The following is a medical media production from 

WR AMC TV.

In selecting material for this 

talk on obstruction of the ureter.

I used as a basis for the selection of 

material a page from a recent 

publication called Gametes and radiology,

which I'm sure you're all familiar with.

It is a comprehensive list of rick in 

differential diagnosis and it is by 

Maurice um reader and Benjamin Felson 

with contributions by Elliott's keith 

Harris,

her beauty parks and George B.

Greenfield,

the first three of these more reader,

Ben Felson and lethal virus are no strangers to this 

podium that I'm standing at right now 

and I am pleased to have them 

as good friends over the 

years.

Let us look at the list of 

uh this gamut which is 

number 831 in their 

book and just go down the 

various causes that can produce an 

obstruction of the euratom.

As you will note,

these causes are divided into common and 

uncommon and they are in alphabetical 

order,

which means I will not necessarily present 

some of these lesions in the order in which they 

are here,

first of all,

in among the common we have a blood clot or 

inspire stated puss calculus.

Congenital eureka row pelvic junction 

obstruction that is banned vessel or adhesion 

valve,

a vessel cystitis across 

normal bladder with compression or obstruction of intramural 

puritan inflammation and a Diemer that 

is pelvic inflammatory disease,

invasion or compression by extrinsic 

malignancy.

That is retro peritoneal lymphoma or 

sarcoma cost normal of the pancreas,

cervix or other pelvic organs.

Post operative that is lacouture or 

Diemer around the urethra pregnancy 

structure.

That is congenital traumatic postoperative 

radiation therapy,

inflammatory tuberculosis.

Just oh,

massages.

You re to re seal vascular compression by 

normal or abnormal vessel or aneurysm.

And among the uncommon causes there are benign 

eureka raw tuna that is polit papilloma,

Mesen,

Kimmel,

Touma Blatter,

diverticular um carcinoma of the Euro to 

primary or metastatic endometriosis,

mega colon,

popular necrosis where they stuffed happily 

pelvic lipo mitosis and finally,

retro peritoneal fibrosis or 

Orman's disease.

Now,

let us look at many of these lesions 

and have a little discussion on some of 

the causes for obstruction 

and some of the embryology and histology 

behind these lesions.

First of all,

among congenital lesions causing obstruction.

We have here an interesting lesion called congenital 

blind ending urata.

And you can see on this radiograph that there 

is two years,

there are two.

Your it is on the left side with one 

uh in the pelvic pelvis of the 

left kidney above the other ending blindly at this 

point right here and rather shortly 

A second one is this one which is another 

congenital blind ending ureter and a 35 year 

old female with chronic urinary track infection.

And we see that the duplication is almost complete 

with the ureter entering uh ending 

blindly at this point,

very close to the pelvis itself.

Now,

what are these congenital blind ending your edges,

they are a failure in an attempt to reduce application 

of the kidney.

Most of these are white type with one year to 

blind the other connected with the renal pelvis.

Sometimes these inter as 

single as single Eureka's into the bladder.

Therefore to your to your general office is 

on the same side.

Or more frequently they are y in type 

With the two joining together before they 

reach the bladder.

There can be anywhere from 1-2 cm in 

length,

at which time they may resemble a diverticular with the ureter.

Or they may,

as in the second case here extend 

almost the complete way.

I call your attention to this appearance of a 

blind ending because we will see this on several other 

cases where your hands have been tied off for one cause or 

another.

I know of nothing else that looks like this in the 

ureter.

It looks like it ends there.

It has no relation no appearance to a 

calculus or to a tumor.

It is a characteristic feature in itself 

and we will see several others of a similar type as we 

go along.

So much for her blind ending.

Eureka's A second type of 

congenital anomaly is this case of a 

retro cable ureter.

In a 27 year old male with a history of two or 

three episodes of the material accompanied by 

lower abdominal pain And the 

latest episode having occurred just 24 hours 

ago.

The patient's physical exam was negative.

His blood count was normal.

