Caspofungin irrigation through percutaneous calicostomy catheter combined with oral flucytosine to treat fluconazole-resistant symptomatic candiduria.

Candiduria may be a marker of serious fungal infections such as pyelonephritis. With the exception of fluconazole and flucytosine, antifungals drugs are not excreted into the urine as active drugs, making the management of infection due to fluconazole-resistant Candida difficult. We report a case of recurrent Candida parapsilosis candiduria in a kidney transplant recipient suffering from chronic ureteral obstruction requiring permanent ureteral catheterization (double-J stent). Attempts to remove the stent led to pyelonephritis episodes during which only Candida was isolated from the urine. Following several courses of azole-based therapy, the causative agent became resistant to fluconazole. Clinical and mycological cure were obtained combining irrigations of caspofungin through a percutaneous calicostomy catheter and oral flucytosine. This strategy may represent an interesting therapeutic alternative in case of fluconazole-resistant symptomatic candiduria.

[Endoscopic treatment of renal diverticular stone (Single Centre Study of 45 cases)]. / Traitement endoscopique des calculs caliciels intradiverticulaires : à propos d'une série monocentrique de 45 patients.

OBJECTIVE: We aim to evaluate the outcome of flexible ureterorenoscopy (F-URS) with holmium laser in treating renal diverticular stone as a minimal invasive option. PATIENTS AND METHODS: We reviewed retrospectively the records of 45 patients who underwent F-URS using holmium laser from 2004 to 2011 for symptomatic renal diverticular stone. The presenting symptoms were renal colic, urinary tract infection or hematuria. The F-URS used after the Shock Wave Lithotripsy (SWL) failure in 30 (66.7 %) patients. The repeated treatment by F-URS was carried out twice for four patients; in three patients, it was correlated to the size of the stone and it was because of failure to identify the diverticulum in one patient. The follow up visit range were between 4 to 6 weeks with plain radiograph (KUB) and renal ultrasound or non-contrast CT scan (NCCT). RESULTS: Of our data, there were 45 patients, 22 women and 23 men (mean age of 46.3 years, range 18-72). We found 28 patients (62.2 %) who had stone free (SF), 10 patients (22.2 %) with clinically insignificant residual fragments (less than 3mm in size) and residual fragments (RF) in seven patients (15.6 %). Success rate was considered as stone free or insignificant residual fragment, which was obtained in 38 patients (84.4 %). The symptom-free was in 42 patients (93.3 %). CONCLUSION: In our experience, F-URS using holmium laser was very effective minimally-invasive technique that could be the best option for the treatment of renal diverticular stone especially for those who resist the treatment with the SWL. It showed an excellent stone clearance rate, minimal morbidity rate and brief hospital stay.

[A western cohort of urinary schistosomiasis]. / Bilharziose urinaire : une série française.

UNLABELLED: Urinary schistosomiasis is very frequent, but there are few data upon its epidemiology in western countries. We wanted to describe the cohort from Tenon hospital, in Paris, France, near a big subsaharian community. METHODS: We searched in our clinical files database for "urinary schistosomiasis" encoding. RESULTS: The cohort comprised 207 men and 34 women seen for the first time at the mean age of 34, mainly for haematuria or LUTS. Patients were mainly native from subsaharian Africa. The lost to follow up rate was 54%. Diagnosis was made on sole endoscopic finding in half of the cases. For non-tumor pathology, were made seven cystoplasties et 12 ureteral dilations. Tumoral pathology was frequent and severe (15/81 from the same age range), mainly represented by urothelial histology (8/14). Imported cases were rare (five cases). CONCLUSION: Despite its limitations, different characteristics from this cohort seemed noticeable: frequency of sole lower urinary tract symptoms, frequency and severity of tumoral diseases, mainly with urothelial carcinoma as histology.

[Evaluation of urologic activity in ambulatory surgery: a single centre experience]. / Évaluation de la pratique de la chirurgie ambulatoire en urologie: expérience d'un centre.

