The most detailed description of these ureteral folds
was published in 1942 by Ostling [1] in a scholarly paper
on the genesis of hydronephrosis, particularly with regard
to changes at the ureteropelvic junction. He studied
the ureters of 250 fetuses in various stages of development,
as well as specimens from a number of newborns
and infants, by means of microscopic sections, retrograde
thorotrast injections, and ureteral cast techniques.
Ureteral folds identical both grossly and histologically to the ones we describe were found in all fetuses as early
as the fourth month of gestation, in 37 of 40 newborns,
and in all of 10 infants less than 1 year old. Ostling
concluded that these folds were normal developmental
structures and postulated that they were due to a length
reserve of the ureter which was used during growth of the spine and the retroperitoneum after birth. He also
hypothesized that disturbances in the development of
these fetal folds might be an important factor in the
genesis of hydronephrosis. In his paper, Ostling [1]
referred to previous similar observations by W#{244}lfler
(1877) and Englisch (1879).
Our review of normal excretory urograms in infants
confirms the high frequency of upper ureteral folds. The
radiology and anatomy of folds in our patients are
identical to those described by Ostling. Transverse upper
ureteral folds are felt to represent a persistence of
normal fetal structures. They have no postnatal clinical
significance.
Trarisverse folds
in the proximal ureter. A normal variant in infants
译文：
近端输尿管的横行皱襞。婴儿期的正常变异
EN → ZH
2025-05-21 11:43
原文：
THE diagnosis of varicose veins of the ureter as a cause
of haematuria will rarely be made preoperatively.
Usually exploration is carried out to exclude more
serious disease, although occasionally the bleeding
itself has been so profuse as to endanger life.
Since the first reported case in 1922 there have been
14 cases reported, I in the British literature. I would
like to add a further case, discuss the pathology and
anatomy, and suggest an aid to diagnosis in the
future.
Ureteric varicosities usually present with painless
haematuria. The condition is commoner in the male
(12 : 3) and on the left side (12 : 3). Although portal
hypertension or other intraperitoneal disease may
predispose to their formation this is unusual-on the
other hand, varicocoele and varicose veins of the
lower limb are commonly associated.
It may have been surmised that the gonadal vessels
would have been always involved, but this is not so.
Ahlberg, Bartley, and Chidekel (1966), in cadaver
studies, have shown that the valves at the upper end
of the gonadal vessels are more commonly incom-
petent on the left than on the right, and in men than
in women. Arey (1944) showed that the develop-
ment of the left renal vein is more complicated than
that of the right and that potential embryological
portacaval anastomoses are common here. Doehner,
Ruzicka, Rousselot, and Hoffman (1956), also working
on cadavers, have confirmed connexions between the
splenic and renal veins on the left side.
Folsum, in I 922, during a discussion on haematuria
of obscure cause, described a man with bleeding seen
cystoscopically to be coming from the right ureteric
orifice. 'The patient had marked varicose veins of the
lower limbs, scrotum, and penis. An intravenous
pyelogram was not carried out, but at operation large
veins were found over the ureter and pelvis of the
kidney, one of which had ruptured into the urinary
tract. Unfortunately he does not describe the outcome.
Sporer and Pollock, in 1947, carried out a left
nephrectomy in a 62-year-old man for profuse
haematuria. In this case the intravenous pyelogram
was normal and the side was determined by cysto-
scopy. ,4t operation marked caval and portal veins
were present, one large varix having ruptured at the
pelvi-ureteric junction. Subsequently the patient
died from a carcinoma of the stomach and it is
probable that this lesion was the prime cause of the
prominent veins.
Maslow and Aron (1949) similarly performed a
right nephrectomy for a ruptured varix at the pelvi-
ureteric
junction.
The intravenous pyelogram
suggested an irregularity at this spot preoperatively.
The patient was only 33 years old and he had required
bilateral varicose-vein operations in the past.
Berman and Copeland (1953) appear to be the
first to describe the scalloped ureteric appearance
typically seen on the intravenous pyelogram in the
majority of these patients. Their 57-year-old male
had haematuria, and the intravenous pyelogram
showed multiple filling defects of the upper two-
thirds of the ureter. Cystoscopically, multiple
'benign polyps' were seen in the bladder. These
were dealt with endoscopically and subsequently a
left retrograde pyelogram confirmed the persistence
of the ureteric defects. The ureter was explored and
large veins were found emptying into a vein on the
anterior surface of the pelvis of the kidney. The
spermatic vein was reported as normal.
SUMMARY
I. Fifteen cases of ureteric varicose veins are
discussed. They nearly all (a) present with haematuria
or (b) show a scalloped corkscrew-like appearance
to the ureter on the intravenous pyelogram
without evidence of proximal obstruction.
2. Varicose veins of the lower limbs and varicocoele
are commonly present.
3. It is suggested that there are two main types:
those draining vertically via the renal pedicle and
those draining via a ‘communicating’ vein in the
gonadal vessels.
4. Spermatic phlebography is suggested as a
possible aid to differential diagnosis in the future.
“Corkscrew ureter” has previously been de-
scribed as occurring in the upper ureter, result-
ing from either ureter-al varices which occur at
any age, or transverse folds in the proximal
ureter as a normal finding in neonates. 1-4 Herein
we report 3 cases of a corkscrew appearance of
the distal ureter, all of which were secondary to
extrinsic compression.
’ A review of the literature
reveals that terms such as corkscrew ureter,
UROIOGY / AUGUST 1982 / VOLUME XX, NUMBER 2
scalloped ureter, and notched ureter have all
been used to describe the effects on the ureter
secondary to varices in the proximal ureterSS7
The term “corkscrew ureter” has also been
applied to the appearance on intravenous urog-
raphy of transverse upper ureteral folds which
are prominent in the neonatal period. These are
postulated to be of no clinical importance.2-4
We have seen a typical corkscrew appearance
of the distal ureter which has not been previously
described. In all 3 cases the original radio-
graphic appearance of these lesions on. retro-
grade pyelography suggested intrinsic ureteral
disease. All 3 patients ultimately were proved to
have extrinsic ureteral compression.
Abstract
A "corkscrew deformity" of the proximal ureter is a rare congenital anomaly that typically lacks any postnatal clinical significance. The rarity of this entity, however, has not allowed the clarification of its natural history and the ideal approach to its management. We herein present a case of a 27-year-old female patient who presented with right flank pain and significant hydronephrosis. On retrograde ureterography, a typical spiral configuration of the proximal ureter was noted. The patient underwent successful reconstruction by laparoscopic transperitoneal dismembered pyeloplasty. We report the first use of laparoscopic reconstruction for the management of "corkscrew deformity" of the proximal ureter and we focus on the imaging findings, technical details, advantages and limitations of this technique.
Then, the patient was admitted. The following
day he developed a septic shock with urinary cultures
positive for multi-drug resistant Klebsiella
pneumoniae. A new abdominal bedside ultrasound
showed a hydronephrosis of the right kidney with
an unusual ureteral dilatation. An emergency
percutaneous pielostomy was performed and anterograde
urethrography showed that the right
ureter was twisted along its long axis with a
characteristic corkscrew appearance (Figure 1).
A ‘‘corkscrew deformity’’ of the proximal ureter
is mainly due to a rare congenital anomaly that
typically lacks any postnatal clinical significance
(1). We probably report a rare case of secondary
corkscrew deformity due to the chronic inflammation/
infection and obstruction (2–4).
The rarity of this entity has not allowed the clarification
of its natural history and the ideal approach
to its management.