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Rometti M, Patel D, Bryczkowski C. Xanthogranulomatous Pyelonephritis: Case Report. J Emerg Med 2024; 66:e534-e537. [PMID: 38485571 DOI: 10.1016/j.jemermed.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 09/26/2023] [Accepted: 11/23/2023] [Indexed: 04/07/2024]
Abstract
BACKGROUND In the emergency department (ED), pyelonephritis is a fairly common diagnosis, especially in patients with unilateral flank pain. Xanthogranulomatous pyelonephritis (XGP) is a rare type of pyelonephritis that is associated with unique features, which may lead to its diagnosis. CASE REPORT A 30-year-old male patient presented to the ED for evaluation of right-sided abdominal pain that has been ongoing for the past 24 hours. He noted the pain was located predominantly in the right flank and described it as sharp in nature. The pain was nonradiating and was associated with scant hematuria. He stated that he had similar pains approximately 1 month earlier that resolved after a few days. The patient underwent a bedside ultrasound and a subsequent computed tomography (CT) scan of the abdomen and pelvis, which showed an enlarged, multiloculated right kidney with dilated calyces and a large staghorn calculus, findings that represent XGP. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case report highlights an unusual variant of pyelonephritis, a relatively common ED diagnosis. XGP should be considered in patients with recurrent pyelonephritis, as treatment for XGP may require surgical intervention in addition to traditional antibiotic management.
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Affiliation(s)
- Mary Rometti
- Emergency Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Depesh Patel
- Emergency Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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White JA, Khalek AA, Rodriguez J, Kandadai J, Hosameddin M, Gonzalez S. Providencia alcalifaciens in a patient with a staghorn calculus: a novel presentation. Diagn Microbiol Infect Dis 2023; 107:116055. [PMID: 37716218 DOI: 10.1016/j.diagmicrobio.2023.116055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 09/18/2023]
Abstract
A member of the Enterobacteriaceae family, Providencia alcalifaciens is typically recognized as a source of gastrointestinal illness. Although its pathogenicity is not well known, many studies have suggested its mechanism of action involves the invasion of the intestinal mucosal layer. Although P. alcalifaciens is a urease producing microorganism, it has not been associated with the formation of a staghorn calculus in the setting of a urinary tract infection. This organism is neither commonly pursued in research or investigation nor is it commonly tested for in the clinical setting. This is especially true when combined with other disease processes, such as calculus formation. The advancement of antibiotic resistance, such as carbapenemase-producing strains, should bring more attention and routine investigation to this organism in the acute stage of infection. In this case report we introduce a 43-year-old Cuban female, who presents with a left-sided staghorn calculi and urine culture positive for carbapenemase-producing P. alcalifaciens.
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Affiliation(s)
| | | | | | - Jagan Kandadai
- Nova Southeastern University College of Osteopathic Medicine, Davie, FL, USA
| | | | - Saul Gonzalez
- Department of Nephrology, Larkin Community Hospital, Hialeah, FL, USA
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Salgado OJ, Pesantes-Barros KS, Rosales BC, Espinosa-Martin L. Pyelo-hepatic abscess caused by staghorn stone infection: a case report. J Med Case Rep 2023; 17:440. [PMID: 37867194 PMCID: PMC10591354 DOI: 10.1186/s13256-023-04173-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/11/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND The most common source of pyogenic liver abscess is biliary tract infection. Other less common routes include the spread of bacteria from distant foci. However, direct extension of a perinephric infection focus to the liver is extremely rare. CASE REPORT The patient was a non-diabetic, immunocompetent, 29-year-old woman of mixed race ancestry with a history of recurrent urinary tract infections who was referred to our hospital because of an ultrasound-detected liver abscess. She was initially treated with metronidazole for 20 days at the referring institution for suspected amebic abscess without improvement. On admission to our center, she was febrile and complained of a dull right upper quadrant pain. A POCUS ultrasound suggested a pyogenic abscess, probably from a staghorn calculus infection. She received meroperem and amikacin for 22 and 10 days, respectively. Repeat hemocultures showed no growth, but urine cultures were positive for Proteus sp. Complete remission of clinical and imaging findings was observed under antibiotics. The patient was referred to the urology outpatient clinic to discuss the option of radical nephrectomy. CONCLUSION : This case underlines the high morbidity of staghorn calculi.
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Affiliation(s)
- Octavio J Salgado
- School of Medicine, Universidad Católica de Cuenca, Av. Las Americas Y Humbolt, Cuenca, 010101, Azuay, Ecuador.
