Search

Imaging is a key component of diagnosis and treatment response evaluation of urinary tract tuberculosis (UT TB). Tuberculosis can have a long latency, but if found early, one may have the opportunity to prevent complications such as ureteral strictures, obstructive nephropathy, contracted (thimble) bladder, renal parenchymal destruction/calcification, and renal failure. Imaging can aid in diagnosis and differential diagnoses, evaluate the extent of disease and complications, and guide image-directed biopsy, surgical planning, and evaluation of treatment response. Imaging abnormalities in the renal parenchyma and urinary tract at different stages of the disease, lymphadenopathy, and extra-urinary tract organ involvement are suggestive of UT TB. Recent advances in imaging modalities aid in UT TB diagnosis, follow-up, and guiding treatment. [ABSTRACT FROM AUTHOR]

A 16.50 kg, 5-year-old male mixed breed dog presented due to complications following a ureterocolonic anastomosis performed to manage of ureteral and urinary bladder injuries. The first revision surgery involved reimplantation of the ureters into the cranial aspect of the prepuce. Dehiscence of the anastomosed ends of the right ureter was observed postoperatively. A second revision surgery was then performed, involving a preputial tube-flap ureteroplasty via preputiotomy. A longitudinal flap was raised from the prepuce and anastomosed to the end of the right ureter to create a neoureter and reduce tension at the anastomosis site. Postoperative follow-up evaluations at 10 days and 6 months revealed no unexpected complications. Six months follow-up, the owner reported that the dog exhibited a satisfactory quality of life. [ABSTRACT FROM AUTHOR]

Simple Summary: The presented MRI results increase the imaging morphologic knowledge of the kidney, ureter and urinary bladder. The data will be useful in imaging anatomy and diagnostic studies of various pathologies of the excretory system in rabbits and other mammalian species. MR urography is a modern imaging technique for the examination of the entire urinary tract that replaces the gold standard excretory urography for the detection of urinary pathological changes. Twelve clinically healthy and sexually mature New Zealand White rabbits were studied. The non-contrast imaging included T1-weighted and T2-weighted spin-echo and gradient-echo sequences in the transverse, sagittal and dorsal planes. Transverse MRI (T2-weighted image) through L1 demonstrated only the right kidney. The transverse T2-weighted image through L2 showed both kidneys. The cranial part of the urinary bladder on T1-weighted transverse scans through L4 was flexed to the left. The T2-weighted sagittal image 30 mm to the right of the median plane showed the right kidney, the right ureter and the urinary bladder. The T2-weighted sagittal image 30 mm to the left of the median plane showed part of the left kidney, the left ureter and the urinary bladder. The T2-weighted sagittal image 45 mm to the left of the median plane presented the lateral part of the left kidney. The dorsal MRI image (T2-weighted sequence) through the horizontal plane 30 mm ventral to the spine demonstrated the whole organs. These data will be useful in imaging anatomy and diagnostic studies of various pathologies of the excretory system in rabbits and other mammalian species. [ABSTRACT FROM AUTHOR]

Urinary catheterisation is a crucial procedure in healthcare, requiring a thorough understanding of the anatomical and physiological differences between males and females to ensure safe and effective care. This guide explores the anatomy of the urinary system, detailing the kidneys, ureters, bladder, and urethra, and highlights key differences in catheterisation techniques for men and women. Emphasising evidence-based practices, it discusses recent advancements, such as antimicrobial catheters, and underscores the importance of comprehensive training and competency assessments for healthcare providers. Additionally, the guide advocates for patient-centred approaches, multidisciplinary collaboration, and adherence to updated policies to reduce complications such as catheter-associated urinary tract infections (CAUTIs). By integrating these critical evaluations and best practices, health professionals can enhance patient outcomes and maintain high standards of care in urinary catheterisation. [ABSTRACT FROM AUTHOR]

This study was performed to segment the urinary system as the basis for diagnosing urinary system diseases on non-contrast computed tomography (CT). This study was conducted with images obtained between January 2016 and December 2020. During the study period, non-contrast abdominopelvic CT scans of patients and diagnosed and treated with urinary stones at the emergency departments of two institutions were collected. Region of interest extraction was first performed, and urinary system segmentation was performed using a modified U-Net. Thereafter, fivefold cross-validation was performed to evaluate the robustness of the model performance. In fivefold cross-validation results of the segmentation of the urinary system, the average dice coefficient was 0.8673, and the dice coefficients for each class (kidney, ureter, and urinary bladder) were 0.9651, 0.7172, and 0.9196, respectively. In the test dataset, the average dice coefficient of best performing model in fivefold cross validation for whole urinary system was 0.8623, and the dice coefficients for each class (kidney, ureter, and urinary bladder) were 0.9613, 0.7225, and 0.9032, respectively. The segmentation of the urinary system using the modified U-Net proposed in this study could be the basis for the detection of kidney, ureter, and urinary bladder lesions, such as stones and tumours, through machine learning. [ABSTRACT FROM AUTHOR]

Copyright of Revista Chilena de Urologia is the property of Sociedad Chilena de Urologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Urolithiasis is frequently followed up with a low‐dose computed tomography of the kidneys ureters and bladder (LD‐CTKUB) with doses typically less than 3 millisieverts. Although X‐ray is a lower dose (0.5–1.1 mSv) alternative for follow up, it has lower diagnostic accuracy and is limited to radiopaque calculi. This study aims to compare the diagnostic accuracy of sub‐millisievert ultra‐low dose CT (ULD‐CTKUB) against X‐ray KUB for the follow up of urolithiasis when both are compared against the standard of care of a low‐dose CT KUB (LD‐CTKUB). Methods: This prospective study included patients with a known diagnosis of urolithiasis on prior CTKUB presenting for follow up. Each patient underwent a repeat reference LD‐CTKUB, ULD‐CTKUB and X‐ray KUB. All imaging studies were interpreted by three readers. The radiation dose and quantitative noise was calculated for each CT. Both CT and X‐ray were assessed for the presence, number and size of all calculi ≥2 mm. Results: A total of 58 patients were included in this study. LD‐CTKUB identified 197 calculi. ULD‐CTKUB in our study had a mean effective dose of 0.5 mSv compared to X‐ray KUB where doses range in the literature from 0.5 to 1.1 mSv. Per‐patient pooled analysis for intrarenal calculi when comparing ULD‐CTKUB versus X‐ray KUB against a reference LD‐CTKUB found a sensitivity of 90% versus 67% (P < 0.01) and specificity of 93% versus 98% (P = 0.18) respectively. For ureteric calculi, the sensitivity was 67% versus 33% (P < 0.01) and specificity 94% versus 94% (P = 1.00) respectively. Per‐stone pooled analysis detection rate was 79% for ULD‐CTKUB versus 48% for X‐ray (P < 0.01) when each was compared to the reference LD‐CTKUB. Interobserver agreement was high for intrarenal calculi and moderate for ureteric calculi. Conclusion: Sub‐millisievert ULD‐CTKUB had lower doses and higher sensitivity than X‐ray in patients requiring follow up of known urolithiasis. [ABSTRACT FROM AUTHOR]

