Corynebacterium urealyticum: aumento de la incidencia de infección y uropatía incrustante / Corinebacterium urealyticum: increased incidence of infection and encrusted uropathy

Introducción: Corynebacterium urealyticum (CU) afecta a pacientes inmunodeprimidos, crónicos o multioperados. La uropatía incrustante (UI) representa una complicación de la infección. Objetivo del estudio: demostrar el aumento creciente de casos de infección por CU y UI en los últimos 5 años. Material y métodos: Estudio descriptivo de pacientes urológicos con urocultivo positivo a CU (enero de 2009-diciembre de 2014). Cálculo de distribución anual y características clínicas de infección por CU y UI. Seguimiento mínimo: 6 meses. Obtención de medias y rangos estadísticos de parámetros clínicos pre/postratamiento. Resultados: Total de pacientes con CU: 115 (hombres 87: mujeres 28). Edad: 67,9 años (rango 6-95). Distribución anual (casos) 2009: 9 (7,8%), 2010: 13 (11,3%), 2011: 9 (7,8%), 2012: 20 (17,4%), 2013: 31 (27%), 2014: 33 (28,7%). Incremento 2009-2014: 300%. Cirugía urológica múltiple: 89 casos (77,3%). Complicaciones quirúrgicas: 77 casos (66,9%). Pacientes con UI: 18 casos (15,6%) (hombres 13: mujeres 5): pielitis 12 (66,7%), cistopatía 3 (16,6%), prostatic capsule disease 2 (11,2%), calcificación de la malla uno (5,5%). Análisis de 18 casos con UI: PH orina pre/postantibiótico: 8 (r = 6-9) vs 6 (r = 5-7). Cultivo negativo postantibiótico: 100%. Aplicación de solución acidificante: 5 casos. Cirugía: 13 casos (72,2%). Resultados pre/postratamiento multimodal: insuficiencia renal: 12 (66,6%) vs 9 (50%), filtrado glomerular (FG): 45,8 (r = 6- > 90) vs 52,7 (r = 13- > 90). Mejoría del FG: 6,94 puntos (T Wilcoxon p = 0,102). Radiología (incrustaciones): mejoría 13 (72,2%), igual 5 (27,8%). No mortalidad específica por CU. Conclusiones: La prevalencia de infección por CU y la UI está aumentando. El tratamiento antibiótico es muy eficaz. Las soluciones acidificantes son una opción aceptable para reducir calcificaciones

Introduction: Corynebacterium urealyticum (CU) affects patients who are immunosuppressed, chronically ill or have undergone numerous operations. Obstructive uropathy (OU) is a complication of infection. Study objective: To demonstrate the growing increase in cases of infection by CU and OU in the past 5 years. Material and methods: A descriptive study was conducted of urological patients with CU-positive urine cultures (January 2009-December 2014). We calculated the annual distribution and clinical characteristics of infection by CU and OU. Minimum follow-up: 6 months. We obtained the statistical means and ranges of clinical parameters pre/post-therapy. Results: The total number of patients with CU was 115 (men, 87; women, 28). The mean age was 67.9 years (range, 6-95 years), and the annual distribution of cases for 2009, 2010, 2011, 2012, 2013 and 2014 was 9 (7.8%), 13 (11.3%), 9 (7.8%), 20 (17.4%), 31 (27%) and 33 (28.7%), respectively. The increase in cases for 2009-2014 was 300%. Multiple urological surgeries were performed in 89 cases (77.3%), with surgical complications in 77 cases (66.9%). Eighteen (15.6%) patients had OU (men, 13; women, 5), 12 had pyelitis (66.7%), 3 had cystopathy (16.6%), 2 had prostatic capsule disease (11.2%) and 1 had mesh calcification (5.5%). The analysis of the 18 cases with OU showed pre/postantibiotic therapy urine pHs of 8 (r, 6-9) vs. 6 (r, 5-7). All postantibiotic cultures were negative. Acidifying solution was applied in 5 cases, and surgery was performed in 13 cases (72.2%). The results from before/after the multimodal therapy showed renal impairment in 12 (66.6%) vs. 9 cases (50%) and glomerular filtration rates (GFR) of 45.8 (r, 6- > 90) vs. 52.7 (r, 13- > 90). The improvement in GFR was 6.94 points (T Wilcoxon; P = .102). The radiology results (incrustations) showed improvement in 13 patients (72.2%) and no change in 5 (27.8%). There was no specific mortality for CU. Conclusions: The prevalence of infection by CU and OU is increasing. Antibiotic treatment is highly effective. Acidifying solutions are an acceptable option for reducing calcifications

Bilateral emphysematous pyelitis: a rare encounter in urology.

