scholarly journals Optimizing the lithotripsy timing after drainage of the upper urinary tract in patients with urolithiasis and obstructive uropathy

2021 ◽  
Vol 9 (3) ◽  
pp. 62-69
Author(s):  
A. I. Khotko ◽  
D. N. Khotko ◽  
V. M. Popkov ◽  
A. I. Tarasenk
Keyword(s):  
Urinary Tract ◽  
Postoperative Period ◽  
Obstructive Uropathy ◽  
Antibiotic Sensitivity ◽  
Percutaneous Nephrostomy ◽  
Upper Urinary Tract ◽  
Urine Sampling ◽  
Surgery Timing ◽  
Remodeling Index ◽  
The Subject

Introduction. Timely unresolved upper urinary tract (UUT) obstruction in patients with infection can cause severe complications, such as sepsis, pyonephrosis and even death. There are no clear recommendations regarding the methods and timing of drainage. At the same time, this issue is still the subject of discussion in publications of recent years.Purpose of the study. To optimize the timing of lithotripsy after drainage of the UUT in patients with urolithiasis and obstructive uropathy (OU).Materials and methods. At the first stage, 90 patients with OU caused by the stone of the ureteropelvic junction underwent drainage of the UUT using a percutaneous nephrostomy. Subsequently, percutaneous nephrolithotripsy (PNLT) was performed at various times after drainage. The level of inflammatory markers (IL-8) and profibrotic factor (MCP-1) in the urine was determined. The calculated concentrations of urinary biomarkers were normalized by the level of urinary creatinine. Urine sampling for the analysis was carried out during and after the PCN placement (nephrostomy urine) 7 days later, and then once weekly before surgery. The coefficient K was calculated using a patented formula to evaluate the process of kidney remodeling. Urine sampling was performed for culture to determine the bacterial spectrum and antibiotic sensitivity.Results. The values of K ≤ 1.85 were observed in 11 patients of the group with OU (12.2%), K > 1.85 in 79 (87.8%) by day 21. The values of K ≤ 1.85 were achieved in 70 patients (88.6%) by day 28 and 4 patients (80.0%) by day 35. PNLT was performed on 21 days in patients with K ≤ 1.85 (11 patients), no complications were noted in the postoperative period., PNLT was performed in patients with K ≤ 1.85 (70 patients) by day 28, exacerbation of pyelonephritis and the development of chronic kidney disease were not noted. Six patients with values of K ˃ 1.85 underwent PNLT by day 28. In the postoperative period, all patients had an exacerbation of calculous pyelonephritis, 50% had a decrease in glomerular filtration rate within 3 months after surgery. The bacteria in urine were detected in 55 (61.0%) patients. Escherichia coli (63.0%), Proteus mirabilis (18.0%), Enterococcus faecalis (14.5%), Streptococcus haemolyticus (2.5%) were identified most often.Conclusion. The use of the developed remodeling index allows optimizing the surgery timing and minimizing the development of complications during the postoperative period. The presence of bacteria is associated with a long process of renal parenchymal remodeling.

scholarly journals Obstrukcinės uropatijos gydymas perkutanine nefrostomija

2005 ◽  
Vol 3 (4) ◽  
pp. 0-0
Author(s):  
Marius Kinčius ◽  
Aivaras Matjošaitis
Keyword(s):  
Urinary Tract ◽  
Malignant Tumors ◽  
Obstructive Uropathy ◽  
Percutaneous Nephrostomy ◽  
Upper Urinary Tract ◽  
Early Postoperative Period ◽  
First Choice ◽  
Segmental Renal Artery ◽  
Almost All ◽  
Artery Obstruction