Background: 10%-15% of the world's population suffers from kidney stones. Nearly 50% increase was observed in diagnosing and treating nephrolithiasis in the last decades. Effective medical treatment for the disease is not yet well established. Moreover, there is an increasing global demand to manage diseases using complementary and alternative medicine. This study aimed to formulate and assess the safety and efficacy of a multi-ingredient formulation from traditional Persian medicine (TPM) known as Mofatet powder in patients suffering from calcium kidney stones. Materials and Methods: The aqueous extract of Mofatet powder was prepared, freeze-dried, and formulated as capsules. 26 patients in the drug group and 25 patients in the placebo group used 500 mg capsules of the drug/placebo twice daily for 5 weeks. Ultrasonography/kidney, ureter and bladder imaging, urine analysis, and biochemical parameters were evaluated before and after the intervention. Results: The imaging results showed a 60.73% decrease (P < 0.001) in stone size in the drug group. Moreover, the urinary calcium decreased (P = 0.02) and the urinary magnesium increased (P < 0.001) in the drug group. No remarkable changes were observed in the placebo group in these parameters. No significant effect was observed in aspartate transaminase, alanine transaminase, serum creatinine, and blood urea nitrogen levels in none of the groups. Conclusion: This study suggests that Mofatet powder was effective in reducing calcium kidney stones size with no potential nephro/hepatotoxicity. After confirming these results in larger clinical trials with longer duration, this formulation can be considered a treatment for nephrolithiasis. [ABSTRACT FROM AUTHOR]

The purpose of this article is to review the effects of different types of pharmacotherapy on symptoms that affect the quality of a patient's life after stent insertion. A thorough Medline/PubMed nonsystematic review was conducted from 1987 to January 2023, using the terms: "pigtail" OR "ureteral stents" AND "lower urinary tracts symptoms" OR "LUTS" AND "pharmacotherapy" OR "drugs". Relevant studies conducted in humans and reported in English language were included. The available reviews and articles associating the use of drugs with stent‐related symptoms (SRS) provide conflicting results. Most of them show a clear benefit of alpha blockers, particularly alfuzosin, on treating urinary SRS, and hence there is a strong recommendation for the use of alpha blockers for the treatment of SRS in the guidelines of the European Association of Urology. Anticholinergics and mirabegron have shown a significant benefit in dealing with irritative bladder symptoms. In contrast, the findings for combination therapies are contradictory, with some studies showing that combination therapy is no superior to monotherapy with regards to most of the subsets of the Ureteral Stent Symptom Questionnaire (USSQ), whereas others present a clear benefit of combination therapies, specifically silodosin and solifenacin, in treating stent‐associated lower urinary tract symptoms (LUTS), in comparison with any other type of monotherapy or combination therapy. Many studies suggest that some categories of pharmacotherapy, such as alpha blockers, can alleviate SRS. However, there is conflicting evidence concerning most other types of medical treatment. Randomized trials with the largest number of patients are needed to investigate the effectiveness of novel approaches on SRS. [ABSTRACT FROM AUTHOR]

A 12-y-old Shetland Pony was presented with a mucus-secreting fistula in the right paralumbar fossa. Surgery was performed to unravel the origin of the fistula. The horse died under anesthesia and was forwarded to autopsy. The right kidney was markedly atrophic and fibrotic, consistent with unilateral end-stage kidney. The right ureter was markedly thickened, but with luminal continuity leading into the urinary bladder where a partial obstruction caused by nodular para-ureteral fat necrosis was evident. The lumen of the cutaneous fistula was continuous with the right ureter; therefore, we diagnosed the lesion as a ureterocutaneous fistula. Anomalies of the ureter are uncommon, and ureterocutaneous fistula formation in equids has not been reported previously to our knowledge. [ABSTRACT FROM AUTHOR]

In the present study, we aimed to report our single-center experience in encrusted ureteral stent management and to compare the utility of two different scoring systems in patient management. This is a retrospective study of patients who underwent various surgical procedures to remove encrusted ureteral stent. Encrusted stent grading was performed using KUB and FECal grading sytems. FECal grading system scored from Grade 1 to Grade 5 according to stone size, location, and degree of stent incrustation and the KUB score is the sum of the stone burden scores of three different parts of an encrusted stent within the kidney, ureter, and bladder determined using a scale from 1 to 5 according to the maximal diameter of encrustation. We compared these two classifications for the prediction of perioperative outcomes. Fifty patients were included in the study (52% female, mean age 48 years). The mean time from ureteral stent insertion until diagnosis of encrustation was 11.4 ± 13.6 months. High-grade incrustations (FECal Grade 3, 4, and 5) accounted for 62% of cases. The mean KUB score was 9.8 ± 2.7. The average number of procedures required to remove the stent was 1.71 ± 1.38. Multimodal surgery was required to remove 42% of the stents. Both, a total KUB score ≥ 9 and high-grade FECal classification were found to be significant predictors of longer operative time (> 100 min), need for multiple surgeries, and need for invasive surgery. While high-grade FECal classification showed a significant association with need for multimodal surgery (OR 6.92, p = 0.008), a total KUB score ≥ 9 showed no association (OR 2.91, p = 0.086). These two scores seem to be good indicators in predicting difficulties for surgical management of encrusted ureteral stent with a clear advantage of the FECal score in terms of prediction of multimodal surgery. [ABSTRACT FROM AUTHOR]

