Easy Notes On 【Ureter】Learn in Just 4 Minutes!
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Fused kidneys are usually ectopic in position. In all fused kidneys, the arterial supply and venous drainage are grossly abnormal [ 9 ]. Horseshoe kidney is the most common renal fusion anomaly, with an incidence of approximately 0. It usually lies in a lower position than the normal kidneys because the isthmus does not permit ascent beyond the inferior mesenteric artery IMA.
Most cases are fused at the lower poles by an isthmus. Isthmus is comprised of either functioning renal parenchyma or fibrous tissue that crosses the midline of the body.
Relationship of uterine artery with ureter.
The isthmus kidneys namely Vesicoureteral reflux, Ureteral duplication, ectopic ureterocele, retrocaval ureter, multicystic dysplasia, adult polycystic kidney disease, hypospadias, undescended testes, bicornuate uterus, and septate vagina [ 9 ]. Other congenital anomalies outside the genitourinary system are musculoskeletal hemivertebrae, scoliosis, rib defects, clubfoot, congenital hip dislocationcardiovascular ventriculoseptal defectsgastrointestinal anorectal malformation, malrotation and Meckel diverticulumand central nervous systems neural tube defects anomalies.
Axial contrast-enhanced CT scan a case of trauma in a horseshoe kidney showing isthmus arrowhead of horseshoe kidney and hematoma arrows formation on the right side due to trauma of right pole of horseshoe kidney. Axial contrast-enhanced CT scan showing isthmus white arrow of horseshoe kidney with malignant mass black arrow in right half of horseshoe kidney.
Two types of horseshoe kidney are identified [ 511 ] depending upon whether midline or lateral fusion has occurred: On imaging, horseshoe kidneys may be identified on abdominal radiographs. Four kinds of abnormal renal outlines [ 10 ] suggestive of horseshoe kidney are - lower than normal, too close to the spine, vertical long axis and visible isthmus Figure Plain X-ray abdomen showing lower poles of kidneys white arrows lying medially and closer to the spine in a case of horseshoe kidney and bilateral symmetrical calculi black arrows in pelvis in lower ureters in a case of bilateral ureterocele.
It is also known as cake or lump kidney.
Congenital Anomalies of Kidney and Ureter
In rare instances, such kidneys possess one ureter. The fused kidney occupies prevertebral or presacral space [ 12 ] Figure Axial contrast-enhanced CT scan showing disc like enhancing structure arrows in pelvis suggestive of a disc kidney. Unilateral fused kidney or crossed fused renal ectopia: Crossed fused renal ectopia is the second most common fusion abnormality of the kidney, with an estimated incidence of approximately 1: In crossed fused ectopia, one kidney crosses over to opposite side, and the parenchyma of the two kidneys fuse.
Usually, the upper pole of the inferiorly positioned crossed ectopic kidney is fused to the lower pole of the superior, normally positioned kidney.
The ureter of the ectopic kidney crosses the midline and enters the bladder on the opposite side [ 13 ]. Types of crossed fused ectopia [ 58 ]: Blood supply to the ectopic kidney most frequently arises from the vessels on the ipsilateral side but occasionally arises from the contralateral side [ 915 ].
Cross fused renal ectopia is typically Asymptomatic and is diagnosed as an incidental finding when the patient is examined for other medical diseases. Complications are nephrolithiasis, ureteropelvic junction obstruction, hydronephrosis, reflux, ectopic ureteroceles and tumors [ 9 - 17 ].
On imaging, diagnosis of crossed renal ectopia may be suggested from abdominal radiograph if one renal outline is not visualised and the opposite renal outline is enlarged or when stones are seen at unusual positions. Excretory urography shows the absence of a kidney in its normal position with evidence of two kidneys on the same side of the abdomen vertically oriented one above the other. Ultrasound can determine if the kidney is in its normal renal fossa.
The presence of the two kidneys on one side and the absence of a kidney in the contralateral side are suggestive of crossed ectopia Figures Contrast-enhanced CT coronal MIP images showing a crossed fused ectopia with polycystic kidney disease black arrow and opening of ectopic ureter white arrow in left side b crossed fused ectopic kidney with cysts black arrow.
