The first case of spontaneous upper ureteric rupture caused by emphysematous pyelitis.

Spontaneous ureteric rupture is a very rare condition which usually occurs due to ureteric obstruction caused by obstructing calculi; in our case, the cause was emphysematous pyelitis, which was considered the first report in the literature as far as we know.

Encrusted Uretero-Pyelitis Caused by Corynebacterium urealyticum: Case Report and Literature Review.

We report the case of a 70-year-old female patient with solitary functioning left kidney and encrusted uretero-pyelitis caused by Corynebacterium urealyticum, which was treated by antibiotic therapy and oral acidification with L-methionine. We review the literature for similarly reported cases.

Case Report of an Atypical Abdominal Pain Found to be a Rare Corynebacterium Emphysematous Pyelitis.

Recognizing life-threatening infections is crucial for an emergency physician. In this case report, we describe an atypical presentation of a severe, infiltrating kidney infection, which, if not recognized early, could have led to a detrimental outcome. Emphysematous pyelitis, which is class I of emphysematous pyelonephritis, is a rare entity, and patients may present with a urinary tract infection or pyelonephritis. To add to this, underrecognition of gram-positive organisms, in this case Corynebacterium, can delay treatment and worsen outcomes, as described in this case. Through this case, we wish to create awareness of this disease and to reinforce emergency physicians to keep this entity on their differential diagnosis when evaluating an immunocompromised patient.

Pielitis incrustante en varón con derivación urinaria tipo bricker portador de catéter ureteral / Encrusted pyelitis in a man with bricker type urinary diversion ureteral catheter carrier

Objetivo: La pielitis incrustante es una infección causada por Corynebacterium Urealyticum cuya incidencia está aumentando, sobre todo en pacientes inmunodeprimidos, y en portadores de catéteres permanentes.Método: Se presenta el caso de un varón de 72 añoscon derivación urinaria tipo Bricker y portador de catéter JJ. Posteriormente se objetiva calcificación del mismocon imágenes en la TAC sugestivas de pielitis incrustantey urocultivos positivos para Corynebacterium Urealyticum.Se realiza tratamiento combinado endoscópico y médicocon antibioterapia y acidificación de la orina, a través denefrostomía con solución acidificante de irrigación y porvía oral con Lit-Control pH Down, para evitar nuevas infecciones.Resultados: El tratamiento fue efectivo, con ausencia dereinfecciones gracias al tratamiento de mantenimiento conLit-Control pH Down. Conclusiones: La sospecha diagnóstica y tratamientoprecoz de la pielitis incrustante evitan las complicacionesasociadas. La antibioterapia asociada a acidificación dela orina son los pilares básicos de tratamiento.

Objetive: Encrusted pyelitis in an infectioncaused by Corynebacterium Urealyticum. The incidencehas increased, specially in immunosuppressed patients andpatients with indwelling urinary catheters.Methods: We are presenting a case of a 72 yearsold male with Bricker urinary derivation with an ureteralcatheter. During the follow up, catheteral calcification andencrusted pyelitis were found in TC images and cultureswere positive for Corynebacteirum Urealitycum. This condition was managed with endoscopic and medical treatment; that consisted in antibiotics and acidification of urinethrough nephrostomy tube using an acidifying irrigationsolution and Lit-Control pH Down orally, in order to avoidnew infections.Results: Treatment was effective, no new reinfectionswere shown with the use of Lit-Control pH Down for themaintenance.Conclusions: The suspected diagnosis and the earlytreatment of encrusted pyelitis avoid complications. Antibiotics and urine acidification are key in the treatment of thisdisease.(AU)

Encrusted pyelitis in a male with bricker urinary derivation and ureteral catheter.

OBJECTIVE: Encrusted pyelitis in an infection caused by Corynebacterium Urealyticum. The incidence has increased, specially in immunosuppressed patients and patients with indwelling urinary catheters. METHODS: We are presenting a case of a 72 years old male with Bricker urinary derivation with an ureteral catheter. During the follow up, catheteral calcification and encrusted pyelitis were found in TC images and cultures were positive for Corynebacteirum Urealitycum. This condition was managed with endoscopic and medical treatment; that consisted in antibiotics and acidification of urine through nephrostomy tube using an acidifying irrigation solution and Lit-Control pH Down orally, in order to avoid new infections. RESULTS: Treatment was effective, no new reinfections were shown with the use of Lit-Control pH Down for the maintenance. CONCLUSIONS: The suspected diagnosis and the early treatment of encrusted pyelitis avoid complications. Antibiotics and urine acidification are key in the treatment of this disease.

