RESUMO
Previous reports show increased severity of perinephric fat stranding (PFS) with elevated serum creatinine in obstructing ureterolithiasis. We sought to investigate this association with our institution's patient population.We reviewed charts of patients diagnosed with obstructive ureterolithiasis or nephrolithiasis in our emergency department between January and October 2018. Patient demographics, lab results, and computed tomography (CT) imaging were reviewed. A blinded radiologist reviewed all CTs and graded hydronephrosis and PFS. Subjects were stratified by degree of PFS and compared via paired t-test, chi-squared test, univariate analysis, and multivariate analysis.We identified 141 patients; 114 had no-mild (Group 1) PFS, while 27 had moderate-severe (Group 2) PFS. Group 1 had a mean age of 56 (SD = 16.1) and mean stone size of 7.3 mm (SD = 4.22); 77% of the cohort had symptoms under 24 h. Group 2 was older with a mean age of 65 (SD = 16.2, p = 0.01) and mean stone size of 10.1 mm (SD = 6.07, p < 0.01); 50% had symptoms less than 24 h (p = 0.01). PFS did not correlate with change in serum creatinine. Univariate and multivariate analysis showed increasing age increased the odds of moderate-severe PFS by 3.5% (OR = 1.035, p < 0.05) while increased stone size increased the odds of moderate-severe PFS by 13.7% (OR = 1.137, p = 0.01).Although increased PFS correlated with increased age and stone size, no correlation was found with presenting creatinine or change in creatinine. Degree of PFS is likely a poor predictor of renal disease severity in acute ureterolithiasis.
Assuntos
Creatinina , Humanos , Pessoa de Meia-Idade , Feminino , Masculino , Creatinina/sangue , Idoso , Estudos Retrospectivos , Fatores Etários , Adulto , Obstrução Ureteral/sangue , Obstrução Ureteral/complicações , Obstrução Ureteral/etiologia , Ureterolitíase/complicações , Ureterolitíase/sangue , Tomografia Computadorizada por Raios X , Índice de Gravidade de Doença , Tecido Adiposo/diagnóstico por imagem , Tecido Adiposo/patologia , Rim/diagnóstico por imagem , Rim/patologiaRESUMO
BACKGROUND: Point-of-care ultrasound (PoCUS) is commonly utilized in the setting of renal colic. The presence of perinephric fluid may be an overlooked finding associated with ureteral obstruction. Our aims were to determine the prevalence of perinephric fluid on emergency physician-performed PoCUS and to determine whether perinephric fluid was associated with stone size or urologic intervention. METHODS: This was a 12-month cross-sectional study at an academic emergency department (ED) that took place from January 1, 2022, to December 31, 2022. All adult ED patients ≥18 years of age who had a renal PoCUS examination performed were included. Patients with missing or inadequate PoCUS images were excluded. Investigators blinded to PoCUS images and interpretations performed chart review for demographic data and outcome variables, while separate investigators blinded to clinical data reviewed PoCUS images to assess for perinephric fluid and hydronephrosis. A chi-square analysis was used to determine significance of association between perinephric fluid and outcome variables (stone size, urologic intervention). RESULTS: There were 442 patients screened; 18 were excluded due to inadequate images and 4 were repeat visits of which only the initial visit was analyzed. Of the remaining 420 patients included, the prevalence of perinephric fluid was 6.2% (n = 26). Most patients (23/26) with perinephric fluid had final diagnoses consistent with ureterolithiasis. Hydronephrosis was present in 115 of the 420 patients (27.4%) and of these, 22 (19.1%) had perinephric fluid which was significantly associated with a need for urologic intervention; odds ratio (OR) 10.38 (95% CI 2.70-39.85), p < 0.01. Among the 67 patients with confirmed ureterolithiasis on computed tomography, perinephric fluid was associated with stone size ≥5 mm; OR 4.00 (95% CI 1.01-15.85), p = 0.04. CONCLUSION: The prevalence of perinephric fluid on emergency physician-performed renal PoCUS was 6.2% of all studies and 19.1% of patients with hydronephrosis. In the setting of ureterolithiasis, perinephric fluid was associated with larger stone size and need for urologic intervention.
