The aim of the present study is to create a computational model of the ureteral system that accurately mimics its dynamic functionality. This model will be able to replicate the peristaltic movement of the ureter for a variety of physiological conditions. The objective of this research was met using our in-house fluid solid interaction model, known as coupled Cgles-Y-code in which the moving boundaries between the solid and fluid domain were replicated using a novel immersed boundary method. First, a comprehensive literature review on ureteral physiology was conducted with a focus on the anatomy of the ureter and theories behind mechanisms of ureteral peristaltic function in various physiological and pathological conditions. Next, the nonlinear tensile properties of the ureteral wall were integrated into the Y-code using the equivalent strain method and the resulting model was compared with a model with linear tensile properties. It was shown that the implementation of nonlinear tensile properties was more accurate and more closely matched the behaviour of the native ureteral wall. Next, the development of more anatomically accurate ureter model geometry was presented along with a variety of approaches to optimise the mesh resolution for this complex model. A new algorithm was then developed in order to model the Intra-Abdominal Pressure (IAP) into the Y-code. Next, two separate contraction models, constant radial and time-window-frame, were introduced. It was observed that a use of the time-window-frame contraction model coupled with the IAP algorithm exhibited a better agreement with the existing clinical data than the constant radial contraction model. Finally, a comprehensive study was conducted on the urodynamic responses when different pathological conditions are modelled. The results from using a linear tensile model, replicating an unhealthy condition, showed a high level of shear stress around the contraction lumen and a higher urine velocity in vicinity of the contraction region. In another scenario, a highly depressed amplitude of peristalsis, known to be a consequence of taking vasodilators, was simulated. It was shown that an inefficient contraction can increase the possibility of continuous reflux during the propagation of peristalsis.