OBJETIVO: La pielitis incrustante es una infección causada por Corynebacterium Urealyticum cuya incidencia está aumentando, sobre todo en pacientes inmunodeprimidos, y en portadores de catéteres permanentes.MÉTODOS: Se presenta el caso de un varón de 72 años con derivación urinaria tipo Bricker y portador de catéter JJ. Posteriormente se objetiva calcificación del mismo con imágenes en la TAC sugestivas de pielitis incrustante y urocultivos positivos para Corynebacterium Urealyticum. Se realiza tratamiento combinado endoscópico y médico con antibioterapia y acidificación de la orina, a través de nefrostomía con solución acidificante de irrigación y por vía oral con Lit-Control pH Down, para evitar nuevas infecciones. RESULTADOS: El tratamiento fue efectivo, con ausencia de reinfecciones gracias al tratamiento de mantenimiento con Lit-Control pH Down. CONCLUSIONES: La sospecha diagnóstica y tratamiento precoz de la pielitis incrustante evitan las complicaciones asociadas. La antibioterapia asociada a acidificación de la orina son los pilares básicos de tratamiento.

CT as a Diagnostic Tool for Emphysematous Pyelitis: A Case Report.

Gas forming infections of the renal collecting system occurs because of organisms like Escherichia coli, Klebsiella, and Proteus. If the gas is restricted to the collecting system, without causing involvement of the cortex, it is called emphysematous pyelitis; whereas, invasion and penetration of the cortex imply a more gruesome diagnosis of emphysematous pyelonephritis. A 59-year-old male patient, previously diagnosed with a large right renal calculus and having multiple co-morbidities presented to the surgery department with right flank pain; Double J (DJ) stenting was done to relieve the pain from colic due to obstructive renal calculi; the patient subsequently discharged without any post-procedural complications. The patient came back a month later with similar complaints and multiple spikes of fever. Blood and urine culture revealed growth of Escherichia coli. The first line radiological investigations, like X-ray and ultrasonography, were suggestive of the presence of air in the pelvis, ureter, bladder; confirmation by CT revealed the presence of air in the collecting system, including the calyx. This air was seen invading focally into the anterior renal cortex. Also, the DJ stent had migrated into the proximal ureter.  The patient had developed emphysematous pyelitis predominantly, which had developed an overlapping component of pyelonephritis. The aetiology for air in the renal system was infection by Escherichia coli. CT proved to be diagnostic in differentiating both of them, as the presence of air entering the renal cortex was detected only on CT. Subsequently, prominent initiation of antibiotic therapy and replacement of DJ stent was carried out, following which the patient recovered fully within two weeks.

Encrusted Urinary Tract Infections Due to Corynebacteria Species.

INTRODUCTION: Encrusted pyelitis and cystitis are peculiar disorders characterized by the calcification of the vesical, the pyelic, and/or the ureteral walls. These calcifications are composed of struvite and calcium carbonate‒apatite due to the presence of Corynebacterium urealyticum. METHODS: We have identified the clinical features and outcomes of 17 patients with encrusted pyelitis (n = 15) or encrusted cystitis (n = 2). Diagnosis was based on computed tomography scan and sonography including thickening and calcified lesions of the urinary tract. RESULTS: The main clinical presentation was suggestive of subacute urinary tract infection with fever and urologic symptoms, mostly gross hematuria. Biologic features were characterized by the presence of struvite crystals and alkaline urine. Acute kidney injury was reported in 70.6% of cases. Predisposing factors were mostly due to urologic background (82.4%) with a history of urologic procedure (71%) and prior exposure to antibiotics (59%). All patients received appropriate antibiotherapy and 15 were treated with topical urinary acidification. A significant reduction of encrusted calcifications was observed in 88% of cases. Renal function improved in 71% of the patients. Nevertheless, poor tolerance of the treatment and side effects were common, affecting 71% of patients, with Gram-negative bacilli urinary tract infections (53%) being the most frequent. At last follow-up, 4 patients (23.5%) progressed to end-stage renal disease and only 1 had a clinical relapse. CONCLUSIONS: Encrusted urinary tract infections are rare, characterized by a severe renal and overall prognosis in the absence of appropriate treatment. Topical urinary acidification and appropriate antibiotherapy are efficient but may be burdened by significant adverse events.

The importance of surgical treatment in encrusted cystitis and pyelitis: A case report.

