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A case of malacoplakia of the kidney is presented. The incidental finding of asymptomatic pyuria focused attention on the urinary system. Urologic evaluation concluded an avascular renal mass. The diagnosis of malacoplakia was established only after histologic studies of the surgical specimen were completed. Purulent perinephritis complicated the postoperative outcome.
Urinary sediments with significant pyuria were supravitally stained to assess the inflammatory state. Clinic patients showed a significant correlation between acute urinary infection, inflammation, and the predominance of live polymorphonuclear leukocytes. Post-transurethral prostatic resection patients demonstrated to show a predominance of live polymorphonuclear leukocytes, which may be clinically usefull in a more careful selection before relying fully on bacteriologic cultures.
The pediatric patient with acute scrotal pain and swelling can pose a difficult diagnostic problem. The therapeutic approach to these patients, however, need not be difficult. Despite the advent of Doppler ultrasonic equipment and technetium pertechnetate scanning to differentiate torsion of the testes from other causes of acute scrotal pain and swelling, the policy of emergency scrotal exploration in nearly all such pediatric patients seems to be most appropriate. The exception to this rule might be the rare child with frank pyuria and/or urinary tract infection in whom the diagnosis of epididymo-orchitis is suggested by all parameters.
A case report of ureteral obstruction from an isolated focus of chronic lymphocytic leukemia to the ureter is presented. Sterile pyuria and Wright stain of the urinary sediment showing only lymphocytes were the clinical features of this case.
A retrospective analysis of 60 patients with Acquired Immune Deficiency Syndrome (AIDS) seen between 1981-1985 was performed to determine the genitourinary manifestations of this disease. Twenty-two per cent were found to have significant proteinuria, while 7 per cent had nephrotic syndrome which was associated with an extremely rapid demise. Renal insufficiency occurred in 27 per cent and renal biopsy results, when abnormal, revealed focal and segmental glomerulosclerosis. Pyuria was found in 52 per cent of patients, and urinary tract infections occurred in 20 per cent. Atypical pathogens including Candida, Salmonella, Acinetobacter calcoaticus, and cytomegalovirus were encountered.
We report 3 cases of primary extranodal lymphoma of the prostate, an unusual extranodal presentation rarely diagnosed antemortem. Symptoms of prostatism associated with an enlarged hard prostate with pyuria and hematuria in younger patients should suggest the diagnosis. Urine cytologic examination should aid in the diagnosis of this condition.
Epidemiological and clinical aspects of 270 episodes of urinary tract infection caused by Staphylococcus saprophyticus were studied. The cases were randomly selected and matched consecutively with 276 others of urinary tract infection according to sex, age and temporal occurrence. Such infections were found typically among young women in the outpatient health service. They were common among professionals handling meat products and were especially associated with prior outdoor swimming. Common symptoms of inflammation of the lower urinary tract, haematuria and pyuria were seen more often among patients with S. saprophyticus infections. Some cases of asymptomatic S. saprophyticus infection, however, were seen. We found S. saprophyticus as the cause of 13% upper urinary tract infections, an incidence which is higher than has been reported for other bacteria. Staphylococcus saprophyticus was less correlated to nephrolithiasis and was not a common cause of catheter-induced infections.
Since urine culture and urinalysis are both of uncertain reliability in diagnosing symptomatic urinary tract infections in patients with chronic urinary catheters, we performed sequential quantitative cultures and urinalyses on 177 urine specimens from 14 patients with long-term urinary catheters during a 12-month period. We found high concentrations of greater than or equal to 2 species of aerobic bacteria or fungi in most specimens examined. Pyuria was common even during asymptomatic periods; hematuria was less common. During symptomatic urinary tract infections, neither urinalyses nor quantitative urine cultures exhibited changes specific for such infections. Thus neither urinalysis nor urine culture appears to be a reliable test for symptomatic urinary tract infections in patients with chronic urinary catheters.
This study evaluates a first-catch urine sediment enzyme immunoassay (EIA) to diagnose Chlamydia trachomatis urethritis in symptomatic adolescent males. Seven of 23 patients evaluated were diagnosed with sexually transmitted urethritis, five caused by C. trachomatis. First-catch urine sediment was accurate in diagnosing C. trachomatis urethritis when compared to urethral swab EIA (p less than 0.003). First-catch urine pyuria was also highly correlated with urethritis (p less than 0.05). First-catch urine testing is a simple, nonpainful method of screening adolescent males for urethritis, and first-catch urine sediment EIA for C. trachomatis is a rapid, painless method of diagnosis. A method for screening and diagnosis with these techniques is described.