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

Clinics in diagnostic imaging (138). Emphysematous pyelitis.

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

Tratamiento de la litiasis piélica con el litotritor Mododulith slx-mx (storz) / Treatment of the pyelic lithiasis using the Mododulith slx-mx (storz)lithotriptor

La litiasis urinaria es una enfermedad de alta prevalencia y recurrencia, a la que los hospitales no pueden dar solución quirúrgica con la celeridad necesaria. La litotricia extracorpórea por ondas de choque (LEC) es la primera opción de tratamiento y las tasas de resolución fluctúan del 33 al 90 por ciento. El objetivo de este estudio fue analizar nuestros resultados con la utilización del litotritor Mododulith slx-mx (storz) para el tratamiento monoterápico de la litiasis de la pelvis renal. Se incluyeron pacientes con litiasis piélica que no hubieran recibido otro tratamiento. Se conformaron 4 grupos según la superficie litiásica y se relacionaron con la terapéutica (sesiones, ondas de choque, energía, complicaciones, aplicación de procedimientos auxiliares, maniobras complementarias y evolución). El mayor número de pacientes tenía cálculos de hasta 2 cm², y más del 92 por ciento fueron resueltos con una sola sesión. Más del 94 por ciento no presentó complicaciones y no se necesitaron procedimientos auxiliares en más del 97 por ciento de los casos. . Se lograron buenos resultados en más del 97 por ciento de los casos mediante LEC monoterápica de la litiasis piélica de hasta 4 cm² utilizando el litotritor Mododulith slx-mx (storz). Los mejores resultados se obtuvieron en los cálculos de hasta 3 cm² y más del 99 por ciento de éstos correspondieron a los cálculos de hasta 2 cm². Las ventajas de este equipo se deben, sobre todo, a su alta eficacia y al hecho de que logra una fragmentación fina que facilita la eliminación total de los cálculos. Por esta razón, se consigue una alta tasa de resolución, sin restos de la litiasis en más del 97 por ciento de los casos y con un mínimo de maniobras complementarias(AU)

The urinary lithiasis is a disease with a high prevalence and recurrence and the hospitals can not give a surgical solution as quickly as possible. The shock waves extracorporeal lithotripsy (SWEL) is the first choice of treatment and the resolution rates fluctuate from 33 to 90 percent. The objective of present study was to analyze our results using the Mododulith slx-mx (storz) lithotriptor for the monotherapy of renal pelvis lithiasis. The patients presenting with pyelic lithiasis and any other treatment were included in study that were divided into four groups according the lithiasis surface and were related to therapeutics (sessions, chock waves, energy, complications and application of auxiliary procedures, complementary manoeuvres and course). RESULTS. Most of patients had 2 cm² calculi and more than the 92 percent were solved with only one session. More than 94 percent had not complications without auxiliary procedures in more than 97 percent of the cases. It was possible to obtain good results in more than 97 percent of the cases using monotherapy-SWEL of pyelic lithiasis of 4 cm² using the Mododulith slx-mx (storz) lithotriptor. The better results were obtained in calculi of 3 cm² and more than the 99 percent belongs to calculi of 2 cm². The advantages of this device were mainly due to its high effectiveness level and to fact that it achieves a fine fragmentation allowing the total removal of calculi. Thus, it is possible to obtain a high rate resolution without rests of lithiasis in more than 97 percent of the cases and with a minimum of complementary manoeuvres(AU)

Resultados de la litotricia extracorpórea utilizando el litotritor MODULITH SLX-MX (STORZ) para el tratamiento de la litiasis ureteral / Results of the shock waves extracorporeal lithotripsy using the MODULITH SLX-MX (STORZ) lithotriptor for treatment or ureteral lithiasis

