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PubMed1990

Percutaneous nephrolithotomy: spinal cord injury vs. ambulatory patients.

One hundred patients, 35 with spinal cord injury (SCI) and 65 who were ambulatory, underwent percutaneous nephrolithotomy (PNL). Success of complete stone excision, operative morbidity and mortality were compared in the two patient populations. Stone size and complexity were evaluated by X-ray and a single-stage PNL was done using general anesthesia, bi-planar C-arm fluoroscopy, Amplatz renofascial dilators, and two guide wires. Eleven percent of the patients had previously-placed percutaneous nephrostomy tubes for hydronephrosis and/or pyonephrosis. In the ambulatory group, 98.5% (64/65) were stone-free after the procedure as compared to 85.7% (31/35) in the SCI group. The success rate in those patients who followed postoperative instructions exceeded 96% in both groups of patients. One operative mortality, related to infectious complications, occurred in the SCI group. Major morbidity in the SCI population consisted of three perirenal abscesses, a hydrothorax, an aspiration pneumonia, a respiratory arrest and a nephro-colonic fistula for a rate of 20% (7/35), or 7% of all patients. One major complication, a nephroduodenal fistula, occurred in the ambulatory population. Four patients, three of whom were SCI, required open surgery related to infectious complications. Other significant complications consisted of hemorrhage requiring transfusion, and fever (101.5 degrees F). Minor complications included dislodged nephrostomy tubes, retained stones, and ureteral edema causing obstruction. These complications were three times more common in the SCI population. Percutaneous nephrolithotomy is an effective surgical means for stone removal for SCI and ambulatory patients. The SCI patient has a high incidence of infectious complications causing increased morbidity and mortality.

Adult↗
PubMed2002

Atypical initial manifestation of acute pyelonephritis in continuous image study: renal cystic feature.

Renal infection, including acute and chronic pyelonephritis, focal bacterial nephritis, renal and perinephric abscess, pyonephrosis and others, represents a spectrum of interrelated conditions. In recent years, computed tomography, ultrasound, nuclear scintigraphy, excretory urography (IVP) and magnetic resonance imaging have offered varying degrees of utility in evaluating renal infection. Although imaging in acute pyelonephritis has been extensively studied, this condition is a rare initial presentation as a renal cystic feature. This investigation presents a case of acute pyelonephritis, with an atypical initial imaging manifestation in renal cystic feature, which became a heterogeneous mass during follow up, and disappeared after treatment. Two conclusions can be drawn: first, a renal cystic lesion may be an initial presentation of acute pyelonephritis; secondly, the abnormalities of the ultrasonography imaging study of renal pyelonephritis persisted and progressed despite the improvement in clinical symptoms and laboratory findings, and displayed complete resolution of imaging abnormalities several months later.

Acute Disease↗
PubMed2001

Evaluation of laparoscopic retroperitoneal surgery in urinary stone disease.

PURPOSE: To assess the safety and effectiveness of laparoscopic retroperitoneal surgery and attempt to define its role in the management of urolithiasis. PATIENTS AND METHODS: Laparoscopic retroperitoneal surgery (LRS) was undertaken in 72 male and 42 female patients with calculous disease from March 1994 to April 2000 for variety of indications that otherwise would have made them candidates for conventional open surgery. Some of these patients were subjected to retroperitoneoscopic ureterolithotomy (RPUL) (40 patients) and retroperitoneoscopic pyelolithomy (RPPL) (7 patients). Retroperitoneoscopic nephrectomy (RPN) and nephroureterectomy (RPNUT) for a nonfunctioning renal unit secondary to renal and or ureteral calculi was done in 53 and 14 patients, respectively. Most of the procedures were performed with three 10-mm ports. In some cases, an additional 5-mm port was used. RESULTS: The procedure was successful in 75%, 71%, 90.5%, and 86% of cases subjected to RPUL, RPPL, RPN, and RPNUT, respectively. The mean operating time for RPUL was 106.3 minutes and for RPPL was 108.2 minutes, whereas it was 99.7 minutes for RPN and 147 minutes for RPNUT of nonfunctioning kidneys secondary to calculous disease. The major complications encountered were colon injury in one patient with calculous pyonephrosis who had dense adhesions and injury to the external iliac artery in another patient having RPUL. The mean blood loss was 69.8, 127.2, 135.6, and 206.5 mL, respectively, for RPUL, RPPL, RPN, and RPNUT. The average hospital ranged from 3 to 4 days. CONCLUSIONS: Laparoscopic retroperitoneal surgery has a definite role in the management of patients requiring open surgery for calculous disease. It is safe and feasible in spite of the dense adhesions that are frequently encountered in such patients. Often, previous attempts at treatment with shockwave lithotripsy or endourologic procedures also lead to inflammation and adhesions, making surgery difficult. However, these problems can be dealt with by LRS with good results.

