Deep infiltrating ureteral endometriosis with catamenial hydroureteronephrosis: a case report

Background

This aim of this case report is to raise awareness of ureteral endometriosis in women of reproductive age with hydronephrosis in the absence of urolithiasis to enable early diagnosis and prevent loss of renal function.

Case presentation

A 44-year-old Asian woman presented with a 4-year history of cyclic right flank pain and right hydronephrosis during menstruation. Despite several evaluations by physicians, including gynecologists, the cause of her symptoms was not diagnosed. On transvaginal ultrasonography, the uterus was observed deviated to the right, with a nodular lesion at the right uterosacral ligament, and the right ovary was attached to the uterus with no apparent cystic lesion. Magnetic resonance imaging showed a mass in the right uterine wall and mild wall thickening with delayed enhancement of the right distal ureter. Right ureteral endometriosis was suspected. Diagnostic laparoscopy revealed narrowing of the distal right ureter between the right uterosacral ligament and the right ovary with adhesions caused by deep infiltrating endometriosis. The adhesion bands and infiltrating endometriosis around the right ureter were dissected.

Conclusions

The nonspecific symptoms of ureteral endometriosis can result in incorrect diagnosis, with renal damage as a result of prolonged hydronephrosis. A high index of suspicion and use of imaging modalities enable earlier diagnosis and preservation of renal function.

     

Active contractions of ureteral segments

The first step in the analysis of the biomechanics of any organ is to obtain its constitutive equation. In pursuit of a constitutive equation describing the peristalsis of the ureter, we measured the relationship between the length of the muscle, the velocity of contraction, and the active tension development of isolated ureter segments. The results of length-tension measurements (giving the maximum tension developed in isometric contraction of a ureter segment of specific length) were similar to those obtained by previous investigators and reflected the behavior of length-tension relationship for other smooth muscles. Two aspects of the force-velocity relationship of the ureter were examined: the effect of releasing the ureter at different times after stimulation, and that at different levels of afterload. Measurements were analyzed using the hyperbolic Hill's equation in the form T/T0 = (1-v/v0) (l + cv/v0)-1 where v is the velocity of contraction, v0 is the velocity of contraction when T = 0, T is the tension in the muscle after release, T0 is the tension in the muscle immediately prior to release, and c is the dimensionless constant. The results of force-velocity measurements showed that the so-called "maximum" velocity v0, is the largest if the tension is released at a time of contraction, early in the rise portion of the contraction cycle. Further, if tension is released from an isometric contraction at a fixed time in the rise portion of the contraction cycle, the largest value of v0 is obtained when the muscle length is in the range of 0.85-0.90 Lmax. Interestingly, the in vivo length of the ureter lies also in this range, 0.85-0.90 Lmax.     

Urinary tract candidiasis: report of a case with bilateral ureteral obstruction

A brief review of the literature on urinary tract candidiasis is presented. The presence of Candida albicans in the urine is rather uncommon and most patients have candiduria without any apparent disease. Among the others, three different clinical types of infection are recognized: (1) pyelonephritis, (2) lower urinary tract infection and (3) ureteral obstruction. Of this last type only seven cases were found in the literature; four of the patients died. We add one case in which the patient did very well after the obstruction of the ureters was relieved by means of ureteral catheters and a large urinary output was maintained for several days.     

Changing patterns in iatrogenic ureteral injuries

Advances in laparoscopic and endoscopic surgery over the past 25 years have changed the preferred methods for performing many operations. We previously reported an increase in the number of patients treated for ureteral injury at our institution that paralleled the introduction of minimally invasive techniques. Since that report, more advanced endoscopic procedures have been introduced. We sought to determine whether the latter influenced the number of ureteral injuries managed at our institution. Reported here are the results of our retrospective study, which sought to determine if the rate of treatment of major iatrogenic ureteral injuries has changed.     

The management of ureteral stone; a guide for physicians in general practice

General practitioners are usually the first to observe a patient with ureteral stone, and often they practice in communities where consultation with a urologist is not immediately available. Study of the records of 423 patients with ureteral stone observed in private practice indicates that by following a definite system for diagnosis, relief of pain, determination of contralateral function, control of infection, and prophylaxis, general practitioners can manage the disease in the great majority of cases, and can determine when treatment by a specialist is imperative.     