Assuntos
Hidronefrose , Ureterolitíase , Adulto , Humanos , Sistemas Automatizados de Assistência Junto ao Leito , Prevalência , Estudos Transversais , Hidronefrose/diagnóstico por imagem , Hidronefrose/epidemiologia , Hidronefrose/complicações , Ureterolitíase/complicações , Ultrassonografia/métodos , Serviço Hospitalar de Emergência , Estudos RetrospectivosRESUMO
BACKGROUND: Inadequate antibiotic coverage in septic patients is associated with higher morbidity and mortality. This multicentric study reports antibiotic susceptibility in patients with ureterolithiasis-associated urosepsis, aiming to propose an optimal empirical therapy for this disease in the Chilean population. METHODS: The prospective cohort study included patients from 7 Chilean hospitals who presented with ureterolithiasis and met sepsis criteria. We analyzed demographic data, vital signs at admission, and microbiological and radiological exams. We used descriptive statistics for the analysis of collected data. RESULTS: Initially, the study included 119 patients; 52 met the inclusion criteria. 77% were female, with a mean age of 52. 100% of the cohort had a urine culture taken at admission, whereas 48,7% had blood cultures. Escherichia Coli was the most common microorganism (73%), followed by Proteus Mirabilis (9.6%) and Klebsiella Pneumoniae (3.9%). Only two patients presented gram-positive pathogens. 100% of gram-negative bacteria were sensible to amikacin. CONCLUSION: The microorganisms found in our cohort were similar to those in international reports. Since the highest level of susceptibility was for amikacin, we propose its use as empirical therapy for urosepsis associated with ureterolithiasis in Chile. It is always necessary to consider the potential nephrotoxic effects of amikacin. An association of beta-lactams and glycopeptides should be considered in patients with risk factors for enterococcal infections.
Assuntos
Antibacterianos , Testes de Sensibilidade Microbiana , Sepse , Infecções Urinárias , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Antibacterianos/uso terapêutico , Antibacterianos/efeitos adversos , Chile/epidemiologia , Sepse/tratamento farmacológico , Sepse/microbiologia , Adulto , Idoso , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia , Ureterolitíase/complicações , Ureterolitíase/tratamento farmacológicoRESUMO
A 4-month-old, 7 kg, intact male, Bernese mountain dog was presented for obstructive struvite ureterolithiasis. Multiple urethroliths, ureteroliths, and urocystoliths were present. Based on an abdominal ultrasound, there was severe left hydronephrosis and hydroureter from distal ureterolith obstruction, just proximal to the vesicoureteral junction. The dog was not azotemic. Successful treatment was accomplished via ventral cystotomy. Bladder wall culture revealed a methicillin-resistant Staphylococcus spp. No predisposing cause was identified. There are no known genetic predispositions in Bernese mountain dogs for struvite urolithiasis. The urinary tract infection resolved with surgical retrieval of the uroliths and antibiotic treatment. The dog remained clinically normal after the cystotomy but developed a subclinical urinary tract infection 4 mo post-operatively. Key clinical message: Urolithiasis is rare in pediatric veterinary patients. To the authors' knowledge, this is the first report of obstructive ureterolithiasis in a puppy. There is no known genetic predisposition for urolithiasis in Bernese mountain dogs.
Urétérolithiase obstructive à struvite chez un bouvier bernois mâle intact de 4 mois. Un bouvier bernois mâle intact de 4 mois, pesant 7 kg, a été présenté pour une urétérolithiase obstructive à struvite. De multiples urétrolithes, urétérolithes et urocystolithes étaient présents. Sur la base d'une échographie abdominale, il y avait une hydronéphrose gauche sévêre et un hydro-uretêre dû à une obstruction distale de l'urétérolithe, juste en amont de la jonction vésico-urétérale. Le chien n'était pas azotémique. Le succês du traitement a été obtenu par cystotomie ventrale. La culture de la paroi vésicale a révélé un Staphylococcus spp. résistant à la méticilline. Aucune cause prédisposante n'a été identifiée. Il n'y a pas de prédisposition génétique connue chez les bouviers bernois pour la lithiase urinaire à struvite. L'infection des voies urinaires s'est résolue avec l'extraction chirurgicale des urolithes et un traitement antibiotique. Le chien est resté cliniquement normal aprês la cystotomie mais a développé une infection subclinique des voies urinaires 4 mois aprês l'opération.Message clinique clé:La lithiase urinaire est rare chez les patients vétérinaires pédiatriques. À la connaissance des auteurs, il s'agit du premier rapport d'urétérolithiase obstructive chez un chiot. Il n'y a pas de prédisposition génétique connue pour la lithiase urinaire chez les bouviers bernois.(Traduit par Dr Serge Messier).
