upper tracts.

Child↗
PubMed1990

Wallstent endoprostheses for the relief of prostatic urethral obstruction in high risk patients.

Twenty-one patients with prostatic urethral obstruction who were unfit for surgery were treated with self-expandable stainless steel endoprostheses inserted under fluoroscopic guidance. The procedure was technically successful in all patients, although in one case a second stent was required 2 months later. One patient developed a urethral stricture in the 12-16 month follow up period. One case of epididymoorchitis and one case of septicaemia after stenting were treated successfully with antibiotics. Endoprostheses represent a satisfactory alternative to prostatectomy in high-risk patients.

Aged↗
PubMed1985

Fetal urethral obstruction: US evaluation.

To further elucidate antenatal sonographic features of fetal urethral obstruction and attempt to determine which features might predict subsequent outcome, 40 in utero cases were reviewed. All fetuses had dilated urinary bladders and/or thickened bladder walls; in 47.5% of fetuses a dilated posterior urethra was seen. Only 15 fetuses (37.5%) survived the neonatal period. Survivors tended to present later in gestation than nonsurvivors. Poor prognostic indicators included oligohydramnios (20 of 21 subsequently died), absence of caliectasis (20 of 24 died), a large amount of urine ascites (five of six died), and dystrophic bladder wall or peritoneal calcification (five of five subsequently died). Conversely, 14 of 19 (74%) fetuses without definite oligohydramnios survived the neonatal period.

Female↗
PubMed2005

[Transvaginal urethrolysis for urethral obstruction after anti-incontinence surgery].

PURPOSE: To analyse the success of transvaginal urethrolysis in resolving voiding dysfunction in patients following an anti-incontinence procedure. MATERIALS AND METHODS: A retrospective chart review was performed on 20 patients who had undergone transvaginal urethrolysis for urethral obstruction following an anti-incontinence procedure. Preoperatively, a history was taken, pelvic examination and urodynamic were done. Mean patient age was 48 years, and the median time between the anti-incontinence procedure and the urethrolysis was nine months. Four patients had urinary retention and had irritative voiding symptoms. Previous surgery included pubovaginal sling in eleven patients, retropubic urethropexy in three and bladder neck suspension in six cases. Mean length of follow up after urethrolysis was 14 months. The urodynamic study demonstrated voiding flow rate of 9.9 ml/s and detrusor pressures at maximum flow of 48cmH20. RESULTS: Of the 20 patients 14 (70%) had relief of symptoms after a single urethrolysis, while two patients underwent a second transvaginal urethrolysis, with placement of a Martius flap between the urethra and the symphysis. There was no correlation between preoperative parameters examined and the outcome from urethrolysis. CONCLUSION: Our data support transvaginal urethrolysis for the treatment of urethral obstruction after anti-incontinence surgery. It is effective and minimally invasive technique with good results that should be considered if voiding dysfunction does not resolve spontaneously.

Adult↗
PubMed1982

The varied sonographic appearance of the urinary tract in the fetus and newborn with urethral obstruction.

The urinary tract in the fetus responds to chronic obstruction differently than in adults. This difference leads to sonographic findings which are unique and occasionally misleading when urinary tract obstruction occurs in utero. These findings include development of macroscopic cysts and relative lack of dilatation of the intrarenal collecting system. Seven cases are presented to illustrate the spectrum of findings in fetal urinary tract obstruction at the urethral level, and criteria for distinguishing atypical renal obstructive disease with cysts from other forms of renal cystic disease in the newborn are offered.

Diagnosis, Differential↗
PubMed2005

Two- and three-dimensional sonographic findings in a case of distal urethral obstruction due to a paraurethral tumor.

The cause of bladder outlet obstruction in women may be categorized generally into two types, functional and anatomical. On ultrasonography, the urethra appears as a tubular structure with a central echolucent part and surrounding hyperechogenic structures. Morphological changes in the echolucent portion of the urethra have been reported to be associated with voiding dysfunction. We present a case of distal urethral obstruction secondary to metastatic paraurethral adenocarcinoma. Three-dimensional sonography clearly demonstrated the configuration of the metastatic tumor and its spatial orientation in association with distal urethral obstruction.

Adenocarcinoma↗
PubMed1993

Effect of partial urethral obstruction on force development of the guinea pig bladder.

We created gradual partial urethral obstruction in 20 guinea pigs using silver jeweler's jump rings. After 4 or 8 weeks obstruction all animals underwent cystometry and were assigned to one of five urodynamic categories: normal, high pressure voiding, unstable, low compliance, or decompensated. After sacrifice, the contractile responses of bladder strips to electrical field stimulation of intramural nerves, direct electrical muscle stimulation, 0.1 mM carbachol, and high K+ solution were sampled by computer for phase plot analysis. Following 8 weeks obstruction, the value of the phase plot parameter Fiso, indicative of the number of contractile muscle units, was reduced to 60% of the control response to nerve stimulation (P < 0.05) and to 77% of the control response to carbachol stimulation (P < 0.05). Parameter C, the slope of the phase plot (indicative of unit recruitment during force development), was unchanged for all forms of stimulation. Although in the latter case not statistically significant, obstruction affected responses to nerve and muscle stimulation similarly suggesting that muscle change may possibly be a common denominator of dysfunction. In view of the reduction in Fiso and the increase in bladder weight, instability may represent a more advanced form of dysfunction due to obstruction than high pressure voiding.