OBJECTIVE: Ambulatory surgery is an alternative to traditional hospitalisation and an opportunity for savings for the healthcare system. Here, we analyze our experience in outpatient surgery in urology over a year. MATERIAL: A prospective database concerning outpatient activity was established in 2009, gathering age, ASA score, type of intervention, discharge and recovery for each patient. An individual questionnaire was sent retrospectively in February 2010, to collect data about history of outpatient surgery, overall satisfaction, preference for traditional hospitalization and emergency department visits within 48 hours after surgery. RESULTS: In 2009, 465 patients aged of 52±16 years (15-98) underwent urologic surgery on an outpatient basis. Median ASA score was 2 (1-3). Types of intervention were mainly endo-urology (44.5%), surgery for urinary incontinence (32.5%), and circumcision (12.3%). The postoperative hospitalization rate was 4.5%. The questionnaire response rate was 28%. Forty-six percent of the patients had already been supported in ambulatory, overall satisfaction was 3.3 out of 4 (±1.06) and 24% of patients would have preferred a traditional hospitalization. 11% of patients required emergency department care within 48 hours whatever the surgery undergone. CONCLUSION: An important part of urological procedures has been done on an outpatient basis without compromising quality of care and patient satisfaction.

Malignant epithelioid renal angiomyolipoma involving the inferior vena cava in a patient with tuberous sclerosis.

Renal angiomyolipomas (AMLs) are mesenchymal tumors that occur either sporadically or are associated with tuberous sclerosis, and are generally considered to be benign. Malignant AML is extremely rare, and most are found to be epithelioid histopathologically. The authors report the case of a patient followed for renal AML. On CT surveillance, this lesion developed features of a malignant tumor involving the renal vein and inferior vena cava. The patient was treated by nephrectomy and tumor thrombectomy with retroperitoneal lymph node dissection. Histological examination demonstrated renal AML with a malignant epithelioid contingent. The various aspects of this histological and radiological variant are discussed.

Lymphoproliferative disorder presenting as a tumor of the renal allograft.

Post-transplant lymphoproliferative diseases (PTLDs) constitute a group of potentially life-threatening complications in solid organ transplantation, occurring in 1-2% of kidney transplant recipients. The absolute number of cases occurring at each transplant center remains small, making it difficult to assess incidence, prognosis, and treatment. We report a case of post-transplant lymphoproliferative disorder that developed in the allograft renal parenchyma 2 years after renal transplantation. This case implies that partial nephrectomy may be a safe and effective treatment protocol for renal lymphoma in allograft kidneys.

Emergency extracorporeal shock wave lithotripsy (ESWL) for obstructing ureteral stones.

OBJECTIVE: To evaluate emergency treatment of obstructing ureteral stones by in situ extracorporeal shock wave lithotripsy (ESWL) during acute renal colic. PATIENTS AND METHODS: From January 1994 to February 2000, 200 patients (mean age: 42 years) were treated by ESWL (EDAP LT-02) for obstructing ureteral stones causing acute renal colic refractory to medical treatment or recurring within 24hours of such treatment. Stones were visualised by fluoroscopic imaging and/or ultrasound. Follow-up included radiological and/or ultrasound examinations and lasted three months. RESULTS: Mean stone size was 7mm (3-20mm). At three months, 164/200 (82%) patients were stone-free. This rate ranged from 79% to 83% according to the location of the stone, and from 75% to 86% according to the size of the stone. These differences in rate were not significant. Two or three ESWL sessions were required in 79 patients. ESWL was well tolerated in 90% of patients. The only complication was a case of pyelonephritis requiring the placement of a JJ stent, administration of antibiotics, and distant ureteroscopy. The 36 patients, in whom ESWL failed, underwent ureteroscopy (n=23) or lithotripsy with a Dornier machine (n=13). CONCLUSION: Non-deferred ESWL for acute renal colic secondary to obstructing ureteral stones has a satisfactory success rate and very low morbidity.

[Bilateral emphysematous pyelonephritis]. / La pyélonéphrite emphysémateuse bilatérale.

Based on a case report and a review of the literature, the authors describe the features of bilateral emphysematous pyelonephritis. This rare disease with a poor prognosis constitutes a difficult clinical diagnosis. The positive diagnosis is based on urgent computed tomography. The reference treatment is emergency nephrectomy in an intensive care context.

[Predictive factors of successful treatment of lower caliceal calculi with Edap LT02 extracorporeal lithotripsy]. / Facteurs prédictifs du succès du traitement des calculs caliciels inférieurs par lithotritie extra corporelle Edap LTO2.