INTRODUCCIÓN. La litiasis del uréter constituye una gran preocupación para los médicos debido a que frecuentemente ocasiona una uropatía obstructiva y el deterioro progresivo de la función renal ipsolateral, estado patológico de alta prevalencia, por lo que los hospitales con frecuencia no pueden dar solución quirúrgica con la celeridad necesaria. El objetivo de esta investigación fue conocer los resultados de la litotricia extracorpórea por ondas de choque (LEC) con el litotritor MODULITH SLX-MX (STORZ) para el tratamiento de la litiasis ureteral. MÉTODOS. Se incluyeron 598 pacientes con litiasis radiopaca del uréter, atendidos en el Hospital Hermanos Ameijeiras entre enero de 2007 y diciembre de 2008. Se conformaron 4 grupos según la localización del cálculo: en la unión pieloureteral (UPU) (96), uréter lumbar (UL) (263), iliaco (UI) (40), pelviano (UP) (199) y se analizó su relación con la superficie litiásica, sesiones de tratamiento, maniobras complementarias previas a la litotricia, aplicación de procedimientos auxiliares posteriores, resolución definitiva por otra técnica quirúrgica y eficacia terapéutica. La colimación se realizó por fluoroscopia. RESULTADOS. El mayor número de cálculos se localizó en el uréter lumbar, y en segundo lugar, en el uréter pelviano. El tamaño medio de la litiasis fue de 0,8 ± 0,5233 cm2, en rango de 0,09-4 cm2. La media de sesiones utilizadas fue de 1,24 ± 0,531, rango de 1-4. Se realizaron maniobras complementarias previas en 72 pacientes (12,04 por ciento) y la más utilizada fue la nefrostomía percutánea (40; 6,6 por ciento). Después de la LEC fue necesaria la conversión a otro procedimiento para la solución del 4,68 por ciento de los casos. La LEC fue eficaz en el 95,32 por ciento, con mejores resultados en el UP (96,99 por ciento) y peores en el UI (92,50 por ciento). CONCLUSIONES. Los resultados fueron buenos utilizando el litotritor MODULITH SLX-MX (STORZ). Los mejores resultados se obtuvieron en el uréter pelviano y en general es posible considerar la LEC como la primera opción terapéutica de la litiasis ureteral(AU)

INTRODUCTION. Ureter lithiasis is a concern for physicians because frequently provokes an obstructive uropathy and a progressive deterioration of ipsilateral renal function and a high prevalence of pathological state that is why the hospitals can not give a surgical solution as quickly as possible. The objective of present research was to know the results of the shock waves extracorporeal lithotripsy (SWEL) using the MODULITH SLX-MX (STORZ) lithotriptor for treatment or ureteral lithiasis. METHODS. In present research 598 patients presenting with ureter radiopaque lithiasis, seen in the Hermanos Ameijeiras Clinical Surgical Hospital from January, 2007 to December, 2008, divided into four groups according to the calculus localization: in pyeloureteral joint (PUJ) (96), lumbar ureter (LU) (263), iliac joint (IJ) (40), pelvic joint (PJ) (199) analyzing its relationship with lithiasis surface, treatment sessions, complementary manoeuvres previous to lithotripsy, application of subsequent auxiliary procedures, definite resolution using other surgical technique and therapeutical effectiveness. Collimation was carried out by fluoroscopy. RESULTS. Most of calculi were located in the lumbar ureter and in the second place in pelvic ureter. The mean size of lithiasis was of 0,8 ± 0,5233 cm2 in the rank of 0,09-4 cm2. The mean of sessions used was of 1,24 ± 0,531, in the rank of 0,09-4 cm2. The mean of sessions used was of 1,24 ± 0,531, rank of 1-4. In 72 patients 12,04 percent) previous complementary manoeuvres were carried out and the more used one was the percutaneous nephrostomy (40; 6,6 percent). After SWEL it was necessary the conversion to other procedure for solution of 4,68 percent of the cases. The SWEL was effective in the 95,32 percent with better results in the UP (96,99 percent) and with worse results in the IJ (92,50 percent). CONCLUSIONS. The results were good using the MODULITH SLX-MX (STORZ) lithotriptor. The better results were obtained in the pelvic ureter and in general, it is possible to consider the SWEL as the first therapeutical choice of ureteral lithiasis(AU)