Animals↗
PubMed1993

[Transrectal echography in the diagnosis of cervico-urethral obstruction in the young].

The authors present a case of severe cervico-urethral obstruction by Von Brunn cysts. These cysts are often found even in macroscopically healthy bladders, but only rarely reach such a size as to be revealed by ultrasound. They can be asymptomatic or cause obstruction if large. They are no longer considered preneoplastic lesions and are therefore treated according to symptoms. When these cysts cause dysuria they are removed, preferably by transurethral resection, as it is the only method (unlike needle aspiration) which prevents recurrence.

Adult↗
PubMed1988

Posterior urethral obstruction. Prenatal sonographic findings and clinical outcome in fourteen cases.

Fourteen cases of fetal urethral obstruction were reviewed retrospectively. The purpose of this study was to emphasize the following: 1) prenatal sonographic findings: 2) clinical outcome: and 3) associated congenital anomalies. Decreased amniotic fluid volume complicated 12 pregnancies (86%). A dilated posterior urethra was identified in nine fetuses (64%) and an enlarged bladder in 13 (93%). Evaluation of the fetal kidneys revealed hydronephrosis in 81%, increased parenchymal echogenicity in 73% and macroscopic renal cysts in 15%. There were seven live births, but only two neonates survived beyond 5 weeks. Pulmonary hypoplasia contributed to the five postnatal deaths. Associated congenital anomalies were noted at autopsy in six cases.

Amniotic Fluid↗
PubMed1994

Reversal of muscle hypertrophy in the rat urinary bladder after removal of urethral obstruction.

We studied the ultrastructure of the bladder musculature after first inducing hypertrophy by means of urethral obstruction and subsequently removing the obstruction. With hypertrophy the bladder musculature increases ten-fold or more in volume; after de-obstruction approximately 4/5 of the hypertrophic muscle weight and volume is lost within six weeks. In spite of this very large decrease in muscle mass there is no degeneration of muscle cells or nerve endings or of other cell types in the de-obstructed bladder either at 5 days or at 6 weeks. The individual muscle cells are smaller in size than in the hypertrophic bladder but still larger than control muscle cells. The decrease in muscle cell size is more substantial than the decrease in muscle cell surface. There are no lysosomes or other signs of intracellular degradation in any cells of the muscle layer. The musculature contains a very large amount of intercellular material, mainly collagen. This study documents the great plasticity of the musculature in the reduction of muscle mass after de-obstruction. However, some of the fine structural features are almost as different from the controls as in the hypertrophic muscle.

Animals↗
PubMed1987

Hyperammonemia associated with urethral obstruction in a dog.

Hyperammonemia was documented in a 10-week-old male Lhasa Apso referred for urethral obstruction and rupture. Results of liver function tests were normal. Staphylococcus sp was isolated from urine. Anomalies of the portal vascular system and hepatic insufficiency are the most common causes of hyperammonemia in the dog. Hyperammonemia, however, in the absence of recognizable concurrent hepatic disease, also may result from urinary stasis and infection with urea-splitting organisms.

Ammonia↗
PubMed1993

Surgical treatment of urethral obstruction due to urolithiasis in male cattle: a review of 85 cases.

Eighty-five male cattle with urethral obstruction due to urolithiasis were treated by surgery. In most cases local anaesthetic techniques combined with sedation were applied to the dorsally recumbent animals. The penis was transected and transposed in animals with a ruptured urethra. A ruptured bladder was repaired by a paramedian abdominal approach. The bladder was fistulated through the ventral abdominal wall when no alternative treatment was possible. Complications related to the different surgical interventions are described. Only 35.3 per cent of the animals recovered satisfactorily.

Animals↗
PubMed2003

Penile urethral obstruction in a subject with spinal cord injury.

STUDY DESIGN: Single case report. OBJECTIVE: To report a case of urethral obstruction because of calculus in a subject with spinal cord injury (SCI). SETTING: Bangalore, India. CASE REPORT: A 25-year-old man sustained complete SCI at C(6) level following a road traffic accident. After 14 months, while on self-intermittent catheterization he noticed difficulty in introducing catheter and acute retention of urine. X-ray examination revealed a calculus in the penile urethra at the level of the glans penis. CONCLUSION: Impaction of calculi in penile urethra, although rare, can manifest with acute painless urinary retention in patients with SCI.

Accidents, Traffic↗