This study reports two cases of prenatal ultrasound diagnosis of ectopic ureter and bilateral renal hypoplasia in two different canine fetuses. These developmental disorders were detected during a routine pregnancy ultrasound examination of a female Golden retriever and a female Old English bulldog. A suspected diagnosis of ectopic ureter was made based on the ultrasonographic detection of fetal kidney hydronephrosis and ureteral dilatation, along with consideration of breed predisposition. Bilateral fetal renal hypoplasia presented with ultrasonographic detection of reduced, hyperechogenic fetal kidneys without a distinguishable renal pelvis. Ultrasonographic findings were subsequently confirmed postnatally at surgery or autopsy and histopathology. Our findings highlight the potential for early detection of urogenital anomalies in canines and the importance of knowledge of normal fetal anatomy during ultrasound examination of pregnancy.

• Klíčová slova
• Ectopic ureter, Prenatal diagnosis, Renal hypoplasia, Ultrasound,
• MeSH
• ledviny * abnormality   diagnostické zobrazování   MeSH
• nemoci psů * diagnostické zobrazování   vrozené   MeSH
• psi abnormality   MeSH
• těhotenství MeSH
• ultrasonografie prenatální * veterinární   MeSH
• ureter * abnormality   diagnostické zobrazování   MeSH
• zvířata MeSH
• Check Tag
• psi abnormality   MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Background: Although previous literature shows tumor location as a prognostic factor in upper tract urothelial carcinoma (UTUC), there remains uninvestigated regarding the impact of tumor location on grade concordance and discrepancies between ureteroscopic (URS) biopsy and final radical nephroureterectomy (RNU) pathology. Methods: In this international study, we retrospectively reviewed the records of 1,498 patients with UTUC who underwent diagnostic URS with concomitant biopsy followed by RNU between 2005 and 2020. Tumor location was divided into four sections: the calyceal-pelvic system, proximal ureter, middle ureter, and distal ureter. Patients with multifocal tumors were excluded from the study. We performed multiple comparison tests and logistic regression analyses. Results: Overall, 1,154 patients were included; 54.4% of those with low-grade URS biopsies were upgraded on RNU. In the multiple comparison tests, middle ureter tumors exhibited the highest probability of upgrading, meanwhile pelvicalyceal tumors exhibited the lowest probability of upgrading (73.7% vs 48.5%, p = 0.007). Downgrading was comparable across all tumor locations. On multivariate analyses, middle ureteral location was significantly associated with a low probability of grade concordance (odds ratio [OR] 0.59; 95% confidence interval [CI], 0.35-1.00; p = 0.049) and an increased risk of upgrading (OR 2.80; 95% CI, 1.20-6.52; p = 0.017). The discordance did not vary regardless of caliceal location, including the lower calyx. Conclusions: Middle ureteral tumors diagnosed to be low grade had a high probability to be undergraded. Our data can inform providers and their patients regarding the likelihood of undergrading according to tumor location, facilitating patient counseling and shared decision making regarding the choice of kidney sparing vs RNU.

• Klíčová slova
• grade concordance, location, tumor grade, upper tract urothelial carcinoma,
• MeSH
• biopsie MeSH
• karcinom z přechodných buněk chirurgie   patologie   MeSH
• klinická relevance MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory ledvin patologie   chirurgie   MeSH
• nádory močovodu * patologie   chirurgie   MeSH
• nefroureterektomie metody   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stupeň nádoru * MeSH
• ureter patologie   chirurgie   diagnostické zobrazování   MeSH
• ureteroskopie * metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

CONTEXT: Radical nephroureterectomy (RNU) with bladder cuff resection is the standard treatment in patients with high-risk upper tract urothelial cancer (UTUC). However, it is unclear which specific surgical technique may lead to improve oncological outcomes in term of intravesical recurrence (IVR) in patients with UTUC. OBJECTIVE: To evaluate the efficacy of surgical techniques and approaches of RNU in reducing IVR in UTUC patients. EVIDENCE ACQUISITION: Three databases were queried in January 2024 for studies analyzing UTUC patients who underwent RNU. The primary outcome of interest was the rate of IVR among various types of surgical techniques and approaches of RNU. EVIDENCE SYNTHESIS: Thirty-one studies, comprising 1 randomized controlled trial and 1 prospective study, were included for a systematic review and meta-analysis. The rate of IVR was significantly lower in RNU patients who had an early ligation (EL) of the ureter compared to those who did not (HR: 0.64, 95% CI: 0.44-0.94, p = 0.02). Laparoscopic RNU significantly increased the IVR compared to open RNU (HR: 1.28, 95% CI: 1.06-1.54, p < 0.001). Intravesical bladder cuff removal significantly reduced the IVR compared to both extravesical and transurethral bladder cuff removal (HR: 0.65, 95% CI: 0.51-0.83, p = 0.02 and HR: 1.64, 95% CI: 1.15-2.34, p = 0.006, respectively). CONCLUSIONS: EL of the affected upper tract system, ureteral management, open RNU, and intravesical bladder cuff removal seem to yield the lowest IVR rate in patients with UTUC. Well-designed prospective studies are needed to conclusively elucidate the optimal surgical technique in the setting of single post-operative intravesical chemotherapy.