His urine showed many mucous threads traces of 

bacteria,

123 red blood cells and 0 to 1 

white blood cells.

This 15 minute IVP shows 

gradual accumulation of 

contrast material within a moderately hydro 

necrotic right kidney,

a normal appearance on the left side.

In a 30 minute film we see further 

accumulation and now we see filling down to the 

port where the retro cable urata 

has occurred.

And in the 60 minute film we see further 

filling of the media in the 

proximal urata.

No filling in the distal.

You're in a retrograde study was done on the same 

patient immediately after the IVP.

And we see here a feeling of the lower part of 

the left right urata with a 

normal size,

normal diameter of this section.

And we see the typical deformity of 

the retro cable.

Your edit in the film up above there.

In this particular patient's surgery was suggested the 

patient preferred to defer and at last 

was uh report we have not seen him 

come back yet for repair of 

this condition.

Another retro cable urata which is somewhat 

more atypical.

Is this one with an associated incomplete 

rotation of the left kidney.

Here we have a more gradual curve of the 

ureter as it passes towards the midline and 

downward with very little obstruction to 

the euro to has shown on the previous 

case.

As we discussed this,

let's look back for just a moment at the 

more characteristic one and let me read you just a little 

bit about how these occur.

Please play,

pay attention to this because this is a favorite 

urinary track 

question on the board 

examinations.

According from an article by Mayor and Methods.

They state this in 18 93.

Hochstedt to first described this interesting 

anomaly,

which is also called post cable or 

circum cable euratom and pre your 

rhetoric vena cava.

The deformity is not due to an error in 

migration upward of the kidney or your data,

but it results from an abnormality of the 

vascular system.

Embry a logically this condition results from the 

right posterior cardinal vein failing to 

undergo atrophy and persisting as the adult 

vena cava.

Normally this vein disappears and the right super 

cardinal vein persists as the vena 

cava.

Occasionally both cardinal veins may possess the vena 

cava being doubled with the ureter passing 

between the two divisions.

Unfortunately,

there are no symptoms pathetic demonic of retro cable.

You're usually the symptoms of those of hydro 

necrosis.

Were superimposed infection of calculus.

Heh material,

gross or microscopic has been frequently noted and 

was the presenting symptoms in this case right 

here.

Most patients have reached adulthood before symptoms 

develop as the onset of hydrogen fibrosis is 

usually insidious.

The pilot graphic finding,

which is almost pathetic.

No Monica.

Retro cable.

Eureka is the S shaped curve in the upper 

ureter with displacement of the urine immediately 

to all beyond the midline at the 

level of the 3rd,

4th or fifth lumbar vertebra.

So much for retro cable.

Your otis.

Now another case of urethral obstruction,

secondary to a congenital abnormalities,

abnormal implantation of the Euro.

To with an associated eureka,

a seal and a female infant in this case 

with a double kidney and double your.

It is on the left.

This ivp film at 

45 minutes,

shows a defect in the base 

of the bladder here,

which later is shown to be the rigorous seal.

It shows a filling of a 

colossal system here which has the group lily 

appearance of a double kidney.

It shows lateral displacement of the 

uh this portion of the kidney and it shows 

nothing in the upper part of the kidney.

This retrograde study of this uh 

same case reveals the reason 

for all of this here is the rigorous zeal 

in the bladder,

causing the bladder deformity.

The ureter in this case being implanted at 

at abnormally low level,

which is not uncommon with congenital yuri to 

sales the Euro to,

to the upper portion of the double kidney being 

implanted,

invariably in the bladder at a 

lower level than the ureter to the lower 

portion of the kidney.

In an article by Salmoni states that your interest 

seal is a cystic dilatation of the lower end of the ureter 

associated with our officials to notice 

stenosis and prolapse of the cyst into 

the bladder,

the wall of the uterus to reseal consists of 

two layers,

The inner layer is derived from the 

balloon during oral mucosa.

While the outer layer represents the vladimir 

cosa carried downwards on the surface of the 

prolapse ng urata.