- Department of Nephrology, University Hospital of Maracaibo, Maracaibo, 4001, Zulia, Venezuela.
| | - Katherine S Pesantes-Barros
- School of Medicine, Universidad Católica de Cuenca, Av. Las Americas Y Humbolt, Cuenca, 010101, Azuay, Ecuador
| | - Beatriz C Rosales
- Department of Nephrology, University Hospital of Maracaibo, Maracaibo, 4001, Zulia, Venezuela
| | - Lizette Espinosa-Martin
- School of Medicine, Universidad Católica de Cuenca, Av. Las Americas Y Humbolt, Cuenca, 010101, Azuay, Ecuador
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Thampravit T, Phengsalae Y, Ketsuwan C. Tubeless mini-percutaneous nephrolithotomy to remove a staghorn stone concurrent with proximal ureteral calculus in an elderly patient: A case report. Urol Case Rep 2023; 47:102332. [PMID: 36756621 PMCID: PMC9900335 DOI: 10.1016/j.eucr.2023.102332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/17/2023] [Accepted: 01/22/2023] [Indexed: 01/24/2023] Open
Abstract
A complex staghorn calculus that is concurrent with an impacted large proximal ureteric calculi is rarely found in elderly patients, and morbidity and mortality rates are much higher if left untreated. We report the case of an 88-year-old female with complex high-volume renal and ureteral calculus who was treated successfully using a tubeless mini-percutaneous nephrolithotomy. The entire stone was retrieved, and the patient fully recovered without any complications.
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Affiliation(s)
| | | | - Chinnakhet Ketsuwan
- Corresponding author. Division of Urology, Department of Surgery, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, 270 Rama VI Road, Toong Phayathai, Ratchathewi, Bangkok, 10400, Thailand.
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Tashkandi E. Staghorn Calculus with Adenomatoid Tumor: A Case Report. Case Rep Oncol 2023; 16:676-680. [PMID: 37933316 PMCID: PMC10625812 DOI: 10.1159/000533268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/24/2023] [Indexed: 11/08/2023] Open
Abstract
Testicular adenomatoid tumor is very rare. More understanding of the tumor and treatment is required for better outcomes. A 63-year-old man visited a urologist for staghorn calculus. During follow-up, he had recurrent left flank pain and intermittent hematuria. Computed tomography demonstrated left staghorn calculus, and then further assessment revealed left testicular swelling. Ultrasound showed epididymal mass. Percutaneous nephrolithotomy was deferred and we performed left radical orchiectomy. A pathologic examination revealed testicular adenomatoid tumor. This case highlights the importance of awareness of a very rare benign tumor in a patient with staghorn calculus.
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Affiliation(s)
- Emad Tashkandi
- College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
- Department of Medical Oncology, Oncology Center, King Abdullah Medical City, Makkah, Saudi Arabia
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Xu Y, Lu Z, Lan Y, Wu D, Xiong L. Retrograde intrarenal surgery for a staghorn renal calculus in a patient with solitary kidney and urinary tract deformity: a case report. Transl Androl Urol 2021; 10:3532-3539. [PMID: 34532278 PMCID: PMC8421840 DOI: 10.21037/tau-21-192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 07/21/2021] [Indexed: 02/05/2023] Open
Abstract
Staghorn renal calculi are large, branched stones in the kidney that partially or completely fill the renal pelvis and renal calyces. Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for staghorn calculi. However, we report a retrograde intrarenal surgery (RIRS) performed to treat a staghorn calculus in a patient with a solitary kidney and a deformed urinary tract. The 37-year-old male patient presented with right-sided lumbar pain. The computed tomography (CT) scan found a solitary kidney on the right side with an opaque 4.5 cm × 2.4 cm renal stone and grade I hydronephrosis. Additionally, a urinary tract deformity was observed, and it was secondary to the deformity of the pelvis caused by a previous pubis fracture, which significantly increased the risk and the difficulty of intrarenal surgery. A total number of 3 sessions of RIRS were conducted, and the patient was discharged 3 days after each session on average. The postoperative X-ray exam of the third session revealed that the renal stone was completely removed. The patient recovered well without any complications. This case demonstrates that RIRS is a safe and effective treatment of staghorn calculi with the presence of urinary tract deformation. This suggests RIRS may be of particular interest in minimizing the procedure-related damage of a solitary kidney.
