A Prospective Study of Bladder Function Following Endometriosis Surgery With Up to Eight years Follow-up.

STUDY OBJECTIVE: To assess long-term urinary function for women having laparoscopic surgery for endometriosis. DESIGN: Institutional Review Board-approved nested cohort study within a larger randomized controlled trial assessing urinary function following any benign laparoscopy for gynecological presentations. SETTING: Two tertiary-level university-affiliated hospitals. PATIENTS: Women with histologically confirmed endometriosis within the randomized controlled trial between April 2012 and November 2019, where baseline urinary function was determined. INTERVENTIONS: Women with histologically confirmed endometriosis were contacted between February and October 2020, and urinary function was re-assessed. MEASUREMENTS AND MAIN RESULTS: Urinary function was assessed using validated questionnaires across the domains of filling, voiding, incontinence, and quality of life determined distant from surgery. Higher scores correlated with a greater severity of symptoms. From 518/711 (72.9%) women with histologically confirmed endometriosis, 289/518 (55.8%) consented to the nested study. At a mean of 50 months (range 12-103 months) post-operatively, 35 participants (12.1%) had sought treatment for bladder symptoms, and 81 participants (28.0%) reported at least one urinary tract infection since their index surgery. There was a significant worsening of symptoms for filling, voiding, incontinence, and quality of life pre-operative to post-operatively (2.27 vs 3.32, 0.93 vs 2.02, 1.06 vs 2.32, 0.83 vs 2.13 respectively, p <.001). There was no statistically significant difference in urinary questionnaire scores in participants with and without uterovesical endometriosis. There was no statistically significant difference in any parameter when comparing any revised American Society of Reproductive Medicine (rASM) stage of endometriosis. Participants who had post-operative urinary retention reported a higher mean voiding score than those who did not (3.24 vs 1.94, p = .017), while participants with post-operative urinary tract infection reported a higher mean frequency score than those who did not (5.17 vs 3.24, p = .016). CONCLUSION: This study suggests a decline in urinary function over time following laparoscopic surgery for endometriosis that is not dependent on the severity or location of the disease.

Urinary tract infection after radiation therapy or radical prostatectomy on the prognosis of patients with prostate cancer: a population-based study.

BACKGROUND: We aimed to assess the trends in urinary tract infections (UTIs) and prognosis of patients with prostate cancer after radical prostatectomy (RP) and radiation therapy (RT) as definitive treatment options. METHODS: The data of patients diagnosed with prostate cancer between 2007 and 2016 were collected from the National Health Insurance Service database. The incidence of UTIs was evaluated in patients treated with RT, open/laparoscopic RP, and robot-assisted RP. The proportional hazard assumption test was performed using the scaled Schoenfeld residuals based on a multivariable Cox proportional hazard model. Kaplan-Meier analysis were performed to assess survival. RESULTS: A total of 28,887 patients were treated with definitive treatment. In the acute phase (< 3 months), UTIs were more frequent in RP than in RT; in the chronic phase (> 12 months), UTIs were more frequent in RT than in RP. In the early follow-up period, the risk of UTIs was higher in the open/laparoscopic RP group (aHR, 1.63; 95% CI, 1.44-1.83; p < 0.001) and the robot-assisted RP group (aHR, 1.26; 95% CI, 1.11-1.43; p < 0.001), compared to the RT group. The robot-assisted RP group had a lower risk of UTIs than the open/laparoscopic RP group in the early (aHR, 0.77; 95% CI, 0.77-0.78; p < 0.001) and late (aHR, 0.90; 95% CI, 0.89-0.91; p < 0.001) follow-up periods. In patients with UTI, Charlson Comorbidity Index score, primary treatment, age at UTI diagnosis, type of UTI, hospitalization, and sepsis from UTI were risk factors for overall survival. CONCLUSIONS: In patients treated with RP or RT, the incidence of UTIs was higher than that in the general population. RP posed a higher risk of UTIs than RT did in early follow-up period. Robot-assisted RP had a lower risk of UTIs than open/laparoscopic RP group in total period. UTI characteristics might be related to poor prognosis.

