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Thanasa E, Thanasa A, Grapsidi V, Xydias E, Kamaretsos E, Ziogas A, Paraoulakis I, Simopoulou E, Mousia M, Thanasas I. Bilateral obstructive uropathy and severe renal dysfunction associated with large prolapsed pedunculated submucosal leiomyoma of the uterus misdiagnosed as an intracervical fibroid: Report of a very rare case and a mini‑review of the literature. Med Int (Lond) 2024; 4:26. [PMID: 38628382 PMCID: PMC11019461 DOI: 10.3892/mi.2024.150] [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] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/14/2024] [Indexed: 04/19/2024]
Abstract
Pedunculated submucosal leiomyomas of the uterus that prolapse into the vagina are common. In extremely rare cases, large pedunculated submucosal leiomyomas may lead to bilateral obstructive uropathy, causing severe renal dysfunction and potentially being misdiagnosed as intracervical leiomyoma. The present study describes the surgical treatment of a patient with a large prolapsed pedunculated submucosal uterine leiomyoma, which was misdiagnosed as an intracervical fibroid. The patient, of menopausal age, presented with uterine bleeding, anemia and severe renal dysfunction. Upon a physical examination, suspicion arose for a cervical leiomyoma, prompting the decision for imaging. Both transvaginal ultrasound and computed tomography, as well as magnetic resonance imaging confirmed the diagnosis of intracervical leiomyoma, accompanied by bilateral obstructive uropathy due to ureteral compression. The surgical management of the patient with laparotomy was decided. Intraoperatively, a large pedunculated submucosal uterine leiomyoma prolapsing into the vagina was identified. Total hysterectomy and bilateral salpingectomy-oophorectomy were performed. The immediate post-operative course was uneventful. At 6 months following surgery, the complete recovery of renal morphology and function was observed. The patient continues to undergo regular follow-up assessment to date. In the present study, a brief literature review is also provided, emphasizing the significant diagnostic and surgical challenges that may arise in the management of patients with large pedunculated submucosal uterine leiomyomas prolapsing into the vagina.
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Affiliation(s)
- Efthymia Thanasa
- Department of Health Sciences, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Anna Thanasa
- Department of Health Sciences, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Vasiliki Grapsidi
- Department of Obstetrics and Gynecology, General Hospital of Trikala, 42100 Trikala, Greece
| | - Emmanouil Xydias
- Department of Obstetrics and Gynaecology, EmbryoClinic IVF, 55133 Thessaloniki, Greece
| | - Evangelos Kamaretsos
- Department of Obstetrics and Gynecology, General Hospital of Trikala, 42100 Trikala, Greece
| | - Apostolos Ziogas
- Department of Medicine, University of Thessaly, School of Health Sciences, 41334 Larissa, Greece
| | - Ioannis Paraoulakis
- Department of Obstetrics and Gynecology, General Hospital of Trikala, 42100 Trikala, Greece
| | | | - Maria Mousia
- Department of Pathology, General Hospital of Trikala, 42100 Trikala, Greece
| | - Ioannis Thanasas
- Department of Obstetrics and Gynecology, General Hospital of Trikala, 42100 Trikala, Greece
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Ebach F, Wagner P, Stein R, Dolscheid‐Pommerich R, Reutter H, Hilger AC. Familial congenital lower urinary tract obstruction (LUTO) suggested by screening for lower urinary tract dysfunction in parents of patients: A descriptive study. Health Sci Rep 2024; 7:e1935. [PMID: 38524771 PMCID: PMC10957716 DOI: 10.1002/hsr2.1935] [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: 09/29/2023] [Revised: 01/12/2024] [Accepted: 02/02/2024] [Indexed: 03/26/2024] Open
Abstract
Background Congenital lower urinary tract obstruction (LUTO) describes a heterogeneous group of congenital malformations. Posterior urethral valves (PUV) represent the most common entity. Familial occurrence has been described, suggestive of underlying genetic factors. LUTO can occur in various degrees of severity. In severe forms, oligohydramnios, pulmonary hypoplasia, and renal damage can occur resulting in high pre- and postnatal mortality. On the contrary, mild forms may become apparent through recurrent urinary tract infections. Such high phenotypic variability has been described even within the same family. Here, we systematically screened parents of affected children for symptoms of LUTO. Methods The study population consisted of parents of LUTO patients. Fathers over 50 years of age were excluded, to avoid inclusion of male phenocopies due to early prostatic hypertrophy. Uroflowmetry, ultrasonography for residual urine and hydronephrosis, and laboratory examination of standard renal retention parameters were assessed, and a detailed patient history was taken, including the assessment of the International Prostate Symptom Score. Results Twenty-nine of 42 LUTO families enrolled were found eligible for the present study. Of these, we identified five families in which the father had already been diagnosed with infravesical obstruction (17%). Of the remaining families, nine agreed to participate in our study. Of these nine families, eight families had a child affected with PUV and one family had a child with urethral stenosis. Here, we found two fathers and one mother with symptoms of LUTO suggestive of mild LUTO and one family, in which the unborn male fetal brother of the affected index patient was also diagnosed prenatally with LUTO. Conclusion Our observations suggest that LUTOs have a higher heritability than previously thought and that first-degree relatives of the affected should be clinically assessed for symptoms of LUTO.
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Affiliation(s)
- Fabian Ebach
- Department of Neonatology and Pediatric Intensive CareUniversity Hospital BonnBonnGermany
| | - Pauline Wagner
- Department of Neonatology and Pediatric Intensive CareUniversity Hospital BonnBonnGermany
| | - Raimund Stein
- Center for Pediatric, Adolescent and Reconstructive Urology, University Medical Center Mannheim, Medical Faculty MannheimHeidelberg UniversityMannheimGermany
| | | | - Heiko Reutter
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology and Pediatric Intensive CareUniversity Hospital ErlangenErlangenGermany
| | - Alina C. Hilger
- Department of Pediatrics and Adolescent MedicineUniversity Hospital ErlangenErlangenGermany
- Research Center on Rare Kidney Diseases (RECORD)University Hospital ErlangenErlangenGermany
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3
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García-Rico E, Ortega-Polledo LE, Carrion DM, Quiroga-Valcarcel A, Fernández Hernández L. Recurrent Ureterosciatic Herniation Causing Right Obstructive Uropathy. Cureus 2024; 16:e57128. [PMID: 38681322 PMCID: PMC11055568 DOI: 10.7759/cureus.57128] [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] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
Sciatic hernias are unusual, challenging to diagnose, and can present some treatment dilemmas. Sciatic hernias containing the ureter are even less common. Symptoms are variable from renal fossa pain, mild or severe pelvic pain, neuropathic pain, or dysesthesias. Although stenting alone can be a treatment option for this condition, in cases where symptoms or ureteral obstruction relapse after initial treatment, sciatic hernioplasty must be considered as the definitive treatment. This article presents the case of a female patient who presented with a history of nonspecific abdominal pain and was diagnosed with a right-sided ureterosciatic hernia. This was managed with a ureteral stent for reduction of herniated ureteral content, but after recurrence, laparoscopic sciatic hernioplasty was performed. The patient was pain-free and without obstructive uropathy at the one-year follow-up.
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Affiliation(s)
| | | | | | - Ana Quiroga-Valcarcel
- General and Colorectal Surgery, Hospital Universitario Príncipe de Asturias, Madrid, ESP
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4
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Richter J, Rickard M, Good H, Kim JK, Shannon P, Dos Santos J, Chua ME, Lorenzo AJ, Van Mieghem T, Shinar S. Pathological Findings in Fetuses Terminated for Suspected Lower Urinary Tract Obstruction: Experience From a High-Risk Fetal Center in Canada. J Urol 2024; 211:305-312. [PMID: 37922376 DOI: 10.1097/ju.0000000000003777] [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: 06/11/2023] [Accepted: 10/27/2023] [Indexed: 11/05/2023]
Abstract
PURPOSE Pregnancies complicated by prenatally suspected lower urinary tract obstruction (LUTO) can be associated with high rates of terminations due to potentially poor outcomes. Herein, we assessed autopsy findings of fetuses terminated for suspected LUTO to evaluate the prenatal diagnostic accuracy and spectrum of underlying pathologies. MATERIALS AND METHODS We performed a retrospective review of all pregnancies referred to a high-risk fetal center in a universal access to care health care system for suspected LUTO that opted for termination of pregnancy between 2009 and 2022. Ultrasound features, genetic investigations, placental findings, and distribution of postmortem diagnoses were assessed. RESULTS Of a total of 190 pregnancies with suspected LUTO evaluated during the study period, 79 (42%) were terminated. We excluded 35 fetuses with incomplete data, resulting in 44 available for analysis. Pregnancies were terminated at a mean gestation of 22 ± 5 weeks. A LUTO diagnosis was confirmed in 37 (84.1%) fetuses (35 males, 2 females), and the remaining 7 showed other pathologies. Pulmonary hypoplasia was found in 62.2% (n = 23) and placental pathologies in 56.8% of confirmed LUTO compared to 33.4% and 71.4% in non-LUTO cases, respectively. Overall, a total of 31 fetuses underwent additional prenatal investigations with genetic anomalies detected only in fetuses with a confirmed LUTO diagnosis (13.6%). CONCLUSIONS In our health care system, almost half of prenatally suspected LUTO pregnancies are terminated. The sonographic diagnostic accuracy for LUTO is reasonable at 84%. However, the remaining 16% still had significant pathologies. Genetic abnormalities are uncommon and rarely the trigger for pregnancy terminations.
