Emphysematous pyelitis: epidemiological, therapeutic and evolutive features.

AIM: Emphysematous pyelitis is an uncommon form of acute pyelonephritis. It has been reported sporadically in the literature. Our objective is to study the epidemiological, clinical and therapeutic characteristics of emphysematous pyelitis. METHODS: The data of six patients managed for emphysematous pyelitis were collected and analyzed. RESULTS: The mean age was 55 years. Urinary lithiasis and diabetes were the most common co-morbidities. Febrile lumbar pain and general health impairment were the presenting symptoms in five patients; the remaining case presented with septic shock. Urine and blood culture grew E. Coli in 4 and 3 cases respectively. Computed tomography of the abdomen led to diagnosis by showing gas images in the collecting system. Treatment consisted of antibiotics associated with collecting system drainage. It avoided emergent nephrectomy in all cases. The treatment of the calculi was held at distance from the infection. Nephrectomy was done in one patient presenting a thinned -- dedifferentiated -- renal parenchyma. Outcome was good. CONCLUSION: Emphysematous pyelonephritis is a rare upper urinary tract infection. Risk factors include diabetes and urinary obstruction. The diagnosis is made by computed tomography. Efficient antibiotics administration associated with collecting system drainage allow soon recovery and avoid nephrectomy.

[Laparoscopic treatment of ureteral stones. Report of 31 cases]. / Le traitement des calculs de l'uretere lombaire par lomboscopie: a propos de 31 cas.

THE AIM: To state the efficiency and the place of lumboscopy in the treatment of ureteral stones. METHODS: We report 31 cases of patients operated by lumboscopy for ureteral stones from January 2001 to December 2005. In most of cases, the indication is stone which size is higher than 15 mm. RESULTS: The mean operating time is 91 min and the rate of conversion to open surgery is 9.7%. 9 (29%) postoperative complication is noted. The mean hospital stay is 5 days. No ureteral stricture or kidney destruction is noted with a mean follow-up of 34 months. CONCLUSION: Lumboscopy is a safe and effective technique in the treatment of the ureteral stones with a low rate of complications. It can replace open surgery in most of cases.

[Lumboscopic treatment of simple renal cysts]. / Traitement lomboscopique des kystes simples du rein.

AIM: To assess feasibility and efficiency of lumboscopy in the treatment of simple renal cysts. METHODS: We report 12 cases of patients presenting symptomatic simple renal cysts treated by lumboscopy from January 2000 to December 2004. The mean age was 57 years (43-72). They were 11 women and one man. The main revealing sign was pain in each case. A mass was found in 2 cases (16 %). Ultrasonography was realized in all cases. Computed Tomography was realized in 4 cases (33 %). It was a unique cyst in 9 cases (75 %), a double cysts in 2 cases (17 %) and 4 cysts in 1 case (8 %). The mean size of the cysts was 7.7 cm (5-16). A parapyelic cyst was found in one case. All the patients were operated through a retroperitoneal approach. Excision of cyst dome was made. RESULTS: The mean operating time was 80 min (50-160). No intraoperative complication was noted. The mean hospital stay was 3 days (1-4). All the cysts were found to be benign histologically. No recurrence is noted with a mean follow-up of 21 months (5-31). CONCLUSION: Lumboscopy is a safe and effective technique in the treatment of the symptomatic simple renal cysts with a low rate of complications and recurrence.