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Behind the typical signs of a staghorn calculus of a kidney and a ureterocele with calculi in x-ray a transitional cell carcinoma of the kidney and the whole ureter was found. The nonfunction of the organ was thought to be due to pyonephrosis. Four other cases reported in the literature are discussed.
Nephrostomy in patients suffering on pyonephrosis and urosepsis is investigated. Good results in long term follow up seem to recommend this intervention as an alternative procedure to a primary nephrectomy.
The highest incidence of defective wound healing in all surgical disciplines is observed after urological operations. Wound infections occur in more than 8% of all urological patients. Defective wound healing appears in about 17% of unselected nephrectomy cases, rising to 50% when pyonephrosis is present. Simple adenomectomy is associated with wound infection rates of between 8 and 12% in preoperatively uninfected patients and up to 50% in patients with preoperative bacteriuria. Numerous factors may influence wound healing, e.g. age, obesity, cachexia, chronic infectious and non-infectious diseases, anaemia, thrombopathy, faulty asepsis and antisepsis, preoperative showering and shaving, skin preparation, hand degerming, skin draping, duration of hospitalization, traumatic operative technique, suture material, diathermy, timing and length of operation, duration of hospitalization, and antibiotic regimen. Strict attention has to be paid to these factors if the incidence of postoperative wound infection is to be kept within reasonable limits.
Thirty-two cases of hydronephrosis caused by pelvi-ureteric junction obstruction, presenting to the Department of Paediatric Surgery in the last 6 years were reviewed. In both infants and older children a palpable abdominal mass was the most common mode of presentation. Anderson-Hynes pyeloplasty was performed in a total of 31 kidneys. In 4 children, whose kidneys were severely hydronephrotic and with hardly any renal parenchyma present a primary nephrectomy was performed. Of the two children who required further operation on the same kidney, a repeat pyeloplasty for persistent obstruction was required in 1 patient, the other patient underwent nephrectomy subsequent to pyeloplasty as a severe pyonephrosis had developed. Twenty-nine of the 31 kidneys were assessed postoperatively by tube nephrogram, intravenous pyelogram (IVP), or diuretic renography. Four kidneys were found to be non-functional or severely damaged.
The authors report 17 personal cases of lithiasis of the upper urinary tract discovered in the course of pregnancy. They discuss the diagnostic and therapeutic problems, taking into account the double risk of mother and foetus. The essential diagnostic sign is renal colic, with or without fever. Spontaneous excretion of these calculi is possible, but in 8 of the 17 cases, a ureteric catheter had to be passed or an operation was required. Neither the delivery nor the health of the infants delivered seemed to be harmed by this renal calculi disease. The authors recall that the most common cause of non-obstetrical abdominal pain in the course of pregnancy is in fact urinary calculi. The incidence is about 1 cases of lithiasis per 1,000 pregnancies. It appear that a physiological hyperparathyroidism of pregnancy is responsible for a hypercalciuria which could be a factor favouring the development of lithiasis during pregnancy. The important point is to know how to distinguish those forms of pyelonephritis of pregnancy which are due to a stone obstructing the upper urinary tract, as any purulent retention in the upper tract can lead to a pyonephrosis, a bacteraemia or even a septicaemia. The presence of the foetus makes interpretation of a plain abdominal film difficult. In any case, its indication is questionable, whenever the urine is septic, particularly with Proteus.(ABSTRACT TRUNCATED AT 250 WORDS)
Ultrasound examinations were analysed in 38 patients with acute renal infections (pyelonephritis, focal pyelonephritis, renal abscess, pyonephrosis). Ultrasound examination is normal in mild inflammatory involvement of parenchyma. In severe involvement diffuse enlargement of parenchyma with low density of echoes structure is found, while in focal pyelonephritis localized low density of echoes swelling of parenchyma is seen. Fever and flank pain are common to acute ureteral obstruction and acute pyelonephritis and ultrasound can distinguish between these diseases. Among mass lesions ultrasound can distinguish between focal pyelonephritis and abscess, but cannot differentiate between tumour and focal pyelonephritis.