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Affiliation(s)
- Juliane Richter
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mandy Rickard
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hayley Good
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jin K Kim
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Shannon
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Joana Dos Santos
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael E Chua
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Urology, St Luke's Medical Center, Manila, Philippines
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tim Van Mieghem
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Shiri Shinar
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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5
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Mustafa M, Pouzi A, Senada P, Suraparaju L, Gupta S. Ureterosciatic Hernia in Focus: A Narrative Review of the Literature. Cureus 2023; 15:e49895. [PMID: 38174201 PMCID: PMC10762697 DOI: 10.7759/cureus.49895] [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] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
Pelvic herniation of the ureter through anatomical musculoskeletal foramina stands out as one of the rarest causes of ureteric obstruction. Historically, most cases have been documented as incidental intraoperative findings. The herniation of the ureter through the sciatic foramen presents as a particularly uncommon variant of this condition, distinguished by its potential to cause life-threatening sepsis or renal failure if not promptly recognized and treated. The diagnostic process remains challenging, attributed partly to the vague initial symptomatology and subtle radiological findings, and second, to the rarity of this condition. This challenge may be further compounded by the lack of a clear description of clinical features and pathways to raise clinician suspicion. In light of these considerations, we conducted this literature review to illuminate this unique cause of obstructive uropathy, aiming to delineate its clinical features and explore common diagnostic and treatment options.
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Affiliation(s)
- Mohamed Mustafa
- Urology, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, GBR
| | - Afiq Pouzi
- Urology, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, GBR
| | - Peter Senada
- Urology, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, GBR
| | - Lokesh Suraparaju
- Urology, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, GBR
| | - Suresh Gupta
- Urology, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, GBR
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6
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Lee SJ, Cho SY, Yi W, Kang KP. Obstructive Uropathy Caused by Massive Fecal Impaction in a Patient With Congenital Anorectal Malformation and Neurogenic Bladder. Cureus 2023; 15:e47036. [PMID: 37965387 PMCID: PMC10642981 DOI: 10.7759/cureus.47036] [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] [Accepted: 10/14/2023] [Indexed: 11/16/2023] Open
Abstract
Anorectal malformations (ARMs) comprise a broad spectrum of congenital anomalies involving both anorectal and urogenital tracts. After diagnosis, urological problems should be evaluated in addition to surgical correction of ARMs. Commonly encountered urological problems in patients with ARMs are recurrent urinary tract infections, vesicoureteral reflux, and chronic kidney disease. Therefore, the proper timing of urination and appropriate defecation habits are essential for preserving renal function in patients with ARMs. Here, we report a case of acute hydronephrosis by severe stool impaction in a patient with a history of congenital ARMs and neurogenic bladder. In this case, the physicians should consider properly managing chronic constipation and urination in patients with ARMs despite successful surgical corrections.
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Affiliation(s)
- Soo Jin Lee
- Department of Internal Medicine, Research Institute of Clinical Medicine, Jeonbuk National University Medical School, Jeonju, KOR
- Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, KOR
| | - Seok Young Cho
- Department of Internal Medicine, Research Institute of Clinical Medicine, Jeonbuk National University Medical School, Jeonju, KOR
- Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, KOR
| | - Wonkyo Yi
- Department of Internal Medicine, Research Institute of Clinical Medicine, Jeonbuk National University Medical School, Jeonju, KOR
- Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, KOR
| | - Kyung Pyo Kang
- Department of Internal Medicine, Research Institute of Clinical Medicine, Jeonbuk National University Medical School, Jeonju, KOR
- Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, KOR
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7
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Khandelwal S, Dhande R, Sood A, Parihar P, Mishra GV. Role of Multidetector Computed Tomography Urography in the Evaluation of Obstructive Uropathy: A Review. Cureus 2023; 15:e48038. [PMID: 38034148 PMCID: PMC10688237 DOI: 10.7759/cureus.48038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/30/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Obstructive uropathy, a prevalent clinical problem, can irreparably harm the kidneys if not treated promptly. As a result, accurate diagnosis is necessary for prompt management. This study examines the utility of multidetector computed tomography (MDCT) urography in identifying obstructive uropathy. PubMed, Google, Embase, Medline, and other electronic databases were used to search the English-language literature. The search phrases were obstructive urinary infections or urinary bladder or kidneys or MDCT. The authors' expertise and experience in the subject area aided in archiving pertinent publications. Even though the dilated upper tract of the ureters can be seen, ultrasonography (USG) has limitations because it cannot show the middle portion of the ureters, even if they are dilated mostly due to bowel gas artifacts. The USG does not emphasize the functioning of the renal tract. To evaluate obstructive uropathy, MDCT urography plays a very important role. For speedy, effective therapy, it provides a quick diagnosis of the source of obstruction.
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Affiliation(s)
- Shreya Khandelwal
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rajasbala Dhande
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anshul Sood
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratapsingh Parihar
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gaurav V Mishra
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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8
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Kanduri SR, Carbajal N, Velez JCQ. Fever and Confusion in an Elderly Man with AKI. Kidney360 2023; 4:1528-1529. [PMID: 37884001 PMCID: PMC10617795 DOI: 10.34067/kid.0000000000000193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/06/2023] [Indexed: 10/28/2023]
Affiliation(s)
- Swetha R Kanduri
- Ochsner Clinical School/The University of Queensland, New Orleans, Louisiana
- Department of Nephrology, Ochsner Health, New Orleans, Louisiana
| | | | - Juan Carlos Q Velez
- Ochsner Clinical School/The University of Queensland, New Orleans, Louisiana
- Department of Nephrology, Ochsner Health, New Orleans, Louisiana
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9
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Khaleel M, Ayyad M, Albandak M, C N Khalil N, M A Abu Taleb S. Acute Renal Failure Caused by Undiagnosed Pelvic Organ Prolapse in a Postmenopausal Woman: A Diagnosis Not to Be Missed. Cureus 2023; 15:e44513. [PMID: 37790056 PMCID: PMC10544584 DOI: 10.7759/cureus.44513] [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] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
Pelvic organ prolapse (POP) is a common condition mainly affecting postmenopausal women, characterized by the descent of pelvic organs through the vaginal canal. While often asymptomatic, POP can manifest with various symptoms such as a painless bulge or pressure sensation, abdominal pain, urinary complaints, and discomfort during intercourse. Severe cases can lead to urinary tract obstruction, hydronephrosis, and renal dysfunction. This case study presents an elderly female with bilateral severe hydronephrosis and pyelonephritis due to undiagnosed POP. Imaging revealed obstructive uropathy resulting from bilateral ureteric compression caused by cystocele and uterine prolapse. The patient's condition improved with antibiotics and supportive management. A vaginal hysterectomy was performed, which led to the resolution of the urinary tract obstruction. This case emphasizes the importance of considering POP in elderly women with urinary symptoms and the need for proactive screening. It highlights the significance of appropriate management to prevent irreversible renal damage. Different treatment modalities, including surgery and pessaries, are discussed, to emphasize the significance of tailoring treatments to individual patient characteristics.
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Affiliation(s)
- Mansour Khaleel
- Internal Medicine, Al-Makassed Charitable Society Hospital, Jerusalem, PSE
| | | | | | - Nabil C N Khalil
- Internal Medicine, Al-Makassed Charitable Society Hospital, Jerusalem, PSE
| | - Sari M A Abu Taleb
- Internal Medicine, I. K. Akhunbaev Kyrgyz State Medical Academy, Bishkek, KGZ
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10
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Gomez D, Perazella MA. A Patient with an Unusual Cause of AKI and Scrotal Swelling. Kidney360 2023; 4:1188-1189. [PMID: 37651667 PMCID: PMC10484347 DOI: 10.34067/kid.0000000000000125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 09/02/2023]
Affiliation(s)
- Daniel Gomez
- Section of Nephrology, Yale School of Medicine, New Haven, Connecticut
| | - Mark A. Perazella
- Section of Nephrology, Yale School of Medicine, New Haven, Connecticut
- VA Medical Center, West Haven, Connecticut
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11
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Batra VS, Singh M, Kathuria S, Jain S, Rasool S, Gupta M, Pandey H, Sharma A. Minimally invasive ureterolysis and intraperitonealization of ureter for idiopathic retroperitoneal fibrosis; single center analysis of an erratic disease. Urologia 2023; 90:535-541. [PMID: 35730727 DOI: 10.1177/03915603221104047] [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] [Indexed: 07/20/2023]
Abstract
INTRODUCTION Idiopathic retroperitoneal fibrosis is a known cause of obstructive uropathy. Ureterolysis is done when medical management fails or the presentation is at an advanced stage. Conventionally ureterolysis without omental wrap has been considered incomplete. Our Institute has experience of laparoscopic or robotic ureterolysis with intraperitonealization of the ureter alone and no other adjunctive procedure. This study retrospectively assesses the result of the procedure with patients presenting with varying severity of disease. METHODS From 2008, all patients who underwent laparoscopic or robotic ureterolysis were analyzed retrospectively for pre-operative management, operative findings, and post operative outcomes. RESULTS We operated and released nine renal units in seven patients. Two of the nine cases were performed robotically completely and the rest was performed by laparoscopic approach. Median follow up was 60 months. All patients documented resolution of symptoms. The mean post-operative creatinine at 1 year was significantly decreased to 1.47 ± 0.49 mg/dl in comparison to preoperative creatinine (p < 0.05). The postoperative mean ESR decreased significantly from a preoperative value of 58.2 ± 19.41 mm to 15.8 ± 17.23. The nuclear scan revealed unobstructed drainage and radiological imaging revealed resolution of hydronephrosis and fibrosis in all. The mean GFR on the nuclear scan after 3 and 12 months of surgery was 36.3 ± 4.33 and 40 ± 3.77, respectively. Thus, there was significant increase noted in GFR at 3 and 12 months in comparison to preoperative GFR (p < 0.05). CONCLUSION Laparoscopic/robotic ureterolysis with intraperitonealization alone is secure and durable procedure for idiopathic retroperitoneal fibrosis needing surgical release.