Adult↗
PubMed2002

Role of acellular collagen matrix surgisis in the endoscopic management of ureteropelvic junction obstruction.

PURPOSE: To investigate the role of acellular collagen matrix (Surgisis during endopyelotomy. MATERIALS AND METHODS: Nine female pigs (25-35 kg) were enrolled in our protocol. The pigs were categorized as follows. Group I (N = 3) had endopyelotomy + insertion of SIS, Group II (N = 3) creation of UPJ stricture + endopyelotomy + insertion of SIS, and Group III (N = 3) Davis intubated ureterotomy using SIS. The contralateral side served as a control for each group (one pig in each group). In three pigs (two in Group III and one in Group II), Surgisis was treated with India ink prior to insertion at the endopyelotomy site. An endopyelotomy stent (14/8 F x 24 cm) was used to stent the ureteropelvic junction (UPJ) for 4 weeks. Four weeks after the stent was removed, laparoscopic nephroureterectomy was performed, and the animals were euthanized. Histopathologic analysis of the Surgisis-regenerated segment of the UPJ was performed using hematoxylin and eosin, reticular (collagen), smooth muscle actin, and S-100 (nerve) stains. RESULTS: All animals tolerated the procedure. The mean operative time was 162 minutes. One pig (Group II) developed pyonephrosis; one pig (Group III) developed significant ascites and was sacrificed 2 week before the end of the experiment. Histopathologic analysis showed complete epithelializaton at 8 weeks. Reticular stain demonstrated abundant collagen matrix in the submucosa. Smooth muscle staining revealed myofibroblastic proliferation within the SIS-regenerated tissue adjacent to disorganized smooth muscle cells. India ink-stained SIS-regenerated tissue did not show smooth muscle cells. The S-100 stain did not demonstrate neurons at 8 weeks; however, in three pigs, peristaltic activity was noted across the UPJ. CONCLUSION: The use of acellular collagen matrix in the endoscopic management of UPJ obstruction is a promising technique. The abundance of myofibroblasts and absence of abundant smooth muscle regeneration indicates a need to investigate the role of growth factors in SIS regeneration of host tissue.

Actins↗
PubMed1998

New endoureteral double-J stent resists extrinsic ureteral compression.

The disadvantages of highly flexible endoureteral (double J) stents in the face of tumor-induced extrinsic ureteral compression are a consequence of insufficient cross-sectional stability, leading to stent compression and thus to hydronephrosis or pyonephrosis. The newly developed tumor stent, which is used in cases of tumor-induced ureteral compression, is available in sizes from 6F to 8F in diameter and 24 to 32 cm in length. The shaft consists of a combination of high-stability plastics that presents sufficient elasticity in length. Both ends are made of extremely elastic J parts, guaranteeing stable fixation. Compared with common double-J stents with the same outside diameter, the tumor stent possesses a comparable interior diameter and compared with available stents promises sufficient interior flow in the face of extrinsic diseases. The application can be undertaken using well-known endoscopic techniques, needs no special instrumentation, and entails no learning curve. To date, 49 stents were placed at our urologic departments without any problems, the latest stent remaining for 15 months. Tumor-induced compression or a higher rate of encrustation were not seen. All patients tolerated these stents well. In our opinion, the new stabilized endoureteral stent can be seen as a better solution than percutaneous nephrostomy or frequent stent changing to tumor-induced extrinsic ureteral compression.