Assuntos
Doenças do Cão , Staphylococcus aureus Resistente à Meticilina , Ureterolitíase , Infecções Urinárias , Urolitíase , Animais , Doenças do Cão/genética , Doenças do Cão/cirurgia , Cães , Feminino , Humanos , Masculino , Estruvita , Ureterolitíase/complicações , Ureterolitíase/cirurgia , Ureterolitíase/veterinária , Infecções Urinárias/complicações , Infecções Urinárias/veterinária , Urolitíase/cirurgia , Urolitíase/veterináriaRESUMO
In patients with symptomatic ureterolithiasis, immediate treatment of concomitant urinary tract infection (UTI) may prevent sepsis. However, urine cultures require at least 24 h to confirm or exclude UTI, and therefore, clinical variables may help to identify patients who require immediate empirical broad-spectrum antibiotics and surgical intervention. Therefore, we divided a consecutive cohort of 705 patients diagnosed with symptomatic ureterolithiasis at a single institution between 2011 and 2017 into a training (80%) and a testing cohort (20%). A machine-learning-based variable selection approach was used for the fitting of a multivariable prognostic logistic regression model. The discriminatory ability of the model was quantified by the area under the curve (AUC) of receiver-operating curves (ROC). After validation and calibration of the model, a nomogram was created, and decision curve analysis (DCA) was used to evaluate the clinical net-benefit. UTI was observed in 40 patients (6%). LASSO regression selected the variables elevated serum CRP, positive nitrite, and positive leukocyte esterase for fitting of the model with the highest discriminatory ability. In the testing cohort, model performance evaluation for prediction of UTI showed an AUC of 82 (95% CI 71.5-95.7%). Model calibration plots showed excellent calibration. DCA showed a clinically meaningful net-benefit between a threshold probability of 0 and 80% for the novel model, which was superior to the net-benefit provided by either one of its singular components. In conclusion, we developed and internally validated a logistic regression model and a corresponding highly accurate nomogram for prediction of concomitant positive midstream urine culture in patients presenting with symptomatic ureterolithiasis.
Assuntos
Nomogramas , Ureterolitíase , Feminino , Humanos , Modelos Logísticos , Masculino , Prognóstico , Fatores de Risco , Ureterolitíase/complicações , Ureterolitíase/diagnósticoRESUMO
A neutered female cat presented with a 9-day history of hyporexia and depression. The referring veterinarian had identified moderate non-regenerative anaemia, haematuria and suspected unilateral obstructive ureterolithiasis. Subsequent ultrasonography revealed moderate distension of the left renal pelvis with echogenic material, ureteral distension and ureterolithiasis. A partial ureteral obstruction was suspected. After 4 days of medical management, there was further distension of the renal pelvis with well-delineated echogenic material and an accumulation of perinephric fluid. A left nephroureterectomy was performed. Renal pelvic rupture with intrapelvic haematoma and retroperitoneal haemorrhage was confirmed by histopathology. Eighteen months following surgery, the cat remained clinically well with normal renal values.