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Affiliation(s)
| | | | | | - Saurabh Jain
- Department of Urology, Sir Ganga Ram Hospital, Delhi, India
| | | | - Manu Gupta
- Department of Urology, Sir Ganga Ram Hospital, Delhi, India
| | | | - Ajay Sharma
- Department of Urology, Sir Ganga Ram Hospital, Delhi, India
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12
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Peyronel F, Vaglio A. IgG4-Related Kidney Disease. Clin J Am Soc Nephrol 2023; 18:994-996. [PMID: 37418275 PMCID: PMC10564360 DOI: 10.2215/cjn.0000000000000235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Affiliation(s)
- Francesco Peyronel
- Nephrology and Dialysis Unit, Meyer Children's University Hospital—IRCCS, Firenze, Italy
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - Augusto Vaglio
- Nephrology and Dialysis Unit, Meyer Children's University Hospital—IRCCS, Firenze, Italy
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio,” University of Firenze, Firenze, Italy
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13
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Mohd Hashim MH, Shukor S, Azizi MH. Giant Prostatic Stones and a Massive Bladder Stone Leading to Obstructive Uropathy: A Rare Case Report. Cureus 2023; 15:e43176. [PMID: 37692733 PMCID: PMC10485180 DOI: 10.7759/cureus.43176] [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] [Accepted: 08/08/2023] [Indexed: 09/12/2023] Open
Abstract
Giant prostatic calculi are rare with less than 20 cases reported in the literature so far. Here, we discuss the presentation, diagnosis, and surgical management of a 25-year-old male patient with giant prostatic stones associated with a large bladder stone resulting from an underlying neurogenic bladder secondary to spina bifida. The patient had a history of congenital spina bifida, hydrocephalus, and non-compliance with clean intermittent self-catheterization. The stones were diagnosed through imaging and cystoscopy, and open cystolithotomy was performed for stone removal. The patient had a successful postoperative recovery with improved renal function. The case highlights the association between prostatic calculi and bladder outlet obstruction, emphasizes the importance of addressing underlying conditions to prevent stone recurrence, and underscores the role of open surgery in managing large bladder stones accompanied by renal impairment.
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Affiliation(s)
| | - Suzliza Shukor
- Urology Unit, Surgical Department, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | - Muhammad Hasif Azizi
- Urology Unit, Surgical Department, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
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14
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Hofstrand R, Casey B, Onyeaso E. Hemophagocytic Lymphohistiocytosis Secondary to Obstructive Uropathy and Escherichia coli Bacteremia. Cureus 2023; 15:e41779. [PMID: 37575709 PMCID: PMC10418134 DOI: 10.7759/cureus.41779] [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] [Accepted: 06/27/2023] [Indexed: 08/15/2023] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare syndrome in which widespread activation of the immune system causes multi-organ tissue damage. HLH is a serious and potentially fatal disorder characterized by excessive immune system activation. It is characterized by a dysregulation in natural killer (NK) T-cell function, causing activation of lymphocytes and histiocytes. These cells secrete a large number of inflammatory cytokines and infiltrate various tissues causing multi-organ system failure. The spectrum consists of hereditary or "primary" HLH that comprises genetically heterogeneous conditions, occurring during childhood. The secondary form presents later in life and is associated with several conditions mainly malignancy, autoimmune diseases, viral or bacterial infections, and hematological diseases. Here we present an interesting case in which a 39-year-old patient presented with a complaint of shortness of breath. He was diagnosed with obstructive uropathy in the emergency department and subsequently developed acute liver injury, acute kidney injury, Escherichia coli bacteremia, and was diagnosed with HLH with comorbid bacteremia.
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Affiliation(s)
- Reese Hofstrand
- Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, USA
| | - Bradley Casey
- Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, USA
| | - Elizabeth Onyeaso
- Internal Medicine/Infectious Disease, Cape Fear Valley Medical Center, Fayetteville, USA
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Ahram DF, Lim TY, Ke J, Jin G, Verbitsky M, Bodria M, Kil BH, Chatterjee D, Piva SE, Marasa M, Zhang JY, Cocchi E, Caridi G, Gucev Z, Lozanovski VJ, Pisani I, Izzi C, Savoldi G, Gnutti B, Capone VP, Morello W, Guarino S, Esposito P, Lambert S, Radhakrishnan J, Appel GB, Uy NS, Rao MK, Canetta PA, Bomback AS, Nestor JG, Hays T, Cohen DJ, Finale C, van Wijk JA, La Scola C, Baraldi O, Tondolo F, Di Renzo D, Jamry-Dziurla A, Pezzutto A, Manca V, Mitrotti A, Santoro D, Conti G, Martino M, Giordano M, Gesualdo L, Zibar L, Masnata G, Bonomini M, Alberti D, La Manna G, Caliskan Y, Ranghino A, Marzuillo P, Kiryluk K, Krzemień G, Miklaszewska M, Lin F, Montini G, Scolari F, Fiaccadori E, Arapović A, Saraga M, McKiernan J, Alam S, Zaniew M, Szczepańska M, Szmigielska A, Sikora P, Drożdż D, Mizerska-Wasiak M, Mane S, Lifton RP, Tasic V, Latos-Bielenska A, Gharavi AG, Ghiggeri GM, Materna-Kiryluk A, Westland R, Sanna-Cherchi S. Rare Single Nucleotide and Copy Number Variants and the Etiology of Congenital Obstructive Uropathy: Implications for Genetic Diagnosis. J Am Soc Nephrol 2023; 34:1105-1119. [PMID: 36995132 PMCID: PMC10278788 DOI: 10.1681/asn.0000000000000132] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 01/18/2023] [Indexed: 03/31/2023] Open
Abstract
SIGNIFICANCE STATEMENT Congenital obstructive uropathy (COU) is a prevalent human developmental defect with highly heterogeneous clinical presentations and outcomes. Genetics may refine diagnosis, prognosis, and treatment, but the genomic architecture of COU is largely unknown. Comprehensive genomic screening study of 733 cases with three distinct COU subphenotypes revealed disease etiology in 10.0% of them. We detected no significant differences in the overall diagnostic yield among COU subphenotypes, with characteristic variable expressivity of several mutant genes. Our findings therefore may legitimize a genetic first diagnostic approach for COU, especially when burdening clinical and imaging characterization is not complete or available. BACKGROUND Congenital obstructive uropathy (COU) is a common cause of developmental defects of the urinary tract, with heterogeneous clinical presentation and outcome. Genetic analysis has the potential to elucidate the underlying diagnosis and help risk stratification. METHODS We performed a comprehensive genomic screen of 733 independent COU cases, which consisted of individuals with ureteropelvic junction obstruction ( n =321), ureterovesical junction obstruction/congenital megaureter ( n =178), and COU not otherwise specified (COU-NOS; n =234). RESULTS We identified pathogenic single nucleotide variants (SNVs) in 53 (7.2%) cases and genomic disorders (GDs) in 23 (3.1%) cases. We detected no significant differences in the overall diagnostic yield between COU sub-phenotypes, and pathogenic SNVs in several genes were associated to any of the three categories. Hence, although COU may appear phenotypically heterogeneous, COU phenotypes are likely to share common molecular bases. On the other hand, mutations in TNXB were more often identified in COU-NOS cases, demonstrating the diagnostic challenge in discriminating COU from hydronephrosis secondary to vesicoureteral reflux, particularly when diagnostic imaging is incomplete. Pathogenic SNVs in only six genes were found in more than one individual, supporting high genetic heterogeneity. Finally, convergence between data on SNVs and GDs suggest MYH11 as a dosage-sensitive gene possibly correlating with severity of COU. CONCLUSIONS We established a genomic diagnosis in 10.0% of COU individuals. The findings underscore the urgent need to identify novel genetic susceptibility factors to COU to better define the natural history of the remaining 90% of cases without a molecular diagnosis.
