Peripyelitis: A risk factor for urinary fistula after tubeless PCNL.

A 43 years-old man presented to our stone clinic complaining of back pain for the last 3 months. He had significant past medical history for nephrolithiasis: he had undergone unsuccessful SWL for left renal calculi five years ago and also presented with several episodes of pyelonephritis in the last months, requiring hospitalization for intravenous antibiotics. Initial laboratory work-up revealed normal serum creatinine (0.92 mg/dL) and hemoglobin levels (15.3 g/dL); urine culture was negative. Abdominal computed tomography (CT) revealed a 140 mm2 stone in the left renal pelvis with 1500 Hounsfield Units (Figure-1a); thickening of the urothelium surrounding the stone was suspected after contrast infusion (Figure-1b) and confirmed in the excretory phase (Figure-1c).

Bilateral emphysematous pyelitis: a rare encounter in urology.

Gas-forming infection of the kidneys can affect either the parenchyma or the collecting system. They are known as emphysematous pyelonephritis (EPN) and emphysematous pyelitis (EP) respectively. Bilateral EPN is a fairly established entity and numerous articles about this condition have been published. However, much less is known about bilateral EP. We report a rare case of bilateral EP and a literature review of this disease. A 66-year-old woman with long-standing bilateral staghorn calculi presented with bilateral EP and severe sepsis. She was treated with antibiotics and bilateral double-J stents to drain the upper urinary tracts. She recovered after 1 month of intensive care and medical therapy. Percutaneous nephrolithotomy (PCNL) had been scheduled to treat her staghorn calculi. A literature search on MEDLINE and Google Scholar with the terms "bilateral emphysematous pyelitis" only found 1 case report in English and another 2 reports in the Korean language that discussed bilateral EP. The collective experience of these few cases, including the present case, suggests that bilateral EP runs a more benign course than bilateral EPN. It should be diagnosed as soon as possible with computed tomography (CT) scans of the renal system. Current evidence shows that can be treated successfully with timely antibiotics. Drainage of the collecting system either percutaneously or with placement of double-J stents might facilitate recovery.

Emphysematous urinoma as a complication of emphysematous pyelitis in a healthy adult male.

Emphysematous pyelitis and urinomas are independently rare conditions. The former is a severe necrotizing infection involving the renal collecting system, the latter an encapsulated collection of urine in the perinephric or paraureteral space. An unusual case of emphysematous urinoma complicating emphysematous pyelitis in a healthy male adult is presented in this study.

Clinics in diagnostic imaging (138). Emphysematous pyelitis.

We present the case of a 49-year-old woman with poorly controlled diabetes mellitus of ten years' duration. She presented to the emergency department with nonspecific left lower abdominal pain. Ultrasonography showed mild left renal hydronephrosis, but the cause was not demonstrated. Computed tomography (CT) showed a swollen left kidney with a mildly dilated collecting system containing gas and dense fluid, confirming the diagnosis of emphysematous pyelitis. Management consisted of emergency antegrade nephrostomy drainage and parenteral antibiotics. Subsequently, the patient made a good recovery and was well when discharged home after two weeks. Gas-forming infections of the genitourinary tract carry high mortality and morbidity, and usually occur in patients with poorly controlled diabetes mellitus. Escherichia coli is the most common microorganism. This case emphasises the importance of CT in making an early diagnosis of emphysematous pyelitis, which allows prompt treatment and improves prognosis.

Alkaline-encrusted pyelitis and cystitis: an easily missed and life-threatening urinary infection.

Alkaline-encrusted pyelitis is a urinary infection characterised by encrustations in the wall of the urinary tract. It is caused by fastidious growing urea splitting microorganisms mainly Corynebacterium group D2. The diagnosis is easily missed and should be evoked on basis of sterile pyuria, alkaline urine pH and calcifications of the urinary excretion ways on the CT scan and then confirmed by prolonged culture on appropriate media. The authors report here the case of a patient who died after a delayed diagnosis from recurrent septic urinary infections.

[Encrusted pyelitis: early diagnosis facilitates conservative management]. / Pyélite incrustante: un diagnostic précoce facilite la prise en charge conservatrice.

Diagnosis of encrusted pyelitis in predisposed patients is difficult. The bacteriology laboratory must be specifically asked to perform the appropriate tests. Computed tomography without injection is very important for diagnosis and follow-up. Conservative treatment is essential insofar as possible. Long-term follow-up is also necessary.