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Affiliation(s)
- Yuancheng Xu
- Department of Urology, The University of Hong Kong- Shenzhen Hospital, Shenzhen, China
| | - Zhengquan Lu
- Department of Urology, The University of Hong Kong- Shenzhen Hospital, Shenzhen, China
| | - Yulong Lan
- Department of Cardiology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Dan Wu
- Department of Pediatrics, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Lin Xiong
- Department of Urology, The University of Hong Kong- Shenzhen Hospital, Shenzhen, China
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Hong Y, Lin H, Yang Q, Zhou D, Hou G, Chen X, Zheng J. Pneumatic Lithotripsy versus Holmium Laser Lithotripsy in Percutaneous Nephrolithotomy for Patients with Guy's Stone Score Grade IV Kidney Stone. Urol Int 2021; 105:45-51. [PMID: 32829337 DOI: 10.1159/000509043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/29/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study was to compare the efficacy and reliability of holmium (Ho:YAG) laser lithotripsy (HLL) and pneumatic lithotripsy (PL) in percutaneous nephrolithotomy (PCNL) in the treatment of patients with Grade IV kidney stones based on Guy's Stone Score. STUDY DESIGN/MATERIALS AND METHODS This retrospective study included 103 patients with Grade IV kidney stones out of 440 patients who underwent PCNL through HLL and PL in Second Affiliated Hospital of Shantou University Medical College, China, from January 2016 to December 2018. We analyzed preoperative, intraoperative, and postoperative variables of the patients to evaluate the efficacy and reliability of PCNL procedures. RESULTS Patients were categorized as Grade I, II, III, and IV, and the patients of each grade were 85 (19.32%), 39 (8.86%), 213 (48.41%), and 103 (23.41%), respectively. In Grade IV, the total operative time (min) for the PL and HLL groups was 137.7 ± 47.79 and 134.27 ± 53.38, respectively (p = 0.744). The variation in laboratory examination values including ΔHGB (g/L), ΔHCT, ΔPCT, and ΔCr (μmol/L) for PL and HLL groups was 19 ± 11.23/12 ± 15.42 (p = 0.012), 0.057 ± 0.034/0.038 ± 0.045 (0.009), 0.027 ± 0.034/0.026 ± 0.034 (0.702), and 3.07 ± 17.4/20.54 ± 65.93 (0.692), respectively. The postoperative hospitalization day was 8.94 ± 4.2 and 7.73 ± 2.75 (p = 0.015), respectively. As for the stone-free rate (SFR), the SFRs for PL and HLL were 48.15% (n = 39/81) and 59.09% (n = 13/22) (p = 0.363), respectively. CONCLUSIONS HLL showed a comparable advantage of not only decreased postoperative hemoglobin and hematocrit but also fewer postoperative hospitalization days. Based on the results of our retrospective study, for those Grade IV kidney stone patients who have a risk of bleeding before PCNL operation, HLL can be a considerable treatment option. Besides, in consideration of reducing human care cost, HLL which showed fewer hospitalization days, would be more welcome by patients.
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Affiliation(s)
- Yuxiang Hong
- Department of Urology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
- Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Hao Lin
- Department of Urology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China,
| | - Qingtao Yang
- Department of Urology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Derong Zhou
- Department of Urology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Gaoming Hou
- Department of Urology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Xiaohong Chen
- Department of Urology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Junhong Zheng
- Department of Urology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
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Kasahara R, Kawahara T, Tajiri R, Uemura H, Kitami K. Renal Squamous Cell Carcinoma with Staghorn Calculus. Case Rep Oncol 2020; 13:403-407. [PMID: 32355497 PMCID: PMC7184838 DOI: 10.1159/000506675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 11/19/2022] Open
Abstract
A 70-year-old Japanese woman was referred to our department due to general fatigue and a persistent low fever. We performed percutaneous nephrostomy and administered antibiotics for the pyelonephritis due to her left staghorn calculus. After the infection had been brought under control and her general condition improved, we performed nephrectomy. A pathologic examination revealed renal squamous cell carcinoma (SCC) in addition to xanthogranulomatous inflammation. Seventeen days after the operation, computed tomography demonstrated local recurrence of the tumor; therefore, she received palliative care. Two months after her operation, she died of renal SCC.
