Arterioureteral Fistula in the Setting of an Indwelling Ureteral Stent, Ileal Conduit and History of Pelvic Radiation

Abstract Background: A history of preoperative obstructive pyelonephritis has been reported as a risk factor for febrile urinary tract infection (fUTI) after ureteroscopic lithotripsy (URSL). But there is no clear evidence of risk factors for developing fUTI including the optimal timing of URSL after obstructive pyelonephritis treatment.Methods: Of the 1361 patients, who underwent URSL at our hospital from January 2011 to December 2017, 239 patients had a history of pre-URSL obstructive pyelonephritis. The risk factors were analyzed by comparing the patients’ backgrounds with the presence or absence of fUTI after URSL. The factors examined were age, gender, body mass index, comorbidity, presence or absence of preoperative ureteral stent, stone position, stone laterality, stone size, Hounsfield unit (HU) value on computed tomography scan, history of sepsis during obstructive pyelonephritis, period from antipyresis to URSL, ureteral stenting period, operation time, and presence or absence of access sheath at URSL. In addition, the stone components and renal pelvic urinary culture bacterial species during pre-URSL pyelonephritis were also examined.Results: Post-URSL fUTI developed in 32 of 239 patients (13.4%), and 11 of these 32 cases led to sepsis (34.4%). Univariate analysis showed that stone position, stone maximum HU value, presence of sepsis during obstructive pyelonephritis, period from antipyresis to URSL, pre-URSL ureteral stent placement, operation time were risk factors of fUTI. Stone components and urinary cultures during pyelonephritis were not associated with risk of fUTI. Multivariate analysis showed that renal stone position, pre-URSL ureteral stent placement > 21 days, and operation time > 75 minutes were independent risk factors of fUTI following the URSL.Conclusions: F-UTI following the URSL could be avoided by ureteral stent placement period 21 days or less and operation time 75 minutes or less in patients with obstructive pyelonephritis.

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Optimal timing of ureteroscopic lithotripsy after the initial drainage treatment and risk factors for postoperative febrile urinary tract infection in patients with obstructive pyelonephritis: a retrospective study

10.21203/rs.3.rs-46783/v2 ◽

2020 ◽

Author(s):

Yoshitaka Itami ◽

Makito Miyake ◽

Takuya Owari ◽

Takashi Iwamoto ◽

Daisuke Gotoh ◽

...

Keyword(s):

Risk Factors ◽

Urinary Tract Infection ◽

Stent Placement ◽

Operation Time ◽

Ureteral Stent ◽

Optimal Timing ◽

Febrile Urinary Tract Infection ◽

Ureteroscopic Lithotripsy ◽

History Of ◽

Obstructive Pyelonephritis

Abstract Background: A history of preoperative obstructive pyelonephritis has been reported as a risk factor for febrile urinary tract infection (fUTI) after ureteroscopic lithotripsy (URSL). But there is no clear evidence of risk factors for developing fUTI including the optimal timing of URSL after obstructive pyelonephritis treatment. Methods: Of the 1361 patients, who underwent URSL at our hospital from January 2011 to December 2017, 239 patients had a history of pre-URSL obstructive pyelonephritis. The risk factors were analyzed by comparing the patients’ backgrounds with the presence or absence of fUTI after URSL. The factors examined were age, gender, body mass index, comorbidity, presence or absence of preoperative ureteral stent, stone position, stone laterality, stone size, Hounsfield unit (HU) value on computed tomography scan, history of sepsis during obstructive pyelonephritis, period from antipyresis to URSL, ureteral stenting period, operation time, and presence or absence of access sheath at URSL. In addition, the stone components and renal pelvic urinary culture bacterial species during pre-URSL pyelonephritis were also examined. Results: Post-URSL fUTI developed in 32 of 239 patients (13.4%), and 11 of these 32 cases led to sepsis (34.4%). Univariate analysis showed that stone position, stone maximum HU value, presence of sepsis during obstructive pyelonephritis, period from antipyresis to URSL, pre-URSL ureteral stent placement, operation time were risk factors of fUTI. Stone components and urinary cultures during pyelonephritis were not associated with risk of fUTI. Multivariate analysis showed that renal stone position, pre-URSL ureteral stent placement > 21 days, and operation time > 75 minutes were independent risk factors of fUTI following the URSL. Conclusions: F-UTI following the URSL could be avoided by ureteral stent placement period 21 days or less and operation time 75 minutes or less in patients with obstructive pyelonephritis.