The responses by 55 of 300 physicians queried at the University Hospital, Cincinnati, to an extensive questionnaire, form the basis for this comment on the clinical impact of screening tests and rapid identification. Examination and interpretation of smears of fluids and tissue were felt to provide useful data within a short time of specimen collection and the majority of physician respondents were willing to sacrifice some degree of accuracy in results in return for an answer delivered shortly after specimen submission. Screening for bacteriuria was felt to be useful if the test was sensitive enough to rule out infection as suggested by the presence of approximately 10,000 CFU/ml of urine, if results could be had within 1 hr of specimen collection for outpatients, 2 hr for inpatients, and if test results for pyuria accompanied the screen results. The value of taxonomy, in general, was directly related to how much knowing the taxon would direct antibiotic therapy. The time required for a taxonomic result seemed to matter only when susceptibility test results were either delayed or not forthcoming. Interest in the taxonomy of anaerobic bacteria appeared to be limited to a small group of physician respondents (infectious disease specialists) and also was relative to the ability of the taxonomic designation to evoke a specific therapeutic regimen. In summary, the impact of microbiologic data on the practice of medicine appears to depend on the ability of the laboratory to complete the entire test process, from order to transmission of answer, within a time frame perceived to be useful by the clinician.(ABSTRACT TRUNCATED AT 250 WORDS)
PURPOSE: We performed a prospective, randomized clinical trial to evaluate the outcome of ureteral stents for solitary ureteral stones 2 cm or less in moderately or severely obstructed systems using shock wave lithotripsy. MATERIALS AND METHODS: Between 2001 and 2004, 186 patients who met study criteria were randomized into 2 groups. Group 1 received a pre-shock wave lithotripsy 6Fr Double-J stent and group 2 had no stent. Patients were treated with a Dornier MFL 5000 lithotripter. Results were compared in terms of clearance rates, number of shock waves and sessions, irritative voiding symptoms, incidence of complications and secondary interventions. Failure was defined as the need for additional procedure(s) for stone extraction. RESULTS: Overall 164 patients (88.2%) became stone-free after shock wave lithotripsy. Complete stone fragmentation was achieved after 1 to 3 and more than 3 session in 108 (58.1%), 30 (16.1%), 13 (7%) and 14 patients (7.5%), respectively. Ureteral stent insertion did not affect the stone-free rate, which was 84.9% and 91.4% in groups 1 and 2, respectively (p = 0.25). There was no statistical difference in the re-treatment rate, flank pain or temperature in the 2 groups. However, all patients in the stented group significantly complained of side effects attributable to the stent, including dysuria, suprapubic pain, hematuria, pyuria and positive urinary culture. CONCLUSIONS: Pretreatment stenting provides no advantage over in situ shock wave lithotripsy for significantly obstructing ureteral calculi. Shock wave lithotripsy is reasonable initial therapy for ureteral stones 2 cm or less that cause moderate or severe hydronephrosis.
OBJECTIVES: To determine the efficacy of prophylactic ciprofloxacin in preventing urinary tract infections caused by urodynamic study (UDS). METHODS: A total of 210 patients presenting for UDS during a 16-month period were offered enrollment in the study. A clean-catch midstream urine sample was taken 24 hours before and 48 to 72 hours after the procedure and after microscopic examination and culture were done. All patients underwent a standard UDS. The 192 patients who had sterile urine before intervention were included in the study. Randomly, 98 of the 192 patients were orally given 500 mg of ciprofloxacin 1 hour before the urodynamic intervention and 94 were not given anything. The patients who were found to have significant bacteriuria after UDS were followed up and treated properly. RESULTS: Eighteen patients (8.6%) who had significant bacteriuria in the urine culture before UDS were excluded from the study. The rate of significant bacteriuria in the urine culture after UDS was 7.3% overall, 1% in the prophylaxis group, and 14% in the controls, a significant difference (P = 0.002). The most common uropathogen was Escherichia coli (57%). Three independent risk factors were identified: not giving antibiotic prophylaxis before UDS; antibiotic use in the preceding month; and the presence of pyuria before UDS. CONCLUSIONS: Urinary tract infections after UDS decreased from 14% to 1% with a single dose of ciprofloxacin 500 mg orally before UDS. We recommend antibiotic prophylaxis for patients undergoing a UDS.
OBJECTIVE: Although the well-recognized pregnancy changes in renal blood flow, cellular function, tubular fluid composition, and flow rates may cause altered excretion rates of formed elements in the urine, relatively little attention has been paid to this in normal pregnancy. The urinary white cell excretion is known to be increased, with loss of the usual relationship between pyuria and urinary infection. Whether the same is true for other formed elements is unknown. Our purpose was to determine normal values for excretion of erythrocytes and casts and to establish whether they became abnormal in women in whom preeclampsia developed. STUDY DESIGN: Study subjects were 174 continuously normotensive pregnant volunteers, 22 women who had preeclampsia, and 8 women who had chronic essential hypertension. Early-morning midstream urine samples were collected at 17 to 20 and at 33 to 36 weeks' amenorrhea after insertion of a vaginal tampon. Urinary microscopy was performed by standard techniques (Kesson et al. Lancet 1978;2:809). RESULTS: The 95th percentile for concentration of erythrocytes was < or = 2500 red blood cells/ml; for casts the concentration was < or = 30 red blood cells/ml in normal pregnancy. Values for those who had preeclampsia and for the small group with chronic essential hypertension were within these limits. CONCLUSION: In an early-morning concentrated urine sample, values of < or = 2500 erythrocytes/ml and < or = 30 hyaline or granular casts per milliliter can be accepted as normal.