OBJECTIVE: To determine the predictive factors of success of extracorporeal shock-wave lithotripsy (ESWL) for lower caliceal stones. PATIENTS AND METHODS: The case files of 100 patients with a single stone in the lower pole of the kidney, ranging in size from 6 to 25 mm, treated by EDAP LTO2 extracorporeal lithotripsy between 1994 and 1997, were studied. Pretreatment intravenous urography was reviewed to assess the characteristics of the stone, to measure the pyelocaliceal angle and to study the anatomy of the lower pole of the kidney. RESULTS: The overall stone-free rate at 3 months was 57%. The success rate was 67.18% for stones smaller than 1 cm and 38.88% for stones larger than 1 cm. Stones denser than bone were successfully treated in 45.5% of cases, those less dense than bone were successfully treated in 71.11% of cases. The success rate was 86.04% when the pyelocaliceal angle was greater than 90 degrees and 35.08% when this angle was less than 90 degrees. The stone-free rate was 75% when the caliceal stalk was less than 3 cm and 37.5% when the stalk was greater than 3 cm. CONCLUSION: In this series, the size of the stone, its density, the pyelocaliceal angle and the length of the caliceal stalk were predictive elements of the success of ESWL for lower caliceal stones. The pyelocaliceal angle was the most significant factor. A very dense stone on the plain abdominal film with a diameter of 1 cm or more and presenting unfavourable anatomical factors should be treated by percutaneous nephrolithotomy as the first-line procedure.

[Spontaneous intraperitoneal rupture of the bladder treated with laparoscopy]. / Rupture spontanée intrapéritonéale de la vessie traitée par coelioscopie.

The authors report the case of a 53-year-old patient admitted for spontaneous bladder rupture occurring during an episode of alcoholic intoxication. Laparoscopic treatment consisted of peritoneal toilet with bladder suture and drainage of the abdominal cavity with a favourable postoperative course.

[Peroperative erection in lower urologic surgery]. / Erection peropératoire en chirurgie urologique basse.

Erection is a rare event during lower urinary tract surgery. When it is extremely refractory, endoscopy is impossible and the lower urinary tract surgery may need to be deferred. The development of erection during spinal anaesthesia is due to manipulations before complete installation of sensory block or incomplete blockade of sacral segments (S2 to S4) supplying the nervi erigentes. The mechanism of erection during general anaesthesia remains poorly elucidated. General anaesthesia may suppress central or peripheral sympathetic control of flaccidity. The peripheral target could be the smooth muscle of the cavernous tissue, either by a direct action or via alpha-adrenergic receptors. Psychogenic and reflexogenic stimuli have also been proposed, possibly facilitated by amplification of sensations during stage II anaesthesia. The various treatments are based on experience acquired in the field of priapism. Systemic treatments such as ketamine an beta 2 mimetics or benzodiazepines are not always effective and are associated with considerable adverse effects. Intracavernous injections of alpha-adrenergic drugs constitute the treatment of choice. Phenylephrine and etilefrine are preferred because of their rapid efficacy and particularly their only moderate cardiovascular adverse effects.

[Value of cloverleaf double J ureteral stents in the treatment of extrinsic ureteral compression]. / Intérêt des sondes urétérales double J tréflées dans le traitement des compressions urétérales extrinsèques.

The authors report three cases of extrinsic bilateral ureteric stenoses in which standard double J ureteric stents did not allow medium-term improvement of renal function or resolution of pyelocaliceal cavity dilatation on ultrasonography. A favourable course was observed after insertion of cloverleaf double J ureteric stents.

[Epididymal gaseous abscess after BCG treatment]. / Abcès caséeux épididymaire après BCG-thérapie.

The authors report a case of unilateral epididymitis with caseous abscess after BCG-therapy for superficial bladder tumour. The severity of the lesions required orchidectomy, followed by four-agent tuberculostatic therapy.

[Pelvic endometriosis with ureteral obstruction. Case report]. / Endometriose pelvienne avec obstruction ureterale: à propos d'un cas.

