Ureter Flashcards
Define intrinsic UPJO
area of ureter lacking peristalsis secondary to collagen deposition or poor circular musculature; also could be due to mucosal folding
Define extrinsic UPJO
aberrant, lower pole vessel crosses anteriorly to the ureter causing it to kink
Tx of choice for UPJO in peds; adults?
Peds = pyeloplasty
Adults: endopyelotomy if etiology is not due to a lower pole vessel
What factors determine success rate for endopyelotomy for UPJO in adults
No lower pole crossing vessel
Good renal function
Stricture segment < 2cm
Mild-moderate hydronephrosis
If your surgery fails to correct the UPJO, what is the next step?
Endopyelotomy fails –> pyeloplasty or vice versa
If both fail, or pyeloplasty is failed with a long stricture, consider ureterocalicostomy
What is Dietl’s Crisis?
Someone with UPJO has renal colic secondary to diuresis, such as alcohol ingestion
What is a bifid ureter/ureter fissus?
Etiology?
It’s where 2 ureters insert the renal pelvis (duplex kidney) with a solitary, shared ureteral orifice
Due to partial division of ureteric bud prior to contacting the metaneprhogenic blastema
What is a duplicated ureter?
Etiology?
2 ureters at the renal pelvis with 2 completely separate ureters with their own UO’s
Due to complete division of the ureteric bud prior to contact with the metanephrogenic blastema
What is the Weigert-Meyer rule?
Upper pole ureter associated with ureterocele (obstructs), is ectopic, and the UO is inferior-medial
Lower pole ureter associated with VUR and UPJO, and the UO is superior-medial
What imaging test can be done to determine function of each renal unit/segment in a duplicated system?
MAG3 scan
In a duplicated system, what is the treatment if symptomatic obstruction and segment has minimal function?
Partial nephrectomy
In a duplicated system, what is the treatment if symptomatic obstruction but kidney has function?
Treat the obstruction (ureterocele ablation or pyeloplasty for UPJO)
In a duplicated system, what is the treatment if asymptomatic but kidney segment has minimal function?
Observe
Define ectopic ureter:
UO not located within bladder trigone
In females, an ectopic ureter will never directly insert into a _____ structure, but rather into associated ____ duct remnants.
promesoneprhos structure (Mullerian)
inserts into a mesonephos (Wolffian) structure
How do females commonly present with ectopic ureter?
continuous incontinence, as ureter can be distal to the spincter/bladder neck, vagina, or rectum
In males, where can ectopic ureters insert?
anywhere from bladder neck to the proximal extent of external sphincter
*males never have incontinence with ectopic ureters b/c it will always insert proximal to the external sphincter
Treatment for ectopic ureter?
Would you ever separate a duplicated or bifid ectopic ureter?
Ureteral reimplantation (ureteroneocystostomy)
NEVER separate ureters, as this will injure ureteral vasculature
Etiology of ureterocele?
Cystic dilation in a distal ectopic ureter due to persistent Chwalla’s membrane
What is a cecoureterocele?
the portion of the ureterocele that extends into the urethra
- hard to diagnose and treat
What study/test is required before surgically treating a ureterocele?
VCUG
IVP or CT urogram or CT cystogram, what is the buzzword for the appearance of a ureterocele (contrast within the ureterocele and not contrast surround it)
Cobra-head appearance
Study of choice to dx a ureterocele in pediatrics?
bladder ultrasound
- will have hydronephrosis (upper pole if duplex system)
What are the various treatment options for a ureterocele?
What should one do to the patient prior to definitive treatment?
Transurethral incision
Excision of ureterocele with ureteral reimplantation
Upper pole nephroureterectomy if non-functioning
Ureteroureterostomy
Patient should be given prophylactic antibiotics
