scholarly journals Intrathoracic ureteric stent migration through a reno-pleural fistula: a case report of rare antegrade ureteric stenting complication

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yi-Hsuan Chen ◽  
Marcelo Chen ◽  
Yu-Hsin Chen
Keyword(s):  
Cervical Cancer ◽  
Renal Function ◽  
Pleural Effusion ◽  
Stent Migration ◽  
Pleural Space ◽  
Considerable Proportion ◽  
Thoracic Cavity ◽  
Ureteric Stent ◽  
Ureteric Stenting ◽  
Continuous Drainage

Abstract Background Malignant obstruction and associated hydronephrosis is a common complication of advanced cervical cancer. Percutaneous nephrostomy (PCN) followed by antegrade stenting is often required to relieve obstruction as retrograde access fails in considerable proportion of such patients. Reno-pleural fistula is a rare complication of PCN which creates a patent connection between the renal collecting system and the thoracic cavity, and urine accumulation in the pleural space can cause pleural effusion (i.e., urinothorax). Upward or downward migration is a complication of indwelling ureteric stents. Further migration with extrusion outside of the urinary tract is uncommon. Herein we present an unprecedented case in adult of ureteric stent upward migration through a reno-pleural fistula into the thoracic cavity managed by thoracoscopy. Case presentation A 66-year-old female was diagnosed of advanced stage cervical cancer with suspicious bladder invasion. Given her bilateral hydronephrosis with impaired renal function, she underwent bilateral PCN and subsequent antegrade ureteric stenting. However, she presented with dyspnea, right back pain, and oliguria four days after bilateral PCN catheter removal. Computed tomography reported massive right pleural effusion and an intrathoracic ureteric stent within reno-pleural fistula. Thoracoscopy with thoracostomy was performed to remove the ureteric stent and urine in right pleural space. A week later, urinothorax had resolved and right PCN was performed again. She was discharged after regaining normal renal function with right PCN and a left ureteric stent in place. Conclusions A reno-pleural fistula can serve as a route for ureteric stent migration and that continuous drainage of urine can cause urinothorax once the stent reaches the thoracic cavity. Anytime a supracostal approach is used for PCN, even when using small caliber catheters, clinicians should pay special attention given the risk of pleural injury and subsequent complications.

Comparison of Heffner Criteria and Light Criteria in Differentiating Exudative and Transudative Pleural Effusion

2020 ◽  
Vol 22 (3) ◽  
pp. 141-145
Author(s):  
Krishna Chandra Devkota ◽  
S Hamal ◽  
PP Panta
Keyword(s):  
Pleural Effusion ◽  
Cross Sectional Study ◽  
Pleural Space ◽  
Sectional Study ◽  
Inclusion Criteria ◽  
Cross Sectional ◽  
Medical College ◽  
The Common ◽  
The Mean ◽  
Exudative Pleural Effusion

Pleural effusion is present when there is >15ml of fluid is accumulated in the pleural space. It can be divided into two types; exudative and transudative pleural effusion. Tuberculosis and parapneumonic effusion are the common cause of exudative pleural effusion whereas heart failure accounts for most of the cases of transudative pleural effusion. This study was a hospital based cross sectional study performed at Nepal Medical College during the period of January 2016-December 2016. A total of 50 patients who fulfilled the inclusion criteria were enrolled. Pleural effusion was confirmed by clinical examination and radiology. After confirmation of pleural effusion, pleural fluid was aspirated and was analysed for protein, LDH, cholesterol. The Heffner criteria was compared with Light criteria to classify exudative or transudative pleural effusion. Among 50 patients, 30 were male and 20 were female. The mean age of patient was 45.4±21.85 years. The sensitivity and specificity of using Light criteria to detect the two type of pleural effusion was 100% and 90.9%, whereas using Heffner criteria was 94.87%, 100% respectively(P<0.01). There are variety of causes for development of pleural effusion and no one criteria is definite to differentiate between exudative or transudative effusion. In this study Light criteria was more sensitive whereas Heffner criteria was more specific to classify exudative pleural effusion. Hence a combination of criteria might be useful in case where there is difficulty to identify the cause of pleural effusion.

scholarly journals Cervical cancer: Renal complications and survival after percutaneous nephrostomy

