{"paper_id":"2372e502-a19c-4735-839a-9f564c0e809a","body_text":"International Journal of \nScience and Research (IJSR)\n \nISSN: 2319\n-\n7064\n \nSJIF (2020): 7.803\n \nVolume 11 Issue 2, February 2022\n \nwww.ijsr.net\n \nLicensed Under Creative Commons \nAttribution CC BY\n \nUreteral Endometriosis Masquerading As Urothelial \nCancer\n \n \nNarayani Kalnawat\n1\n, N. B. D’souza\n2\n, Devyani Mahajan\n3\n, H. B. Tongaonkar\n4\n \n \n1\nFellow\n, \nGynaecologic\n \nOncology\n, \nNanavati\n \nMax\n \nInstitute\n \nof\n \nCancer\n \nCare\n, Mumbai, India\n \nnkalnawat\n[at]gmail.com\n \n \n2\nClinical\n \nAssociate\n \nin\n \nGynaecologic\n \nOncology\n, \nNanavati\n \nMax\n \nInstitute\n \nof\n \nCancer\n \nCare\n, Mumbai, India\n \nnatdsouza\n.8\n7\n[at]gmail.com\n \n \n3\nAssociate\n \nConsultant\n, \nGynaecologic\n \nOncology\n, \nNanavati\n \nMax\n \nInstitute\n \nof\n \nCancer\n \nCare\n, Mumbai, India\n \ndevyani\n. \nm\n[at]gmail.com\n \n \n4\nConsultant\n \nUrologic\n \n&\n \nGynaecologic\n \nOncologist\n, \nNanavati\n \nMax\n \nInstitute\n \nof\n \nCancer\n \nCare\n, Mumbai, India\n \nhtongaonkar\n[at]gmail.com\n \n \nAbstract\n: \nWe\n \npresent\n \na\n \ncase\n \nof\n \nureteral\n \nendometriosis\n \nmasquerading\n \nas\n \nurothelial\n \ncarcinoma\n \nof\n \nureter\n. \nThe\n \npatient\n \nwas\n \ndiagnosed\n \nintraoperatively\n \nto\n \nhave\n \nureteral\n \nendometriosis\n, \nafter\n \nexcision\n \nof\n \nthe\n \nlesion\n \nand\n \nintraoperative\n \nfrozen\n \nsection\n.\n \n \nKey\nwords\n: \nureteral\n, \nendometriosis\n, \nurothelial\n, \ncarcinoma\n, \nsurgery\n \n \n1.\nIntroduction\n \n \nUreteral\n \nendometriosis\n \nis\n \na\n \nrare\n \nform\n \nof\n \ndeep\n \nendometriosis\n \nwhich\n \noften\n \nevades\n \ndiagnosis\n \ntill\n \nthe\n \nlate\n \nstages\n \nwhen\n \nthere\n \nis\n \nimpending\n \nor\n \nestablished\n \nrenal\n \nfailure\n. \nWe\n \npresent\n \na\n \nrare\n \ncase\n \nof\n \nendometriosis\n \nand\n \nobstructive\n \nuropathy\n, \nmasquerading\n \nas\n \nprimary\n \nurothelial\n \ncarcinoma\n \nof\n \nthe\n \nureter\n. \n \n \n2.\nCase\n \nReport\n \n \nA\n \n42\n-\nyear\n-\nold\n \nwoman\n \npresented\n \nwith\n \nvague\n \nleft\n \nflank\n \npain\n \nsince\n \n4\n \nmonths\n. \nThere\n \nwere\n \nno\n \nepisodes\n \nof\n \nacute\n \nexacerbation\n \nof\n \nthe\n \npain\n \nand\n \nno\n \nhistory\n \nof\n \nhaematuria\n \nor\n \nany\n \nlower\n \nurinary\n \ntract\n \nsymptoms\n. \nThere\n \nwere\n \nno\n \nbowel\n \ncomplaints\n, \nno\n \nabdominal\n \npain\n \nor\n \nback\n \npain\n. \nShe\n \nalso\n \ncomplained\n \nof\n \nloss\n \nof\n \nappetite\n \nwith\n \na\n \nweight\n \nloss\n \nof\n \naround\n \n2\n \nkg\n \nin\n \n4\n \nmonths\n. \nOn\n \nenquiry\n, \nshe\n \ngave\n \na\n \nhistory\n \nof\n \nhaving\n \nundergone\n \ntotal\n \nabdominal\n \nhysterectomy\n \nwith\n \npreservation\n \nof\n \nboth\n \novaries\n \nat\n \nthe\n \nage\n \nof\n \n34\n \nyears\n \nfor\n \ncomplaints\n \nof\n \nmenorrhagia\n. \nPrior\n \nto\n \nthis\n \nsurgery\n, \nher\n \nmenses\n \nwere\n \npainful\n, \nbut\n \nregular\n. \n \n \nUltrasonography\n \nrevealed\n \nleft\n \nsevere\n \nhydronephrosis\n \nsecondary\n \nto\n \nleft\n \nlower\n \nureteric\n \nobstruction\n \nand\n \na\n \nleft\n \nhaemorrhagic\n \novarian\n \ncyst\n. \nContrast\n \nenhanced\n \nC\nT\n \nscan\n \n(\nFigure \n1\n, \n2a\n \n&2b\n) \nrevealed\n \na\n \n5\n.2 \nx\n \n3\n \ncm\n \nleft\n \nureteric\n \nmass\n \nwith\n \nintraluminal\n \nas\n \nwell\n \nas\n \nextraluminal\n \nextension\n \nat\n \nthe\n \nlevel\n \nof\n \nS3\n \nvertebra\n \ncausing\n \nsevere\n \nleft\n \nhydronephrosis\n \nand\n \nhydroureter\n \nwith\n \na\n \n2\n.9 \nx\n \n3\n.2 \ncm\n \nleft\n \npara\n-\naortic\n \nand\n \nbilateral\n \nenlarged\n \niliac\n \nlymph\n \nnodes\n. \nUreteroscopic\n \nevaluation\n \nof\n \nthe\n \nleft\n \nureter\n \nshowed\n \nnarrowed\n \nirregular\n \nhaemorrhagic\n \nlower\n \nureteric\n \nsegment\n, \nand\n \nit\n \nwas\n \nnot\n \npossible\n \nto\n \nnegotiate\n \nthe\n \nscope\n \nbeyond\n \nthat\n. \nIt\n \nwas\n \nnot\n \npossible\n \nto\n \ntake\n \nan\n \nadequate\n \nbiopsy\n \nfrom\n \nthis\n \narea\n. \nMetastatic\n \nwork\n \nup\n \nin\n \nthe\n \nform\n \nof\n \nCECT\n \nchest\n \nand\n \nisotope\n \nbone\n \nscan\n \nwas\n \nnormal\n. \nOn\n \nDTPA\n \nscan\n, \nthe\n \nGFR\n \nof\n \nthe\n \nright\n \nand\n \nleft\n \nkidneys\n \nwere\n \n50\n \nml/min\n \nand\n \n16\n \nml/min\n. \n \n \nIn\n \nview\n \nof\n \nthe\n \nfindings\n \non\n \nimaging\n \nstudies\n, \nthe\n \npatient\n \nwas\n \nadvised\n \nsurgery\n. \nIn\ntra\n-\noperatively\n, \nthere\n \nwas\n \na\n \nsolid\n \nmass\n \nlesion\n \nof\n \n6\n \nx\n \n3\n \ncm\n \ninvolving\n \nthe\n \nleft\n \ndistal\n \nureter\n \ncausing\n \ngross\n \nleft\n \nhydroureter\n. \nThe\n \nmass\n \nwas\n \nextending\n \nlaterally\n \nto\n \ninvolve\n \nthe\n \nleft\n \nadnexa\n. \nExcision\n \nof\n \nthe\n \nleft\n \nureteric\n \nmass\n \nwas\n \ndone\n \nand\n \nthe\n \nintraoperative\n \nfrozen\n \nsection\n \nrevealed\n \npresence\n \nof\n \n“endometriosis\n \nof\n \nthe\n \nureter\n, \nwith\n \nno\n \nevidence\n \nof\n \nmalignancy”\n. \nL\neft\n \nureteric\n \nre\n-\nimplantation\n \ninto\n \nbladder\n \n[\nureteroneocystostomy\n]\n \nwith\n \npsoas\n \nhitch\n \nwas\n \ndone\n. \nThe\n \nfrozen\n \nsection\n \nrevealed\n \n“\nextrinsic\n \nendometriosis\n \nin\n \nthe\n \nureter\n”\n. \nBilateral\n \noophorectomy\n \nwas\n \nalso\n \ndone\n. \n \n \nSix\n \nmonths\n \npost\n-\noperatively\n, \nthe\n \nleft\n \nsided\n \nhydronephrosis\n \nhas\n \nresolved\n \nand\n \nrepeat\n \nCT\n \nscan\n \nshowed\n \nbilateral\n \nwell\n-\nfunctioning\n \nkidneys\n. \nShe\n \nis\n \npresently\n \nasymptomatic\n \nand\n \nfree\n \nof\n \nrecurrence\n \nof\n \nendometriosis\n \nclinically\n \nand\n \nradiologically\n. \n \n \n3.\nDiscussion\n \n \nEndometriosis\n \nis\n \nthe\n \npresence\n \nof\n \nfunctioning\n \nendometrial\n \ntissue\n \noutside\n \nthe\n \nuterine\n \ncavity\n \nand\n \ncan\n \nbe\n \nsuperficial\n \n(\nperitoneal\n, \novarian\n) \nor\n \ndeep\n \nand\n \ninfiltrating\n \n(\n>5\n \nmm\n) [\n1]\n. \nThe\n \nincidence\n \nof\n \nurinary\n \ntract\n \nendometriosis\n \nis\n \n1\n-\n1\n.5\n%\n \nwith\n \nthe\n \nbladder\n \nbeing\n \ninvolved\n \nin\n \n70\n-\n80%\n, \nureter\n \nin\n \n9\n-\n23%\n, \nkidney\n \nin\n \n4%\n \nand\n \nurethra\n \nin\n \n2%\n \n[\n2\n, \n3\n]\n. \nPatients\n \nwith\n \nureteric\n \nendometriosis\n \nare\n \nusually\n \nassociated\n \nwith\n \nmore\n \nad\nvanced\n \nstages\n \nof\n \nendometriosis\n \n[\n2\n]\n. \n \n \nWith\n \nit\ns\n \npeak\n \nincidence\n \nin\n \nthe\n \nage\n \ngroup\n \nof\n \n30\n-\n35\n \nyear\ns\n \n[\n3\n]\n, \nt\nhe\n \ndiagnosis\n \nof\n \nureteral\n \nendometriosis\n \nis\n \ndifficult\n \nsince\n \nthe\n \ndisease\n \nmay\n \nbe\n \nclinically\n \nsilent\n \nin\n \nabout\n \n30%\n \nof\n \npatients\n \nand\n \nnon\n-\nspecific\n \nsymptoms\n \nare\n \npresent\n \nin\n \nup\n \nto\n \n5\n0%\n \nof\n \nwomen\n \n[\n4\n, \n5\n]\n \nlead\ning\n \nto\n \nan\n \nunderestimation\n \nin\n \nits\n \nprevalence\n \n[\n2\n, \n5\n]\n. \nW\nhile\n \npelvic\n \npain\n \nand\n \ndysmenorrhoea\n \nare\n \nthe\n \nmost\n \ncommon\n \nsymptoms\n \nreported\n \nby\n \nthe\n \npatients\n, \no\nnly\n \nabout\n \n10\n-\n15%\n \npatients\n \npresent\n \nwith\n \nurinary\n \nsymptoms\n \nincluding\n \ncyclical\n \nhaematuria\n \nconsidered\n \nhighly\n \ncharacteristic\n \nof\n \nureteral\n \nendometriosis\n \n[\n6\n]\n. \nPaper ID: SR22212111239\nDOI: 10.21275/SR22212111239\n694 \n\nInternational Journal of \nScience and Research (IJSR)\n \nISSN: 2319\n-\n7064\n \nSJIF (2020): 7.803\n \nVolume 11 Issue 2, February 2022\n \nwww.ijsr.net\n \nLicensed Under Creative Commons \nAttribution CC BY\n \nAlthough\n \nbilateral\n \nlesions\n \noccur\n \nin\n \n10\n-\n42%\n, \nunilateral\n \nlesions\n \nare\n \nmuch\n \nmore\n \ncommon\n \nwith\n \na\n \npred\nisposition\n \nfor\n \nthe\n \nleft\n \nside\n \n[\n7\n]\n \nand\n \nusually\n \ninvolves\n \nthe\n \ndistal\n \n3\n-\n4\n \ncm\n \nof\n \nthe\n \nureter\n. \nThe\n \ndegree\n \nof\n \nsymptoms\n \ncorrelates\n \npoorly\n \nwith\n \nthe\n \nseverity\n \nof\n \nobstruction\n, \nwhich\n \nif\n \nlong\n-\nstandi\nng\n, \ncould\n \nlead\n \nto\n \nrenal\n \nfailure\n \n[\n8\n]\n. \nPateman\n \n(\n2015\n) \nreported\n \na\n \nsensitivity\n \nof\n \n92%\n \nand\n \na\n \nspecificity\n \nof\n \n100%\n \nwith\n \nultrasonography\n \nfor\n \ndiagnosing\n \nureteric\n \nendometriosis\n \n[\n9\n]\n. \nKnabben\n \n(\n2015\n) \nproposed\n \na\n \nradiological\n-\nclinical\n \nclassification\n \nof\n \nureteric\n \nendometriosis\n \n–\n \nour\n \npatient\n \nhad\n \na\n \nGrade\n \n4\n \nureteric\n \nendometriosis\n \nin\n \nview\n \nof\n \nthe\n \nimpaired\n \nrenal\n \nclearance\n \n[\n2\n]\n. \nT\nhe\n \ndefinitive\n \ndiagnosis\n \nof\n \nureteric\n \nendometriosis\n \nand\n \nits\n \nextent\n \nand\n \nseverity\n \nis\n \noften\n \nbased\n \non\n \nsurgery\n \nand\n \nhistopathological\n \nexamination\n \nand\n \nnot\n \non\n \nimaging\n \nstudies\n. \n \n \nOptimal\n \nrecommendations\n \nregarding\n \ndiagnostic\n \nmethods\n \nand\n \ntherapeutic\n \nmanagement\n \ncannot\n \nbe\n \nmade\n \nin\n \nview\n \nof\n \nthe\n \nrelative\n \nrarity\n \nof\n \nthis\n \ncondition\n. \nH\normonal\n \ncontraceptives\n \nand\n \nprogestogens\n \nare\n \nthe\n \nfirst\n \nline\n \nfor\n \npain\n \nrelief\n \nin\n \ndeep\n \nendometriosis\n \n[\n5\n]\n. \nUreteral\n \nendometriosis\n \nis\n \nusually\n \ntreated\n \nwith\n \nsurgery\n \nand\n \nthe\n \nmode\n \nof\n \ntreatment\n \nvaries\n \ndepending\n \non\n \nthe\n \nlevel\n \nand\n \nlength\n \nof\n \nureteric\n \ninvolvement\n, \nthe\n \ndegree\n \nof\n \nobstruction\n \nand\n \nthe\n \nrenal\n \nfunction\n \nand\n \ncan\n \nrange\n \nfrom\n \nhormonal\n \ntherapy\n \nalone\n \nor\n \nwith\n \ndouble\n-\nJ\n \nstent\n \ninsertion\n \nto\n \nureterolysis\n, \nsegmental\n \nureterectomy\n \nand\n \nend\n-\nto\n-\nend\n \nanastomosis\n, \nor\n \nsegmental\n \nureterectomy\n \nand\n \nuretro\n-\nneocysto\nstomy\n, \nand\n \nnephrectomy\n. \nDTPA\n \nrenal\n \nscan\n \ncan\n \nbe\n \nquite\n \nuseful\n \nin\n \ndeciding\n \nbetween\n \npreservation\n \nof\n \nkidney\n \nand\n \nnephrectomy\n. \nU\nreteric\n \nresection\n \nis\n \nthe\n \nmethod\n \nof\n \nchoice\n \nin\n \ncases\n \nof\n \nureteric\n \nobstruction\n \nin\n \norder\n \nto\n \nreduce\n \nthe\n \nri\nsk\n \nof\n \nrecurrence\n, \nas\n \nwas\n \ndone\n \nin\n \nour\n \npatient\n \n[\n10\n]\n. \nThe\n \neffectiveness\n \nof\n \npost\n-\noperative\n \nmedical\n \ntherapy\n \nhas\n \nnot\n \nyet\n \nbeen\n \nproven\n. \nOur\n \npatient\n \nhad\n \na\n \nlong\n \nsegment\n \nlower\n \nureteric\n \ninvolvement\n \nand\n \na\n \nlarge\n \nmass\n \nimplicating\n \nthe\n \nureter\n \nand\n \nhence\n \nshe\n \nwas\n \nnot\n \nsuitable\n \nfor\n \nsimple\n \nureterolysis\n \nor\n \nend\n-\nto\n-\nend\n \nureteric\n \nanastomosis\n \nafter\n \nresection\n \nof\n \nureteric\n \nsegment\n. \nHence\n \nshe\n \nunderwent\n \nureteroneocystostomy\n \nwith\n \na\n \npsoas\n \nhitch\n \nto\n \nmake\n \na\n \ntension\n-\nfree\n \nanastomosis\n. \n \n \n4.\nConclusion\n \n \nUreteral\n \nendometriosis\n \nis\n \na\n \nrare\n \nelusive\n \ndisease\n \nwhich\n \ncould\n \nlead\n \nto\n \npermanent\n \nrenal\n \ndamage\n. \nA\n \nhigh\n \nindex\n \nof\n \nsuspicion\n \nis\n \nrequired\n \nto\n \naid\n \nearly\n \ndetection\n \nin\n \norder\n \nto\n \nensure\n \ntreatment\n \nis\n \nless\n \ninvasive\n \nand\n \nprognosis\n \nis\n \nbetter\n. \nOur\n \npatient\n \nhad\n \na\n \npelvic\n \nmass\n \nmasquerading\n \nas\n \nurothelial\n \ncancer\n \nand\n \nureteric\n \nendometriosis\n \nwas\n \ndiagnosed\n \nonly\n \nat\n \nlaparotomy\n. \n \n \nReferences\n \n \n[1]\n \nVercellini\n \nP\n, \nViganò\n \nP\n, \nSomigliana\n \nE\n, \nFedele\n \nL\n. \nEndometriosis\n: \npathogenesis\n \nand\n \ntreatment\n. \nNat\n \nRev\n \nEndocrinol\n.2\n014\n; \n10\n \n[\n5\n]\n: \n261\n-\n275\n. \n \n[2]\n \nKnabben\n \nL\n, \nImboden\n \nS\n, \nFellmann\n \nB\n, \nNirgianakis\n \nK\n, \nKuhn\n \nA\n, \nMueller\n \nMD\n. \nUrinary\n \ntract\n \nendometriosis\n \nin\n \npatients\n \nwith\n \ndeep\n \ninfiltrating\n \nendometriosis\n: \nprevalence\n, \nsymptoms\n, \nmanagement\n, \nand\n \nproposal\n \nfor\n \na\n \nnew\n \nclinical\n \nclassification\n. \nFertil\n \nSteril\n.2\n015\n; \n103\n \n[\n1\n]\n: \n147\n-\n152\n. \n \n[3]\n \nBerlanda\n \nN\n, \nVercellini\n \nP\n, \nCarmignani\n \nL\n, \nAimi\n \nG\n, \nAmicarelli\n \nF\n \nFL\n. \nUreteral\n \nand\n \nvesical\n \nendometriosis\n. \nTwo\n \ndifferent\n \nclinical\n \nentities\n \nsharing\n \nthe\n \nsame\n \npathogenesis\n. \nObs\n \nGynecol\n \nSurv\n.2\n009\n; \n64\n: \n830\n-\n842\n. \n \n[4]\n \nHuang\n \nJ\n-\nZ\n, \nGuo\n \nH\n-\nL\n, \nLi\n \nJ\n-\nB\n, \nChen\n \nS\n-\nQ\n. \nManagement\n \nof\n \nureteral\n \nendometriosis\n \nwith\n \nhydronephrosis\n: \nExperience\n \nfrom\n \na\n \ntertiary\n \nmedical\n \ncenter\n. \nJ\n \nObstet\n \nGynaecol\n \nRes\n.2\n017\n; \n43\n \n[\n10\n]\n: \n1555\n-\n1562\n.1\n3\n \n[5]\n \nBarra\n \nF\n, \nScala\n \nC\n, \nBiscaldi\n \nE\n, \net\n \nal\n. \nUreteral\n \nendometriosis\n: \na\n \nsystematic\n \nreview\n \nof\n \nepidemiology\n, \npathogenesis\n, \ndiagnosis\n, \ntreatment\n, \nrisk\n \nof\n \nmalignant\n \ntransformation\n \nand\n \nfertility\n. \nHum\n \nReprod\n \nUpdate\n.2\n018\n; \n24\n \n[\n6\n]\n: \n710\n-\n730\n.1\n4\n \n[6]\n \nPerez\n-\nUtrilla\n \nPerez\n \nM\n, \nAguilera\n \nBazan\n \nA\n, \nAlonso\n \nDorrego\n \nJM\n, \nHernandez\n \nA\n, \nde\n \nFrancisco\n \nMG\n, \nMartin\n \nHernandez\n \nM\n, \nde\n \nSantiago\n \nJ\n, \nde\n \nla\n \nPena\n \nBarthel\n \nJ\n. \nUrinary\n \ntract\n \nendometriosis\n: \nclinical\n, \ndiagnostic\n, \nand\n \ntherapeutic\n \naspects\n. \nUrology\n \n2009\n; \n73\n: \n47\n–\n51\n. \n \n[7]\n \nAlves\n \nJ\n, \nPuga\n \nM\n, \nFernandes\n \nR\n, \net\n \nal\n. \nLaparoscopic\n \nManagement\n \nof\n \nUreteral\n \nEndometriosis\n \nand\n \nHydronephrosis\n \nAssociated\n \nWith\n \nEndometriosis\n. \nJ\n \nMinim\n \nInvasive\n \nGynecol\n.2\n4\n \n[\n3\n]\n: \n466\n-\n472\n.1\n7\n \n \n[8]\n \nVercellini\n \nP\n, \nViganò\n \nP\n, \nSomigliana\n \nE\n, \nFedele\n \nL\n. \nEndometriosis\n: \npathogenesis\n \nand\n \ntreatment\n. \nNat\n \nRev\n \nEndocrinol\n.2\n014\n; \n10\n \n[\n5\n]\n: \n261\n-\n275\n.2\n0\n \n[9]\n \nPateman\n \nK\n, \nHolland\n \nTK\n, \nKnez\n \nJ\n, \nDerdelis\n \nG\n, \nCutner\n \nA\n, \nSaridogan\n \nE\n, \nJurkovic\n \nD\n. \nShould\n \na\n \ndetailed\n \nultrasound\n \nexamination\n \nof\n \nthe\n \ncomplete\n \nurinary\n \ntract\n \nbe\n \nrou\n-\ntinely\n \nperformed\n \nin\n \nwomen\n \nwith\n \nsuspected\n \npelvic\n \nendometriosis?\n \nHum\n \nReprod\n \n2015\n; \n30\n: \n2802\n–\n2807\n. \n \n[10]\n \nChapron\n \nC\n, \nChiodo\n \nI\n, \nLeconte\n \nM\n, \nAmsellem\n-\nOuazana\n \nD\n, \nChopin\n \nN\n, \nBorghese\n \nB\n, \nDousset\n \nB\n. \nSevere\n \nureteral\n \nendometriosis\n: \nthe\n \nintrinsic\n \ntype\n \nis\n \nnot\n \nso\n \nrare\n \nafter\n \ncomplete\n \nsurgical\n \nexeresis\n \nof\n \ndeep\n \nendometriotic\n \nlesions\n. \nFertil\n \nSteril\n \n2010\n; \n93\n: \n2115\n–\n2120\n. \n \n \n \nFigure \n1\n:\n \nCT scan showing a left ureteric mass\n \n \nPaper ID: SR22212111239\nDOI: 10.21275/SR22212111239\n695 \n\nInternational Journal of \nScience and Research (IJSR)\n \nISSN: 2319\n-\n7064\n \nSJIF (2020): 7.803\n \nVolume 11 Issue 2, February 2022\n \nwww.ijsr.net\n \nLicensed Under Creative Commons \nAttribution CC BY\n \n \nFigure \n2A\n:\n \nCT scan showing left hydronephrosis\n \nsecondary to left ureteric mass\n \n \n \nFigure \n2B\n:\n \nCT IVU showing cut\n-\noff at lower end of left \nureter with proximal left hydroureter and hydronephrosis\n \n \n \nFigure \n3\n:\n \nSurgical specimen (cut section) of excised left \nureteric mass\n \nPaper ID: SR22212111239\nDOI: 10.21275/SR22212111239\n696","source_license":"CC0","license_restricted":false}