The result of all of this is stasis urethral 

dilatation and infection in the Euro.

To and in the kidney.

This still yuri to roll the treasure.

Another congenital anomaly uh of 

the Euro to we have already seen at the 

previous talk.

And again,

let me just amplify this by showing you 

uh a longitudinal 

uh sonogram of the case that we 

saw earlier in the talk on pelvic masses.

Here is the distal ureter 

producing this large uh 

translucent mass at this point right here 

and at a higher level,

producing some of this mass at this point.

Right here,

here again is the Eureka showing its very 

large dilated sausage shaped 

deformity,

which was the cause for the uh 

mass.

And uh which resulted from 

the urethral stenosis at the just 

above the bladder.

In this particular case,

you can see the deformed small cystic 

kidney.

This is a multi cystic kidney which has its 

characteristic findings of a small 

artery,

a small ureter or no urata at all,

your eternal of treasure etcetera.

We will not go further into 

that description 

this morning.

Now you readable 

calculus.

I probably the most common form of your 

federal obstruction of all.

And here are a few atypical cases of 

this condition we have here a 

small calculus with a very high grade obstruction,

resulting in real extra visitation of the contrast 

media with the IVP.

This patient was 68 years old.

He was.

She was awakened at one a.m. with a sharp left 

sided flag pain.

They close up is shown here of this very small 

calculus just in the lower your,

approximate to the bladder entrance.

On this examination.

At five minutes we begin to see an accumulation of the 

contrast material in the involved left side with 

hydro necrosis of the left kidney,

normal findings on the right side.

At 15 minutes there,

further accumulation of the media.

And at 30 minutes we now see 

the filled system 

with extra visitation of some of the media media 

presumably back flowing from the 

what are these with dissection 

downward along the kidney pelvis 

and along the upper part of the your Akhter as 

well.

A very characteristic appearance of extra 

visitation of media from the kidney 

and very commonly and not commonly but occasionally 

seen in high grade obstructions 

of an acute eureka 

associated with an acute urinary 

calculus.

The stone eventually was removed with a basket 

catheter in this individual case.

Uh a complication of pregnancy is the 

presence of a charitable calculus.

And here we have such a case.

This is a close up of the calculus 

just adjacent to the infants.

Uh,

fetuses,

head at this point right here and a 

long shot of the whole system shows 

the distended 

your to down to the level of the calculus 

here.

The stitching above here and the hydro nephritis 

kidney here.

The presence of media in the 

you're too down here probably uh 

excludes the possibility of the so 

called ovarian vein syndrome,

which is also another.

Your it'll type obstruction associated with 

pregnancy.

And we will see such a case of that in just 

a few minutes.

Here's a calculus in a patient who has had an 

illegal conduit uh,

secondary to a pelvic clean out for carcinoma of the 

cervix,

one of the most common malignancies that will 

produce a frozen pelvis and necessitates 

uh a 

diversion of the urinary 

stream,

usually into an illegal can't do it.

On the left side,

there's normal function and the media is passing into the illegal 

pouch here.

Excuse me.

This was not an illegal pouch in this case.

This was one of the old fashioned sigmoid 

pouches which used to be 

done.

But because of various reasons including 

infection,

they are not done to any extent anymore.

The right side shows a new program,

but no feeling of media and we trace it down to this point 

right here and we see a calculus in the 

lower part of this respected urata,

just proximity to its entrance into the illegal 

conduit.

This eventually passed and the patient was relieved of 

the pain.

There's a calculus that resembles a tooth.

This is merely put in here to say that 

one has to differentiate occasionally a calculus in the 

ureter large calculus from a possible 

tooth within a derm board of the ovary.

There are no other findings here to indicate a Dermot of the 

ovary other than the presence of this 

large calculus which does resemble a tooth 

to some extent A far 

invited within the euro to may produce similar obstructive 

symptoms.

And here is one in a 23 year old female with 

sickle cell anemia.

And we see two foreign 

materials within the uh you're too 

here at this point.

