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PubMed1995

Does eradicating bacteriuria affect the severity of chronic urinary incontinence in nursing home residents?

OBJECTIVE: To determine the effects of eradicating otherwise asymptomatic bacteriuria on the severity of chronic urinary incontinence among nursing home residents. DESIGN: Residents were categorized as nonbacteriuric or bacteriuric on the basis of urine cultures. Bacteriuric residents were then randomly assigned to immediate and delayed treatment groups. The delayed treatment group was included to control for spontaneous changes in the severity of incontinence. The immediate treatment group received antimicrobial therapy for 7 days; after outcome measures had been repeated, the delayed treatment group was treated. SETTING: 6 community-based nursing homes. PATIENTS: Nursing home residents with chronic urinary incontinence. MEASUREMENTS: The frequency and volume of urinary incontinence were determined by physical checks for wetness by trained research aides hourly between 7 a.m. and 7 p.m. for 3 days in all patient groups (non-bacteriuric, bacteriuric with immediate treatment, and bacteriuric with delayed treatment) at baseline, after the immediate treatment group was treated, and again after the delayed treatment group was treated. RESULTS: 191 residents were enrolled, and 176 completed the study. Bacteriuria was eradicated by antimicrobial therapy in 71 residents (40%), and 17 residents (10%) had bacteriuria before and after therapy. The percentage of hourly checks at which the residents were found wet and other measures of incontinence severity remained essentially the same after bacteriuria was eradicated. In the nonbacteriuric group, the percentage of checks that were wet increased from 29% (95% CI, 26% to 32%) at baseline to 30% (CI, 27% to 34%) on repeated measurement. In the bacteriuric groups, the percentage increased from 34% (CI, 30% to 38%) before treatment to 35% (CI, 31% to 39%) after bacteriuria was eradicated. The presence of pyuria did not affect the results. CONCLUSION: Eradicating bacteriuria has no short-term effects on the severity of chronic urinary incontinence among nursing home residents. Our data support the practice of not treating asymptomatic bacteriuria in this population and validate the recommendations in the Health Care Financing Administration's Resident Assessment Protocol for urinary incontinence.

Aged↗
PubMed1982

Clinical and laboratory manifestations of toxic shock syndrome.

We studied 28 women and two men, with a median age of 20 years, who first had toxic shock syndrome between 1 February 1980 and 15 July 1981. Two of these patients died. All patients had intense myalgia, high fever (greater than or equal to 38.9 degrees C), hypotension or syncope, skin rash and desquamation, and abnormalities in at least three organ systems. Over half had sterile pyuria; immature granulocytic leukocytosis; coagulation abnormalities; hypocalcemia; low serum albumin and total protein concentrations; and elevations of blood urea nitrogen, alanine transaminase, bilirubin, and creatine kinase. Staphylococcus aureus was isolated from cultures from sites of soft-tissue infection in both male patients and from 13 of 19 vaginal and eight of 12 cervical cultures. All isolates produced both pyrogenic exotoxin C and enterotoxin F. All patients with a febrile, exanthematous, multisystem illness, particularly one associated with menstruation or a staphylococcal infection, should be promptly evaluated and empirically treated for toxic shock syndrome.

Adolescent↗
PubMed2003

[Renal and ureter complications from the treatment of Hodgkin's disease].

PURPOSE: The authors analysed renal and ureter complications in Hodgkin's disease patients after treatment. PATIENTS AND METHODS: We examined retrospectively 512 primary treated and followed up patients with Hodgkin's disease. RESULTS: We observed renal, ureter or bladder complications after irradiation in 16 cases (3.125%). Five patients had injured left kidney, out of them only two had pyuria or proteinuria and 4 received radiotherapy and chemotherapy as well. We observed complications of both kidneys in 7 patients. Four patients had pyelonephritis or cystitis. We did not find severe cystitis in patients treated wsith cyclophosphamide. CONCLUSIONS: Acute and chronic irradiation nephropathy are rather anatomic than functional lesions. Planning, dose and period of the radiotherapy, irradiation volume play parts in the development of complications. Prior chemotherapy increases incidence of irradiation nephropathy. These rare complications of Hodgkin's disease are usually avoided with the use of modern radiotherapy apparatus and the up to date treatment methods.

Adult↗
PubMed1999

Removal of an ectopic left kidney through a ventral midline celiotomy in a calf.

