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PubMedDate not supplied

[Hydronephrosis in a horseshoe kidney].

The authors studied hydronephrosis characteristics for horseshoe kidney in 170 patients aged 15-70. Basing on anatomic and functional features and urethral condition in each patient 136 operative interventions on one or two parts of the fused kidney in 125 patients were conducted. 26 heminephrectomies were carried out in hydronephrosis stage III, pyonephrosis and acute purulent focal pyelonephritis. 110 stage I-II hydronephrosis patients underwent an original reconstructive combined surgery on the fused kidney ending in formation of two separate organs. High incidence of hydronephrosis in horseshoe kidney against that in normal kidney (64 and 7%, respectively) and not infrequent bilateral involvement (63%) can be explained by anomalous structure of the organ conducive to obstruction of the urinary tracts. In 136 surgical cases the obstruction was due to: peripelvic compression of the ureter above the isthmus of the kidney (128 cases), high branching of the ureter from the renal pelvis with formation of the "spur" (114 cases), periurethritis and the fixed peripelvic ureteral kink by the adhesions (64 cases), congenital stricture of the peripelvic ureter (42 cases) or its compression by the accessory vessel (12 cases). To correct these abnormalities, it is reasonable to employ reconstructive surgery proposed by E. M. Shimkus. The procedure implies the isthmus resection with renal segment part, resection of the lower calyx, pelvic plasty according to Anderson-Hines technique, pyelolithotomy and nephropexy. This surgery abolishes all the underlying causes of fused kidney hydronephrosis and reestablishes urodynamics. It secured positive results by 2-28-year follow-up in 95% of the patients and is recommended as a method of choice.

Adolescent↗
PubMed1994

Acute renal and urinary tract disease.

Patients with acute urinary tract disorders often present with acute abdominal symptoms. Sonography and CT are often the first investigations performed when the clinical nature of the symptoms is unclear. However, excretory urography and cystography, scintigraphy, and angiography all play useful roles in evaluating patients with acute urinary tract disorders. Patients with suspected acute renal obstruction due to ureteric calculi are best assessed by excretory urography. If the latter study is contraindicated, sonography with duplex Doppler analysis of small intra-renal arteries may suggest the diagnosis by showing a dilated collecting system and an elevated resistive index. Patients with acute renal trauma are best imaged by CT, although excretory urography is an appropriate alternative if a mild exclusively renal injury is suspected. Patients with refractory acute renal infections require imaging to identify either pyonephrosis or large renal or perinephric abscesses that require immediate intervention. CT and sonography are most useful for identifying these complications. Acute renal vascular disorders, including renal hemorrhage, renal infarction, and renal vein thrombosis are readily diagnosed by contrast-enhanced CT. Both sonography and MR imaging help in the diagnosis of acute renal vein thrombosis. Most acute bladder disorders are diagnosed clinically. Cystography, however, is essential for the diagnosis of traumatic bladder rupture. Pelvic CT is a useful alternative to cystography for diagnosing bladder rupture in patients who undergo CT as their first imaging study because of suspected head or abdominal injuries.

Abdomen, Acute↗
PubMed1994

Ureteral obstruction following acute pancreatitis.

A patient with hydronephrosis caused by extrinsic right ureteral obstruction due to extension of pancreatic inflammation is reported. At surgery, pyonephrosis was detected and nephrectomy had to be carried out. We recommend a careful ultrasonographic follow-up of all patients with acute pancreatitis for back pressure changes in the kidneys.

Acute Disease↗
PubMed1994

Laparoscopic nephrectomy: the learning-curve experience.

OBJECTIVE: To report the learning-curve experience with laparoscopic nephrectomy. DESIGN: Case series. SETTING: A tertiary-care referral centre serving southern Saskatchewan. PATIENTS: Sixteen patients (7 men, 9 women), selected to undergo laparoscopic nephrectomy. They ranged in age from 19 to 83 years. Indications for surgery were: recurrent atrophic pyelonephritis with pain (three patients), obstruction at the ureteropelvic junction with pain (three), small ectopic kidney with pain (one), renovascular hypertension (two), a solid renal mass confirmed by computed tomography (four), Staghorn calculus (one), transitional cell tumour of upper ureter (one) and pyonephrosis with a nonfunctioning kidney (one). INTERVENTIONS: Laparoscopic nephrectomy. MAIN OUTCOME MEASURES: Postoperative morbidity, complications of the procedure and duration of postoperative hospitalization. RESULTS: Kidneys were removed laparoscopically in 13 patients. Open nephrectomy was necessary in three patients, owing to a lack of experience in patient selection in two cases and to intraoperative hemorrhage in the third. All patients resumed oral intake on the 1st postoperative day, and most did not require analgesics for relief of pain beyond 36 hours postoperatively. Complications of laparoscopic nephrectomy included pneumonia (one patient), low-grade fever (two patients), need for blood transfusion (three patients) and transient ischemic attack (one patient). The mean postoperative hospital stay was 4.3 days. CONCLUSIONS: When patients are properly selected, laparoscopic nephrectomy provides decreased postoperative morbidity, a shorter convalescence, and thus cost savings, compared with open nephrectomy.