Assuntos
Ureter , Obstrução Ureteral , Ureterolitíase , Animais , Feminino , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Hematoma/veterinária , Pelve Renal , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/cirurgia , Obstrução Ureteral/veterinária , Ureterolitíase/complicações , Ureterolitíase/diagnóstico por imagem , Ureterolitíase/cirurgia , Ureterolitíase/veterináriaRESUMO
PURPOSE OF REVIEW: Better understanding of sex differences affecting urolithiasis may help us offer tailored treatment strategies to our patients. RECENT FINDINGS: The incidence of urolithiasis is increasing and the male-to-female ratio has decreased from 3â:â1 to 1.3â:â1 between 1970 and 2000. In women, obesity has a larger effect on the risk of developing urolithiasis [odds ratio (OR) 1.35; 95% confidence interval (CI): 1.33-1.37] compared with men (OR 1.04; 95% CI: 1.02-1.06). Urolithiasis is a risk factor for coronary artery disease in men (risk ratioâ=â1.23; 95% CI: 1.02-1.49) and for stroke in women (risk ratioâ=â1.12; 95% CI: 1.03-1.21). Women tolerate cystoscopic stent removal and shock wave lithotripsy better than men. For shock wave lithotripsy menopaused women have reported lower visual analog scale scores than menstruating women (Pâ<â0.001). Female sex was an independent predictor of stone impaction (OR 1.15; 95% CI: 1.03-1.27) and postoperative sepsis after ureteroscopy (OR 2.31; 95% CI: 1.14-4.37). SUMMARY: The sex gap in urolithiasis is closing. The changing role of women in society and dietary habits can be responsible for this epidemiologic shift. Women show a higher threshold for pain during urologic procedures, but they suffer from infectious complications more than men. Urolithiasis is a risk factor for cardiovascular events in both sexes.
Assuntos
Cálculos Renais/terapia , Litotripsia , Nefrolitíase/terapia , Cálculos Ureterais/terapia , Ureterolitíase/terapia , Doenças Cardiovasculares/etiologia , Cistoscopia , Feminino , Humanos , Cálculos Renais/complicações , Litotripsia/efeitos adversos , Litotripsia/métodos , Masculino , Nefrolitíase/complicações , Fatores Sexuais , Resultado do Tratamento , Cálculos Ureterais/complicações , Ureterolitíase/complicações , UreteroscopiaRESUMO
Direct hemoperfusion with polymyxin B-immobilized fiber (PMX-DHP) has been widely used for severe sepsis and septic shock. However, data are limited regarding the clinical experience and efficacy of PMX-DHP for septic shock resulting from urinary tract infection (UTI). At our institution, 15 patients with septic shock resulting from a UTI received PMX-DHP from January 2013 to July 2017. The cause of the urosepsis was mainly obstructive pyelonephritis secondary to ureterolithiasis or neurogenic bladder. Average Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores were 25.9 ± 4.3 and 10.5 ± 2.2, respectively. If patients were still hypotensive after initial resuscitation, we began PMX-DHP. Mean arterial pressure increased significantly from 58.3 ± 9.6 mm Hg to 93.6 ± 14.8 mm Hg just after PMX-DHP and to 94.7 ± 16.9 mm Hg (P < 0.0001) 24 h after the treatment. Catecholamine index decreased significantly from 20.7 ± 11.3 to 9.3 ± 13.5 (P = 0.0001) 24 h after the treatment. Of 15 patients, 14 (93.3%) had survived 28 days after admission. Our results suggest a possible role for PMX-DHP in the rapid stabilization of hemodynamics in patients with septic shock with an underlying UTI. These patients may be good candidates for PMX-DHP.
Assuntos
Hemodinâmica/efeitos dos fármacos , Hemoperfusão/métodos , Polimixina B/farmacologia , Choque Séptico , Infecções Urinárias , APACHE , Idoso , Antibacterianos/farmacologia , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Pielonefrite/complicações , Choque Séptico/diagnóstico , Choque Séptico/etiologia , Choque Séptico/terapia , Resultado do Tratamento , Ureterolitíase/complicações , Bexiga Urinaria Neurogênica/complicações , Infecções Urinárias/diagnóstico , Infecções Urinárias/etiologia , Infecções Urinárias/fisiopatologia , Infecções Urinárias/terapiaRESUMO
Acute flank pain from suspected urolithiasis is a common presenting complaint in the Emergency Department. Multiple computed tomography (CT) has traditionally been the standard imaging modality used to diagnose obstructive kidney stones, however point of care ultrasound (PoCUS) can play an important role in the diagnostic algorithm and risk stratification of acute flank pain. Here, we present the case of a 29-year-old female with suspected urolithiasis, who underwent PoCUS that revealed right-sided hydronephrosis and normal left kidney, bladder, and aorta. A subsequent KUB was negative. As the clinical course failed to improve with therapy, an abdominal and pelvic CT was ordered revealing a 5 mm distal obstructing ureteric calculus at the right vesico-ureteric junction and another 5 mm left mid ureteric calculus. To the best of our knowledge, this is the first case in which a patient presenting with acute right-sided flank pain demonstrated unilateral hydronephrosis on PoCUS, but had clinically significant bilateral ureteric stones on CT. Emergency physicians who employ PoCUS for evaluation of flank pain must be aware of its benefits and drawbacks and how they apply to each patient. As such, we have developed a script emergency physicians can use for shared decision-making with renal colic patients when deciding on the appropriate imaging modality.
