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PubMed2004

Long-term follow-up of ureteral stump tumors after nephrectomy for benign renal disease.

OBJECTIVE: The occurrence of primary carcinoma of the ureteral stump after nephrectomy is rare. In this study, we evaluated the clinical characteristics of ureteral stump tumors after nephrectomy for benign renal disease. METHODS: During a 16-year period, 318 consecutive patients underwent simple nephrectomy for benign renal disease (216 cases) or for donation (102 cases). Eight of these 318 patients diagnosed as having an ureteral stump tumor were treated by ipsilateral ureterectomy with cuff excision of the bladder. Pathologic findings, tumor stages, and clinical characteristics were analyzed. RESULTS: The eight ureteral stump tumors comprised; 6 transitional cell carcinomas (TCCs) and 2 squamous cell carcinomas (SCCs). The mean interval between nephrectomy and ureteral stump tumor diagnosis was 76.5 months. Six of the 8 patients had pyonephrosis and two renal tuberculosis as original renal diseases. Four of the 6 TCCs were stage T1 and 2 stage T2. There was no concomitant bladder tumor at stump tumor diagnosis. Hematuria was the major presenting symptom in 3 of the 8 patients and 4 patients were diagnosed by follow-up imaging study. Two of the 6 ureteral stump TCC patients developed bladder TCC during follow-up. The 5-year survival rate of patients with ureteral stump tumor was 37.5%. T1G1 TCC was associated with a better survival than T2 or G2 TCC. No ureteral stump tumor occurred in cases of donor nephrectomy. CONCLUSION: This study demonstrate, that long-term closed observation is needed to detect ureteral stump tumor, particularly in patients that have undergo nephrectomy for a long-standing inflammatory renal disease such as pyonephrosis or tuberculosis. Hematuria is a major presenting symptom of ureteral stump tumor. However, a follow-up imaging study is also important for ureteral stump tumor detection. The prognosis is poor in cases developing ureteral stump SCC, bladder tumor recurrence, or a high-grade ureteral tumor.

Aged↗
PubMed1989

Nonintubated Anderson-Hynes repair of ureteropelvic junction obstruction in 60 patients.

We reviewed our experience with 68 consecutive Anderson-Hynes ureteropyeloplasties. The 64 infants, children and young adults ranged from 2 days to 28 years old (median age 2 years), and 28 were less than 1 year old. Intubation was used in only 4 patients: 2 who also underwent ureteral reimplantation for vesicoureteral reflux, 1 with stones in the renal pelvis and 1 with pyonephrosis. We successfully repaired 60 of 64 nonintubated renal units (93.4 per cent). Temporary postoperative ureteral stenting was required for extravasation from 8 renal units (12.5 per cent). Two patients later underwent repeat ureteropyeloplasty for recurrent obstruction. Nephrectomy was performed for pyonephrosis in 1 patient and for a nonfunctioning kidney that had exhibited poor function preoperatively in 1. Prolonged ileus necessitated extended hospitalization in 3 patients (4.6 per cent). We conclude that nonintubated dismembered ureteropyeloplasty for uncomplicated, primary ureteropelvic junction obstruction can be performed safely and successfully, and should be considered the standard treatment. Positioning of the Penrose drain is critical to avoid urinoma formation. When persistent urinary leakage occurs temporary diversion is easy and well tolerated. Hospital stay averaged 12.1 days for patients with extravasation compared to 4.3 days when no extravasation occurred. Immediate preoperative retrograde pyelography did not seem to contribute to postoperative urinary extravasation by causing edema of the ureteral orifice.

Adolescent↗
PubMed1982

Accuracy of ultrasound in the diagnosis of nonfunctioning kidneys.

The accuracy and reliability of ultrasound were assessed in 246 patients with 338 radiologically nonfunctioning renal units. The causes of nonfunction included hydronephrosis, pyonephrosis, renal parenchymal disease, renal agenesis, renal neoplasm and polycystic disease. Obstruction was proved in 158 patients, with an accuracy of 98.1 per cent. Retrograde pyelography was avoided. The diagnosis of a small end stage kidney was correct in 42 patients. In 9 patients with a unilateral nonfunctioning kidney less than 9 cm. long a thin coarsely textured cortex with dilatation of 1 or more calices was found. To our knowledge the presence of dilated calices in a small kidney, suggestive of chronic pyelonephritic changes, has not been described previously by ultrasound. Nonvisualization occurred in 16 cases (4.7 per cent) despite the anatomical presence of a kidney. An advanced degree of pyonephrosis with thick inspissated pus sometimes may mimic the ultrasonic appearance of a renal neoplasm.