Alterations in urinary metabolites due to unilateral ureteral obstruction in a rodent model

Urinary tract obstruction (UTO) results in renal compensatory mechanisms and may progress to irrecoverable functional loss and histologic alterations. The pathophysiology of this progression is poorly understood. We identified urinary metabolite alterations in a rodent model of partial and complete UTO using (1)H nuclear magnetic resonance ((1)H-NMR) spectroscopy. Principal component analysis (PCA) was used for classification and discovery of differentiating metabolites. UTO was associated with elevated urinary levels of alanine, succinate, dimethylglycine (DMG), creatinine, taurine, choline-like compounds, hippurate, and lactate. Decreased urinary levels of 2-oxoglutarate and citrate were noted. The patterns of alteration in partial and complete UTO were similar except that an absence of elevated urinary osmolytes (DMG and hippurate) was noted in complete UTO. This pattern of metabolite alteration indicates impaired oxidative metabolism of the mitochondria in renal proximal tubules and production of renal protective osmolytes by the medulla. Decreased production of osmolytes in complete obstruction better elucidates the pathophysiology of progression from renal compensatory mechanisms to irrecoverable changes. Further confirmation of these potential biomarkers in children with UTO is necessary.     

Laparoscopic conservative management of ureteral endometriosis: a survey of eighty patients submitted to ureterolysis

Background  

this study aims to evaluate the effectiveness and safety of laparoscopic conservative management of ureteral endometriosis.     

Effect of beraprost sodium (BPS) in a new rat partial unilateral ureteral obstruction model

Unilateral ureteral obstruction (UUO) is a representative model for investigating the common mechanism of decreasing renal function in chronic renal failure. In this study, we present a new partial UUO model in adult rats and evaluated the effect of beraprost sodium (BPS: stable prostaglandin I₂ (PGI₂) analog). We could make reproductive and uniform partial UUO by ligating the left ureter together with a 0.5 mm diameter stainless steel wire with nylon thread, and withdrawing the stainless wire. One week later, the ureteral obstruction was released. After 3 weeks from the release of UUO, all animals of control group, without BPS administration, developed basophilic degeneration of tubular epithelium, tubular dilatation and interstitial fibrosis. The areas of tubular degeneration and fibrosis were significantly reduced in the BPS group, orally administered BPS 300 μg/kg twice a day from the next day of the release of obstruction, than in control group.In conclusion, we can established the adult rat partial UUO-release model and revealed that BPS can inhibit renal tubular damage and tubulointerstitial fibrosis.     

SAMP1/Sku as a murine model for tubulointerstitial nephritis: a study using unilateral ureteral obstruction.

The SAMP1/Sku mouse is a substrain of the SAMP1 (senescence-accelerated-mouse prone 1) which exhibits renal mononuclear cell infiltration from a younger age. We hypothesized that this renal characteristic is related to the incidence of tubulointerstitial nephritis (TIN). The purpose of the present study was to evaluate the applicability of the SAMP1/Sku mouse as a murine model for TIN. TIN was experimentally induced by unilateral ureteral obstruction (UUO). The SAMP1/Sku and control ICR of both sexes received either a sham or UUO operation and were sacrificed 7 days after the operation. The kidneys of the mice were observed histopathologically, immunohistochemically and semiquantitatively. UUO kidneys showed mononuclear cell infiltration, tubular atrophy and interstitial fibrosis. In males, semiquantitative scores of mononuclear cell infiltration, tubular atrophy, and F4/80, alpha-smooth muscle actin (alpha-SMA) and transforming growth factor (TGF)-beta1 reactions were significantly higher in SAMP1/Sku than in ICR. Likewise, in females, tubular atrophy and F4/80 reaction scores were significantly higher in SAMP1/Sku than in ICR. In conclusion, induction of TIN damage by UUO was more serious in SAMP1/Sku mice than in ICR. Therefore, we propose that SAMP1/Sku mice, especially male SAMP1/Sku, have congenital risk factors for the development of TIN.