Assuntos
Serviço Hospitalar de Emergência , Cólica Renal/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Ureterolitíase/diagnóstico , Adulto , Diagnóstico Diferencial , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Humanos , Sistemas Automatizados de Assistência Junto ao Leito , Cólica Renal/etiologia , Ureterolitíase/complicaçõesAssuntos
Amicacina/farmacologia , Antibacterianos/farmacologia , Escherichia coli/efeitos dos fármacos , Sepse/urina , Infecções Urinárias/urina , Adolescente , Adulto , Idoso , Hemocultura , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Prospectivos , Sepse/sangue , Sepse/etiologia , Ureterolitíase/complicações , Infecções Urinárias/sangue , Infecções Urinárias/etiologia , Adulto JovemRESUMO
Inguinal hernias containing a kidney or perinephric tissue are extremely rare and usually related to cases involving a kidney positioned in the pelvis. We report the case of a 79-year-old man who presented with abdominal pain and scrotal swelling. He was found on imaging to have an inferiorly displaced kidney with an inguinal herniation of Gerota fascia, as well as an obstructing ureteral stone with an associated forniceal rupture. The unusual renal anatomy, as well as the management of a forniceal rupture, is discussed.
Assuntos
Hérnia Inguinal/etiologia , Nefropatias/etiologia , Ureterolitíase/complicações , Dor Abdominal/etiologia , Idoso , Hérnia Inguinal/diagnóstico por imagem , Humanos , Nefropatias/diagnóstico por imagem , Masculino , Ruptura Espontânea/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Obstrução Ureteral/complicações , Ureterolitíase/diagnóstico por imagemRESUMO
INTRODUCTION: Urolithiasis is a common medical condition that accounts for a large number of emergency department (ED) visits each year and contributes significantly to annual healthcare costs. Urinalysis is an important screening test for patients presenting with symptoms suspicious for urolithiasis. At present there is a paucity of medical literature examining the characteristics of ureteral stones in patients who have microscopic hematuria on urinalysis versus those who do not. The purpose of this study was to examine mean ureteral stone size and its relationship to the incidence of clinically significant hydronephrosis in patients with and without microscopic hematuria. METHODS: This is a retrospective chart review of patient visits to a single, tertiary academic medical center ED between July 1, 2008, and August 1, 2013, of patients who underwent non-contrast computed tomography of the abdomen and pelvis and urinalysis. For patient visits meeting inclusion criteria, we compared mean stone size and the rate of moderate-to-severe hydronephrosis found on imaging in patients with and without microscopic hematuria on urinalysis. RESULTS: Out of a total of 2,370 patient visits 393 (16.6%) met inclusion criteria. Of those, 321 (82%) had microscopic hematuria present on urinalysis. Patient visits without microscopic hematuria had a higher rate of moderate-to-severe hydronephrosis (42%), when compared to patients with microscopic hematuria present (25%, p=.005). Mean ureteral stone size among patient visits without microscopic hematuria was 5.7 mm; it was 4.7 mm for those patients with microscopic hematuria (p=.09). For ureteral stones 5 mm or larger, the incidence of moderate-to-severe hydronephrosis was 49%, whereas for ureteral calculi less than 5 mm in size, the incidence of moderate-to-severe hydronephrosis was 14% (p < 0.0001). CONCLUSION: Patients visiting the ED with single-stone ureterolithiasis without microscopic hematuria on urinalysis could be at increased risk of having moderate-to-severe hydronephrosis compared to similar patients presenting with microscopic hematuria on urinalysis. Although the presence of hematuria on urinalysis is a moderately sensitive screening test for urolithiasis, these results suggest patients without hematuria tend to have more clinically significant ureteral calculi, making their detection more important. Clinicians should maintain a high index of suspicion for urolithiasis, even in the absence of hematuria, since ureteral stones in these patients were found to be associated with a higher incidence of obstructive uropathy.
