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PubMed2002

[A case of acute spongiositis with diabetes mellitus].

We report a case of acute spongiositis with diabetes mellitus. A 63-year-old man with a 7-year history of diabetes mellitus was admitted to our hospital complaining of perineal pain and pyrexia. Physical examinations revealed induration and tenderness of the corpus spongiosum, but no signs of rubor or erosion. A laboratory investigation showed leukocytosis (12,000/microliter), an elevated level of C-reactive protein (3.38 mg/dl) and hyperglycemia (532 mg/dl). Pyuria and bacteriuria were absent. Magnetic resonance imaging (MRI) yielded abscess-like lesion of the corpus spongiosum. Culture of the aspirated specimen demonstrated B-hemolytic streptococci. Treatment with antibiotics and insulin resolved leukocytosis and tenderness of corpus spongiosum. He left the hospital on the 23rd day after admission and no evidence of recurrence of the spongiositis was found for 1 year after discharge.

Acute Disease↗
PubMed2002

Randomised controlled trial of nitrofurantoin versus placebo in the treatment of uncomplicated urinary tract infection in adult women.

BACKGROUND: Urinary tract infections (UTIs) are very common and have been treated with apparent success with antimicrobials for many years. However, there is a paucity of placebo-controlled clinical trials. AIM: To measure the symptomatic and bacteriological short-term effect of nitrofurantoin treatment versus placebo, in the treatment of uncomplicated UTI in adult non-pregnant women. DESIGN OF STUDY: Randomised placebo-controlled trial in general practice. SETTING: Non-pregnant women, aged between 15 and 54 years old, consulting a general practitioner for symtoms suggestive of uncomplicated lower UTI and with pyuria (positive for leucocyte esterase test). METHOD: A dipslide was inoculated in first-void midstream urine and sent for examinion. The patients were randomised to receive nitrofurantoin 100 mg or placebo four times daily for three days. After three, seven, and 14 days a new dipslide was inoculated and symptoms of UTI were checked or improvement of symptoms and bacteriuria. RESULTS: Of 166 women consulting with symptoms suggestive for UTI, 78 had pyuia and agreed to participate in the study (the clinically suspected UTI group); of these, 40 received nitrofurantoin and 38 received placebo. The result for combined symptomatic improvement and cure after three days was 27/35 in the nitrofurantoin group and 19/35 in the placebo group (c2 with Yates' correction P = 0.008; number needed to treat [NNT] = 4.4, 95% confidence interval [CI] = 2.3 to 79). After seven days, combined improvement and cure was observed in 30/34 and 17/33 respectively (P = 0.003, NNT = 2.7, 95% CI = 1.8 to 6.0). At inclusion, 56 women had bacteriuria of > or = 10(5) CFU/ml (the bacteriologically proven UTI group). Of these, 29 received nitrofurantoin and 27 received placebo. After three days the bacteriological cure was 21/26 in the treatment group, compared with 5/25 in the placebo group (P < 0.001; NNT = 1.6, 95% CI= 1.2 to 2.6). After seven days the bacteriological cure rate was 17/23 in the intervention group and 9/22 in the placebo group (P = 0.05, NNT = 3, 95% CI = 1.7 to 17). CONCLUSION: In women with bacteriologically proven UTI, nitrofurantoin was significantly more effective than placebo in achieving bacteriological cure and symptomatic relief in just three days; this was still present after seven days. In patients with clinically suspected UTI the symptomatic effect was statistically significant after

Adolescent↗
PubMed2002

Ammonium acid urate urinary stone caused by a low-caloric diet: a case report.

A 32-year-old woman complained of right back pain and pyuria. The plain radiograph (KUB) and drip infusion pyelography (DIP) demonstrated a right renal stone and hydronephrosis. The stone was successfully treated using extracorporeal shock wave lithotripsy. Infrared spectrophotometry revealed that the stone was composed of pure ammonium acid urate. The patient had a 3-year history of excessive anorexia. The low-caloric diet was considered to have caused the disease.

Adult↗
PubMed2002

[Supernumerary kidney: a case report].

We report a case of a supernumerary kidney discovered while investigating an isolated pyuria in a 47-year-old male patient. Embryology and diagnostic difficulties are discussed.