And at this point,

right here in this retrograde study and 

on a drainage film,

made a short time later,

we see that there have been impregnation of 

these non opaque densities 

in the 

uh your turn at this point 

and at this point and we see uh 

a rather large uh 

kayla sees in the kidney superior lee 

here to some extent a little bit lower here.

And obviously this is a case of papillary necrosis 

and a sickle cell er who has 

stuffed the potbelly.

And they have passed down the ureter causing a partial 

obstruction of the urinary 

so much for calculator to go now to 

your Itaru tumors.

Let me very quickly give you a 

classification of the tumors that may 

be seen in a euratom.

And then you show you several examples of these.

First of all,

there are the epithelial tumors 

and these may be benign or malignant,

The benign being the papilloma as 

polyps and the adenomas and 

the malignant epithelial tumors being the 

transitional cell carcinomas,

squamous cell carcinomas and 

adenocarcinoma.

In addition to the epithelial tumors,

there is also the occasional meta dermal uh 

tumors which include among the benign the 

five Roma's hemangioma is a blood vascular 

tumors,

mama's limb,

Fangio mazar lymph vascular tumors 

and among the malignant there maybe the occasional 

sarcoma of the urine.

You read all chambers have about a 

1-2% incidence of 

all guiyu tumors.

They occur in male,

about 2 - one over the female.

They range anywhere from the teens and 

20s up to the later years.

The 80s and the 90s.

The mean for these lesions being about 74 

years The pathologist shows 

75-80% being malignant and most 

of these are of the epithelial origin.

The location is usually in the lower third.

In about 75% of cases,

the symptoms include about 70 to 90% of 

cases with the material,

20 to 35% with pain associated 

with the material,

2 to 5% short and abdominal mass.

These would have to be very large in such a case And 

about 10-20% showing abdominal pain 

alone in this 

case.

Right here we have a 

benign.

Excuse me.

In this case.

Right here we have a transition.

Excuse me,

I'll go back again.

The first case here is a urine or a polyp 

in the mail with the material.

This retrograde study of the urinary track reveals a 

filling defect in the lower part of the left ureter with slight 

dilatation of the aorta,

just proximal to the filling defect and violation of the 

euro area and the area of the filling defect,

as shown by the catheter outlining the your 

laterally here.

And if then trickle of contrast.

Media,

media,

media media.

Immediately When the euro was 

opened in this area,

operation out popped a small polyp on a 

pinnacle about one cm in length.

Surgical findings are shown on this uh 

sketch right here,

the lesion was removed and the ureter was 

closed without difficulty.

A second case,

have you read the polyp is of interest?

This 64 year old male was admitted for a vascular 

work up.

The initial IVP examination showed a long filling 

defect in the right proximal year or two has 

shown right here.

Uh huh.

There was a mile hydro necrosis of the right kidney.

Several I.

V.

P.

S over the next six weeks continued to show the filling 

defect and the hydro necrosis.

And this is the last of the several examinations that were 

made.

This persistent defect was thought to be on the basis of a 

benign lesion of some type,

but a definite diagnosis could not be made 

that operation.

The urethral polyp was found measuring about six 

centimeters in length and attached by a very narrow 

base,

just distal to the right you p junction.

This unusual configuration of the lesion was 

probably the result of a soft tissue.

A tumour contained within a very firm loom 

in the ureter with a floor of urine,

continuously washing the fixed mass and accorded 

direction,

thus stretching it out in the configuration that we 

see in this case 

before leaving benign tumors of the 

Euro.

And let me show you an entity that resembles multiple 

tumors of the Euro to but it's not in 

reality these lesions are related to chronic 

infection.

This is a case of Eureka right assist aka 

involving both your photos with a touch 

of power light of cystic A.

As well.

In a 62 year old male with a long history of 

chronic urinary track infection and renal 

calculus.

We can very nicely see 

demonstrated here the multiple,

small,

more or less uniform filling defects within 

the upper half of the two thirds of the right ureter 

and similar defects within the upper part 

of the left ear.