In the case of transurethral lithotripsy performed with a rigid ureteroscope, the saline used in reflux may remain in the bladder, causing poor reflux and changing the angle of the ureter. Additionally, it often necessitates surgery, which may be difficult. Conventionally, a thin catheter is introduced from the side of a rigid ureteroscope, or the outer tube of a rigid cystoscope is inserted and operated through a rigid ureteroscope as a countermeasure during surgery for lower ureteral stones. However, there can be problems such as difficulty in operating the borescope when using a catheter, urethral injury due to insertion of the rigid cystoscope's outer cylinder, and insertion limitations due to the outer cylinder length. In order to improve these problems, we considered using a three-tip-hole catheter. With this method, shortening the surgical time by smoothly approach and keeping the good view by drainage of dust. It is possible to reduce pressure on the kidneys and bladder. Another advantage is that it can be performed safely regardless of the surgeon's skill. We herein report our experience using TUL for low)er ureteral stones, with the intention of addressing these problems and managing decompression, while allowing access to the ureter seamlessly. [ABSTRACT FROM AUTHOR]

Summary. A 7-month-old female Jack Russell Terrier weighing 4.6 kg was referred to a veterinary hospital for persistent urinary incontinence. Blood test results and vital signs were within the normal range. Computed tomography allowed the diagnosis of extramural ectopic ureter and unilateral renal agenesis. After the first neoureterocystostomy surgery, the dog had severe complications, such as hydroureter and hydronephrosis, so a second surgery was performed. A commercial ureteral stent was not an option, and it was decided to fabricate a homemade stent to avoid euthanasia. The stent used was a soft, DEHP-free PVC tube with a lumen of 3 × 4.1 mm and a length of approximately 40 mm that connected the ureter to the urinary bladder. Two years after surgery, the dog is in good general condition, and the results of regularly performed blood and urine tests are within the normal range for dogs. [ABSTRACT FROM AUTHOR]

Our results were obtained by studying 128 CT urographies. We found the total length of the ureter to be between 17.34-25.73 cm, with the lumbar ureter between 7.92-12.64 cm, the iliac ureter between 5.61-8.62 cm, and the pelvic ureter between 3.0-11.28 cm. The external diameter of the ureter was found to be between 1.50-7.20 mm. At its origin, the ureter was between 2.40-7.20 mm in diameter, at the iliac level 2.90-4.60 mm, at the supravesical level 1.70-5.0 mm, at the retrovesical level 2.10-2.90 mm and the vesical level 1.50-1.80 mm. We measured the distance between the two ureters, right and left, on a total of 31 cases. At the pyelo-ureteral junction, we found a distance between the two ureters of 7.2-12.53 cm, in the male sex this distance was 7.2-12.53 cm and in the female sex, the distance was 7.16-12.08 cm. At the level of the iliac ureters, this distance was between 2.26-7.36 cm, for males it was 2.26-7.36 cm, and for females 3.34-6.45 cm. At the supravesical level, the distance between the two ureters was 3.04-6.84 cm, with 3.04-6.84 cm for the male sex and 34.6-6.73 cm for the female sex. At the urinary bladder level, the distance between the two ureters was 2.13-4.5 cm, 2.13-4.5 cm for the male sex, and 2.2-3.47 cm for the female sex. At the retrovesical level, the distance between the two ureters was between 3.04-5.71 cm. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the age, gender, survival, and etiology of cases diagnosed with urothelial carcinoma (UC) in the genitourinary system simultaneously or later in a different localization (lower tract and/or upper tract). Materials and Methods: Sixty-four patients diagnosed with concurrent or subsequent lower and/or upper tract UC in the Department of Pathology between 2010 and 2020 were evaluated for age, gender, survival, and etiology. Our study is a retrospective study. Results: Fifty-eight patients were male and six were female. The ages of the patients ranged between 27 and 87 years. The patients were evaluated for noncoagulable and painless hematuria. While 52 of the patients were smokers, 12 of them were non-smokers. Ten of our patients were initially diagnosed with UC in the renal pelvis and/or ureter and three months to eight years later with UC in the bladder, whereas 14 patients were initially diagnosed with UC in the bladder and four months to 10 years later with UC in the renal pelvis and/or ureter. Of the remaining 40 patients, 14 were diagnosed with UC simultaneously in the bladder and ureter, nine in the renal pelvis and ureter, seven in the renal pelvis and bladder, and 10 in the renal pelvis, ureter, and bladder. The mean duration of symptoms before diagnosis was seven months (range; 7 days to 1.5 years). Conclusion: Because UC can affect multifocal organs, close surveillance of patients diagnosed with upper or lower urinary tract disease UC and who are smokers is recommended at the time of diagnosis or especially during the first three years after diagnosis to prevent the formation of primary tumors in other regions. [ABSTRACT FROM AUTHOR]

In a contrast to the trauma of open prostatectomy, an alternative treatment for benign prostatic hyperplasia (BPH) is laparoscopic prostatectomy. It was implemented in the practical work of urologists as a minimally invasive alternative procedure to open prostatectomies (transvesical and pubic) in patients with large BPH. The objective: to consider technique and analysis of the results of laparoscopic extraperitoneal pubic (transcapsular) prostatectomy in patients with large BPH (more than 80 ml). Materials and methods. The early (inpatient) and long-term (after discharge from the hospital and up to two years of followup) results of laparoscopic extraperitoneal pubic (transcapsular) prostatectomy in 50 patients with BPH who were operated in Center for Plastic Reconstructive and Minimally Invasive Oncourology of the Cherkasy Regional Oncology Dispensary and the Urology Department of the Vinnytsia Regional Clinical Hospital named after M. I. Pirogov during 2021-2023 are presented. The average age of the patients was 68.2±2.4 years old, the average body mass index was 28.5±1.5, and the average volume of the prostate gland (PG) was 111.5±17.4 ml. Laparoscopic extraperitoneal pubic prostatectomy was performed by creating a pre-abdominal pubic space using a Space Marker balloon trocar. The incision of the PG capsule is transverse, hyperplastic parts of the bladder were removed with step-by-step hemostasis with an attempt to preserve the wall of the prostatic urethra, the anastomosis between the bladder neck and the bladder capsule was placed using a continuous V-Loc suture (2-0). Hyperplastic nodes of the PG were removed by morcellation. The urethral catheter was removed on the 5th day after surgery. The quality of urination before and after surgery was assessed using the International Symptom Questionnaire for PG diseases before and after surgery. Results. The average operation time was 120.3±11.7 min, the average intraoperative blood loss was 118.7±33.6 ml. In 10 (20%) patients the prostatic part of the ureter was saved. One patient had a stone removed from the urinary bladder by cystotomy, another patient had simultaneous pre-abdominal laparoscopic inguinal hernioplasty with a mesh polypropylene implant for an oblique hernia. No intraoperative or postoperative bleeding was observed, no hemotransfusion was performed. The average postoperative bed-day was 6.1±1.1 days. In the postoperative period (up to two years), complications (ureteral and bladder neck strictures, bladder stones, urinary incontinence, infectious complications, etc.) were not registered. Conclusions. The obtained results of laparoscopic extraperitoneal pubic prostatectomy in patients with large BPH confirmed its reliable intra- and postoperative hemostasis, short postoperative bed-day, satisfactory recovery of the act of urination with a minimum number of complications. Further studies should be conducted to establish the benefits of performing laparoscopic extraperitoneal pubic prostatectomy in patients with BPH. [ABSTRACT FROM AUTHOR]