2016 ◽  
Vol 62 (3) ◽  
pp. 255-261 ◽  
Author(s):  
Alzira Carvalho Paula de Souza ◽  
Alfredo Nunes Souza ◽  
Rubens Kirsztajn ◽  
Gianna Mastroianni Kirsztajn
Keyword(s):  
Blood Pressure ◽  
Cervical Cancer ◽  
Renal Function ◽  
Percutaneous Nephrostomy ◽  
Cross Sectional Study ◽  
Obstructive Nephropathy ◽  
Cross Sectional ◽  
Low Blood Pressure ◽  
Northern Brazil

SUMMARY Introduction: Obstructive nephropathy is a frequent complication in the course of advanced cervical cancer (CC), and ultrasonography-guided percutaneous nephrostomy (PCN) is a well established technique for fast ureteral desobstruction. Objective: To identify possible factors related to the survival and quality of life of patients with advanced CC presenting acute urinary obstructive complications that after desobstruction by PCN recovered urinary flux and renal function. Method: This is an analytical, descriptive, cross-sectional study that included 45 patients with CC who underwent PCN and were divided into 2 groups: “death” (DG) and “survival” (SG), in a public hospital that is reference for oncologic diseases in Northern Brazil. Results: The mean serum creatinine of the patients preceding PCN was >10 mg/dL, and after PCN <2 mg/dL. The cutoffs of 8.7 g/dL for Hb (p=0.0241) and 27% for Ht (p=0.0065) indicated the values that better discriminate the outcomes of the groups. The presence of low blood pressure was statistically correlated (p=0.0037) to the outcome “death”. Changes in glomerular filtration rate (already reduced in all cases) were not associated to the levels of Hb/Ht or to the outcome “death” during the nephrological follow-up. Conclusion: PCN was responsible for the recovery of renal function in 61.7% of the patients, leading to interruption of renal replacement therapy (RRT) in all of those patients. Hb levels >8.7g/dL and Ht >27% were associated to longer survival, and the presence of low blood pressure during follow-up was associated with progression to death.

scholarly journals Hepatic Hydrothorax in a Patient with Liver Cirrhosis: a Case Report

2021 ◽  
Vol 2 (2) ◽  
pp. 42
Author(s):  
Martino Handoyo ◽  
Titong Sugihartono
Keyword(s):  
Liver Cirrhosis ◽  
Case Report ◽  
Portal Hypertension ◽  
Pleural Effusion ◽  
Ascitic Fluid ◽  
Pleural Space ◽  
Sodium Restriction ◽  
Hepatic Hydrothorax ◽  
Lower Survival Rate ◽  
Advanced Liver Cirrhosis

Hepatic hydrothorax is a transudative pleural effusion which presents in 5-10% patients with liver cirrhosis. Although fairly uncommon, it is associated with higher morbidity and lower survival rate. The mechanism is yet to be understood fully, but the most widely accepted pathogenesis involves the presence of portal hypertension, diaphragmatic defects, and negative intrathoracal pressure, all of which lead to the formation of unidirectional passage of ascitic fluid from peritoneal cavity into pleural space. Due to its origin, the pleural effusion has similar characteristics to ascitic fluid. We herein report the case of a 60-year-old woman with advanced liver cirrhosis and right-sided moderate hepatic hydrothorax. Treatment given to the patient includes diuretics, sodium restriction, and repeated thoracentesis. Subsequent evaluation of the patient revealed improvement both clinically and radiologically.

Pleural Effusion

Chest Imaging ◽  
2019 ◽  
pp. 165-170
Author(s):  
Christopher M. Walker
Keyword(s):  
Computed Tomography ◽  
Pleural Effusion ◽  
Pleural Fluid ◽  
Lateral Displacement ◽  
Pleural Space ◽  
Gravitational Effects ◽  
Pleural Thickening ◽  
Air Bubble ◽  
Fluid Analysis ◽  
Exudative Pleural Effusion

Pleural effusion discusses the radiographic and computed tomography (CT) manifestations of this entity. Pleural effusion is classified based on pleural fluid analysis using Light’s criteria: transudative and exudative. Free pleural fluid collects in the most dependent aspect of the pleural space due to gravitational effects. It exhibits a meniscus configuration on upright chest radiography. Pleural effusion in a supine or semiupright patient is more difficult to identify but may be suspected in cases with a homogeneous or gradient-like opacity over the lower hemithorax, elevation of the hemidiaphragm contour, or an apical cap. Subpulmonic pleural effusion manifests with lateral displacement of the apex of the ipsilateral hemidiaphragm contour and increased distance between the gastric air bubble and pseudodiaphragmatic contour. Exudative pleural effusion should be suspected in cases with CT findings of pleural thickening, enhancement, septations, and/or loculations.