Adult↗
PubMed1993

[Peritonitis caused by rupture of a retroperitoneal abscess].

A 30 year old man presented with an initial clinical picture limited to low back pain. Increasing severity of the pain after one month led to his admission to a surgical department and the diagnosis of a large right retroperitoneal abscess. Several hours before the proposed operation for extraperitoneal surgical drainage of the abscess through a lumbar approach, his condition was complicated by the intraperitoneal rupture of the abscess. The resulting peritonitis and the retroperitoneal abscess were treated through a laparotomy and the postoperative course was uncomplicated. A literature review showed this to be only the second case of this rare generalized peritonitis complication to be reported, for which a parallel can be drawn with the intraperitoneal rupture of a pyonephrosis. A general overview of retroperitoneal abscesses is presented.

Abscess↗
PubMed1993

[Complications in urological laparoscopic surgery].

Laparoscopic surgery is often associated with complications which never occur in open conventional surgery. We investigated operative and postoperative complications in urological laparoscopic surgery. From February 1990 to November 1992, 91 laparoscopic operations were performed, including 62 varicocelectomies, 5 pelvic lymphadenectomies, 6 adrenalectomies, 5 simple nephrectomies, 2 radical nephrectomies, 1 staged Fowler-Stephens operation and 10 laparoscopies for cryptorchidism or other disorders. The patients ranged from 3 months to 77 years old. Nine (9.9%) of the 91 patients had complications associated with laparoscopic procedures and 4 (4.4%) of them had major complications. Pneumoextraperitoneum occurred in 3 patients. Two patients, who suffered from preperitoneal insufflation or pneumothorax associated with pneumomediastinum, failed to undergo laparoscopy. A small amount of scrotal emphysema developed in one patient, which subsided within 12 hours. Another patient, who underwent radical nephrectomy and para-aortic lymphadenectomy for left renal cell carcinoma, complained of symptoms due to persistent pneumoperitoneum and subcutaneous emphysema, which subsided 2 weeks after the operation. Respiratory acidosis caused by carbon dioxide absorption, which was difficult to be controlled, occurred in the other two patients; one was an adult male with reduced respiratory function and the other was a 1-year-and-8-month-old child. Bleeding during or after the procedure was another serious complication. Vena caval laceration occurred during right simple nephrectomy for pyonephrosis with renal calculi and was managed with laparotomy. Two patients, one after simple nephrectomy and the other after right adrenalectomy, suffered from postoperative bleeding about 300 ml through the penrose drain, which subsided following a bed rest.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Urinary calculous disease in south-eastern Nigeria.

Prospective observations are reported on 96 South Eastern Nigerians with urinary calculi, during a five year period. An overall hospital incidence of 19.1 per 100,000, and male: female ratio of 2.7:1, were obtained. There were 79% upper-urinary tract stones and 21% lower-tract stones. Thirty-two per cent of the patients were idiopathic stone formers. Other associated aetiologic factors include obstructive uropathy (29%), UTI (30%) prolonged catheterisation (9%), hyperuricaemia (6%), foreign body in the bladder (3.8%) and hyperparathyroidism (2.5%). The lower socio-economic group accounted for 55% of the patients. Fifty three (55%) stones were removed surgically whilst 38% (45%) were passed spontaneously. Mean size of the latter was 6.3 mm +/- 1.6 mm, and of the former 17.7 mm +/- 9.5 mm. Five patients did not know when they passed the stones. Clinical features were similar to other reported series but six females had pyonephrosis, one with nephrocutaneous fistula. One urethral stone was recovered from a periurethral abscess. Infection and dietary intake appear to be important aetiologic agents. Ninety-eight per cent of stones contained calcium. Other components were similar to other reported series, but it was not possible to detect any case of cystinuria. The relatively high incidence in contrast to most other Nigerian centres may be due to high consumption of calcium/magnesium-rich sea foods and vegetables, as well as the soft water of the South-East. Endemic bladder stones were absent in the series. The close similarity with caucasian stone patterns is a curiosity and of particular interest, deserving further elucidation.

Adolescent↗
PubMed1996

[Complications of urinary calculi].

Urinary stones is a frequent disease whose renal complications can engage both functional and vital prognosis. We report 769 complicated cases observed 10 years. The diagnosis was made by intravenous urography and ultrasonography. 607 cases were mechanical complications, 582 hydronephrosis, 25 anuria, 262 were infectious complications, 82 chronic pyelonephritis, 60 pyonephrosis, 10 perinephric abscess. Treatment included adapted antibiotic therapy, ureteral catheter in case of anuria ; surgical extraction of the stone nephrectomy was performed in 100 patients. Results were generally good. 9 patients had endstage chronic renal failure. The high frequency of urinary stone complications is due to the fact that most patients consult late. The diagnosis must obviously be made.

Adult↗
PubMed1996

[Polycystic kidney in the adult and kidney transplantation. Our experience].