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A SIMPLE TECHNIQUE TO CHANGE AN OBSTRUCTED URETERAL STENT IN PATIENTS WITH AN ILEAL CONDUIT

The Journal of Urology ◽

10.1097/00005392-200011000-00034 ◽

2000 ◽

pp. 1604-1605

Author(s):

MOTOAKI SAITO ◽

NAOYUKI SAKARIDANI ◽

YASUHISA YAMAMOTO ◽

IKUO MIYAGAWA

Keyword(s):

Simple Technique ◽

Ileal Conduit ◽

Ureteral Stent

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TREATMENT WITH INSTILLATION OF HYALURONIC ACID IN PATIENTS WITH A HISTORY OF PELVIC RADIATION THERAPY AND URINARY STORAGE SYMPTOMS

10.26226/morressier.59b63e3fd462b8029238922f ◽

2017 ◽

Author(s):

Argimiro Collado

Keyword(s):

Radiation Therapy ◽

Hyaluronic Acid ◽

Pelvic Radiation ◽

History Of

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Alfa-Fetoprotein-Producing Female Primary Urethral Adenocarcinoma with Neuroendocrine Differentiation

Case Reports in Urology ◽

10.1155/2019/3454037 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

Takao Natsuyama ◽

Yozo Mitsui ◽

Masato Uetani ◽

Shigeyuki Ohta ◽

Masafumi Inoue ◽

...

Keyword(s):

Bladder Neck ◽

Ileal Conduit ◽

Neuroendocrine Differentiation ◽

Urinary Frequency ◽

Normal Range ◽

Poorly Differentiated Adenocarcinoma ◽

History Of ◽

Poorly Differentiated ◽

Proximal Urethra ◽

Enhanced Computed Tomography

We report an extremely rare case of an alpha-fetoprotein- (AFP-) producing female primary urethral adenocarcinoma with neuroendocrine differentiation (NED). The patient was a 65-year-old woman with a 2-year history of urinary frequency and voiding difficulty. Enhanced computed tomography showed an approximately 3.0×5.0-cm mass around the proximal urethra and bladder neck. Of examined tumor markers, serum AFP was elevated (48.3 ng/mL), while others including carcinoembryonic antigen were within a normal range. Transurethral resection of the tumor led to a diagnosis of carcinosarcoma of the urethra, with a radical cystourethrectomy and ileal conduit formation subsequently performed. The pathological assessment was poorly differentiated adenocarcinoma in the urethra. Immunostaining showed tumor cells strongly positive for AFP. In addition, some cancer cells were positive for CD56, chromogranin A, and synaptophysin, indicating focal NED. The tumor was finally diagnosed as an AFP-producing urethral adenocarcinoma with NED. Serum AFP was immediately normalized after surgery and no sign of tumor recurrence has been noted 2 years postoperatively.

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PD35-05 INCIDENCE, RISK FACTORS, AND NATURAL HISTORY OF PARASTOMAL HERNIA FOLLOWING RADICAL CYSTECTOMY AND ILEAL CONDUIT URINARY DIVERSION

The Journal of Urology ◽

10.1097/ju.0000000000002039.05 ◽

2021 ◽

Vol 206 (Supplement 3) ◽

Author(s):

Alireza Ghoreifi ◽

Evan Allgood ◽

Gilbert Whang ◽

Wenhao Yu ◽

Jie Cai ◽

...

Keyword(s):

Risk Factors ◽

Natural History ◽

Radical Cystectomy ◽

Urinary Diversion ◽

Parastomal Hernia ◽

Ileal Conduit ◽

Incidence Risk ◽

History Of

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Is There a Role for Prophylactic Antibiotics Post Pediatric Pyeloplasty?

10.21203/rs.3.rs-23095/v1 ◽

2020 ◽

Author(s):

Kunj Sheth ◽

Kathleen Puttmann ◽

Paige Nichols ◽

Jordon C King ◽

Huirong Zhu ◽

...