Perioperative predictors for complications in patients with Xanthogranulomatous Pyelonephritis treated with nephrectomy.

INTRODUCTION: Xanthogranulomatous pyelonephritis is an inflammatory disease characterized by chronic obstruction and infection. This pathology is a life-threatening condition when surgical treatment is carried out. We decided to retrospectively evaluate whether there were perioperative factors that predict complications in patients who undergo nephrectomy. METHODS: We reviewed all nephrectomies done in the period of 2013-2018, in a tertiary referral Hospital with the histopathological diagnosis of Xanthogranulomatous Pyelonephritis. RESULTS: The presence of renal abscess at admission was observed as a risk factor associated with perioperative complications (p = 0.002), presence of abscess was observed in 47.4% of subjects without complications compared to 89.3% of the perioperative complication group. Higher rates of blood transfusion requirement were observed in the perioperative complication group, 89.3% compared to 68.4% (p = 0.029), furthermore, perioperative bleeding was slightly greater in the complication group compared to its counterpart, 700 mL, and 600 mL, respectively (p = 0.01). CONCLUSIONS: Anemia and the presence of abscess were important perioperative factors that predict perioperative complications.

Risk Factors of Urinary Tract Infection in Pediatric Patients with Ureteropelvic Junction Obstruction after Primary Unilateral Pyeloplasty.

Objective: Ureteropelvic junction obstruction (UPJO) represents to a leading cause of fetal hydronephrosis, which is associated with urinary tract infection (UTI) and urinary stone disease. This study is aimed at investigating risk factors of UTI in pediatric patients with UPJO after primary unilateral pyeloplasty. Methods: The records of a consecutive series of patients undergoing primary pyeloplasty at a single institution between June 2015 and November 2021 were retrospectively reviewed. Demographic and clinical characteristics, including age, gender, weight, height, body mass index (BMI), creatinine (Cr), blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR), neutrophil ratio, lymphocyte ratio, neutrophil/lymphocyte ratio, renal pelvis anteroposterior diameter (APD), renal cortex thickness, caliectasis, open or laparoscopic pyeloplasty, and internal drainage or external drainage, were collected and analyzed. The incidence of postoperative UTI and its risk factors was analyzed. Results: A total of 504 patients were enrolled in the study, and they were classified into the UTI group (n = 188) and non-UTI group (n = 361). Univariate analysis of the incidence of UTI revealed that age, gender, weight, height, BMI, surgical modality, Cr level, BUN level, neutrophil ratio, lymphocyte ratio and neutrophil/lymphocyte ratio, renal cortex thickness, and postoperative drainage modality were associated with UTI incidence after pyeloplasty in pediatric patients with UPJO. Multivariate analysis revealed that male gender, <19 months, weight < 11.5 (kg), height < 83 (cm), BMI < 17.09, BUN > 4.08 (mmol/L), and internal drainage were risk factors of postoperative UTI in pediatric patients with UPJO. Conclusion: Our study demonstrated that male gender, <19 months, weight < 11.5 (kg), height < 83 (cm), BMI < 17.09, BUN > 4.08 (mmol/L), and internal drainage were risk factors of UTI in pediatric patients with UPJO after primary unilateral pyeloplasty, which may provide reference for prophylactic antibiotics for those patients with risk factors.

How I Handle Retreatment of LUTS Following a Failed MIST.

PURPOSE OF REVIEW: The goal of this paper is to review retreatment management after failed minimally invasive treatment (MIST) of various technologies. RECENT FINDINGS: A failed MIST can be defined by the return, persistence, or worsening of LUTS, as documented by symptom scores. Persistence, development, or recurrence of comorbidities such as recurrent urinary tract infection (UTI), retention, stones, hematuria, and incontinence can also signal a failed MIST. The common etiology for MIST failure is the preoperative consequence of long-term bladder outlet obstruction (BOO) on the bladder function. Close monitoring of therapies with antimuscarinics or beta-agonists can be empirically utilized if post-void bladder residual (PVR) is low. If there is a high PVR, urodynamic studies and cystoscopy can be used to determine overactive bladder (OAB), BOO, or necrosis. Depending on the timing of the observed BOO/OAB, subsequent retreatments involving transurethral debridement, medical and behavioral therapies, or repeat surgical debulking can be employed.