Resultados de la litotricia extracorpórea utilizando el litotritor MODULITH SLX-MX (STORZ) para el tratamiento de la litiasis ureteral / Results of the shock waves extracorporeal lithotripsy using the MODULITH SLX-MX (STORZ) lithotriptor for treatment or ureteral lithiasis

La litiasis del uréter constituye una gran preocupación para los médicos debido a que frecuentemente ocasiona una uropatía obstructiva y el deterioro progresivo de la función renal ipsolateral, estado patológico de alta prevalencia, por lo que los hospitales con frecuencia no pueden dar solución quirúrgica con la celeridad necesaria. El objetivo de esta investigación fue conocer los resultados de la litotricia extracorpórea por ondas de choque (LEC) con el litotritor MODULITH SLX-MX (STORZ) para el tratamiento de la litiasis ureteral. Se incluyeron 598 pacientes con litiasis radiopaca del uréter, atendidos en el Hospital Hermanos Ameijeiras entre enero de 2007 y diciembre de 2008. Se conformaron 4 grupos según la localización del cálculo: en la unión pieloureteral (UPU) (96), uréter lumbar (UL) (263), iliaco (UI) (40), pelviano (UP) (199) y se analizó su relación con la superficie litiásica, sesiones de tratamiento, maniobras complementarias previas a la litotricia, aplicación de procedimientos auxiliares posteriores, resolución definitiva por otra técnica quirúrgica y eficacia terapéutica. La colimación se realizó por fluoroscopia. El mayor número de cálculos se localizó en el uréter lumbar, y en segundo lugar, en el uréter pelviano. El tamaño medio de la litiasis fue de 0,8 ± 0,5233 cm², en rango de 0,09-4 cm². La media de sesiones utilizadas fue de 1,24 ± 0,531, rango de 1-4. Se realizaron maniobras complementarias previas en 72 pacientes (12,04 por ciento) y la más utilizada fue la nefrostomía percutánea (40; 6,6 por ciento). Después de la LEC fue necesaria la conversión a otro procedimiento para la solución del 4,68 por ciento de los casos. La LEC fue eficaz en el 95,32 por ciento, con mejores resultados en el UP (96,99 por ciento) y peores en el UI (92,50 por ciento). Los resultados fueron buenos utilizando el litotritor MODULITH SLX-MX (STORZ)...(AU)

Ureter lithiasis is a concern for physicians because frequently provokes an obstructive uropathy and a progressive deterioration of ipsilateral renal function and a high prevalence of pathological state that is why the hospitals can not give a surgical solution as quickly as possible. The objective of present research was to know the results of the shock waves extracorporeal lithotripsy (SWEL) using the MODULITH SLX-MX (STORZ) lithotriptor for treatment or ureteral lithiasis. In present research 598 patients presenting with ureter radiopaque lithiasis, seen in the Hermanos Ameijeiras Clinical Surgical Hospital from January, 2007 to December, 2008, divided into four groups according to the calculus localization: in pyeloureteral joint (PUJ) (96), lumbar ureter (LU) (263), iliac joint (IJ) (40), pelvic joint (PJ) (199) analyzing its relationship with lithiasis surface, treatment sessions, complementary manoeuvres previous to lithotripsy, application of subsequent auxiliary procedures, definite resolution using other surgical technique and therapeutical effectiveness. Collimation was carried out by fluoroscopy. Most of calculi were located in the lumbar ureter and in the second place in pelvic ureter. The mean size of lithiasis was of 0,8 ± 0,5233 cm² in the rank of 0,09-4 cm². The mean of sessions used was of 1,24 ± 0,531, in the rank of 0,09-4 cm². The mean of sessions used was of 1,24 ± 0,531, rank of 1-4. In 72 patients 12,04 percent) previous complementary manoeuvres were carried out and the more used one was the percutaneous nephrostomy (40; 6,6 percent). After SWEL it was necessary the conversion to other procedure for solution of 4,68 percent of the cases. The SWEL was effective in the 95,32 percent with better results in the UP (96,99 percent) and with worse results in the IJ (92,50 percent). CONCLUSIONS. The results were good using the MODULITH SLX-MX (STORZ) lithotriptor...(AU)

Emphysematous pyelitis: epidemiological, therapeutic and evolutive features.

