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World Journal of Urology Apr 2024To prospectively evaluate the rate and associated risk factors of early infectious complications after ureterorenoscopy for urolithiasis.
PURPOSE
To prospectively evaluate the rate and associated risk factors of early infectious complications after ureterorenoscopy for urolithiasis.
METHODS
After ethical committee approval, 400 therapeutic retrograde ureterorenoscopy procedures between August 3, 2020 and November 24, 2021 were included for analysis in a single-center study. Postoperative infection was defined as an afebrile urinary tract infection, fever (≥ 38 °C) with pyuria (≥ 300 WBC/μL) or proven urinary pathogen, and urosepsis. The primary outcome was the rate of infectious complications after ureterorenoscopy. Secondary outcomes were the perioperative factors that increased the risk of infectious complications within 30 days of surgery using univariate and multivariate logistic regression analysis.
RESULTS
Twenty-nine of four hundred (7.3%) patients developed an infectious complication within 30 days after ureterorenoscopy. Ten (2.5%) patients developed an afebrile urinary tract infection, eight (2.0%) developed fever with pyuria, five (1.3%) febrile urinary tract infection, and six (1.5%) urosepsis. On univariate analysis, preoperative stent-type JFil pigtail suture stent was significantly associated with the dependent variable (p < 0.001). On multivariate logistic regression analysis, older age (OR 1.035; 95% CI 1.006-1.070; p = 0.02) was found to be significantly associated with developing a postoperative infectious complication.
CONCLUSIONS
A 7.3% rate of postoperative infectious complications and 1.5% urosepsis rate were observed after therapeutic ureterorenoscopy, without the need of intensive care admission. The only significant risk factors were preoperative stent type (JFil pigtail suture stent) on univariate analysis, and older age on multivariate logistic regression analysis. Further multicentric prospective observational data are needed in this field.
Topics: Humans; Male; Female; Prospective Studies; Risk Factors; Ureteroscopy; Middle Aged; Urinary Tract Infections; Adult; Postoperative Complications; Aged; Time Factors; Sepsis; Urolithiasis
PubMed: 38691160
DOI: 10.1007/s00345-024-04983-6 -
Annals of Medicine and Surgery (2012) Oct 2023It is rare for calcium oxalate renal stone, presented mainly in sterile urine, to result in urinary tract infection. The stone-related infection could develop...
INTRODUCTION AND IMPORTANCE
It is rare for calcium oxalate renal stone, presented mainly in sterile urine, to result in urinary tract infection. The stone-related infection could develop spondylodiscitis, causing neurological deficits. To date, there are no reports about calcium oxalate partial staghorn stone and spondylodiscitis.
CASE PRESENTATION
A 62-year-old male suffered from haematuria, fever, and flank pain. He came to the urology outpatient department, where acute pyelonephritis was diagnosed, and a left partial staghorn stone was seen on computed tomography. Oral antibiotics were prescribed with improvement. Two weeks after antibiotics treatment, he developed bilateral lower limb weakness and numbness under the nipple level. He was brought to the emergency department, where the spine MRI revealed T2-T3 spondylodiscitis with epidural abscess and spinal cord compression. He underwent T2-T3 spine operation with improvement in muscle power and hypesthesia. The culture of the surgical lesion yielded Citrobacter koseri, the same as the urine culture obtained at his first visit. Left-side percutaneous nephrolithotomy was performed 1 month after with successful stone removal and resolution of pyuria. Stone analyses reported calcium oxalate. Follow-up MRI showed marked improvement with resolution of spondylodiscitis.
CLINICAL DISCUSSION
Urinary tract infection resulting from partial staghorn stone, with additional hematogenous spread causing spondylodiscitis, is scarcely discussed. The authors illustrated a case with calcium oxalate stone, belonging to sterile Jensen's classification type 1. However, a urinary tract infection could be seen in urine stasis or obstruction.