Secondary stone formation 8 weeks after percutaneous nephrolithotomy treatment: A case report.

INTRODUCTION: This work reports a patient with recurrent renal calculi subjected to three surgeries in half a year to be in the same position, and the high-throughput sequencing data showed different species in the renal pus and urine samples, which suggested that partial renal infection or stone formation can be judged by the bacteria in urine. PATIENT CONCERNS: The female patient aged 43 years was referred to the authors' department on April 13, 2020, due to left waist pain and fever for 3 days. DIAGNOSIS: Kidney stones and hydronephrosis were determined by a urinary system computed tomography scan. INTERVENTIONS: On April 20, 2020 and June 15, 2020, the patient was successfully treated with left percutaneous nephrolithotomy twice under general anesthesia. An investigation on the health and eating habits of the patient within 6 months was completed at the last admission. The components of the second renal calculus sample were analyzed with an infrared spectrum analyzer. The third renal stone (renal pus, triplicates) was subjected to microbial metagenome sequencing, and urine samples before and after surgery were subjected to 16S RNA sequencing by SEQHEALTH (Wuhan, China). OUTCOMES: After percutaneous nephrolithotomy, the left kidney stones were basically cleared, stone analysis revealed that the main components were calcium oxalate monohydrate, silica, and a small amount of calcium oxalate dehydrate. Although the urine samples exhibited differences, the renal pus and urine sample shared a single species. CONCLUSION: It is not clear that the prospects of partial renal infection or stone formation can be judged by the bacteria in urine.

Rapid Prostatic Regrowth and a Free-Floating Necrotic Bladder Mass Serving as a Nidus for Infection Following ThuLEP: Management With Morcellation and HoLEP.

We present a question regarding the management of a patient with recurrent urinary tract infections (UTIs) following multiple procedures for benign prostatic hyperplasia (BPH).

Intravenous Iron Isomaltoside 1000 Reduces Postoperative Anemia in Patients Undergoing Elective Urologic Surgery and Those with Urosepsis.

PURPOSE: Postoperative anemia is associated with increased morbidity and mortality in patients undergoing surgery. Anemia is also a common feature during sepsis. Therefore, here, we aimed to investigate the safety and efficacy of intravenous iron isomaltoside 1000 (Monofer®) in patients undergoing elective urologic surgery and in those with urosepsis. MATERIALS AND METHODS: This multicenter study was conducted through the review of the medical records of patients with postoperative anemia undergoing elective urologic surgery or with urosepsis in a multicenter hospital. Patients received a single intravenous iron isomaltoside (IIM), and their hemoglobin (Hb) level was evaluated before and after administration of IIM. Safety data included adverse effects and hypersensitivity reactions. In addition, the patients were divided into three groups (200 mg, 400 mg, and 600 mg IIM) to compare Hb changes before and after the administration of IIM. RESULTS: The study analyzed 52 men and 30 women with a mean age of 67 years. There was a significant difference between pre-treatment Hb and post-treatment Hb according to the type of the surgery after administration (p=0.01) of IIM in patients with postoperative anemia, and the mean preoperative Hb before IIM administration was 8.5 g/dL and that after IIM administration was 9.9 g/dL (p=0.006) in patients with urosepsis. The mean preoperative Hb changed from 10 g/dL to 11 g/dL after administration (p<0.001) of IIM in the whole cohort. There were no side effects due to the administration of intravenous IIM. CONCLUSION: A single perioperative intravenous injection of IIM 1000 significantly increased the Hb level in patients with anemia who underwent urologic elective surgery. Moreover, this treatment can be considered to have potential clinical benefits for anemia caused by sepsis.

Prevalence of virulent Candida spp. in complicated urinary tract infection of nephrolithiatic patients from surgical units of tertiary care hospitals Islamabad.