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Affiliation(s)
- Dina F. Ahram
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Tze Y. Lim
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Juntao Ke
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Gina Jin
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Miguel Verbitsky
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Monica Bodria
- Division of Nephrology and Renal Transplantation, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Byum Hee Kil
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Debanjana Chatterjee
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Stacy E. Piva
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Maddalena Marasa
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Jun Y. Zhang
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Enrico Cocchi
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Gianluca Caridi
- Division of Nephrology and Renal Transplantation, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Laboratory on Molecular Nephrology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Zoran Gucev
- Medical Faculty of Skopje, University Children's Hospital, Skopje, Macedonia
| | - Vladimir J. Lozanovski
- Medical Faculty of Skopje, University Children's Hospital, Skopje, Macedonia
- Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Isabella Pisani
- Unità Operativa Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Claudia Izzi
- Division of Nephrology, Department of Obstetrics and Gynecology, ASST Spedali Civili of Brescia, Brescia, Italy
| | | | - Barbara Gnutti
- Medical Genetics Laboratory, ASST-Spedali Civili, Brescia, Italy
| | - Valentina P. Capone
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - William Morello
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Guarino
- Department of Woman and Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli,” Naples, Italy
| | - Pasquale Esposito
- Department of Internal Medicine, University of Genoa, Genova, Italy
- Unit of Nephrology, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Sarah Lambert
- Yale School of Medicine/Yale New Haven Health System, New Haven, Connecticut
| | - Jai Radhakrishnan
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Gerald B. Appel
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Natalie S. Uy
- Division of Pediatric Nephrology, Department of Pediatric, NewYork-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York
| | - Maya K. Rao
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Pietro A. Canetta
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Andrew S. Bomback
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Jordan G. Nestor
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Thomas Hays
- Department of Pediatrics, Division of Neonatology, Columbia University, New York, New York
| | - David J. Cohen
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Carolina Finale
- Nephrology, Dialysis and Renal Transplantation Unit, Azienda Ospedaliera Universitaria Ospedali Riuniti Umberto I, Lancisi, Salesi of Ancona, Ancona, Italy
| | - Joanna A.E. van Wijk
- Department of Pediatric Nephrology, Emma Children's Hospital, University of Amsterdam, Amsterdam, The Netherlands
| | - Claudio La Scola
- Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria Sant'Orsola-Malpighi, Bologna, Italy
| | - Olga Baraldi
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Tondolo
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Dacia Di Renzo
- “Spirito Santo” Hospital of Pescara, Pediatric Surgery of “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Anna Jamry-Dziurla
- Polish Registry of Congenital Malformations, Chair and Department of Medical Genetics, University of Medical Sciences, Poznan, Poland
| | - Alessandro Pezzutto
- Nephrology and Dialysis Unit, Department of Medicine, SS Annunziata Hospital, “G. d'Annunzio” University, Chieti, Italy
| | - Valeria Manca
- Department of Pediatric Urology, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Adele Mitrotti
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
- Section of Nephrology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Domenico Santoro
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giovanni Conti
- Department of Pediatric Nephrology, Azienda Ospedaliera Universitaria “G. Martino,” Messina, Italy
| | - Marida Martino
- Pediatric Nephrology and Dialysis Unit, Pediatric Hospital “Giovanni XXIII,” Bari, Italy
| | - Mario Giordano
- Pediatric Nephrology and Dialysis Unit, Pediatric Hospital “Giovanni XXIII,” Bari, Italy
| | - Loreto Gesualdo
- Section of Nephrology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Lada Zibar
- Department of Nephrology, University Hospital Merkur, Zagreb, Croatia
- Faculty of Medicine, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia
| | - Giuseppe Masnata
- Department of Pediatric Urology, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Mario Bonomini
- Nephrology and Dialysis Unit, Department of Medicine, SS Annunziata Hospital, “G. d'Annunzio” University, Chieti, Italy
| | | | - Gaetano La Manna
- IRCCS Azienda Ospedaliera di Bologna, Nephrology, Dialysis and Kidney Transplant Unit, St. Orsola University Hospital, Bologna, Italy
| | - Yasar Caliskan
- Division of Nephrology, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Andrea Ranghino
- Nephrology, Dialysis and Renal Transplantation Unit, Azienda Ospedaliera Universitaria Ospedali Riuniti Umberto I, Lancisi, Salesi of Ancona, Ancona, Italy
| | - Pierluigi Marzuillo
- Department of Woman and Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli,” Naples, Italy
| | - Krzysztof Kiryluk
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Grażyna Krzemień
- Department of Pediatrics and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | - Monika Miklaszewska
- Department of Pediatric Nephrology and Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Fangming Lin
- Division of Pediatric Nephrology, Department of Pediatric, NewYork-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Giuliana and Bernardo Caprotti Chair of Pediatrics, University of Milano, Milano, Italy
| | - Francesco Scolari
- Division of Nephrology and Dialysis, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Enrico Fiaccadori
- Unità Operativa Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Adela Arapović
- Department of Pediatrics, University Hospital of Split, Split, Croatia
- School of Medicine, University of Split, Split, Croatia
| | - Marijan Saraga
- Department of Pediatrics, University Hospital of Split, Split, Croatia
- School of Medicine, University of Split, Split, Croatia
| | - James McKiernan
- Department of Urology, Columbia University Irving Medical Center, New York, New York
| | - Shumyle Alam
- Department of Urology, Columbia University Irving Medical Center, New York, New York
- Division of Pediatric Urology, MUSC Health-University Medical Center, Charleston, South Carolina
| | - Marcin Zaniew
- Department of Pediatrics, University of Zielona Góra, Zielona Góra, Poland
| | - Maria Szczepańska
- Department of Pediatrics, FMS in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Szmigielska
- Department of Pediatrics and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | - Przemysław Sikora
- Department of Pediatric Nephrology, Medical University of Lublin, Lublin, Poland
| | - Dorota Drożdż
- Department of Pediatric Nephrology and Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | | | - Shrikant Mane
- Yale Center for Mendelian Genomics (YCMG), New Haven, Connecticut
| | | | - Velibor Tasic
- Medical Faculty of Skopje, University Children's Hospital, Skopje, Macedonia
| | - Anna Latos-Bielenska
- Polish Registry of Congenital Malformations, Chair and Department of Medical Genetics, University of Medical Sciences, Poznan, Poland
| | - Ali G. Gharavi
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Gian Marco Ghiggeri
- Division of Nephrology and Renal Transplantation, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Laboratory on Molecular Nephrology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Anna Materna-Kiryluk
- Polish Registry of Congenital Malformations, Chair and Department of Medical Genetics, University of Medical Sciences, Poznan, Poland
| | - Rik Westland
- Department of Pediatric Nephrology, Emma Children's Hospital, University of Amsterdam, Amsterdam, The Netherlands
| | - Simone Sanna-Cherchi
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
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Liu CM, Liu CJ, Lu ZH, Huang HS. Use of Urine N-Terminal Prohormone of Brain-Natriuretic Peptide (NT-proBNP) as a Non-Invasive Indicator for Renal Function Recovery after Surgical Relief of Hydronephrosis. Diagnostics (Basel) 2023; 13. [PMID: 36673056 DOI: 10.3390/diagnostics13020247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 01/10/2023] Open
Abstract
Cardiorenal syndrome is rarely discussed in patients with obstructive uropathy. On the other hand, there is currently no accurate and convenient clinical biomarker to predict the recovery of renal function after the resolution of ureteral obstruction. The purpose of this study is to explore the association between hydronephrosis and cardiorenal syndrome by measuring the change of the N-terminal prohormone of brain-natriuretic peptide (NT-proBNP), which is a biomarker typically used for cardiac failure, in patients receiving surgery to relieve obstructive uropathy. A total of 212 patients admitted for ureteroscopic (URS) procedures to relieve hydronephrosis were enrolled in this study. The severity of hydronephrosis as well as plasma and urine NT-proBNP levels were obtained before and after surgery. The results showed a significant correlation between urine NT-proBNP levels and renal function recovery following the resolution of hydronephrosis (OR 3.24, 95% CI 1.09−9.70, p = 0.035). Urine NT-proBNP could even predict the recovery of renal function with an area under the ROC = 0.775 (0.65−0.88, p < 0.001). In conclusion, urine NT-proBNP could be a useful early marker of renal function recovery after URS surgery, identifying patients whose renal and heart functions were compromised by the obstruction.
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Osinibi E, Doan H, Mercado-Campero A, Abbaraju J, Masood S, Madaan S. The implications when offering percutaneous nephrostomy for the management of malignant obstructive uropathy secondary to urological malignancy: can we be more selective? Ther Adv Urol 2023; 15:17562872231207729. [PMID: 37901283 PMCID: PMC10612453 DOI: 10.1177/17562872231207729] [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: 03/07/2023] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
Background & Objectives Percutaneous nephrostomy (PN) for malignant ureteric obstruction (MUO) is increasingly accessible with high success rates. However, it is not without associated risks and morbidity, impacting quality of life, while not improving overall survival. In two UK hospitals, we investigated the outcomes of undergoing PN for MUO, to inform future patient counselling and selection for this intervention. Methods A retrospective audit of electronic records identified patients that received PN for bladder, and prostate cancer (PCa) between January 2015 and December 2018. Hospital 1 had a 24-h nephrostomy service, while Hospital 2 had a limited service; Group A: recurrent or treatment-resistant PCa, Group B: primary PCa, Group C: Bladder cancer. Results A total of 261 patients (Hospital 1 = 186, Hospital 2 = 75), had PN insertion. Seventy-eight had prostate or bladder cancer. Group A n = 30, Group B n = 12, Group C n = 36. Median age = 79 [interquartile range (IQR) = 72-86]. Following PN insertion, 12-month mortality was significantly greater in Hospital 1 at 82%, versus 52% in Hospital 2 (p = 0.015). Median survival: Group A: 177 days (IQR = 80-266), Group B: 209 days (IQR = 77-352), Group C: 145 days (IQR = 97-362). There was no significant difference in same-admission mortality, although group A had the greatest same-admission mortality at 17%. A total of 69% of all patients received bilateral nephrostomies. Patients with bilateral versus unilateral PN had no difference in mortality or nadir creatinine. Conclusion Most patients with malignant obstruction secondary to prostate or bladder cancer lived less than 12 months after PN insertion. When offering PN, careful consideration of disease prognosis should be made, and frank discussion of the implications of a life-long nephrostomy with patients and relatives.
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Affiliation(s)
- Elizabeth Osinibi
- Darent Valley Hospital Medway Maritime Hospital, Darenth Wood Road, Dartford, DA2 8DA, UK
| | - Hong Doan
- Medway Maritime Hospital, Gillingham, UK
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18
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Novikova EV, Khan MA, Turova EA. [Medical rehabilitation of children with obstructive uropathy]. Vopr Kurortol Fizioter Lech Fiz Kult 2023; 100:21-26. [PMID: 38016053 DOI: 10.17116/kurort202310005121] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Obstructive uropathy in children is predominantly urinary system malformation and one of the leading causes of chronic renal failure. Antenatal ultrasound can detect obstructive uropathy in infants. It is important to conduct diagnostics not only to identify the obstruction level in urinary system, but to assess renal function, renal blood flow and urination. Children are given conservative and surgical treatment methods to restore urodynamics, prevent infectious complications, improve renal blood flow. Currently, there are no principles, approaches and technologies for medical rehabilitation of patients with obstructive uropathy, therefore, the use of selective chromotherapy, which has an activating effect on regional circulation, and sound stimulation improving muscles tone of pelvis and ureters, is pathogenetically reasonable and promising. OBJECTIVE To develop technologies of physiotherapy application (sound stimulation, selective chromotherapy) for inclusion in comprehensive medical rehabilitation of children with megaloureter. MATERIAL AND METHODS Clinical observations and special examinations have been performed in 90 children with megaloureter aged from 1 to 10 years. The patients were divided into 2 groups: 30 children (study group) received sound stimulation combined with selective chromotherapy; 30 children (the 1st comparison group) - sound stimulation; 30 children (the 2nd comparison group) - selective chromotherapy (blue spectrum). General clinical methods, ultrasound of kidneys and bladder with Doppler monitoring of intrarenal blood flow, functional methods of bladder examination were used. RESULTS The positive effects of separate and combined application of sound stimulation and selective chromotherapy on clinical and laboratory indicators, urodynamics of urinary tract and renal blood flow in children with megaloureter after surgery have been revealed. The efficacy of selective chromotherapy use in children with megaloureter and comorbid neurologic bladder dysfunction has been proven. CONCLUSION Modern technologies for the application of physiotherapy, namely selective chromotherapy and sound stimulation, to include them in the comprehensive medical rehabilitation of children with megaloureter, have been developed for the first time and their high efficacy has been proven.