Humans↗
PubMed1999

Percutaneous nephrostomy as adjunct management in advanced upper urinary tract infection.

OBJECTIVES: To determine by retrospective review of 315 percutaneous nephrostomies, performed for pyonephrosis, whether this intervention has major clinical advantages. METHODS: From 1977 to 1996, under the direct supervision of the senior author of this report (E.K.L.), at seven hospital sites, 315 patients (181 males, 134 females; 17 to 88 years of age) were treated with percutaneous nephrostomy and antibiotic therapy for infected hydronephrosis. RESULTS: Additional or disparate pathogens were identified in 116 (36.8%) of 315 patients, leading to a clinically significant change in, or addition of, antibiotics and/or antifungal agents in 84 (73%) of 116. Most notably, we often found a clinically important disparity between the results of cultures obtained from the nephrostomy and those obtained from bladder-urine specimens. CONCLUSIONS: This retrospective review confirms previously reported advantages of percutaneous upper urinary tract drainage as a potentially life-saving adjunct in the treatment of pyonephrosis. Several case studies highlight the advantage of this maneuver in difficult cases involving obstruction due to extensive fungus or debris. In particular, our review focuses attention on the clinically important insight that urine cultures from percutaneous nephrostomy drainage often identify pathogens that differ from those detected in concurrent bladder cultures.

Humans↗
PubMed2001

Retroperitoneoscopic dismembered pyeloplasty for pelvi-ureteric junction obstruction in infants and children.

OBJECTIVE: To report our initial experience of endoscopic dismembered pyeloplasty through a retroperitoneal approach in infants and children with pelvi-ureteric junction (PUJ) obstruction. PATIENTS AND METHODS: Thirteen infants and children with PUJ obstruction underwent retroperitoneoscopic dismembered pyeloplasty (mean age at operation 2.7 years, range 0.25-10). Nine patients presented with complications secondary to PUJ obstruction, including urinary tract infection, pyonephrosis and increasing hydronephrosis with impairment in renal function. The other four patients had recurrent loin pain secondary to intermittent PUJ obstruction. The patient was placed in semi-prone (for left-sided) or a semilateral position (for right-sided PUJ obstruction). The retroperitoneal space was entered via a 1-cm incision over the mid-axillary line and further developed using a glove balloon. Video-retroperitoneoscopy was undertaken using a 5-mm laparoscope. Dismembered pyeloplasty was carried out with the pelvi-ureteric anastomosis fashioned using fine polydioxanone sutures over a double-pigtail ureteric stent. RESULTS: The retroperitoneoscopic dismembered pyeloplasty was successful in 12 patients, while one with previous percutaneous nephrostomy drainage for pyonephrosis required open conversion because of difficulties in developing the retroperitoneal space. The mean (range) operative duration was 143 (103-235) min. All patients had a rapid and uneventful recovery. The drainage was satisfactory in all 12 patients on a follow-up scan. CONCLUSIONS: Retroperitoneoscopic dismembered pyeloplasty is effective and safe in infants and young children giving a good early outcome, although the long-term results await further studies.

Anastomosis, Surgical↗
PubMed2006

Xanthogranulomatous pyelonephritis: our experience with review of published reports.

BACKGROUND: The aim of this study was to analyse the cases of xanthogranulomatous pyelonephritis with review of published reports. METHODS: We retrospectively reviewed all nephrectomy specimens during February 1995 to January 2006. We found 26 cases of xanthogranulomatous pyelonephritis. We prepared a chart of these cases consisting of preoperative symptoms, laboratory findings, radiological imaging results and preoperative diagnosis. Open nephrectomy was carried out in all cases. RESULTS: Age group of the patients was 6-65 years and male : female ratio was 1.6:1. Twenty-two patients presented to us with intermittent high-grade fever, 21 with flank pain, 18 with loin mass, 2 with haematuria and 1 was detected during screening of vague gastrointestinal symptoms. Twenty-five patients had pyuria and only 10 had sterile urine culture. In all patients, only one kidney was affected. All patients had renal calculi 10-42 mm in size with bilaterally enlarged kidneys. Ipsilateral kidney was enlarged because of hydronephrosis or pyonephrosis in all cases and contralateral kidney was enlarged because of compensatory hypertrophy in 13 cases. Ipsilateral kidney had severely compromised renal function in all cases. Associated psoas abscess was present in one and tuberculosis in another. CONCLUSION: Xanthogranulomatous pyelonephritis is a relatively rare entity that is associated with obstruction, stones and infection of the urinary tract. Late presentation leads to loss of renal parenchyma. It cannot be differentiated preoperatively with renal tumours (renal cell carcinoma and Wilms' tumour), pyonephrosis, infected hydronephrosis and renal lymphoma. Nephrectomy and antibiotics are the treatment of choice.