• Klíčová slova
• Intravesical recurrence, Radical nephroureterectomy, Upper tract urinary cancer,
• MeSH
• karcinom z přechodných buněk * chirurgie   patologie   MeSH
• lidé MeSH
• lokální recidiva nádoru epidemiologie   MeSH
• nádory ledvin chirurgie   patologie   MeSH
• nádory močového měchýře * chirurgie   patologie   MeSH
• nádory močovodu * chirurgie   MeSH
• nefroureterektomie * metody   MeSH
• ureter chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• systematický přehled MeSH

OBJECTIVES: We evaluated the feasibility, safety, and long-term outcomes of pyelovesicostomy as an alternative surgical treatment for complex ureteral lesions after kidney transplant. MATERIALS AND METHODS: A single-center, retrospective, observational cohort study was conducted on 5 adult kidney transplant recipients who underwent pyelovesicostomy between January 2000 and June 2023. The collected data included patient demographics, surgery indication, time from transplant to pyelovesicostomy, procedure details, and kidney function at various time points after surgery. Primary outcomes were allograft function and complications. RESULTS: The 5 patients (4 female, 1 male) had a mean age of 65.8 years and mean body mass index of 26.8. Indications were complex ureteral lesions. The time between transplant and reoperation ranged from 4 days to 12 years. Renal function improved for all patients, with a progressive decrease in mean serum creatinine concentration. The mean follow-up period extended to 7 years. One patient died with the graft still functional at 20 years after the operation, whereas the remaining 4 patients continue to live with functional grafts. CONCLUSIONS: Our study suggests that pyelovesicostomy may provide a potent alternative for the management of complex ureteral lesions after kidney transplant. We have observed good short-term and long-term outcomes in specific patients, pointing toward a promising avenue oftreatment worth further exploration. This reaffirms the importance of a personalized approach in medicine, to consider each patient's unique conditions and characteristics during therapeutic decisions.

• MeSH
• dospělí MeSH
• kohortové studie MeSH
• lidé MeSH
• retrospektivní studie MeSH
• senioři MeSH
• transplantace ledvin * škodlivé účinky   metody   MeSH
• ureter * chirurgie   patologie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

OBJECTIVE: To assess the incidence of ureteric injuries, clinical value of prophylactic ureteric stenting and impact of intra- or postoperative detection of ureteric injuries in patients treated with gynaecological or colorectal surgery. METHODS: Multiple databases were searched for articles published before September 2021 according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. Studies were deemed eligible if they evaluated the differences in the rate of ureteric injuries between laparoscopic and open surgery, prophylactic ureteric stenting or not, and those of final treatment success between intra- and postoperative detection in patients who underwent gynaecological or colorectal surgery. RESULTS: Overall, 46 studies were eligible for this meta-analysis. Compared to open surgery, laparoscopic hysterectomy was associated with a higher incidence of ureteric injuries (pooled odds ratio [OR] 2.12, 95% confidence interval [CI] 1.71-2.62), but there was no statistically significant difference in colectomy (pooled OR 0.89, 95% CI 0.77-1.03). Prophylactic ureteric stenting was associated with a lower incidence of ureteric injuries during gynaecological surgery (pooled OR 0.61, 95% CI 0.39-0.96). The number needed to perform ureteric stenting to prevent one ureteric injury was 224 in gynaecological surgery. On the other hand, prophylactic ureteric stenting did not reduce the risk of ureteric injuries during colorectal surgery. Intraoperative detection of a ureteric injury was associated with a lower rate of complication management failure compared to postoperative detection (pooled OR 0.22, 95% CI 0.12-0.41). CONCLUSIONS: Laparoscopic hysterectomy seems to be associated with a higher rate of ureteric injuries compared to an open approach. Prophylactic ureteric stenting seems to reduce this risk during gynaecological surgery. Intraoperative detection of a ureteric injury during abdominal/pelvic surgery improves outcomes, suggesting the need for awareness and proactive problem identification. Further well-designed studies assessing the candidates who are more likely to benefit from prophylactic ureteric stenting including cost analysis are needed.