Marius Kinčius, Aivaras MatjošaitisKauno medicinos universiteto Urologijos klinika,Eivenių g. 2, LT-50009 KaunasEl paštas: [email protected] Tikslas Perkutaninė nefrostomija šiuo metu yra alternatyva atvirajai nefrostomijai ir pirmo pasirinkimo operacija drenuojant viršutinius šlapimo takus dėl jų obstrukcijos. Šiuo darbu siekta apžvelgti dažniausias priežastis, sukeliančias obstrukcinę uropatiją, ir įvertinti perkutaninės nefrostomijos veiksmingumą ir saugumą. Ligoniai ir metodai Retrospektyviai ištirti 126 ligoniai, kuriems Kauno medicinos universiteto klinikų Urologijos klinikoje per trejus metus buvo atliktos perkutaninės nefrostomijos. Išsiaiškintos dažniausios ligos, kurios komplikavosi vieno ar abiejų inkstų blokada, o šlapimo nutekėjimui atkurti buvo atliktos perkutaninės nefrostomijos, taip pat nustatytos dažniausios komplikacijos po šių operacijų. Rezultatai Nuo 2002 m. rugsėjo iki 2005 m. rugsėjo Kauno medicinos universiteto klinikų Urologijos klinikoje iš viso buvo atliktos 156 perkutaninės nefrostomijos. Šlapimo nutekėjimas 47 ligoniams (37,3%) sutriko dėl nenavikinės šlapimo takų obstrukcijos, kitiems 79 (62,7%) – dėl piktybinių navikų. Dažniausios nenavikinės obstrukcijos priežastys buvo inkstų akmenligė, pieloureterinio segmento striktūra ir prostatos nepiktybinė hiperplazija. Pažengusios šlapimo pūslės, prostatos ir gimdos kaklelio karcinomos buvo dažniausios navikinės kilmės obstrukcinės uropatijos priežastys. Bendras komplikacijų skaičius siekė 19 (12,2%). Išvada Perkutaninė nefrostomija yra mažai traumuojanti ir visiškai saugi operacija, kurią atlikti turėtų mokėti kiekvienas urologas. Reikšminiai žodžiai: perkutaninė nefrostomija, obstrukcinė uropatija Percutaneous nephrostomy in the treatment of obstructive uropathies at Urology Department of Kaunas University of Medicine Hospital Marius Kinčius, Aivaras MatjošaitisClinic of Urology, Kaunas University of Medicine,Eivenių g. 2, LT-50009 Kaunas, LithuaniaE-mail: [email protected] Background Percutaneous nephrostomy is an alternative for open surgery and nowadays is the first choice operation for draining the upper urinary tract complicated with obstruction. Patients and methods Between September 2002 – September 2005 at Urology Department of Kaunas University of Medicine Hospital 126 patients underwent percutaneous nephrostomy. Percutaneous nephrostomy was used as a preparatory step towards radical elimination of obstruction and as a palliative treatment for draining the upper urinary tract complicated with obstruction. Results Percutaneous nephrostomy was done to 75 men and 51 women. The reasons for urine flow disorders were removable obstruction of the urinary tract in 47 patients (37.3%) and malignant tumors in 79 patients (62.7%). Bilateral percutaneous nephrostomies were performed for 14 patients. Haematuria appeared in almost all the patients in the early postoperative period. Four patients developed medium or great intensity bleeding (2.6%). In one case segmental renal artery obstruction was performed. The overall complication rate didn’t exceed 13%. Conclusion Percutaneous nephrostomy is a low traumatizing and safe operation which all urologists should be able to perform. Keywords: percutaneous nephrostomy, obstructive uropathy

scholarly journals 154 Complete Inguinal Bladder Hernia Causing Acute Obstruction of Right Upper Urinary Tract

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
C Madden-McKee ◽  
M Getty ◽  
T Thompson
Keyword(s):  
Urinary Tract ◽  
Hernia Repair ◽  
Acalculous Cholecystitis ◽  
Percutaneous Nephrostomy ◽  
Upper Urinary Tract ◽  
Bladder Injury ◽  
Acute Acalculous Cholecystitis ◽  
Bladder Hernia ◽  
Urinary Tract Symptoms ◽  
Obstructive Renal Failure

Abstract Case Summary An 86-year-old male nursing home resident presented with increasing confusion and was initially treated for catheter-associated urinary tract infection. CT scan demonstrated acute acalculous cholecystitis and complete inguinal bladder hernia with compression of right vesico-ureteric junction leading to acute obstructive renal failure. Percutaneous cholecystostomy and percutaneous nephrostomy were attempted but were not possible due to patient non-compliance. Patient improved with conservative management. Discussion Bladder involvement in inguinal herniae is rare with most cases being identified at the time of hernia repair and there is a 17% risk of intra-operative bladder injury. Key risk factors include increasing age, male gender, lower urinary tract symptoms and previous hernia repair. Percutaneous nephrostomy followed by inguinal hernia repair is the treatment of choice for most patients. Clinicians should aim to make the diagnosis of inguinal bladder hernia pre-operatively to reduce risk of intra-operative bladder injury during hernia repair. Acute acalculous cholecystitis tends to occur in critically ill patients and is a marker of poor prognosis.