Axial T2W MRI of same patient depicting polycystic kidney disease arrows in case of right crossed fused ectopia. Intravenous urography film in a case of ureteropelvic junction obstruction PUJO of right crossed fused ectopic kidney showing excretion of contrast in displaced pelvicalyceal system black arrow and ureter white arrow of orthotopic kidney with obscuration of right psoas shadow by PUJO of crossed fused ectopic kidney black arrowhead and non-visualised left kidney in left renal fossa.
Coronal contrast-enhanced CT scan in same case of ureteropelvic junction obstruction PUJO of right crossed fused ectopic kidney showing excretion of contrast in displaced pelvicalyceal system white arrow and PUJO black arrow of crossed fused ectopic kidney. Intravenous urography in a case of left crossed fused ectopia showing a orthotopic kidney black arrowhead with caudally placed crossed fused ectopic kidney white arrowhead and ureter white arrow of ectopic kidney opening on the right side b ureter black arrow of orthotopic kidney opening on left side.
- The Ureters
Intravenous urography film in a case of left crossed fused ectopia showing ureteropelvic junction obstruction black arrow of the orthotopic kidney and crossed fused ectopic kidney white arrow located caudally and its ureter curved arrow crossing and opening in its normal position. Anomalies in size Renal hypoplasia: Renal hypoplasia signifies a congenital renal parenchyma anomaly in which too few nephrons are present [ 5 ].
Ask-Upmark kidney consists of a segmental renal scar and is characterized by hypertension, generally seen in young females. It usually affects only one kidney, which tends to be small and excretes normally. The scar is in the midzone. The number of calyces is less than seven and the calyces under these scars are clubbed [ 5 - 33 ]. Renal Dysplasia — It is a congenital renal parenchyma malformation in which abnormal nephrons and mesenchymal stroma are found.
It is important to differentiate hypoplastic kidneys from dysplastic kidneys. On imaging, a hypoplastic kidney is small Figure 21 but otherwise normal whereas a dysplastic kidney is also small but it is poorly defined with presence of cortical cysts Figure Coronal contrast- enhanced CT scan showing small hypoplastic right kidney arrow which shows normal outline and nephrographic enhancement.
Coronal contrast-enhanced CT scan showing small left kidney with presence of multiple cysts arrow suggestive of dysplastic left kidney. Differentials of unilateral renal dysgenesis are postobstructive atrophy, renal vascular anomalies, post inflammatory atrophy, VUR, post radiation therapy and heminephrectomy. Congenital Anomalies of Ureter Megaureter Megaureter is defined as presence of an enlarged ureter with or without concomitant dilatation of the upper collecting system.
A ureteric diameter of 7 mm or more should be considered a megaureter [ 18 ].
Congenital Anomalies of Kidney and Ureter | OMICS International
Primary megaureter includes all cases of megaureter due to an idiopathic congenital alteration at the Vesicoureteral junction Figure There are three subtypes - obstructed primary megaureterrefluxing primary megaureter, and nonrefluxing unobstructed primary megaureter. Intravenous urography film showing a case of dilated tortuous megaureter white arrow on the left side and a normal caliber ureter black arrow on the right side.
In obstructed primary megaureter, there is dilatation above a short 0. Refluxing primary megaureter is caused by a short or absent intravesical ureter, congenital paraureteric diverticulum, or other derangement of the Vesicoureteral junction. Secondary megaureter occurs as a result of some abnormality involving the bladder or urethra eg, urethral valves, neuropathic bladder dysfunction, urethral strictures, ureteroceles, and acquired causes of obstruction.
US shows hydronephrosis and ureteral dilatation above the persistently narrowed distal aperistaltic segment. Real-time US reveals active peristaltic waves passing to and fro in the dilated ureter above the narrowed segment and disproportionate dilatation of the lower ureter relative to the upper ureter and renal pelvis [ 22 ].