CONCLUSION
With accurate diagnosis and essential interventions, the patient had immediate neurological improvement and reached disease-free status.
PubMed: 37811066
DOI: 10.1097/MS9.0000000000001202 -
BMJ Case Reports Jan 2024We report a case of multisystem inflammatory syndrome in children (MIS-C) in an East Asian toddler. He presented with a 2-day history of fever and pyuria, 5 weeks...
We report a case of multisystem inflammatory syndrome in children (MIS-C) in an East Asian toddler. He presented with a 2-day history of fever and pyuria, 5 weeks before that he had recovered from COVID-19. He was initially treated as urinary tract infection. On day 5 of fever, he was noted to have bilateral non-suppurative limbus-sparing conjunctivitis, red and cracked lips and erythematous extremities. Investigations showed raised inflammatory markers (C-reactive protein and erythrocyte sedimentation rate), thrombocytopenia and a markedly elevated NT-proBNP. He received prompt and appropriate treatment inpatient; however, he still had mild coronary abnormalities at 9 months postdischarge. The aim of this paper is to describe the initial presentation and progress of a case of MIS-C. The unique features of this case are his initial presentation of pyuria and notably, his demography (young age, East Asian) which is more typical of Kawasaki disease than MIS-C.
Topics: Male; Child, Preschool; Humans; Pyuria; Aftercare; Patient Discharge; Fever; Systemic Inflammatory Response Syndrome; COVID-19; Conjunctivitis
PubMed: 38171640
DOI: 10.1136/bcr-2022-253756 -
BMC Urology Nov 2023Ectopic kidney and median arcuate ligament syndrome are both rare conditions. The clinical presentation and diagnosis of these conditions are not well studied. There are...
BACKGROUND
Ectopic kidney and median arcuate ligament syndrome are both rare conditions. The clinical presentation and diagnosis of these conditions are not well studied. There are no reports on the combination of these two rare conditions.
CASE PRESENTATION
We report a 24-year-old woman with fever, dysuria, urinary frequency and left flank pain for two days. The primary diagnoses in the clinic were left acute pyelonephritis and left hydronephrosis due to throbbing pain in the left costovertebral angle and pyuria. However, further computed tomography showed right ectopic pelvic kidney, left renal pelvis dilatation without definite ureteral lesion, good bilateral renal contrast enhancement, and compression of the celiac axis due to obstruction by the median arcuate ligament. Chronic abdominal symptoms were reported by the patient after repeat history taking. The patient's condition was fully explained and discussed with her and her family, but they refused further therapy. After the acute pyelonephritis began improving, the patient was discharged for follow-up at our outpatient clinic.
CONCLUSION
We present an extremely rare case of a combination of two rare conditions: ectopic kidney and median arcuate ligament syndrome. No study to date has reported on the relationship between the two diseases. Given the rarity of the two conditions, no evidence or even a hypothesis exists to explain the possible etiology of their combination. More reports are required to enhance the understanding of these rare conditions.
Topics: Female; Humans; Young Adult; Celiac Artery; Kidney; Kidney Diseases; Ligaments; Median Arcuate Ligament Syndrome; Pyelonephritis
PubMed: 37980517
DOI: 10.1186/s12894-023-01361-z -
Cureus Mar 2024A 53-year-old man with diabetes mellitus presented to the emergency department with a fever and impaired mobility. A preliminary diagnosis of urinary tract infection was...
A 53-year-old man with diabetes mellitus presented to the emergency department with a fever and impaired mobility. A preliminary diagnosis of urinary tract infection was made based on dysuria and pyuria. History-taking revealed a history of gait disturbance and difficult urination. A thorough physical examination suggested a spinal abnormality. MRI scan revealed a narrow spinal canal due to ossification of the posterior longitudinal ligament and diffuse idiopathic skeletal hyperostosis. Throughout the diagnostic process, we employed both vertical tracing to investigate the causes of urinary tract infection and horizontal tracing to explore comorbidities such as diabetes. Additionally, we introduced appropriate social security and support systems under the name of diagnostic excellence.