Assuntos
Hematúria/urina , Hidronefrose/diagnóstico por imagem , Urolitíase/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência , Feminino , Hematúria/etiologia , Humanos , Hidronefrose/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Cálculos Ureterais/complicações , Cálculos Ureterais/diagnóstico por imagem , Cálculos Ureterais/urina , Ureterolitíase/complicações , Ureterolitíase/diagnóstico , Ureterolitíase/diagnóstico por imagem , Ureterolitíase/urina , Urolitíase/complicações , Urolitíase/diagnóstico por imagem , Urolitíase/urina , Adulto JovemRESUMO
Background: Early inappropriate antibiotic therapy for the management of urosepsis is associated with higher mortality. Therefore, to establish an adequate empirical therapy is crucial. Aim: To determine an optimal antibiotic treatment, adjusted according local bacterial resistance in patients diagnosed with urosepsis secondary to ureteral lithiasis. Material and Methods: Urine cultures and blood cultures from a prospective cohort of patients with ureteral lithiasis admitted for urosepsis in our center between November 2013 and May 2016, were reviewed. Patients who presented two or more criteria of systemic inflammatory response syndrome (SIRS) and positive blood or urine cultures were admitted. Antimicrobial sensitivity patters derived from cultures were analyzed to describe bacterial susceptibility to commonly used antibiotics. Results: Data from 31 patients were analyzed. Seventeen blood cultures (55%) and 29 urine cultures (94%) were positive. The most commonly isolated pathogens were Escherichia coli in 65% of the cultures, followed by Klebsiella pneumoniae, Proteus mirabilis and Enterococcus faecalis. After performing an analysis of sensitivity and resistance for all bacteria in both blood and urine cultures, amikacin showed the highest sensitivity (100%), followed by 2nd and 3rd generation cephalosporins. Conclusions: Amikacin demonstrated higher antibiotic sensitivity in comparison to other antibiotics for empirical management of patients with urosepsis secondary to ureteral lithiasis.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Infecções Urinárias/urina , Amicacina/farmacologia , Sepse/urina , Escherichia coli/efeitos dos fármacos , Antibacterianos/farmacologia , Infecções Urinárias/etiologia , Infecções Urinárias/sangue , Testes de Sensibilidade Microbiana , Estudos Prospectivos , Sepse/etiologia , Sepse/sangue , Ureterolitíase/complicações , HemoculturaRESUMO
ABSTRACT A 34 year-old woman was admitted to our hospital with left flank pain. A non-contrast enhanced computerized tomography (NCCT) revealed a 1.5x2cm left proximal ureter stone. Patient was scheduled for ureterorenoscopy (URS) and stone removal. She was submitted to retrograde intrarenal surgery (RIRS). At the postoperative 1st day, the patient began to suffer from left flank pain. A NCCT was taken, which revealed a subcapsular hematoma and perirenal fluid. The patient was managed conservatively with intravenous fluid, antibiotic and non-steroidal anti-inflammatory drug therapy and was discharged at the postoperative 6th day. Two weeks after the discharge the patient was admitted to emergency department with severe left flank pain, palpitation and malaise. KUB (kidney-ureter-bladder) radiography showed double-J stent (DJS) to be repositioned to the proximal ureter. Patient was evaluated with contrast enhanced CT which revealed an 8cm intraparenchymal hematoma/abscess in the middle part of the kidney. A percutaneous drainage catheter was inserted into the collection. The percutaneous drainage catheter and the DJS were removed at the 10th day of second hospitalization. RIRS surgery is an effective and feasible choice for renal stones with high success and acceptable complication rates. However, clinician should be alert to possible complications.