by Yeung Chung Kwong. / Thesis (M.D.)--Chinese University of Hong Kong, 1995. / Includes bibliographical references (leaves 279-311). / STATEMENT OF ORIGINALITY --- p.8 / ABSTRACT --- p.9 / INDEX TO TABLES --- p.17 / INDEX TO FIGURES --- p.19 / ACKNOWLEDGEMENTS --- p.22 / Chapter SECTION I --- INTRODUCTION / Chapter CHAPTER 1 --- Traditional Concepts of Vesicoureteric Reflux --- p.25 / Chapter 1.1 --- Historic Review --- p.26 / Chapter 1.2 --- Vesicoureteric Reflux (VUR) as an Anomaly --- p.28 / Chapter 1.2.1 --- The Normal Ureterovesical Junction --- p.28 / Chapter 1.2.2 --- Proposed Pathogenesis of VUR --- p.29 / Chapter 1.2.3 --- Ureteric Bud Theory --- p.31 / Chapter 1.2.4 --- Primary versus Secondary VUR --- p.31 / Chapter 1.3 --- Prevalence and Sex Distribution of VUR --- p.33 / Chapter 1.4 --- Diagnosis and Grading --- p.35 / Chapter 1.4.1 --- Micturating Cystourethrogram in the Diagnosis of VUR --- p.35 / Chapter 1.4.2 --- Radionuclide Cystography --- p.36 / Chapter 1.4.3 --- Grading Systems of VUR --- p.37 / Chapter 1.5 --- Natural History of VUR --- p.38 / Chapter CHAPTER 2 --- Reflux Nephropathy --- p.40 / Chapter 2.1 --- Introduction --- p.41 / Chapter 2.2 --- Pathogenesis of Reflux-associated Scarring --- p.41 / Chapter 2.2.1 --- VUR and Urinary Tract Infection --- p.43 / Chapter 2.2.2 --- "Intrarenal Reflux and ""Big Bang"" Theory" --- p.45 / Chapter 2.2.3 --- VUR with Sterile Urine --- p.47 / Chapter 2.3 --- Effect of VUR on Renal Growth and Function --- p.49 / Chapter CHAPTER 3 --- Management of VUR --- p.52 / Chapter 3.1 --- Introduction --- p.53 / Chapter 3.2 --- Medical Management --- p.54 / Chapter 3.3 --- Antireflux surgery --- p.56 / Chapter 3.3.1 --- Ureteric Reimplantation --- p.57 / Chapter 3.3.2 --- Endoscopic Procedure --- p.58 / Chapter 3.4 --- Medical versus Surgical Treatment: Continuing Dilemma --- p.59 / Chapter CHAPTER 4 --- Antenatal Diagnosis of Fetal Uropathies: Impact on Pathogenesis of VUR --- p.63 / Chapter 4.1 --- Primary VUR Detected Following Antenatal Diagnosis of Fetal Hydronephrosis --- p.64 / Chapter 4.2 --- Impact on Traditional Concepts of VUR and Reflux Nephropathy --- p.67 / Chapter CHAPTER 5 --- Cystometric Concept of VUR --- p.70 / Chapter 5.1 --- Introduction --- p.71 / Chapter 5.2 --- Bladder Dysfunctions Associated with VUR --- p.73 / Chapter 5.3 --- Need for A Cystometric Classification of VUR --- p.75 / Chapter CHAPTER 6 --- "Summary, Hypothesis and Outline of Studies" --- p.77 / Chapter 6.1 --- Continuing Controversies in VUR and Reflux Nephropathy --- p.78 / Chapter 6.2 --- "Hypothesis, Objectives and Outline of Studies" --- p.81 / Chapter SECTION II --- STUDY DESIGN AND RESULTS / Chapter CHAPTER 7 --- Primary VUR in Infants with Prenatally Diagnosed Hydronephrosis: Differences Between the Two Sexes --- p.87 / Chapter CHAPTER 8 --- A Clinicopathological Study on Reflux Nephropathy in Children Submitted to Unilateral Nephrectomy --- p.109 / Chapter CHAPTER 9 --- Urethrograms in Male Refluxing Infants with Prenatally Diagnosed Hydronephrosis: Further Evidence for Transient In-utero Bladder Outlet Obstruction --- p.127 / Chapter CHAPTER 10 --- Urodynamic Studies in Children --- p.144 / Chapter 10.1 --- Conventional Cystometry in Children --- p.145 / Chapter 10.2 --- Difficulties for Conventional Cystometry in Infants with VUR --- p.146 / Chapter CHAPTER 11 --- Natural Filling Cystometry in Infants and Young Children: A New Technique --- p.149 / Chapter CHAPTER 12 --- Some New Insights into Bladder Function in Infancy --- p.168 / Chapter CHAPTER 13 --- Natural Filling Urodynamic Studies in Young Infants with Primary VUR --- p.185 / Chapter CHAPTER 14 --- Primary VUR Detected in Early Infancy: Relationship Between Bladder Functional Status and Outcome of Reflux in the Second Year of Life --- p.207 / Chapter CHAPTER 15 --- Natural Filling Direct Isotope Cystography with Synchronous Urodynamic Study (NFDIC): A New Technique with Significant Prognostic Value for Primary VUR --- p.226 / Chapter CHAPTER 16 --- Quantitation of VUR and Bladder Emptying by Synchronous Isotope Cystograpgy and Urodynamic Recording (QIC) --- p.242 / SECTION III DISCUSSION --- p.266 / REFERENCES --- p.279

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2009. / Härtill 4 uppsatser.

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde. Programa de Pós-Graduação em Ciências Médicas. / Made available in DSpace on 2012-10-22T01:57:21Z (GMT). No. of bitstreams: 1 232381.pdf: 570316 bytes, checksum: dc5e19ca32340026a0b6f691a0e3d267 (MD5) / Introdução: A correção da estenose da Junção Ureteropiélica vem se desenvolvendo ao longo das últimas décadas com técnicas minimamente invasivas, culminando com o aparecimento das técnicas laparoscópicas. Objetivo: Avaliar os resultados das pieloplastias Vídeo-laparoscópicas realizadas pela técnica de Fenger no período de novembro de 1996 a março de 2003. Método: Elaborado protocolo para coleta dos dados dos pacientes submetidos à operação. Resultados: Foram realizadas 21 operações. O diagnóstico da estenose foi estabelecido através dos sintomas clínicos e confirmado por urografia excretora e cintilografia renal dinâmica. O acompanhamento pós-operatório foi realizado através da avaliação clínica e urografia excretora. A média de idade de 35,1 anos, sendo 12 (57,1%) homens. O tempo operatório médio foi de 125minutos. O índice de complicações de 9,52%, com taxa de sucesso de 95,24%. Conclusão: A pieloplastia Vídeo-laparoscópica é uma alternativa efetiva para o tratamento da estenose da JUP.