The authors report 1 clinical case of pelvic endometriosis. The urinary symptoms and the radiological appearance of endometriosis with compression of the ureter are non specific. The diagnosis was established by histological examination of the resection specimen. The authors describe the therapeutic approach based on radical surgery designed to eradicate the endometriosis, while remaining as conservative as possible in order to allow subsequent pregnancy, and the place of urological surgery combined with medical treatment with LHRH analogue.

[Balloon catheter parieto-renal dilatation in percutaneous kidney surgery]. / La dilatation pariéto rénale au ballonnet dans la chirurgie percutanée du rein.

OBJECTIVE: To compare two techniques of parieto-renal dilatation for percutaneous surgery: Alken dilators and balloon catheter. MATERIAL AND METHODS: This prospective, non-randomized study was conducted between July 1999 and April 2000 in 20 patients undergoing percutaneous renal surgery. 10 patients were dilated with a balloon catheter (NephroMax, Boston Scientific) and the other 10 patients were dilated with Alken metal dilators. Statistical analysis was performed with the Mann-Whitney test. RESULT: The dilatation time and x-ray exposure time were shorter during balloon catheter dilatation (statistically significant difference) and the two techniques were associated with a comparable morbidity. CONCLUSION: Balloon catheter parieto-renal dilatation significantly decrease dilatation and x-ray exposure times and very considerably simplifies this operative step, essential to the success of percutaneous surgery.

[Emphysematous pyelonephritis: apropos of a case and review of the literature]. / La pyélonéphrite emphysémateuse: à propos d'un cas et revue de la littérature.

Based on a case report and a review of the literature, the authors describe the features of emphysematous pyelonephritis. This rare disease with a poor prognosis constitutes a difficult clinical diagnosis. The positive diagnosis is based on urgent computed tomography. The reference treatment is emergency nephrectomy in an intensive care context.

[Outpatient treatment of pelvic ureteral calculi with extracorporeal lithotripsy. Report of a series of 200 patients consecutively treated]. / Traitement ambulatoire des calculs de l'uretère pelvien par lithotritie extra corporelle. A propos d'une série de 200 patients traités consécutivement.

OBJECTIVE: To demonstrate the feasibility of first-line outpatient treatment of symptomatic stones of the pelvic ureter (sometimes immediately following an episode of renal colic), without anaesthesia, by extracorporeal shock-wave lithotripsy using a latest generation apparatus (EDAP LT02) with concomitant dual guidance. PATIENTS AND METHODS: The mean age of the patients was 45 years. The mean stone diameter was 7 mm (range: 3 to 25 mm). Lithotripsy was performed under dual ultrasound and fluoroscopic guidance. All patients were reviewed at 3 months with follow-up and x-rays. RESULTS: Fragmentation was considered to be complete in 79% of cases, partial in 10.5% of cases and absent in 10.5% of cases. Overall, 87% of stones were completely eliminated at 3 months. The only complication was fever of 38.5 degrees C requiring urinary tract drainage and subsequent ureteroscopy. Complementary treatment was necessary in 26 cases: ureteroscopy (n = 20), alkalinization (n = 1), Dornier ESWL (n = 5). CONCLUSION: ESWL by EDAP LT02 allows first-line outpatient treatment of stones of the pelvic ureter with a satisfactory success rate.

Helical CT and 3D reconstruction of ureteropelvic junction obstruction: accuracy in detection of crossing vessels.

PURPOSE: The purpose of our study was to evaluate the accuracy of 3D helical CT and its value in surgical planning for the treatment of ureteropelvic junction obstruction (UPJO). METHOD: CT scans and 3D reconstruction of renal vessels and the renal pelvis were performed in 20 cases of UPJO treated by open surgery. We analyzed scans in search of a vessel at the junction and its position relative to the UPJ. Helical CT scans and 3D reconstructions were correlated with macroscopic surgical findings. RESULTS: CT scans demonstrated the presence of a UPJO in all cases. Crossing vessels were present at the junction in 13 of 20 cases. The vessel crossed the junction posteriorly in six cases and anteriorly in seven cases. Macroscopic surgical findings were in agreement with helical CT reconstructions in 100% of the cases. CONCLUSION: Axial scans together with 3D reconstruction are an accurate way of detecting crossing vessels when UPJO occurs, and the choice of the most adequate surgical technique is facilitated.