An 18-year-old woman developed acute polyarthritis one week and bilateral, acute, mucopurulent conjunctivitis and sterile pyuria two weeks after onset of Campylobacter jejuni enteritis. The conjunctivitis resolved spontaneously in one week and the arthritis in two months. The patient had HLA-B27 antigen. Campylobacter organisms may lead to Reiter's syndrome in a patient with HLA-B27 antigen.
The bladder can be the site of various foreign bodies. We report one case of bladder stone including a foreign body in a 24 years old man with a psychomotor deficiency who was admitted for pyuria, block miction and bladder symptoms. The pelvic X-Ray film showed a bladder stone including a sewing needle. We analysed the diagnosis, aspect and therapeutic management of this case.
Persons with spinal cord injury (SCI) have an increased risk of developing urinary tract infections. Certain structural and physiological factors, such as bladder over-distention, vesicoureteral reflux, high-pressure voiding, large post-void residuals, stones in the urinary tract, and outlet obstruction increase the risk of infection. The method of bladder drainage also influences the risk of urinary tract infection, and most persons with SCI on indwelling or intermittent catheterization develop urinary tract infection. The association of behavioral and demographic factors with the risk of urinary tract infection are less well understood. The method of specimen collection must be considered when determining the significance of bacteria. A national consensus conference sponsored by the National Institute on Disability and Rehabilitation Research defined significant bacteriuria as: > or = 10(2) colony forming units (cfu) of uropathogens per milliliter of urine in catheter specimens from persons on intermittent catheterization; > or = 10(4)cfu/mL in clean-voided specimens from catheter-free males using condom catheters; and any detectable concentration of uropathogens in indwelling catheter or suprapubic aspirate specimens. Symptomatic urinary tract infection warrants therapy, but the diagnosis is complicated by the poor sensitivity and specificity of symptoms and signs. Pyuria is generally present in persons with symptomatic urinary tract infection, although it is a nonspecific test, and its absence generally indicates the absence of symptomatic urinary tract infection. Treatment of asymptomatic bacteriuria has not been shown to be beneficial and increases the risk of development of antimicrobial-resistant uropathogens. Antibiotic prophylaxis is generally not recommended because of its unproven benefit in several studies and its association with emergence of antimicrobial resistance.(ABSTRACT TRUNCATED AT 250 WORDS)
Nubian goats were experimentally infected with Corynebacterium renale type II by either the intravenous or intraurethral routes using infection rates of 1.75 x 10(10), 7.08 x 10(19) or 5 x 10(23) organisms. All inoculated goats were anorexic, lost weight and became dull or depressed. Albuminuria, pyuria and epithelial casts were noted in the urine. Following intravenous challenge the animals showed a dose-related elevation of serum ammonia, urea, and creatinine with significant changes in haemoglobin concentration, packed cell volume and leucocyte counts. A mild to severe (sometimes haemorrhagic) cystitis and urethritis and a mild nephrosis were noted post mortem and mucoserous or mucogelatinous non-purulent discharges were present in the renal pelvis. The findings are compared to the naturally occurring C. renale pyelonephritis in cattle and the suitability of the goat as a model for that disease is discussed.
The clinical and radiological features of pyonephrosis are reviewed, based on a consecutive series of 40 cases. There were 32 female and eight male patients, with a peak incidence in the 50-59 year age group. In 63% of cases the right kidney was involved. Almost all patients complained of loin pain and 48% had lower urinary tract symptoms. In 58% of cases a renal mass was palpable. An anaemia, pyuria and elevated blood sedimentation rate were usual. Plain films of the abdomen revealed enlargement of the outline of the involved kidney in 75%, ipsilateral absence of the psoas shadow in 63% and urinary tract calculi in 60%. At high-dose excretion urography a nephrogram was obtained in 58% of cases and a pyelogram produced in 34%. No single clinical or radiological entity emerged, there being an unbroken spectrum of disease ranging from infected hydronephrosis to xanthogranulomatous pyelonephritis. There is an increasing incidence of calculi, loss of the renal and psoas outlines and reduced renal function with increasing chronicity of disease. High-dose excretion urography is the investigation of choice since not only may the diagnosis be established but also there precise pathological state of the involved kidney. Further radiological investigation is infrequently required.