Ureter Flashcards
Best scan of choice to look for a stone in the ureter?
CT non-contrast
Describe the “soft-tissue rim sign” for ureterolithiasis:
adjacent, surrounding soft tissue associated with ureteral edema from an impacted stone
Describe the “Comet tail sign”:
adjacent, irregular tapering of soft tissue mass that is from a non-calcified vein associated with phleboliths
What is the Weigert-Meyer Rule?
It is the rule regarding a duplicated system of the kidneys (two ureters).
The upper pole ureter inserts the bladder inferior-medially, while the lower pole inserts the bladder superior-laterally
In regards to the Weigert-Meyer Rule, which pole is more commonly obstructed, and which one more commonly refluxes?
Upper pole -> inserts inferior-medially usually with an associated ureterocele that obstructs (therefore, upper pole hydronephrosis)
Lower pole -> inserts superior-laterally and refluxes
In regards to the Weigert-Meyer Rule, which pole is most commonly associated with an ectopic ureter?
The upper pole
Best imaging modality to ID an ectopic ureter?
MRI
Describe the course of a retrocaval ureter:
The right ureter courses posterior and medial to the IVC, then crosses anterior to the IVC while coursing laterally towards the common iliac bifurcation.
What is the etiology of a retrocaval ureter?
Symptoms?
Treatment?
Etiology: persistent right subcardinal vein (anomaly of the IVC, not the ureter!!!)
Symptoms: flank pain (due to obstruction/hydronephrosis), UTI’s, or asymptomatic
Treatment: ureteroureterostomy with removal of retrocaval portion (it is usually aperistaltic)
Describe the “Drooping Lily sign”:
hydronephrotic nonfunctioning upper pole displaces the opacified, functioning lower pole inferiorly, thus appearing like a drooping lily
Seen in duplicated systems
What is “Ormond’s disease?”
What position are the ureters in compared to normal?
Retroperitoneal fibrosis
Medial deviation of the ureters
What is the “Goblet sign?”
Ureteral dilation just DISTAL to a ureteral TUMOR, giving an appearance of a goblet
*ureteral calculi cause distal ureteral spasm
The right or left ureter is more commonly affected by pregnancy associated hydroureter?
Right > left
Around which weeks is pregnancy associated hydroureter most prominent?
22-24 weeks
Etiology of pregnancy associated hydroureter?
1) Gravid uterine compression
2) High progesterone causes smooth muscle relaxation