We report a case of a solitary kidney and a single-system ectopic ureter draining into the vestibule in an infant with a Müllerian duct defect. Due to the absence of the upper vagina and uterus, an extremely underdeveloped bladder masqueraded as the vagina, and bladder agenesis was suspected preoperatively. Urinary continence was achieved using staged bladder surgery without augmentation or urinary diversion. [ABSTRACT FROM AUTHOR]

Schistosoma japonicum causes intestinal schistosomiasis, which affects mainly the rectum and sigmoid colon but rarely the urinary tract. Here we report a rare case of S. japonicum infection of the bladder and ureter, and describe its clinical features and imaging findings. We also put this case in perspective with the literature on S. japonicum infections in humans. [ABSTRACT FROM AUTHOR]

Background: Intravesical recurrence (IVR) after surgery for upper tract urothelial carcinoma (UTUC) is a clinical problem. We investigated if preoperative invasive diagnostic modalities (IDM) such as antegrade/retrograde uretero-pyelography and/or selective urine cytology/barbotage, and URS with or without concomitant biopsy are associated with IVR after radical surgery for UTUC. Risk of death from urothelial cancer and all causes was investigated as secondary outcomes. Methods: We investigated a population-based cohort of 1038 consecutive patients subjected to radical surgery for UTUC 2015–2019 in Sweden, using the Bladder Cancer Data Base Sweden (BladderBaSe 2.0), comprising all patients in the Swedish National Registry of Urinary Bladder Cancer. Risk estimates of IVR, death from urothelial cancer, and all causes was assessed using multivariable Cox regression models. Results: The study included 536 cases with and 502 without preoperative IDM. IDM was associated with increased risk of IVR (HR 1.24, 95% CI 1.03–1.52) and risk of urothelial cancer death (HR 1.56, CI 1.12–2.18), compared to no IDM after a median follow-up of 1.3 yrs. Stratified analysis for tumor location showed that IDM was associated with risk of IVR in ureteric cancer (HR 1.66, 95% CI 1.21–2.28) but not in renal pelvic cancer (HR 1.07, 95% CI 0.81–1.41). Limitations included the observational setting and the lack of variables such as tumour grade, multifocality and preoperative hydronephrosis. Conclusions: Worse outcomes for patients subjected to preoperative IDM highlight the need for carefully considering diagnostic decisions for UTUC patients, specifically in tumours located in the ureter. [ABSTRACT FROM AUTHOR]

Objective: To assess the role of unenhanced multidetector computed tomography (CT) of kidneys, ureters and bladder (KUB) in the initial imaging of suspected acute renal colic. Study Design: Retrospective longitudinal study. Place and Duration of Study: Combined Military Hospital, Kharian Pakistan, from Jan 2020 to Jan 2021. Methodology: One hundred and thirty-eight cases of suspected acute renal colic underwent CT-KUB. The demographic, radiological, clinical, and follow-up data were recorded for each patient. Results: There were 88(51.8%) males and 82(48.2%) females in the present study, with a mean age of 50.86±18.57 years. Out of 170 patients, only 138(81.17%) were indicated with acute findings, whereas 32(18.82%) individuals showed no acute findings. The mean stone size was found to be 4.77±0.98mm. Most of the stones had a location near the pelvic brim (n=47; 34.15%). Conclusion: The use of CT KUB should be encouraged for the evaluation of renal colic. [ABSTRACT FROM AUTHOR]

Bilateral single-system ectopic ureter (BSSEU) is often associated with underdeveloped incompetent bladder neck; hence, to achieve continence, bladder neck reconstruction (BNR) is usually advocated with ureteric reimplantation. Presented here is a 14-year-old girl with BSSEU who achieved continence without BNR. An attempt is made to look at factors that could identify patients in whom BNR could be avoided. [ABSTRACT FROM AUTHOR]

Background: High urinary activity in urinary bladder and ureters may hamper interpretation of prostate cancer and regional nodal metastases in prostate-specific membrane antigen (PSMA) PET/CT. The goal of this study was to assess effects of furosemide and choice of tracer on urinary activity in the bladder and ureters, as well as on occurrence of peri-bladder artefacts in PET/CT. Methods: Four cohorts with a total of 202 men staged with PSMA PET/CT for prostate cancer received either 68Ga-PSMA-11 as tracer, with (cohort G+) or without 10mg intravenous furosemide (G−) concurrent with tracer, or 18F-DCFPyL with (F+) or without furosemide (F−). SUVmax of bladder and ureters, presence, type, and severity of peri-bladder artefacts were compared between cohorts. The influence of furosemide and choice of tracer was determined while taking differences in biodistribution time into account. Results: Median SUVmax bladder was 43,5; 14,8; 61,7 and 22,8 in cohorts G−, G+, F− and F+, respectively, resulting in significant overall (p < 0.001) and between cohort differences (p adjusted < 0.001 to 0.003) except between G− and F+. Median SUVmax ureter was 6.4; 4.5; 8.1 and 6.0 in cohorts G−, G+, F− and F+, respectively, resulting in significant overall (p < 0.001) and between cohort differences for G+ : F− and F− : F+ (p < 0.001, respectively, 0.019). Significant effects of furosemide and choice of tracer on SUVmax bladder (p < 0.001 resp. p = 0.001) and of furosemide on SUVmax ureter (p < 0.001) were found, whereas differences in biodistribution time had not impacted these results significantly. Peri-bladder artefacts were present in 42/202 (21%) patients and were significantly more frequent in the F− cohort, respectively, less frequent in the G+ cohort (p = 0.001 resp. p < 0.001). Peri-bladder artefacts had a direct positive correlation with SUVmax bladder (p = 0.033). Conclusions: Increased urinary activity and higher incidence of peri-bladder artefacts were found in 18F-DCFPyL compared to 68Ga-PSMA-11 PET/CT. Effective reduction of urinary activity may be reached through forced diuresis using 10mg intravenous furosemide, which is especially advantageous in 18F-DCFPyL PET/CT. [ABSTRACT FROM AUTHOR]