A 4-month-old Holstein heifer was examined because of poor growth, weight loss, dysuria, hematuria, pyuria, and a palpable mass in the right caudal quadrant of the abdomen. Clinicopathologic abnormalities included hyperfibrinogenemia, hyperproteinemia, anemia, and leukocytosis, and were consistent with chronic inflammation. Results of ultrasonographic evaluation of the umbilical cord remnants were suggestive of urachal abscess formation. Transabdominal ultrasonography of the kidneys was attempted; the right kidney appeared normal, but the left kidney could not be imaged. The calf was anesthetized and a ventral midline celiotomy was performed. The left kidney was larger than normal, was multilobulated, and contained multiple abscess. It had also broken through the peritoneum and was located in the peritoneal cavity. Unilateral nephrectomy and resection of umbilical cord remnants were performed. The calf recovered without complications and was healthy 5 years later. In this calf, ventral midline celiotomy provided sufficient surgical exposure for removal of the ectopic left kidney and resection of umbilical cord remnants.

Animals↗
PubMed1999

Imaging characteristics of indinavir calculi.

PURPOSE: Indinavir sulfate is an effective protease inhibitor of the human immunodeficiency virus type 1. Use is associated with a significant incidence of crystallization and stone formation in the urinary tract, and these calculi are not visible on plain radiographs. Previously all urinary stones, including uric acid and matrix, were believed to be radiodense on computerized tomography (CT). We conducted a retrospective study to evaluate the radiographic appearance of indinavir calculi. MATERIALS AND METHODS: Retrospective chart review of 36 patients taking indinavir sulfate and presenting with renal colic was performed with attention to presentation, urinalysis, radiographic evaluation and management. Specifically, imaging characteristics on CT were addressed. RESULTS: All patients complained of ipsilateral flank pain and 35 had nausea and/or vomiting. Of 30 patients with dysuria or urgency the majority had hematuria, and most had pyuria and/or proteinuria. No stones were visualized on abdominal radiography. Diagnosis was confirmed on 1 of 13 excretory urograms and 4 of 11 renal ultrasounds. None of 12 CT scans was diagnostic of renal lithiasis. CONCLUSIONS: Indinavir sulfate is a protease inhibitor with poor solubility and significant urinary excretion. Crystallization and stone formation are demonstrated in as many as 20% of patients taking the medication. Most patients present with flank pain, nausea or vomiting and hematuria. Previously CT was thought to identify all urinary calculi with clarity but it cannot reliably confirm the presence of indinavir calculi.

Adult↗
PubMed1999

[Mucinous adenocarcinoma of the renal pelvis associated with renal calculi of the inflammatory type].

A rare case of mucinous adenocarcinoma of the renal pelvis associated with renal staghorn calculosis in a 60-years-old male patient with pyuria and mucin content of the urine is presented. History was significant for recurrent calculosis of the left kidney. A non functioning hydronephrotic left kidney with staghorn calculosis was diagnosed. Laboratory tests were remarkable only for Carcinoembrionic Antigen (CEA). Pathology of the surgical specimen followed by its immunoreactivity revealed an intestinal type metaplasia and papillary, tubular and mucinous adenocarcinoma of the renal pelvis. Pathogenesis of the intestinal metaplasia and the role of chronic irritation of the urothelium are mentioned.

Adenocarcinoma, Mucinous↗
PubMed1999

[A case of spontaneous pyeloduodenal fistula].

A 61-year-old woman visited our hospital complaining of right flank pain and fever. The radiograph demonstrated multiple renal calculi. Radio renography showed no uptake in the right kidney. Therefore, we diagnosed her with pyonephrosis, and recommended open nephrectomy. However, she selected the conservative treatment with extra corporeal shockwave lithotripsy (ESWL). In spite of disappearance of multiple calculi, pyuria continued for 3 months after ESWL. Retrograde pyelography showed a fistula from the right pelvis into the duodenum. The patient was successfully treated by nephrectomy and duodeno-fistelectomy.

Duodenal Diseases↗
PubMed1998

Use of rapid dipstick tests to exclude urinary tract infection in children.