Candida species are the commensal organisms of human mucosa and opportunistically cause the diseases in susceptible persons. This study aimed to determine the prevalence and virulence of different Candida spp. among nephrolithiatic patients and their association with complicated UTI (cUTI). A total of 164 urine samples were collected from surgical units of two tertiary care hospitals (Poly Clinic and Pakistan Institute of Medical Sciences Hospital, Islamabad). From 74 kidney stone patients, 77 isolates of Candida spp. were confirmed through standard microbiological and molecular characterization. C. albicans was the predominant species with 51 isolates (66.2%) followed by 26 (33.8%) of C. non-albicans. The nephrolithiatic patients suffering from cUTI were more prone to be infected with Candida (P=0.047). Among all isolates, 83% (64) of the Candida isolates were biofilm formers, 80% (60) showed the esterase production and 64.9% (50) showed phospholipase production. Candida isolates positive for various virulence factors were more prevalently isolated from both catheterized and recurrent UTI patients. Among Candida spp., 16.9% (13) isolates showed resistance to fluconazole and 19.5% (15) against voriconazole and 11 isolates were resistant for both tested antifungals. Candida isolated from cUTI cases showed comparatively enhanced virulence attributes and antifungal resistance, suggesting that these factors might have role in development of cUTI in nephrolithiatic patients. Hence, this work highlights the high prevalence of both C. albicans and non albicans spp. in nephrolithiatic patients. So, there is need to administer evidence based antifungal therapy rather than empirical therapy to reduce the cUTI in nephrolithiatic patients.

How Early Postoperative Urinary Tract Infections Affect Renal Graft Function at 1-Year Follow-up.

BACKGROUND: Urinary tract infection (UTI) occurs in 21% of kidney recipients within the first 3 months after transplantation (KTx). It is associated with impaired graft function. Ureteral stent placement increases the occurrence of UTIs. The aim of this study was to assess the correlation between double-J placement, UTI incidence, and graft function. MATERIAL AND METHODS: We conducted an observational study in 753 patients transplanted between 2010 and 2017 in compliance with the Helsinki Congress and the Istanbul Declaration. Recipients with preserved graft function at the 1-year follow-up were included. Medical records were searched for intraoperative double-J placement, UTI incidence, and estimated glomerular filtration rate (eGFR) on the 30th and 360th days post-transplant. Pretransplant hypothetical estimated GFR (heGFR) of each donor was calculated from donors' age and physiological age-dependent loss of functional nephrons. Spearman's correlation and linear regression analyses were applied. P < .05 was considered significant. RESULTS: UTIs occurred in 239 (31.8%) patients. On the 30th day after KTx, eGFR was significantly lower in the UTI group (median, 39.5 vs 43.2; P < .01). A similar pattern was seen 1 year after KTx (47.5 vs 54.2; P < .01). Urinary stents were placed in 213 (28.3%) patients. UTIs occurred in 92 (43.2%) of them and in 147 (27.2%) of nonstented patients (odds ratio: 2; 95% confidence interval [CI], 1.5-2.8; P < .01). Median donor heGFR was 105.8 mL/min/1.73 m2, whereas median donor Modification of Diet in Renal Disease (MDRD) GFR was 64.2 mL/min/1.73 m2. A moderate correlation between age-adjusted heGFR and 1-year transplant function (r = .47) was noted. CONCLUSIONS: UTIs in the early post-transplant period decreased 1-year eGFR by 4 to 5 mL/min/1.73 m2. UTIs occurred twice as often when a urinary stent was placed.

Safety of retrograde pyelography for infected ureteral stones.