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Affiliation(s)
- E V Novikova
- Moscow Scientific and Practical Center of Medical Rehabilitation, Restorative and Sports Medicine, Moscow, Russia
- Filatov Children's City Hospital, Moscow, Russia
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - M A Khan
- Moscow Scientific and Practical Center of Medical Rehabilitation, Restorative and Sports Medicine, Moscow, Russia
- Filatov Children's City Hospital, Moscow, Russia
| | - E A Turova
- Moscow Scientific and Practical Center of Medical Rehabilitation, Restorative and Sports Medicine, Moscow, Russia
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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19
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Kim JY, Leem J, Park KK. Antioxidant, Anti-Apoptotic, and Anti-Inflammatory Effects of Farrerol in a Mouse Model of Obstructive Uropathy. Curr Issues Mol Biol 2023; 45:337-52. [PMID: 36661510 DOI: 10.3390/cimb45010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/21/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
Obstructive uropathy is a clinical condition that can lead to chronic kidney disease. However, treatments that can prevent the progression of renal injury and fibrosis are limited. Farrerol (FA) is a natural flavone with potent antioxidant and anti-inflammatory properties. Here, we investigated the effect of FA on renal injury and fibrosis in a mouse model of unilateral ureteral obstruction (UUO). Mice underwent a sham or UUO operation and received intraperitoneal injections of FA (20 mg/kg) daily for 8 consecutive days. Histochemistry, immunohistochemistry and immunofluorescence staining, TdT-mediated dUTP nick end labeling assay, Western blotting, gene expression analysis, and biochemical tests were performed. FA attenuated renal dysfunction (p < 0.05) and ameliorated renal tubular injury (p < 0.01) and interstitial fibrosis (p < 0.001) in UUO mice. FA alleviated 4-hydroxynonenal expression (p < 0.001) and malondialdehyde levels (p < 0.01) by regulating pro-oxidant and antioxidant enzymes. Apoptosis in the kidneys of UUO mice was inhibited by FA (p < 0.001), and this action was accompanied by decreased expression of cleaved caspase-3 (p < 0.01). Moreover, FA alleviated pro-inflammatory cytokine production (p < 0.001) and macrophage infiltration (p < 0.01) in the kidneys of UUO mice. These results suggest that FA ameliorates renal injury and fibrosis in the UUO model by inhibiting oxidative stress, apoptosis, and inflammation.
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20
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Nathan A, Morris M, Parry MG, Berry B, Sujenthiran A, Nossiter J, Payne H, Van Der Meulen J, Clarke NW, Green JSA. Interventions for obstructive uropathy in advanced prostate cancer: a population-based study. BJU Int 2022; 130:688-695. [PMID: 35485254 DOI: 10.1111/bju.15766] [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] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To develop and validate a coding framework to identify interventions for upper tract obstructive uropathy (UTOU) in men with locally advanced and metastatic prostate cancer (PCa) using administrative hospital data to assess clinical outcomes. There are no population-based studies on the incidence, treatment, and outcomes of this complication. PATIENTS AND METHODS Patients newly diagnosed with PCa between April 2014 and March 2019 were identified in the English cancer registry. A coding framework based on procedure (Office of Population Censuses and Surveys Classification of Surgical Operations and Procedures fourth edition) and diagnostic (International Classification of Diseases, 10th edition) codes was developed and validated. Subsequent clinical outcomes were determined using Hospital Episodes Statistics to determine the utility of the intervention. RESULTS A total of 77 010 patients newly diagnosed with locally advanced, and 30 083 patients with metastatic PCa were identified. Of these, 1951 (1.8%) patients underwent an intervention for UTOU according to our coding framework: 830 (42.5%) had locally advanced disease and 1121 (57.5%) had metastatic disease. In all, 844 (43.3%) had a percutaneous nephrostomy (PCN), 473 (24.2%) had a PCN with antegrade stent, and 634 (32.5%) had a retrograde stent. The mean follow-up was 43.2 months. The cumulative incidence of the use of these interventions at 1, 3, and 5 years was 2.5%, 3.6% and 4.2% in men with metastases compared to 0.5%, 0.9% and 1.4% in men with locally advanced disease. CONCLUSION A new coding framework, developed to identify procedures for UTOU was applied in the largest study to date of UTOU in men with primary locally advanced and metastatic PCa. Results demonstrated that 2% of men with locally advanced PCa and 4% of men with metastatic PCa require an intervention to resolve UTOU within 5 years of their PCa diagnosis.
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Affiliation(s)
- Arjun Nathan
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.,Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Melanie Morris
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew G Parry
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Brendan Berry
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Arunan Sujenthiran
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.,Flatiron Health, UK
| | - Julie Nossiter
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Heather Payne
- Department of Oncology, University College London Hospitals, London, UK
| | - Jan Van Der Meulen
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Noel W Clarke
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts Manchester, UK
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Khaladkar SM, Singh T, Mohanan K, Kuber R, Dhirawani S. A case of leiomyosarcoma of the ovarian vein with obstructive uropathy and hepatic metastasis. SA J Radiol 2022; 26:2501. [PMCID: PMC9634827 DOI: 10.4102/sajr.v26i1.2501] [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: 06/22/2022] [Accepted: 08/19/2022] [Indexed: 11/06/2022] Open
Abstract
Leiomyosarcoma (LMS) is a smooth muscle-derived malignant mesenchymal tumour. Primary LMS arising from the ovarian vein is uncommon. A 51-year-old female presented with left loin pain and was diagnosed with a LMS arising from the gonadal vein. The patient refused any treatment. Early detection and timely diagnosis of retroperitoneal masses will improve the prognosis and survival rate in these patients. CT imaging plays an important role in diagnosis.
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Affiliation(s)
- Sanjay M. Khaladkar
- Department of Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, India
| | - Tejvir Singh
- Department of Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, India
| | - Karthik Mohanan
- Department of Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, India
| | - Rajesh Kuber
- Department of Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, India
| | - Satvik Dhirawani
- Department of Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, India
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22
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Wijaya WS, Irdam GA, Rahman F. Predicting Parameters of Renal Function Recoverability after Obstructive Uropathy Treatment in Adults. Acta Med Indones 2022; 54:500-512. [PMID: 36156471] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Obstructive uropathy can have many causes and can manifest as supravesical, vesical, or infravesical levels of obstruction. Treatment of obstructive uropathy, whether definitive or temporary, has a risk of complications or could worsen the patient's quality of life. Thus, knowledge of the parameters that predict recoverability of renal function after obstructive uropathy treatment is essential for patients and their families. Several studies have evaluated many factors that might potentially predict recoverability of renal function after obstruction release and these essentially are divided into factors predicting unilateral or bilateral obstruction. Almost all unilateral obstruction studies used ureteropelvic junction obstruction cases as their subjects and utilized nuclear scan renography to evaluate kidney recoverability. Factors confirmed as predicting factors for recoverability of renal function were age, hemoglobin level, BUN-to-creatinine ratio, postoperative urine volume and sodium excretion, cortical thickness, type of renal pelvis, hydronephrosis grade, corticomedullary differentiation, parenchymal echogenicity, renal resistive index, and initial kidney function. Thus, these studies all had different criteria for defining the recovery of renal function, and this might explain the differences observed from study to study.
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Affiliation(s)
- William Saputra Wijaya
- Department of Urology, Adam Malik Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
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23
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Abstract
Urinary tract infection (UTI) is the most common type of urogenital disease. UTI affects the urethra, bladder, ureter, and kidney. A total of 13.3% of women, 2.3% of men, and 3.4% of children in the United States will require treatment for UTI. Traditionally, bladder (cystitis) and kidney (pyelonephritis) infections are considered independently. However, both infections induce host defenses that are either shared or coordinated across the urinary tract. Here, we review the chemical and biophysical mechanisms of bacteriostasis, which limit the duration and severity of the illness. Urinary bacteria attempt to overcome each of these defenses, complicating description of the natural history of UTI.
