Distal ureteral atresia, megaureter of a lower pole of a duplicated kidney: the rare clinical case

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Ureteral atresia is a rare pathology, the diagnosis of which is difficult, and a unified approach to the method of surgical correction has not been formed. The aim of this study is to demonstrate a rare clinical case of a patient with distal ureteral atresia of a non-functioning lower pole of a duplicated kidney, and also to present the method of surgical treatment. A 12-year-old female patient was diagnosed with a cystic formation of the retroperitoneal space. During the operation, it was determined that this cyst was an atretic, dilated ureter of a lower pole of the duplacated kidney. Lower heminefrureterectomy was chosen as the method of surgical correction. Ureteral atresia is rarely combined with any other anomalies of the upper urinary tract, and the presented clinical case has not previously been described in the available foreign and Russian literature. The methods of surgical correction of ureteral atresia include nephrureterectomy, ureteroureterostomy, intestinal ureteroplasty, and Boari procedure. In the presented case, heminefrureterectomy was chosen because of severe hypoplasia of the lower pole of the duplicated kidney and the almost complete absence of its parenchyma. When examining patients with cystic formations of the retroperitoneal space, it is necessary to remember about the ureteral atresia, which may be accompanied by other anomalies of the upper urinary tract.

作者简介

Iliya Kagantsov

Almazov National Medical Research Centre; North-Western State Medical University named after I.I. Mechnikov

Email: ilkagan@rambler.ru
ORCID iD: 0000-0002-3957-1615
SPIN 代码: 7936-8722
Scopus 作者 ID: 55358760000

MD, Dr. Sci. (Med.)

俄罗斯联邦, 2 Akkuratova st., Saint Petersburg, 191014; 41, Kirochnaya st., Saint Petersburg, 191015

Evgeniia Kondrateva

Almazov National Medical Research Centre; North-Western State Medical University named after I.I. Mechnikov

编辑信件的主要联系方式.
Email: zhenya-muz@mail.ru
ORCID iD: 0000-0001-5435-8487
SPIN 代码: 4818-9170
Scopus 作者 ID: 58090859300

Junior Researcher, Research Laboratory for Surgery of Congenital and Hereditary Pathology, Postgraduate Student

俄罗斯联邦, 2 Akkuratova st., Saint Petersburg, 191014; 41, Kirochnaya st., Saint Petersburg, 191015

Nadezhda Kokhreidze

Almazov National Medical Research Centre

Email: kokhreidze_na@almazovcentre.ru
SPIN 代码: 9382-2225

MD, Dr. Sci. (Medicine), Assistant Professor

俄罗斯联邦, 2 Akkuratova st., Saint Petersburg, 191014

Svetlana Karavaeva

North-Western State Medical University named after I.I. Mechnikov; Children’s City Multidisciplinary Clinical Specialized Center for High Medical Technologies

Email: swetl.karawaewa2015@yandex.ru
ORCID iD: 0000-0001-5884-9128
SPIN 代码: 4224-5532
Scopus 作者 ID: 6603178807

Dr. Sci. (Medicine), Professor

俄罗斯联邦, 41, Kirochnaya st., Saint Petersburg, 191015; Saint Petersburg

Tatiana Pervunina

Almazov National Medical Research Centre

Email: ptm.pervunina@yandex.ru
ORCID iD: 0000-0001-9948-7303
SPIN 代码: 3288-4986
Scopus 作者 ID: 56572907100

Dr. Sci. (Medicine)

俄罗斯联邦, 2 Akkuratova st., Saint Petersburg, 191014

参考

  1. Zundel S, Szavay P, Schaefer JF, et al. Single kidney and ureteral atresia in a newborn girl: a treatment concept. J Ped Urol. 2011;7(5):576–578. doi: 10.1016/j.jpurol.2011.02.002
  2. Morozumi M, Ogawa Y, Fujime M, Kitagawa R. Distal ureteral atresia associated with crossed renal ectopia with fusion: recovery of renal function after release of a 10-year ureteral obstruction. Int J Urol. 1997;4(5):512–515. doi: 10.1111/j.1442-2042.1997.tb00295.x
  3. Shuiqing W, Ran X, Xuan Z, Xiaokun Z. Distal ureteral atresia with ureteropelvic junction obstruction in a female child: a rare case. Int J Clin Exp Med. 2015;8(1):1472–1474.
  4. Bleve C, Conighi ML, Fasoli L, et al. Proximal ureteral atresia, a rare congenital anomaly — incidental finding: a case repor. J Transl Pediatr. 2017;6(1):67–71. doi: 10.21037/tp.2017.01.02
  5. Mishra K, Elliot CS. A violation of the Weigert–Meyer law — an ectopic ureter arising from the lower renal pole. J Clin Urol. 2016;10(3):1–3. doi: 10.1177/2051415815570651
  6. Kondrateva EA, Kagantsov IM, Karavaeva SA, et al. Ureteroureterostomy in case of renal duplication. Experimental and Clinical Urology. 2022;15(3)148–155. EDN: LLFOBQ doi: 10.29188/2222-8543-2022-15-3-148-155
  7. Kagantsov IM, Kondrateva EA, Karavaeva SA, et al. Lower pole obstructive megaureter of duplex kidney: an exception to the Weigert–Meyer rule. Urology Herald. 2022;10(3):138–144. EDN: FEVLGA doi: 10.21886/2308-6424-2022-10-3-138-144

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2. Fig. 1. Computed tomography urography (frontal and sagittal section), delayed phase. A cystic formation is visualized (dimensions are indicated), located along the lower third of the right ureter, which does not accumulate contrast

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3. Fig. 2. Intraoperative view of a retroperitoneal formation protruding into the abdominal cavity (indicated by an arrow)

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4. Fig. 3. Type of detected retroperitoneal cystic formation (indicated by a black arrow), along the anterior wall of which the right ureter is visualized (indicated by an arrow with a contour)

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5. Fig. 4. Intraoperative view of a partially exposed atretic ureter (indicated by an asterisk). The arrow indicates the round ligament of the uterus, at the level of which atresia was visualized

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6. Fig. 5. View of the isolated hypoplastic lower segment of the doubled right kidney (indicated by a white arrow). The upper segment is indicated by an asterisk, the atretic ureter of the lower segment is indicated by a yellow arrow

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7. Fig. 6. The final view of the extracted specimen. 1 — sharply hypoplastic lower segment of the double right kidney; 2 — atretic ureter (mucosa)

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8. Fig. 7. Schematic representation of the described pathology

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