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Ureterolithiasis after Cohen re-implantation--case report
Sonal Chaudhary1, Miranda Lee, Henry O Andrews
1Barts and the London Queen Mary's School of Medicine and Dentistry, London, United Kingdom. sonalch@yahoo.com
Insights
Transverse ureters from childhood surgery pose challenges for adult urological procedures like ureteroscopy. Specialized care is recommended for patients with difficult ureteric access or abnormal anatomy.
Area of Science:
- Urology
- Endourology
Background:
- Cross-trigonal ureteral reimplantation for pediatric vesicoureteral reflux creates a population with transversely lying ureters.
- This anatomical variation increases risks for stone and urothelial cancer formation in adulthood.
- Transverse ureters complicate ureteroscopy, often making ureteric access impossible.
Observation:
- A young man with hyperparathyroidism-induced urolithiasis presented with treatment difficulties.
- He had undergone a Cohen reimplantation of the right ureter in childhood, resulting in a transverse ureter.
- The patient initially omitted this crucial surgical history.
Findings:
- The case highlights significant challenges endoscopists face with patients who have undergone prior ureteral reimplantation.
- Difficult ureteric access due to anatomical abnormalities, such as transverse ureters, can impede necessary urological interventions.
Implications:
- Patients with challenging ureteric access, abnormal anatomy, or known cross-trigonal reimplantations require specialized endourology unit management.
- Early identification and management in specialized centers can improve outcomes for these complex cases.
Background:
In the past decades, the widespread use of cross-trigonal ureteral reimplants for the treatment of children with vesicoureteral reflux has resulted in a large population of patients with transversely lying ureters. As this population gets older they will consequently be entering an age group at higher risk for stone and urothelial cancer formation. If ureteroscopy becomes necessary, the transverse position of the ureter makes ureteric access often impossible.
Case Presentation:
We present the case of a young man who not only suffered from urolithiasis due to hyperparathyroidism, but also further jeopardized his treatment by omitting the fact that as a child he underwent Cohen reimplantation of the right ureter.
Conclusions:
This case illustrates the particular difficulties the endoscopist may face in this group of patients. Patients with difficult ureteric access, abnormal anatomy, or those with known cross-trigonal ureteric reimplantations should be managed in a specialised endourology unit.
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