Objective: To study the possibility of creating mucosal valve mechanism at ureteric orifice without obstructing the urine outflow but preventing the urine backflow into the ureters. Materials and Methods: Ethical waiver was obtained from the institutional ethical committee. Prospective experimental study was conducted on the post-mortem specimen of intact bladder with urethra and bilateral ureters retrieved from the already slaughtered lamb available in the meat market. Feeding tube inserted via urethral opening into the bladder lumen and bladder inflated with saline demonstrated no reflux of urine via transverse cut opening of ureters. Bladder lumen opened, ureteric orifices incised backwards to eliminate the obliquity. After closing the bladder opening, saline inflation test demonstrated bilateral reflux of saline via cut openings of bilateral ureters. Bladder was re-opened. The upper limb of horizontal U started 10 mm lateral and 8 mm above the refluxing ureteric orifice. Distal most curvature of horizontal U was kept 5 mm medial to ureteric orifice continuing along the lower limb of horizontal U terminating 10 mm lateral and 8 mm below the refluxing ureteric orifice, mucosal flaps from superior and inferior incision mobilized and edges joined to cover the ureteric orifice creating a flap valve mechanism. Influx of saline via cut end of ureters demonstrated no obstruction. Bladder was closed. Saline inflation test and contrast study demonstrated abolition of reflux on flap side and persistence of reflux on another side. Results: Five such experiments were conducted. On the side where the valve was created, Vesicoureteral reflux was abolished in four but in one minimal reflux still persisted. Conclusion: Creating a mucosal flap valve around the ureteric orifice can prevent reflux in 80% of cases without obstruction and without the necessity of ureteric mobilization or creating submucosal tunnel. [ABSTRACT FROM AUTHOR]

Background: Urological injuries are an important matter of a gynecologist especially during hysterectomy and Caesarean section. These complications, although rare, can lead to morbidity and mortality and also can create worry and psychosocial concerns for couples. The most common site liable for injury are bladder and distal ureter . Objective: The objective of this study is to find out the frequency and kind of urological injuries in obstetric and gynecological procedures. Patients and method: This Prospective case series study,performed at Al-Batool maternity teaching hospital, Mosul, Iraq during the period from January 2013 to July 2014, The study include 21 patients who underwent obstetric and gynecologic surgeries that complicated with Iatrogenic Bladder & Ureter Injury (IBI&IUI).All patient accessed with focus history and examination, Intraoperative and postoperative bladder and ureter injury was recorded and studied. Results: The results of the study showed that out of 11,861 obstetric& gynecological (OBG) procedures 21(0.18%) patients have urological injuries. The patients ages ranged between 23–55 years [mean ±STD (36.47±7.69 years)] and patients parity 0–12 [mean ±STD (4.33±2.56)]. Of the 21 patients who have injury,17 patients (80.95%) due to obstetrical procedures & 4 patients (19.05%) due to gynecological procedures .13(61.9%) cases were emergency VS 8(38.1%) cases were elective . Among the obstetric procedure 16 (94.11 %) had previous caesarean sections with 11(64.70 %) had more than one scar. Pelvic adhesion of severe type was found in 13 (61.9%) patients. Morbidly adherents placenta in the form of accreta, percreta occurred in 5 patients (29.4%) The frequency of urological injury (17 case) among all obstetric operastion (11344 case) was 0.15% while the frequency of urological injury(4 cases) among all gynecological operation (517 case )was 0.77% . 50% of bladder injury are of grade 3. Conclusion and recommendations : Iatrogenic ureteric and bladder injuries from obstetric and gynecologic surgeries though uncommon but are liable to occur. Bladder injury occurred more commonly than ureteral injury,Possible injury to the urinary tract should be discussed with all patients undergoing a surgical intervention, as it is a recognized complication. [ABSTRACT FROM AUTHOR]

Ureteral duplication is a common embryologic abnormality of the kidney with an incidence rate of 0.8% in adults. However, complete duplex ureters opening independently into the urinary bladder are rarely present. We report a 35-year-old female who presented with left flank pain in the last three years. Abdominal CT scan showed left complete duplicated system with lower moiety hydroureteronephrosis and obstructed midureteral stone. The patient underwent left retroperitoneal exploration with complete excision of the hydronephrotic sac. The postoperative course was uneventful without complications. In conclusion, a complete duplex kidney with lower moiety hydronephrosis caused by mid ureteric stone is rare. The renal duplication system should be diagnosed and followed with image guidance periodically as the late diagnosis may have poor outcomes with loss of the kidney or part of it. [ABSTRACT FROM AUTHOR]

Background: Ureteral ectopy is a congenital anomaly, affecting young dogs, predominantly bitches. The main complication of the disease is urinary incontinence, which leads to low life quality for both animals and their owners. However, only two less invasive surgical management options are reported. Laser ablation is quite popular, while monopolar electrocautery use is very rare. Case Description: A 3-month and 1-week-old, 1.7 kg female Poodle was admitted to the Vetamicus clinic with severe urinary incontinence and moisture-associated dermatitis. After diagnosing intramural ectopy type during computed tomography scan and video cystoscopy, a search for surgical management options began. We proceeded with the monopolar cauterization technique, where a semirigid Karl Storz monopolar coagulating ball electrode is used to cut a mucous membrane partition between the ureter and urinary bladder. No complications occurred during or after the surgery. Ureter successfully healed and full continence was achieved together with sporadically using phenylpropanolamine syrup. Conclusion: The present case indicates that monopolar electrocautery use in intramural ectopy type management and possibly other urinary tract pathologies might be strongly beneficial. [ABSTRACT FROM AUTHOR]

We investigated a method for bladder augmentation in rats using a decellularized ureter graft. We used 16 rats divided into two groups of eight. After partial cystectomy, the bladders in group 1 were grafted with a 1 cm2 patch of human decellularized ureter. Rats in group 2 were untreated controls. Biopsies of the graft were taken at 1, 3 and 9 months postoperatively for histological investigation. Total removal of cells and preservation of extracellular matrix (ECM) was confirmed in the decellularized ureter. Histological examination after 1 month revealed few cells at the border of the graft. Three months after the operation, the graft was infiltrated by vessels and smooth muscle and the mucosal lining was complete. All bladder wall components resembled native bladder wall by 9 months after implantation. CD34, CD31, α-smooth muscle actin, S100, cytokeratin AE1/AE3 and vimentin were detected 9 months after the operation. We demonstrated the potential of decellularized biocompatible ureteric grafts for use as a natural collagen scaffold for bladder repair in rats. [ABSTRACT FROM AUTHOR]