In urology wound infections are of particular importance, since they occur in more than 8 of 100 patients. Of all surgical disciplines, urology in fact, is the one with the highest incidence of secondary wound healing. Thus, defective wound healing is seen in about 20% of unselected nephrectomy cases while adenomectomies associated with pyuria and prostatic abscesses show delayed healing in about 40%. In the presence of pyonephrosis or pyelonephritis surgical wounds are infected in 50% of cases. Prolonged preoperative hospitalization increases the chances of skin contamination and, as a result, the risk of wound infection. In addition, it is associated with a higher incidence of hospital infections, which constitutes another endogenous factor underlying defective wound healing. The rate of postoperative wound infections can only be kept within reasonable limits, if close attention is paid to the many factors which contribute to wound healing (e. g. hygiene and preoperative preparation, removal of hair, skin degerming, draping, preoperative disinfection of hands, prophylactic antibiotics etc.) and if strict aseptic and antiseptic precautions are taken.
Newer techniques have supplanted the urogram as the preferred procedure for evaluation of several renal infections. When imaging is indicated in acute pyelonephritis, sonography should be performed first. In focal pyelonephritis, sonography and/or computed tomography are preferred. These techniques are also generally required for elucidation of renal abscess and pyonephrosis.
1) Cefoxitin (CFX) was administered to seven patients: two with acute pneumonia, two with acute pyelonephritis, one with pyonephrosis complicated to pyelolithotomy, one with acute cystitis and one with CONN syndrome complicated to liver cirrhosis. 2) Response to the CFX treatment was excellent in three patients, good in three, and poor in one. 3) No side effect was observed in all cases. In two patients in whom CFX and furosemide were concomitantly administered, no aggravation of the renal function was observed.
Adhesive and invasive strains of Escherichia coli induced chronic pyelonephritis in mice following the acute phase. The pathological features of the induced chronic pyelonephritis were different between the groups of mice infected with these strains. In piliated adhesive strain (E77156)-infection, the kidneys with viable bacilli showed pyonephrosis with incomplete obstruction or atrophy with coarse scar. Mice with these renal lesions showed high serum antibody levels, but histologically recurrent infection was frequent. On the other hand, in non-piliated invasive strain (633-65)-infection, sterile pyelonephritis developed. This chronic lesion was characterized by the migration of antigen-bearing macrophages and lymphocytes and by a negative serum antibody response. In infections with either strain the predominant lymphocytes in the renal lesions were smooth-surfaced T-lymphocytes.
Fifty-three surgical operations, including 43 enlarged nephrectomies for cancer, were conducted employing the anterior transperitoneal approach along the costal margin. This technique has been used for the last 4 years for excision of renal cancers, as well as certain difficult nephrectomies (pyonephrosis, repeated kidney operations), and for surgery on the renal vessels, the adrenals, and the peri-aortic lymphatics. The approach is solid and easy to enlarge, and gives direct access to the diaphragm, the large vessels, the renal pedicle, and the upper pole of the kidney. As only the abdomen is incised, morbidity is low.
In acute obstructive pyelonephritis, obstruction is the most dangerous factor. This danger is for the kidney where pyelocanalicular reflux is responsible for interstitial nephritis and pyonephrosis. A danger also for the life of the patient, since pyelo-venous and pyelo-lymphatic reflux are responsible for septicaemia. During a short period of two years, the authors have been able, thanks to cooperation of all physicians working in their teaching hospital group, to collect 89 cases of acute obstructive pyelonephritis, 29 of them with concomitant septicaemia. By virtue of their resolutely aggressive attitude, relief of urinary tract obstruction was obtained on average only 15 hours after hospitalisation of the patients. Fifty nine of these patients had lithiasis. Despite such rapid care, it should be emphasised that 11 patients died. This reflects the gravity of such retention of infected urine proximal to the upper excretory tract. This gravity is considerably multiplied by the onset of septicaemia. Among the 11 deaths, 9 were in the group of 29 patients with septicaemia, whilst there were only 2 deaths amongst the group of 60 patients with no clinical evidence of septicaemia. In the opinion of the authors, treatment should, whenever possible, include elimination of the obstruction and thorough urinary drainage. In the presence of any apparently isolated septicaemia, it is essential to seek a renal cause. The rapidity of the elimination of obstruction of the urinary tract is the essential step in treatment, antibiotics being only an adjuvant.