To hear A 

little bit about your to write assist,

Aka.

The first recorded description of you,

you read write a cystic a.

Was by our friend Morgue agony in 

1761.

In a post mortem examination of an old man who had suffered 

from chronic urinary obstruction,

he found in both europe is quote spherical 

drops unquote of various sizes.

Cyst formation is the final stage of the 

proliferated change in the mucosa,

which occurs in the renal pelvis ureter or bladder 

in response to any longstanding irritation,

but usually to a chronic infection,

solid bands of epithelium become 

isolated in the to look appropriate and 

by meta pleasure develop into secretary 

glands.

Finally,

the cyst result from retention of secretions 

elaborated by these glands.

The disease usually occurs in the old age groups and is more 

common in women.

There are no pathetic demonic symptoms or signs,

but almost always urinary infection is 

present often with renal calculus.

I slightly material occurs very frequently and 

is thought to result from spontaneous rupture of one or 

more of these cysts.

The retrograde you're a gram is generally the best method of 

demonstrating the disease,

although a good IVP can do it too.

The salient feature is the presence of constant small 

defects in the contrast field urata or renal 

pelvis.

They may be large indiscreet or multiple and 

small and may occur anywhere along the 

track,

including the pelvis of the kidney,

the Yoda and in the bladder tune 

differential diagnosis.

Although really this can,

this looks doesn't look exactly like anything else 

includes air bubbles,

multiple papilloma to tuberculosis,

granule ations,

multiple small calcula blood clots,

and possibly multiple hemangioma.

Tous formations within the irritant.

So much for benign lesions,

let's go now to the primary malignant 

lesions of the aorta and as I've already mentioned,

most of these are of epithelial origin.

Here is a rather characteristic,

typical pathetic pneumonic picture of a 

primary transitional cell carcinoma of the ureter 

and it has rather characteristic findings.

First of all,

there is what has been described as a goblet 

or wine shaped deformity of the 

contrast media column within 

the ureter.

Second,

there is a modern dilation of 

the Euro to just below the tumor,

which is rather a constant feature,

was first described by 

Bergman and is known as frequently 

as Bergman's sign.

There is a high grade obstruction here,

secondary to the mass of the tumor itself,

which occupies a level through here and there 

is a moderate hydro necrosis and hydro your 

to approximate to this 

lesion,

the kidney and ureter in this case were 

removed.

A second case of interest 

somewhat atypical is this patient who was 

for 65 years of age And had 

had a four year history of Eureka 

assisted juncture obstruction.

This general was apparently treated prior to admission,

but the type of treatment was not stated.

Chief complaint was pelvic pain.

In this patient,

she was admitted.

An examination revealed papa 

limiter on the wall of the bladder and up into the left your 

them and the lesion was cauterized in the bladder.

Three days afterward,

the patient was dismissed from the hospital.

Three days after the patient was dismissed from the 

hospital,

she had further symptoms pathology and she 

was readmitted surgery at this time 

included removal of the left,

your removal of the left kidney and removal of the involved 

parts of the bladder.

The pathological diagnosis was superficial 

transitional cell carcinoma of the bladder 

with extensive papilloma ketosis of the lower ureter,

which probably was a superficial 

uh involvement of the ureter in 

a similar uh type of 

histology that is transitional cell 

carcinoma in this 

patient.

Right here,

the transitional cell carcinoma began in the 

kidney and was later ceded 

to the euratom.

Here is a patient who has a deformity of the 

upper pole of the left 

kidney with an infant nebula involvement and 

a superior pelvic involvement here.

Further study showed that the Euro two was normal in this 

case the patient was an elderly 

man with cardiovascular disease.

So it was elected to do only an effect to 

me and to remove that portion of the your 

took which they could get to through the 

flank incision.

The best treatment of these of course,

is to remove not only that you're that you can get to that 

way,

but to make a lower incision and remove the 

lower part of the ureter as well along 

with a cuff of the bladder and in order to 

forestall seeding of the tumor downward 

and re ah 

development of additional metastatic 

or implant lesions.