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Affiliation(s)
- Ryo Kasahara
- Department of Urology, Fujisawa City Hospital, Fujisawa, Japan
| | - Takashi Kawahara
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Ryosuke Tajiri
- Department of Pathology, Fujisawa City Hospital, Fujisawa, Japan
| | - Hiroji Uemura
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazuo Kitami
- Department of Urology, Fujisawa City Hospital, Fujisawa, Japan
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Mohammadi M, Nouri-Mahdavi K, Barzegar A. Effects of Tranexamic Acid on Bleeding and Hemoglobin Levels in Patients with Staghorn Calculi Undergoing Percutaneous Nephrolithotomy: Randomized Controlled Trial. Iran J Med Sci 2019; 44:457-464. [PMID: 31875080 PMCID: PMC6885721 DOI: 10.30476/ijms.2019.44969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: The incidence of renal hemorrhage during percutaneous nephrolithotomy (PCNL) is high. We sought to evaluate the effects of tranexamic acid (TXA) on bleeding and hemoglobin levels of patients with staghorn calculi treated with PCNL.
Methods: In a double-blind clinical trial, 120 patients with staghorn calculi candidated for PCNL in Alzahra Hospital between January 2014 and November 2017, Isfahan, Iran, were classified into two groups in terms of the stone size (>4 cm and <4 cm). The patients in both groups were then randomly assigned to receive either 1 g of TXA intravenously or normal saline. (The generation of random numbers was done by computer.) Thus, there were four groups of 30 patients each. The transfusion rate, the mean volume of blood loss, the operative duration, and the hemoglobin level were compared between the intervention and control groups for each stone-size category. Statistical analysis was performed using SPSS, version 19. The paired and independent t test and the Pearson coefficient correlation were used, and a P value less than 0.05 was considered statistically significant.
Results: The mean volume of blood loss was significantly higher in the control group patients than in those receiving TXA, in both stone-size categories (P<0.001). There was no significant difference in the postoperative hemoglobin level between the intervention and control groups, in both stone-size categories (P=0.26 and P=0.10, respectively). In addition, the mean volume of blood loss increased significantly with an increase in the operative duration (P<0.001).
Conclusion: TXA reduced the risk of bleeding during and after PCNL and attenuated the drop in the hemoglobin level in the postoperative period. Longer operative procedures were associated with an increase in the bleeding volume.
Trial Registration Number: IRCT20180209038673N1
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Affiliation(s)
- Mehrdad Mohammadi
- Isfahan Kidney Transplantation Research Center, Department of Urology, Alzahra Research Centers, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Kia Nouri-Mahdavi
- Isfahan Kidney Transplantation Research Center, Department of Urology, Alzahra Research Centers, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abbas Barzegar
- Isfahan Kidney Transplantation Research Center, Department of Urology, Alzahra Research Centers, Isfahan University of Medical Sciences, Isfahan, Iran
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Bhat D, Shankar R, Shenoy RD, Rai S. Cystine Urolithiasis in Early Childhood. Indian J Clin Biochem 2019; 34:361-362. [PMID: 31391730 DOI: 10.1007/s12291-018-0783-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 07/05/2018] [Indexed: 11/30/2022]
Abstract
Urolithiasis in children is rare with reported incidence of 1.8 per 1000 children. A metabolic cause is identifiable in 40-50% of children with stones and is considered when multiple, recurrent and bilateral. Cystinuria is an important preventable cause of urolithiasis. We present an infant with recurrent gross hematuria due to cystine urolithiasis for its rarity.
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Affiliation(s)
- Divyashree Bhat
- Department of Surgery, K.S. Hegde Medical Academy, NITTE (Deemed to be University), Mangalore, Karnataka India
| | - Raghu Shankar
- Department of Paediatric Surgery, K.S. Hegde Medical Academy, NITTE (Deemed to be University), Mangalore, Karnataka India
| | - Rathika Damodara Shenoy
- Department of Paediatrics, K.S. Hegde Medical Academy, NITTE (Deemed to be University), Mangalore, Karnataka India
| | - Sandeep Rai
- Department of Paediatric Surgery, K.S. Hegde Medical Academy, NITTE (Deemed to be University), Mangalore, Karnataka India
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Affiliation(s)
- Hao Xiang
- Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Jason Han
- Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | | | - Lloyd J Ridley
- Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,Medical Imaging, University of Sydney, Sydney, New South Wales, Australia
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Mani VR, Kalabin A, Mishra A, Davis-Joseph B. Incidental Finding of Urethral Diverticulum in a Woman with History of Recurrent Urinary Tract Infections. Curr Urol 2018; 11:163-165. [PMID: 29692697 DOI: 10.1159/000447212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 04/28/2017] [Indexed: 11/19/2022] Open
Abstract
We present an incidental finding and management of a urethral diverticulum containing mixed composition of struvite and ammonium urate stones. Status post sleeve gastrectomy, patient presented to our bariatric clinic with epigastric pain associated with nausea and vomiting. A computed tomography scan was performed to rule out any complications of the procedure in which urethral stones were reported contained within a diverticulum. This finding, in retrospect, correlated with patient's past history of recurrent urinary tract infections. Over all, urethral diverticulum with struvite stones is a rare entity with few reported cases in literature thus a high index of suspicion is needed in patients with related symptoms. Here a case presentation and treatment rationale are described along with a brief review of existing literature.
