Efficacy and Safety of Extracorporeal Shock Wave Lithotripsy (ESWL) in Patients With Infected Ureterohydronephrosis Due to Ureteral Stones Following Double-J Catheter Insertion.

INTRODUCTION: Double-J ureteral catheters in patients with ureteral lithiasis undergoing extracorporeal shockwave lithotripsy (ESWL) procedures reduce the efficacy of the procedure or have no effect on the stone-free rate. However, the effect of double-J catheters on the patients in whom they were inserted for infected hydronephrosis is not known. The aim of our study was to evaluate the efficacy and safety of the ESWL procedure in patients with ureteral lithiasis and double-J catheters previously inserted for infected hydronephrosis. METHOD: We conducted a comparative case-control, match-paired study in a group of patients with ureteral lithiasis treated by ESWL from January 1, 2018, to March 1, 2023, who were divided into two groups according to the presence of the double-J catheter. For each patient with the double-J catheter from the study group, we selected one patient for the control group without the double-J catheter and matched them in terms of size, location of stones, and body mass index (BMI). We analyzed the stone-free rate and complications that occurred in the two groups. RESULTS: Forty patients with ureteral lithiasis and a double-J catheter inserted for infected hydronephrosis were enrolled in the study group. The control group included 40 patients with ureteral stones without double-J catheters. The patients in the two groups were predominantly men with stones located in the lumbar region and on the right side and with a BMI between 25 and 30 kg/m2. The stones had an average size of 0.9+/-0.12mm and 0.89+/-0.15mm, respectively (p=0.624). There was no statistically significant difference in stone-free rate between the two groups after the first session of ESWL (47.5% vs. 52.5%, p=0.502), the second (70% vs. 75%, p = 0.616), and the third session (85% vs. 87.5%, p=0.761). The rate of complications was similar in both groups (7.5% vs. 5%, p=0.761). CONCLUSIONS: The presence of double-J catheters inserted in patients with ureteral stones who underwent ESWL for infected hydronephrosis does not affect the stone-free rate of the procedure or the complication rate. The procedure of ESWL in patients with ureteral lithiasis and double-J catheters inserted for infected hydronephrosis is a safe and efficient method that can be recommended as an initial treatment alongside retrograde ureteroscopy.

Effects of continuing nursing care under cognitive behavioral intervention on psychological state and living quality in patients with double J catheter after ureterolithiasis surgery.

OBJECTIVE: The effects of continuing nursing care under cognitive behavioral intervention on the psychological state and living quality of patients with double J catheter after ureterolithiasis surgery were analyzed in this research. METHODS: The research subjects in this study were 142 patients who were discharged from our hospital with a double J tube after ureterolithiasis surgeries from June 2019 to June 2020. According to the patient care plan, the subjects were divided into the control group (n=71) and the observation group (n=71) and respectively treated with routine basic nursing measures and continuing nursing care under cognitive-behavior intervention. Subsequently, the psychological state, living quality and the complications that occurred were compared between the two groups. RESULTS: The depression and anxiety scores of the two groups after 4 weeks of intervention, comparing to thoes before intervention, were seen with remarkably decreased significance (P<0.05). The scores of living quality and self-care quality of patients in the observation group were obviously higher than those in the control group (P<0.05). In addition, the incidence of complications in the observation group was critically lower than that in control group (P<0.05). CONCLUSION: Continuous nursing care under cognitive behavioral intervention can substantially improve the psychological state, living quality and self-care ability of patients with double J tube after ureterolithiasis surgery, and reduce the incidence of complications, which is worthy of clinic promotion.

Ureteral diverticulum complicated by urinary lihiasis: About a case report.

Ureteral diverticulum is a rare urinary malformation and can frequently lead to urinary complications. It can be congenital, acquired or an abortive ureteral duplication. Most are treated conservatively. A surgical indication is made in case of symptomatic or complicated diverticulum. It can be congenital, acquired or an abortive ureteral duplication. Most of them are treated conservatively. A surgical indication is given in case of symptomatic or complicated diverticulum. and recurrent total hematuria. Radiological investigations confirmed the diagnosis of congenital ureteral diverticulum complicated with lithiasis.

Pathogen distribution and risk factors for urinary tract infection in infants and young children with retained double-J catheters.

