[Actinomycosis of the kidney: a case report]. / Aktinomykose der Niere: Ein Fallbericht.

Actinomycosis is a rare infection mainly of the head and neck region (cervicofacial actinomycosis). The cause of this infection is bacterial invasion of the host's mucosal barrier with consecutive infiltration of the surrounding tissues. The treatment of choice after diagnosis is a prolonged course of high-dose antibiotics. The presence of abdominal actinomycosis is at a maximum of 25%, whereas renal involvement appears only sporadically. Aggravating causes for early diagnosis are the appearance of abscesses, fistulae and a debilitating illness resembling carcinoma and leading to surgery as the treatment of choice. Renal actinomycosis is a diagnostic challenge because it is included in the differential diagnosis of renal masses with coexisting B-symptoms. The suspicion requires surgical treatment--nephrectomy. We report on a patient who was transferred to our department for nephrectomy because of radiologically diagnosed renal and perirenal abscesses. The histological result showed renal actinomycosis.

Ureteroscopy: anesthetic considerations.

Ureterorenoscopy (URS) is a vital procedure in the armamentarium of the modern-day urologist for the management of ureteral and renal pathology. With advances in ureteroscopic design and the introduction of short-acting anesthetics, URS can now be performed efficiently with high patient satisfaction and minimal posteroperative recovery time. Recently, URS under local anesthesia, with or without sedation, has become a viable option for a high percentage of correctly selected patients. For those patients who then require deeper sedation or general anesthesia, anesthesia can be induced quickly with the new agents such as remifentanil, propofol, and desflurane, without a prolonged postoperative recovery period.

[Upper urinary tract MRI]. / IRM du haut appareil urinaire.

New MRI modalities today available allow exploration of many kidney diseases. Main developments have been made in the diagnosis of small tumors and tumoral extension of huge masses. The other important way of application is MR urography which perfectly show the dilated urinary tract in few seconds. Their potential application are for renal insufficiency, allergic reaction to iodine contrast media and in cases of contra indication to ionised radiations. It is a complementary sequence to assess the urinary tract in pelvic exploration. The evaluation of kidney function will be possible in the near future.

Transurethral ureteroscopy: is local anesthesia with intravenous sedation sufficiently effective and safe?

OBJECTIVE: To evaluate the effectiveness and safety of local anesthesia and sedation in ureteroscopic interventions and to compare the results with other kinds of anesthesia. METHODS: 107 ureteroscopic interventions have been done to 99 renoureteral units involving 77 patients under different kinds of anesthesia. RESULTS: 45 of 107 procedures were performed under general anesthesia, 11 under spinal/epidural anesthesia, and 51 using local anesthesia and intravenous sedation. The overall success rate was 90%. The failure rate was 18% for the procedures undertaken using local anesthesia. CONCLUSION: Local anesthesia in ureteroscopic interventions may be considered as a first choice because of almost similar success rates to other kinds of anesthesia: is has a low morbidity and low cost.

[Ureteroscopy under local anesthesia with or without intravenous analgesia]. / Urétéroscopie sous anesthésie locale avec ou sans analgésie intraveineuse.

We report our experience on performing ureteroscopic procedures using local anaesthesia with or without intravenous analgesia. During a two year period 334 ureteroscopic procedures were performed in our hospital. 159 of them were begun but only 138 completed without the use of general or regional anaesthesia. In 9 patients ureteroscopy was performed with lindocaine jelly in the urethra only, and in 129 with additional intravenous analgesia Fentanyl, a synthetic morphine derivative, was used for intravenous analgesia. Ureteroscopy was performed for stone fragmentation or extraction in 119 patients for taking away a double J catheter which showed migration into ureter in 8 and for diagnostic purposes in 11. Ureteric lesions were observed in 7 patients (5%). The findings suggest that ureteroscopy when performed without general or regional anaesthesia does not increase the risk of complications or compromise the results of treatment.

Ureteroscopy under local anaesthesia with and without intravenous analgesia.

In a prospective study of 302 ureteroscopic procedures, 161 were commenced and 133 completed without the use of general or regional anaesthesia. In 15 patients ureteroscopy (URS) was performed with lignocaine jelly in the urethra only, and in 118 with additional intravenous analgesia. Alfentanil, a synthetic morphine derivative, was used for intravenous analgesia. Ureteroscopy was performed prior to extracorporeal shock wave lithotripsy in 46 patients, for stone basketing in 40, for stone fragmentation in 29, for diagnostic purposes in 14 and for cold knife ureterotomy in 4. Ureteric lesions were observed in 9 patients (6.8%) treated under intravenous sedoanalgesia. This percentage is within the range reported in other series of patients treated under general anaesthesia. The findings suggest that URS, when performed without general or regional anaesthesia, does not increase the risk of complications or compromise the results of treatment.

Ureteroscopy under local anesthesia.

Ureteroscopy has been performed with local anesthesia with and without sedation in 30 patients. Flexible endoscopes were used in 18, rigid endoscopes alone in 7, and rigid and flexible instruments in 5 patients. The flexible instruments ranged in size from 4F to 10F, while rigid instruments were 10F to 12F. Although most procedures were diagnostic, calculi were removed from the distal ureter in 4 patients and from the midureter in 1 patient. Ultrasonic lithotripsy was utilized in 1 patient. The success and tolerance of flexible or distal rigid ureteroscopy with local anesthesia permits its recommendation in carefully selected patients.