Assuntos
Humanos , Feminino , Adulto , Ureteroscopia/efeitos adversos , Ureteroscópios/efeitos adversos , Ureterolitíase/cirurgia , Tecido Parenquimatoso/lesões , Hematoma/etiologia , Nefropatias/etiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Pressão , Stents/efeitos adversos , Ureterolitíase/complicações , Tecido Parenquimatoso/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Nefropatias/diagnóstico por imagemRESUMO
A 34 year-old woman was admitted to our hospital with left flank pain. A non-contrast enhanced computerized tomography (NCCT) revealed a 1.5x2cm left proximal ureter stone. Patient was scheduled for ureterorenoscopy (URS) and stone removal. She was submitted to retrograde intrarenal surgery (RIRS). At the postoperative 1st day, the patient began to suffer from left flank pain. A NCCT was taken, which revealed a subcapsular hematoma and perirenal fluid. The patient was managed conservatively with intravenous fluid, antibiotic and non-steroidal anti-inflammatory drug therapy and was discharged at the postoperative 6th day. Two weeks after the discharge the patient was admitted to emergency department with severe left flank pain, palpitation and malaise. KUB (kidney-ureter-bladder) radiography showed double-J stent (DJS) to be repositioned to the proximal ureter. Patient was evaluated with contrast enhanced CT which revealed an 8cm intraparenchymal hematoma/abscess in the middle part of the kidney. A percutaneous drainage catheter was inserted into the collection. The percutaneous drainage catheter and the DJS were removed at the 10th day of second hospitalization. RIRS surgery is an effective and feasible choice for renal stones with high success and acceptable complication rates. However, clinician should be alert to possible complications.
Assuntos
Hematoma/etiologia , Nefropatias/etiologia , Tecido Parenquimatoso/lesões , Complicações Pós-Operatórias , Ureterolitíase/cirurgia , Ureteroscópios/efeitos adversos , Ureteroscopia/efeitos adversos , Adulto , Feminino , Hematoma/diagnóstico por imagem , Humanos , Nefropatias/diagnóstico por imagem , Tecido Parenquimatoso/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Pressão , Stents/efeitos adversos , Ureterolitíase/complicaçõesRESUMO
Ureterolithiasis is one of the most frequently diagnosed urologic diseases worldwide. Its annual incidence in Japan increased three-fold from 1965 to 2005. Ureterolithiasis incidence is affected by numerous factors, including race, sex, body weight, fluid intake, and climate. Here, we aimed to address the latter by considering the effect of seasonal variation on stone incidence and incorporating this information into a predictive model for differential diagnosis of ureteral stone from other conditions with similar presentations. We retrospectively identified 491 patients in our emergency department computer database who complained of back, flank, or lower abdominal pain during 2007-2015. Among them, 358 had stones, as confirmed by computerized tomography or plain abdominal X-ray of kidney-ureter-bladder. We also charted the mean ambient temperatures in our city for a year. The cases of ureteral stones paralleled the ambient temperatures, peaking during the hottest weather. Univariate analysis identified 13 factors associated with ureteral stones. Multivariate analysis narrowed the number to eight: age <60 years, male sex, short duration of pain (<6 h), nausea/vomiting, hydronephrosis, hematuria, history of urinary stone(s), and summer (July-September in Japan). Pain appearing during summer was nine times more likely to be due to a ureteral stone than was pain appearing during other seasons. We incorporated the eight variables identified into a predictive logistic regression model, which yielded good prediction of ureteral stones. Awareness that hot weather is associated with increased incidence of ureterolithiasis could facilitate differential diagnosis, and our prediction model could be useful for screening for ureterolithiasis.