OBJECTIVES: To determine the need for nephrectomy prior to renal transplantation in patients with adult polycystic renal disease. METHODS: We reviewed the records of 54 (31 females, 23 males) of 62 patients with polycystic renal disease that had been treated at our center from 1951 to 1994. Eight of the earlier cases, whose complete clinical data were unavailable, were excluded from the study. The patients were classified into three groups: nephrectomized transplanted, nephrectomized non-transplanted and non-nephrectomized transplanted patients. RESULTS: No patient had required nephrectomy due to a tumor. No surgical difficulty during transplantation had been reported in the non-nephrectomized patients. Nephrectomy had been performed in most of the cases for hematuria or preparatory to renal transplantation. The infections complications (11.76%) were resolved with antibiotic therapy. CONCLUSIONS: In the absence of renal tumor and given the low prevalence of complicated cysts, in our view it is unnecessary to perform nephrectomy routinely prior to renal transplantation in patients with adult polycystic renal disease. Nephrectomy should be reserved for cases with severe cystic complications, such as severe intracystic hemorrhage, hematuria causing anemia, pyonephrosis, or patients with grossly enlarged kidneys in whom we suspect that technical difficulties might arise at the time of transplantation.

Adult↗
PubMed1996

[Arterial hypertension caused by abnormality and translocation of the kidney].

The authors described developmental anomaly of the right kidney associated with hypertension and pyonephrosis in a 37 years old male. The authors reported the diagnostic problems in this kind of hypertension. After nephrectomy had been performed the elevated blood pressure returned to normal values without any additional pharmacological treatment.

Adult↗
PubMed1976

[Clinic of Urotuberculosis (author's transl)].

Most of all cases of extrapulmonary tuberculosis i.e. 35% are urogenital tuberculosis UGT. A shifting of morbidity to older age Groups could be ascertained. 1164 cases were evaluated, 684 in a combined medicamentons - operative manner. Of the conservatively treated Group were 283 males and 197 females; the relation of the sexus in the other group is roughly the same. The frequency has a maximum in the forth decade. Whereas most of 90 patients, who have been in stationary treatment in April 1975, were between 40 and 60 years old. The pathogeny of the UGT is shown according to the scherne of Gloor. Most of the initial Symptoms (26.5%) are dysuria, the mext are hematuriae and ache of the flanks. On an average 1-2 years pass from the first appearance of symtonis to the time of diagnosis. The diagnosis can only be verified by evidence of Tbc-bacteria in cultures and biological experiments or through histological appearance. Essential informations on localisation and expansion are obtained by x-ray examination, that is urograms and urethrocystograms. Angiography and side-disconnectet isotope clearance are importantant additional examinations. According to the results of the x-ray examinations the stages can be ascertained: Stage I: parenchymal-ulcerated pattern - Stage II: ulcerated-cavernous pattern - Stage III: totally-destructing tuberculosis, tbc-pyonephrosis, Special terms characterize the obstructions of the urinary tract. For the therapy the following polity can be proposed: Stage I: chemotherapy - Stage II: chemotherapy, perhaps backed by conservative operative treatment - Stage III: chemotherapy and nephro-ureterektomy.

Adolescent↗
PubMed1998

[Echoguided percutaneous nephrostomy].

Percutaneous US guided nephrostomy is the simplest and most direct technique to drain an obstructed kidney. The indications are included in two groups: temporary drainage and permanent drainage; the former is indicated in the non endoscopically superable ureteral obstruction, in pyonephrosis, in pregnant women and in transplanted kidneys (due to the easier access), the latter is exclusively reserved to neoplastic obstructions. The only real contraindication to the method, besides a documented allergy to local anaesthetics, is represented by a severe coagulopathy. Positioning techniques are the "one shot" technique, in which dilation and positioning are synchronous (it can avoid fluoroscopy but it is more traumatic) and angiographic derived Seldinger's technique, that utilizes fluoroscopy and an instrumentation including a guidewire and a set of Amplatz dilators. Complications are due to the access route; the choice of an intercostal access is always inadvisable, due to the risk of pneumothorax or pulmonary injury; the most frequent complications are vascular (hemorrhage, retroperitoneal hematoma) and usually well controlled; more severe lesions (renal artery laceration and arteriovenous fistula) may require intervention or embolization, but the incidence of nephrectomies due to vascular injury accounts for one per thousand.

Humans↗
PubMed1978

[A contribution to radiological diagnostics of xanthogranulomatous pyelonephritis (author's transl)].

Pyelonephritis xanthogranulomatosa is a peculiar manifestation of destructive interstitial nephritis which can be differentiated from other types of pyonephrosis exclusively by microscopic examination. Clinical symptomatology often points towards the existence of a renal tumor. The author analyses the clinical and radiological symptomatology of seven patients treated by him. The angiographic picture presented by pyelonephritis xanthogranulomatosa differs according to the character and extension of the inflammatory tissue lesion. The angiographic picture of the circumscribed and diffuse granular proliferative types resembles that of a poorly vascularised malignoma, whereas the destructive type resembles hydropyonephrosis.

Adolescent↗