OBJECTIVES: To investigate the pathogens and potential risk factors for urinary tract infection (UTI) in patients with retained double-J catheters (DJCs). METHODS: In total, 107 infants and young children with DJCs were included in this retrospective analysis. Patients were included in the infection group (n = 30) or non-infection group (n = 77), according to UTI presence or absence. The species and characteristics of pathogens were investigated, and the clinical features of the patients were recorded for further analysis. RESULTS: Gram-negative bacilli were the most common causative pathogens (69.2%), among which Escherichia coli was most frequent (38.5%). The second most common causative pathogens were Gram-positive cocci (28.2%), among which Enterococcus faecalis was most frequent (10.3%). UTIs among patients in this study were associated with the following factors: catheter retention (long-term) (odds ratio [OR] = 2.514, 95% confidence interval [CI] = 1.176-5.373), sex (male) (OR = 2.966, 95% CI = 1.032-8.529), DJC retention (long-term) (OR = 1.869, 95% CI = 1.194-2.926), and DJC number (unilateral) (OR = 0.309, 95% CI = 0.103-0.922). CONCLUSIONS: Infants and young children with DJCs were likely to experience UTIs, mainly caused by Gram-negative bacilli. Long-term catheter retention or DJC retention, male sex, and bilateral DJC retention were risk factors for UTI.

Actinotignum schaalii: Relation to Concomitants and Connection to Patients' Conditions in Polymicrobial Biofilms of Urinary Tract Catheters and Urines.

Actinotignum schaalii is an emerging, opportunistic pathogen and its connection to non-infectious diseases and conditions, such as prostate or bladder cancer, or chronic inflammation has been proposed. Here, we analyzed 297 urine, ureteral and urinary catheter samples from 128 patients by Polymerase Chain Reaction followed by Denaturing Gradient Gel Electrophoresis and Sequencing (PCR-DGGE-S), and culture, and 29 of these samples also by 16S rRNA Illumina sequencing, to establish A. schaalii's prevalence in urinary tract-related samples, its relation to other bacteria, and its potential association with patients' conditions and samples' characteristics. A. schaalii-positive samples were significantly more diverse than A. schaalii negative and between-group diversity was higher than intra-group. Propionimicrobium lymphophilum, Fusobacterium nucleatum, Veillonella sp., Morganella sp., and Aerococcus sp. were significantly more often present in A. schaalii-positive samples; thus, we suggest these species are A. schaalii's concomitants, while Enterobacter and Staphylococcaceae were more often identified in A. schaalii-negative samples; therefore, we propose A. schaalii and these species are mutually exclusive. Additionally, a significantly higher A. schaalii prevalence in patients with ureter stricture associated hydronephrosis (p = 0.020) was noted. We suggest that A. schaalii could be an early polybacterial biofilm colonizer, together with concomitant species, known for pro-inflammatory features.

Pyonephrosis drained by double-J catheter.

An infectious disease with obstructive hydronephrosis, pyonephrosis causes suppurative destruction of the renal parenchyma. In such cases, retrograde ureteric stenting is considered a good choice for the drainage of pyonephrosis, as an alternative to percutaneous nephrostomy and nephrectomy. The complication rate is minimal in retrograde ureteric stenting compared with about 4% in percutaneous nephrostomy.

Computed tomograpy evaluation of ureteral length in children.

INTRODUCTION: Although ureteral length (UL) is highly variable in children, reliable data on this topic are scarce. During urinary tract surgery, the use of an inappropriately dimensioned ureteral stent is associated with adverse effects. This study aimed to evaluate UL as a function of the child's age, using contrast-enhanced computed tomography (CT) of the abdomen and pelvis, and to calculate a new equation for predicting UL (and thus the optimal length of ureteral stents) in children. MATERIAL AND METHODS: A retrospective, single-centre study of children (younger than 16 years) who are free of abdominal mass syndrome and severe scoliosis was conducted. After three-dimensional reconstruction of the CT data, the ureter was measured between the ureteropelvic junction and ureterovesical junction by two observers. The lengths of the right and left ureters were analyzed by age, with at least 10 CT measurements per age class. RESULTS: The mean ULs on the right and left were, respectively, 9.7 and 9.91 cm before the age of 1 year, 20.10 and 21.08 cm at the age of 7 and 26.55 and 27.46 cm at the age of 16. The interobserver reproducibility of UL determination was high (intraclass correlation coefficient [95% confidence interval]: 0.97 [0.94-0.99]). On the basis of these results, the length of the double-J catheter should be equal to the child's age +12 cm (Table 1). CONCLUSION: Computed tomography measurement of the UL in healthy children is reproducible and reliable and enabled the estimation of the UL by age group. This knowledge should facilitate the choice of the stent used in ureteral surgery. To confirm the study results, the stent size suggested here should be evaluated in routine practice.