Objective: To describe detection and management of alternative pathology established by Computed Tomography (CT) Kidney, Ureter, and Bladder (KUB) in patients associated with acute flank pain. Methodology: This retrospective review of 300 patients, presented with acute flank pain during one year from March 2019 to March 2020. All Computerized Tomographies were ordered from the Emergency Room after consultation with a urologist and subsequently reported by a consultant radiologist having a minimum of two years of experience in reporting non-contrast CT scans. Results: A total of 300 patients presented to the emergency room with acute flank pain, out of whom 198 (66%) were male and 102 (34%) were female patients with a mean age of 35 years. The majority (n=249) of the patients were diagnosed with ureteric calculi and the remaining 51 patients (17%) came out to have alternative radiological findings. Eighteen (35.2%) patients were those who needed acute surgical management which included 13 female and 5 male patients. The remaining 33 (64.7%) patients were referred to specialized clinics as there was no emergency involved. The clinically important alternative findings were overall higher in the female cohort i.e., 25.5% versus 9.8% in male patients. Genitourinary findings were discovered in 11(21.5%) patients while 7 (13.7%) patients had non-genitourinary pathologies requiring emergency management. Conclusion: CT-KUB is a useful tool for investigating acute flank pain aiding the decision-making process. The majority of the patients were diagnosed to have ureteric calculi with a significant number of alternative diagnoses mainly in the female population. [ABSTRACT FROM AUTHOR]

Purpose: The bladder cuff (BC) management and its surgical approach represent an essential and debated step in radical nephroureterectomy (RNU) for upper tract urothelial carcinoma. The objective of our study was to determine which BC management has the best oncologic outcomes in terms of bladder recurrence-free survival (BRFS). Methods: We retrospectively analyzed all patients who underwent an open robot-assisted laparoscopic (RNU) or a combined RNU between March 2012 and March 2019 in three academic hospitals. BC management approaches were divided into two categories: (O-cuff) open BC and (R-cuff) robot-assisted BC. We assessed demographic characteristics, distal ureter approach, pathology, and operative details, as well as oncologic outcomes including BRFS. Survival was analyzed using the Kaplan–Meier method and compared using the log-rank test. A multivariable analysis was performed to identify predictive factors of bladder recurrence (BR). Results: A total of 117 patients were included with a mean follow-up of 40.4 months. Patients with a history of bladder cancer, RNU with pure laparoscopic approach, and endoscopic BC were excluded. There were 53 (45%) patients in the O-cuff group and 64 (55%) in the R-cuff group. BRFS at 2 years was 73.3% and 72.7% for O-cuff and R-cuff, respectively (p = 0.9). On multivariable analysis, distal ureter tumor (odds ratio: 6.24, 95% confidence interval: 1.95–21.5; p < 0.01) was associated with BR. Conclusion: There was no statistically significant difference in BRFS between the O-cuff and R-cuff groups. Nevertheless, we underlined that distal ureter tumor was associated with BR. Although we did not find differences regarding the surgical approach, BC remains a very important step of RNU and caution should be taken when performed laparoscopically to avoid any tumor spillage. Risk factors for bladder cancer recurrence might be taken into account for the choice of its surgical approach. [ABSTRACT FROM AUTHOR]

Introduction: The objective of the study is to evaluate the outcome of robot-assisted laparoscopic repair of injuries to urinary tract following gynecological surgery and obstetric injury. Methods: This retrospective analysis from prospectively collected data of repair of injuries to bladder and ureter using da Vinci Si robotic platform was carried out. Between April 2014 and May 2019, 27 patients were operated on in a single surgical unit; 25 had hysterectomy and 2 were obstetric cases. Fifteen patients underwent vesicovaginal fistula (VVF) repair, ten underwent ureteral reimplant, with concomitant psoas hitch, and two underwent Boari flap repair following gynecological surgery and obstetric injury. Results: Among 15 patients of VVF repair, 3 cases were previously attempted failed repair, 2 underwent concomitant ureteral reimplant, and 1 underwent concomitant ovarian cystectomy. The mean total operative time was 126 (75–206) min, and the mean hospital stay was 4.4 (3–6) days. Among 12 cases of ureteral injury, 5 were on the right side and 7 were on the left side; the mean total operative time was 150.16 (110–215) min, and the mean hospital stay was 4 (3–7) days. No case required conversion to open in this cohort. All cases were successfully cured without any recurrence of fistula or stricture during their mean follow-up period of 35.3 (9–66) months. Conclusions: Robot-assisted laparoscopic repair for injuries to bladder and ureter is effective and highly successful even in previously failed cases. [ABSTRACT FROM AUTHOR]

Objective: To review prospectively the clinical characteristics of patients suffering from urinary tract endometriosis (UTE) in France, in 2017.Study Design: We conducted a prospective observational multicenter study including women managed surgically for UTE in 31 French endometriosis expert centers (FRIENDS group) from January 1, 2017 to December 31, 2017. We distinguished patient with isolated bladder endometriosis ("IBE") or isolated ureteral endometriosis ("IUE") and patients associating both locations (mixed locations "ML"). Surgeons belonging to FRIENDS group enrolled patients by filling a 24 items questionnaire the day of the surgery and 6 weeks later. Data on the locations of UTE, preoperative assessment, urinary symptoms and associated pelvic locations were collected in a single anonymized database.Results: A total of 232 patients from 31 centers were included. IBE concerned 82 patients (35.3%), IUE 126 patients (54.4%) ML 24 patients (10.3%). 111 patients reported urinary symptoms (47.8%). IUE was more often asymptomatic than the rest of the locations (59.5% versus 43.3%, OR 1,92, p = 0.017). Associated deep infiltrating endometriosis (DIE) lesions were found in 193 patients (83.1%). IUE was significantly associated with other DIE lesions (82.5% versus 66%, OR2.4, p = 0.006), particularly with rectum or sigmoid nodules (57.1% versus 36.8%, OR 2.3, p = 0.002) and retrocervical space nodules (31.7% versus 19.8%, OR 1.9, p = 0.05).Conclusion: Our study reports the second largest series of patients operated from a UTE and shows that ureteral location seems more frequent, less symptomatic and more frequently associated to other DIE locations than bladder endometriosis. [ABSTRACT FROM AUTHOR]

