The Congenital Ureterocele Along with Nephrolithiasis case presentation has been conducted by the Faradarmani and Psymentology group under provision of Dr. M.A Taheri the founder of Faradarmani and Psymentology. This cervical radiculopathy study has been selected from Supplement of Danesh-e Pezeshki Medical Journal. Specialized Faradarmani Edition 3; Tehran , Iran; English Version (Dec, 2010). License holder and director is Shahabedin Sadr. A Case Report on Recovery of Congenital Ureterocele along with (Kidney Stone) Nephrolithiasis via Fradarmani Congenital Abnormality of Ureter tract infection UTI, family history and care- Ureterocele is a congenital abnormality of ful examination of dietary regimen. Primary ureter. The distal ureter balloons at its open- screening includes evaluation of electrolytes, ing into the bladder. This condition may Creatinine, Calcium, Phosphate and serum cause ureter obstruction, formation of stone Uric Acid. In order to treat kidney stones, as the result of stasis and urethral obstruc- the stone type should be determined. Com- tion as a result of prolapse. Most ureteroce- plete urinalysis is helpful in determining PH, les don’t cause any problem and don’t need detection of hematuria, ruling out infection, treatment. The large types can be excised; and more importantly; diagnosing the crystal however reflux may appear which needs re- type. Most kidney stones (about 90%) will be implantation. eliminated (passes through the urinary tract) Nephrolithiasis (Kidney stone) spontaneously. Probability of passing stone Maximum incidences of kidney stones depends on the size (particularly the width) happen between the ages of 20 to 45 and men and also the anatomic location of the stone. are affected more often than women. Based Ureteral stones smaller than 4 mm in width; on the composition of the stone, 5 types of generally pass within a year. Stones bigger kidney stones are known. Calcium stones are than 5 mm in width; generally will not pass. the most common and comprise 75% of all Obstruction symptoms, pain and fever ne- the stones. Mostly they are made of Calcium cessitates surgery. Extracorporeal shock wave oxalate and account for more than 50% of all lithotripsy (ESWL) is mostly used for the diagnosed kidney stones. stones in renal pelvis and the proximal ure- Patients who suffer from stones, often re- ter. Ureteroscopy along with stone catching fer to a doctor with Hematuria, sudden and tool or ultrasonic lithotripsy is used for the disturbing renal colic pain, which is felt in stones in distal ureter. the flanks and spreads toward the groin of Case Presentation the same side. Sometimes kidney stone is ac- The patient is a 27 year old married fe- companied by Polyuria, Dysuria, vomiting male employee who lives in Tehran. She has and ileus. Primary evaluation includes his- been a known case of congenital ureterocele tory of hematuria or passing stone, urinary and kidney stone since 1387 (2008). In Mehr 1 1387 (September 2008) she was admitted to tion of a friend. Only after 10 days, all of hospital with severe pain of flanks and dysu- her symptoms including flank pain and dy- ria in which she also had a history. With the suria disappeared. The patient stopped tak- probability of kidney stone and infection, ing her previous medications (antibiotics for she was examined and underwent specific urinary infection and painkillers) while she analysis. In 87/7/29 (20 Oct. 2008) Intra- was undertaking Faradarmani treatment. venous Urography with injection of contrast Seeing that she felt totally normal after 20 medium was done; duplicated right systems, days, she consulted the physician for more deformed left systems and low volume pelvis, examination; CT Scan was recommended. no obstruction in the left ureter, only distal Non-contrast CT Scan in 87/10/14 (3 Jan. dilation which is because of ureterocele were 2009) revealed no sign of bladder or kidney reported (Appendix 1). She was treated with problem; no dilatation indicating ureterocele oral antibiotics and painkiller (analgesic); ap- and no sign of kidney stone in ureter. (Ap- parently when she left the hospital her infec- pendix 3) tion was rectified and clinical symptoms such Discussion as flank pain and dysuria disappeared. After In the above patient simultaneous exis- a month, because of reoccurrence of the pre- tence of Congenital Ureterocele and urinary vious symptoms; especially flank pain, she stone with a diameter bigger than 5 mm in sought medical advice again and in 87/9/2 ureter, can not be treated with simple medi- (22 Nov. 2008) sonography was performed cal treatments. As we know the stones bigger in which the kidneys and bladder appeared than 4 mm in diameter are not eliminated to be of normal volume and size, the distal by themselves (spontaneously) and in such end of the left ureter was dilated and a stone cases where the symptoms are severe, remov- with the diameter of 5mm was detected in ing the stone is necessary. Also Ureterocele this area (Appendix 2). treatment is possible through surgery where As the patient was due to go abroad soon there is an obstruction by the stone. and was afraid of becoming hospitalized Nevertheless in this patient both problems and repeating the previous treatments, she were rectified simultaneously via Faradar- started Faradarmani upon recommenda- mani; particularly ureterocele which is gen- 2 erally considered as a congenital defect and Documentation and evidence so far it has no report of automatic recovery. The original reports of all diagnostic Conclusion test results and sonographies are available at This report shows that Faradarmani can the journal’s office. be effective even for congenital disorders and Faratherapists also in a very short period of time. In this Members of Faradarmani Medical Re- patient after a few sessions of Faradarmani search Group the pain has completely disappeared (from Resources clinical point of view), and from paraclini- 1. Mohamad Ali Taheri, Human from cal point of view all disorders have been re- Another Outlook, Bijan Publication 1388. solved. (2009) Patient’s Consent 2. Cecil’s Principles of Internal Medicine The patient has given full consent to pub- (Renal Diseases), Andishe Rafi Publication lish this report. 1386. (2007) Patient’s view 3. John Blandy Urology, Mashhad Uni- She is satisfied with the treatment results. versity of Medicine, 1387. (2008) Hospital’s Medical Radiography Center Radiography Report Date: 1387/07/29 age: 26 File number: 56454 Injective Urography ( Intravenous urogram) -------------------------- In simple cliché, abdomen is not ready. After injection, the kidneys simultaneously have excreted. Duplicated right systems, deformed left systems and low volume pelvis, no obstruction in the left ureter, only distal dilation which is because of ureterocele, is observed. Bladder is screened via contrast medium and after residual discharge, appears within normal level. Signed by: Radiologist, physician Appendix 1 3 Institute of Radiology and Sonography Physician: Medical Code Number: 8 date: 1387/09/02 Sonography of the Kidney and the bladder The right kidney with the length of 95 mm, and the left kidney with the length of 92 mm are observable. The thickness of the Cortex and the appearance of the pyeloca- lyceal system, on both sides, are normal. No sign of urinary stone and space occupy- ing lesion is observed. The bladder has normal volume and the thickness of its wall is normal. The distal end of the left ureter shows cystic condition and a stone with the diameter of 5mm, is observed in this area. After evacuation, the bladder’s urinal residue is 8cc which is within normal level. Conclusion: ureterocele ( left ureter) with Nephrolithiasis Sonography of the Uterus and its adnexa Uterus with dimensions of 73x47x40 mm in anteverted position is situated in the midline. Endometrium thickness (7mm) and Myometrium echoes are at the normal level. Ovaries have normal size and echo. In adnexa no space occupying lesion is seen. In the Cul de Sac area there is no abnormal fluid. Result: Normal uterus and adnexa Appendix 2 4 .