Adolescent↗
PubMed2004

Lithiasic obstructive uropathy. Hydronephrosis characterization by magnetic resonance pyelography.

OBJECTIVES: The purpose of this study was to evaluate the role of magnetic resonance (MR) pyelography in patients affected by hydronephrosis due to ureteric stones, in order to identify a pyonephrotic condition. MATERIALS AND METHODS: In the last 3 years, 315 patients, who had originally been investigated by ultrasonography, were evaluated with MR pyelography in order to define the etiology of obstruction. In 67 patients hydronephrosis was referred as caused by lithiasis. RESULTS: MR pyelography not only confirmed urinary tract dilatation in all patients, but also identified grade and site of obstruction, both in acute dilatation (25 patients) and in chronic obstructions (42 patients). In 7 patients, MR pyelography documented pyonephrosis that was obviously confirmed by nephrostomic drainage. CONCLUSION: MR pyelography, made with ultrafast breath-hold sequences, has a great value in identifying hydronephrosis in patients with ureteric stones. Furthermore, it provides the chance to identify pyonephrosis requiring an immediate drainage of the kidney before major complications develop.

Adult↗
PubMed2001

Unpredicted spontaneous extrusion of a renal calculus in an adult male with spina bifida and paraplegia: report of a misdiagnosis. Measures to be taken to reduce urological errors in spinal cord injury patients.

BACKGROUND: A delay in diagnosis or a misdiagnosis may occur in patients with spinal cord injury (SCI) or spinal bifida as typical symptoms of a clinical condition may be absent because of their neurological impairment. CASE PRESENTATION: A 29-year old male, who was born with spina bifida and hydrocephalus, became unwell and developed a swelling and large red mark in his left loin eighteen months ago. Pyonephrosis or perinephric abscess was suspected. X-ray of the abdomen showed left-sided staghorn calculus. Since ultrasound scan showed no features of pyonephrosis or perinephric abscess, he was prescribed a prolonged course of antibiotics for infection presumed to arise from the site of metal implant in spine. He developed a discharging sinus, following which the loin swelling and red mark subsided. About three months ago, he again developed a red mark and minimal swelling in the left loin. Ultrasound scan detected no abnormality in the renal or perinephric region. Therefore, the red mark and swelling were attributed to pressure from the backrest of his chair. Five weeks later, the swelling in the left loin burst open and a large stone was extruded spontaneously. An X-ray of the abdomen showed that he had extruded the central portion of the staghorn calculus from left kidney. With hindsight, the extruded renal calculus could be seen lying in the subcutaneous tissue of left loin lateral to the 10th rib in the X-ray of abdomen, which was taken when he presented with red mark and minimal swelling. CONCLUSION: This case illustrates how mistakes in diagnosis could occur in spinal cord injury patients, and highlights the need for corrective measures to reduce urological errors in these patients. Voluntary reporting of urological errors is recommended to facilitate learning from our mistakes. In the patients who have marked spinal curvature, ultrasonography of kidneys and perinephric region may not be entirely reliable. As clinical symptoms and signs may be non-specific in SCI patients, they require prompt, detailed and occasionally, repeated investigations. A joint team approach by health professionals belonging to various medical disciplines, which is strengthened by frequent, informal and honest discussions of a patient's clinical condition, is likely to reduce urological errors in SCI patients.

Adult↗
PubMedDate not supplied

Hand-assisted laparoscopic nephrectomy as a minimally invasive option in the treatment of large renal specimens.

INTRODUCTION: We describe our experience with hand-assisted laparoscopy (HAL) as an option for the treatment of large renal specimens. MATERIALS AND METHODS: Between March 2000 and August 2004, 13 patients candidate to nephrectomies due to benign renal conditions with kidneys larger than 20 cm were included in a prospective protocol. Unilateral nephrectomy was performed in cases of hydronephrosis (6 patients) or giant pyonephrosis (4 patients). Bilateral nephrectomy was performed in 3 patients with adult polycystic kidney disease (APKD) with low back pain refractory to clinical treatment previous to kidney transplant. The technique included the introduction of 2 to 3 10 mm ports, manual incision to allow enough space for the surgeon's wrist without a commercial device to keep the pneumoperitoneum. The kidney was empty, preferably extracorporeally, enough to be removed through manual incision. We have assessed operative times, transfusions, complications, conversions, hospital stay and convalescence. RESULTS: The patients mean age (9 women and 4 men) was 58 years. Mean operating time was 120 +/- 10 min (hydronephrosis), 160 +/- 28 min (pyonephrosis) and 190 +/- 13 min (bilateral surgery for APKD). There was a need for a conversion in 1 case and another patient needed a transfusion due to a lesion in the renal vein; 2 patients had minor complications. CONCLUSIONS: HAL surgery is a minimally invasive alternative in the treatment of large renal specimens, with or without significant inflammation.

