Acute Acalculous Cholecystitis Associated with Abscesses-An Unknown Dual Pathology.

(1) Introduction and Aims: Little is known about the relationship between renal pathology and gallbladder pathology, although the two organs (the gallbladder and the right kidney) are in close proximity to one another. If a renal abscess disseminates, the gallbladder would be one of the secondary organs involved. As the bile provides a favorable environment for the development of pathogenic germs, it allows for the development of acute cholecystitis, even if calculi are absent, thus resulting in the development of acute acalculous cholecystitis. The aim of our study was to analyze the association between acute acalculous cholecystitis (AAC) and renal abscesses. (2) Methods: A department-wide retrospective cohort observational study including 67 patients with renal abscesses, with a mean age of 34.5+/-16.21 years and with five males and 62 females, was conducted. All of the patients were examined by an abdominal ultrasound. The lab tests included CBC with differential liver enzymes and serum bilirubin (in order to assess alterations in the liver function which can be associated with AAC) and serum creatinine (in order to assess the renal function). Blood culture and urine culture tests were also performed. (3) Results: Of the 67 patients with renal abscesses, eight (11.94%) were associated with acute cholecystitis: four cases (5.97%) of acalculous cholecystitis and four cases (5.97%) of calculous cholecystitis, two of which presented biliary sludge (acute micro-calculous cholecystitis). All four cases of acute acalculous cholecystitis presented with sepsis, and there was one case of septic shock at onset. We did not observe an impairment in renal function in the patients presenting with acute acalculous cholecystitis, and hepatic impairment was inconstant and moderate. All of the cases had a favorable outcome after a prompt initiation of intensive antibiotic therapy; both the renal abscess and the acute acalculous cholecystitis receded without further complications. (4) Conclusions: The association of acute acalculous cholecystitis with renal abscesses could be related to the possibility of germ dissemination from the infectious focus. In the case of a renal abscess, careful clinical, lab, and imaging exams of the gallbladder are recommended in order to ensure early therapeutic intervention in the event of an association with acute acalculous cholecystitis.

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.

Extensively drug-resistant Myroides odoratimimus - a case series of urinary tract infections in immunocompromised patients.

PURPOSE: We report an outbreak of urinary tract infections (UTIs) caused by Myroides odoratimimus, which occurred in the largest clinical hospital in western Romania. PATIENTS AND METHODS: From June to August 2017, four strains of M. odoratimimus were isolated from the urine samples of patients hospitalized in the urology, diabetes, and surgery departments. Hospital records of all patients whose urine cultures were positive for M. odoratimimus were reviewed retrospectively. We also reviewed the cases reported in the literature. RESULTS: All UTIs, except one, were hospital-acquired infections. All patients with M. odoratimimus UTIs were immunocompromised. Three patients underwent urinary catheterization with a Foley's catheter upon admission in the emergency department and one presented for replacement of ureterostomy tubes. All Myroides isolates were resistant to almost all the tested antibiotics. Two patients were successfully treated with tigecycline and one was receiving antimicrobial treatment for another infection at the time of isolation of the microorganism. CONCLUSION: Although M. odoratimimus is an uncommon pathogen, clinicians should be aware of its ability to cause UTI outbreaks, especially in the immunocompromised population. Due to its multi-drug resistance, it is important to rapidly identify Myroides spp. in order to choose the best treatment regimen.

Intravesical prostatic protrusion can be a predicting factor for the treatment outcome in patients with lower urinary tract symptoms due to benign prostatic obstruction treated with tamsulosin.

OBJECTIVE: To assess the effect of the intravesical protrusion of the prostate (IPP) on the response to medical treatment with tamsulosin for a 3 month period. MATERIALS AND METHODS: The study, which was conducted between 2009 and 2011 in the ambulatory clinic of an academic hospital, divided 183 patients with lower urinary tract symptoms due to benign prostatic obstruction in 2 groups (90 and 93 patients, respectively) according to intravesical prostatic protrusion (IPP): group A ≤10 mm; group B >10 mm. Patients were treated with tamsulosin (0.4 mg, once daily) for 3 months. The International Prostate Symptom Score (IPSS; -35% and -3 points) and maximum urinary flow (Qmax) assessed by uroflowmetry (+1.6 mL/s and +25%) response criteria were defined. Patients' responses from the 2 groups were compared. RESULTS: After 3 months of treatment, Qmax increased, with 2.74 mL/s (25%) in group A (P <.01) and 1.59 mL/s (19%) in group B (P = .07). IPSS decreased, with 39.9% (P < .01) and 29.7% (P = .08), respectively. Statistically significant differences were noted for IPSS -35% responders (78% group A vs 58% group B, P <.01), -3 points IPSS responders (82% vs 64%), Qmax +25% responders (82% vs 58%), and Qmax +1.6 mL/s responders (85% vs 62%, P <.01). No major adverse events occurred. The relative small number of patients enrolled was the main study limitation. CONCLUSION: Men with IPP exceeding 10 mm seem to be more frequently poor responders to medical treatment with tamsulosin among patients with lower urinary tract symptoms due to benign prostatic obstruction, prostatic volume <40 mL, and prostate-specific antigen <1.5 ng/mL.

Management of single large nonstaghorn renal stones in the CROES PCNL global study.

PURPOSE: We compared stone characteristics and outcomes in patients with a single large nonstaghorn renal calculus treated with percutaneous nephrolithotomy in the Clinical Research Office of Endourological Society global study. MATERIALS AND METHODS: Two statistical analyses were done, including one comparing renal stone size (20 to 30, 31 to 40 and 41 to 60 mm) and the other comparing renal stone site (pelvis, or upper, mid or lower calyx). Surgical outcomes, including operative time, hospital stay, stone-free rate and postoperative fever, were compared between groups. Fitness for surgery was assessed using the American Society of Anesthesiologists scoring system. Severity of postoperative complications was graded with the modified Clavien classification. RESULTS: Of 1,448 stones 1,202 (83%) were 20 to 30 mm, 202 (14%) were 31 to 40 mm and 44 (3%) were 41 to 60 mm. Of the large stones 73% were located in the renal pelvis. A statistically significantly lower stone-free rate, and higher postoperative fever and blood transfusion rates were seen with increased calculous size. With increased American Society of Anesthesiologists score the proportion of large stones in the calyces increased. At a score of III the proportion of large stones in the calyces was more than twice that of stones in the renal pelvis (13.5% vs 5.7%). Generally more patients with large calyceal than large pelvic stones had postoperative complications across the range of Clavien scores from I to IIIB. CONCLUSIONS: Calyceal site was associated with decreased fitness for surgery and an increased risk of postoperative complications compared to renal site. An increase in stone size results in a lower stone-free rate, and higher rates of postoperative fever and blood transfusion.