This patient later on came back and now we 

see the stump of the right ureter which 

was left with involvement at several 

levels,

including right here with transitional cell carcinoma 

and up here with transitional cell carcinoma,

the entire ureter and a portion of the bladder was 

removed at this time.

Again,

I point out the bulbous 

deformity of the approximately end of the ureter here 

where it was tied off.

Similar to that we saw in the 

blind ending your to at the earlier part of 

this talk,

This patient came in for the next several years 

with 10 or more admissions for additional fall durations of 

tumors developing in the bladder and he eventually 

died of a cardiovascular death,

not of a urinary truck death,

pelvic abnormalities causing urinal 

obstructions,

including inflammations causing a Diemer,

a stricture at the offices to us in the 

bladder and prostate and prostatic hypertrophy 

anomalies of the bladder,

such as extra fee displacements by pro 

laps adjacent lesions and so forth.

Let's look at three cases illustrating some of these 

abnormalities.

First,

here is a patient with extra fee of the bladder with the 

characteristic deformity of the pelvis,

a lack of a synthesis pubis.

As shown here.

If this patient was examined clinically,

one would have seen prior to surgery that the 

anterior wall of the bladder was absent or 

poorly developed and that the 

Eureka's could be seen entering the 

bladder on its posterior superior 

side.

This patient was repaired and here is a tantalum 

mesh over the area of repair at this point right 

here.

This had not prevented the patient,

though from having an obstructed right your order at 

least with a hydro necrosis 

associated in the right 

kidney.

Here is an interesting patient with bilateral 

obstructions of the your eaters,

Secondary to bladder 

calculate this was a 24 year old male 

with persistent diarrhea.

The patient's history is of interest and I'll give it to you 

in just a second on a plane film 

examination these large opaque 

calculus I was seen.

And at a closer look at these,

calculate eye,

one can see that they have a poorly 

defined radio lucent center.

These were removed and examined and they were found 

to have as the night us in the center of these 

some paraffin and the history 

uh came out that this patient 

had on several occasions,

uh self instrumented his bladder with 

rolled up tubes of paraffin and 

evidently at one time some of these 

paraffin parts broke off into the 

bladder,

remained there and worthy noticed for these 

large exorcised,

calculate I,

which developed at a later time.

Mm.

Here is the examination of the 

patient several weeks later,

following the removal of these.

And we can see that the re Toral 

obstructions which probably were 

not secondary to the calcula but rather to infection 

within the bladder and the Deemer of the offices 

has now subsided and there is no longer 

any hydro necrosis.

This is another example of a broader deformity causing 

the hydro necrosis.

Here is a patient with a sister seal.

This was a 64 year old female with the material,

flank pain and temperature 

104 F.

She was found to have a urinary tract infection.

She was also found by clinical examination to have 

a sister seal.

A rector sealed and an epidural 

seal.

A passerby was inserted as a temporary 

measure.

And we can see this car didn't quite drop.

But that's all right.

We can see that the pastry uh 

one week following the previous examination 

has cleared up the hydro necrosis 

here that the earth has now entered at a higher 

level into the bladder rather than into the pull down and 

stretched portions as shown on the previous film.

And that there is now relatively little if any 

hydro necrosis in the 

kidneys.

Uh huh.

Several examples of urinary obstruction related to 

surgery here is a 

patient with advanced carcinoma of the 

cervix.

The patient has had a pelvic clean out and an illegal 

conduit,

elio conduits,

as you're probably aware uh isolated 

segments of ilium which are closed off at 

one end and the other end is brought out to the 

skin for drainage.

The non resected parts of the Euro.

Tas following surgery for the pelvic 

clean out or implanted into this illegal 

loop.

The remaining ilium of course,

which was not used for the conduit is reinvest 

opposed indian for a bowel function.

It has frequently happens that there are temporary obstructions 

associated with these probably due 

to uh edema 

around the office where the Yorkies are 

implanted into the illegal conduit.