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Affiliation(s)
- Vishnu R Mani
- Department of Surgery, New York University School of Medicine, New York, NY, USA
| | - Aleksandr Kalabin
- Department of Surgery, Columbia University College of Physicians and Surgeons at Harlem Hospital Center, New York, NY, USA
| | - Ankita Mishra
- Department of Surgery, New York University School of Medicine, New York, NY, USA
| | - Brian Davis-Joseph
- Department of Surgery, Columbia University College of Physicians and Surgeons at Harlem Hospital Center, New York, NY, USA
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13
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Abreu LDADS, Camilo-Silva DG, Fiedler G, Corguinha GB, Paiva MM, Pereira-Correia JA, Muller VJF. Review on renal recovery after anatrophic nephrolithotomy: Are we really healing our patients? World J Nephrol 2015; 4:105-110. [PMID: 25664252 PMCID: PMC4317620 DOI: 10.5527/wjn.v4.i1.105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 10/02/2014] [Accepted: 11/19/2014] [Indexed: 02/06/2023] Open
Abstract
The main goals for urinary stone treatment are to preserve renal function, reduce or avoid complications related to calculi, and to render the patient free of calculi as soon as possible. Anatrophic nephrolithotomy (ANL) is a valid and useful alternative for conventional staghorn calculi excision. Although excellent stone free rates can be achieved with ANL there are some drawbacks that may be of concern. Morbidity related to intraoperative and postoperative complications is one of them. Another, great concern is the possibility of reduction on renal function related to the procedure itself. This may be related to nephron injury during nephrotomy and parenchymal closure or to ischemic injury. In this review we assess functional results after anatrophic nephrolithotomy.
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Sotelo R, Astigueta JC, Giedelman C, de Andrade R, Carmona O, Ramirez D, Clavijo R. Robotic extended pyelolithotomy for complete staghorn calculus. J Robot Surg 2010; 4:99-102. [PMID: 27628774 DOI: 10.1007/s11701-010-0192-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Accepted: 04/28/2010] [Indexed: 10/19/2022]
Abstract
Staghorn stones represent a therapeutic challenge to urologists. We present our experience with laparoscopic extended pyelolithotomy for treatment of staghorn and complex renal calculi in highly selected cases. This approach provides the principles of open surgery with the advantages of minimally invasive surgery. We describe our experience with robot-assisted extended pyelolithotomy for complex coralliform calculi. Since January 2007, robotic extended pyelolithotomy has been performed by transperitoneal approach in two patients with complete coralliform lithiasis (calculi average size 8 cm). One patient had history of percutaneous nephrolithotomy. Demographic and operative data were collected. All procedures were technically successful without need for open conversion. Mean estimated blood loss was 175 ml (range 50-300 ml), and mean operative time was 150 min (range 120-150 min). A perinephric drain was employed in one patient with duration of 5 days. Postoperative imaging confirmed complete stone clearance. Robotic extended pyelolithotomy is a feasible and reproducible procedure for removal of complete and partial staghorn calculi in selected patients with complex nephrolithiasis. This approach might limit the role of open surgery for these calculi, but further publications with more cases are necessary to further define its utility.
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Affiliation(s)
- Rene Sotelo
- Centro de Cirugía Robótica y de Invasión Mínima Unidad de Urología, Instituto Médico La Floresta, Calle Santa Ana Urbanización La Floresta, Annex B, 2nd Floor, Caracas, Venezuela.