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Affiliation(s)
| | - Anne-Catrin Uhlemann
- Department of Medicine and Pathology and Urology, Columbia University, New York, NY, USA;
| | - Jonathan Barasch
- Department of Medicine and Pathology and Urology, Columbia University, New York, NY, USA;
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24
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Gebreselassie KH, Gebrehiwot FG, Hailu HE, Beyene AD, Hassen SM, Mummed FO, Issack FH. Emergency Decompression of Obstructive Uropathy Using Percutaneous Nephrostomy: Disease Pattern and Treatment Outcome at Two Urology Centers in Ethiopia. Open Access Emerg Med 2022; 14:15-24. [PMID: 35046735 PMCID: PMC8761074 DOI: 10.2147/oaem.s344744] [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: 10/16/2021] [Accepted: 12/21/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Obstructive uropathy (OU) is a potentially life-threatening urologic emergency that requires urgent decompression. Percutaneous nephrostomy (PCN) is a commonly performed procedure to decompress OU. The objective of this study is to assess disease patterns and treatment outcome at two urologic centers in Ethiopia. Methods A cross-sectional study was conducted on 110 patients who underwent emergency PCN from October 1, 2019 to September 30, 2020. Data were collected by a retrospective chart review. SPSS 25 was used for analysis. Descriptive statistics and logistic regression were utilized to assess disease pattern and significant predictors. A p-value of <0.05 on multivariate logistic regression was considered statistically significant. Results Females accounted for 70% of cases and mean age at presentation was 48 ± 12.9 years. Bilateral OU was diagnosed in 60% of patients and 77.3% of obstructions occurred at the level of the ureter. Malignancies were diagnosed in >80% of patients among which cervical cancer was the commonest (37.3%) followed by bladder cancer (17.3%). Acute kidney injury (AKI) accounted for 70% of the presenting indications for PCN. Success rate after emergency PCN was 75.5% and 41.8% of the cases developed post-procedure complications. Factors that predicted successful outcome include male gender [AOR = 5.72 (1.13–28.92), 95% CI; p = 0.035], severe hydronephrosis pre-operatively [AOR = 7.12 (1.32–38.45), 95% CI; p = 0.022], and use of combined imaging (ultrasound and fluoroscope) to guide PCN [AOR = 12.91 (1.13–46.54), 95% CI; p = 0.039]. On the other hand, postoperative complication is a negative predictor [AOR = 0.26 (0.08–0.86), 95% CI; p = 0.027]. Conclusion In this study, overall success of emergency PCN is low. Presence of severe hydronephrosis predicts technical ease and better outcome of PCN. Procedures performed under ultrasound and fluoroscope guidance also improve outcome. Postoperative complication rate is high in this study and mandates strict preventive measures as it predicts unfavorable outcome.
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Affiliation(s)
| | | | - Haimanot Ewnetu Hailu
- Department of Public Health, Saint Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia
| | - Andualem Deneke Beyene
- Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University (AAU), Addis Ababa, Ethiopia
| | - Seid Mohammed Hassen
- Urology Unit, Department of Surgery, Saint Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia
| | - Ferid Ousman Mummed
- Urology Unit, Department of Surgery, Saint Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia
| | - Feysel Hassen Issack
- Urology Unit, Department of Surgery, Saint Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia
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25
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Öztürk FH, Türkmen GG, Ergun E, Tiryaki HT, Şahin D. Prenatal diagnosis of congenital megalourethra: case report and literature review. Turk J Pediatr 2022; 64:1136-1145. [PMID: 36583897 DOI: 10.24953/turkjped.2021.1252] [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] [Indexed: 12/31/2022]
Abstract
BACKGROUND Congenital megalourethra is an uncommon cause of lower urinary tract obstruction that is rarely prenatally diagnosed in second trimester sonographic examination as a cystic genital mass. CASE In the presented case, the megalourethra was accompanied with bilateral mild pelviectasis. The newborn had no morbidity during follow-up period. To review the literature, electronic databases including PubMed, Web of Science and Google Scholar were searched up to February 15, 2021. In 51 prenatally diagnosed cases in the literature, most of the cases had accompanying congenital anomalies, especially structural abnormalities in the genitourinary. CONCLUSIONS In the absence of associated abnormalities, the condition of the upper urinary tract is the main determinant of postnatal outcome. The outcome of congenital megalourethra may be good as in our case, but there may also be serious disorders such as renal failure, pulmonary hypoplasia, erectile dysfunction and fertility issues.
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Affiliation(s)
- Filiz Halıcı Öztürk
- Department of Obstetrics and Gynecology, Ankara City Hospital, Ankara, Türkiye
| | - Gülenay Gençosmanoğlu Türkmen
- Department of Obstetrics and Gynecology, Dr. Sami Ulus Women and Child Health Training and Research Hospital, Ankara, Türkiye
| | - Elif Ergun
- Department of Radiology, Ankara Training and Research Hospital, Ankara, Türkiye
| | - H Tuğrul Tiryaki
- Department of Pediatric Urology, Ankara City Hospital, Ankara, Türkiye
| | - Dilek Şahin
- Department of Obstetrics and Gynecology, Ankara City Hospital, Ankara, Türkiye
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26
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van der Zanden LFM, Maj C, Borisov O, van Rooij IALM, Quaedackers JSLT, Steffens M, Schierbaum L, Schneider S, Waffenschmidt L, Kiemeney LALM, de Wall LLL, Heilmann S, Hofmann A, Gehlen J, Schumacher J, Szczepanska M, Taranta-Janusz K, Kroll P, Krzemien G, Szmigielska A, Schreuder MF, Weber S, Zaniew M, Roeleveld N, Reutter H, Feitz WFJ, Hilger AC. Genome-wide association study in patients with posterior urethral valves. Front Pediatr 2022; 10:988374. [PMID: 36238604 PMCID: PMC9552614 DOI: 10.3389/fped.2022.988374] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
Congenital lower urinary tract obstructions (LUTO) are most often caused by posterior urethral valves (PUV), a male limited anatomical obstruction of the urethra affecting 1 in 4,000 male live births. Little is known about the genetic background of PUV. Here, we report the largest genome-wide association study (GWAS) for PUV in 4 cohorts of patients and controls. The final meta-analysis included 756 patients and 4,823 ethnicity matched controls and comprised 5,754,208 variants that were genotyped or imputed and passed quality control in all 4 cohorts. No genome-wide significant locus was identified, but 33 variants showed suggestive significance (P < 1 × 10-5). When considering only loci with multiple variants residing within < 10 kB of each other showing suggestive significance and with the same effect direction in all 4 cohorts, 3 loci comprising a total of 9 variants remained. These loci resided on chromosomes 13, 16, and 20. The present GWAS and meta-analysis is the largest genetic study on PUV performed to date. The fact that no genome-wide significant locus was identified, can be explained by lack of power or may indicate that common variants do not play a major role in the etiology of PUV. Nevertheless, future studies are warranted to replicate and validate the 3 loci that yielded suggestive associations.
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Affiliation(s)
- Loes F M van der Zanden
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Carlo Maj
- Institute for Genomic Statistics and Bioinformatics, Medical Faculty, University of Bonn, Bonn, Germany
| | - Oleg Borisov
- Institute for Genomic Statistics and Bioinformatics, Medical Faculty, University of Bonn, Bonn, Germany
| | - Iris A L M van Rooij
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | | | | | - Luca Schierbaum
- Institute of Human Genetics, School of Medicine and University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Sophia Schneider
- Institute of Human Genetics, School of Medicine and University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Lea Waffenschmidt
- Institute of Human Genetics, School of Medicine and University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Lambertus A L M Kiemeney
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Liesbeth L L de Wall
- Division of Pediatric Urology, Department of Urology, Radboud Institute for Molecular Life Sciences, Radboudumc Amalia Children's Hospital, Nijmegen, Netherlands
| | - Stefanie Heilmann
- Institute of Human Genetics, School of Medicine and University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Aybike Hofmann
- Department of Pediatric Urology, Clinic St. Hedwig, University Medical Center Regensburg, Regensburg, Germany
| | - Jan Gehlen
- Center for Human Genetics, University Hospital of Marburg, Marburg, Germany
| | | | - Maria Szczepanska
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | | | - Pawel Kroll
- Neurourology Unit, Pediatric Surgery and Urology Clinic, Poznań, Poland
| | - Grazyna Krzemien
- Department of Pediatrics and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Szmigielska
- Department of Pediatrics and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | - Michiel F Schreuder
- Department of Pediatric Nephrology, Radboud Institute for Molecular Life Sciences, Radboudumc Amalia Children's Hospital, Nijmegen, Netherlands
| | - Stefanie Weber
- University Children Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Marcin Zaniew
- Department of Pediatrics, University of Zielona Góra, Zielona Góra, Poland
| | - Nel Roeleveld
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Heiko Reutter
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Wout F J Feitz
- Division of Pediatric Urology, Department of Urology, Radboud Institute for Molecular Life Sciences, Radboudumc Amalia Children's Hospital, Nijmegen, Netherlands
| | - Alina C Hilger
- Institute of Human Genetics, School of Medicine and University Hospital Bonn, University of Bonn, Bonn, Germany.,Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany.,Research Center on Rare Kidney Diseases, University Hospital Erlangen, Erlangen, Germany
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27
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Akimenko MA, Kolmakova TS, Voronova OV, Kogan MI. [Nephron epithelial changes of the obstructive kidney in unilateral ureteral obstruction (experimental study)]. Urologiia 2021:47-50. [PMID: 34967164] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The high prevalence of kidney diseases caused by urinary tract obstruction has led to the need for experimental studies of the dynamics of pathological processes in their lesions. Despite the fact that the general patterns of development of obstructive uropathy are known, the features of renal tissue damage, in particular structural and molecular biological changes in this pathology, remain insufficiently studied. OBJECTIVE to study the dynamics of changes in the phenotype of epithelial cells of the nephron of an obstructive kidney with unilateral ureteral obstruction using an experimental model. MATERIALS AND METHODS The experimental study was carried out on the basis of the Rostov State Medical University. The model of unilateral ureteral obstruction was reproduced in adult rabbits. The studies were carried out on the 7th, 14th and 21st days of complete obstruction of the left ureter. Immunophenotyping of obstructive kidney tissue samples was performed for markers of epithelial phenotype (cytokeratin 7, E-cadherin) and mesenchymal phenotype (vimentin, - smooth muscle actin). RESULTS The sequence of changes in the phenotype of nephron epithelial cells during ureteral obstruction has been established. The first signs of an epithelial-mesenchymal transition (EMT) appear by day 7 in the form of a decrease in visualization of markers of the epithelial phenotype. On the 14th day, the expression of both epithelial and mesenchymal markers is noted. Significant changes in the phenotype of nephron epithelial cells: loss of epithelial markers (cytokeratin 7, E-cadherin) and the acquisition of mesenchymal markers (vimentin, - smooth muscle actin), are noted by the 21st day of the experiment. CONCLUSION An experimental model of unilateral ureteral obstruction revealed the transformation of the nephron tubule cell phenotype from epithelial to mesenchymal.