Aquaporins (AQP) are transmembrane proteins that function as channels for water molecules' movement. It is conserved across bacteria, plants and animals. It helps in thermoregulation during extreme climatic conditions. So, this study focuses on the expression of AQP1, AQP2 and AQP3 in the ureter and bladder tissues of goat (Capra hircus) during winter, spring and summer seasons. The study was conducted on goats (n=30) to investigate the expression of AQP (water channels) in ureter and urinary bladder and metabolic and hormonal influence by aquaporins. mRNAs were isolated from ureter and urinary bladder tissues and cDNA were synthesized for RT-PCR expression studies. Biochemical parameters were studied in the blood samples. AQP1 mRNA expression was non-significant in goat ureters but considerably greater (p<0.05) in the urine bladder during summer compared to winter. During the summer, both ureter and urinary bladder tissue samples showed increased expression of AQP2 and AQP3. Aquaporins 3 had significantly greater (p<0.05) mRNA expression in the ureter and urine bladder than Aquaporins 1 and 2 throughout the summer season. The significant (p<0.05) increase in physiological responses, haematological counts and blood biochemical components seen in goats throughout the summer season. Finally, it concludes that AQP and their role in thermotolerance and direct association with effective water balance mechanisms in the body via expression of AQP in different extreme climatic conditions. • AQP1 mRNA expression was greater in urine bladder during summer. • During summer, ureter & urinary bladder showed increased expression of AQP2 and AQP3. • AQP3 had greater (p<0.05) mRNA expression in ureter & urine bladder than AQP1 & AQP2 throughout summer. • The (p<0.05) increase in physiological responses, haematological counts & biochemical components throughout summer. • It demonstrates thermotolerance & direct association with water balance in body. [ABSTRACT FROM AUTHOR]

Endometriosis is a chronic, debilitating condition affecting up to 10% of reproductive-age women. Urinary tract endometriosis is found in 1%-6% of women diagnosed with pelvic endometriosis, with the most common sites being the bladder (70%-85%), ureter (9%-23%), and kidney (4%). Patients typically present with symptoms such as lower abdominal pain, dysuria, and urgency. Unfortunately, urinary tract endometriosis is often asymptomatic, potentially leading to silent obstructive uropathy and kidney failure. To demonstrate a step-by-step approach for the surgical management of urinary tract endometriosis using conventional laparoscopy for partial cystectomy and robotic-assisted laparoscopy for ureteroneocystostomy. Surgical video of 2 cases managed in an academic tertiary referral center for endometriosis. The first case was a 38-year-old Gravida 3, Para 3 with a history of hysterectomy who had an MRI which revealed a T2 hypointense bladder nodule consistent with endometriosis. Patient had significant urinary urgency, dysuria, and suprapubpic pain that improved but did not disappear after starting oral progestin therapy (5 mg of norethindrone). A cystoscopy was first performed to confirm MRI findings of bladder lesion and to delineate borders and depth of invasion. The second case was a 35-year-old nulliparous woman with chronic pelvic pain and primary infertility. The patient had a history of stage IV endometriosis with deep endometriosis into the bowel and extrinsic encasement of the ureters causing subsequent hydronephrosis requiring bilateral ureteral stents. She had continued daily pelvic pain despite of being on oral contraceptives for medical management of endometriosis. She subsequently underwent bilateral percutaneous nephrostomy tube placement to allow for ureteral rest prior to surgery. In the first case, conventional laparoscopy was utilized to perform bilateral ureterolysis, bladder mobilization, partial cystectomy for complete excision of the lesion, and 2-layered bladder closure. Use of indigo carmine assisted with ureteral orifice identification. In the second case, a cystoscopy was performed with injection of Indocyanine green to assist with ureteral identification. After ureterolysis, distal ureteric obstruction due to extensive disease was confirmed on laparoscopy and ureteroscopy. Bilateral ureteroneocystostomy with placement of Double-J ureteral stents was performed using a robotic-assisted approach. Each patient had an indwelling Foley catheter for bladder decompression during recovery. Pathology in both cases revealed endometriosis. Both patients had an uneventful postoperative course. A postoperative retrograde cystogram confirmed adequate repair prior to removal of each Foley catheter. Patient 2 had uncomplicated office stent removal 6 weeks postoperatively and had a normal renal ultrasound with no hydronephrosis 6 months postoperatively. Endometriosis is an increasingly common condition. It is important for gynecological surgeons to have the proper understanding of anatomy, surgical technique, and multidisciplinary care needed with urology for safe and complete excision of bladder and ureter endometriosis. [ABSTRACT FROM AUTHOR]

Objective: To compare pressure, dilation, and histology in a porcine model after stenting with a pigtail suture stent (PSS)-where the ureteral and bladder component consists of a suture and a double J (DJ) stent.Methods: Twelve pigs were studied with a PSS (4.8F/MiniJFil®) and DJ stent (4.8F/RocaJJ Soft) inserted in both sides, except in one where the DJ was not placed to serve as control. Intrapelvic pressure (IPP) and ureteral pressures were recorded. Five pigs were stented for 7 days, and the next 7 for 13-15 days, where a retrograde study was performed after stent removal. Ureteral histology in 4 and 3 pigs stented for 7- and 13-15 days, respectively, were assessed in a blinded manner.Results: In total, 11 renal units were stented with PSS and DJ, respectively. There was a rise in IPP and ureteral pressure after stenting. There were no significant differences in post-stenting pressures between DJ and PSS systems. Ureteral dilation occurred in 100% of DJ and 83% of PSS units. PSS suture migration occurred in 3 of 11. Gross edema at the ureteral orifice was greater with the DJ compared to the PSS (82% vs 18%; p = .003). Histology demonstrated greater inflammation at the ureteral orifice in the DJ group (2.3 vs 1; p = .016) when stented for 13-15 days.Conclusion: There was no difference in IPP after stenting with a PSS compared to a DJ stent. When stented for 13-15 days, the PSS resulted in ureteral dilation, but with less edema and inflammation at the ureteral orifice. [ABSTRACT FROM AUTHOR]