Leung Yee Fong. / "August 2002." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2002. / Includes bibliographical references (p. 262-287). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

Thesis (Ph.D.)--University of Adelaide, Dept. of Paediatrics, 1999. / Bibliography: leaves 231-266.

Thesis (doctoral)--Rijksuniversiteit te Groningen.

Thesis--Umeå University, Sweden. / Also published as Umeå University Medical dissertations, ISSN 0346-6612 ; new ser. no. 75.

Background: Ureteral herniations are a rare occurrence, generally found incidentally on cross sectional imaging or during surgical intervention for unrelated processes. Several locations of ureteral herniations can occur including the inguinal, femoral, sciatic, obturator, and thoracic regions. While few reports of ureteral hernias are reported in the literature overall, the vast majority of those reported are inguinoscrotal herniations found during evaluation and treatment of inguinal hernias. Pelvic outlet ureteral herniations intrinsically are more common secondary to their dependent locations. Intrathoracic ureteral herniations through diaphragmatic defects are an exceptionally rare subset of ureteral herniations and have only been described sparingly. Fewer than ten case reports of diaphramatic ureteral herniations have been reported and none have described both cystoscopic management and open reconstruction. Case presentation: We report the case of a 81 year old female with flank pain who was found to have idiopathic diaphragmatic hernia with incarcerated proximal ureter. She had no prior injury or surgery that explained her clinical presentation. She was initially observed and then managed conservatively with ureteral stent exchanges. Ultimately she underwent open surgical repair of her diaphragmatic hernia, reduction, resection and anastomosis of redundant proximal incarcerated ureteral segment, and nephropexy for a hypermobile right renal unit. This case report illustrates the pre-and post-operative imaging studies of a very rare intrathoracic ureteral herniation as well as surgical approach to repair. Conclusion: A herniated ureter is a potential source of serious renal and ureteral complications. The thoracic herniation of ureter is the rarest of the ureteral herniations. When discovered, they should be managed to preserve renal function and prevent strangulation of the affected segment of ureter. This case report documents the treatment of a thoracic ureteral herniation with observation, conservative endoscopic management, and finally open surgical reconstruction.

