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Emphysematous cystitis is a rare complication of lower urinary tract infection, occurring almost exclusively in diabetic women. The prognosis, usually good, depends on early diagnosis and prompt treatment which consists of urinary drainage, antibiotic therapy and strict blood glucose control. The authors report a case of emphysematous cystitis diagnosed on laparotomy for acute abdomen. Death occurred despite treatment.
A group of 175 patients had barium enema. Pour-plate blood cultures were obtained immediately before and after the procedure and 5, 10, 15, and 30 minutes later. Bacteremia was demonstrable in 20 (11.4%) patients. In some, blood cultures were positive for as long as 15 minutes after barium enema; all were negative at 30 minutes. Among the bacteria associated with the 20 episodes of bacteremia were Escherichia coli, Klebsiella, enterococci, Proteus morganii, Bacteroides, and Veillonella. The incidence of bacteremia among patients with ulcerative colitis, regional enteritis, rectal polyps, colonic or rectal carcinoma, nonspecific diarrhea, or other lower intestinal tract disorders was not much different from patients free of rectosigmoid disease. The results of this study suggest that a history of recent barium enema may be important in patients who have endocarditis.
Staghorn calculi are infrequent and generally are infected stones. Struvite or apatite calculi are embedded with gram-negative bacteria, which can produce endotoxin. Sepsis syndrome may occur after surgical therapy or endoscopic manipulation of infected or staghorn calculi. Sepsis, which can occur despite perioperative antibiotic use, may be due to bacteremia or endotoxemia. We present a child with an infected staghorn calculus who developed overwhelming sepsis and died after percutaneous stone manipulation. Endotoxin assay of stone fragments demonstrated an extremely high level of endotoxin despite low colony bacterial culture growth. This is the first reported case in which endotoxin was demonstrated in stone fragments from a child who died of severe sepsis syndrome after percutaneous staghorn stone manipulation.
Most staghorn calculi occur in patients who have chronic urinary tract infections with urea-splitting organisms. Acetohydroxamic acid, an inhibitor of the bacterial urease enzyme, is currently undergoing clinical trials to determine whether or not it can prevent stone growth in patients at risk. We report on a patient whose stones grew while she was taking placebo and then decreased in size when she took the active drug.
We assessed the efficacy and morbidity of extracorporeal shock-wave lithotripsy (ESWL) monotherapy in the treatment of 25 consecutive patients with large-volume renal calculi (surface area greater than or equal to 5.0 cm2). Eighteen of the calculi were infection (struvite) stones and 7 were sterile stones. In 21 cases internal ureteral stents were positioned before ESWL, but no patient underwent pretreatment percutaneous nephrostomy (PCN) or percutaneous nephrostolithotomy (PNL). An average of 2.1 procedures including ESWL, PCN, or ureteral interventions were required to achieve a stone-free renal collecting system and ureter, or residual stone particles less than 4 mm in diameter confined to the renal collecting system. Sixty percent of the patients required no ancillary procedures after ESWL. There were no differences in the mean duration of hospitalization, need for post-treatment ancillary procedures, time to clearance of ureteral fragments, and incidence of residual stone particles among patients with infection and sterile stones. Of 23 patients observed greater than three months (mean 10.9 mos) after ESWL, 43 percent had residual stone particles in the renal collecting system. Expansion of these particles or stone recurrence in the absence of residual particles has not been observed. We conclude that large volume renal calculi may be managed effectively and safely with ESWL monotherapy.
Stone formation in the double J ureteral catheter is an uncommon complication that generally appears in patients that are predisposed to stone formation and persistent infection of the urinary tract. We report on a 29-year-old female patient in whom stone formation was observed in both ends of the catheter, less than 3 months after it had been placed. Urine culture was positive for P. mirabilis. Percutaneous nephrolithotomy was warranted in the treatment of the pyelic stone and for removal of the double J catheter. We underscore the importance of doing urine cultures and radiologic control in this patient group and shortening the time the catheter is left indwelling.
A group of 44 patients, aged from 10 months to 14 years, underwent surgery for urinary calculi over a 7-year period (1982-1989). Eleven patients had bilateral or multiple calculi (total number of stones = 55, 20 of which were staghorn). Metabolic disorders (n = 25) and Proteus urinary infection (n = 15) were the 2 factors most often associated with lithiasis. Of the 55 stones, 51 were removed by open surgery. Complete stone clearance was achieved in 29 of 36 kidneys. Follow-up periods in the remaining 7 renal units (with small residual fragments) ranged from 3.5 to 7.5 years (mean 6.2) and revealed stone recurrence in only 2 patients. Evaluation of childhood urolithiasis should include thorough metabolic investigation and sound surgical judgment; effective management requires prolonged post-operative follow-up.
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In vitro activities of antibacterial agents against E. coli, Klebsiella, Citrobacter and Proteus which were isolated from patients with urinary tract infections at 8 hospitals in Japan, were investigated by dilution broth method using MIC 2000 (Dynatec) during July to October in 1981. The summarized results are as follows: Among oral antibacterial agents, MPC and PPA have showed potent antibacterial activities against E. coli and Klebsiella. In vitro activities of oral antibacterial agents against Proteus and Citrobacter showed not so potent. Among the first and second generation's parenteral antibacterial agents, CTM has showed potent antibacterial activities against E. coli and Klebsiella. Among the third generation's parenteral antibacterial agents, CMX, CTX and CZX have showed potent antibacterial activities against E. coli, Klebsiella, Proteus and Citrobacter.
Swabs were taken for culture from the periurethral area and urethral meatus in 124 uncircumcised and 60 circumcised boys. Proteus mirabilis was grown from 28 (22.6%) swabs from uncircumcised boys and from only one (1.7%) swab from circumcised boys. This supports the idea that the prepuce may be the source of proteus urinary tract infection.
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