Rutin (Vitamin P1) is an antioxidant and anti-inflammatory flavonoid. This study examined the effect of rutin on the potential of cisplatin to cause oxidative and proinflammatory damage in blood serum, ureter, bladder and urethra in rats. Animals were divided into four groups: (i) healthy (HG), (ii) 50 mg/kg of rutin + 5 mg/kg of cisplatin (C + R50), (iii) 100 mg/kg of rutin + 5 mg/kg of cisplatin (C + R100) and (iv) only cisplatin (CG). Rutin and distilled water were applied once a day for eight days. Cisplatin was injected intraperitoneally at a dose of 5 mg/kg for eight days, once every two days. Finally, animals were sacrificed by high -dose anesthesia after blood samples were taken. Ureter, bladder and urethra tissues were removed and malondialdehyde (MDA), myeloperoxidase (MPO), total glutathione (tGSH), superoxide dismutase (SOD) interleukin beta (IL-1β) and tumor necrosis factor alpha (TNF-α) levels were measured. The results showed that the levels of MDA, MPO, IL-1β and TNF-α in the blood serum of the CG group increased significantly (p < 0.0001) and the tGSH and SOD levels decreased compared to the HG. Rutin administration reversed the effect as seen in C + R50 and C + R100 groups. However, there was no statistically significant difference in the levels of MDA, MPO, tGSH, SOD, IL-1β and TNF-α in ureter, bladder and urethra tissue (p > 0.05).This suggests that cisplatin produces oxidative stress in the blood serum but not in the ureter, bladder and urethra tissues. It was observed that rutin prevented the cisplatin-related oxidative and proinflammatory damage in the blood serum. [ABSTRACT FROM AUTHOR]

Genitourinary tuberculosis (GUTB) is associated with significant morbidity and mortality. As patients with GUTB have no specific symptoms or clinical features, early diagnosis and treatment of GUTB is clinically challenging. The present study assessed the current spectrum of clinical presentation, urinary findings and radiological signs of patients with GUTB. Patients with confirmed GUTB (n = 53) were analysed for clinical presentation, diagnostic tests and management. Data about demographic details, clinical presentation, urine routine examination, urine acid-fast bacillus (AFB) smear test, urine Mycobacterium tuberculosis culture, routine blood investigations, radiological, cystoscopic and histopathological examinations were recorded for all study patients. Various surgical interventions were performed on the basis of the site involved. After surgical procedure, patients were treated with chemotherapy and followed up for one year to till date. The present study patients were from the age range of 19–75 years with female preponderance. The most common clinical presentation was irritative voiding symptoms (69.81%), haematuria and flank pain (56.60%, each). The most commonly affected organ was kidney (62.26%) following ureter (30.19%), urinary bladder (24.53%), prostate (9.43%) and epididymis (1.89%). The urine AFB smear and urine culture for M. tuberculosis tests were positive in 13.18% and 54.71% of patients, respectively. Surgical interventions were done in majority (75.47%) of patients. Accurate and early diagnosis is vital for the better management of patients with GUTB. Apart from the available course of chemotherapy, surgical intervention is also required for complete management. [ABSTRACT FROM AUTHOR]

Copyright of Summa, Animali da Compagnia is the property of Point Veterinaire Italie s.r.l. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: As a relatively new approach, popularity of pneumovesicoscopic surgery is increasing, but slower than expected due to complex nature of the procedure with efforts to overcome the difficult steps of the procedure. Bladder fixation is one of the crucial steps of the procedure. In this study, we present a novel and simple T-bar technique to overcome this difficulty. Methods: We retrospectively evaluated 24 consecutive patients (39 ureters) who underwent pneumovesicoscopic surgery with fixation of the bladder wall between December 2017 and September 2019. Results: Fixation by transabdominal suture (TS) was performed in 3 patients, while fixation by thread loops with needle in 3 and T-bar device in 18. Tearing of the bladder wall was encountered in 2 patients in TS, in 2 patients with thread loop groups, but none in the T-bar group. Conversion to open surgery was necessary in 3 patients in the T-bar group, but only 1 was related with the fixation technique. Conclusions: T-bar technique is an inexpensive and simple solution providing stable and reliable bladder wall and working port fixation during pneumovesicoscopy. [ABSTRACT FROM AUTHOR]

Copyright of Summa, Animali da Compagnia is the property of Point Veterinaire Italie s.r.l. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

During a kidney transplant, a plastic tube (stent) is placed in the ureter, connecting the new kidney to the bladder, in order to keep the new join open during the initial phase of transplantation. The stent is then removed after a few weeks via a camera procedure (cystoscopy), as it is no longer needed. The present study compared performing this in the operating theatre or in clinic for transplanted patients using a new single-use type of camera with an integrated grasper system. The results have shown that it is safe and cost-effective to do this in clinic, despite patients being susceptible to infection after transplantation. [ABSTRACT FROM AUTHOR]

Primary effusion lymphoma (PEL) is a rare and very aggressive large B-cell lymphoma usually presenting as serous effusions without a tumor mass. It is universally associated with human herpesvirus type-8 (HHV-8) infection. It most commonly occurs in the body cavities and rarely develops as solid tumor masses in the wall of cavity and other organs, and it has been termed as extracavitary PEL. Extracavitary PEL has been reported in the lymph nodes and extranodal sites. Here we report a rare case of extracavitary PEL occurring in the bladder and ureter of a human immunodeficiency virus (HIV)-negative 76-year-old Chinese male, presenting with right leg swelling, erythema, and pain. To the best of our knowledge, this is the first case of extracavitary PEL presenting in the bladder and ureter. [ABSTRACT FROM AUTHOR]

Background: Preoperative imaging assessment is essential to draw an accurate map of endometriotic lesions. Knowledge of the extension and severity of disease is paramount for the surgical team in order to plan the type of surgery, complete the operating team and properly inform the patient with details of the risks. Material and Method: Transvaginal ultrasound is the fi rst-line imaging technique for ovarian and deep infi ltrating endometriosis, but the accuracy of the diagnosis is proportional with the experience of the operator. Respecting the four steps of ultrasound evaluation technique decreases the probability of misdiagnosis. Step 1 include evaluation of the uterus and adnexa, step 2 - evaluation of "soft marker", step 3 - assessment of the Pouch of Douglas using "sliding sign" and step 4 - assessment of anterior pelvic compartment (urinary bladder, uterovesical region and ureters) and posterior pelvic compartment (rectovaginal septum, posterior vaginal fornix, uterosacral ligaments, rectum and sigmoid). MRI is performed as an additional examination in complex cases prior to surgery, in symptomatic patients with negative or equivocal ultrasound fi ndings and it can be useful for diagnosis of multiple sites of deep infi ltrating endometriosis. Results: Important information from recent guidelines and relevant literature are highlighted. Ovarian and deep endometriosis diagnosed by ultrasound scan and MRI imaging - case series (personal experience) will be commented. Conclusion: As with cancer pathology, the success of treatment depends on complete excision of the endometriotic lesions. Rigorous imaging investigation avoids „the tip of the iceberg” mirage and enhances the quality of medical care. [ABSTRACT FROM AUTHOR]