-
World Journal of Nephrology Jan 2022Unilateral small-sized kidney is a radiological term referring to both the congenital and acquired causes of reduced kidney volume. However, the hypoplastic kidney may...
BACKGROUND
Unilateral small-sized kidney is a radiological term referring to both the congenital and acquired causes of reduced kidney volume. However, the hypoplastic kidney may have peculiar clinical and radiological characterizations.
AIM
To evaluate the clinical presentations, complications, and management approaches of the radiologically diagnosed unilateral hypoplastic kidney.
METHODS
A retrospective review of the records of patients with a radiological diagnosis of unilateral hypoplastic kidney between July 2015 and June 2020 was done at Assiut Urology and Nephrology Hospital, Assiut University, Egypt.
RESULTS
A total of 33 cases were diagnosed to have unilateral hypoplastic kidney with a mean (range) age of 39.5 ± 11.2 (19-73) years. The main clinical presentation was loin pain (51.5%), stone passer (9.1%), anuria (12.1%), accidental discovery (15.2%), or manifestations of urinary tract infections (12.1%). Computed tomography was the most useful tool for radiological diagnosis. However, radioisotope scanning could be requested for verification of surgical interventions and nephrectomy decisions. Urolithiasis occurred in 23 (69.7%) cases and pyuria was detected in 22 (66.7%) cases where the infection was documented by culture and sensitivity test in 19 cases. While the non-complicated cases were managed by assurance only (12.1%), nephrectomy (15.2%) was performed for persistent complications. However, symptomatic (27.3%) and endoscopic (45.6%) approaches were used for the management of correctable complications.
CONCLUSION
Unilateral hypoplastic kidney in adults has various complications that range from urinary tract infections to death from septicemia. Diagnosis is mainly radiological and management is usually conservative or minimally invasive.
PubMed: 35117977
DOI: 10.5527/wjn.v11.i1.30 -
Journal of Ayub Medical College,... 2022Granulomatosis with polyangiitis (GPA) is an uncommon pauci-immune small-vessel necrotising granulomatous vasculitis mostly seen in age 45-60 years. We present the case...
Granulomatosis with polyangiitis (GPA) is an uncommon pauci-immune small-vessel necrotising granulomatous vasculitis mostly seen in age 45-60 years. We present the case of a formerly healthy 44 years old male presenting with dysuria and intermittent urinary retention for 8 months, not responding to empirical antibiotic therapy and TURP. A prostate biopsy showed necrotising granulomatous prostatitis. Urinalysis demonstrated persistent pyuria and haematuria, but cultures showed no growth. Subsequently he complained of fever, cough, dyspnoea and skin ulcers. CT of the chest showed multiple cavitatory lesions and pleural effusion. On work up, c-ANCA was positive and a diagnosis of granulomatosis with polyangiitis was established. This depicts a rarely seen presentation of prostatitis as the initial feature of GPA.
Topics: Humans; Male; Middle Aged; Adult; Granulomatosis with Polyangiitis; Prostatitis
PubMed: 36550673
DOI: 10.55519/JAMC-04-S4-10658 -
European Review For Medical and... Jun 2022The objective of the present communication is to report the safety and efficacy of applying miniaturized percutaneous nephrolithotomy (mini-PCNL) in Vietnamese patients...
Updated evidence of the safety and efficacy of the miniaturized percutaneous nephrolithotomy with holmium laser lithotripsy for the treatment of recurrent nephrolithiasis.
OBJECTIVE
The objective of the present communication is to report the safety and efficacy of applying miniaturized percutaneous nephrolithotomy (mini-PCNL) in Vietnamese patients with recurrent kidney stones using a miniature nephroscope through a 18F metal access sheath.
PATIENTS AND METHODS
We performed a retrospective cohort study of patients who were diagnosed with recurrent nephrolithiasis and underwent mini-PCNL after previous treatments between 2017 and 2020. Clinical profile, preoperative characteristics, intraoperative events, and postoperative outcomes were obtained from the hospital database. Descriptive statistics were used for the whole analysis.