INTRODUCTION: Initial management of obstructing ureteral stones with concomitant urinary tract infection (UTI) includes prompt renal decompression and antibiotics. Some urologists theorize that performing retrograde pyelography (RGP) at the time of ureteral stent placement may cause pyelovenous backflow of bacteria thereby worsening clinical outcomes. We compared outcomes in patients with infected ureteral stones who underwent RGP versus no RGP prior to stent placement. MATERIALS AND METHODS: A retrospective chart review was conducted involving patients who presented between 2015 and 2017 with an obstructing ureteral stone and associated UTI. Computed tomography scans were evaluated for stone size and location. Operative reports were reviewed to determine whether the patient underwent RGP at time of ureteral stent placement. Demographics, perioperative information, intensive care unit (ICU) admission rate, and length of stay (LOS) were compared. RESULTS: Seventy-two patients were identified and stratified by severity of condition at presentation, including UTI without sepsis (n = 18), sepsis (n = 32), severe sepsis (n = 11), and septic shock (n = 11). Forty-three patients underwent RGP at the time of stent placement, and 29 did not. Between both patient cohorts, statistical analysis revealed no significant difference in postoperative ICU admission rate (p = 0.35) or LOS for patients with UTI without sepsis (p = 0.17), sepsis (p = 0.45), severe sepsis (p = 0.66), and septic shock (p = 0.25). CONCLUSION: The use of RGP prior to ureteral stent placement for an obstructing ureteral stone with concomitant UTI was not associated with unfavorable clinical outcomes in our retrospective series. While these findings support the safety of RGP in this setting, prospective trials are warranted.

Características clínicas y evolución del reflujo vesicoureteral en la infancia / Clinical characteristics and outcome of childhood vesicoureteral reflux

Introducción. El objetivo fue evaluar las características clínicas y la evolución del reflujo vesicoureteral (RVU) según el sexo y grado de RVU.Población y métodos. Se incluyeron pacientes con RVU vistos durante el seguimiento de rutina entre enero de 2014 y enero de 2015. Se registraron las características demográficas, la evolución, los laboratorios y las imágenes.Resultados. Se seleccionó a 220 pacientes, cuya media de edad del diagnóstico era 3,17 ± 3,08 años; en ese momento, los varones eran menores que las niñas (2,00 ± 2,59 vs. 3,81 ± 3,15, p < 0,001). La infección urinaria fue la presentación más frecuente, seguida de hidronefrosis prenatal (HNP). El 22 % de los pacientes tuvo reflujo de grado 1-2; el 51 %, de grado 3; y el 27 %, de grado 4-5. En el reflujo de grado 4-5, las ecografías y gammagrafías con ácido dimercaptosuccínico (DMSA) marcado con 99mTc presentaron más anomalías, y se realizaron más cirugías (p < 0,001). En los varones, fueron más comunes el reflujo de grado 4-5 (43,6 % vs. 18,3 %) y las anomalías ecográficas (77 % vs. 54 %) y en la DMSA (77 % vs. 59 %) (p < 0,05). En las niñas, hubo mayores tasas de infección urinaria, disfunción de las vías urinarias inferiores y resolución espontánea (p < 0,05).Conclusiones. A pesar de la menor edad al momento del diagnóstico, la resolución espontánea fue menor en los varones, y estos presentaron HNP, reflujo grave y anomalías radiológicas más frecuentemente.

Introduction. The aim of the study was to assess the clinical features and outcome parameters of children with vesicoureteral reflux (VUR) based on gender and VUR grade.Population and methods. Patients with VUR who were seen during routine follow-up visits at Ankara University Children's Hospital between January 2014-January 2015 were included in this retrospective study. Patient demographics, clinical course, laboratory investigations, imaging were noted.Results. Two hundred and twenty patients were recruited. Mean age at the time of diagnosis was 3,17 ± 3,08 years. Boys were diagnosed at younger ages as compared to girls (2.00 ± 2,59 vs. 3,81 ± 3.15, p < 0.001). Urinary tract infection (UTI) was the most common presentation. The second presentation form was antenatal hydronephrosis (AHN) which was more common in males (25.6 %, p < 0.001). Twenty-two percent of the patients had grade 1-2, 51 % grade 3 and 27 % grade 4-5 reflux. Patients with grade 4-5 reflux had more abnormal ultrasound (US) and Tech 99m dimercaptosuccinic acid scintigraphy (DMSA) findings and surgery was performed more frequently in this group (p < 0.001). In males, grade 4-5 reflux (43.6 % vs. 18.3 %), abnormal US (77 % vs. 54 %) and DMSA (77 % vs. 59 %) findings were more frequent (p < 0.05). In girls higher rates of UTIs, lower urinary tract dysfunction (LUTD) and spontaneous reflux resolution were seen (p < 0.05).Conclusions: Despite younger age at diagnosis, spontaneous resolution was found lower in boys and they had more frequent AHN, more severe reflux, and radiological abnormalities.

