Haemophilus influenzae septicaemia and urinary tract infection associated with nefrocalcinosis: case report.

Haemophilus influenzae is an uncommon uropathogen with fastidious growth requirements, which must be taken into consideration in the diagnostic process. We present a rare case of urosepsis with H. influenzae in a young patient with nefrocalcinosis.

Kidney stone disease.

Kidney stone disease is rapidly increasing with a strong relationship to metabolic syndrome. This review gives a brief overview of the current state and current treatment modalities. Increasing use of CT and ultrasound scans leads to increased diagnosis of asymptomatic kidney stones, which rarely require treatment. The trend in stone treatment goes towards endoscopic lithotripsy which together with ESWL enables a personalised approach. Obstructive stones with infection require urgent intervention to reduce mortality. Increased fluid intake, dietary changes as well as potassium citrate supplements are the most important elements in stone prevention in the common idiopathic stone disease.

Using a three-dimensional computer assisted stone volume estimates to evaluate extracorporeal shockwave lithotripsy treatment of kidney stones.

This study describes and evaluates the use of non-contrast enhanced computerized tomography (NCCT) before and after extracorporeal shockwave lithotripsy (SWL). Computer measured stone volume was used as an exact measurement for treatment response. 81 patients received SWL of kidney stones at Herlev Hospital between April 2013 and January 2014 and follow-up was possible in 77 (95 %) patients. NCCT was used before and after treatment. Treatment response was expressed as a reduction of the stone volume. Stone characteristics as the stone volumes, HU, SSD and localization were measured by radiologist using a vendor non-specific computer program. Complications, patient characteristics and additional treatment were registered. On average, 5858 shocks were given each patient. The follow-up NCCT was performed 24 days after treatment. It was possible to calculate the stone volume in 88 % of the patients-the remaining 12 % it was not possible due to stone disintegration. The stone free rate was 22 %. The average relative reduction in stone burden was 62 %. Only 8 % of the patients were radiological non-responders. Steinstrasse was observed in 13 (17 %) and 28 (36 %) patients had additional treatment performed. Irradiation dose per NCCT was 2.6 mSv. Stone volume could be calculated in most patients. The relative reduction in stone burden after treatment was 62 %. The stone volume was redundant when evaluating stone free patients, but in cases of partial response it gave an exact quantification, to be used in the further management and follow-up of the patients.

A qualitative study exploring male cancer patients' experiences with percutaneous nephrostomy.

OBJECTIVE: Obstructive uropathy due to advanced cancer can be efficiently treated with a percutaneous nephrostomy. The treatment is associated with complications and frequent readmissions. How the patients' quality of life is affected by a nephrostomy remains uncertain. The aim of this study was to describe how a nephrostomy is perceived by patients and its effects on their everyday lives. MATERIAL AND METHODS: Semi-structured interviews were conducted in the patients' home using a mind map. The inclusion criteria were locally advanced or metastatic urological cancer treated with a nephrostomy for a minimum of 1 month. All interviews were audio recorded, transcribed and analysed using a grounded theory approach. Ten male patients were interviewed, eight with prostate cancer and two with bladder cancer. RESULTS: Treatment with nephrostomy influenced the physical activity level and restricted normal social activities. Readmissions had a negative influence on mood. However, the patients who experienced symptom improvement were thankful for having had the nephrostomy, despite the inconveniences. Communicating about the hazards and benefits helped patients to adjust their expectations of a nephrostomy. CONCLUSIONS: The study describes how nephrostomy is a burdensome intervention accompanied by a plethora of complex physical and psychosocial issues. Having a nephrostomy on a palliative indication has extensive implications for the patients, which should not be neglected or underestimated. Individual assessment of each patient, together with excellent communication regarding the procedure and outcome, is essential. Most patients had frequent contact with the healthcare system and additional support could be offered by a palliative care service.

[Function of neobladders in women after cystectomy]. / Funktion af neoblaere hos kvinder efter cystektomi.

INTRODUCTION: Since 1999, Rigshospitalet (RH) and Aarhus University Hospital, Skejby (SKS) have been offering women an orthotopic neobladder following cystectomy. The aim of the present study was to describe the function of the neobladders in women by examining continence and voiding function. Cancer stage, cancer recurrence, complications and mortality are also described. MATERIALS AND METHODS: The data was retrospectively collected from patient files. Between 1999 and 2006, a total of 20 female patients at RH and SKS underwent reconstructive surgery with a neobladder. Continence and voiding function were evaluated from existing tests and examinations performed during follow-up. RESULTS: The average follow-up was 3.1 years (range: 0.4-7.4). The average age was 57.1 years (40.1-70.6). Fifteen patients (75%) were continent during the daytime, and three of the patients (15%) were incontinent during the night-time. Five patients (25%) were partly incontinent during the day- and night-time, but in two of the patients the incontinence was related to recurrence. Eight patients (40%) used intermittent catheterization as a supplement to the spontaneous voiding. Ten patients (50%) had early complications. Six patients (30%) had late complications. The most common complication was pyelonephritis. Fifteen patients (75%) were alive at the end of follow-up, and twelve patients (60%) were without recurrence. CONCLUSION: Neobladders in women after cystectomy function adequately. Patients achieve a high degree of continence and acceptable bladder emptying. However, the best functional results were seen in patients without cancer recurrence.