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Varices of the Ureter: A Rare Cause of Hematuria
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VoL 94, July Printed in U.S.A.
THE JOURNAL OF UROLOGY
Copyright © 1965 by The Williams & Wilkins Co.
VARICES O_F THE URETER: A RARE CAUSE OF HEMATURIA WILLIAM SAMELLAS From the Department of Siirger:lj (Urology), Veterans Administration Hospital, Brooklyn, New York
An attempt to trace the origin of varices was frustrated by bleeding and was abandoned. The rest of the meter appeared normal as well as the iliac and spermatic vessels. No cause for the existence of the ureteral varices was apparent_ The varicose veins were ligated with plain catgut.
The purpose of this communication is to present a rare cause of hematuria resulting from varices of the ureter This entity has been reported thrice previously. 1 • 2 , 3 CASE REPORT
G. L.A., No. A-14153, a 56-year-old white man, entered the hospital because of gross total painless hematuria. Past history was insignificant. The blood pressure was 156/90. The physical examination was unremarkable except for bilateral varicose veins. The chest x-ray and electrocardiogram were normal. The urine showed specific gravity 1.022, 1 plus albumin and 60 to 90 red blood cells per high power field. The excretory urogram disclosed prompt function bilaterally with a normal-appearing right collecting system. On the left side, there was a duplication of the renal pelvis and ureter. Small filling defects were observed in the distal third of the ureter (fig. 1). These findings were confirmed by retrograde pyelography. There were also brush-like formations of the contrast material in the papillae of both kidneys consistent with the picture of a medullary sponge kidney. The cystoscopic examination was negative. Pink efflux was noted from the left ureteral orifice. The Papanicolaou smear was class 3. Because of the presence of the filling defects in the ureter and the history of gross hematuria, the ureter was explored through a left paramedian incision. After observing that the lateral aspect of the low third of the ureter was encased by a network of varicose veins, the ureter -was opened. The mucosa appeared indented by the projection of these veins.
FIG.
1
COMMENT
The presence of filling defects in the ureter associated with gross hematuria demanded exploration. The differential diagnosis included ureteritis cystica, ureteral tumors and extrinsic pressure on the ureter. In ureteritis cystica the involvement of the ureter is usually bilateral and more extensive. The most probable diagnosis was benign papillary tumors. As in the previously reported cases, no explanation for the pathological process could be advanced.
Accepted for publication December 3, 1964. 1 Berman, M. H. and Copeland, H.: Filling defects in ureteragram caused by varicose ureteral vein. J. Ural., 70: 168, 1953. 2 Woodard, J. R.: Vascular imprints on the upper ureter. J. Ural., 87: 666, 1962. 3 Gillernvater, J. Y., Burros, H. :VI. and Nackphairajj, S.: Varicosities of the renal pelvis and ureter. J. Urol., 90: 37, 1963.
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VoL 94, July Printed in U.S.A.
THE JOURNAL OF UROLOGY
Copyright © 1965 by The Williams & Wilkins Co.
VARICES O_F THE URETER: A RARE CAUSE OF HEMATURIA WILLIAM SAMELLAS From the Department of Siirger:lj (Urology), Veterans Administration Hospital, Brooklyn, New York
An attempt to trace the origin of varices was frustrated by bleeding and was abandoned. The rest of the meter appeared normal as well as the iliac and spermatic vessels. No cause for the existence of the ureteral varices was apparent_ The varicose veins were ligated with plain catgut.
The purpose of this communication is to present a rare cause of hematuria resulting from varices of the ureter This entity has been reported thrice previously. 1 • 2 , 3 CASE REPORT
G. L.A., No. A-14153, a 56-year-old white man, entered the hospital because of gross total painless hematuria. Past history was insignificant. The blood pressure was 156/90. The physical examination was unremarkable except for bilateral varicose veins. The chest x-ray and electrocardiogram were normal. The urine showed specific gravity 1.022, 1 plus albumin and 60 to 90 red blood cells per high power field. The excretory urogram disclosed prompt function bilaterally with a normal-appearing right collecting system. On the left side, there was a duplication of the renal pelvis and ureter. Small filling defects were observed in the distal third of the ureter (fig. 1). These findings were confirmed by retrograde pyelography. There were also brush-like formations of the contrast material in the papillae of both kidneys consistent with the picture of a medullary sponge kidney. The cystoscopic examination was negative. Pink efflux was noted from the left ureteral orifice. The Papanicolaou smear was class 3. Because of the presence of the filling defects in the ureter and the history of gross hematuria, the ureter was explored through a left paramedian incision. After observing that the lateral aspect of the low third of the ureter was encased by a network of varicose veins, the ureter -was opened. The mucosa appeared indented by the projection of these veins.
FIG.
1
COMMENT
The presence of filling defects in the ureter associated with gross hematuria demanded exploration. The differential diagnosis included ureteritis cystica, ureteral tumors and extrinsic pressure on the ureter. In ureteritis cystica the involvement of the ureter is usually bilateral and more extensive. The most probable diagnosis was benign papillary tumors. As in the previously reported cases, no explanation for the pathological process could be advanced.
Accepted for publication December 3, 1964. 1 Berman, M. H. and Copeland, H.: Filling defects in ureteragram caused by varicose ureteral vein. J. Ural., 70: 168, 1953. 2 Woodard, J. R.: Vascular imprints on the upper ureter. J. Ural., 87: 666, 1962. 3 Gillernvater, J. Y., Burros, H. :VI. and Nackphairajj, S.: Varicosities of the renal pelvis and ureter. J. Urol., 90: 37, 1963.
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