Constriction, Pathologic↗
PubMed2002

Management of life-threatening autonomic hyper-reflexia using magnesium sulphate in a patient with a high spinal cord injury in the intensive care unit.

We report the successful use of i.v. magnesium sulphate to control life-threatening autonomic hyper-reflexia associated with chronic spinal cord injury in the intensive care environment. A 37-yr-old, male was admitted to the intensive care unit with a diagnosis of septic shock and acute renal failure secondary to pyelonephritis. He had been found unresponsive at home following a 2-day history of pyrexia and purulent discharge from his suprapubic catheter. He had sustained a T5 spinal cord transection 20 yr previously. Initial management included assisted ventilation, fluid resuscitation, vasopressor support, and continuous veno-venous haemofiltration. The sepsis was treated with antibiotic therapy and percutaneous nephrostomy drainage of the pyonephrosis. On the fifth day, the patient developed profuse diarrhoea. This was associated with paroxysms of systemic hypertension and diaphoresis, his arterial pressure rising on occasion to 240/140 mm Hg. A diagnosis of autonomic hyper-reflexia was made and a bolus dose of magnesium sulphate 5 g was administered over 15 min followed by an infusion of 1-2 g h(-1). There was an almost immediate decrease in the severity and frequency of the hypertensive episodes. There were no adverse cardiac effects associated with the administration of magnesium, only a slight decrease in minute ventilation as the plasma level approached the upper end of the therapeutic range (2-4 mmol litre(-1)). In view of the beneficial effects observed in this case we advocate further research into the use of magnesium sulphate in the treatment or prevention of autonomic hyper-reflexia secondary to chronic spinal cord injury in the intensive care unit.

Adult↗
PubMed1996

Flavobacterium indologenes bacteremia: clinical and microbiological characteristics.

To our knowledge, Flavobacterium indologenes has never been reported as a cause of bacteremia in humans. F. indologenes bacteremia was diagnosed in 12 patients at a tertiary referral center in southern Taiwan between 1 January 1992 and 31 December 1994. Six of these patients had ventilator-associated pneumonia, two had primary bacteremia, and one patient each had pyonephrosis, peritonitis, biliary tract infection, and surgical wound infection. Five patients (42%) had malignancies, and three (25%) had multiple burns. Polymicrobial bacteremia was diagnosed in eight patients (67%). Two (17%) of the patients in this study died; both had polymicrobial bacteremia. Antimicrobial susceptibility testing of the blood isolates from the 12 patients showed that > 90% of the isolates were susceptible to piperacillin, cefoperazone, ceftazidime, and minocycline. The chromatograms of esterified fatty acids for the isolates were identical. F. indologenes should be considered an etiologic agent of bloodstream infection, especially in hospitalized patients with severe underlying diseases.

Adult↗
PubMed1975

Renocolic fistula.

A case of left renocolic fistula secondary to chronic pyonephrosis has been reported. Neprectomy, excision of the fistulous tract, and closure of the colon is the treatment of choice. This was accomplished in this case with excellent results.

Adult↗
PubMed2004

Percutaneous nephrolithotomy in early pregnancy.

Most cases of urolithiasis in pregnancy are managed conservatively either with ureteric stents or percutaneous nephrostomy tubes, which need to be changed at regular intervals. Definitive management of the stone is usually delayed till after delivery. We describe a patient who presented with pyonephrosis in the fifth week of gestation, due to a stone obstructing the right ureteropelvic junction. This was managed by insertion of a nephrostomy tube. She declined nephrostomy tube/stent changes during the rest of her pregnancy and requested termination as an alternative. She successfully underwent percutaneous nephrolithotomy in the 14th week of pregnancy, with radiation exposure strictly localised to the kidney for 6 s. A healthy male baby was delivered at term.

Adult↗
PubMed2004

Urinary tract and genito-urinary suppurative infections due to anaerobic bacteria.