Female↗
PubMedDate not supplied

Ascariasis of the kidney.

The very rare occurrence of ascariasis of the kidney is reported in a 6-year-old boy from Cape Town, South Africa. He was acutely ill with pyonephrosis and passed adult Ascaris lumbricoides per urethra before having a nephrectomy. There was no evidence of a fistula between the intestines and the urinary system, and as the development of larvae into mature helminths within the renal system is not considered to be possible it is likely that mature worms gained entrance through the urethra. It appears that the worms obstructed the right ureter and caused hydronephrosis, pyonephrosis, and deposition of ova in renal tissue.

Animals↗
PubMed1999

[A renocolic fistula diagnosed by retrograde pyelography].

OBJECTIVE: To describe a case of renocolic fistula diagnosed by retrograde pyelography. METHODS: A case of renocolic fistula associated with pyonephrosis and left pleural empyema in a 48-year-old female with a history of recurrent pyelonephritis is presented. RESULTS: The ultrasound findings were suggestive of pyonephrosis and an excretory urogram showed a non-functioning left kidney. Retrograde pyelography showed passage of contrast medium into the descending colon. Surgical treatment consisted of nephrectomy, exteriorization of the compromised colon and pleurotomy. The patient died from septic shock. CONCLUSIONS: The utility of retrograde pyelography in the diagnosis of renocolic fistula is demonstrated in the case described herein.

Colon↗
PubMed2000

[Percutaneous nephrostomy: indications, techniques and results. Retrospective study of 81 cases].

A retrospective study has been made of 81 cases of percutaneous nephrostomy (PCN) which were treated during the period 1989-1998. The mean patient age was 41 years (age range: 21-66 years). The reasons for the diversion via nephrostomy catheter were oligoanuria (43 cases), pyonephrosis (34 cases), and evaluation of renal function (four cases). The initial disease was found to be malignant in 23.25% of cases of oligoanuria, with six cancers of the cervix, three bladder cancers and one prostate cancer. Lithiasis was the main etiology in subjects with benign disease, and was the causative factor of oligoanuria in 55.8% and pyonephrosis in 67.6% of cases, i.e., a total of 47 cases (58%). PCN catheter placement was successfully carried out in 100% of cases, and resulted in improved renal function, and/or in the treatment of the initial infectious syndrome in the majority of cases. PCN is an excellent technique for upper urinary tract drainage due to its simplicity, efficacy, ease of insertion, low cost and satisfactory results. It is a minimally invasive technique, which necessitates only the use of a local anesthetic, a sound knowledge of the human anatomy involved, a trained operator and a minimum of material.

Adult↗
PubMed2000

[Nephrobronchial fistula: a case report].

Nephrobronchial fistulas following pyonephrosis associated with urolithiasis are a rare occurrence. The possibility of severe problems arising during surgery should be taken into considerations; both the surgeon and the anesthetist should be fully informed of the specific risk factors involved. A favorable outcome mainly depends on the appropriate treatment and timely management of any thoracic complications. Although this rare pathology has been described in detail in the literature, the problems encountered during anesthesia and surgery have not been fully reported. This study therefore provides new data, as a case has been reported of a 38-year old female who underwent surgery for pyonephrosis; disease management and prognosis problems have been discussed.

Adult↗
PubMed1990

[Purulent retention in the upper urinary tract and pregnancy. Apropos of 3 cases].

The purulent retention of the upper urinary tract is fortunately a rare urologic complication for the pregnant women. It decompensates a congenital or acquired uropathy. It is an important urologic emergency in which the diagnosis of obstruction, and the drainage of urines must be of immediate necessity as important as antibiotherapy, to avoid pyonephrosis and the destruction of the kidney. Concerning 3 cases, treated in the stage of pyonephrosis in the department of urology in Susa, we emphasize a premature diagnosis, which can only be done through an ultrasonography, the only guarantee to preserve the kidney. When possible, percutaneous nephrostomy constitutes an excellent means of drainage, while expecting a final disappearance of the obstruction.

Adult↗
PubMedDate not supplied

Ultrasound in renal pyogenic infection. Imaging and intervention.