INTRODUCTION: Encrusted cystitis and Encrusted pyelitis are rare chronic inflammatory diseases. Those conditions are commonly caused by the Corynebacterium spp. especially the type D2 which is a gram positive, aerobic, slow-growing, and urea-sliting bacteria with a multi-antibiotic resistant profile. PRESENTATION OF CASE: We report the case of a 62-year-old man with a past history of chronic obstructive pulmonary disease. He was referred to the department of urology for urosepsis. Bacterial culture results were positive to Corynebacterium urealyticum. The diagnosis of encrusted cystitis and pyelitis were highly considered. An adapted antibiotherapy was undertaken using vancomycin during 3 weeks. The patient presented two acute peritonitis : the first was caused by a spontaneous bladder dome rupture which was surgically repaired and the second was caused by a total bladder rupture which required cysto-prostatectomy and bilateral ureterostomy. The post operative outcomes were uneventful. Bacterial urinalysis was negative and total recovery was obtained. DISCUSSION: In the majority of the reported cases, there were no sepsis or peritonitis conditions. Medical treatment by the glycopeptides and urine acidification was sufficient. However in this case, the sepsis condition and the bladder rupture with acute peritonitis made exclusively medical treatment by antibiotics insufficient. Therefore cystectomy associated to conventional antibiotics were able to limit the systemic dissemination of the bacteria and save the patient's life. CONCLUSION: Glycopeptides antibiotics are currently the preferential treatment of encrusted cystitis. In some complicated conditions such as bladder rupture and urosepsis as in this case, radical surgical treatment by cystectomy must be realized early to avoid peritonea and septic shock.

Post operative visual loss after nephrectomy performed in lateral position in female patient with congenitally left blindness.

Postoperative visual loss (POVL) after non-ocular surgery is relatively uncommon. Patients undergoing spinal and cardiac surgery seems to be at the highest risk and ischemic optic Neuropathy was the most commonly diagnosed cause1 POVL following urological procedures are rare, only a few cases were reported mainly in prone position. Here, we present the first case of a patient with congenital left blindness having many risk factors of POVL who experienced this complication following a nephrectomy performed in the lateral position. The aim of this case presentation is to know this complication in order to prevent or minimize its occurrence.

Renal failure due to encrusted cystitis and pyelitis.

INTRODUCTION: Encrusted cystitis and pyelitis are a rare urinary tract infection characterized by mold-like calcification of collecting system. Here, we show a case of encrusted cystitis proceeding to pyelitis during a 1-month delay in diagnosis. CASE PRESENTATION: A 73-year-old man developed hematuria and pain during micturition while he was being treated for granulomatosis with polyangiitis and lung abscess. Cystoscopy revealed calcification of the bladder wall, and an initial diagnosis of a bladder stone was made. While awaiting surgery, the bladder wall calcification extended to the renal pelvis on both sides, with renal failure. He underwent bilateral nephrostomy replacement and bladder irrigation with Solita T1 and was administered intravenous vancomycin. Calcification almost regressed after 4 weeks of treatment. CONCLUSION: Encrusted cystitis and pyelitis should be suspected if the patient shows alkaline urine and urothelial mucosa calcification. Appropriate treatment includes antibiotics, urine drainage, and chemolysis by bladder irrigation.

An Unexpected Complication After Extracorporeal Shock Wave Lithotripsy: Emphysematous Pyelitis.

Emphysematous urinary tract infections (UTI) are life-threatening conditions caused by gas-forming organisms. Emphysematous pyelitis (EP) is a rare, acute bacterial UTI characterized by gas formation only in the renal collecting system. Extracorporeal shock wave lithotripsy (ESWL) treatment was performed for 10-mm sized stone in the left renal pelvis in an 81-year-old female patient with no known comorbidities other than hypertension. In the 10th hour following ESWL treatment, the patient referred to the emergency department with fever and left flank pain. Gas was noticed in the left renal collecting system in non-contrast computed tomography (NCCT). A wide spectrum antibiotic was given to the patient due to EP diagnosis and a nephrostomy catheter was placed in the left renal pelvis. EP should be considered in the patient with fever and flank pain after ESWL and NCCT should be performed for further examination. Quick diagnosis, examination and treatment of these patients in the emergency department are important.

Alkaline-Encrusted Pyelitis Causing Renal Failure in a Transplant Kidney: Treatment with Percutaneous Nephrolithotomy and Urinary Acidification.