scholarly journals Viršutinių šlapimo takų obstrukcijos sukelto inkstų funkcijos pažeidimo gydymas drenuojant viršutinius šlapimo takus

2005 ◽  
Vol 3 (4) ◽  
pp. 0-0
Author(s):  
Henrikas Ramonas
Keyword(s):  
Urinary Tract ◽  
Renal Impairment ◽  
Treatment Option ◽  
Cortical Thickness ◽  
Functional Recovery ◽  
Urinary Tract Obstruction ◽  
Severe Renal Impairment ◽  
Obstructive Uropathy ◽  
Upper Urinary Tract ◽  
University Hospital

Henrikas RamonasVilniaus universiteto Gastroenterologijos,nefrologijos, urologijos ir pilvo chirurgijos klinika,Vilniaus universiteto ligoninės Santariškių klinikosNefrologijos ir urologijos centras,I Nefrourologijos skyrius,Santariškių g. 2, LT-08661 VilniusEl paštas: [email protected] Įvadas / tikslas Šiame darbe siekiama nustatyti šlapimo takų pokyčių reikšmę inkstų funkcijos atsitaisymui, drenavus viršutinius šlapimo takus dėl jų obstrukcijos ir ryškaus inkstų pažeidimo. Tai padėtų planuoti optimalų gydymą po drenavimo. Ligoniai ir metodai Retrospektyviai išanalizuota 60 ligonių, kuriems 1999–2004 metais drenuoti viršutiniai šlapimo takai dėl obstrukcijos ir koreguota ryškiai pažeista inkstų funkcija. Statistinės analizės būdu nustatyta ikioperacinių šlapimo takų funkcinių ir morfologinių pokyčių įtaka inkstų funkcijos atsitaisymui po drenuojamųjų operacijų. Rezultatai Vidutinis ligonių amžius – 66,38 ± 1,54 metų. Nuo abiejų inkstų obstrukcijos gydyti 35 (58,33%), nuo vienintelio funkcionuojančio inksto – 25 (41,67%) ligoniai. Perkutaninė nefrostomija atlikta 48 (80,0%), operacinė nefrostomija – 5 (8,33%), šlapimtakių stentavimas – 7 (11,67%) ligoniams. Paliatyvus inkstų drenavimas atliktas 31 (51,67%) ligoniui. Pacientams, kuriems kliniškai nustatyta greita obstrukcijos eiga, vidutinė kreatinino koncentracija po gydymo daug geresnė, palyginti su lėtinės obstrukcijos atvejais, – atitinkamai 240,48 ± 25,7 µmol/l ir 395,83 ± 22,3 µmol/l (p < 0,05). Iš morfologinių parametrų geriausiai koreliuoja vidutinis inkstų parenchimos storis ir pooperacinis kasdienis kreatinino mažėjimo rodiklis, ypač pacientų, sergančių inkstų akmenlige (r = 0,55). Diagnozavus abipusę obstrukciją 31 onkologiniam ligoniui, vienpusė nefrostomija buvo pakankama koreguojant inkstų funkciją 27 (87,1%) ligoniams. Išvados Viršutinių šlapimo takų drenažas dėl obstrukcijos ir inkstų funkcijos pažeidimo visais atvejais šią funkciją pagerino. Greičiau ji atsitaiso ligonių, kuriems kliniškai nustatyta greita obstrukcijos eiga ir kuriems iki drenažo rasta storesnė parenchima. Vienpusis paliatyvus viršutinių šlapimo takų drenažas pagerino inkstų funkciją 87% ligonių. Reikšminiai žodžiai: obstrukcinė uropatija, inkstų nepakankamumas, nefrostomija Treatment of renal impairment in patients with obstructive upper urinary tract by draining procedures Henrikas RamonasVilnius University, Clinic of Gastroenterology,Urology and Abdominal Surgery,Center of Nephrology and Urology,Vilnius University Hospital "Santariškių klinikos",Santariškių str. 2, LT-08661 Vilnius, LithuaniaE-mail: [email protected] Background / objective To evaluate the influence of urinary tract changes on renal functional recovery when drainage of the upper urinary tract is performed in the case of ureteric obstruction and severe renal impairment, looking for options of more optimal postoperative therapy. Patients and methods In 60 consecutive patients with upper urinary tract obstruction and severe renal impairment, treated in the urological department from 1999 until 2004, a retrospective analysis of treatment cases was done. Statistical analysis of preoperative functional and morphological changes of the urinary tract, evaluation of their influence on postoperative renal functional recovery was done. Results The patients’ age was 66.38 ± 1.54 years. Bilateral obstruction was found in 35 (58.33%), solitary kidney obstruction in 25 (41.67%) patients. Percutaneous nephrostomy was performed in 48 (80.0%), operative nephrostomy in 5 (8.33%), ureteric stenting in 7 (11.67%) cases. Palliative kidney drainage was employed for 31 (51,67%) patients. In the patients in whom obstruction development was clinically defined as rapid, the mean plasma creatinine concentration after treatment was lower in comparison with chronic obstruction, reaching respectively 240.48 ± 25.7 µmol/l and 395.83 ± 22.3 µmol/l (p < 0.05). A positive correlation was found among renal cortical thickness and daily postoperative creatinine level decrease, especially in cases of nephrolithiasis (r = 0.55). When bilateral obstruction was diagnosed in 31 oncological patients, unilateral nephrostomy was a sufficient treatment option in 27 (87.1%) cases. Conclusions Drainage of the obstructed upper urinary tract influences renal functional recovery in all cases. In clinically defined rapid obstruction cases, renal functional recovery is better in comparison with chronic obstruction. Renal functional recovery postively corellated with renal cortical thickness. Unilateral nephrostomy was a sufficient treatment option in the palliative obstructive treatment course in 87% of patients. Keywords: obstructive uropathy, renal failure, nephrostomy