AIM: Emphysematous pyelitis is an uncommon form of acute pyelonephritis. It has been reported sporadically in the literature. Our objective is to study the epidemiological, clinical and therapeutic characteristics of emphysematous pyelitis. METHODS: The data of six patients managed for emphysematous pyelitis were collected and analyzed. RESULTS: The mean age was 55 years. Urinary lithiasis and diabetes were the most common co-morbidities. Febrile lumbar pain and general health impairment were the presenting symptoms in five patients; the remaining case presented with septic shock. Urine and blood culture grew E. Coli in 4 and 3 cases respectively. Computed tomography of the abdomen led to diagnosis by showing gas images in the collecting system. Treatment consisted of antibiotics associated with collecting system drainage. It avoided emergent nephrectomy in all cases. The treatment of the calculi was held at distance from the infection. Nephrectomy was done in one patient presenting a thinned -- dedifferentiated -- renal parenchyma. Outcome was good. CONCLUSION: Emphysematous pyelonephritis is a rare upper urinary tract infection. Risk factors include diabetes and urinary obstruction. The diagnosis is made by computed tomography. Efficient antibiotics administration associated with collecting system drainage allow soon recovery and avoid nephrectomy.

Alkaline encrusted pyelitis.

Alkaline encrusted pyelitis is an infectious disease characterised by encrustations in the wall of the upper urinary tract, surrounded by severe inflammation. Destruction of native kidneys and kidney grafts may occur, resulting in end stage renal failure. Corynebacterium group D2, an urea splitting microorganism, is nearly exclusively associated with this disease. The most important predisposing factors are previous urological procedures and an immunosuppressed state. In a suggestive clinical context, diagnosis should be made with unenhanced computed tomography findings and bacteriologic isolation of the responsible microorganism. The treatment is threefold: appropriate antibiotic therapy, by preference with glycopeptides, acidification of urine and chemolysis, and if needed, surgical removal of encrustations. We report the case of a patient who was diagnosed with this rare condition and could escape maintenance dialysis after correct diagnosis was made and conservative treatment was started using antibiotics and combined oral and local acidification.

Encrusted cystitis and pyelitis in children: an unusual condition with potentially severe consequences.

OBJECTIVES: To report our experience with the management of encrusted cystitis and pyelitis (EC and EP) in the pediatric population. EC and EP are well-known entities in adults but are rarely identified in children. They consist of mucosal encrustations and are due to specific microorganisms. METHODS: Between 1996 and 2001, 4 children with a mean age of 9 years (range 4 to 13) were treated for EC (n = 2), EP (n = 1), and EC and EP (n = 1). The latter was a kidney transplant recipient. We retrospectively evaluated the clinical characteristics of the patients and the results of conservative management. RESULTS: The delay between the beginning of the symptoms and the diagnosis was longer than 1 month in all cases. The diagnosis of EC was not evoked and was made during cystoscopy in all cases. EP was diagnosed during pyelotomy in 1 patient because it was evoked and confirmed by computed tomography scan in the kidney transplant recipient. Corynebacterium urealyticum was identified in the urine of all patients. EC was treated by antibiotics and endoscopic debulking, and EP was treated by antibiotics and local acidification. The duration of antibiotic therapy was between 1 and 6 months. The tolerance to local acidification of the kidneys was poor. Cure was achieved in 3 cases, but the treatment of EP failed in the kidney transplant recipient and graft removal was decided after 6 months of failed management because intractable febrile urinary tract infections became life threatening for the patient. CONCLUSIONS: EC and EP are uncommon in children; however, these diseases must be considered. They must be diagnosed rapidly and require, if possible, conservative management. Nevertheless, kidney loss can occur in transplant recipients with EP.

[Encrusted pyelitis in a transplanted kidney]. / Pielitis incrustante en riñón trasplantado.