Introduction to Pleural Disease

Chest Imaging ◽  
2019 ◽  
pp. 155-158
Author(s):  
Christopher M. Walker
Keyword(s):  
Pleural Effusion ◽  
Asbestos Exposure ◽  
Pleural Space ◽  
Pulmonary Vasculature ◽  
Pleural Disease ◽  
Pleural Thickening ◽  
Pleural Plaques ◽  
Pleural Surface ◽  
Pleural Neoplasm ◽  
Ct Features

The chapter titled introduction to pleural disease discusses the imaging and clinical features of diseases of the pleura. The pleural space is a potential space located between the visceral and parietal pleural surfaces. Pleural effusion and pneumothorax are the most common manifestations of pleural disease and are caused by a wide variety of disease processes. Pleural thickening may be related to benign or malignant processes. Bilateral discontinuous nodular pleural thickening is characteristic of pleural plaques. Pleural thickening with calcification may also be seen in fibrothorax. Malignant pleural disease may manifest with pleural effusion, pleural nodules or masses, or a combination of the two. There are several CT features suggestive of malignant pleural thickening including circumferential pleural thickening, pleural nodules or masses, involvement of the mediastinal pleural surface, and pleural thickening measuring greater than 1 cm in thickness. Metastatic disease is the most common pleural neoplasm. Mesothelioma is uncommon but remains the most common primary pleural malignancy and is almost always seen in patients with previous asbestos exposure. Pleural abnormalities must be differentiated from pulmonary processes. Pleural masses may exhibit obtuse angles with the adjacent pleural surfaces, displace rather than engulf adjacent pulmonary vasculature, and may exhibit the incomplete border sign.

Long‐term evaluation of renal function and neurogenic bladder following radical hysterectomy in patients with uterine cervical cancer

2020 ◽  
Vol 46 (10) ◽  
pp. 2108-2114
Author(s):  
Hiroaki Komatsu ◽  
Tetsuro Oishi ◽  
Daiken Osaku ◽  
Akiko Kudoh ◽  
Ruri Shimogai ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Renal Function ◽  
Neurogenic Bladder ◽  
Radical Hysterectomy ◽  
Uterine Cervical Cancer ◽  
Term Evaluation

Effect of Cisplatin-Containing Chemotherapy on Lithium Serum Concentrations

1992 ◽  
Vol 26 (4) ◽  
pp. 488-490 ◽  
Author(s):  
Jos H. Beijnen ◽  
L. Thomas Vlasveld ◽  
Jantien Wanders ◽  
Wim W. ten Bokkel Huinink ◽  
Sjoerd Rodenhuis
Keyword(s):  
Cervical Cancer ◽  
Renal Function ◽  
Depressive Disorder ◽  
Progressive Disease ◽  
Lithium Carbonate ◽  
Serum Concentrations ◽  
Data Synthesis ◽  
Metastatic Lesions ◽  
Manic Depressive ◽  
Serial Serum

OBJECTIVE: A case in which a possible cisplatin interference with lithium pharmacokinetics is evaluated. DATA SYNTHESIS: A 36–year-old woman with disseminated cervical cancer and multiple metastatic lesions in both kidneys was being treated with five courses of bleomycin, vindesine, mitomycin C, and cisplatin. The patient had also been taking lithium carbonate for the management of a manic-depressive disorder. Serum and urinary lithium concentrations were measured daily during the first course of chemotherapy and on a periodic basis during and between the consecutive courses. Lithium concentrations remained within the therapeutic range during the first course and increased later in association with deterioration of the patient's renal function secondary to progressive disease in both kidneys. This required dose adjustments of lithium. CONCLUSIONS: Lithium therapy should be guided by serial serum concentrations in such patients.

scholarly journals One-stage tubeless antegrade ureteric stenting: a safe and cost-effective option?