PubMed: 38571861
DOI: 10.7759/cureus.55475 -
The Canadian Veterinary Journal = La... Jan 2024A 3-year-old spayed female Rottweiler dog was brought to a veterinary clinic because of weakness, lethargy, and hair coat changes. Hematology and clinical chemistry...
A 3-year-old spayed female Rottweiler dog was brought to a veterinary clinic because of weakness, lethargy, and hair coat changes. Hematology and clinical chemistry assessments revealed anemia, hypoalbuminemia, hyperglobulinemia, and hypothyroid. After persistent pyuria, an ultrasound-guided cystocentesis was completed, which revealed a large abdominal mass. A presumptive diagnosis of canine lymphoma with renal spread was made. Due to a poor prognosis, the dog was euthanized.
Topics: Dogs; Animals; Female; Dog Diseases; Ultrasonography; Lymphoma; Ultrasonography, Interventional
PubMed: 38164385
DOI: No ID Found -
International Urogynecology Journal May 2024In this second episode of the Microbiologist in the Clinic series, clinicians and laboratory scientists share their perspectives about a 75-year-old woman who was...
In this second episode of the Microbiologist in the Clinic series, clinicians and laboratory scientists share their perspectives about a 75-year-old woman who was diagnosed with asymptomatic bacteriuria based on positive urine cultures. The patient and her GP are concerned about this laboratory finding as the patient will become immunosuppressed with planned chemotherapy. The patient has had an overactive bladder (OAB) for approximately 20 years, with good control of her urinary urgency and frequency (no incontinence) with a stable dose of OAB medication. The challenges of this clinical presentation are discussed, with evidence for evaluation and treatment.
PubMed: 38801554
DOI: 10.1007/s00192-024-05819-y -
BMC Urology Jun 2024Neurogenic bladder dysfunction is a major problem for spinal cord injury (SCI) patients not only due to the risk of serious complications but also because of the impact... (Comparative Study)
Comparative Study
BACKGROUND
Neurogenic bladder dysfunction is a major problem for spinal cord injury (SCI) patients not only due to the risk of serious complications but also because of the impact on quality of life. The main aim of this study is to compare the rate of urinary tract infection (UTI) associated with hydrophilic-coated catheters versus uncoated polyvinyl chloride (PVC) catheters among SCI patients presenting with functional neurogenic bladder sphincter disorders.
METHODOLOGY
This was a retrospective cohort study from 2005 to 2020 including adult male or female patients who have an SCI at least more than 1 month ago with neurogenic bladder dysfunction and were using intermittent catheterization (single-use hydrophilic-coated or the standard-of-care polyvinyl chloride uncoated standard catheters) at least 3 times a day to maintain bladder emptying.
RESULTS
A total of 1000 patients were selected and recruited through a stratified random sampling technique with 467 (47.60%) patients in the uncoated catheter arm and 524 (52.60%) in the coated catheter groups. The three outcome measures, namely: symptomatic UTI, Bacteriuria, and pyuria were significantly higher in the group using uncoated polyvinyl chloride (PVC) catheters compared to hydrophilic-coated catheters at the rate of 79.60% vs.46.60%, 81.10% vs. 64.69, and 53.57% versus 41.79% respectively. Males, elder patients, longer duration, and severity of SCI were associated with increased risk of symptomatic UTI.
CONCLUSIONS
The results indicate a beneficial effect regarding clinical UTI when using hydrophilic-coated catheters in terms of fewer cases of symptomatic UTI. Bacteriuria is inevitable in patients with long-term catheterization, however, treatment should not be started unless the clinical symptoms exist. More attention should be given to the high-risk group for symptomatic UTIs.
