Midstream Urine Culture Had a Higher Predictive Value of Post-PNL SIRS in Patients Without Upper Urinary Tract Obstruction

Introduction: Systemic inflammatory response syndrome (SIRS) is a common complication of percutaneous nephrolithotomy (PNL). Midstream urine culture (MUC) is reported to be associated with postoperative SIRS, but this correlation is uncertain, as MUC may not represent infection of obstructed urine in patients with upper urinary tract obstruction (UUTO). Instead, for patients without UUTO, positive MUC may be an indicator of intrarenal infection. The aim of this study was to investigate whether MUC had a higher predictive value in patients without UUTO. Materials and Methods The data of 175 patients who underwent PNL between September 2015 and June 2016 were retrospectively reviewed. Preoperative and intraoperative factors including MUC were collected and analyzed. The primary endpoint was development of SIRS. Subgroup analysis according to the presence of UUTO was conducted. Results Generally, patients who suffered SIRS had a higher incidence of positive MUC (56%[25/45] vs. 32%[41/130], p=0.005). Subgroup analysis showed that among patients without UUTO, positive MUC (75%[13/17] vs. 33%[13/39], p=0.003) was still associated with development of SIRS. Among patients with UUTO, however, there was no obvious correlation between positive MUC and SIRS. Multivariate analysis controlling for age, previous ipsilateral kidney surgery, multiple tracts, and blood creatinine conducted in patients without UUTO demonstrated that positive MUC (odds ratio [OR] = 6.419, 95% confidence interval [CI]: 1.424-28.942, p=0.016) was still associated with development of SIRS. The rate of positive urine culture was 37.7% (66/72), 72 isolates of 24 species were reported, including 6 patients with mixed infection and 2 patients with fungi infection. Gram-negative bacteria accounted for a large proportion of all isolates (68.1%), and Escherichia coli was the most common bacteria (34.7%). Conclusions MUC had a higher predictive value of post-PNL SIRS in patients without UUTO.

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

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.

Congenital midureteral stenosis in children: a 13-year retrospective study based on data from a large pediatric medical center

Background Midureteral stenosis is very rare in children and can cause congenital hydronephrosis. We report our experience treating children with congenital midureteral stenosis at our center, focusing on the differences in preoperative diagnosis and treatment compared with other congenital obstructive uropathies. Methods We retrospectively reviewed the medical records of 26 children diagnosed with congenital midureteral stenosis at our center between January 2007 and December 2020, such as preoperative examination methods, intraoperative conditions, and postoperative follow-up results. Results Of the 1625 children treated surgically for ureteral narrowing, only 26 (1.6%) were diagnosed with midureteral stenosis, including 15 infants and 11 children. Eighteen (69.2%) were boys, 13 (50%) were affected on the left side, and 23 (88.5%) had isolated ureteral stenosis. Overall, 13 (50%) of the children presented with prenatal hydronephrosis, and 13 (50%) presented with abdominal pain or a mass. All the children had undergone urinary ultrasound and intravenous urography preoperatively; the diagnostic rate of ultrasound was 92.3%. Only 7 (26.9%) children had undergone pyelography. All the children had undergone surgery. The ureteral stenotic segment was less than 1 cm long in 25 (96.2)% of the children. The mean follow-up duration was 22 months (range: 6–50 months). One child developed anastomotic strictures. Urinary tract obstruction was relieved in the other children without long-term complications. Conclusions Congenital midureteral stenosis is rare, accounting for 1.6% of all ureteral obstructions, and its diagnosis is crucial. Urinary ultrasound has a high diagnostic rate and should be the first choice for midureteral stenosis. Retrograde pyelography can be used when the diagnosis is difficult, but routine retrograde pyelography is not recommended. Congenital ureteral stenosis has a relatively short lesion range, largely within 1 cm. The treatment is mainly resection of the stenotic segment and end-to-end ureteral anastomosis, with a good prognosis.

Primary diffuse large B-cell lymphoma of the prostate: a case report and review of the literature

Background Primary lymphoma of the prostate is an exceedingly rare disease, with diffuse large B-cell lymphoma being the most common known subtype in a small number of reported cases. Due to its low prevalence, there has been a chronic lack of targeted diagnostic guidelines and treatment procedures. Case presentation In this article, we report a case of primary diffuse large B-cell lymphoma of the prostate in a 70-year-old Asian man who presented with symptoms of urinary tract obstruction. Histological and immunocytochemical studies of transurethral biopsy of the prostate showed diffuse large B-cell lymphoma. The patient was managed by a combination of eight courses of chemotherapy with a regimen including rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone and radiotherapy. Post-chemotherapy computed tomography scans showed complete remission. He remained disease free, until now, 15 months after the end of therapy. We also reviewed and analyzed relevant literature to illustrate the diagnosis, treatment, and prognosis of this disease. Conclusion Diffuse large B-cell non-Hodgkin’s lymphoma originating in the prostate is a rare and highly aggressive disease that lacks specificity in its clinical presentation and is easily misdiagnosed. This disease should be considered clinically in patients with significant prostate enlargement and insignificant prostate-specific antigen elevation. The diagnosis can be clarified with a prostate puncture biopsy. Chemotherapy is the main treatment for patients and may be supplemented with surgical treatment and radiotherapy.