[Ganglioneuroma revealed by complicated nephritic colic]. / Ganglioneurome rétropéritonéal révélé par une colique néphrétique compliquée.

INTRODUCTION: Ganglioneuroma is a rare benign nervous tumour frequently located in the retroperitoneal area. We report the case of a 22-year-old female patient where this tumour was revealed by nephritic colic complicated by pyelitis and kidney abscess. EXEGESIS: The patient presented with brutal feverish lumbar pains and urinary signs. Abundant iconography, in particular contrasted enhanced sonography, allowed to show a massive retroperitoneal lump and a puncture-biopsy indicated a ganglioneuroma which was surgically removed by laparotomy. Signs may be varied and misleading. Biological and radiological exams are useful for the diagnosis which can only be confirmed by the thorough histological examination of the removed sample. CONCLUSION: A large retroperitoneal lump without alteration of the patient's health should point to this diagnosis, since the complete surgical removal leads to recovery without recurrence, but all the other differential diagnoses must first be dismissed.

[Pneumopyocystitis in a patient with adult polycystic kidney disease]. / Pioneumoquistes en paciente con enfermedad poliquística del adulto.

OBJECTIVES: We present a case of adult polycystic kidney disease, also known as autosomal dominant polycystic kidney, complicated by infection of the cysts and the formation of gas within them. METHODS/RESULTS: A 59 year old patient diagnosed of adult polycystic kidney disease with chronic renal failure on treatment with haemodialysis, who presented sepsis secondary to infection of the renal cysts. The CT scan demonstrated the presence of gas within the cysts and the microbiology revealed E. coli in one of them. Urgent nephrectomy was performed. A histological specimen of the excised organ is also presented. CONCLUSIONS: Infection of one or more cysts in adult polycystic kidney disease is a rare and serious complication which may require immediate nephrectomy, particularly if gas appears within the cysts.

[Cystic pyeloureteritis and infection. Presentation forms and review of the literature]. / Pieloureteritis quística e infección. Formas de presentación y revisión de la literatura.

OBJECTIVE: To present three illustrative cases of pyeloureteritis cystica and review the literature. METHODS: Three illustrative cases diagnosed at our department are described. Patient history, clinical features, diagnostic procedures and treatment are analyzed and the literature is reviewed. RESULTS: Our patients had no specific symptoms. All three patients had urinary tract infection with pyeloureteral involvement, which was bilateral in two cases. One of these patients had a long-indwelling catheter. CONCLUSIONS: Pyeloureteritis cystica is a benign and uncommon condition whose etiology is not well-known. It is generally associated with chronic infection and inflammation, and may be difficult to distinguish from other filling defects of the urinary tract. Due to its benign nature, treatment must always be conservative and close follow-up is recommended.

Emphysematous cystitis and pyelitis in a diabetic renal transplant recipient.

Emphysematous cystitis is a rare complication of urinary tract infection. Patients with diabetes mellitus, neurogenic bladder, bladder outlet obstruction, and recurrent urinary tract infection are at increased risk for the disease. We present a case of emphysematous cystitis and pyelitis in a diabetic renal transplant recipient. He was treated with antibiotics alone with complete clinical and radiologic resolution. The clinical course was benign, as described in most patients. The prognosis of emphysematous cystitis is good after early diagnosis and prompt treatment with appropriate antibiotics, blood glucose control, and adequate urinary drainage.

[Cystic pyeloureteritis. A diagnosis to keep in mind]. / Pieloureteritis quística. Un diagnóstico a tener en cuenta.

OBJECTIVES: Cystic pyeloureteritis is a disease entity of unknown etiology and unspecific symptoms. It is incidentally detected and is difficult to distinguish from other disorders showing filling defects on urographic evaluation. All the foregoing prompted us to report the present case. METHODS/RESULTS: We report a case of cystic pyeloureteritis that had been diagnosed during ureterorenoscopy in a patient with lithiasis and recurrent urinary tract infection. The etiopathogenesis, diagnostic and therapeutic aspects described in the literature are briefly reviewed. CONCLUSIONS: We underscore the importance of confirming the diagnosis by endoscopic and cytological studies. Conservative management is advocated. Patient follow up should include urinalysis, urine culture and cytology twice yearly and intravenous urography once a year.