Children presenting with symptoms attributable to urinary tract infection (UTI) are not uncommonly referred to paediatric departments for assessment. The aim of this study was to evaluate the use of rapid dipstick tests in the diagnosis of urinary tract infection in children. Urine was collected from 375 children admitted to a general paediatric ward, in whom UTI was a possibility on clinical grounds. Of these, 124 were less than one year old. Urine was tested with a dipstick for the presence of nitrite and leucocyte esterase. Bacterial culture and examination for white cells, red cells and other formed elements were performed. The results of the dipstick tests, microscopy and culture were correlated with the clinical details. Combination of a negative dipstick test for nitrite and leucocyte esterase showed a negative predictive value for UTI of 96.9% and a specificity of 98.7%. In children less than a year old these values were 96.7% and 99.2% respectively. The leucocyte esterase strip test showed a negative predictive value for pyuria of 94.3% with a specificity of 86.9%. In children less than a year old these values were 93.1% and 84.4% respectively. The use of dipsticks for the detection of urinary nitrate and leucocyte esterase in daily clinical practice is recommended. In children, the absence of both nitrite and leucocyte esterase in urine indicates that UTI is unlikely; however, positive dipstick tests for nitrite and/or leucocyte esterase are not specific indicators of UTI, and should not be used in place of laboratory examination. The dipstick method is most likely to be useful as a screening test to exclude UTI in children, but may be less suitable for infants. It should not be used to diagnose urinary tract infection.

Adolescent↗
PubMed1999

[Emphysematous pyelonephritis complicated with diabetes mellitus: a case report].

A 46-year-old woman with diabetes mellitus was admitted to our hospital due to lower right abdominal pain. Urinalysis did not show marked pyuria. Abdominal computed tomography showed an abnormal gas shadow in the right renal parenchyma. A diagnosis was made of right emphysematous pyelonephritis. Despite aggressive supportive therapy, the patient's condition worsened. Therefore, right nephrectomy was performed. The next day her general condition was markedly improved. We reviewed 122 cases of emphysematous pyelonephritis including our case in the Japanese literature, and discussed its etiology, symptomatology, choice of treatment and prognosis.

Diabetes Complications↗
PubMed1999

Clinical and radiological findings in patients with gas forming renal abscess treated conservatively.

PURPOSE: Emphysematous pyelonephritis in diabetics is considered a potentially lethal infection. Mortality rates of patients treated conservatively approaches 80% in some series. These patients often present with signs of sepsis or septic shock. In contrast, gas forming renal abscess is rare, with patients presenting entirely differently from those with emphysematous pyelonephritis. To our knowledge this process has been previously described only in isolated case reports. We describe a series of 5 patients with this distinct process. MATERIALS AND METHODS: We reviewed the clinical and radiological features of 5 patients with gas forming renal abscesses. RESULTS: Each patient presented with diabetes mellitus with initial blood glucose ranging from 313 to 552 mg./dl., fever (average 101F), flank or abdominal pain and pyuria. No patient had evidence of septic shock at hospitalization. Escherichia coli was the documented organism in each case. Mild renal insufficiency was noted in most patients based on serum creatinine. Radiological evaluation revealed gas filled pockets within the renal parenchyma, which were most effectively shown by computerized tomography (CT) of the abdomen. There was no radiological evidence of pus. Percutaneous drainage of an abscess in 1 case did not produce any purulent material or alter the clinical course. Each patient responded to correction of the underlying metabolic abnormalities with intravenous antibiotics (average 23 days) followed by prolonged oral antibiotic therapy (average 9 weeks). In contrast to the management of emphysematous pyelonephritis, surgical or percutaneous drainage was not necessary. Serial CT revealed complete resolution of gas in the parenchyma within 6 months in patients with long-term followup. Of note, gas was persistent on CT months after infection had clinically resolved. CONCLUSIONS: We describe a unique entity within the spectrum of pyelonephritis. The clinical appearance of gas forming abscesses within the renal parenchyma without liquefaction in diabetic patients was remarkably benign compared to the radiographic appearance of the disease process. Conservative management with intravenous and oral antibiotics was successful in each patient, avoiding the need for invasive intervention.

Abdominal Abscess↗
PubMed1999

[Immunomodulation of recurrent urinary tract infections with Urvakol vaccine].