Risk Factors for Urosepsis after Minimally Invasive Percutaneous Nephrolithotomy in Patients with Preoperative Urinary Tract Infection.

The purpose of this study was to assess risk factors of urosepsis after minimally invasive percutaneous nephrolithotomy (MPCNL) for the treatment of upper urinary tract stones in patients with preoperative urinary tract infection (UTI) and to explore preventive measures. Between 2008 and 2016, patients with preoperative UTI who underwent MPCNL for upper urinary tract stones were retrospectively collected. Patients were divided into nonurosepsis and urosepsis groups. Perioperative outcomes of all patients were evaluated and compared between the two groups. Risk factors for post-MPCNL urosepsis were investigated using univariate and multivariate regression analysis. A total of 843 patients including 22 patients with postoperative urosepsis (urosepsis group) and 821 patients without urosepsis (nonurosepsis group) were finally included in this study. All patients with postoperative urosepsis were cured and discharged after treatment. In univariate analysis it was demonstrated that the incidence of urosepsis after MPCNL was significantly correlated with channel size (P=0.001), surgical time (P=0.003), as well as the tear of the collection system and percutaneous renal channel crossing the renal papilla (P=0.004). Moreover, multivariate analysis showed that smaller channel size (OR = 11.192, 95% CI: 2.425-51.650, P=0.002), longer surgical time (OR = 6.762, 95% CI: 1.712-17.844, P=0.008), and tear of collection system and percutaneous renal channel crossing the renal papilla (OR = 5.531, 95% CI 1.228-14.469, P=0.012) were independent risk factors for urosepsis following MPCNL in patients with preoperative UTI. In conclusion, in patients with preoperative UTI undergoing MPCNL for upper urinary tract stones, smaller channel size, prolonged operation time, as well as tear of the collection system and percutaneous renal channel crossing the renal papilla are independent risk factors for postoperative urosepsis. Therefore, it is indicated that, in clinical practice, it is of great significance to choose appropriate channel size and avoid renal injury and control surgical time to prevent the urosepsis after MPCNL in patients with preoperative UTI.

Outcomes of ileal conduit urinary diversion in patients with multiple sclerosis.

AIM: The objective of this study was to report the long-term outcomes and complications of patients with multiple sclerosis (MS) who underwent noncontinent urinary diversion to treat lower urinary tract symptoms (LUTS). MATERIAL AND METHODS: A retrospective study included all adult patients with MS who underwent an ileal conduit urinary diversion between 2000 and 2015. Early postoperative complications were reported as well as long-term complications, reoperation rates, and renal function. RESULTS: Overall, 91 patients were included. The surgery was indicated for refractory urinary incontinence (n = 73), renal failure (n = 8), major perineal skin ulcer due to urinary incontinence (n = 6), and recurrent urinary tract infections (n = 4). The median follow-up was 50 months (range, 3-158 months). A significant reduction (P < .05) of postoperative nonobstructive pyelonephritis rate was observed. There was no significant difference between preoperative and postoperative renal function (P = .32). Early postoperative complications were reported in 24 patients (26%): 4 Clavien I, 6 Clavien II, 9 Clavien III, 4 Clavien IV, and 1 Clavien V. Nine patients required reoperation for these complications (9.9%). Late complications were reported in 28 patients (30.8%): 8 ureteral anastomosis stenosis, 2 stoma stenosis, 2 incisional hernias, 6 kidney or ureteral lithiasis, and 10 pyelonephritis. Among them, 15 patients (16.5%) required reoperation for late complications. CONCLUSION: Noncontinent urinary diversion using ileal conduit appears to be an effective end-stage solution in MS patients. The perioperative morbidity rate of 26% and the late complication rate of 31% should be considered to better inform patients before the surgery.

Outcomes of Elective Ureteroscopy for Ureteric Stones in Patients with Prior Urosepsis and Emergency Drainage: Prospective Study over 5 yr from a Tertiary Endourology Centre.