Diagnosis, Differential↗
PubMed2002

[A case of pyoderma gangrenosum involving the prostate gland after radiation therapy for prostate cancer].

A 76-year-old man complained of difficulty in urination and miction pain with abacterial pyuria after radiation therapy for prostate cancer. Transurethral resection of the prostate was performed and histopathologically widespread necrosis was observed in the prostate. Thereafter retention of urine and fever occurred and computed tomography scan revealed an abscess of the penile corpus. The abscess was drained, but the fever continued. He developed an abacterial lung abscess and abacterial necrotic ulcerating lesions on his back, his left leg and his lower abdomen. Macroscopic findings demonstrated typical features of pyoderma gangrenosum. Steroid treatment was initiated and the response to steroid therapy was dramatic. Finally urinary diversion using an ileal conduit was performed. We found few cases of pyoderma gangrenosum involving lesions other than those of the skin in the literature. This is the first report of pyoderma gangrenosum involving the prostate gland after radiation therapy for prostate cancer.

Aged↗
PubMed2002

[Renal artery embolism].

OBJECTIVES: To report a case of renal artery embolism. To review the clinical, diagnostic and therapeutic features of this disease interesting for the urologist. METHODS/RESULTS: Case of a 47 year old male with history of cardiovascular disease who presents in the emergency room with left flank pain. Radiological studies (Intravenous pyelogram (IVP) and ultrasound) ruled out urinary tract obstruction and oriented to renal vascular disease. Arteriography was performed showing left renal artery embolism. Fibrinolytic therapy was successful. CONCLUSIONS: Renal artery embolism is an unusual non traumatic vascular urologic emergency. Generally, it appears in patients with emboligenous heart diseases, mainly auricular fibrillation associated with mitral stenosis. More than half the cases are asymptomatic; if they have symptoms, the most common presentation is sudden onset of intense flank pain, resistive to analgesia. Laboratory tests show hematuria, pyuria, proteinuria, leucocytosis, increased LDH, GOT and alkaline phosphatase, and variable renal function impairment. An ultrasound showing no signs of obstructive uropathy and absent function in the IVP lead to diagnosis. In the case of early diagnosis, intra-arterial fibinolysis is the treatment of choice, leaving surgery for cases where renal function is in danger. Main complications are vasculorenal hypertension and renal failure.

Embolism↗
PubMed2003

Treatment of urinary tract infection with gentamicin once or three times daily.

AIM: To examine the safety and efficacy of once-daily (OD) gentamicin treatment compared with conventional 8-hourly dosing (TDS) for urinary tract infection (UTI). METHODS: This was a prospective, randomized, controlled trial of children 1 mo to 13 y of age with presumed UTI. Children were randomly assigned to OD gentamicin 5 mg kg(-1) d(-1) or TDS gentamicin 6 mg kg(-1) d(-1) divided 8 hourly. Microbiological efficacy, nephrotoxicity, ototoxicity and renal scarring were assessed at the end of treatment. RESULTS: 210 patients with presumed UTI were recruited, of whom 172 were analysable (OD 84, TDS 88). The median age was 7 mo, 50% were male and 74% (n = 127) of patients had pyelonephritis. The majority of infections were due to Escherichia coli (n = 153, 89%), of which 9 (5.2%) were bacteraemic. Comparing the two groups, there was no significant difference in age, gender, duration of fever before admission, pyuria, nitrite positivity or initial total white blood cell count. All patients had negative urine cultures after 2-3 d of treatment, demonstrating 100% microbiological efficacy. There was no difference between the two groups in terms of ototoxicity, nephrotoxicity, duration of gentamicin treatment or time to fever defervescence. CONCLUSION: OD gentamicin is as efficacious as TDS gentamicin in the treatment of UTI in children, with no difference in ototoxicity and nephrotoxicity.

Adolescent↗
PubMed2003

Use of drotrecorgin alfa--recombinant activated human protein C in treatment of septic shock in the course of therapy for nephrolithiasis.