The authors present the results of the URVAKOL vaccine use in clinical practice. The vaccine was administered in the treatment of recurrent cystitis, persistent lower urinary tract infection, chronic pyelonephritis and prostatovesiculitis. The clinical efficacy of the vaccine was assessed by detection of bacteria and leukocytes in the urine, subjective complaints, skin tests and the assessment of selected specific and nonspecific immunity parameters in the urine and saliva. Significantly positive clinical and laboratory responses were observed in patients with uncomplicated cystitis. In the group of persistent urinary tract infections excellent responses were detected in one half of the patients. The remainder half stated disappearance of subjective complaints, but with persistence of pyuria or bacteriuria. Similar results of "improvement" were observed in 10 patients with chronic pyelonephritis. There were no changes of the clinical state observed in patients with chronic prostatitis. (Tab. 5, Fig. 2, Ref. 7.)

Adult↗
PubMed1999

[Molecular biological testing for diagnosis and treatment of urothelial cancer].

Detection of urinary telomerase activity is superior to the conventional urine cytological examination in terms of sensitivity for diagnosis of low grade urothelial cancers. Several causative factors including pyuria and hematuria which might have affected falsely positive and negative rates of urinary telomerase activity were investigated but their influence seemed negligible. As for progression from superficial to invasive urothelial cancers, destruction of the basement membrane underlying tumor is considered as an important event in the initial step of invasion. Our immunohistochemical analyses revealed that expression of type IV collagen in the basement membrane was reduced or disappeared in more than half of grade 2 to 3, pTa urothelial cancers. Overexpression of p53 tumor suppressor and/or mdm2 oncoprotein was strongly correlated with this basement membrane destruction. Urothelial cancers harboring p53 aberration may be resistant to cisplatin-based chemotherapy because of impairment of apoptosis induction. The relationship between chemosensitivity and p53 status in urothelial cancers was investigated, and a favorable response to neoadjuvant chemotherapy was found in tumors without p53 aberration.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1999

Routine urine analysis in university candidates: is it worthwhile?

The study aimed to investigate the abnormalities in urine analysis in university candidates. A total of 247 students (150 males, 97 females) (mean age 20.08 years) had a medical check-up including urine analysis. In all, 38 urine samples had abnormalities (one or more abnormality/urinalysis). Pyuria was found in 20 students (8.1%), haematuria in 15 (6.1%), albuminuria in 12 (4.8%) and casts in 9 (3.6%). No glycosuria was found. Bacteria were found in 22 students (8.9%) and yeasts in two (0.8%). Urinalysis is warranted as a routine test in university students because of the percentage of abnormalities found and its importance in disease surveillance. However, it should not be a criterion for refusal by universities.

Adult↗
PubMed2000

Urinary beta-glucuronidase in renal cell carcinoma.

The aim of the paper was to study the urinary beta-glucuronidase activity in 30 patients with renal cell carcinoma (RCC), histopathologically proven after surgery, and 32 healthy subjects taken as controls. Classification of patients was done using the TNM system. A statistically significant increase (p < 0.01) in this enzyme was found in RCC patients, without relation to the changes in the urinary sediment (hematuria, pyuria, bacteriuria) or tumor dissemination. Urinary beta-glucuronidase is a useful marker in the diagnosis of malignant renal tumors.

Adult↗
PubMed1999

[TB-test in the diagnosis of "closed" tuberculosis of the urinary tract. Preliminary study].

BACKGROUND: Tuberculosis (TBC) is a disease that is found throughout the world with a particularly high incidence in under developed countries. Genitourinary tuberculosis has been reported in 8-10% of all cases in developed countries and in 20% in Third World countries. This study aimed to describe a method of diagnosis applicable to so-called "closed" forms of tuberculosis affecting the urinary tract, namely those with negative results for KB bacteriological and culture assay, but in which suspected diagnosis based on clinical grounds and diagnostic procedures call for further analysis; these forms account for 10% of the total cases. METHODS: A prospective study was carried out in order to tritade the antigenic fraction A60 of the group of thermostable macromolecular antigens (TMA); the latter belong to the pool of liposoluble antigens forming the cell wall and represent the main component of tuberculin and purified protein derivative (PPD). The identification and assay of antigen A60, which can stimulate both the antibody and cell-mediated response, was performed using the ELISA method in order to identify IgG and IgM specific antibodies (TB-test). Twenty-nine patients were selected (11 males, 18 females) with a clinical history of recurrent symptomatic manifestations of upper and lower urinary tract infections resistant to common antibiotic treatment. Urinary tests showed that 96.5% of patients presented an acid urinary pH associated with pyuria, and the urographic imaging revealed calico/pyelic lesions of the excretory tracts. RESULTS: Seven patients (24%) showed a form of urinary TBC of an areactive type (AA) or with intermediate reactivity (RI.AI); six patients (20.64%) showed reactive TBC or in the process of resolution; fifteen patients (51.6%) were negative to the TB-test, and after one year's follow-up still showed no positivity to assays for Koch's bacillus. CONCLUSIONS: The authors affirm that the TB-test, a rapid and relatively inexpensive diagnostic method, is a valid aid for the diagnosis of "closed" forms of urinary tract TBC.