Anaerobes have been involved in many different types of urinary tract infection. This review describes the microbiology, diagnosis and management of urinary tract and genito-urinary suppurative infections caused by anaerobic bacteria. The types of infections of the urinary tract in which anaerobes have been involved include para- or periurethral cellulitis or abscess, acute and chronic urethritis, cystitis, acute and chronic prostatitis, prostatic and scrotal abscesses, periprostatic phlegmon, ureteritis, periureteritis, pyelitis, pyelonephritis, renal abscess, scrotal gangrene, metastatic renal infection pyonephrosis, perinephric abscess, retroperitoneal abscess and other infections. The anaerobes recovered in these studies were Gram-negative bacilli (including Bacteroides fragilis and pigmented Prevotella and Porphyromonas sp.), Clostridium sp., anaerobic Gram-positive cocci and Actinomyces sp. In many cases, they were recovered mixed with coliforms or streptococci. The recovery of anaerobes requires the administration of antimicrobial therapy that is effective against these organisms. These antimicrobials include metronidazole, chloramphenicol, clindamycin, a carbapenem, cefoxitin and the combination of a penicillin and a beta-lactamase inhibitor. Percutaneous drainage, open surgical drainage or nephectomy might be indicated for abscesses.

Abscess↗
PubMed1981

Surgical management of idiopathic retroperitoneal fibrosis.

The management of 10 patients with idiopathic retroperitoneal fibrosis causing obstructive uropathy is presented. In all cases the obstruction was relieved by ureterolysis and corticosteroid therapy was not used during the initial treatment. In 9 patients the operation was well tolerated but one, who developed a pyonephrosis after pre-operative ureteric drainage, died of septiceamia 15 days post-operatively. In 2 patients further explorations and ureterolysis were necessary for recurrent fibrosis which may have been related to urinary leakage. A policy for the management of these cases is presented which recommends the use of silastic tubing splints after ureteric mobilisation and the use of an omental wrap.

Adult↗
PubMed2005

Familial multiple endocrine neoplasia type I: the urologist is first on the scene.

OBJECTIVE: To study the urological manifestations of familial multiple endocrine neoplasia type 1 (MEN-1). PATIENTS AND METHODS: The study included 26 adults (median age 38.5 years, range 18-80) from two unrelated MEN-1 pedigrees. In 15 of the patients the diagnosis was confirmed by genetic analysis, while in the rest the diagnosis was based on clinical criteria combined with genealogy data. RESULTS: Urolithiasis associated with primary hyperparathyroidism was present in 65% of MEN-1 patients and in 77% of those who were symptomatic. In 68% of patients complications of urolithiasis (renal/ureteric colic, urinary tract infection) were the presenting clinical manifestations of MEN-1, whereas in 50% they constituted the only clinical manifestation of the syndrome. The mean time from the onset of symptoms of urolithiasis to the diagnosis of the polyendocrinopathy was 17.2 years. Initial failure to recognize the presence of MEN-1 in patients with primary hyperparathyroidism led to conservative parathyroid surgery, with subsequent relapse of the hyperparathyroidism, requiring re-operation. Serious renal morbidity included one case of pyonephrosis necessitating nephrectomy. While urolithiasis was a cardinal clinical manifestation of MEN-1, there was otherwise considerable phenotypic polymorphism, even among patients bearing the same MEN1 gene mutation. CONCLUSION: In patients with familial MEN-1 the complications of urolithiasis are the commonest presenting clinical manifestations and the cause of significant morbidity. In the presence of a family history of renal stones, appropriate investigations may lead to the timely diagnosis of this important, albeit rare, disorder.

Adolescent↗
PubMed2001

Short report: Hyperammonaemia in critically ill septic infants.

Three infants with subphrenic abscess, pyonephrosis, and obstructive ureterocoele respectively had grossly increased concentrations of plasma ammonia. This was considered to be a result of infections with urea splitting organisms. All died in spite of intensive care support, including specific measures to reduce plasma ammonia.

Ammonia↗
PubMed1984

Percutaneous nephrostomy in neonates, infants, and children.