| | - Juan Carlos Astigueta
- Centro de Cirugía Robótica y de Invasión Mínima Unidad de Urología, Instituto Médico La Floresta, Calle Santa Ana Urbanización La Floresta, Annex B, 2nd Floor, Caracas, Venezuela
| | - Camilo Giedelman
- Centro de Cirugía Robótica y de Invasión Mínima Unidad de Urología, Instituto Médico La Floresta, Calle Santa Ana Urbanización La Floresta, Annex B, 2nd Floor, Caracas, Venezuela
| | - Robert de Andrade
- Centro de Cirugía Robótica y de Invasión Mínima Unidad de Urología, Instituto Médico La Floresta, Calle Santa Ana Urbanización La Floresta, Annex B, 2nd Floor, Caracas, Venezuela
| | - Oswaldo Carmona
- Centro de Cirugía Robótica y de Invasión Mínima Unidad de Urología, Instituto Médico La Floresta, Calle Santa Ana Urbanización La Floresta, Annex B, 2nd Floor, Caracas, Venezuela
| | - Daniel Ramirez
- Centro de Cirugía Robótica y de Invasión Mínima Unidad de Urología, Instituto Médico La Floresta, Calle Santa Ana Urbanización La Floresta, Annex B, 2nd Floor, Caracas, Venezuela
| | - Rafael Clavijo
- Centro de Cirugía Robótica y de Invasión Mínima Unidad de Urología, Instituto Médico La Floresta, Calle Santa Ana Urbanización La Floresta, Annex B, 2nd Floor, Caracas, Venezuela
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Rai RS, Patrulu K, Rai R, Gupta E, Kayastha A, Sawhney S. Lithoclast(®) Master in Intracorporeal Lithotripsy during Percutaneous Nephrolithotomy : Our Experience. Med J Armed Forces India 2008; 64:232-3. [PMID: 27408153 DOI: 10.1016/s0377-1237(08)80100-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2006] [Accepted: 08/25/2007] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND This study was carried out to compare the efficacy of Lithoclast(®) Master with pneumolithotriptor during percutaneous nephrolithotomy (PNL) in the treatment of renal staghorn calculi. METHODS In this prospective study, 60 patients suffering from partial or complete staghorn renal stones were included. Patients were divided randomly in two groups : Groups I and II and underwent PNL for removal of stones. In Group I patients, standard pneumolithotriptor and in Group II, Lithoclast(®) Master was used for stone fragmentation. The patients were evaluated for rate of fragmentation/clearance, presence of residual fragments by KUB radiograph/ultrasound. Result was analyzed by Chi-square test. RESULT The rate of fragmentation using Swiss Lithoclast(®) Master was more effective and quicker in comparison to standard pneumolithotriptor. The average time taken for fragmentation and clearance in Group I using pneumolithotriptor was 65 minutes, whereas it was 58 minutes using Lithoclast® Master, which was statistically significant (p< 0.01). Only 4% patients had significant residual fragments (> 4mm) in Group II and 16 (53%) patients in Group I, which was significant (p < 0.01). The complications in both the modalities were insignificant; one (1.33%) patient had bleeding and three (10%) patients had urine leak in Group I; whereas three(10%) patients had bleeding and five (16.7%) urine leak in Group II. CONCLUSION Lithoclast(®) Master is an effective intracorporeal lithotripter during percutaneous nephrolithotomy in the treatment of renal staghorn calculi for stone fragmentation/clearance with minimal residual fragments and complications.
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Affiliation(s)
- R S Rai
- Classified Specialist (Surgery & Urology), Command Hospital (Western Command), Chandimandir-134107 (Haryana)
| | - Ksk Patrulu
- Classified Specialist (Surgery & Urology), Command Hospital (Northern Command), C/o 56 APO
| | - R Rai
- Internee Medical Officer, Government Medical College & Hospital, Chandigarh
| | - E Gupta
- Internee Medical Officer, Government Medical College & Hospital, Chandigarh
| | | | - S Sawhney
- Senior Advisor (Anaesthesiology), Command Hospital (Northern Command), C/o 56 APO
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Nayyar R, Wadhwa P, Hemal AK. Pure robotic extended pyelolithotomy: cosmetic replica of open surgery. J Robot Surg 2007; 1:207-11. [PMID: 25484964 DOI: 10.1007/s11701-007-0039-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2007] [Accepted: 08/20/2007] [Indexed: 11/21/2022]
Abstract
Percutaneous nephrolithotomy (PCNL) has replaced open pyelolithotomy as the procedure of choice for treating large-burden renal stone disease, especially staghorn calculi. Although it is a minimally invasive procedure, it involves transgressing the renal parenchyma and is thus associated with its unique set of complications. The evolution of laparoscopic pyelolithotomy and robotic assistance has provided an opportunity to the surgeon to revisit pyelolithotomy in a minimally invasive manner following the age-old principles of the era of open renal surgery. We report the feasibility and our experience with this technique in three cases of partial staghorn calculus with intra-renal pelvis.
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