RESULTS
Of 89 eligible patients, 54 were male. The mean age was 53.4 years. Mean stone size was 24.9 mm. 37 patients had right side stone, 39 had left side stone, and 13 had stone on both sides. Pain in the flanks and back was the most symptom in our patients (n = 87, 97.8%), followed by hematuria (n = 13, 14.6%), dysuria (n = 8, 8.9%), fever (n = 7, 7.9%), acute renal colic (n = 5, 5.6%), and pyuria in 2 patients. 27 had complex stones, and the remaining stone position included renal pelvis (21, 23.6%), upper calyx (15, 16.9%), lower calyx (14, 15.7%), and middle calyx (12, 13.5%). 35 of them had grade I, 27 grade II, 8 grade III and 2 grade IV of hydronephrosis. Renal failure was documented in 12 patients (13.5%). 18 patients were performed with 2-times punctures (20.2%) and 13 with 3-times punctures (14.6%). We used one percutaneous tract in 79 patients and the remaining 10 were performed with two tracts. The upper, middle, and lower calyx was the site of puncture access in 6 (6.7%), 73 (82.0%), and 10 (11.3%) cases, respectively. 3 patients had bleeding requiring intraoperative blood transfusion and 2 were converted to open surgery. Intraoperative parameters recorded percutaneous puncture duration of 20.9 minutes (5-50), and total operative duration of 112.9 minutes (40-240). 7 patients developed secondary bleeding after surgery, besides 5 cases of fever, 2 cases of septic shock and one case of drainage failure. Early stone-free rate was 89.9% and this rate was 94.4% for patients after one month of mini-PCNL. Mean duration of ureteral catheter circulation was 2.7 days (2-20), mean length of postoperative hospitalization was 6.6 days (4-25) and mean total hospital stay was 12.9 days (7-28).
CONCLUSIONS
Present results show the safety of mini-PCNL with respect to recurrent nephrolithiasis. Our updated evidence may provide appropriate modified approaches that aim at reducing the risk of recurrent kidney stone development.
Topics: Female; Fever; Holmium; Humans; Kidney Calculi; Lithotripsy; Lithotripsy, Laser; Male; Middle Aged; Nephrolithotomy, Percutaneous; Nephrostomy, Percutaneous; Retrospective Studies; Treatment Outcome
PubMed: 35731058
DOI: 10.26355/eurrev_202206_28956 -
Ghana Medical Journal Jan 2023This study compared the infection rates, degree of encrustation, symptoms, and complications in patients regarding the duration of urethral catheterisation (three weeks,...
OBJECTIVES
This study compared the infection rates, degree of encrustation, symptoms, and complications in patients regarding the duration of urethral catheterisation (three weeks, six weeks, and eight weeks).
DESIGN
A cross-sectional study with stratified simple random sampling.
SETTING
Urology Unit, Korle Bu Teaching Hospital.
PARTICIPANTS
One hundred and thirty-seven male patients with long-term urinary catheters.
INTERVENTIONS
Participants were grouped into 3 weeks, 6 weeks, and 8 weeks duration of catheter replacements.
PRIMARY OUTCOMES MEASURES
Symptoms due to the urinary catheters, urinalysis, urine and catheter tip cultures, sensitivity, and catheter encrustations were assessed.
RESULTS
Eighty-six patients had a primary diagnosis of benign prostatic hyperplasia (BPH), 35 had urethral strictures,13 had prostate cancer, two had BPH and urethral strictures, and one participant had bladder cancer. There was no difference in the symptoms the participants in the different groups experienced due to the urinary catheters (p > 0.05). The frequency of occurrence of complications (pyuria, p = 0.784; blocked catheter, p=0.097; urethral bleeding, p=0.148; epididymo-orchitis, p=0.769 and bladder spasms, p=1.000) showed no differences in the three groups. There was no statistical difference in the urinalysis for the three groups (p>0.05) and the degree of encrustations (3 weeks: 0.03 ± 0.06, 6 weeks: 0.11±0.27 and eight weeks: 0.12 ±0.27) with p=0.065.
CONCLUSIONS
In this study, the duration of urinary catheterisation using silicone Foley's catheters did not influence the complication and symptom rates; hence silicon catheters can be placed in situ for up to 8 weeks before replacement instead of the traditional three-weekly change.
FUNDING
Enterprise Computing Limited.
Topics: Humans; Male; Catheters, Indwelling; Urinary Tract Infections; Silicon; Urethral Stricture; Cross-Sectional Studies; Prostatic Hyperplasia
PubMed: 37576373
DOI: 10.4314/gmj.v57i1.10 -
Journal of Clinical Medicine Jul 2022Laser ureteroscopic lithotripsy (URSL) is an efficacious treatment for ureteral stones. There have been few previous studies comparing the different energy and frequency...