Between 1971 and 1981, 120 patients or 127 kidneys underwent surgery for staghorn calculi in the Department of Urology at the University of Berne. The following surgical procedures were performed: 7 primary nephrectomies, 29 intrasinusal pyelotomies by the method of Gil-Vernet, 69 nephrotomies, 17 partial resections and 5 nephrotomies combined with partial resection of the kidney. All the surgical procedure in the parenchyma were done in cold ischemia produced by regional cooling of the surface with ice. In our retrospective study special emphasis is placed on important functional aspects of the surgical technique and possible intraoperative and early postoperative complications. Secondary nephrectomy was necessary in only one case. In 102 patients it was possible to record the late results after an average observation time of 4.8 years. 75% of the patients showed good results i.e. they were free of infections and stones and the intravenous urogram was functionally satisfactory. 15.6% had residual stones or recurrent stone formation whereas only 4.9% presented with chronic urinary infections resistant to therapy despite the absence of detectable stones. In 25 patients who underwent differential 131I-hippuran clearance studies the average loss of function was 8.6% for the kidney operated on in hypothermia. In the same 10-year period there were only 7 cases with staghorn calculi (all over 55 years of age) in which primary nephrectomy was necessary because of silent hydronephrosis or pyonephrosis. Our results are compared with a series published by Blandy and Singh who followed 60 patients in whom staghorn calculi were treated exclusively by conservative means. Today new surgical techniques make it possible to free the kidney of staghorn calculi without major loss of renal function, and they remain free of calculi and infection if the metaphylaxis is carefully followed.
The following has been established in examinations under optimal conditions: 1. Ultrasound and CT scan appear to be of equal value in respect of validity and significance of information on the nature of findings, especially in connection with spaceoccupying processes, hydronephrosis and pyonephrosis. However, CT supplies a better anatomical and topographical overall view of the situation. 2. CT scanning, is definitely superior in respect of significance of information on the extension and behaviour in respect of neighbouring organs. This is particularly evident in the visualisation of relapses after hyponephromas and in perirenal processes. 3. Computer tomography is clearly superior in the identification of renal aplasias and hypoplasias.
51 urologic patients were dialyzed following acute indications during 1968-77. The 47 adults were 31-81 (average 59) years old. Due to the frequency of occurrence the predominant diseases were: Urolithiasis (combined with pyonephrosis, urosepsis, nephrocirrhosis), malignant tumors, and bladder neck adenomas. 18 patients were postoperative cases. 32 patients suffered from severe diseases or complications outside the urogenital tract. According to a differentiation of three risk groups, there were 33 patients belonging to the most severe group III. The patients' admission to the dialysis unit was late in most cases: 13 patients were already in coma or precoma, 18 patients overhydrated, 11 patients' serum potassium was more than 7 mval/1,28 patients' serum creatinine was more than 10 mg/dl. A prophylactic dialysis was possible in 11 cases only. We have accepted all 51 acute urologic patients, admitted to our clinic, for dialysis treatment. Peritoneal dialysis was performed in all 51 patients, only in 6 of them this treatment was followed by haemodialyses. The reasons for prefering peritoneal dialysis were haemorrhages or the danger of haemorrhages, a critical cardiovascular state, or an extreme acotaemia. In 143 peritoneal dialyses with 91 insertions of stilet catheters, one perforation of the small intestine occurred. The patient survived the resulting peritonitis. 13 of 15 patients with this indication got into an operable state in the course of dialysis treatment. Lethality of 61 per cent (31 of the 51 patients died) was related to the severity of the basic urologic disease. 4 of these latter patients could have been admitted to a regular dialysis treatment. In further 6 cases this would have been possible after a special urologic treatment.
Results of experiments conducted in dogs are reported, in which the first few centimetres of the ureter were replaced by a prosthesis in silicone elastomer, the upper extremity being intubated by a trans-renal approach into the lower calyx and the upper extremity into the iliolumbar ureter. The one case of failure among the 6 dogs studied was due to a pyonephrosis from a technical error. In the 5 surviving dogs, the by-pass has remained permeable and there is no sign of incrustation. Control I.V.U. examinations after periods ranging from 26 months to 3 years showed normal function. This procedure has now been used in two human cases with good results.
Xanthogranulomatous pyelonephritis is a rare manifestation of chronic pyelonephritis. 11 cases were treated between 1988 and 1993. Patients age ranged from 17 to 60 years (mean 34 j). A pseudotumoral form was documented in 3 patients and pyonephrosis was found in 8 cases. Urine culture was usually positive for a non specific germ. Imaging technics could differentiate pseudotumoral disease from diffuse disease. Treatment consisted in a nephrectomy.
The authors report the various therapeutic modalities of uropathies associated with horseshoe kidney, based on a series of 20 pathologic horseshoe kidneys, associated with 12 cases of renal stones, 5 ureteropelvic junction obstructions, 3 kidney tumors, 2 cases of pyonephrosis and finally 1 traumatic horseshoe kidney. The specific anatomic and surgical features of this uncommon malformation are emphasized and the therapeutic features of each uropathy associated with horseshoe kidney are discussed.