BACKGROUND: Septic shock is the most dangerous complication of nephrolithiasis management utilizing percutaneous methods. CASE REPORT: The patient, D.M., aged 60 was subjected to scheduled percutaneous nephrolithotomy due to coral calculosis of the pyelocalyceal system. As pyuria was noted intraoperatively, nephrostomy was left after the procedure. Over ten hours after the surgery the patient developed the symptoms of severe septic shock with progressive respiratory distress, renal failure, intravascular coagulation syndrome and impaired consciousness. Nephrectomy was performed, antibiotic treatment and high doses of norepinephrine instituted. Hemodynamic stabilization was obtained, without, however, marked improvement of the patient's condition. Because of persistent coagulation disorders and multiorgan dysfunction, recombinant activated protein C preparation--drotrecorgin alfa (Xigris Eli Lilly) was added to the therapeutic regimen. From the second day of infusion, systematic improvement of the coagulation system parameters was observed, making it possible to reduce the doses of catecholamines, oxygen concentration in the gas mixture used for ventilation, as well as stabilization of the function of the preserved kidney. The patient was weaned off the respirator on the 8th day of treatment and on the 13th day referred to the Urology Department, from which she was soon discharged home. CONCLUSIONS: 1. Surgical resection of the infection source and cause of the septic shock is the prerequisite for successful pharmacological treatment. 2. Administration of rh-APC to a patient meeting the PROWESS criteria may be an effective and safe method of treatment in the complex management of septic shock.

Disseminated Intravascular Coagulation↗
PubMed1992

[Clinical analysis of urolithiasis in Poh Ai Hospital of I-Lan, Taiwan, R.O.C.--a comparative study with urolithiasis in Japan].

Between August 1987 and December 1990, 546 patients were admitted to the department of Urology at the Poh Ai Hospital of I-Lan, Taiwan, R.O.C. for the treatment of urinary stones. These urinary stone cases accounted for 50 to 60% of all urology patients admitted. The incidence of urolithiasis in I-Lan was estimated at 147/100,000 population in 1990. There were 402 male patients and 144 female patients, The male to female ratio was 2.8: 1. There were 450 upper urinary tract stones (kidney, ureter) in 314 males and 136 females, and 79 lower urinary tract stones (bladder, urethra) in 72 males and 7 females. The ratio of upper to lower urinary tract stones was 6:1. Endourological treatments such as percutaneous nephrolithotripsy and transurethral ureterolithotripsy have increased rapidly in recent years. A summary of the present analysis for composition of 365 stones follows. The most frequent type was calcium-containing stone (92.3%), followed by infection stone (4.7%), then uric acid (UA) stone (3.0%). There were no UA stones found in the female patients. According to urinalysis criteria of more than 10 WBC/HPF (x 400), pyuria was found in 67 cases of 334 metabolic stones (20.1%), and 11 cases of 17 infection stones (67.7%). There were neither pediatric case of stone formation nor cystine stones.

Adolescent↗
PubMed1992

[Solitary infected renal cyst: a case report].

A 48-year-old man was admitted to our hospital because of high fever and left flank pain. Laboratory findings revealed a high white blood cell count, high C-reactive protein level, and severe pyuria. Sonographic examination revealed an enlargement of the cyst at the upper pole of the left kidney that had already been detected. Percutaneous drainage was performed for the cyst and 60 ml of purulent fluid was obtained. Bacterial culture of the fluid was positive for Propionibacterium acnes and gamma-Streptococcus. The drainage and administration of povidone-iodine was continued for 7 days. The size of the cyst was reduced with disappearance of symptoms.

C-Reactive Protein↗
PubMed1992

Diagnostic criteria of analgesic nephropathy in patients with end-stage renal failure: results of the Belgian study.

Diagnostic criteria of analgesic nephropathy with well-defined sensitivity and specificity are not available. During a 2-year period all new patients (n = 273) starting renal replacement therapy in 13 Belgian dialysis units were investigated aiming to select diagnostic criteria of analgesic nephropathy with acceptable performance. Using several interview techniques, a history of analgesic abuse was found in 31% of the patients. Analgesic abusers presenting a clear non-analgesic-related renal diagnosis were excluded from analysis (n = 25). Comparing the remaining abusers (n = 60) and patients without a history of analgesic abuse (n = 188) it was found that renal imaging investigations (sonography plus tomography), showing a decrease in length combined with bumpy contours of both kidneys, presented a sensitivity of 90% and a specificity of 95%. The additional finding of signs of renal papillary necrosis resulted in an overall sensitivity of 72% and a specificity of 97%, giving a positive predictive value of 92%. Other signs frequently mentioned in the literature (hypertension, anaemia, sterile pyuria, bacteriuria, proteinuria) showed insufficient sensitivity and/or specificity to be of help for diagnosing analgesic nephropathy in end-stage renal failure (ESRF) patients starting renal replacement therapy.