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Affiliation(s)
- M A Akimenko
- Rostov State Medical University, Rostov-on-Don, Russia
| | - T S Kolmakova
- Rostov State Medical University, Rostov-on-Don, Russia
| | - O V Voronova
- Rostov State Medical University, Rostov-on-Don, Russia
| | - M I Kogan
- Rostov State Medical University, Rostov-on-Don, Russia
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28
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Ustyniak S, Kurnatowska I, Stefańczyk L, Kaczmarska M, Wieczorek P. Is contrast-enhanced ultrasonography (CEUS) useful in the assessment of obstructive uropathy-induced perfusion disorders? J Ultrason 2021; 21:e348-e352. [PMID: 34970447 PMCID: PMC8678698 DOI: 10.15557/jou.2021.0057] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/21/2021] [Indexed: 11/22/2022] Open
Abstract
Aim: The study aimed to evaluate the usefulness of contrast-enhanced ultrasonography in renal perfusion disorders caused by obstructive uropathy. Case description: We present a case of a patient with a horseshoe kidney, in which the urine outflow from the right part of the kidney was blocked due to the presence of a bladder tumour infiltrating the ureter. Perfusion disorders in both parts of the kidney, visible in computed tomography, were partially reflected in the ultrasound image. Conclusions: Doppler ultrasound and contrast-enhanced ultrasound may be useful for monitoring perfusion disorders in the course of obstructive uropathy, provided that appropriate methodology is developed to compare blood flow in both kidneys.
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Affiliation(s)
- Sergiusz Ustyniak
- Department of Radiology and Diagnostic Imaging, Norbert Barlicki Memorial Teaching Hospital No. 1 of The Medical University of Lodz, Poland
| | - Ilona Kurnatowska
- Department of Internal Medicine and Transplantation Nephrology, Norbert Barlicki Memorial Teaching Hospital No. 1 of The Medical University of Lodz, Poland
| | - Ludomir Stefańczyk
- Department of Radiology and Diagnostic Imaging, Norbert Barlicki Memorial Teaching Hospital No. 1 of The Medical University of Lodz, Poland
| | - Magdalena Kaczmarska
- Department of Radiology and Diagnostic Imaging, Norbert Barlicki Memorial Teaching Hospital No. 1 of The Medical University of Lodz, Poland
| | - Patryk Wieczorek
- Department of Radiology and Diagnostic Imaging, Norbert Barlicki Memorial Teaching Hospital No. 1 of The Medical University of Lodz, Poland
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29
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Bianco M, Castagnetti M, Masieri L, Mele E, Gennaro MDE. Pre and postoperative imaging in patients undergoing pyeloplasty: A survey of current adult and paediatric practice. Urologia 2021; 89:153-159. [PMID: 34651537 DOI: 10.1177/03915603211052165] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Imaging to be used during the workup and follow-up of patients undergoing pyeloplasty is still controversial. Present survey aimed at assessing variations in pre- and post-operative imaging between adults and paediatric specialists in patients undergoing pyeloplasty. METHODS A survey of members of the 'Italian Society of Urology' (SIU) and the 'Italian Society of Paediatric Urology' (SIUP) was conducted using an online platform. RESULTS Respondents included 87 (74.4%) adult and 30 (25.6%) paediatric specialists. Adult specialists were significantly more likely to use a CT scan during preoperative workup (p = 0.001) and postoperative follow-up (p < 0.001). In contrast, paediatric specialists were significantly more likely to recommend voiding cystourethrography during the workup (p < 0.001) and an MRI in cases requiring additional diagnostic study (<0.001). Adult specialists reported to deal significantly more commonly with symptomatic or complicated hydronephroses (p < 0.001). The majority of respondents recommend an ultrasound scan at 1-3 months as first postoperative investigation. Two-third also recommended a nuclear scintigraphy, but 67.8% of adult specialists recommended to perform it within 6 months of surgery whereas 76.7% of paediatric specialists between 6 and 12 months (p < 0.001). CONCLUSIONS Present survey suggests quite a significant variation between adult and paediatric specialists in pre- and post-operative assessment of patients requiring pyeloplasty. This may just reflect different attitudes that could be improved with appropriate studies, or essential differences in the condition or the characteristics of treated patients. In any case, such differences are important and should be taken into account.
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Affiliation(s)
- Marta Bianco
- Pediatric Urology Unit, Department of Mother and Chile Health, University Hospital of Padova, Padua, Italy
| | - Marco Castagnetti
- Pediatric Urology Unit, Department of Mother and Chile Health, University Hospital of Padova, Padua, Italy.,Pediatric Urology Unit, Department of Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy.,Department of Surgery, Oncology and Gastroenterology, University Of Padova, Padua, Italy.,Working Group on Pediatric Urology, Italian Society of Urology, Roma, Italy
| | - Lorenzo Masieri
- Working Group on Pediatric Urology, Italian Society of Urology, Roma, Italy.,Department of Pediatric Urology, Meyer Hospital, University of Florence, Florence, Italy
| | - Ermelinda Mele
- Pediatric Urology Unit, Department of Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy.,Working Group on Pediatric Urology, Italian Society of Urology, Roma, Italy
| | - Mario DE Gennaro
- Working Group on Pediatric Urology, Italian Society of Urology, Roma, Italy
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30
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Jesrani G, Gupta S, Raju T, Bhardwaj N, Gupta M. Bilateral Renal Replacement Lipomatosis: A Case Report on Rare Complication of Obstructive Uropathy. Cureus 2021; 13:e16596. [PMID: 34447641 PMCID: PMC8380856 DOI: 10.7759/cureus.16596] [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] [Accepted: 07/23/2021] [Indexed: 11/05/2022] Open
Abstract
Renal replacement lipomatosis (RRL) is an uncommon complication, leading to the fatty replacement of the renal parenchyma. Various etiologies have been described for this long-term infirmity, but obstructive uropathy is one paramount cause. Previously described reports have documented unilateral disease in the majority, but we are narrating a case of bilateral RRL, which is very scarce in the literature. A 57-year-old man, who was a known case of obstructive uropathy, presented to us with the symptoms of urinary tract infection. In imaging evaluation, the patient was found to have bilateral RRL.
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Affiliation(s)
- Gautam Jesrani
- General Medicine, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Samiksha Gupta
- General Medicine, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Tagru Raju
- General Medicine, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Nidhi Bhardwaj
- General Medicine, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Monica Gupta
- General Medicine, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
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31
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Xenou A, Boulas KA, Nathanailidou M, Kyriakidou E, Paraskeva A, Triantafyllidis A, Chatzipourganis K, Hatzigeorgiadis A. An unusual case of obstructive uropathy. Clin Case Rep 2021; 9:e04569. [PMID: 34429987 PMCID: PMC8365403 DOI: 10.1002/ccr3.4569] [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: 02/09/2021] [Revised: 06/23/2021] [Accepted: 06/23/2021] [Indexed: 11/28/2022] Open
Abstract
Although inguinal bladder hernia associated with obstructive uropathy is an extremely rare entity, it should be suspected in elderly patients with bladder outlet obstruction presented with inguinal hernia and lower urinary tract symptoms.
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Affiliation(s)
- Antigoni Xenou
- Department of General SurgeryGeneral Hospital of DramaDramaGreece
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32
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Bhana K, Lazarus J, Kesner K, John J. Florid cystitis cystica et glandularis causing irreversible renal injury. Ther Adv Urol 2021; 13:17562872211022465. [PMID: 34178117 PMCID: PMC8202316 DOI: 10.1177/17562872211022465] [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: 02/24/2021] [Accepted: 05/13/2021] [Indexed: 11/25/2022] Open
Abstract
Cystitis cystica et glandularis (CCEG) is widely believed to be innocuous and self-limiting. We report a case of a 32-year-old male patient who was found to have gross bilateral hydroureter and hydronephrosis and an estimated glomerular filtration rate of 3 ml/min/1.73 m2. Cystoscopy revealed extensive cystic and nodular lesions involving most of the bladder urothelium, which proved to be CCEG on histopathological analysis. Retrograde and anterograde stents could not be inserted due to obstruction of the ureters at the level of the vesicoureteric junction. Percutaneous nephrostomies were subsequently inserted. Although there was evidence of improvement of the CCEG on follow-up cystoscopy, no improvement of renal function, despite decompression with percutaneous nephrostomies, was seen. He was subsequently placed on the waiting list for a renal transplant. We believe this to be the only known case reported of florid CCEG obstructing the upper urinary tracts bilaterally, causing irreversible renal injury.
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Affiliation(s)
- Kerisha Bhana
- Division of Urology, Department of Surgery, Frere Hospital and Walter Sisulu University, East London, South Africa
| | - John Lazarus
- Division of Urology, Department of Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Ken Kesner
- Division of Urology, Department of Surgery, Frere Hospital and Walter Sisulu University, East London, South Africa
| | - Jeff John
- Department of Urology, Department of Surgery, Frere Hospital and Walter Sisulu University, East London 5200, South Africa
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Abstract
Prostate abscess (PA) is an uncommon clinical manifestation that typically presents in the fifth to sixth decade of age and sporadically affects neonates. These characteristics, coupled with the atypical presentation, represent a clinical dilemma and a challenging diagnosis. A detailed history depicting the clinical course and the presence of risk factors is imperative to alert the clinician of the possibility of a PA. In this case report, we present a surgically confirmed PA, a diagnosis that is rarely encountered within the paediatric age group.