A series of 34 patients with renal or perirenal pyogenic infection (18 with pyonephrosis, 10 with renal abscess and 6 with perirenal abscess) is presented to evaluate diagnosis with ultrasound and treatment with percutaneous ultrasound guided aspiration/drainage. Specific findings, defined as sediment echoes or dispersed internal echoes in a hydronephrotic renal collecting system, were noted in 39 per cent of pyonephrosis cases. Abscesses were mainly round or oval hypoechoic lesions measuring from 2 to 15 cm in diameter. Two abscesses were multilocular and one showed a septum. The appearance suggested tumor in 25 per cent. Because of this non-specificity of ultrasound we recommend diagnostic aspirations and further radiologic and other examinations in difficult cases. Four patients were treated by conservative means only, 13 with percutaneous aspiration or drainage, 9 with a combined drainage procedure and surgery, and 8 surgically. The length of the mean hospital stay was shortest in the group with the percutaneous drainage procedure (PDP) although the difference was not statistically significant. PDP was not effective in 12 per cent and surgery was used in these two cases to ensure cure. Complications occurred more often in the PDP group than in the surgery group but the most serious complication was a post-operative one. The different modes of treatment are discussed. The overall mortality was 5.9 per cent.

Abscess↗
PubMed1994

[Ultrasonographic aspects of kidney pelvis tumors associated with infectious hydronephrosis of lithiasic origin].

The ultrasonographic findings of 4 patients with surgically confirmed urothelial tumors associated with calculic pyonephrosis are presented. All the involved were markedly enlarged and hydronephrotic with obstructive calculi, stigmata of pyonephrosis and, an echoic pelvic mass, extending in calyceas in 2 cases. The sonographic appearance correlated well with the gross pathological findings. The histological types were 2 squamous cell carcinomas, 1 adeno-squamous cell carcinoma and 1 transitional carcinoma. The chronic calculic irritation was proved to induce squamous and glandular metaplasia. The subsequent squamous carcinoma and adenocarcinoma were documented in the literature. The preoperative diagnosis of the associated tumor was rarely done. The sonographic features reported are highly suggestive of urothelial tumor and may lead to an accurate preoperative diagnosis.

Adenocarcinoma↗
PubMed1993

[Urological emergencies].

Every general practitioner has to deal with urologic emergencies. The most frequent illnesses are urinary retention, acute scrotum, priapism, macrohematuria, nephritic colic, obstructive pyelonephritis and pyonephrosis. Whereas urinary retention, as well as acute ureteric stone colic must generally be treated by the practitioner, the urologist must often be consulted in case of an acute scrotum or for priapism. Testicular torsion is one situation, where surgical treatment needs to be performed within 6 hours. Of utmost importance is his timely assistance with the obstructive pyelonephritis and pyonephrosis. These are initially often not recognized, especially because the first ultrasound examination of the intrarenal pyelone may not show a dilatation of the collecting system despite obstruction. If the adequate treatment with drainage and antibiotics is applied too late, this can result in serious and potentially lethal consequences.

Adult↗
PubMed2001

Sonographic features of xanthogranulomatous pyelonephritis.

PURPOSE: The purpose of this study was to describe the various sonographic features of xanthogranulomatous pyelonephritis (XGP). METHODS: We retrospectively reviewed the CT, sonographic, and medical records of patients diagnosed with XGP from January 1981 to December 1998. Twenty-seven patients for whom XGP was histopathologically confirmed were included in the study. There were 12 men and 15 women, with an age range of 21-86 years (mean, 57 years). All patients had undergone sonography of the kidneys. The renal size, shape, and outline were recorded. The presence of perinephric fluid accumulation, of obstructive uropathy, or of internal echoes in the dilated collecting system and the echotexture of the renal parenchyma were documented. RESULTS: We categorized the XGP into 4 groups on the basis of the sonographic features: (1) diffuse hydronephrotic, 12 patients (44%); (2) diffuse parenchymal, 9 patients (33%); (3) diffuse contracted, 4 patients (15%); and (4) segmental or focal, 2 patients (7%). A localized perinephric fluid collection was present in 4 patients (15%). The preoperative sonographic diagnoses were pyonephrosis (n = 14, 52%), renal pelvic tumor with possible associated infection (n = 5, 19%), renal parenchymal mass (n = 2, 7%), hydronephrosis (n = 2, 7%), and chronic pyelonephritis with renal atrophy (n = 4, 15%). XGP was considered a possible diagnosis in only 11 patients (41%). CONCLUSIONS: XGP has no specific sonographic features but is suggested by parenchymal thinning and hydronephrosis, sonographic signs of chronic obstructive uropathy caused by stones; echoes in the dilated collecting system; and a perinephric fluid collection. CT, needle biopsy, or both are recommended to further evaluate and confirm sonographically suspected XGP.

Adult↗