Obstructive Uropathy

A 72-year-old man presented with urinary retention, weight loss, haematuria and severe acute kidney injury. He had never before been admitted to hospital and his past medical history included only an inguinal hernia. On examination, he appeared uraemic and had a right-sided painful hernia. A three-way catheter was inserted, bladder washouts performed and irrigation started. An ultrasound showed severe bilateral hydronephrosis and a ‘thickened bladder’ and this was thought to be obstructive uropathy secondary to bladder cancer. Twenty-four hours later his hernia doubled in diameter, became incarcerated and a CT of the abdomen and pelvis showed an inguinal hernia of both bladder and bowel, with the catheter tip inside the bladder hernia. He was taken to theatres and an open mesh repair was performed with a rigid cystoscopy to assist in locating and reducing the bladder. He required intensive care and dialysis postoperatively and remains on regular dialysis following discharge.

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Obstructive uropathy in the context of ureteroinguinal hernia: experience of challenges in surgical management of an unwell patient

BMJ Case Reports ◽

10.1136/bcr-2020-235060 ◽

2020 ◽

Vol 13 (8) ◽

pp. e235060

Author(s):

Mitchell Egerton Barns ◽

Arvind Vasudevan ◽

Emma Lucy Marsdin

Keyword(s):

Obstructive Uropathy ◽

Anatomical Variation ◽

Surgical Patients ◽

Definitive Treatment ◽

Ureteric Stent ◽

Common Presentation ◽

Iatrogenic Damage ◽

Vesicoureteric Junction ◽

Collecting System

This case exemplifies an unusual anatomical variation of a common presentation and highlights the importance of perioperative diagnosis and planning in complex surgical patients. A 72-year-old comorbid man presented to the emergency department with an infected obstructed right kidney secondary to an obstructing 12 mm vesicoureteric junction calculi. However, imaging also showed concurrent ureteroinguinal hernia associated with a 130 cm-long ureter, too long for conventional treatment with a ureteric stent. Acutely, the patient’s collecting system was decompressed via nephrostomy, but due to the rarity of this anatomical variation, definitive treatment had to be rethought to help reduce the risk of iatrogenic damage and the associated long-term complications.

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Percutaneous nephrostomy versus retrograde ureteral stenting for acute upper obstructive uropathy: a systematic review and meta-analysis

Scientific Reports ◽

10.1038/s41598-021-86136-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ismail Zul Khairul Azwadi ◽

Mohd Noor Norhayati ◽

Mohd Shafie Abdullah

Keyword(s):

Quality Of Life ◽

Clinical Trials ◽

Obstructive Uropathy ◽

Meta Analysis ◽

Percutaneous Nephrostomy ◽

Procedural Pain ◽

Controlled Trials ◽

Failure Rates ◽

Ureteral Stenting

AbstractAcute obstructive uropathy is associated with significant morbidity among patients with any condition that leads to urinary tract obstruction. Immediate urinary diversion is necessary to prevent further damage to the kidneys. In many centres, the two main treatment options include percutaneous nephrostomy (PCN) and retrograde ureteral stenting (RUS). The purpose of this study if to compare the efficacy and safety of PCN and RUS for the treatment of acute obstructive uropathy. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL, EMBASE, the World Health Organisation International Clinical Trials Registry Platform and ClinicalTrials.gov. We also searched the reference lists of included studies to identify any additional trials. We included randomised controlled trials and controlled clinical trials comparing the outcomes of clinical improvement (septic parameters), hospitalisation duration, quality of life, urinary-related symptoms, failure rates, post-procedural pain [measured using a visual analogue scale (VAS)] and analgesics use. We conducted statistical analyses using random effects models and expressed the results as risk ratio (RR) and risk difference (RD) for dichotomous outcomes and mean difference (MD) for continuous outcomes, with 95% confidence intervals (CIs). Seven trials were identified that included 667 patients. Meta-analysis of the data revealed no difference in the two methods in improvement of septic parameters, quality of life, failure rates, post-procedural pain (VAS), or analgesics use. Patients receiving PCN had lower rates of haematuria and dysuria post-operatively and longer hospitalisation duration than those receiving RUS. PCN and RUS are effective for the decompression of an obstructed urinary system, with no significant difference in most outcomes. However, PCN is preferable to RUS because of its reduced impact on the patient’s post-operative quality of life due to haematuria and dysuria, although it is associated with slightly longer hospitalisation duration.

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Medical management of deeply infiltrating endometriosis - 7 year experience in a tertiary endometriosis centre in London

Gynecological Surgery ◽

10.1186/s10397-019-1065-9 ◽

2019 ◽

Vol 16 (1) ◽

Cited By ~ 2

Author(s):

Marianne Wild ◽

Tariq Miskry ◽

Asmaa Al-Kufaishi ◽

Gillian Rose ◽

Mary Crofton

Keyword(s):

Medical Management ◽

Obstructive Uropathy ◽

Intrauterine Device ◽

Secondary Analysis ◽

Surgical Excision ◽

Hormonal Contraceptive ◽

Reproductive Age ◽

Deeply Infiltrating Endometriosis ◽

Hormonal Therapies ◽

Infiltrating Endometriosis

Abstract Background Deeply infiltrating endometriosis has an estimated prevalence of 1% in women of reproductive age. Ninety percent have rectovaginal lesions but disease may also include the bowel, bladder and ureters. Current practice often favours minimally invasive surgical excision; however, there is increasing evidence that medical management can be as effective as long as obstructive uropathy and bowel stenosis are excluded. Our objective was to establish the proportion of women with deeply infiltrating endometriosis successfully managed with hormonal therapies within our tertiary endometriosis centre in West London. Secondary analysis was performed on anonymised data from the Trust’s endometriosis database. Results One hundred fifty-two women with deeply infiltrating endometriosis were discussed at our endometriosis multidisciplinary meeting between January 2010 and December 2016. Seventy-five percent of women underwent a trial of medical management. Of these, 44.7% did not require any surgical intervention during the study period, and 7.9% were symptomatically content but required interventions to optimise their fertility prospects. Another 7.0% were successfully medically managed for at least 12 months, but ultimately required surgery as their symptoms deteriorated. 26.5% took combined oral contraceptives, 14.7% oral progestogens, 1.5% progestogen implant, 13.2% levonorgestrel intrauterine device, 22.1% gonadotrophin-releasing hormone analogues, and 22.1% had analogues for 3–6 months then stepped down to another hormonal contraceptive. All women who underwent serial imaging demonstrated improvement or stable disease on MRI or ultrasound. Conclusions Medical treatments are generally safe, well tolerated and inexpensive. More than half (52.6%) of women were successfully managed with medical therapy to control their symptoms. This study supports the growing evidence supporting hormonal therapies in the management of deeply infiltrating endometriosis. The findings may be used to counsel women on the likely success rate of medical management.

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