2010 ◽  
Vol 92 (3) ◽  
pp. 218-224 ◽  
Author(s):  
Sudhanshu Chitale ◽  
Vaiyapuri Raja ◽  
Nabeel Hussain ◽  
Janak Saada ◽  
Simon Girling ◽  
...  
Keyword(s):  
Cost Effective ◽  
Radiology Department ◽  
Complication Rates ◽  
Two Stage ◽  
Ureteric Stent ◽  
One Stage ◽  
Ureteric Stenting ◽  
Effective Option ◽  
Retrospective Data Collection ◽  
Procedural Costs

INTRODUCTION Antegrade insertion of ureteric stent has become an established mode of management of upper tract obstruction secondary to ureteric pathology. It is conventionally performed as a two-stage procedure for various reasons but, more recently, a one-stage approach has been adopted. PATIENTS AND METHODS We discuss our experience of primary one-stage insertion of antegrade ureteric stent as a safe and cost-effective option for the management of these difficult cases in this retrospective observational case cohort study of patients referred to a radiology department for decompression of obstructed upper tracts. Data were retrieved from case notes and a radiology database for patients undergoing one-stage and two-stage antegrade stenting. It was followed by telephone survey of regional centres about the prevalent local practice for antegrade stenting. Outcome measures like hospital stay, procedural costs, requirement of analgesia/antimicrobials and complication rates were compared for the two approaches. RESULTS a one-stage approach was found to be suitable in most cases with many advantages over the two-stage approach with comparable or better outcomes at lower costs. Some of the limitations of the study were retrospective data collection, more than one radiologist performing stenting procedures and non-availability of interventional radiologist falsely raising the incidence of two-stage procedures. CONCLUSIONS In the absence of any clinical contra-indications and subject to availability of an interventional radiologist’s support, one-stage antegrade stenting could easily be adopted as a routine approach for the management of benign or malignant ureteric obstruction.

scholarly journals Antegrade Double-J Stenting in Grossly Dilated and Tortuous Ureters

2020 ◽  
Vol 4 (02) ◽  
pp. 125-129
Author(s):  
Manish Kiran Shreshta ◽  
Amey Narkhede ◽  
Arun Gupta
Keyword(s):  
Guide Wire ◽  
Stable Condition ◽  
Percutaneous Nephrostomy ◽  
The Other ◽  
Retrograde Approach ◽  
External Drainage ◽  
Ureteric Stent ◽  
Ureteric Stenting ◽  
Pull Through ◽  
Turning Maneuver

AbstractFailure of retrograde approach for ureteric stenting warrants percutaneous nephrostomy with antergrade stenting to relieve the pressure symptoms and prevent the need for external drainage. However, in some tight ureteric strictures with grossly dilated tortuous ureter it may not be possible to navigate a ureteric stent across. In such instances pull through or rendezvous techniques have been advocated. Here, we have illustrated simple and novel techniques for traversing tortuous ureters with tight strictures. In one instance, a guide wire was snared via the perurethral approach and the system stabilized from both ends; the flexometallic sheath was then advanced into the urinary bladder across the stricture and a ureteric stent was deployed. In the other situation where the ureter was very tortuous, plain twisting and turning maneuver with retraction of whole assembly was done to straighten the ureter followed by advancement of the flexometallic sheath and stationing of the ureteric stent. In both the cases no significant procedure-related complications were seen and patients were discharged in stable condition. Our experience has led us to believe that occasionally all facilities may not be accessible immediately or the desired armamentarium may be unavailable for interventional radiologists, especially when the patient is on the table; in such cases, simple improvisation and techniques can come in handy to place a ureteric stent across a dilated tortuous ureter.

Renal function after Wertheim-Meigs operation for cervical cancer

1979 ◽  
Vol 8 (1) ◽  
pp. 27-33 ◽  
Author(s):  
P. Marziale ◽  
G.A. Benedetti ◽  
A. Iacovelli ◽  
U. Marzi ◽  
M. Pozzi
Keyword(s):  
Cervical Cancer ◽  
Renal Function
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