Adult↗
PubMed1992

[Clinical evaluation of oral ofloxacin in 3-day therapy for transurethral resection of the prostate].

The effectiveness of oral administration of an antibacterial alone was compared with that of intravenous administration of an antibiotic in patients with benign prostatic hyperplasia undergoing transurethral resection of the prostate (TUR-P). In group A (23 patients), surgery was carried out by administering 200 mg of ofloxacin (OFLX) alone, during the day before surgery and in the morning of the day of surgery and three times a day from the morning after surgery for two days, making the total dose 1,800 mg, and total period of administration 3 days. In group B (22 patients), 1 g of Cefotetan (CTT) was intravenously infused twice a day for 3 days from the operative day, making the total dose 6 g. The patients in both groups were given no other antibacterials or antibiotics. The maximum body temperature was recorded for post-operative 2 weeks. Negativization of bacteria by bacterial culture in the urine and disappearance of the pyria, were followed up on an outpatient bases. The mean maximum body temperature up to post-operative week 2 was 37.1 +/- 0.3 degrees C and 37.0 +/- 0.3 degrees C in groups A and B, respectively. The mean number of days required until negativization of bacteria in the urine was 41.5 +/- 38.9 days and 43.3 +/- 24.9 days in groups A and B, respectively. The mean number of days required until disappearance of the pyuria was 76.5 +/- 23.0 days and 68.2 +/- 17.9 days in groups A and B, respectively. No significant differences were noted by Student's t-test between groups A and B.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1992

[Clinical evaluation of flucytosine in patients with urinary fungal infections].

The clinical effectiveness of flucytosine (5-FC) was evaluated in 52 patients with urinary fungal infections which were diagnosed because of the presence of both funguria (greater than or equal to 10(4) cfu/ml) and pyuria (greater than or equal to 5 WBC/hpf). The patients received oral daily doses of 5-FC ranging 20 to 150 mg/kg, with a mean treatment duration of 11 days. The 57 fungus strains isolated from urine specimens consisted of 51 Candida spp. including 28 Candida albicans, 10 Candida glabrata, 4 Candida tropicalis and 6 Trichosporon beigelii. Forty-seven (92.2%) and 4 (66.7%) of the 51 Candida spp. and 6 T. beigelii strains isolated were eradicated by the treatment, respectively, giving an overall eradication rate of 89.5%. Clinical responses in 32 patients, from whom only fungi were submitted, were excellent in 5, moderate in 22, and poor in 5, thus the overall efficacy rate was 84.4%, based on the criteria of Japanese UTI Committee. Of the 18 strains of Candida spp. tested, 5-FC showed 0.20 micrograms/ml or less of the minimum inhibitory concentrations (MICs) against 16 strains and higher than 100 micrograms/ml against the remaining 2 strains. The MICs of the 5 T. beigelii strains tested were between 3.12 and 6.25 micrograms/ml. As adverse reactions, only 2 patients (3.8%) experienced diarrhea but did not require treatment cessation. These results suggest that flucytosine is an effective drug for urinary fungal infections.

Adult↗
PubMed2003

[Acute pyelonephritis].

Acute pyelonephritis is frequent. Its usual signs and symptoms comprise renal pain, fever, inflammation, and pyuria. Simple acute E. coli pyelonephritis is frequent in the young female and in most cases is a benign condition. A typical pyelonephritis may be painless, or without high fever, or lacking bacterial growth in the urine due to previous inappropriate treatment. Severe, complicated pyelonephritis is mainly observed in diabetic, alcoholic or immunocompromised patients. In occasional cases, a common form of pyelonephritis may progress to formation of a renal abscess requiring drainage. When secondary to urinary tract abnormalities, pyelonephritis may be complicated with septicemia and can induce early and severe renal tissue damage. This form warrants emergency urologic treatment. Simple pyelonephritis of the young female without febrile UTI history requires little imaging. Conversely, extensive imaging workup is mandatory in the male, the elderly, when treatment is not rapidly effective or in case of early relapse. In some cases, acute pyelonephritis leads to the development of cortical scars, the long-term prognosis of which remains to be determined.