OBJECTIVES: To emphasize the importance of early diagnosis of encrusted pyelitis in kidney transplant patients. METHODS: We report one case of encrusted pyelitis in a 10-year-old girl with a kidney graft who was treated by means of nephrostomy tube irrigation with an acidifier liquid substance. RESULTS: After 16 days of treatment there was a significant decrease of the size of the calcified pyelic plaque, keeping a good renal function afterwards. CONCLUSIONS: This disease should be thought of in every case of kidney transplant patient with negative urine cultures and alkaline pH, and the microbiologist should be alerted of the possibility of urinary tract infection by Corynebacterium.

La pielitis incrustante: hallazgos en ecografía y TC / Encrusted pyelitis: ultrasound and computed tomography findings

La pielitis incrustante (PI) es una enfermedad infecciosa producida por Corynebacterium urealyticum, cuya prevalencia es muy elevada en pacientes con trasplante renal que ha sufrido frecuentes manipulaciones urológicas y tratamientos antibióticos prolongados. Esta enfermedad es de graves consecuencias para el paciente si no se realiza un diagnóstico y tratamiento antibiótico temprano. La ecografía y la TC muestran imágenes típicas de calcificación en el sistema colector, pudiendo ser la radiografía simple de abdomen normal. Describimos un caso de PI en un paciente transplantado renal (AU)

Encrusted pyelitis of native kidneys.

This study reports the first four cases of encrusted pyelitis involving native kidneys. The clinical features, management, and outcome of these patients were analyzed. Predisposing factors were underlying urologic disease and/or urologic manipulations, debilitating diseases, hospitalization, and prolonged antibiotic therapies. Presenting symptoms were renal failure in three patients with ureteroileal urinary diversion and manifestations of cystitis in one patient. Computed tomography scan of the urinary tract was critical for diagnosis. Presence of struvite was demonstrated by crystalluria and infrared spectrophotometry analysis of the encrusted material. Corynebacterium urealyticum urinary infection was identified in one case. Surgery (one patient) and palliative ureteral diversion (one patient), respectively, led to death and end-stage renal failure. Successful dissolution of encrusted pyelitis was obtained in two patients treated with intravenous vancomycin and local acidification of the renal collecting system. Clinical observation shows that encrusted pyelitis is a threatening disorder that destroys the native kidneys and may lead to end-stage renal failure. Successful treatment of the disease by chemolysis and antibiotics depends on correct and early diagnosis. Diagnosis required recognition of the predisposing factors, computed tomography imaging of the urinary tract, crystalluria, and identification of urea-splitting bacteria with prolonged culture on selective medium.

The conservative management of corynebacterium group D2 encrusted pyelitis.

OBJECTIVE: To evaluate the conservative management of encrusted pyelitis (EP), an infectious disease caused by urea-splitting micro-organisms (Corynebacterium group D2 being the most common), and characterized by stone encrustation of the collecting system. PATIENTS AND METHODS: Four patients (aged 17-62 years) with EP caused by Corynebacterium group D2 were treated conservatively with intravenous vancomycin and percutaneous acidification of the renal collecting system. Percutaneous nephrostomy tubes were placed to allow irrigation with Thomas' acid solution, the outflow being ensured by ureteric catheters. Patients were monitored and the results of and tolerance to treatment evaluated clinically, by biological assays, and by imaging techniques (ultrasonography, computed tomography and pyelography). RESULTS: No kidneys were lost and in all patients with initial renal failure, creatinine levels recovered to previous values. The adverse effects were moderate, consisting of flank pain or discomfort, and low-grade fever. Three patients developed asymptomatic fungal urinary tract infections requiring antifungal agents. The encrustations were treated effectively and almost disappeared in two patients, while the other two had no residual calcification. One transplanted-kidney recipient developed a ureteric stricture requiring surgical repair. Within a mean follow-up of 16 months, there was no recurrence of EP and the residual encrustation remained small. CONCLUSION: The conservative treatment of EP can avoid surgery in many cases, although there are some adverse effects of irrigation. The long-term follow-up and prevention of recurrent EP are nevertheless required.

[Cystic pyeloureteritis]. / Pieloureteritis quística.

The pyelitis or cystic pyeloureteritis is a rare disease of unknown etiology. The clinic is unspecific and the treatment, medical and expectant. The importance of this disease consists of a correct differential diagnosis with other repletion defect imaging in the excretory tract and its frequent association to other diseases.