Topics: Humans; Retrospective Studies; Spinal Cord Injuries; Male; Female; Urinary Tract Infections; Middle Aged; Adult; Urinary Bladder, Neurogenic; Urinary Catheters; Intermittent Urethral Catheterization; Hydrophobic and Hydrophilic Interactions; Polyvinyl Chloride; Cohort Studies; Aged; Urinary Catheterization; Catheter-Related Infections
PubMed: 38867233
DOI: 10.1186/s12894-024-01510-y -
Journal of Infection and Chemotherapy :... Aug 2024Qualitative urinalysis using the Sternheimer stain is a common method in Japan for identifying bacteriuria, but there is a lack of studies examining its test...
INTRODUCTION
Qualitative urinalysis using the Sternheimer stain is a common method in Japan for identifying bacteriuria, but there is a lack of studies examining its test characteristics. In this study, we aimed to investigate the sensitivity and specificity of the Sternheimer stain for urine culture results and compare it with the sensitivity and specificity of the Gram stain. Our goal was to determine the usefulness of the Sternheimer stain in identifying bacteriuria.
PATIENTS AND METHODS
Among 986 patients aged 16 years or older from whom samples for both urinalysis and urine culture were obtained at the emergency room of Tenri Hospital from January 2019 to December 2019, 342 patients with pyuria, defined as the presence of 10 or more white cells per cubic millimeter in a urine specimen, who had not received prior antimicrobial therapy were included. Urine cultures were used for comparison to determine the sensitivity and specificity of Sternheimer and Gram stain in this patient group. A positive Sternheimer stain result was defined as bacteriuria ≥ (1+), and that of Gram stain was defined as ≥ 1/1 field of high-power ( × 1000) oil immersion.
RESULTS
Using urine culture results for comparison, the sensitivity of Sternheimer stain was 92.2%, the specificity was 48.5%, the positive likelihood ratio was 1.79, and the negative likelihood ratio was 0.16.
DISCUSSION
Sternheimer stain is a rapid and useful method to exclude bacteriuria in a group of patients with pyuria in the emergency department.
Topics: Humans; Emergency Service, Hospital; Retrospective Studies; Male; Female; Gentian Violet; Middle Aged; Sensitivity and Specificity; Phenazines; Urinary Tract Infections; Urinalysis; Adult; Aged; Bacteriuria; Japan; Staining and Labeling; Young Adult; Pyuria; Adolescent; Aged, 80 and over
PubMed: 38387786
DOI: 10.1016/j.jiac.2024.02.019 -
Cureus Feb 2024species, typically considered commensal organisms of the human urogenital tract, have been implicated in various urinary tract infections (UTIs), including the rare and...
species, typically considered commensal organisms of the human urogenital tract, have been implicated in various urinary tract infections (UTIs), including the rare and challenging presentation of pyelonephritis. This case report describes a unique instance of pyelonephritis induced by , characterized by a negative routine urine culture and a lack of response to empirical antibiotic treatment, highlighting the complexities associated with diagnosing and managing infections caused by atypical pathogens. A 50-year-old female presented to the emergency department with symptoms suggestive of UTI, including fever, vomiting, and dysuria. However, initial urine analysis was notable for pyuria while routine bacterial culture returned negative results, creating a diagnostic dilemma. Empirical treatment with third-generation cephalosporin was initiated. However, the patient's condition failed to improve, raising concerns about antibiotic resistance or atypical pathogens. Subsequent molecular diagnostics, precisely polymerase chain reaction (PCR), identified as the causative agent. This prompted a change in the treatment regimen to doxycycline, to which the patient showed significant clinical improvement. Physicians should be aware of as a potential cause of pyelonephritis, especially in cases of culture-negative UTIs and when patients do not respond to standard empirical treatment. This case emphasizes the importance of considering atypical pathogens in differential diagnosis and the role of molecular diagnostic techniques in guiding appropriate management.
PubMed: 38544616
DOI: 10.7759/cureus.54958