Acute Disease↗
PubMed2003

Isolated fatal renal mucormycosis in a patient with chronic obstructive pulmonary disease and tuberculosis.

Renal mucormyosis is a rare entity and normally diagnosed at postmortem. Isolated cases diagnosed antemortem are even rarer and only a few cases have been reported. The disease is associated with a high mortality rate, especially in patients with underlying disease. Clinical presentation is non-specific and includes flank pain, fever and pyuria with or without haematuria. Identifying fungal hyphae microscopically is essential for diagnosis. We present a rare isolated fatal case of renal mucormycosis in a 77-year-old man with chronic obstructive pulmonary disease (COPD) and old tuberculosis (TB) who had been diagnosed after a right nephrectomy. We believe early diagnosis and appropriate treatment for fungal infection, together with the predisposing underlying disease, is crucial for survival.

Aged↗
PubMed1992

Asymptomatic significant bacteriuria among pregnant and non-pregnant women in Sagam, Nigeria.

In a study carried out among 510 pregnant and 304 non-pregnant women at Ogun State University Teaching Hospital, Sagamu, 122 (23.9 pc) of the pregnant women and 37 (2.2 pc) of the non-pregnant women had significant bacteriuria. The rate amongst the pregnant women was significantly higher than in non-pregnant women (P < 0.001). There was a correlation between pyuria and significant bacteriuria in 45 (8.8 pc) of the pregnant women and in 11 (3.6 pc) of the non-pregnant women. Significant bacteriuria was closely associated with nulliparae. Most of the pregnant women with significant bacteriuria belonged to the low socio-economic group. Unlike in previous studies in this country, the most prevalent organism in this study was the Staphylococcus aureus.

Adolescent↗
PubMed2004

[A case of fistula between the urinary bladder and an ovarian dermoid cyst].

A 20-year-old woman was referred to our hospital for further evaluation on persistent pyuria. Physical examination showed a tender solid suprapubic mass. Computed tomography showed a right ovarian multilocular cystic tumor just above the urinary bladder. Cystoscopy showed pus leakage from an orifice in a hemisphere protrusion of the bladder wall. A small catheter could be inserted into the orifice. It revealed a fistula 4 cm in length between the right ovarian tumor and the vesical cavity. The tumor and the adjacent thickened bladder wall with an abscess and fistula were resected en bloc. Also a small left ovarian cyst was enucleated. Histopathological examination showed bilateral ovarian dermoid cysts, abscess formation, and marked inflammatory change around the fistula in the vesical wall. The fistula was thought to be the consequence of infection of the ovarian cyst.

Adult↗
PubMed2004

[Persistent fever of unknown origin in two young infants caused by the atypical form of Kawasaki disease].

Two previously healthy infants, a boy and a girl aged 3 and 4 months, respectively, were admitted for fever of unknown origin with laboratory results indicating an inflammation. The boy presented with vomiting, pyuria, anaemia, and thrombocytosis. The girl presented with irritability, erythema and diarrhoea. All viral and bacterial cultures remained negative and supplementary radiology was unable to detect a focus of infection. The fever had persisted for at least 12 days in both cases before the diagnosis 'atypical Kawasaki disease' was considered. Cardiac echograms showed dilatation of the coronary arteries in both patients and confirmed the diagnosis. Immediate therapy with intravenous immunoglobulins and acetylsalicylic acid was given, whereupon the fever subsided within 24 hours; the further clinical course was uneventful. These cases illustrate the fact that atypical Kawasaki disease is often a late consideration, especially when the symptoms of the classical form are absent. This condition should be considered in every infant presenting with long-lasting unexplained fever.

Anti-Inflammatory Agents, Non-Steroidal↗