INTRODUÇÃO E OBJETIVOS: Há controvérsias em relação à indicação e ao momento ideal de realização de derivação urinária em pacientes com obstrução ureteral secundária a neoplasias malignas avançadas. O objetivo do presente estudo foi identificar fatores relacionados ao mau prognóstico de pacientes com nefropatia obstrutiva maligna e criar um modelo de estratificação de risco desses pacientes, a fim de fornecer evidências para uma melhor decisão terapêutica. MÉTODO: Realizou-se estudo prospectivo com pacientes portadores de insuficiência renal obstrutiva por neoplasias pélvicas, acompanhados por um tempo mínimo de seis meses, tratados entre janeiro de 2009 à novembro de 2011. De um total de 340 pacientes submetidos à procedimentos de descompressão ureteral por catéter ureteral (CUR) ou nefrostomia percutânea (NPC), 208 foram incluídos no estudo por serem maiores de 18 anos, apresentarem obstrução ureteral secundária à neoplasias malignas, confirmada por tomografia computadorizada (TC) ou ultrassom (USG) e por terem realizado derivação urinária por catéter ureteral ou nefrostomia percutânea em nossa Instituição. RESULTADOS: A sobrevida média global foi de 144 dias, com mortalidade ao final do estudo de 164 pacientes (78.8%), sendo 44 (21.2%) durante a internação hospitalar. Não houve diferença significativa na sobrevida global entre os dois tipos de derivação urinária realizada (p = 0.216). Após análise univariada, a presença de qualquer sintoma (p = 0.014), derrame pleural (p = 0.015), grau de hidronefrose 1 e 2 (p = 0.001), Índice de Charlson >= 6 (p = 0.003), linfonodos retroperitoneais metastáticos (p = 0.002), linfonodos pélvicos metastáticos (p = 0.024), número de sítios relacionados à disseminação da doença >= 4 (p < 0.001), niveis séricos iniciais de uréia >= 80mg/dl (p = 0.01), sódio <= 138 mEq/L (p = 0.018) e albumina < 3.0 mg/dl (p = 0.035), diálise peri-operatória (p = 0.05) e índice de ECOG PS (Eastern Cooperative Oncology Group Performance Status) >= 2 (p < 0.001), foram associados a menor sobrevida média. A análise multivariada de Cox revelou que apenas o número de sítios relacionados à disseminação maligna (quatro ou mais) e o índice de ECOG PS >= 2 foram significativamente associados à menor sobrevida. A fim de criar um modelo de estratificação de risco, os pacientes foram, posteriormente, divididos em três grupos: nenhum fator de risco - grupo I, um fator de risco - II e dois fatores de risco - III. As taxas de sobrevida mediana de 1,6 e 12 meses nesses grupos foram, respectivamente de 94.4%, 57.3% e 44.9% no grupo I, de 78.0%, 36.3% e 15.5% no grupo II e de 46.4%, 14.3% e 7.1% no grupo III, com diferenças significativas nos perfis de sobrevivência dos três grupos de risco (p < 0.001). CONCLUSÕES: Nosso modelo de estratificação de risco poderá representar uma ferramenta útil na decisão de se instituir procedimentos de desobstrução ureteral em pacientes com neoplasias abdominopélvicas malignas avançadas. Pacientes com mais de quatro sítios de metástases e com índice de performance (ECOG) igual ou superior a 2 apresentam pobre evolução após derivações urinárias realizadas para tratar nefropatia obstrutiva maligna. De acordo com o método de estratificação de risco de óbito por nós descrito, pacientes com um ou mais fatores de risco evoluem com sobrevida mais precária que os casos sem fatores de risco presentes / INTRODUCTION AND OBJECTIVES: There is a controversy regarding the decision to perform diversion procedures in patients with ureteral obstruction secondary to advanced malignancies. The goal of this study was to identify poor prognosis factors and to create a model to stratify patients with malignant obstructive nephropathy in order to provide evidence-based information for better treatment decisions. METHODS: A prospective study was performed from January 2009 to November 2011, with patients followed at least for 6 months. From 340 patients initially submitted to ureteral decompression procedures by ureteral stents or percutaneous nephrostomy, 208 were elected for the study because they were 18 years old or more and presented ureteric obstruction secondary to any type of malignancy, confirmed by computadorized tomography (CT) or ultrasound (US) and were submitted to urinary diversion by ureteral stents or percutaneous nephrostomy at our institution.RESULTS: The median survival for all patients was 144 days, with mortality at the end of study seen in 164 patients (78.8%) including 44 (21.2%) during hospitalization. There was no significant difference in overall survival between the two types of urinary diversion (p = 0.216). After univariated analysis the presence of any symptoms (p = 0.014), pleural effusion (p = 0.015), degree of hydronephrosis 1 and 2 (p = 0.001), Charlson Index >= 6 (p = 0.003), metastatic retroperitoneal lymph nodes (p = 0.002), metastatic pelvic lymph nodes (p = 0.024), number of sites related to dissemination >= 4 (p < 0.001), preoperative serum level urea >= 80mg/dl (p = 0.01), sodium <= 138mEq/L (p = 0.018), albumin < 3.0 mg/dl (p = 0.035), perioperative dyalisis (p = 0.05) and ECOG PS index >= 2 (p < 0.001) were associated to shorter mean survival. The multivariate Cox proportional hazards regression model revelead that only the number of sites related to malignant dissemination (4 or more) and the index of performance status of Eastern Cooperative Oncology Group (ECOG PS >= 2) were significantly associated with short survival. To creat a risk stratification model, the patients were further divided into three risk groups: no risk factor - favorable group, one risk factor - intermediate and two risk factors - unfavorable, to creat a risk stratification model. The median survival rates at 1,6 and 12 months were respectively, 94.4%, 57.3% and 44.9% in the favorable group; 78.0%, 36.3% and 15.5% in the intermediate group and 46.4%, 14.3% and 7.1% in the unfavorable group. There were significant differences in the survival profiles of the three risk groups (p < 0.001). CONCLUSION: Our model of stratification may be a useful tool before deciding on ureteral desobstruction procedures in patients with advanced abdominopelvic malignancies. Patients with more than four sites of metastases and performance index (ECOG) equal to or greater than 2 have a poorer outcome after urinary diversion. According to the method of risk stratification for death from we described, patients with one or more risk factors have significant poorer outcome than cases with no risk factors