It frequently happens that this 

partial obstruction clears up later.

And we have more or less normal 

findings in the urinary track either on the left 

or right side on both sides.

Here is a patient that had a persistent 

obstruction to some extent partial in 

nature which produced a mild degree 

of hydro ureter and a moderate degree of hydro 

necrosis uh bilaterally.

Another your obstructed 

by surgery is this one in a 49 

year old female.

She had a hysterectomy during which 

the left ovarian artery was relegated at the 

pelvic inlet.

Following surgery and abnormally small urinary 

output was noted and an IvP was done 

on here is shown.

We see that the left ureter is 

blocked off at this point again with a bulb 

ascending characteristic of a tied off 

or a respected your toe.

And that there is a martyr degree of hydro 

hydro necrosis.

This is a four hour film so that the right kidney 

normal side has already drained out.

This patient was re admitted 

uh For surgery was was re 

operated upon and the lacouture 

was removed from the ureter and 

urinary tract function was normal.

Following thereafter 

this patient was 

submitted for surgery and she had a vaginal 

hysterectomy.

Uh It was realized after 

surgery that the urinary output which was first 

three or 400 CC.

On the next postoperative day diminished to 

zero an I.

V.

P.

At this time was done.

And we see here the 

obstructed your actors with 

bilateral hydro necrosis and 

some extra visitation of contrast material 

due to this high grade obstruction of an 

acute nature.

Similar to that we saw on the left side caused by the 

urinary calculus.

A little bit later earlier the patient was taken 

to the operating room.

Following this,

she was prepped and draped in the dorsal,

the thought of my position and after adequate general 

anesthesia was obtained.

Both external called Golda plastic 

suitcases were located,

grasp and cut and removed.

There was noted to be almost immediate flow of urine from 

the foley catheter.

Here is an example 

of the ureter after it had been 

dis dislocated and uh 

Retrograde Catheters had been inserted 

into the Euro two for the drainage.

Following the surgery,

the construction of the ureter is noted in the 

left side at that point,

right there and the construction of the right 

ureter was noted in the right side,

right here.

This could be an alarming thing if it was not discovered.

But fortunately in this patient,

the lesion was determined.

The cause for the obstruction was determined 

and the patient was dislocated with 

good results.

Mm hmm.

Finally,

some uh your edible obstructions and 

displacements secondary to non 

urinary tract lesions.

There are many causes for these but we want to cite just 

a few of them I mentioned a 

little earlier that there can be during 

pregnancy.

A syndrome which is known as ovarian 

vein syndrome,

in which characteristically there is a cut 

off of the ureter 

at the point right here where 

the your two 

passes over the iliac 

artery and vein and the ovarian 

vein and there's usually no 

media distantly in the urinary 

shown here,

this is thought to be due to thickening of the 

right ovarian vein related 

to the pregnancy.

And since the right ovarian vein drains 

into the in pierre 

part of the vena cava,

it is commonly a 

cause,

it is occasionally it cause during pregnancy 

for obstruction on the right side.

This entity does not occur on the left side 

because the left ovarian vein does not enter the 

inferior vena cave and thus does not obstruct the Euro 

to.

But rather it is into the 

uh renal vein 

at the higher level on the left 

side.

Here is an interesting case 

that I have not seen before in a 

patient with a right 

urethral obstruction at about the 

same level as the ovarian vein 

syndrome,

which was caused by a tortuous 

iliac artery.

In this case we see the 

deformity of the you order at this 

point right here.

In a uh an oblique view,

we see a little bit better filling and know that it is 

not a tumor within the order itself,

but rather appears to be caused by 

external compression and displacement.

And in this bleak view,

we see that the causes 

appears to be posterior to 

the here are two.

An angiogram was done on this patient and they 

oughta graham where they run off into the iliac arteries.

And we see a very interesting tortuous city of the 

right iliac artery at this point,

right here which corresponded identically to the 

defect that we saw on the medial and 

posterior aspects of the ureter at that 

point,

right there 

here is an example of a right 

law urinal obstruction by large 

endometrium,

a in the pelvic area which is not readily 

demonstrated in these views.

