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Related Concept Videos

Disorders of the Urinary System01:20

Disorders of the Urinary System

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The urinary system is responsible for eliminating waste and excess fluids from the body. However, disorders of the urinary system can arise due to various reasons like infections, stress, age, congenital abnormalities, and lifestyle.
Urinary tract infections (UTIs) are one of the most common urinary system disorders. They are caused by bacteria that enter the urethra and can spread to the bladder resulting in cystitis. Pyelonephritis is the result of a UTI that has ascended to the level of the...
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Anatomy of the Genitourinary System I: Kidneys and Ureters01:11

Anatomy of the Genitourinary System I: Kidneys and Ureters

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The upper urinary system comprises two kidneys and two ureters, which are crucial in filtering blood and forming urine.KidneysLocation and Structure:The kidneys are two bean-shaped organs positioned behind the peritoneum on either side of the spine.Kidneys are between the 12th thoracic (T12) and the 3rd lumbar (L3) vertebrae.The position of the liver causes the right kidney to sit slightly lower than the left.Protective Layers:Each kidney is enveloped in a tough, fibrous membrane called the...
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Ureters01:22

Ureters

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The ureters are retroperitoneal tubes located on either side of the vertebral column. They are responsible for transporting urine from each kidney to the urinary bladder. These tubes have thick walls and are approximately 25-30 cm long. Their diameter is around 10 mm at the renal pelvis, gradually narrowing to 1 mm as the ureter obliquely enters the posterior bladder wall through the ureteric orifices. The shape of these orifices is slit-like, which helps to prevent urine backflow toward the...
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Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations01:26

Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations

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Renal calculi, commonly termed kidney stones, are crystalline solid masses that form in the kidneys but can occur at any point within the urinary system, encompassing the kidneys, ureters, bladder, and urethra.The pathophysiology of renal stones involves several key factors: supersaturation of the urine with stone-forming constituents, changes in urine pH, a decrease in urine volume, and the presence of substances that promote or inhibit stone formation.Supersaturation of Urine: This is the...
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Urinary Tract Infection I: Introduction01:26

Urinary Tract Infection I: Introduction

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Urinary tract infections (UTIs) impact various parts of the urinary system, including the kidneys, ureters, bladder, and urethra. These infections are generally bacterial, with Escherichia coli being the most common causative agent, often originating from the gastrointestinal tract. However, other bacteria, such as Staphylococcus saprophyticus, Klebsiella pneumoniae, and Proteus mirabilis, are also known to cause UTIs. The type, location, and underlying complexity of the UTI guide both...
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Anatomy of the Genitourinary System II: Bladder and Urethra01:19

Anatomy of the Genitourinary System II: Bladder and Urethra

888
The lower urinary system consists of the urinary bladder and urethra, which are essential in storing and expelling urine from the body. Together with the internal and external sphincters, these structures work together to regulate urination effectively.Anatomy of the BladderThe urinary bladder is a muscular, stretchable organ behind the pubic bone and in front of the rectum. In females, the bladder is positioned anterior to the vagina and inferior to the uterus, while in males, it is located...
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Assessing Urinary Tract Junction Obstruction Defects by Methylene Blue Dye Injection
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A rare case of herniated duplex collecting system causing obstructive uropathy.

Christopher El Mouhayyar1,2, Haoyang Wang3,4, Laith Hattar3,4

  • 1Department of Medicine, St. Elizabeth's Medical Center, Boston, MA, USA. christopher.elmouhayyar@steward.org.

BMC Urology
|July 3, 2020
PubMed
Summary

This case report details a rare uretero-inguinal hernia involving duplicated ureters, leading to obstructive uropathy and acute kidney injury in a 78-year-old male. Surgical repair successfully restored kidney function, highlighting the importance of considering this rare diagnosis.

Keywords:
Acute kidney injuryDuplex collecting systemUretero-inguinal hernia

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Area of Science:

  • Urology
  • Nephrology
  • Radiology

Background:

  • Inguinal hernias typically involve abdominal organs, but uretero-inguinal hernias of the native collecting system are exceptionally rare.
  • A duplex collecting system, a congenital anomaly, affects 0.8% of the population and has not been previously linked to uretero-inguinal hernias.

Observation:

  • A 78-year-old male with a known inguinal hernia presented with symptoms of urinary tract obstruction and acute kidney injury.
  • CT imaging revealed duplicated left ureters within an inguinal hernia sac, causing cystic dilation, hydroureteronephrosis, and elevated creatinine levels.

Findings:

  • The patient underwent successful inguinal hernia repair with ureteral stent placement.
  • Post-surgery, his kidney function improved to baseline levels, indicating successful management of the obstructive uropathy.

Implications:

  • This case highlights the critical need to consider uretero-inguinal hernias in patients with herniation and acute kidney injury, especially those with congenital urinary anomalies.
  • CT scans are crucial for diagnosing the cause of urinary tract obstruction and identifying the herniated structures.
  • Prompt diagnosis and management, potentially involving ureteral stenting, can prevent severe complications like kidney failure.