• Klíčová slova
• #UroTrauma, #Urology, colectomy, hysterectomy, iatrogenic, laparoscopic, ureteric injury, ureteric stent,
• MeSH
• gynekologické chirurgické výkony MeSH
• iatrogenní nemoci epidemiologie   prevence a kontrola   MeSH
• laparoskopie * škodlivé účinky   MeSH
• lidé MeSH
• ureter * chirurgie   zranění   MeSH
• urologické nemoci * chirurgie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• přehledy MeSH

INTRODUCTION: The ureter is present in surgical field during inguinal hernia repair in 0.5-4% of cases. It typically occurs in obese patients, in men and patients after kidney transplants. Right-sided and indirect location of ureteral herniation prevails. The clinical picture is mostly asymptomatic, but possible manifestations include increased frequency of urination with urgency, nocturia, recurrent pyelonephritis, urosepsis, feeling of incomplete emptying of the bladder, signs of GIT obstruction. Diagnostic methods include retrograde pyelography or CT urography. Surgical treatment is indicated in every case of ureteral herniation. Reposition of the ureter retroperitoneally and standard plasty of the inguinal canal is the method of choice. METHODS: 33 cases of ureteral hernia were reviewed in order to write a systematized review of the topic. The case report describes a 68-year-old patient with prostatic hyperplasia and dysuria treated at our institution. A preoperative CT examination with intravenous contrast showed herniation of the right ureter into the inguinal area with hydronephrosis of 2nd degree. Preoperative insertion of a mono-J stent into the right ureter and reposition of the ureter retroperitoneally followed by hernia repair using alloplastic material was performed. There were no postoperative complications. RESULTS AND CONCLUSION: In risky cases, the surgeon should assume the possible presence of a ureter in the inguinal region. Careful dissection in the inguinal area reduces the risk of iatrogenic damage to the ureter.

• MeSH
• inguinální hernie * komplikace   chirurgie   MeSH
• lidé MeSH
• operace kýly metody   MeSH
• senioři MeSH
• transplantace ledvin * škodlivé účinky   MeSH
• třísla MeSH
• ureter * transplantace   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Ileus is one of the most severe diagnoses of the group of acute abdomen events. Some patients with certain forms of bowel obstruction respond well to conservative therapy. However, the diagnosis of strangulation ileus can be delayed in some situations, resulting in high morbidity and mortality in such cases. Our paper presents the case of an 81-year-old female patient who developed an ileus shortly after ureteral stent placement due to obstructive hydroureteronephrosis. The strangulation of the small intestine was caused by an atypical position of the right ureter in the abdominal cavity.

• Klíčová slova
• case report, ileus, stents, ureter,
• MeSH
• břišní dutina * MeSH
• ileus * diagnostické zobrazování   etiologie   MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• stenty škodlivé účinky   MeSH
• střevní obstrukce * diagnostické zobrazování   etiologie   chirurgie   MeSH
• tenké střevo MeSH
• ureter * MeSH
• Check Tag
• lidé MeSH
• senioři nad 80 let MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

We systematically reviewed the literature and summarized oncologic and safety outcomes for endoscopic management (EM) compared to radical nephroureterectomy (RNU) for patients with upper tract urothelial carcinoma (UTUC). Studies comparing oncologic and/or safety results for EM versus RNU in patients with UTUC were included in our review. Overall, 13 studies met the criteria, and five studies were included in a meta-analysis using adjusted hazard ratios (HRs) for overall survival (OS), cancer-specific survival (CSS), and bladder recurrence-free survival (BRFS). EM was associated similar OS (HR 1.27, 95% confidence interval [CI] 0.75-2.16), CSS (HR 1.37, 95% CI 0.99-1.91), and BRFS (HR 0.98, 95% CI 0.61-1.55) to RNU, while 28-85% of patients treated with EM experienced upper tract recurrence across the studies. EM required more interventions with a higher cumulative risk of complications and lower likelihood of renal preservation. In summary, EM for low-grade UTUC had comparable survival outcomes to RNU at the cost of higher local recurrence rates resulting in a need for long-term rigorous surveillance and repeated interventions. PATIENT SUMMARY: For selected cases of cancer in the upper urinary tract, surgical treatment via a telescope inserted through the urethra or the skin (endoscope) results in cancer control outcomes that are comparable to those after removal of the kidney and ureter. However, because of its higher rate of local recurrence, this approach requires repeated endoscopic treatment sessions. Patients should be well informed about these issues to help in shared decision-making.