Ureterocele Ureterocele is ballooning of the distal end of the ureter. Ureteroceles may be associated with either a single or a duplex ureter. On US, simple ureterocele is seen as a cystic intravesical mass. With real-time US, partial or complete collapse of a simple ureterocele secondary to ureteric peristalsis can be demonstrated. At VCUG, a collapsed simple ureterocele usually manifests as a rounded filling defect within the bladder.
Ectopic ureterocele is almost invariably associated with a duplex collecting system and represents the distal portion of the ureter of the upper renal moiety. An ectopic ureterocele is more inferiorly located than a simple ureterocele. Intravenous urography film demonstrating bilateral ureterocele arrow larger in size on the right side.
Axial contrast-enhanced CT scan showing right sided ureterocele white arrow with calculi within the ureterocele black arrow. Pseudoureteroceles [ 5 ] are rare and consist of two types — i coiled uniformly dilated distal segment of the ureter forming a submucosal mass ii ectopic ureter draining into a mesonephric duct cyst. Duplex systems Duplex system — a renal unit in which two pyelocalyceal systems are present and is associated with a single or bifid ureter incomplete or complete duplication.
Nubbin Sign — refers to urographic appearance of a nonfunctioning or poorly functioning lower pole of a duplex kidney Figure Bifid, Trifid and Multifid renal pelves — refers to two, three or more renal pelves that unite distal to the normally expected position of the ureteropelvic junction. The lower pole is generally larger than the other pelvis or pelves and drains a larger number of calyces. Bifid ureter — In the upper part there are two ureters while lower down the ureters join to form a single ureter.
This joining may be extravesical Y- junction or intravesical V-junction Figures 27 and Double ureters — ureters remain completely separate to the point where they insert in the bladder or beyond.
According to Weigert-R Meyer rule, the upper pole ureter opens below and medial to the lowerpole ureter Figures 29 and Coronal contrast-enhanced MIP images showing incomplete left duplex system black arrow and hydronephrosis of upper moiety white arrow mimicking a cystic mass. Intravenous urography film showing incomplete duplication white arrow on right side and complete duplication black arrow left side with ureterocele curved arrow of upper moiety ureter Figure Intravenous urography film showing complete duplication right side with upper moiety black arrow with its ureter black arrowhead opening inferomedially and lower moiety white arrow with its ureter white arrowhead opening in normal location.
Normal left pelvicalyceal system curved arrow is seen. Contrast-enhanced CT coronal MIP images of a case of left sided complete duplication showing a two pelvicalyceal system black arrow and b two ureters white arrow.
The referred pain of ureteric colic is associated with the cutaneous regions innervated by exactly the same spinal segments as that of the ureter, i. Pain of ureteric colic commences in the loin, shoots downward and forward to the groin and after that into the scrotum or labium majus. Pain from upper ureteral obstruction is referred to the lumbar region T12 and L1.
Pain from middle ureteral obstruction is referred to the inguinal, scrotal or mons pubis, and upper medial aspect of the thigh L1, L2. Pain from lower ureteral obstruction is referred to the perineum S2 S4.
Localization of a Ureteric Stone on the Plain Radiograph of the Abdomen To localize the stone in the ureter in plane X-ray abdomen, one must understand the course of ureter in connection to the bony skeleton. Ureter is located in front of the tips of the transverse processes of the lower 4 lumbar vertebraecrosses in front of the sacroiliac joint, swings out to the spine of the ischiumand after that runs medially to the urinary bladder.
In plane X-ray of abdomen, for that reason the radiopaque shadow of ureteric calculus is generally viewed in these sites: Near the tips of the transverse processes of lumbar vertebrae. Overlying the sacroiliac joint. Overlying or somewhat medial to the ischial spine. Injury to Ureter Based on Kenson and Hinman, the ureter could possibly be injured at one of many subsequent 4 dangerous sites: Point where the ureter crosses the iliac vessels.
In the ovarian fossa. Where the ureter is crossed by the uterine artery most dangerous site as damage is likely at this site during hysterectomy. At the base of the bladder. Ureteric Calculus Ureteric calculus probably will stay at 1 of the sites of anatomical narrowings of the ureter especially: At the pelvic ureteric junction.
Where it crosses the pelvic brim. In the intramural part- the narrowest part.