19 obstruction of the ureter

19 Obstruction of the Ureter

CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSIS

EISENBERG

DR. Muhammad Bin Zulfiqar PGR-FCPS III SIMS/SHL

• Fig GU 19-1 Obstructing ureteral calculus. Excretory urogram demonstrates a prolonged nephrogram and marked dilatation of the collecting system and pelvis proximal to the obstructing stone (arrow).

• Fig GU 19-2 Congenital ureteropelvic junction (UPJ) obstruction. Note the characteristic kink or angulation at the UPJ (arrow).

Fig GU 19-3 Postsurgery stricture. Fibrotic narrowing of the proximal ureter secondary to stone removal.

• Fig GU 19-4 Radiation cystitis causing ureteral obstruction. After external and intracavitary radiotherapy for cervical cancer, an excretory urogram shows the bladder wall to be thickened and bladder opacity to be reduced. Narrowing of the distal ureters causes bilateral hydronephrosis.4

Fig GU 19-5 Pelvic tumor. Dilatation of the right ureter and pelvis due to partial obstruction by a large ovarian mass.

• Fig GU 19-6 Bladder cancer causing left ureteral obstruction. Contrast material opacifies the distal left ureter to the point of obstruction. The tumor involves the ureteral orifice and produces a “pseudoureterocele” appearance.4

• Fig GU 19-7 Severe interstitial cystitis. Bilateral ureteral obstruction and marked contraction of the bladder secondary to severe interstitial cystitis due to systemic lupus erythematosus in a young woman on steroids. The bladder capacity was reduced to approximately 1 ounce.4

• Fig GU 19-8 Simple ureterocele (arrows).

• Fig GU 19-9 Ectopic ureterocele. (A) Excretory urogram demonstrates a large lucency (arrows) filling much of the bladder. There is slight downward and lateral displacement of the visualized collecting system on the left. (B) Cystogram shows contrast material refluxing to fill the markedly dilated collecting system draining the upper pole of the left kidney. Note the severe dilatation and tortuosity of the ureter.

Fig GU 19-10 Retrocaval ureter. Note the medial swing of the right ureter distal to the ureteropelvic junction.

• Fig GU 19-11 Transitional cell carcinoma of the ureter. Irregular stricture (arrow) causing proximal ureteral and pelvocalyceal dilatation.

• Fig GU 19-12 Hydronephrosis of pregnancy. Excretory urogram performed 3 days postpartum demonstrates bilateral large kidneys with dilatation of the ureters and pelvocalyceal systems, especially on the right. The large pelvic mass (arrows) indenting the superior surface of the bladder represents the uterus, which is still causing extrinsic pressure on the ureters.

• Fig GU 19-13 Retroperitoneal fibrosis. Marked bilateral hydronephrosis with bilateral ureterectasis above the level of the sacral promontory. Below this point, both ureters, where visualized, appear to be normal in caliber. No definite ureteral deviation is seen. An excretory urogram performed 1 year previously was entirely normal.7

• Fig GU 19-14 Obstructing valve (arrow) at the ureteropelvic junction. Retrograde study shows smooth infoldings below the valve representing fetal folds, which usually regress as the child grows.19