But this rvP made because of the 

pelvic mass with films in 

Supan and in upright 

positions shows a fairly 

marked obstruction on the right side with hydro 

necrosis and hydro urata.

And in the upright film,

a leveling out of the heavier 

media under the urine contained 

within the pelvis of and policies of the right 

kidney and a tortuous city 

of the kidney itself,

your to itself.

And this was proven to result from the large 

endometrium in the pelvic area obstructing 

the right urata to a high 

grade here 

is an example of Crohn's disease.

Obstructing the right ureter and causing a deformity 

of the bladder.

Several articles in recent times have 

indicated and have suggested 

the use of the IVP in all 

cases of regional underwriters,

particularly with involvement of the distal ilium 

because of the presence of 

fistulas tracks and thickening of 

tissues and abscess formation and so on that might 

obstruct one or both of the year.

It is in this case the right ureter was 

obstructed and there is a mild hydro 

Yoda and hydro necrosis on the right and 

there is a deformity of the bladder with an upward 

elevation into a testing process at this 

point right here,

here is some contrast media barium which had 

been given to the patient in a previous small 

intestinal examination.

And here is the picture in the same patient of 

the small intestine showing the 

mark,

degree of involvement of the distal 

ilium in this regional 

enteritis.

And I believe that these areas right here are the 

areas that we saw on the IVP where the 

media had uh collected 

and had caused 

thickening and probably abscess formation in this 

area.

And uh this plus surrounding non 

visualized tissues caused the deformity 

of the bladder itself.

A similar type can happen.

Similar type thing can happen in ovarian 

and in appendix cell 

abscesses which 

cause uh mass 

formation within the retro peritoneal area 

and obstruction of the 

right ureter.

Here is a patient 

similar to the one we saw earlier in 

which there was a retro 

peritoneal.

Adn apathy again,

the curator's are partially 

deformed and displaced by 

these nodes in the iliac area and 

in the para aortic areas.

And we see some of the deformities here again 

in this classical picture caused 

by the enlarged retro iliac 

nodes on the left side,

particularly to the right side to some extent here 

and at higher levels.

The lateral displacements of the kidneys 

and the ureter is caused by the large masses of retro 

peritoneal and apathy notice in this case too 

that there has been some rotation of the kidneys.

And this is not an uncommon finding in 

this entity.

And here is a case of the 

left Eureka and the kidney 

markedly displaced upward and 

immediately by very large 

retro peritoneal mass,

which has a relative radio loose syncing.

This mass extends all the way from the kidney,

above,

down into the pelvic area below,

and one can see in here relative radio loosest 

areas with the lines of water density 

here,

which represented the fibrous 

tissues within a large lipo 

sarcoma of the retro peritoneal 

space.

Not an uncommon place to have 

lipo sarcoma developed and 

particularly around the urinary structures 

with subsequent displacement of 

these structures.

And here finally,

is a large retro peritoneal 

hematoma.

In a patient with hemophilia.

And we see here the large mass 

of blood accumulated in this 

retro peritoneal area in this 

patient with hemophilia with 

subsequent mark deformity of the 

ureter,

even to displacement across the midline to the 

right side,

and with partial obstruction of the ureter 

causing this hydra necrosis in 

the right,

in the left kidney.

So these are some of the examples 

of your eternal obstructions that were 

mentioned in Gamut age 31 

from the book.

Gametes in radiology,

I might say,

for those who don't know it,

that this is a wonderful book for 

differential diagnosis and certainly one 

should be on your shelf in your own 

office or home.

This is my last talk to you today,

and I appreciate the opportunity 

that the doctor made well.

And his staff gave me for coming to the F.

I.

P.

And giving these four talks 

on the subjects of the media steinem,

the pelvic masses and the 

uh your natural obstructions.

And thank all of you for your attention,

a medical media production from w.

R.

M.

C t.

V.