Spontaneous, literature report.A (b)(6) year-old girl presented us with a recurrent febrile urinary tract infection.Ultrasound demonstrated no hydronephrosis and bladder wall appeared smooth.Dimercaptosuccinic acid (dmsa) renal scan revealed bilateral renal scarring.Voiding cystourethrogram (vcug) showed grade 2 on the right and grade 3 on the left vur.Although she had sometimes experienced night incontinence, obvious bladder dysfunction was not detected.A bilateral combined hydrodistensionimplantation technique (hit)/subureteral tansurethral injection (sting) procedure was performed using of 0.7ml of dx/ha on the right side and 1.0ml on the left side.On initial postoperative ultrasound at 2 weeks later, hydronephrosis was not detected in both kidney.At seven months, ultrasound imaging revealed an asymptomatic bilateral de novo hydronephrosis.At ten month postoperatively, findings had deteriorated with bilateral hydroureteronephrosis.Significant distal ureteral dilation were seen on transverse images of bladder.Mercaptoacetyltriglycine (mag3) diuretic renal scan showed delayed washout on both kidney.Ct scan demonstrated bilateral hydroureteronephrosis and fluid collection on bilateral ureterovesical junction.The child underwent an open bilateral reimplantation immediately after ct examination.Intraoperatively, a 14 mm nodule on the right and a 16 mm on the left located periureteral orifice were observed.When a small incision was made on nodules, a yellowish-white mucinous fluid flowed out from both sides.The dx/ha material was irrigated with saline, and complete evacuation of the cavity was achieved.Macroscopically, the fluid replaced the usual appearance of the dx/ha.The distal ureters were excised and a cohen cross-trigonal ureteral reimplantation was performed.Follow-up ultrasound at fifty days postoperatively showed a resolution of hydronephrosis.The examination of dx/ha material culture was negative.Pathological analysis revealed giant cell reaction in setting of acute and chronic inflammation encapsulating dextranomer microspheres and it was located in the serosa.
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