RESUMO
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
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
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
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
Staphylococcus saprophyticus is a well-known cause of uncomplicated urinary tract infections, especially in young and sexually active women. Presence in blood cultures is rare and often attributed to contamination. When bacteremia is significant, it occurs mostly in patients with hematologic malignancies and is predominantly catheter-related. However, we describe a case of significant bacteremia with S. saprophyticus associated with urinary tract infection after extracorporeal shock wave lithotripsy of an ureterolithiasis in an otherwise healthy patient.
Assuntos
Ciprofloxacina/administração & dosagem , Litotripsia/efeitos adversos , Infecções Estafilocócicas , Staphylococcus saprophyticus , Ureterolitíase/complicações , Infecções Urinárias , Antibacterianos/administração & dosagem , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Bacteriemia/etiologia , Feminino , Humanos , Litotripsia/métodos , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Radiografia , Infecções Estafilocócicas/sangue , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/urina , Staphylococcus saprophyticus/efeitos dos fármacos , Staphylococcus saprophyticus/isolamento & purificação , Resultado do Tratamento , Ureterolitíase/diagnóstico por imagem , Ureterolitíase/fisiopatologia , Ureterolitíase/terapia , Infecções Urinárias/sangue , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/etiologia , Infecções Urinárias/microbiologia , Infecções Urinárias/urinaRESUMO
BACKGROUND AND PURPOSE: The outcomes of ureteroscopy (URS) after urgent decompression and antibiotics for patients who initially present with urosepsis because of obstructive urolithiasis have not been previously evaluated. The aim of this study was to compare the outcomes and complications of URS in patients with a recent history of sepsis with those without sepsis. METHODS: The study included 138 patients who underwent URS for stone removal from January 2004 to September 2011 at a university medical center. A matched-pair analysis was performed using three parameters (age, sex, and race) to compare outcomes and complications between 69 patients who had sepsis vs a matched cohort who did not have sepsis before URS. RESULTS: The study included 138 patients, 88 (64%) females and 50 (36%) males with a median age of 57.5 years (range 18-88 years). Patients with previous sepsis had similar patient characteristics and stone-free rates (81% vs 77%) compared with patients without previous sepsis (P>0.05). Patients with previous sepsis, however, had a significantly higher complications rate (20% vs 7%), longer hospital length of stay (LOS), and longer courses of postoperative antibiotics after URS (P<0.05). Sepsis developed postoperatively in two patients with diabetes (one with and one without previous sepsis), and postoperative fever developed in five patients with previous sepsis. CONCLUSIONS: URS after decompression for urolithiasis-related sepsis has similar success but higher complication rates, greater LOS, and longer course of postoperative antibiotics. This is important in counseling patients who present for definitive URS after urgent decompression for urolithiasis-related sepsis.
Assuntos
Antibacterianos/uso terapêutico , Litotripsia , Sepse/terapia , Obstrução Ureteral/cirurgia , Ureterolitíase/cirurgia , Ureteroscopia , Infecções Urinárias/terapia , Centros Médicos Acadêmicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Tempo de Internação , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Sepse/etiologia , Resultado do Tratamento , Obstrução Ureteral/complicações , Ureterolitíase/complicações , Infecções Urinárias/etiologia , Adulto JovemRESUMO
The aim of this study is to compare two major urological procedures in terms of patient exposure to radiation. We evaluated 175 patients, that were subjected to retrograde ureteroscopy (URS) and extracorporeal shock waves lithotripsy (ESWL) for lumbar or pelvic ureteral lithiasis, at two urological departments. The C-arm Siemens (produced in 2010 by Siemens AG, Germany) was used for ureteroscopy. The radiological devices of the lithotripters used in this study in the two clinical centers had similar characteristics. We evaluated patient exposure to ionizing radiation by using a relevant parameter, the air kerma-area product (PKA; all values in cGy cm(2)), calculated from the radiation dose values recorded by the fluoroscopy device. PKA depends on technical parameters that change due to anatomical characteristics of each case examined, such as body mass index (BMI), waist circumference, and stone location. For the patients subjected to ESWL for lumbar ureteral lithiasis the mean of PKA (cGy cm(2)) was 509 (SD=180), while for those treated for pelvic ureteral lithiasis the mean of PKA was 342 (SD=201). In the URS group for lumbar ureteral lithiasis, the mean of PKA (cGy cm(2)) was 892 (SD=436), while for patients with pelvic ureteral lithiasis, the mean of PKA was 601 (SD=429). The patients treated by URS had higher exposure to ionizing radiation dose than patients treated by ESWL. The risk factors of higher radiation doses were obesity, exposure time, and localization of the stones.