Urinothorax causing massive left side pleural effusion in a young lady; case report and literature review.

Urinothorax is the presence of the urine in the pleural space. This condition is very rare and occurs due to unrelieved obstruction of urinary flow. A 20-year-old female presented 7 days after cesarean section with tachypnea, and generalized abdominal pain. There was absent air entry over the left hemithorax. CT scan showed massive left pleural effusion and a stone obstructing the renal pelvis with hydronephrosis and peri-renal collection. The pleural fluid had high fluid creatinine level suggesting urine collection. Ureteroscopy done and double J catheter inserted. The effusion became loculated, thoracotomy and pleural decortication done.

Molecular Techniques Complement Culture-Based Assessment of Bacteria Composition in Mixed Biofilms of Urinary Tract Catheter-Related Samples.

Urinary or ureteral catheter insertion remains one of the most common urological procedures, yet is considered a predisposing factor for urinary tract infection. Diverse bacterial consortia adhere to foreign body surfaces and create various difficult to treat biofilm structures. We analyzed 347 urinary catheter- and stent-related samples, treated with sonication, using both routine culture and broad-range 16S rDNA PCR followed by Denaturing Gradient Gel Electrophoresis and Sanger sequencing (PCR-DGGE-S). In 29 selected samples, 16S rRNA amplicon Illumina sequencing was performed. The results of all methods were compared. In 338 positive samples, from which 86.1% were polybacterial, 1,295 representatives of 153 unique OTUs were detected. Gram-positive microbes were found in 46.5 and 59.1% of catheter- and stent-related samples, respectively. PCR-DGGE-S was shown as a feasible method with higher overall specificity (95 vs. 85%, p < 0.01) though lower sensitivity (50 vs. 69%, p < 0.01) in comparison to standard culture. Molecular methods considerably widened a spectrum of microbes detected in biofilms, including the very prevalent emerging opportunistic pathogen Actinotignum schaalii. Using massive parallel sequencing as a reference method in selected specimens, culture combined with PCR-DGGE was shown to be an efficient and reliable tool for determining the composition of urinary catheter-related biofilms. This might be applicable particularly to immunocompromised patients, in whom catheter-colonizing bacteria may lead to severe infectious complications. For the first time, broad-range molecular detection sensitivity and specificity were evaluated in this setting. This study extends the knowledge of biofilm consortia composition by analyzing large urinary catheter and stent sample sets using both molecular and culture techniques, including the widest dataset of catheter-related samples characterized by 16S rRNA amplicon Illumina sequencing.

[Arterioureteral fistulas in the last 10 years at the University of Lübeck]. / Arterioureterale Fisteln innerhalb der letzten 10 Jahre an der Universität zu Lübeck.

INTRODUCTION: Arterioureteral fistulas are rare, life-threatening, and difficult to diagnose. Risk factors are medical interventions in the lesser pelvis (general, urological, gynecological, and vascular surgery), radiation therapy of the lesser pelvis, permanent double J catheters, and previous vessel malformations. MATERIALS AND METHODS: We retrospectively evaluated all cases of arterioureteral fistulas registered over the last 10 years in the clinic's documentation system. For all cases, clinical symptoms, diagnostics, therapies as well as clinical outcome were evaluated. RESULTS: Four of the 5 patients were women. The most common initial symptom was a gross hematuria (4/5). All patients had a permanent double J catheter after extensive surgery of the lesser pelvis. In one case the initial diagnosis was done by retrograde ureterography, in 2 patients by provocative angiography and in the other 2 cases with a laparotomy due to cardiovascular problems. Three patients were treated by open surgery and 2 patients were treated by stenting of the iliac artery. One patient died, 2 patients had a permanent kidney fistula, and 2 patients continued treatment with a permanent double J catheter. CONCLUSION: Based on the more aggressive therapy regimens, we expect that the number of patients presenting with arterioureteral fistulas will continue to rise. The identification of these patients based on their risk profile is essential.

Colonizations on biofilm layers of D-J catheters under sterile urine conditions. / Colonización de las capas de biofilm de los catéteres doble J en condiciones de orina estéril.

