scholarly journals Do gynecologic oncology patients with severely diminished renal function and urinary tract obstruction benefit from ureteral stenting or percutaneous nephrostomy?

2019 ◽  
Vol 28 ◽  
pp. 136-140
Author(s):  
Brooke Liang ◽  
Sara S. Lange ◽  
L. Stewart Massad ◽  
Rebecca Dick ◽  
Kathryn A. Mills ◽  
...  
Keyword(s):  
Renal Function ◽  
Urinary Tract ◽  
Urinary Tract Obstruction ◽  
Gynecologic Oncology ◽  
Percutaneous Nephrostomy ◽  
Oncology Patients ◽  
Ureteral Stenting

scholarly journals Percutaneous Nephrostomy Tube-related Infections

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S349-S349 ◽  
Author(s):  
Hanine El Haddad ◽  
George Viola ◽  
Ying Jiang ◽  
Issam Raad ◽  
Kenneth V Rolston ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Median Time ◽  
Antimicrobial Therapy ◽  
Urinary Tract Obstruction ◽  
Recurrent Infection ◽  
Percutaneous Nephrostomy ◽  
Infectious Complications ◽  
High Rate ◽  
History Of

Abstract Background Percutaneous nephrostomy tubes (PCN) are indicated for relief of urinary tract obstruction. These devices are prone to mechanical and infectious complications. The infection rate at 90 days is ±20%. Our objective was to determine whether discordant antimicrobial coverage provided prior to PCN exchange was associated with a higher rate of recurrent infection compared with those who received concordant therapy. Methods We retrospectively reviewed 780 patients that had undergone initial PCN placement at our institution between July 2014 and February 2017. We only included patients that had developed a definite PCN infection, subsequent PCN exchange, with a minimum 30 day post-PCN exchange follow up. We defined PCN infection as the presence of a positive urine culture (≥104 cfu/mL) plus symptoms consistent with a urinary tract infection. Recurrence was defined as a new PCN infection with the isolation of the same organism to the initial episode. Antibiotics were defined as concordant if they had activity against all organisms’ isolated based on antimicrobial susceptibilities. Results A total of 47 patients met our inclusion criteria. The median age of patients was 59, with 49% being male. The most common underlying tumors were urothelial (45%), cervical (17%) and prostate cancer (15%). Clinical characteristics included ureteral stents (17%), diabetes (19%), history of GU surgery (38%), and active chemotherapy at the time of PCN insertion (70%). The median time to onset of infection was 42 days. Infections were polymicrobial in 50% of the cases. The most common organisms encountered were Pseudomonas spp. (36%), Enterococcus spp. (23%) and Escherichia coli (18%). The median length of follow up of PCN tubes after exchange was 55 days. There were 12 (26%) recurrences occurring at a median time of 27 days. The provision of discordant antibiotics preceding PCN exchange was significantly associated with recurrence of infection (66.7% vs. 12.8%; P < 0.002). Conclusion Discordant antimicrobial therapy provided during PCN exchange, in the setting of a PCN infection is associated with a higher rate of relapse. Therefore, to decrease the high rate for PCN reinfection, we propose that prior to PCN exchange secondary to infection, patients should be receiving concordant antimicrobial therapy. Disclosures All authors: No reported disclosures.

scholarly journals Roles Played by Biomarkers of Kidney Injury in Patients with Upper Urinary Tract Obstruction

2020 ◽  
Vol 21 (15) ◽  
pp. 5490 ◽  
Author(s):  
Satoshi Washino ◽  
Keiko Hosohata ◽  
Tomoaki Miyagawa
Keyword(s):  
Renal Function ◽  
Urinary Tract ◽  
Interstitial Fibrosis ◽  
Urinary Tract Obstruction ◽  
Kidney Injury ◽  
Upper Urinary Tract ◽  
Obstructive Nephropathy ◽  
Ureteral Stricture ◽  
Kidney Injury Molecule 1 ◽  
Upper Urinary Tract Obstruction