In a 20-month period, 13 percutaneous nephrostomies were placed in 10 pediatric patients ranging in age from one day to six and one-half years. The procedure was successful in all cases with no significant complications. Final diagnoses included ureteropelvic junction obstruction, ureterovesical junction obstruction, posterior urethral valves, and pyonephrosis. Localization of the obstruction as detected on initial antegrade nephrostography was found to be incomplete or incorrect in three patients. In one patient, both ureteropelvic and ureterovesical junction obstruction were present. In the other two patients, the misdiagnosis probably related to the difficulty of filling a distended, obstructed ureter prior to drainage.

Age Factors↗
PubMed1986

Percutaneous studies of the upper urinary tract in children, with special emphasis on infants.

Of 101 antegrade pyelography and/or percutaneous nephrostomy procedures performed within a 6-year period, 18 involved patients less than 6 months of age. The procedures in this age group were characterized by ease of performance -without sedation in the neonates and with sedation in the children -and by the use of smaller needles and catheters. The procedures enabled differentiation between obstructed and nonobstructed dilated systems with pressure-flow studies, depiction of the intimate anatomy of complicated urologic abnormalities, temporary drainage, decompression of pyonephrosis, endourologic access, and collection of urine for cultures after ureterosigmoidostomy. The procedures were highly successful and had few complications.

Adolescent↗
PubMed1989

Bacterial renal infection: role of CT.

The imaging studies done on 62 patients hospitalized for acute renal infections were retrospectively reviewed. Thirty-six (58%) had one or more abscesses, 17 (27%) had focal or diffuse acute bacterial nephritis, five (8%) had pyonephrosis, and four (6%) had pyelonephritis. All had prolonged fever (greater than or equal to 72 hours) and leukocytosis. Among 25 patients examined with both ultrasound (US) and computed tomography (CT), US failed to depict three of five (60%) cases of acute bacterial nephritis and seven of 15 (47%) intrarenal and extrarenal abscesses. One renal abscess was misdiagnosed as a tumor at CT. US is not an adequate screening test for detecting lesions that may require invasive therapy. CT is more sensitive for the detection of acute renal inflammatory disease and for defining the extent of disease for planning of radiologic or surgical intervention.

Abscess↗
PubMed2005

[Assessment of long-term renal function after nephrectomy. Study of 53 patients].

BACKGROUND AND OBJECTIVE: Patients with unilateral nephrectomy maintain the remaining kidney function over time, as it has been described in healthy kidney donors. PATIENTS AND METHOD: We performed a cross-sectional study of 53 patients who were followed 5 or more years after nephrectomy. Serum creatinine, BUN, Glomerular Filtration Rate (GFR) (24 hours urine collection and Cockcroft formula), microalbuminuria, proteinuria, Body Mass Index and the annual loss rate of renal function were measured or calculated over the follow-up period. We retrospectively considered the presence of risk factors like diabetes, hypertension, microalbuminuria, dyslipemia, smoking habit, obesity and ACE inhibitors or angiotensin-receptor antagonists treatment. We divided our patients into two groups: group I (normal or mild renal failure: GFR > 50 cc/min and or serum creatinine < 1.4 mg/dL) and group II (moderate or severe renal failure). RESULTS: The main cause of nephrectomy was renal tuberculosis, followed by lithiasis and pyonephrosis. In addition, 7.5% of patients were kidney donors. At the time of study, 22.7% had diabetes, 60.4% hypertension and 39.6% were obese. The mean age was 60 years (37 years at the moment of nephrectomy). The GFR final mean was 53.6 cc/min (58.8 cc/min by Cockcroft formula). The mean renal function loss rate was 1 cc/min/year. 35% of the patients had moderate or severe kidney failure and were included in group II; 32% had proteinuria and 56.6% had abnormal microalbuminuria. The univariate risk factors analysis for the development of renal failure showed inter-group statistical significative differences in current age, nephrectomy age, microalbuminuria, proteinuria, and hypertension prevalence (p = 0.008). With regard to the progression rate, we found a significant correlation with final microalbuminuria (r = 0.358, p = 0.03). Current age and final proteinuria were found to be significant risk factors in the multivariate analysis. CONCLUSIONS: A high prevalence of renal insufficiency was found among patients with unilateral nephrectomy, which is mainly related to age and proteinuria. The renal function loss rate is slow and is influenced by microalbuminuria.

Aged↗