Cavernous lymphangioma of the urinary bladder in an adult woman: an additional case report of a rare lesion and literature review

Background Urinary bladder lymphangioma is a rare and benign lesion that is often causes symptoms related to irritation and urinary tract obstruction. Because a lymphangioma may resemble a true neoplasm of the urinary bladder clinically, the lesion must be removed for accurate histologic diagnosis and to rule out malignancy. Case presentation We present a case of a 40-year-old female who was evaluated for painless gross hematuria. Clinical and diagnostic work up revealed a sharply defined mass involving the wall and bulging into the cavity on the dome of the bladder. Partial cystectomy was performed and histologic findings were compatible with cavernous lymphangioma. The symptom of hematuria relieved after the procedure and the patient was in good status without evidence of recurrence by cystoscopy at follow-up 6 months later. Conclusions Lymphangioma of the urinary bladder is treated with surgical excision and seems to have no recurrence once completely resected, but long-time follow-up may be needed.

Urinary tract obstruction: Ultrasound-guided intervention

Introduction Urinary tract obstruction (UTO) is a common clinical problem of which there are many potential causes. The aim of this feature article is to explore the role of ultrasound in diagnosing UTO, during guided interventional procedures and the potential procedural complications. Topic description and discussion: Ultrasound is an integral imaging modality throughout the management pathway of a patient with UTO and is often utilised as a first-line test in diagnosis and treatment. Percutaneous nephrostomy is an interventional technique, usually performed by radiologists or interventional sonographers, as either a short- or long-term management strategy. It can either be used in isolation or to gain access to the renal collecting system prior to more complex interventional or surgical techniques. Ultrasound-guided interventional techniques to relieve UTO can be employed in a number of clinical scenarios each with their own indications, contraindications and complications. Conclusion Ultrasound plays a unique role in the planning and active stages of intervention with the provision of dynamic imaging which is crucial for providing safe and effective patient management.

The changes of the tubular epithelium phenotype in the contralateral kidney nephrons while developing unilateral ureteral obstruction: an experimental study

Introduction. The high prevalence of renal diseases caused by urinary tract obstruction led to the need for experimental research of compensatory and pathological processes with kidney injury. It is also of relevance to study key mechanisms providing a compensatory function of the contralateral kidney for early diagnosis, treatment, and prognosis of obstructive renal diseases.Purpose of the study. To examine epithelial nephron cells phenotype dynamics changes in contralateral kidney using unilateral ureteral obstruction experimental model.Materials and methods. Model of unilateral ureteral obstruction was established using adult rabbits. The studies were carried out on days 7, 14 and 21 of complete obstruction of the left ureter. Immunophenotyping was performed on contralateral kidney tissue samples using epithelial (cytokeratin 7, E-cadherin) and mesenchymal (vimentin, α-smooth muscle actin) markers.Results. The contralateral kidney under additional load can maintain the morphological and functional characteristics of the nephron for a long time. The first transmogrify signs in the nephron epithelium phenotype were detected by day 21 as the diffuse appearance of mesenchymal marker vimentin with unaltered visualization of epithelial phenotype markers.Conclusion. The results obtained allow us to assume that the compensatory reserve of the contralateral kidney is gradually decreasing when the duration of the obstruction increases. Thus, the likelihood of developing negative disorders increases.

The three-dimensional reconstruction of the dilated renal pelvicalyceal system by non-enhanced computed tomography

Introduction. The three-dimensional reconstruction of the renal pelvicalyceal system (PCS) is possible when performing enhanced computed tomography (CT). However, the use of a contrast agent has its limitations associated with the presence of allergy and chronic kidney disease.Purpose of the study. To describe the method of semi-autonomous three-dimensional (3D) reconstruction of the PCS based on non-enhanced CT images of patients with upper urinary tract obstruction.Materials and methods. Five patients diagnosed with renal colic were recruited from April-May 2021. All patients underwent CT-urography after informed consent. Medical Imaging Interaction Toolkit program (MITK) expanded with explainable update were used for 3D-reconstruction of PCS via excretory and native phases. To assess the accuracy of the latter, both contrast and non-contrast models were compared regarding their surface area. Also, the PCS of one patient was used to reconstruct virtual endoscopic views based on enhanced and non-enhanced models. Five urologists estimated their similarity and potential use of non-enhanced models for the interventional planning via a Likert scale questionnaire. The resulting models were also analyzed by programmer-engineers to test their suitability for 3D-printing.Results. The average surface area of enhanced and non-enhanced models was 3291 mm2 and 2879 mm2, respectively. Obtained models were suitable for their intraluminal reconstruction and potential 3D-printing. Analyzed properties of non-enhanced models were estimated at 4.5 out of 5.0.Conclusion. The described semi-autonomous reconstruction of the renal PCS based on non-enhanced CT images allows for a short time to reconstruct its 3D-view in patients with the upper urinary tract obstruction.