BACKGROUND: Elective treatment of ureteric stones is needed after emergency drainage of urosepsis. OBJECTIVE: We wanted to look at the outcomes of elective ureteroscopic stone treatment in patients with prior sepsis and emergency drainage via retrograde ureteric stent (RUS) or percutaneous nephrostomy (PCN). DESIGN, SETTING, AND PARTICIPANTS: Data of all patients who underwent elective ureteroscopy (URS) for stone disease over 5 yr (March 2012-December 2016) were prospectively collected. INTERVENTION: Elective URS following previous emergency RUS or PCN. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Outcomes were collated for consecutive patients who underwent emergency drainage for urosepsis secondary to stone disease, followed by elective URS. Data was collected regarding patient demographics, stone parameters, and clinical outcomes. Statistical analysis was performed using SPSS version 24. RESULTS AND LIMITATIONS: In total, 76 patients underwent 82 elective procedures (six underwent bilateral URS) with a male to female ratio of 1:2 and a mean age of 57 yr. Emergency decompression was achieved via RUS in 63 (83%) and PCN in 13 (17%) patients. A positive urine culture on presentation was obtained in 26 (34%) patients, and 27 (36%) patients were admitted to the intensive care unit (ICU). The mean single and overall stone size was 8.6 (2-23) and 10.8 (2-32) mm, respectively. The mean operating time was 42 (5-129) min with stone-free rate (SFR) of 97% (n=74). There were three (4%) complications in total, of which two patients developed urinary tract infection needing intravenous antibiotics (Clavien II) and a third developed sepsis (Clavien IV) needing ICU admission. There was no difference in ureteroscopic lithotripsy outcomes (operative time, complications, or SFR) on comparing initial RUS or PCN, admission to ICU or ward, positive or negative urine culture result, presence of single or multiple stones, and between American Society of Anaesthesiologists (ASA) grade of patients. The ASA grade of patients was a significant predictor of day case procedures (p=0.001). CONCLUSIONS: Elective URS achieved excellent outcomes in patients who previously presented with obstructing calculi and sepsis needing emergency decompression. Overnight inpatient admission was needed in some patients with a higher ASA grade. PATIENT SUMMARY: In this report, we look at the outcomes of planned ureteroscopy procedures for stone disease in patients with previous urosepsis. These patients with previous emergency drainage for urosepsis had excellent outcomes from their planned ureteroscopic surgery. This information will help in preoperative patient optimisation and counselling.

Frequency of urinary tract infection in children with antenatal diagnosis of urinary tract dilatation.

BACKGROUND: Neonates with congenital urinary tract dilatation (UTD) may have an increased risk of urinary tract infections (UTI). At present, the management of these patients is controversial and the utility of continuous antibiotic prophylaxis (CAP) remains uncertain as the literature presents contradicting evidence. The aim of this observational study was to assess UTI occurrence in children with prenatal diagnosis of urinary collecting system dilatation without antibiotic prophylaxis. METHODS: Between June 2012 and August 2016, we evaluated the incidence of UTI and the clinical and ultrasonography evolution in 407 children with a prenatally diagnosed UTD. All subjects underwent two prenatal ultrasounds scans (USs) at 20 weeks and 30 weeks of gestation and within 1 month of birth. Patients with a confirmed diagnosis of UTD underwent US follow-up at 6, 12 and 24 months of life. According to the UTD classification system stratify risk, after birth UTD were classified into three groups: UTD-P1 (low risk group), UTD-P2 (intermediate risk group), and UTD-P3 (high risk group). Voiding cystourethrogram was performed in all patients who presented a UTI and in those with UTD-P3. No patient underwent CAP. RESULTS: Postnatal US confirmed UTD in 278 out of 428 patients with the following rates: UTD-P1 (126), UTD-P2 (95) and UTD-P3 (57). During postnatal follow-up, 6.83% patients presented a UTI (19 out of 278). Eleven out of 19 had vesicoureteral reflux (VUR), and other four were diagnosed with obstructive uropathy and underwent surgical correction. Five patients presented a UTI reinfection. CONCLUSION: The occurrence of UTI in patients with urinary collecting system dilatation was low. The recent literature reports an increased selection of multirestistant germs in patients with VUR exposed to CAP. This study constitutes a strong hint that routine continuous antibiotic prophylaxis could be avoided in patients with UTD.