Co-existent renal replacement lipomatosis and pyelitis glandularis.

A 50 year old female was found to have a lump on the right side of abdomen with discharging wound on the same side and was ultrasonographically diagnosed as renal cell carcinoma. On histopathology, it showed replacement of the kidney by mature adipose tissue renal replacement lipomatosis, along with pyelitis glandularis which is a rare condition.

Exploration and endoscopic treatment of unilateral primary haematuria: is non-specific diffuse pyelitis a real entity?

Chronic unilateral primary haematuria is rare and raises difficult problems of diagnosis and treatment as most of the knowledge in this field has been based on a very limited number of patients. This clinical entity needs critical reevaluation as recent progress in endourological investigations has revealed that lesions other than the classical submucosal haemangioma are just as frequently responsible for unilateral primary haematuria. These endoscopic lesions have generally been poorly defined up to now and our data based on a retrospective review of 8 patients emphasises the persistent gaps in our understanding of the pathophysiology of this disease. Among the lesions responsible for unilateral primary haematuria, diffuse petachiae of the renal pelvis and cavities represent the most frequent endoscopic lesion described in our experience (50% of cases). Histologically, these diffuse lesions correspond to non-specific pyelitis, consisting of simple oedema of the lamina propria. In addition to its diagnostic role, endoscopy can also be used to effectively treat the lesions responsible for unilateral primary haematuria, using either electrocoagulation or nitrate cautery, provided a retrograde approach can be completed by a percutaneous approach, with an overall success rate of 75% of cases with a mean follow-up of 16 months.

Emphysematous pyelitis and emphysematous pyelonephritis characterized by computerized tomography.

We report three cases of emphysematous pyelonephritis, all of them associated with perinephric emphysema, and one case of emphysematous pyelitis to demonstrate the value of computerized tomography (CT) in both diagnosis and patient management. The differentiation between air in the collecting system (emphysematous pyelitis), air within the parenchyma (emphysematous pyelonephritis), and air in the perinephric space (perinephric emphysema) may have significant prognostic (survival) and therapeutic (medical vs surgical) implications. Computerized tomography is currently the best method for demonstrating intrarenal air and for characterizing the location of that air (intracalyceal, intraparenchymal, perinephric, or pararenal).

Open randomized controlled parallel study of ofloxacin versus trimethoprim-sulfamethoxazole treatment of lower respiratory tract and urinary infections.

A total of 60 patients with lower respiratory tract or urinary tract infections were enrolled in an open, randomized, controlled, parallel study comparing 300 mg ofloxacin (OFX) b.i.d. with trimethoprim + sulfamethoxazole (TMP 800 mg + SMX 160 mg), 1 tablet, b.i.d. The signs and symptoms of low respiratory tract infection were cured in 12 patients (80%) of the OFX group and improved in 2 other patients (13%); at the end of therapy, the 2 germs that persisted were Streptococcus pneumoniae and Branhamella catarrhalis. Clinical cure was achieved in 13 patients (86%) in the TMP-SMX group, while 2 patients were considered as failures (14%); after therapy, the 3 organisms that persisted were 2 S. pneumoniae and 1 Pseudomonas aeruginosa. As far as urinary tract infections are concerned clinical cure and complete eradication of bacteria were achieved in 14 patients in the OFX group (93%); the germ that persisted was Escherichia coli (100,000 CFU), but the patient was asymptomatic. In patients of the TMP-SMX group the urinary infections were cured in 11 subjects (73%); the germs that persisted were 2 E. coli and 1 Proteus mirabilis. Adverse effects were reported for 3 patients (10%) in the OFX group and 4 patients (13%) in the TMP-SMX group. The measurement of serum and intracellular (polymorphonuclear cells and lymphocytes) levels of OFX and TMP-SMX and the assessment of the host's immunocompetence ruled out the possibility of any immunotoxicological side effect.

[Emphysematous pyelitis and pyelonephritis: unrecognized clinical entities]. / Pyélite et pyélonéphrite emphysémateuses: entités cliniques méconnues.

A case of emphysematous pyelitis occurring in an old diabetic woman is described. The data of the literature about the pathologic agents, the epidemiology and the physiopathology of the disease are reviewed. The approach for diagnosis and the therapy are discussed.