Assuntos
Cólica Renal/diagnóstico , Cólica Renal/etiologia , Estações do Ano , Ureterolitíase/complicações , Ureterolitíase/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Cólica Renal/epidemiologia , Estudos Retrospectivos , Cálculos Ureterais/complicações , Cálculos Ureterais/epidemiologia , Adulto JovemRESUMO
PURPOSE: Although the course of the ureter is described as a straight descent in the retroperitoneum, kinking of the upper ureter is often seen at imaging. The aim of this study was to investigate kinking of the ureter and its underlying anatomico-clinical significance. METHODS: We evaluated 176 computed tomography (CT) images and classified kinking into three grades: no/mild kinking as Grade 1, moderate as Grade 2, and severe as Grade 3. We defined the "crossing point" (CP) as where the ureter crosses over the gonadal vein and assessed its relation to the kinking. Fourteen halves from seven cadavers were used for examination. Approaching anteriorly, we macroscopically observed the ureter and surrounding structures. RESULTS: On CT, the rate of the radiologically "significant" kinking classified into either Grade 2 or 3 was 18.4 % on the right and 21.8 % on the left. All kinking was either at or above the level of the CP. In cadavers, the ureter was relatively mobile in the perirenal fat and then beginning at approximately the level of the CP became firmly fixed to the anteromedial aspect of the psoas major muscle. CONCLUSIONS: Kinking of the upper ureter is not a clinically significant finding and arises from the ureter having a relatively mobile portion in the perirenal space compared to its caudal portion. The fixation boundary can be identified by observing the CP.
Assuntos
Ureter/diagnóstico por imagem , Ureter/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cadáver , Dissecação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Psoas/anatomia & histologia , Músculos Psoas/diagnóstico por imagem , Radiografia Abdominal , Espaço Retroperitoneal , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Cálculos Ureterais/etiologia , Obstrução Ureteral/etiologia , Ureterolitíase/complicações , Urografia , Adulto JovemRESUMO
A 51-year-old Japanese woman developed candidemia as an outpatient secondary to a Candida albicans upper urinary tract infection complicated by previously undiagnosed type 2 diabetes mellitus with poor glycemic control and ureterolithiasis. The patient did not have any risk factors typically associated with candidemia, such as an indwelling vascular catheter, parenteral nutrition or broad-spectrum antibiotic use. During the clinical course, her condition was complicated by unilateral candida endophthalmitis, which progressed despite the administration of systemic antifungal agents and ultimately required vitreous surgery. The etiology of candidemia in this patient and the reason she developed progressive ocular symptoms after starting antifungal treatment are reviewed.
Assuntos
Candidemia/etiologia , Endoftalmite/etiologia , Infecções Urinárias/complicações , Antifúngicos/uso terapêutico , Glicemia , Candida albicans , Candidemia/tratamento farmacológico , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Nutrição Parenteral Total , Fatores de Risco , Ureterolitíase/complicações , Infecções Urinárias/microbiologiaRESUMO
INTRODUCTION: Determining which patients with ureterolithiasis are likely to require urologic intervention is a common challenge in the emergency department (ED). The objective was to determine if normal renal sonogram could identify low-risk renal colic patients, who were defined as not requiring urologic intervention within 90 days of their initial ED visit and can be managed conservatively. METHODS: This was a prospective cohort study involving adult patients presenting to the EDs of a tertiary care centre with suspected renal colic over a 20-month period. Renal ultrasonography (US) was performed in the diagnostic imaging department by trained ultrasonographers, and the results were categorized into four mutually exclusive groups: normal, suggestive of ureterolithiasis, visualized ureteric stone, or findings unrelated to urolithiasis. Electronic medical records were reviewed to determine if patients received urologic intervention within 90 days of their ED visit. RESULTS: Of 610 patients enrolled, 341 (55.9%) had US for suspected renal colic. Of those, 105 (30.8%) were classified as normal; none of these patients underwent urologic intervention within 90 days of their ED visit. Ninety (26.4%) US results were classified as suggestive, and nine (10%) patients received urologic intervention. A total of 139 (40.8%) US results were classified as visualized ureteric stone, and 34 (24.5%) patients had urologic intervention. Seven (2.1%) US results were classified as findings unrelated to urolithiasis, and none of these patients required urologic intervention. The rate of urologic intervention was significantly lower in those with normal US results (p<0.001) than in those with abnormal findings. CONCLUSION: A normal renal sonogram predicts a low likelihood for urologic intervention within 90 days for adult ED patients with suspected renal colic.