Adult↗
PubMed2000

[Renocolic fistula: a case report].

A 78-year-old woman had disregarded pneumaturia since April 1998. In March 1999, computed tomography and barium enema were done to examine anemia and positive fecal occult blood, revealing a left renocolic fistula and bilateral renal stones. Intravenous pyelography revealed a left staghorn calculus, non-functioning kidney, and right partial staghorn calculus. Urinalysis showed pyuria and the culture grew Proteus vulgaris and Klebsiella oxytoca. Smear and culture of the urine were negative for acid-fast bacilli. In consideration of the patient's age and conservation of right renal function, right pyelolithotomy was performed first. Three weeks later, left nephrectomy and partial colectomy were done. The postoperative course was uneventful. A renocolic fistula is relatively rare and to our knowledge there have been 37 cases reported in Japan, including our case. Surgery is the main therapy and was performed in 31 patients. Among them, surgery was not curative in 1 and 5 died of postoperative complications. Thus, surgery is not safe in all cases. However, despite her age and bilateral renal dysfunction, our patient was successfully operated on.

Aged↗
PubMed2000

[A case of patent urachus in an adult male].

A 31-year-old man was referred to our hospital for evaluation of urachal rest. The history of his present illness dated back to birth, when the umbilicus was projected and urinary discharge was noted. At that time, the symptom of discharge had spontaneously subsided. At the age of 22, however, the patient again experienced discharge from the umbilicus. Although he did not seek treatment, after six years this symptom disappeared. Around this time, however, pyuria was revealed during medical examination, and abdominal ultrasonography (US) suggested the presence of urachal rest. At the time of hospitalization, physical examination revealed that the patient's right testis was not palpable. He was diagnosed with patent urachus with hemilateral aplasia and monorchism by US, computed tomography, magnetic resonance imaging and cystoscopy. The patient subsequently underwent radical operation. Patent urachus in adults is very rare, and only a few cases have been reported. To our knowledge, only one previously reported case involved a recurrence after spontaneous healing. Further, this is the first report of a patient with patent urachus with hemilateral aplasia and monorchism. Radical operation is generally recommended, based on the fact that very few cases heal conservatively.

Adult↗
PubMed2000

[Pyonephrosis: diagnosis and treatment: report of 14 cases].

Prior to the introduction of antibiotics, the treatment of pyelonephrosis frequently consisted of nephrectomy to remove the non-functional kidney, which was a potentially dangerous source of systemic infection. This approach was later modified as a result of the advances made in antibiotic therapy, and included vigorous antibiotic treatment and prompt drainage of the kidney. At present, percutaneous nephrostomy provides a means of draining off the pus and determining a possible residual renal function. In this study, 14 cases of pyonephrosis were observed over a 7-month period. Lumbar pain was noted in 70% of cases, painful lumbar contact in 5 cases and fever, shivering and pyuria in all cases. Cytobacteriological urine analysis showed the presence of Escherichia coli in 7 patients, Proteus in 4 patients, and in 3 cases abacterial leucocyturia; in 2 patients with only one functional kidney, renal insufficiency was observed. In all cases, the diagnosis was confirmed by ultrasonography. The main etiological factors were urinary lithiasis in 10 patients (71%), followed by uropathy of the pyeloureteral junction in 4 patients (29%). Treatment consisted of primary nephrectomy in 10 cases; in 3 cases, primary nephrostomy was performed with a positive outcome and recovery of renal function in 2 subjects; in one case of renal failure treated by nephrostomy followed by conservative surgery, the patient did not survive. In conclusion, nephrectomy is advocated as the treatment of choice in the case of a damaged kidney and a normal contralateral kidney. Conservative treatment should be envisaged particularly in the case of a single kidney, or if the patient's state of health is poor. The best treatment consists of the detection and cure of the lithiasis which is the main etiological factor in this pathology.

Adult↗