Assuntos
Litotripsia , Ureterolitíase/diagnóstico por imagem , Ureterolitíase/terapia , Ureteroscopia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fluoroscopia , Humanos , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Pelve , Estudos Prospectivos , Doses de Radiação , Ureterolitíase/complicações , Adulto JovemRESUMO
Summary Hutch diverticula are rare congenital diverticula. The general consensus is that they occur secondary to a congenital failure of normal muscle development around the ureteral orifice where Waldeyer sheath anatomically covers the space between the intravesical ureter and muscular layer of the bladder. Our case highlights the radiological appearance of Hutch diverticula and the need for contrast-enhanced imaging to enable accurate evaluation and diagnosis. It illustrates how the presence of periureteric diverticula can contribute to ureteric obstruction and calculus formation; complicate the interpretation of renal tract imaging and the subsequent management of renal calculi.
Assuntos
Divertículo/diagnóstico por imagem , Hidronefrose/diagnóstico por imagem , Doenças Ureterais/diagnóstico por imagem , Obstrução Ureteral/diagnóstico por imagem , Ureterolitíase/diagnóstico por imagem , Meios de Contraste , Cistoscopia , Divertículo/complicações , Divertículo/congênito , Humanos , Hidronefrose/etiologia , Masculino , Pessoa de Meia-Idade , Doenças Ureterais/complicações , Doenças Ureterais/congênito , Obstrução Ureteral/complicações , Obstrução Ureteral/cirurgia , Ureterolitíase/complicações , Ureterolitíase/cirurgia , Ureteroscopia , Urografia/métodosRESUMO
AIM: To compare the effectiveness of Stone Cone™, PercSys and lidocaine jelly instillation to prevent stone migration during ureterorenoscopy (URS). MATERIALS AND METHODS: One hundred patients who underwent URS for proximal ureteral stones between 2007 and 2012 were evaluated prospectively. The patients were divided into four groups consecutively. The control group (Group I) consisted of the 25 consecutive patients, in whom no device or method was used to prevent stone migration. Group II consisted of 25 patients treated with the Stone Cone, group III consisted of 25 patients treated with PercSys, and group IV consisted of 25 patients treated with lidocaine jelly instillation. RESULTS: The migration rates were 4.5% in group II, 8.7% in group III, 21.7% in group IV, and 31.8% in group I. The migration rate was found to be statistically significantly lower in the groups treated with the Stone Cone and PercSys compared to the control group (p = 0.014, p = 0.048). However, there was no statistically significant difference between the lidocaine jelly group and the control group in terms of migration rates (p = 0.444). CONCLUSIONS: Our results suggested that the Stone Cone and PercSys were the most successful methods with significantly low migration rates (4.5 and 8.7%, respectively).
Assuntos
Anestésicos Locais/administração & dosagem , Migração de Corpo Estranho/prevenção & controle , Histeroscopia , Lidocaína/administração & dosagem , Litotripsia , Ureterolitíase/cirurgia , Cateteres Urinários , Adulto , Desenho de Equipamento , Migração de Corpo Estranho/etiologia , Humanos , Histeroscopia/efeitos adversos , Histeroscopia/instrumentação , Litotripsia/efeitos adversos , Litotripsia/instrumentação , Litotripsia/métodos , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Ureterolitíase/complicações , Ureterolitíase/diagnósticoAssuntos
Infiltração Leucêmica/diagnóstico por imagem , Fígado/diagnóstico por imagem , Leucemia-Linfoma Linfoblástico de Células Precursoras B/diagnóstico , Biomarcadores Tumorais/metabolismo , Biópsia , Neoplasias da Mama/complicações , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Antígenos CD79/metabolismo , Diagnóstico Diferencial , Fadiga/etiologia , Feminino , Cefaleia/etiologia , Humanos , Infiltração Leucêmica/metabolismo , Infiltração Leucêmica/patologia , Infiltração Leucêmica/fisiopatologia , Fígado/metabolismo , Fígado/patologia , Fígado/fisiopatologia , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/secundário , Pessoa de Meia-Idade , Leucemia-Linfoma Linfoblástico de Células Precursoras B/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras B/fisiopatologia , Leucemia-Linfoma Linfoblástico de Células Precursoras B/terapia , Recidiva , Tomografia Computadorizada por Raios X , Ureterolitíase/complicações , Ureterolitíase/diagnóstico por imagem , Ureterolitíase/terapiaRESUMO
Ureteroscopic management of urolithiasis in pregnancy has been on the rise. Technological advancements such as the development of the semi-rigid or flexible ureteroscope, improvements in the design of baskets used for retrieval and the availability of laser have enabled atraumatic fragmentation of stones. We did a systematic review of literature from January 1990 to December 2012. Data were analysed separately for the time period from January 1990 to June 2010 (Period 1) and for last 2.5 years from July 2010 to December 2012 (Period 2). Inclusion criteria were all English language articles with at least three patients reported. Data were extracted on the outcomes and complications reported in the literature. A total of 271 procedures (116 in period 1, 155 in period 2) across 21 studies were reported in the last 22 years. General anaesthesia was used in 38% (44/116) in period 1 and in 64% (99/155) in period 2. The average stone size (7.6 mm) and stone-free rate (SFR) (85%) were similar in both time periods. Fluoroscopy was used in 20% (23/116) and 24% (38/155) in period 1 and 2, respectively. There were fewer complications in period 1 (n = 9) than period 2 (n = 25). These complications were divided into obstetric (n = 5) and non-obstetric complications (n = 29). There were no maternal or foetal deaths during the 22 years. Stone treatment using ureteroscopic techniques in pregnancy can achieve a high success rate. Evidence suggests a rise in the risk of complications with increasing number of these procedures in pregnancy.