Partial or complete obstruction of the urinary tract is a common and challenging urological condition caused by a variety of conditions, including ureteral calculi, ureteral pelvic junction obstruction, ureteral stricture, and malignant ureteral obstruction. The condition, which may develop in patients of any age, induces tubular and interstitial injury followed by inflammatory cell infiltration and interstitial fibrosis, eventually impairing renal function. The serum creatinine level is commonly used to evaluate global renal function but is not sensitive to early changes in the glomerular filtration rate and unilateral renal damage. Biomarkers of acute kidney injury are useful for the early detection and monitoring of kidney injury induced by upper urinary tract obstruction. These markers include levels of neutrophil gelatinase-associated lipocalin (NGAL), monocyte chemotactic protein-1, kidney injury molecule 1, N-acetyl-b-D-glucosaminidase, and vanin-1 in the urine and serum NGAL and cystatin C concentrations. This review summarizes the pathophysiology of kidney injury caused by upper urinary tract obstruction, the roles played by emerging biomarkers of obstructive nephropathy, the mechanisms involved, and the clinical utility and limitations of the biomarkers.

Urinary tract obstruction

2010 ◽  
pp. 4151-4161
Author(s):  
Muhammad M. Yaqoob ◽  
Islam Junaid
Keyword(s):  
Renal Function ◽  
Urinary Tract ◽  
Renal Pelvis ◽  
Urinary Tract Obstruction ◽  
Obstructive Nephropathy ◽  
Characteristic Finding ◽  
Pelvicalyceal System ◽  
Outflow System

Obstructive nephropathy can manifest as either a sudden or an insidious decline in renal function, which can be can halted or even reversed by relief of obstruction. Obstruction can be due to anatomical or functional abnormalities of the urethra, bladder, ureter, or renal pelvis, which may be congenital or acquired, and it can also occur as a consequence of diseases extrinsic to the urinary tract. Although dilatation of the outflow system proximal to the site of obstruction is a characteristic finding, widening of the ureter and/or pelvicalyceal system does not necessarily indicate the presence of obstruction, and flow may be obstructed without such dilatation....

Percutaneous Nephrostomy in Gynecologic Oncology Patients

1989 ◽  
Vol 141 (2) ◽  
pp. 472-473
Author(s):  
J.T. Soper ◽  
T.M. Blaszczyk ◽  
E. Oke ◽  
D. Clarke-Pearson ◽  
W.T. Creasman
Keyword(s):  
Gynecologic Oncology ◽  
Percutaneous Nephrostomy ◽  
Oncology Patients

scholarly journals Acute Urinary Tract Obstruction

2015 ◽  
Vol 16 (3) ◽  
pp. 249-253
Author(s):  
Djordje Aleksic
Keyword(s):  
Primary Care ◽  
Emergency Medicine ◽  
Renal Function ◽  
Urinary Tract ◽  
Primary Care Physicians ◽  
Bladder Dysfunction ◽  
Urinary Tract Obstruction ◽  
The Body ◽  
Bottom Line ◽  
Common Causes

AbstractThe kidneys are paired organs with the primary function of helping to remove toxins from the body and regulate water balance. They are vital to survival. After urine is produced in the kidneys, it must pass into the bladder, where it can be stored before being eliminated from the body through the urethra. Urinary tract obstruction is a common problem encountered by urologists, primary care physicians, and emergency medicine physicians. Urine can become obstructed at any point in this pathway. There are three groups of urinary tract obstructions: 1) obstruction of the urinary tract lumen; 2) obstruction of the urinary tract wall; and 3) extrinsic obstruction, which can press on the urinary tract lumen. An obstruction can be present from birth or develop later in life. The most common causes of obstruction include stones, strictures, tumours, and bladder dysfunction. These obstructions may result in the hydronephrosis of one or both kidneys, which, if left untreated, may lead to the deterioration of renal function. The goal of an initial treatment of urinary tract obstruction is to remove the obstruction. Later, we treat the cause that led to the obstruction. The bottom line is that all efforts should be made to preserve kidney function to avoid the need for dialysis or renal transplantation.

Management of extreme azotemia from urinary tract obstruction without dialysis. Clinical correlates and kinetic modeling of the recovery of renal function

2007 ◽  
Vol 39 (2) ◽  
pp. 587-593 ◽  
Author(s):  
Richard Wang ◽  
Antonios H. Tzamaloukas ◽  
Emmanuel I. Agaba ◽  
Karen S. Servilla ◽  
Dorothy J. VanderJagt ◽  
...  
Keyword(s):  
Renal Function ◽  
Urinary Tract ◽  
Kinetic Modeling ◽  
Urinary Tract Obstruction ◽  
Clinical Correlates
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