Clinical outcomes of 28 cats 12-24 months after urethrostomy.

OBJECTIVES: The aim of this study was to evaluate and compare the long-term clinical outcomes and quality of life of cats having undergone perineal urethrostomy (PU) or prepubic urethrostomy (PPU). METHODS: This clinical study followed 28 cats (PU, n = 22; PPU, n = 6) that underwent a urethrostomy, with a minimum of 1 year postoperative follow-up. Medical records, pet owner surveys and urologic laboratory tests were used for assessment. Urologic laboratory tests included serum symmetric dimethylarginine (SDMA), serum creatinine, urinalysis, urine specific gravity (USG), urine protein:creatinine (UPC) ratio and urine culture. RESULTS: The main indications for urethrostomy were multiple catheterizations and PU stricture. The overall complication rates of PU and PPU were 31.8% and 83.3%, respectively. Recurrent urinary tract infection (UTI) and urine scald dermatitis were less frequent in PU than in PPU cats (UTI 22.7% vs 66.6%; dermatitis 4.5% vs 83.3%). Bacteriuria was present in 77.2% and 100% of PU and PPU cats, respectively. Owner satisfaction rates were excellent in 81.8% of PU and 33.3% of PPU cases. CONCLUSIONS AND RELEVANCE: A proportion of cats that underwent urethrostomy showed bacteriuria, recurrent UTIs and increased levels of SDMA. PPU is important as a salvage procedure; however, it should be limited to cases in which standard techniques for PU cannot be performed, owing to the potential for recurrent complications and lower owner satisfaction.

The Role of Antegrade Irrigation via Percutaneous Nephrostomy on Surgical Outcomes in Semirigid Ureteroscopy among Patients with Upper Ureteral Stones.

OBJECTIVE: We aimed to investigate the role of antegrade irrigation via percutaneous nephrostomy on surgical outcomes in retrograde ureteroscopy in patients with upper ureter stones. MATERIALS AND METHODS: In this retrospective study, we analyzed 134 patients who underwent retrograde semirigid ureteroscopy for upper ureter stones between August 2012 and December 2017. Patients were divided into two groups: retrograde irrigation group (conventional URS) and antegrade irrigation group (using percutaneous nephrostomy). Operation time, postoperative hospital stay, complications, and stone-free rate were measured for each patient after ureteroscopy. RESULTS: The mean age in the retrograde irrigation and antegrade irrigation groups was 53.3 and 60.7 years, respectively (p=0.007). The operation time was 60.8 min vs. 43.0 min (p=0.002), and stone-free rate was 82.0 % vs. 95.5 % (p=0.033). Stone size, laterality, the proportion of male patients, and urinary tract infection prevalence were comparable between the groups. In the subgroup analysis of stone size >10 mm, the antegrade irrigation group had a shorter operation time and a higher stone-free rate. For stone size of 5-10 mm, operation time in the antegrade irrigation group was shorter and the stone-free rate between the two groups was comparable. CONCLUSION: Antegrade irrigation via percutaneous nephrostomy during ureteroscopy has a higher stone-free rate with a shorter operation time without an increased urinary tract infection risk. Therefore, if percutaneous nephrostomy is necessary before ureteroscopy, antegrade irrigation of external fluid via percutaneous nephrostomy is strongly recommended.

The effect of perirenal puncture and drainage with urokinase treatment of perirenal hematoma complicated by infection: Two cases' report.

The aim of this study was to discuss the clinical significance of perirenal puncture and drainage with urokinase treatment of perirenal hematoma complicated by infection following surgery for upper urinary tract calculi. Two cases of perirenal hematoma complicated by infection following surgery for upper urinary tract calculi in 2017, and later received perirenal puncture and drainage of perirenal hematoma with urokinase treatment were selected. Puncture and drainage of perirenal hematoma with urokinase treatment were performed without the occurrence of severe complications such as sepsis, septic shock, or secondary bleeding. Both the renal morphology and functions were well restored. Puncture and drainage with urokinase treatment had definite efficacy in the treatment of perirenal hematoma complicated by infection.