Assuntos
Complicações na Gravidez/cirurgia , Ureterolitíase/complicações , Ureterolitíase/cirurgia , Ureteroscopia , Adolescente , Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Resultado do Tratamento , Ureteroscopia/efeitos adversos , Ureteroscopia/métodos , Ureteroscopia/tendências , Adulto JovemRESUMO
La extravasación espontánea de orina, descrita por Albarrán y publicada por Sole se consideraba como un hallazgo radiológico poco frecuente y la definió en 198 como la salida de orina fuera del tracto urinario en ausencia de trauma, de intervención quirúrgica previa o reciente y tampoco sin antecedente de instrumentación urológica o de urografía excretora practicada con compresión externa. Se presenta a un paciente de 28 años, sin antecedentes de interés, que acudió con cuadro astenia de 1 mes de evolución, asociado a dolor en fosa lumbar izquierda. Que fue estudiado mediante ecografía y tomografía computarizada (TC). Las exploraciones radiológicas identificaron múltiples litiasis en uréter proximal y distal izquierdo. Voluminosa colección de baja densidad rodeando al riñón izquierdo, limitada por la fascia pararrenal sugestiva de urinoma, identificando solución de continuidad en cáliz superior, que se comunica con el urinoma. El tratamiento inicial del paciente fue la colocación de Nefrostomía percutánea de urgencia, para realizar posteriormente, ureteroscopia con ascensión de las litiasis y extracción de estas mediante pielolitotomía abierta. Conclusión: El conocimiento de la clínica y de los hallazgos radiológicos de la extravasación urinaria espontánea por litiasis ureteral en las distintas pruebas de imágenes son cruciales para el manejo de los pacientes afectados por esta infrecuente complicación...
Spontaneous extravasation of urine, described by Albarran and published by Sole was considered a rare radiological finding in 198 and defined as the flow of urine out of the urinary tract in the absence of trauma, previous surgery or recent nor no history of urological instrumentation or excretory urography performed with external compression. We report a patient of 28 years, with no history of interest came with asthenia of 1 months duration, associated with pain in left lumbar fossa. That was studied by ultrasound and computed tomography (CT). The radiological identified multiple stones in proximal and distal left ureter. Collection bulky low density surrounding the left kidney limited by suggesting pararenal urinoma fascia, identifying continuity solution upper calyx, which communicates with the urinoma. The patients initial treatment was percutaneous nephrostomy placement of urgency for later ascension of the stones with ureteroscopy and removal of these by open pyelolithotomy. The knowledge of the clinical and radiological findings of spontaneous urinary extravasation with ureteral stones in various imaging tests are crucial for the management of patients affected by this rare complication...
Assuntos
Humanos , Masculino , Adulto , Nefropatias/etiologia , Urina , Procedimentos Cirúrgicos Urológicos/métodos , Ureterolitíase/cirurgia , Ureterolitíase/complicações , UrinomaRESUMO
Ceftriaxone is known to cause biliary pseudolithiasis and, rarely, nephrolithiasis mainly in children. However, we reported the development of bilateral distal ureteral ceftriaxone-associated lithiasis in 7 adults, which suggests that the risk of ureterolithiasis impaction should be considered when treating patients with ceftriaxone, even in adults. To avoid strengthening greater renal damage, ureteroscopic insertion of double J stents may be an alternative management for patients with ureteral ceftriaxone-associated lithiasis.