Laser ureteroscopic lithotripsy (URSL) is an efficacious treatment for ureteral stones. There have been few previous studies comparing the different energy and frequency settings for URSL in a single center. We compared these two laser modalities, which were simultaneously used in our medical center for the treatment of ureteral stones. Patients who underwent fragmentation or dusting laser URSL between September 2018 and June 2020 were retrospectively reviewed. We compared patients who underwent fragmentation and dusting laser and assessed the enhancing factors for stone free rate. There were a total of 421 patients with ureteral stones who met the study criteria. There was no significant difference between the characteristics of both groups. The fragmentation group had a better stone free rate and a lower retropulsion rate compared with the dusting group. Multivariate analysis revealed that stone basket use, no upper ureteral stone or pyuria significantly improved the stone free rate. Both laser modes were effective and safe for ureteral lithotripsy although the fragmentation system showed slightly higher effectiveness and lower complication rate.
PubMed: 35887919
DOI: 10.3390/jcm11144155 -
Pediatrics and Neonatology Nov 2023The co-occurrence of bronchiolitis and urinary tract infections (UTI) in hospitalized children is associated with high morbidity and economic strain. However, due to a...
BACKGROUND
The co-occurrence of bronchiolitis and urinary tract infections (UTI) in hospitalized children is associated with high morbidity and economic strain. However, due to a low prevalence (<3%) and inconsistent diagnostic criteria, there is ongoing debate regarding the necessity of systematic screening. This study estimated the prevalence of UTI among children admitted for bronchiolitis and analyzed the associated demographic and clinical factors.
METHODS
A 5-year (2016-2020) retrospective chart review was conducted among all children admitted for bronchiolitis at a referral pediatrics department in Jeddah, Saudi Arabia. UTI was diagnosed according to the American Association of Pediatrics criteria. Demographic, clinical, microbiological, and imaging data were extracted from the hospital electronic records.
RESULTS
Of the 491 cases of children with bronchiolitis, urine culture and analysis were available for 320 patients. Based on urine culture criteria alone, the prevalence of UTI was 13.1% (95% CI 9.6-17.3), and the most common pathogens included E. coli (33.3%), K. pneumoniae (23.8%), and Enterococcus faecalis (14.3%), and 13 (31.0%) of the isolates were EBSL. By considering urinalysis criteria, i.e., pyuria or nitrituria, the estimated prevalence of UTI decreased to 3.4% (1.7-6.1%), and the most common pathogens were K. pneumoniae (5/11) and E. coli (3/11), with 6/11 ESBL-producing isolates. Regurgitation associated with a higher risk of UTI compared to absence of regurgitation (5.3% versus 0.8%; p = 0.031). Urinary tract ultrasound showed high specificity (98.7-100%) and negative predictive value (97.4-97.7%) in UTI using either criterion.
CONCLUSIONS
There is a higher prevalence of UTI among children with bronchiolitis in the study center, which has several implications in screening, diagnosis, and management. Further multicenter studies are required to enhance the external validity of these findings and assess the cost-effectiveness of screening strategy at a national level.
PubMed: 38044234
DOI: 10.1016/j.pedneo.2023.08.009 -
The Western Journal of Emergency... May 2024Bacterial urinary tract infections (UTI) and some sexually transmitted infections (STI) can have overlapping signs and symptoms or nonspecific findings, such as pyuria...
INTRODUCTION
Bacterial urinary tract infections (UTI) and some sexually transmitted infections (STI) can have overlapping signs and symptoms or nonspecific findings, such as pyuria on urinalysis. Furthermore, results from the urine culture and the nucleic acid amplification test for an STI may not be available during the clinical encounter. We sought to determine whether gonorrhea, chlamydia, and trichomoniasis are associated with bacteriuria, information that might aid in the differentiation of STIs and UTIs.
METHODS
We used multinomial logistic regression to analyze 9,650 encounters of female patients who were aged ≥18 years and who underwent testing for STIs. The ED encounters took place from April 18, 2014-March 7, 2017. We used a multivariable regression analysis to account for patient demographics, urinalysis findings, vaginal wet-mount results, and positive or negative (or no) findings from the urine culture and testing for or
RESULTS
In multivariable analysis, infection with , or was not associated with having a urine culture yielding 10,000 or more colony-forming units per mililiter (CFU/mL) of bacteria compared with a urine culture yielding less than 10,000 CFU/mL or no urine culture obtained. The diagnosis of a UTI in the ED was not associated with having a urine culture yielding 10,000 or more CFU/mL compared with a urine culture yielding less than 10,000 CFU/mL.
CONCLUSION
After adjusting for covariates, no association was observed between urine culture results and testing positive for trichomoniasis, gonorrhea, or chlamydia. Our results suggest that having a concurrent STI and bacterial UTI is unlikely.