OBJECTIVE: To evaluate colonizations onbiofilm layers of Double J (D-J) catheters implanted forkidney stones or ureteral stones under sterile conditions. METHODS: D-J catheters implanted between January2012 and February 2014 and removed in 0-90 days,were examined in microbiology laboratory prospectively.Fifty two patients divided into three groups regardingthe duration of the D-J catheters as; 0-30 days, 31-60days, 61-90 days. The colonization (≥1.000 colony)was reported after biofilm layer on D-J catheter was holdin culture media. The upper, middle and lower parts ofthe catheters were analyzed seperately. RESULTS: Thirty five patients had symptomatic urinarytract infection or positive urine culture after implantationwere excluded from the study. Colonization on biofilm layer was detected in 11 patients (21.15%) [Coagulase-negative staphylococci (CNS): 3, Escherichia coli (E. coli): 3, Candida species (Candida spp.): 3, Klebsiella species (Klebsiella spp.): 2]. The rates of colonization according to the duration of the catheterization were; 12.5% in 0-30 days, 18.51% in 30-60 days, 29.4% in 60-90 days (Group 1 vs 2; .696 , group 1 vs group 3; .356 , group 2 vs group 3; .401). The rates of colonization according to the location of the catheter were; 100% in upper and lower parts, 54.4% in middle part (Group 1 vs 2; .011, group 1 vs group 3; , group 2 vs group 3; .011). CONCLUSIONS: Colonization on catheters is possibleeven in the sterile urinary conditions according to thepresent findings. The risk of colonization increases 1.5times in 30-60 days and 2.5 times in 60-90 days comparedto the first 30 days. Besides the risk of colonizationincreases about 2 times in the convoluted edges ofthe catheter compared with the middle part. Thus, D-Jcatheter should be removed as soon as possible and therisk of colonization should be minimalized.

OBJETIVO: Evaluar la colonización de las capas de biofilm de los catéteres doble J (DJ) implantados por litiasis renal o ureteral bajo condiciones estériles.MÉTODOS: Los catéteres DJ implantados entre enero 2012 y febrero 2014 y retirados en 0-90 días fueron examinados de forma prospectiva en el laboratorio de microbiología. Cincuenta y dos pacientes fueron divididos en tres grupos conforme al tiempo del DJ: 0-30 días, 31-60 días y 61-90 días. La colonización (>100.000colonias) fue comunicada tras el cultivo de la capa de biofilm del catéter. Se analizaron por separado las zonas superior, media e inferior de los catéteres DJ. RESULTADOS: 35 pacientes que tenían infección urinaria sintomática o cultivo de orina positivo después del implante fueron excluidos del estudio. Se detectó colonización de la capa de biofilm en 11 pacientes (21,5%) [estafilococo coagulasa negativo (SCN): 3, Escherichia coli (E.coli): 3, Cándida especies (Cándida spp: 3, Klebsiela especies (Klebsiela spp.): 2] Las tasas de colonización de acuerdo con el tiempo de catéter fueron 12,5% en 0-30 días, 18,51% en 30-60 días, 29,4% en 60-90 días (Grupo 1 vs 2; ,696 , grupo 1 vs grupo 3; ,356, grupo 2 vs grupo 3; ,401). Las tasas de colonización de acuerdo con la localización del catéter fueron del 100% en las porciones superior e inferior y 54% en la porción media (Grupo 1 vs 2; ,011, grupo 1 vs grupo 3; , grupo 2 vs grupo 3; ,011). CONCLUSIONES: La colonización de los catéteres es posible incluso en condiciones de orina estéril de acuerdo con los hallazgos presentes. El riesgo de colonización aumenta 1,5 veces en 30-60 días y 2,5 veces en 60-90 días comparado con los primeros 30 días. Además, el riesgo de colonización aumenta unas 2 veces en los extremos espirales del catéter en comparación con la porción media. Así, los catéteres DJ deben ser retirados tan pronto como sea posible y el riesgo de colonización debe ser minimizado.

How to stent the ureter after kidney transplantation in children?-A comparison of two methods of urinary drainage.

Ureteral stenting after pediatric renal transplantation serves to prevent obstruction and urinary leakage, but can also cause complications. This study compares the complication rates of both methods. Data were retrospectively collected at Erasmus MC, Rotterdam, the Netherlands (splint group, n = 61) and Hospital for Sick Children, Toronto, Canada (JJ catheter group, n = 50). Outcome measures included urological interventions and incidence of UTIs during the first 3 months post-transplantation. The splint was removed after a median of 9 (IQR 8-12), the JJ catheter after 42 (IQR 36-50) days. Seven (11.5%) children in the splint group needed at least one urological re-intervention versus two in the JJ catheter group (P-value .20). UTIs developed in 19 children (31.1%) in the splint group and in twenty-five (50.0%) children in the JJ catheter group (P-value .04), with a total number of 27 vs. 57 UTIs (P-value .02). Nine (33.3%) vs. 35 (61.4%) of these, respectively, occurred during the presence of the splint (P-value <.001). Children with a JJ catheter developed more UTIs than children with a splint; the latter, however, tended to require more re-interventions. Modification of either method is needed to find the best way to stent the ureter.

