Post on 05-Apr-2018
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Case Presentation
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The condition started 5 ys. Ago
Recurrent attacks.Patient asked medical advice several times and
received medical ttt for UTI & chronic prostatitis
several times.
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Operations
Medical illness
Bilhariziazes
TB
Stone passage
-Ve
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Abdominal & ext. Genitalia NAD
DRE Soft tender prostate
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CBC -------- NAD
Kidney & Liver Function ------- NAD
Urine:
Pus cells : 8-10
Ca Oxalate: +
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Culture & Sensitivity For Urine & EPS
Nogrowth
Nogrowth
Nogrowth
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KUB------ NAD
US --------- Non visualized
Rt. Kidney in its normal
position but cystic swelling
at the pelvis beside UB ??
Hydronephrotic ectopic
Kidney
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KUB------ NAD
US --------- Non visualized
Rt. Kidney in its normal
position but cystic swelling
at the pelvis beside UB ??
Hydronephrotic ectopic
Kidney
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IVU ------- Non visualized
Rt. Kidney with
compensatory hypertrophy
of left kidney
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IVU ------- Non visualized
Rt. Kidney with
compensatory hypertrophy
of left kidney
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Isotope Scan
No Rt. Renal perfusion
Adequate function of Lt.
Kidney.
Adequate compensatory
power of Lt. Kid. For the
complete loss of Rt. Renal
function.
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Isotope Scan
Global GFR = 70 ml/m
Lt. GFR = 70 ml/m
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CT Scan
Non visualized Rt. Kid.
Hypertrophied Lt. Kid.
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CT Scan
A 5x6 cm cystic structure
at the Rt. Side of the
pelvis displacing the Rt.
Aspect of the UB.
No evident contrast
enhancement.
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CT Scan
A 5x6 cm cystic structure
at the Rt. Side of the
pelvis displacing the Rt.
Aspect of the UB.
No evident contrast
enhancement.
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CT Scan
A 5x6 cm cystic structure
at the Rt. Side of the
pelvis displacing the Rt.
Aspect of the UB.
No evident contrast
enhancement.
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CT Scan
A 5x6 cm cystic structure
at the Rt. Side of the
pelvis displacing the Rt.
Aspect of the UB.
No evident contrast
enhancement.
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A R E T H E S E F I N D I N G S R E S P O N S I B L E F O R
P A T I E N T S Y M P T O M S ?
The question is ??????
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Mucinouscyst of a Seminal Vesicle Associated with Ectopic Ureter andIpsilateral Renal Agenesis
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Ectopic ureters
Ectopic ureters occur in 0.025% of the population.
Approximately 10% are bilateral.
Ectopic ureters occur more frequently in females than in males (by a
ratio of 6:1).
In females, more than 80% of ectopic ureters drain duplicated systems.
In males, most ectopic ureters drain a single system.
Approximately 80% of all ectopic ureters drain the upper pole of a
duplex kidney.
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In males: the ureters may terminate at :
bladder neck/prostatic urethra (48%)
seminal vesicle (40%) ejaculatory duct (8%)
vas deferens (3%)
epididymis (0.5%)
In females, the ureters may terminate at :
bladder neck/urethra (35%)
vestibule (30%)
vagina (25%)
uterus (5%).
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pathophysiology
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Etiology
A ureteral bud, branches off from the caudal portion of the wolffian
(mesonephric) duct between the fourth and sixth week of gestation.
The cranial portion of the ureteral bud joins with the metanephric
blastema and begins to induce nephron formation. The bud
subsequently branches into the renal pelvis and the calyces and
induces nephron formation.
the mesonephric duct (along with the ureteral bud) is incorporated
into the cloaca as it forms the bladder trigone. Alterations in budnumber, position, or time of development result in ureteral
anomalies.
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Ectopic termination of a single system or of the ureter of a duplex
system is the result of the high (cranial) origin of the ureteral bud
from the mesonephric duct. Because of the delayed incorporation of
the ureteral bud into the bladder, the resulting position of the
ureteral orifice is more caudal and medial.
Ectopia in these areas may be associated with reflux or
obstruction, and this is the suggested cause of renal functional
impairment or absence . So, seminal vesicle cysts are
commonly associated with renal agenesis or dysgenesis on the
ipsilateral side
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