Topics: Humans; Female; Adult; Urinary Tract Infections; Sexually Transmitted Diseases; Gonorrhea; Urinalysis; Chlamydia Infections; Middle Aged; Chlamydia trachomatis; Emergency Service, Hospital; Trichomonas vaginalis; Bacteriuria; Young Adult; Neisseria gonorrhoeae; Urine; Retrospective Studies; Adolescent; Trichomonas Infections
PubMed: 38801042
DOI: 10.5811/westjem.60033 -
Cureus Jun 2021A 69-year-old man presented to the ED of our hospital with fever, loss of appetite, malaise, and pyuria and was admitted. He was diagnosed as having urinary infection....
A 69-year-old man presented to the ED of our hospital with fever, loss of appetite, malaise, and pyuria and was admitted. He was diagnosed as having urinary infection. We instituted treatment with cefmetazole, and he was discharged on hospital day 7. is a rare infection in adults in Japan. urinary infection usually occurs as an opportunistic infection in immunocompromised adults or older adults. This patient was not immunocompromised, so spp. should be recognized as potential pathogens in non-diabetic, non-immunocompromised adults.
PubMed: 34295590
DOI: 10.7759/cureus.15780 -
International Journal of Surgery Case... May 2022Giant bladder stone is a rare entity in the modern urological practice. There have been limited reports on giant bladder stone with concomitant renal failure and bladder...
INTRODUCTION AND IMPORTANCE
Giant bladder stone is a rare entity in the modern urological practice. There have been limited reports on giant bladder stone with concomitant renal failure and bladder cancer available in the literature.
CASE PRESENTATION
A 43-year-old male patient presented to the ER with chronic gross hematuria, dysuria, intermittent urination, and bilateral flank pain. Laboratory investigations showed markedly elevated blood urea and serum creatinine levels at admission. Urinalysis revealed pyuria and hematuria with positive nitrite. The kidney-ureter-bladder (KUB) film showed a large single urinary bladder stone measuring 10 × 9 cm. Ultrasound examination revealed bilateral hydronephrosis. Suprapubic cystolithotomy was performed, and the stone was extracted from the bladder. A suspicious bladder mass was found incidentally. Biopsy of the mass showed a low-grade urothelial carcinoma with glandular differentiation and invasion of lamina propria, staged pT1NxMx. The kidney function test marked unimprovement of serum urea and creatinine after the surgery.
CLINICAL DISCUSSION
Open cystolithotomy was performed to release the obstruction and preserve renal function. Chronic obstruction, long-standing chronic inflammation, and urinary tract infection might play a vital role in the progression of kidney injury and the development of bladder cancer.
CONCLUSION
Complications that follow giant bladder stone could be long-lasting and taxing for the sufferer. The risk of renal failure and bladder cancer precipitated by chronic obstruction and mucosal injury should be considered when encountering such case.
PubMed: 35658321
DOI: 10.1016/j.ijscr.2022.107170 -
Children (Basel, Switzerland) Sep 2023This study aimed to investigate the characteristics of COVID-19-associated multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease shock syndrome...
This study aimed to investigate the characteristics of COVID-19-associated multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease shock syndrome (KDSS) and to compare the similarities and differences between the two diseases. The incidence of KDSS and MIS-C was also estimated. Medical records of patients diagnosed with MIS-C or KDSS at four hospitals from January 2013 to December 2022 were retrospectively reviewed. Thirty-one patients were enrolled in the study in either an MIS-C group ( = 22) or a KDSS group ( = 9). The incidence of KDSS in KD was 0.8% (9/1095) and the incidence of MIS-C versus KD was 10.2% (22/216). Compared with the MIS-C group, the KDSS group had longer hospital stays and more severe systemic inflammation (e.g., anemia, elevated C-reactive protein, hypoalbuminemia, and pyuria) and organ dysfunction (e.g., number of involved organs, shock, vasoactive infusion, and intensive care unit admission). All patients in the MIS-C group, but none in the KDSS group, including two patients during the COVID-19 pandemic, had laboratory evidence of SARS-CoV-2 infection. MIS-C and KDSS shared demographic, clinical, and laboratory characteristics; organ dysfunction; treatment; and outcomes. Overall severity was more severe in patients with KDSS than in those with MIS-C. The most important difference between MIS-C and KDSS was whether SARS-CoV-2 was identified as an infectious trigger.
PubMed: 37761488
DOI: 10.3390/children10091527