Keyword(s):

Urinary Tract ◽

Urine Culture ◽

Significant Risk ◽

Prophylactic Antibiotics ◽

Ureteral Stent ◽

Secondary Outcome ◽

Prior History ◽

Febrile Uti ◽

History Of ◽

Tract Infections

Abstract Background: The use of postoperative prophylactic antibiotics in pediatric upper urinary tract reconstruction remains controversial. In this study, we elected to examine if prophylactic antibiotics post pediatric dismember pyeloplasty reduce the incidence of clinically symptomatic urinary tract infections (UTIs) in our institution. As a secondary outcome, we also examine which patient population benefits the most from low dose prophylactic antibiotics.Methods: Institutional review board approval (IRB) was obtained. A retrospective study was performed in patients who underwent dismember pyeloplasty (2011-2017) at our institution. Patients with prior history of urologic interventions or other abnormalities of the genitourinary tract were excluded. Demographics (age, gender, ethnicity, insurance status), prior history of culture proven UTIs, surgical details (administration of perioperative antibiotics), and postoperative outcomes, including any readmission 30 days post repair, any urine samples, and culture results were collected.Results: 209 patients (149 boys, 60 girls) met our inclusion criteria. The average age was 6 years (range: 2 months-18 years). 160 patients (77%) underwent robotic-assisted pyeloplasty. Thirty-one patients underwent open repair (15%). 176 (84%) had an indwelling ureteral stent. Eleven patients (5%) had a culture-proven febrile UTI within 30-days postoperatively. No significant differences were seen in postoperative complications or incidence of UTIs when comparing surgical approaches, ureteral stent, or the use of prophylactic post-operative antibiotics. Secondary review of patients with post-operative febrile UTIs noted younger age (2.8 v. 6.2 years, p = 0.02) and positive intraoperative urine culture (p = 0.01) as significant risk factors. Conclusion: The incidence of postoperative UTIs in our cohort is relatively low. There is a higher incidence of febrile UTIs in patients less than 3 years old and those with positive intraoperative urine culture. The use of prophylactic antibiotics in patients post dismember pyeloplasty did not appear to affect the incidence of febrile culture proven UTIs, however, might be important in younger patients pre potty training.

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Optimal Timing of Ureteroscopic Lithotripsy after the Initial Drainage Treatment and Risk Factors for Postoperative Febrile Urinary Tract Infection in Patients with Obstructive Pyelonephritis: A Retrospective Study

10.21203/rs.3.rs-46783/v1 ◽

2020 ◽

Author(s):

Yoshitaka Itami ◽

Makito Miyake ◽

Takuya Owari ◽

Takashi Iwamoto ◽

Daisuke Gotoh ◽

...

Keyword(s):

Risk Factors ◽

Urinary Tract Infection ◽

Stent Placement ◽

Operation Time ◽

Ureteral Stent ◽

Optimal Timing ◽

Febrile Urinary Tract Infection ◽

Ureteroscopic Lithotripsy ◽

History Of ◽

Obstructive Pyelonephritis

Abstract Background: A history of preoperative obstructive pyelonephritis has been reported as a risk factor for febrile urinary tract infection (fUTI) after ureteroscopic lithotripsy (URSL). But there is no clear evidence of risk factors for developing fUTI including the optimal timing of URSL after obstructive pyelonephritis treatment.Methods: Of the 1361 patients, who underwent URSL at our hospital from January 2011 to December 2017, 239 patients had a history of pre-URSL obstructive pyelonephritis. The risk factors were analyzed by comparing the patients’ backgrounds with the presence or absence of fUTI after URSL. The factors examined were age, gender, body mass index, comorbidity, presence or absence of preoperative ureteral stent, stone position, stone laterality, stone size, Hounsfield unit (HU) value on computed tomography scan, history of systemic inflammatory response syndrome (SIRS) during obstructive pyelonephritis, period from antipyresis to URSL, ureteral stenting period, operation time, and presence or absence of access sheath at URSL. In addition, the stone components and renal pelvic urinary culture bacterial species during pre-URSL pyelonephritis were also examined.Results: Post-URSL fUTI developed in 32 of 239 patients (13.4%), and 11 of these 32 cases led to SIRS (34.4%). Univariate analysis showed that stone position, stone maximum HU value, presence of SIRS during obstructive pyelonephritis, period from antipyresis to URSL, pre-URSL ureteral stent placement, operation time were risk factors of fUTI. Stone components and urinary cultures during pyelonephritis were not associated with risk of fUTI. Multivariate analysis showed that renal stone position, pre-URSL ureteral stent placement > 21 days, and operation time > 75 minutes were independent risk factors of fUTI following the URSL.Conclusions: F-UTI following the URSL could be avoided by ureteral stent placement period 21 days or less and operation time 75 minutes or less in patients with obstructive pyelonephritis.

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