American cranberry (proanthocyanidin 120 mg): its value for the prevention of urinary tracts infections after ureteral catheter placement.

INTRODUCTION: Urinary tract infection (UTI) is among the most frequent complications after urinary tract surgical procedures, mainly when catheter placement is necessary. Although the use of American cranberry has been related with a reduced risk of UTI, there is no study reporting the value of its prevention effect against catheter-associated urinary tract infections. MATERIAL AND METHODS: A prospective trial comparing UTI rate (positive urine culture) among 31 patients with double J catheter (JJ) and adding American cranberry (120 mg) in routine prophylactic therapy, and 31 patients with JJ catheter only receiving routine prophylactic therapy. RESULTS: Regarding general characteristics of the populations no significant difference among groups have been found. Only significant differences have been observed when the variables "cranberry treatment" and "dwell time of JJ catheter" were related. "Dwell time of JJ catheter" was higher in patients with UTI (35.9 compared 28.5 days [P=.03]). UTI percentage was lower in cranberry supplemented patient group (12.9 compared to 38.7% [P=.04]). CONCLUSIONS: We can conclude that American cranberry (120 mg) has an adjuvant effect in the prevention of UTI in patients with JJ catheter after surgery.

The application of looping technique by using a gooseneck snare and a loach guide wire in retrieving foreign bodies within the vascular or ureteral duct / 介入放射学杂志

Objective To investigate the feasibility and application scope of the looping technique by using a gooseneck snare and a loach guide wire in retrieving tubular foreign bodies within the vascular or ureteral duct. Methods During the period from July 2009 to Dec. 2013, six patients with ruptured catheter were admitted to authors’ hospital. All six patients were females. Three patients had internal ruptured peripherally inserted central venous catheter (PICC), one patient had ruptured implantable venous access port catheter and two patients had replacement of double “J” ureteral catheter stent. By using looping technique, i.e. a loach guide wire and a gooseneck snare were separately placed at the two ends of the tubular foreign body, then the gooseneck snare entangled the soft leading end of the loach guide wire to form a annular structure to seize the ruptured tubular catheter and then to pull it out of the body. Results With the help of the looping technique, the internal ruptured catheter or the double “J” ureteral catheter was successfully removed in all the six patients. Conclusion For the retrieval of the tubular foreign bodies within the vascular or ureteral duct, the looping technique by using a gooseneck snare and a loach guide wire is an effective and fast treatment. Therefore, this technique should be recommended in the clinical practice.

Application of double-J catheter in treatment of renal tuberculosis / 第二军医大学学报

Objective: To investigate the therapeutic efficacy of double-J catheter in treatment of renal tuberculosis(TB) and in rescuing the structure and function of the kidney. Methods: Thirty-four patients with renal TB (22 combined with single side hydronephrosis) were divided into 2 groups randomly. Group A were treated with antituberculous therapy and group B with antituberculous therapy combined with pre-treatment with double-J catheter. All 34 patients were followed up for 3 months and were re-examined. Results: The results of B ultrasound, intravenous urogram (IVU), CT and isotope nephrogram were comparable between the 2 groups before treatment, and the results were significantly different between the two groups after 3 months' drug treatment (P<0.05). The results of routine urine tests, ESR and the positive rates of urine ABF were not significantly different between the 2 groups (P<0.05). Nephrectomy was performed in 21 cases, with 15 cases(88.2%) in group A and 6 cases(35.3%)in group B (P<0.05). Conclusion: Pre-treatment with double-J catheter in the diseased side of patients with renal TB can better preserve the structure and function of the kidney, and can help to lower the rate of nephrectomy.

Application of double-J catheter in treatment of renal tuberculosis / 第二军医大学学报

Objective:To investigate the therapeutic efficacy of double-J catheter in treatment of renal tuberculosis(TB)and in rescuing the structure and function of the kidney.Methods:Thirty-four patients with renal TB(22 combined with single side hydronephrosis)were divided into 2 groups randomly.Group A were treated with antituberculous therapy and group B with antituberculous therapy combined with pre-treatment with double-J catheter.All 34 patients were followed up for 3 months and were re-examined.Results:The results of B ultrasound,intravenous urogram(IVU),CT and isotope nephrogram were comparable between the 2 groups before treatment,and the results were significantly different between the two groups after 3 months'drug treatment(P