Background: Alkaline-encrusted pyelitis (AEP) is rare and most often stems from a triad of immunodeficiency, urogenital tract trauma, and alkaline urinary infection. Corynebacterium Group D2 is the most common organism. It results in encrusting calcifications that adhere to most of the urothelial lining of the pelvicaliceal system and ureter. Left unchecked, or unrecognized, the disease process can progress to renal compromise. Studies suggest that management is based on elimination of the bacterium, acidification of the urine, and elimination of calcified plaques and encrustations. Herein, we report a case of a 56-year-old woman who developed AEP in her second transplanted kidney, and detail the diagnosis and treatment of the uncommon, yet potentially devastating, disease. Case Presentation: A 56-year-old woman with a history of lupus, end-stage renal disease, who was on her second renal transplant presented with symptoms of urinary tract infection. Urine was consistently alkaline with cultures repeatedly growing urease-splitting Corynebacterium. Subsequent imaging showed large obstructing ureteral and renal stones concerning for AEP. She was treated with transplant kidney percutaneous nephrolithotomy, culture-specific antibiotics, and urinary acidification. Conclusion: Clinical presentation, urinalysis, culture, and renal imaging, often with CT, are the mainstays for diagnosing AEP. If not addressed, AEP can advance to renal failure. Management often includes a multimodal approach involving treatment and prevention of the underlying infection, urinary acidification, and percutaneous or endoscopic removal of obstructing and large burden stones and encrustation.

Gas-Containing Renal Matrix Stones in a Patient with Emphysematous Pyelitis Treated with Delayed Percutaneous Nephrolithotomy.

Background: The presence of intra-calcular gas might indicate the coexistence of gas-forming bacterial infections, which are potentially severe and life threatening. Gas-containing renal stones are rare. Herein, we present a case of gas-containing renal matrix stone that was associated with emphysematous pyelitis and reflect on its management. Case Presentation: A 30-year-old woman, with no underlying comorbidities, presented at 30 weeks of pregnancy with symptoms of pyelonephritis. Imaging showed no renal stones. Postdelivery, she presented again with similar symptoms in addition to pneumaturia. Imaging showed several large gas-containing renal matrix stones associated with emphysematous pyelitis, pneumoureter, and pneumobladder. She improved with oral antibiotics and underwent percutaneous nephrolithotomy 6 weeks later. Conclusion: The presence of intra-calcular gas does not necessarily indicate a serious condition and the treatment can be planned according to the patient's symptoms and the presence and type of any emphysematous renal infection.

Encrusted Uropathy: A Comprehensive Overview-To the Bottom of the Crust.

Encrusted uropathy is a rare subacute to chronic inflammatory disorder caused by infection with urease-producing bacteria, mainly Corynebacterium urealyticum. The disorder is characterized by urothelial deposition of struvite and carbonated apatite, resulting in encrustations and ulceronecrotic inflammation of the urothelium and surrounding tissues. Most commonly, encrusted uropathy is encountered in patients with predisposing conditions. The disease remains underdiagnosed. High urinary pH and negative conventional urine cultures should raise suspicion of the diagnosis. Prognosis is dependent on timely diagnosis and treatment installment, which consists of urological removal of encrustations in combination with urinary acidification and long-term antibiotic therapy.

Reconsideration of urine culture for the diagnosis of acute pyelonephritis in children: a new challenging method for diagnosing acute pyelonephritis.

Acute pyelonephritis (APN) should be detected and treated as soon as possible to reduce the risk of the development of acquired renal scarring. However, in the medical field, urine culture results are not available or considered when the prompt discrimination of APN is necessary and empirical treatment is started. Furthermore, urine culture cannot discriminate APN among children with febrile urinary tract infection (UTI) (pyelitis, lower UTI with other fever focus). Therefore, the usefulness of urine culture for diagnostic purposes is small and the sampling procedure is invasive. Congenital hypoplastic kidney is the most common cause of chronic kidney injury in children. Thus, it is desirable that a main target be detected as early as possible when imaging studies are performed in children with APN. However, if APN does not recur, no medical or surgical treatment or imaging studies would be needed because the acquired renal scar would not progress further. Therefore, the long-term prognosis of APN in young children, particularly infants, depends on the number of recurrent APN, not other febrile UTI. New methods that enable prompt, practical, and comfortable APN diagnosis in children are needed as alternatives to urinary catheterization for urine culture sampling.

Perinephric Abscess Causing Mycotic Celiac and Splenic Artery Aneurysm: A Case Report.

Perinephric abscess is a known complication of urologic infection, sometimes requiring surgical debridement. Extension into adjacent structures is rarely reported. We present a case of a woman with xanthogranulomatous emphysematous pyelonephritis accompanied by massive perinephric abscess, resulting in celiac and splenic artery mycotic aneurysms via direct invasion.