Assuntos
Antibacterianos/efeitos adversos , Ceftriaxona/efeitos adversos , Ureterolitíase/induzido quimicamente , Dor Abdominal/etiologia , Adulto , Anuria/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Infecções Respiratórias/tratamento farmacológico , Ultrassonografia , Ureter/diagnóstico por imagem , Ureterolitíase/complicações , Ureterolitíase/terapia , Ureteroscopia , Adulto JovemRESUMO
The goal in the treatment of stone disease causing infantile obstructive uropathy is to obtain a quick resolution of the obstruction using the least invasive treatment modality available and rendering the patient stone-free, if possible. Two infants with bilateral kidney stones, the first of whom also had ureteral stone, were referred to our clinic with acute renal failure and were treated successfully in a single session using minimally invasive methods. In this report, we discuss the management of these two cases, aged 9 and 26 months, which resulted in favorable outcomes.
Assuntos
Cálculos Renais/terapia , Litotripsia , Nefrostomia Percutânea , Ureterolitíase/terapia , Injúria Renal Aguda/etiologia , Pré-Escolar , Humanos , Lactente , Cálculos Renais/complicações , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos , Ureterolitíase/complicações , UreteroscopiaRESUMO
OBJECTIVE: Computed tomography (CT) is an imaging modality used to detect renal stones. However, there is concern about the lifetime cumulative radiation exposure attributed to CT. Ultrasonography (US) has been used to diagnose urolithiasis, thereby avoiding radiation exposure. The objective of this study was to determine the ability of US to identify renal colic patients with a low risk of requiring urologic intervention within 90 days of their initial emergency department (ED) visit. METHODS: We completed a retrospective medical record review for all adult patients who underwent ED-ordered renal US for suspected urolithiasis over a 1-year period. Independent, double data extraction was performed for all imaging reports and US results were categorized as "normal," "suggestive of ureterolithiasis," "ureteric stone seen" or "disease unrelated to urolithiasis." Charts were reviewed to determine how many patients underwent subsequent CT and urologic intervention. RESULTS: Of the 817 renal US procedures ordered for suspected urolithiasis during the study period, the results of 352 (43.2%) were classified as normal, and only 2 (0.6%) of these patients required urologic intervention. The results of 177 (21.7%) renal US procedures were suggestive of ureterolithiasis. Of these, 12 (6.8%) patients required urologic intervention. Of the 241 (29.5%) patients who had a ureteric stone seen on US, 15 (6.2%) required urologic intervention. The rate of urologic intervention was significantly lower in those with normal results on US (p < 0.001) than in those with abnormal results on US. CONCLUSION: A normal result on renal US predicts a low likelihood for urologic intervention within 90 days for adult ED patients with suspected urolithiasis.
Assuntos
Cólica Renal/diagnóstico por imagem , Ureterolitíase/diagnóstico por imagem , Adulto , Emergências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ontário , Lesões por Radiação/prevenção & controle , Cólica Renal/etiologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Ultrassonografia , Ureterolitíase/complicações , Urolitíase/complicações , Urolitíase/diagnóstico por imagemRESUMO
PURPOSE: To report our experience with the laparoscopic approach to managing ileal ureter substitution for extensive ureteral stenosis. PATIENTS AND METHODS: Two patients, one man and one woman, ages 38 and 51 years, respectively, underwent laparoscopic ileal substitution between March 2004 and December 2005 because of extensive ureteral stenosis after stone disease management. A three-port technique was used. The ileal segment was managed extracorporeally through a McBurney incision. Pyeloileal or ileoureteral anastomosis was performed intracorporeally. Follow-up included clinical evaluation, nuclear renography, intravenous urography. and serum chemistry analysis. RESULTS: There were no complications, and there was minimal blood loss. Mean operative time was 195 minutes (range 180-210 min). Both patients remain without any symptoms or complaints at a median of 18.5 months follow-up (range 8-29 months). Postoperative pyelography verified adequate excretion from the renal unit. Nuclear renography showed no evidence of loss of renal function. No evident variations of preoperative and postoperative serum chemistry values were noted. None of the patients had any complaint or symptoms of urinary-tract infection or urolithiasis. CONCLUSIONS: The laparoscopic approach appears to be a safe and effective alternative to open surgery for ileal ureter substitution. Extracorporeal management of the ileal segment would appear advantageous because it reduces operative time and morbidity.