Recurrence of sigmoid colon carcinoma in the retained urethra after cystectomy: A case report and review of the literature.

Urethral recurrence arising from a primary colorectal adenocarcinoma is rare. Here, we report a case of urethral recurrence of sigmoid colon cancer, which developed after cysto-prostato-sigmoidectomy for sigmoid colon cancer invading the bladder. The patient underwent urethrectomy successfully and is currently tumor-free. Surgeons who follow patients with colorectal cancer invading the bladder should be aware of this case. The early detection of recurrence improves the chances for disease-free survival.

[Nurse questionnaire survey about the urethral catheterization and clinical analysis of iatrogenic urethral injury].

OBJECTIVE: This study was aimed at determining the status of iatrogenic urethral injury associated with insertion of urethral catheters at our hospital. SUBJECTS AND METHODS: We studied the data of 32 patients with iatrogenic urethral injury at our hospital. We also carried out a questionnaire survey of 150 nurses who could be in charge of urethral catheter insertions, and conducted an analysis based on the answers obtained from 133 of the 150 nurses (response rate 88.7%). RESULTS: The 32 patients included 14 patients with reduced activity of daily living (ADL) who required assistance in daily life (44%), 4 patients with spinal cord injury (13%), and 4 patients under anesthesia or sedation (13%). Acute complications included sepsis in 5 patients (16%) and septic shock in 3 patients (9%). Long-term urethral catheterization was indicated in all the patients with sepsis. Examination of the responses to the questionnaire showed that while 86% of the nurses said "I inject water to fix the balloon after confirming urine outflow," 7% answered "I inject water into the balloon even if there is no urine outflow"; 46% said "I compress the lower abdomen when there is no urine outflow," 6% said "I perform urinary bladder irrigation," and 48% said "I neither compress the lower abdomen when there is no urinary flow nor perform urinary bladder irrigation". CONCLUSION: Nearly half of the patients with iatrogenic urethral injury at our hospital had reduced ADL. In the patients in whom long-term catheterization was indicated, urethral injury at the time of regular replacement of a catheter was associated with a high likelihood of sepsis occurring as a complication. Based on the results of the questionnaire, more than 80% of the nurses complied with the rule that water to fix the balloon must be injected only after confirming urinary outflow at the time of inserting a urethral catheter. However, when there was no urine outflow after insertion of the catheter, there were variations in the procedure to handle the situation. In the education of nurses, training on the appropriate actions that must be taken in this situation appears to be important.

Can excretory phase computed tomography predict bacteremia in obstructive calculous pyelonephritis?

PURPOSE: Acute pyelonephritis (AP), a complication of urolithiasis, can be fatal if it progresses to septic shock. We aimed to evaluate the performance of excretory phase computed tomography (CT) in predicting bacteremia among AP patients with upper urinary tract calculi. METHODS: We reviewed medical records of 250 patients diagnosed with AP and upper urinary tract calculi and who were admitted to our institute. We analyzed 132 patients who underwent excretory phase CT. Excretory phase CT images were obtained 7 min after injection with the contrast agent. Obstruction was classified either as high or low grade. Univariate and multivariate analyses were performed to identify the risk factors of bacteremia. RESULTS: Of 132 patients, 73 (55.3%) had bacteremia. Escherichia coli was the most frequently identified pathogen in blood cultures. Univariate analysis demonstrated that high-grade obstruction on excretory phase CT and quick Sepsis-related Organ Failure Assessment (qSOFA) score ≥ 2 were correlated with bacteremia. In addition, the administration of vasopressors was significantly associated with bacteremia (31.5% vs. 6.8%; p < 0.001). Multivariate analysis identified high-grade obstruction on excretory phase CT [odds ratio (OR) 6.68; p < 0.001] and qSOFA score ≥ 2 (OR 3.59, p = 0.03) as independent risk factors for bacteremia. CONCLUSIONS: Excretory phase CT images can be used to predict bacteremia by evaluating the degree of ureteral obstruction. The evaluation of the passage of urine shown by excretory phase CT is critical in patients with AP associated with upper urinary tract calculi.

Acute pyelonephritis and secondary bacteraemia caused by Veillonella during pregnancy.

We report a case of pyelonephritis and secondary bacteraemia caused by Veillonella species during pregnancy. Veillonella is part of the normal flora from the oral cavity, gut and vagina. However, because Veillonella is usually isolated from cultures of clinical specimens as part of commensal flora, it is frequently regarded as a contaminant. In the present case, Veillonella was isolated from the patient's urine and blood samples that showed evidence of pyelonephritis and secondary bacteraemia. We found that ureteral stenting is an extremely effective therapeutic option for pregnant woman with hydronephrosis and clear signs and symptoms of urosepsis.