• Klíčová slova
• Endoscopic surgery, Upper tract urothelial carcinoma,
• MeSH
• karcinom z přechodných buněk * chirurgie   MeSH
• lidé MeSH
• nádory močového měchýře * chirurgie   MeSH
• nefroureterektomie metody   MeSH
• ureter * chirurgie   MeSH
• ureteroskopie škodlivé účinky   metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• systematický přehled MeSH

INTRODUCTION: The aim of this study was to investigate factors that may predict a negative ureteroscopy (URS) performed for ureteric calculi in prestented patients and to assess preoperative imaging in reducing the rate of negative URS. METHODS: Data were collected on emergency stent placement for a ureteric calculus from April 2011 to February 2016 (Group A) and October 2016 to October 2019 (Group B). Data included patient demographics, indication for a stent, stone characteristics, baseline bloods, urine culture, readmission, negative URS rate and the use of pre-URS imaging. Multivariate logistic regression was used for statistical analysis. RESULTS: Of 257 patients who underwent emergency stent insertion, 251 underwent deferred URS for a ureteric calculus and 6 avoided URS due to pre-URS imaging. Indications for stent were pain (42%), sepsis (39%) and acute kidney injury (19%). Mean stone size was 7.8mm, mean stone density was 699 Hounsfield units (HU) and the stone locations were upper (62%), mid (13%) and lower ureter (25%). The overall negative URS rate was 12%. The negative URS rate was lower in patients with pre-URS imaging compared with those with none, 6% and 14%, respectively (OR=2.33, 95% CI: 0.69-7.56, p=0.2214). Logistic regression analysis indicated stone size as the only significant predictor of a negative URS, where the greater the size of the stone the less likely URS would be negative (β=0.75, 95% CI: 0.60-0.94 p=0.011). CONCLUSIONS: Utilising pre-URS imaging can lead to a reduction in negative URS rate. Stone size <5mm appears to be the subgroup most likely to benefit from imaging.

• Klíčová slova
• Ureteroscopy, Urolithiasis, Uroradiology,
• MeSH
• kameny v močovodu * diagnostické zobrazování   chirurgie   MeSH
• ledvinové kameny * diagnostické zobrazování   chirurgie   MeSH
• lidé MeSH
• močové kameny * MeSH
• retrospektivní studie MeSH
• ureter * diagnostické zobrazování   chirurgie   MeSH
• ureteroskopie metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: We present two case reports of asymptomatic ureteral endometriosis leading to hydronephrosis. We demonstrate the significance of routine ultrasound scanning of the upper urinary tract in patients with dia gnosed deep infiltrating endometriosis. CASE REPORTS: The first case report describes a symptomatic patient after a surgery for deep endometriosis. After the surgery, she was completely without symptoms, but during regular check-ups she developed progressive hydronephrosis on the right side and it did not respond to conservative treatment. Surgery deliberation of the ureter was indicated. The second case report describes a patient with already developed severe hydronephrosis on the left side. The functional kidney examination proved complete renal loss of the left kidney. Because of recurrent pyelonephritis in the nonfunctional kidney, nephrectomy was indicated. CONCLUSION: Ureteral endometriosis presents a rare, but insidious form of endometriosis, which is very often asymptomatic and diagnosed at a later stage. It can cause a complete silent loss of renal function. Routine ultrasound scanning examination of the upper urinary tract in all patients with diagnosed endometriosis could prevent this severe complication.

• Klíčová slova
• hydronephrosis, routine US scanning, ureteral endometriosis,
• MeSH
• endometrióza * diagnóza   diagnostické zobrazování   MeSH
• hydronefróza * diagnostické zobrazování   etiologie   MeSH
• lidé MeSH
• nemoci močovodu * diagnóza   diagnostické zobrazování   MeSH
• ultrasonografie MeSH
• ureter * diagnostické zobrazování   chirurgie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH