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.

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.

647 Management of Malignant Upper Urinary Tract Obstruction

Background Malignant Upper Urinary Tract Obstruction (MUUTO) is a common emergency presentation. These are often complex patients and require multiple specialty input to make time-critical decisions. There are currently no national guidelines for the management of MUUTO, a review was conducted to assess the management and outcomes of MUUTO. Aim To agreed and review a pathway for patients with MUUTO in order to streamline patient care and to review the management. Method The pathway was devised by several consultants at Oxford University Hospital. Through retrospective data collection, the outcomes over six months were reviewed. Results Over the six-month period 49 interventions were performed for MUUTO; 44 Percutaneous Nephrostomy (PCN) and five cystoscopies with retrograde ureteric stents (RUS). Patients were admitted to urology in 45% of cases and oncology in 39%. The obstruction was located above the pelvis in 16 (33%) of the cases and within the pelvis in 25 (51%). The most common cancers causing obstruction were bladder cancer (41%), prostate (16%), and colorectal (14%). MDT advice was sought in 63% of cases. The mean time from diagnosis to the intervention was four days. Of the five retrograde inserted ureteric stents, four were unsuccessful and the patients proceeded to PCN. At the conclusion of data collection, 26 (53%) patients had died. Discussion The most striking findings were the high failure rate of RUS and the overall poor prognosis of MUUTO. As such this review suggests that more patients should proceed directly to PCN for decompression.

Comparative evaluation of the effectiveness of dilatation correction of the pyelocaliceal system of the kidneys in the context of using various options for drainage of the upper urinary tract

Introduction. Upper urinary tract (UUT) obstruction remains a socially significant problem due to its high frequency and serious pathogenetic consequences. Dilation of calyx-pelvic system (CPS) remains one of the pathognomonic manifestations of this condition, which should be immediately corrected. Percutaneous puncture nephrotostomy, internal stenting, and ureteral catheterization are the most commonly used methods for draining the upper urinary tract. However, the problem of choosing a drainage method in a specific clinical situation based on the criterion of the effectiveness of elimination of CPS dilatation has not yet been resolved. Purpose of the study. Comparative analysis of the efficiency of drainage of the upper urinary tract under the conditions of the use of three alternative methods –распредеpercutaneous puncture nephrostomy, internal stenting and ureteral catheterization – followed by substantiation of the choice in a specific clinical situation according to the criterion of the effectiveness of correction of the dilatation of the CPS. Materials and methods. We included in this study 300 patients with obstruction of the upper urinary tract due to urolithiasis, oncourological and oncogynecological pathology. The presence and resolution of dilatation of the CPS was determined using ultrasound diagnostics and intravenous urography. Results. Percutaneous puncture nephrostomy is the most effective in treating upper urinary tract obstruction in terms of eliminating CPS dilatation, ureteral catheterization is less effective, and internal ureteral stenting occupies an «intermediate position». Conclusion. When planning and implementing the treatment of upper urinary tract obstruction, one of the main criteria should be taken into account the effectiveness of correction of the dilatation of the CPS. In a specific clinical situation in which dilatation of the PCS will be of the greatest importance, percutaneous puncture nephrostomy will be the optimal method of drainage.