scholarly journals Ultrasound guided direct puncture percutaneous nephrostomy: a single tertiary centre observational study

2021 ◽  
Vol 8 (12) ◽  
pp. 3548
Author(s):  
Suresh Kumar Rulaniya ◽  
Samir Swain ◽  
Vishal Kumar Neniwal ◽  
Shweta Bhalothia ◽  
Kishor Tonge ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Obstruction ◽  
Low Cost ◽  
Percutaneous Nephrostomy ◽  
Upper Urinary Tract ◽  
Tube Placement ◽  
Ultrasound Guided ◽  
Direct Puncture ◽  
Upper Urinary Tract Obstruction ◽  
Grade Iii

Background: Percutaneous nephrostomy (PCN) is indicated to drain the upper urinary tract collecting system in cases of obstruction. Objective of our study is to evaluate the safety and efficacy of Ultrasound guided direct puncture PCN in our populations.Methods: This observational study was conducted from May 2020 to April 2021in department of urology and renal transplant. The total 65 patients with upper urinary tract obstruction requiring PCN were enrolled. All parameters were recorded and statistical analysis was performed using the Statistical package for the social sciences (SPSS 16.0) for windows.Results: In our study Ca Cervix with ureteric infiltration (35%) was the most common indication for PCN tube placement. Majority of patients (83%) had Grade IV and Grade III hydroneprosis. Single attempt for tube placement was sufficient most of the time in (86% cases). Direct Puncture PCN tube placement was successful in 62 (95.4%) cases. The mean duration of procedure was 12.4 minutes. Loin pain was the most common procedure related complication observed in 58 patients. There was no evidence of visceral injury, no need of blood transfusion in post procedural duration in our study.Conclusions: USG guided direct puncture PCN technique is simple, low cost, less time consuming, less chance of loss of tract and effective procedure for drainage of urine in case of upper urinary tract obstruction. We recommended this procedure in grade III and IV hydronephrosis and this procedure suitable for developing countries like India because of procedure related low cost.

Role of percutaneous nephrostomy inpatients with upper urinary tract transitional cell carcinoma

Urology ◽  
1991 ◽  
Vol 37 (4) ◽  
pp. 331-336 ◽  
Author(s):  
Brian Guz ◽  
Stevan B. Streem ◽  
Andrew C. Novick ◽  
James E. Montie ◽  
Margaret G. Zelch ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Transitional Cell Carcinoma ◽  
Cell Carcinoma ◽  
Transitional Cell ◽  
Percutaneous Nephrostomy ◽  
Upper Urinary Tract

scholarly journals Adenocarcinoma at Anastomotic Site of Ureterosigmoidostomy Potentially of Urothelial Origin Spreading to the Upper Urinary Tract

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Katsuhiro Makino ◽  
Haruki Kume ◽  
Teppei Morikawa ◽  
Aya Niimi ◽  
Tetsuya Fujimura ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Unusual Case ◽  
Percutaneous Nephrostomy ◽  
Upper Urinary Tract ◽  
Late Complications ◽  
Nuclear Accumulation ◽  
Anastomotic Site ◽  
Cytokeratin 20 ◽  
The Right ◽  
Renal Pelvic Tumor

Ureterosigmoidostomy is associated with the risk of several late complications including cancer development at anastomotic sites. We present an unusual case with adenocarcinoma of the anastomotic site associated with multiple adenocarcinoma lesions in the upper urinary tract. A 69-year-old man complained of persistent melena and hematuria. He had undergone radical cystectomy for high-grade bladder cancer and ureterosigmoidostomy 30 years before. Colonoscopy showed a tumor at the right ureterocolonic anastomosis, which was endoscopically resected and histologically diagnosed as adenocarcinoma. Seven years later, a tumor of the left ureterocolonic anastomosis associated with hydronephrosis was found. He underwent temporal percutaneous nephrostomy followed by sigmoidectomy and left ureterocutaneostomy. Eighteen months after the operation, computed tomography (CT) detected left renal pelvic tumor with a mass along the former nephrostomy tract. Left nephroureterectomy and resection of the nephrostomy tract tumor revealed adenocarcinoma with multiple lesions of adenocarcinoma in the ureter. These tumors showed atypical immunohistochemistry as a colonic adenocarcinoma: positive for cytokeratin 7, negative for cytokeratin 20, and negative forβ-catenin nuclear accumulation. Anastomotic site adenocarcinoma of the present case is potentially of urothelial origin because of unusual clinical manifestation and immunohistochemistry as a colon cancer.

EFFECTIVENESS OF DRAINAGE FOR ACUTE OBSTRUCTIVE PYELONEPHRITIS SECONDARY TO URETERIC CALCULI

2019 ◽  
pp. 19-25
Author(s):  
Dinh Dam Le ◽  
Xuan My Nguyen ◽  
Truong An Nguyen ◽  
Khoa Hung Nguyen ◽  
Dinh Khanh Le
Keyword(s):  
Blood Pressure ◽  
Septic Shock ◽  
Urinary Tract ◽  
Percutaneous Nephrostomy ◽  
Upper Urinary Tract ◽  
Ureteral Catheter ◽  
Laboratory Findings ◽  
Female Ratio ◽  
Ureteric Calculi ◽  
Obstructive Pyelonephritis

Purposes: To evaluate the effectiveness drainage for acute obstructive pyelonephritis secondary to ureteric calculi. Materials and Methods: 45 patients with obstructive pyelonephritis due to urolithiasis were hospitalized between October 2015 and Mars 2018 at Hue University of Medicine and Pharmacy Hospital. Results: The male to female ratio was 1 : 5.5. The median age was 54.16 ± 10.29 years (range 34 – 74 years). The physical findings at the time of hospitalization were as follows: body temperature 38.87 ± 0.66°C, pulse rate 94.38 + 12.29/min, respiratory rate 24.62 ± 5.57/min, systolic blood pressure 120.11 ± 16.39 mmHg, diastolic blood pressure 73.66 ± 9.19 mmHg. The laboratory findings were as follows: WBC: 13.97 ± 5.27g/l, platelets 266.91 ± 139.932 g/l, serum creatinine 96.09 ± 34.023 umol/l, serum CRP 160.08 ± 96.42 mg/l, serum procalcitonin 9.21 ± 22.57 ng/ml. The average size of the stones was 15.89 ± 9.84 mm (5 - 47). 14 patients had a positive urine culture result. The SIRS in 39 patients (86.7%). 44 patients (97.8%) received transurethral stenting using a double-J ureteral catheter and 1 patient (2.2%) received percutaneous nephrostomy. All patients received antimicrobial therapies. After the drainage of the upper urinary tract and antimicrobial therapies, all patients were apyretic. The flank pain and of the costovertebral angle tenderness disappeared. The serum WBC, CRP and Procalcitonin were decreased. Conclusions: Upper urinary tract infection in the patient with obstructive urolithiasis is a urologic emergency. It is necessary to drainage early to avoid septic shock and eventually death. Key words: acute obstructive pyelonephritis secondary, ureteric calculi, septic shock

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