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Affiliation(s)
- Atish Vanmali
- Department of Radiology, Jackpersad and Partners Inc., Durban, South Africa
| | - Mario Haines
- Department of Radiology, Jackpersad and Partners Inc., Durban, South Africa
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34
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Iwamoto H, Anno T, Takenouchi H, Takahashi K, Horiya M, Kimura Y, Kawasaki F, Kaku K, Tomoda K, Uehara S, Kaneto H. Case Report: Emphysematous Cystitis and Pyelonephritis Induced by Uterine Prolapse in a Subject With Untreated Diabetes Mellitus. Front Med (Lausanne) 2021; 8:658682. [PMID: 33937293 PMCID: PMC8083874 DOI: 10.3389/fmed.2021.658682] [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: 01/26/2021] [Accepted: 03/17/2021] [Indexed: 11/25/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is often accompanied by a lot of complications due to chronic hyperglycemia and inflammation. Emphysematous cystitis and pyelonephritis are rare types of urinary tract infections and are often complicated with DM. Herein, we report a case of emphysematous cystitis and pyelonephritis complicated with untreated DM. In addition, this case was very rare and interesting in that her emphysematous cystitis and pyelonephritis were induced by severe uterine prolapse, obstructive uropathy and urination disorders. Both uterine prolapse and DM should be appropriately treated because both can lead to the development of emphysematous cystitis and pyelonephritis.
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Affiliation(s)
- Hideyuki Iwamoto
- Department of General Internal Medicine, Kawasaki Medical School, Kawasaki, Japan
| | - Takatoshi Anno
- Department of General Internal Medicine, Kawasaki Medical School, Kawasaki, Japan
| | - Haruka Takenouchi
- Department of General Internal Medicine, Kawasaki Medical School, Kawasaki, Japan
| | - Kaio Takahashi
- Department of General Internal Medicine, Kawasaki Medical School, Kawasaki, Japan
| | - Megumi Horiya
- Department of General Internal Medicine, Kawasaki Medical School, Kawasaki, Japan
| | - Yukiko Kimura
- Department of General Internal Medicine, Kawasaki Medical School, Kawasaki, Japan
| | - Fumiko Kawasaki
- Department of General Internal Medicine, Kawasaki Medical School, Kawasaki, Japan
| | - Kohei Kaku
- Department of General Internal Medicine, Kawasaki Medical School, Kawasaki, Japan
| | - Koichi Tomoda
- Department of General Internal Medicine, Kawasaki Medical School, Kawasaki, Japan
| | - Shinya Uehara
- Department of Urology, Kawasaki Medical School, Kawasaki, Japan
| | - Hideaki Kaneto
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kawasaki, Japan
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Noegroho BS, Kurniawan AP, Wijayanti Z, Mustafa A. Factors Affecting Survival Outcome After Percutaneous Nephrostomy as Palliative Urinary Diversion in Obstructive Uropathy due to Advance Cervical Cancer Patients. Asian Pac J Cancer Prev 2021; 22:1211-1216. [PMID: 33906314 PMCID: PMC8325148 DOI: 10.31557/apjcp.2021.22.4.1211] [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: 01/02/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: Cervical cancer is the 3rd most common cancer in women. In late stages, obstructive uropathy due to mass infiltration is common and the mainstay of treatment for this condition is palliative urinary diversion through percutaneous nephrostomy. Nevertheless, complications due to nephrostomy may have adverse effects on some patients. Further study is necessary to determine whether nephrostomy is suitable for all cervical cancer patients with obstructive uropathy. This study aims to identify the determinants of survival rate of cervical cancer patients undergoing nephrostomy for obstructive uropathy and determine the group of cervical cancer patients that would benefit the most from nephrostomy. Methods: Data were obtained from medical records of cervical cancer patients in Hasan Sadikin Central Public Hospital from January 2018 to December 2019. Log-rank analysis was performed to assess the survival rate of patients based on clinical conditions (age, metastasis, and ECOG performance status) and initial laboratory results (hemoglobin, leukocyte, thrombocyte and blood acidity). Results: A total of 163 cases were identified from the medical records, with a median survival of 5(1-17) months. The results of the analysis showed that the survival rates of cervical cancer patients undergoing nephrostomy were significantly affected by age (p = 0.0001), metastasis (p = 0.0001), and ECOG performance status (p = 0.0001), while laboratory findings were not significant factors affecting survival (pHb=0.501; pLeu=0.634; pTr=0.077; pBGA=0.687). Conclusion: The survival after nephrostomy in advanced cervical cancer patients is largely affected by age, metastasis, and performance status. The choices of doing nephrostomy in those patients should be considering those factors to maximize the benefit over the risk of complications.
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Affiliation(s)
- Bambang Sasongko Noegroho
- Department of Urology, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Andri Pratama Kurniawan
- Department of Urology, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Zola Wijayanti
- Department of Urology, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Akhmad Mustafa
- Department of Urology, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia
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Abstract
Retroperitoneal fibrosis (RPF) is a rare condition characterized by fibroinflammatory tissue infiltrating and compressing retroperitoneal structures. While mostly idiopathic (idiopathic retroperitoneal fibrosis or IRF), RPF is frequently associated with certain drugs, infections, and malignancies. It is thought to be immune-mediated because of response to steroids and RPF is commonly seen with other autoimmune diseases, especially IgG4-related disease (IgG4-RD). IRF is also a part of the chronic aortitis syndromes and the presence of aortic aneurysms is another characteristic of this disease. A 63-year old woman presented with left-sided flank pain. Computed tomography (CT) scan showed left hydronephrosis from compression of the ureter by a retroperitoneal mass. A thoracoabdominal aneurysm was also noted. A [18F]- fluorodeoxyglucose positron emission tomography (FDG-PET) scan showed hypermetabolism in the mass, with no abnormally increased activity noted elsewhere. Within four months, the mass enlarged to involve the right ureter as well, leading to right hydronephrosis. She required bilateral ureteral stents and aneurysm repair. Biopsy of the mass showed dense fibrosis with a mononuclear cell infiltrate. The histology of the aneurysm specimen showed chronic periaortic inflammation. Laboratory investigations were significant for elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), with no evidence of monoclonal gammopathy. She was referred to the rheumatology clinic to receive steroid treatment for IRF. IRF commonly involves the ureters and is diagnosed on CT scans during a workup for obstructive uropathy. The treatment is high dose steroids, while in resistant cases, other immunosuppressants have been used. The presentation of a patient with IRF can commonly mimic that of urinary calculi and malignancy. While rare, IRF should not be forgotten when evaluating a patient for obstructive uropathy.
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Affiliation(s)
- Radhika Sheth
- Internal Medicine, Henry Ford Health System, Jackson, USA
| | - Devin Malik
- Hematology/Oncology, Henry Ford Health System, Jackson, USA
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Dębska M, Koleśnik A, Kretowicz P, Olędzka A, Rebizant B, Gastoł P, Dębski R. Urethroplasty with balloon catheterization in fetal lower urinary tract obstruction: observational study of 10 fetuses. Ultrasound Obstet Gynecol 2020; 56:916-920. [PMID: 31763721 DOI: 10.1002/uog.21932] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 09/28/2019] [Accepted: 11/12/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To present the preliminary outcomes of fetal urethroplasty using a coronary angioplasty balloon catheter in lower urinary tract obstruction (LUTO). METHODS We included 10 consecutive male fetuses diagnosed with LUTO caused by presumed isolated posterior urethral valves (PUVs), who underwent urethroplasty with a balloon catheter in our center between 2015 and 2018. During urethroplasty, the fetal urethra was dilated using a balloon catheter (diameter, 0.014 inches; balloon size, 2 × 9 mm) inserted under ultrasonographic guidance via an 18-gauge needle introduced into the fetal bladder. RESULTS Mean gestational age at the time of urethroplasty was 17.8 (range, 16.5-20.4) weeks. All fetuses survived the procedure without any complications and there was no case of preterm prelabor rupture of the membranes. The procedure was successful in 5/10 (50%) fetuses, while in the other five (50%), we were unable to insert the balloon catheter into the urethra. In the five successfully treated cases, mean gestational age at delivery was 38 (range, 36-40) weeks and presence of PUVs was confirmed after birth. All five neonates micturated spontaneously and presented with normal urine output after birth. During the follow-up period, the parameters of kidney function were within normal limits in two neonates, whereas signs of impaired renal function were seen in another two. The other was diagnosed with renal insufficiency and required kidney transplant with bladder sparing at 2 years of age. CONCLUSIONS Urethroplasty with a balloon catheter is a new prenatal treatment option for fetuses with PUVs. By restoring fetal micturition, the procedure can preserve normal urinary bladder and kidney function. Although data on its efficacy and potential to differentiate the etiology of LUTO are sparse, a significant advantage of this method is its safety for the fetus and the mother. Even if the neonates develop renal insufficiency, they may be eligible for kidney transplant with connection to their own bladder, without the need for urostomy. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Dębska
- 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - A Koleśnik
- Cardiac Catheterization Laboratory, Children's Memorial Health Institute, Warsaw, Poland
- Department of Perinatal Cardiology and Congenital Anomalies, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - P Kretowicz
- 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - A Olędzka
- 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - B Rebizant
- 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - P Gastoł
- Department of Pediatric Urology, Children's Memorial Health Institute, Warsaw, Poland
| | - R Dębski
- 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland
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Chiancone F, Meccariello C, Ferraiuolo M, De Marco GP, Fedelini M, Langella NA, Fedelini P. A rare case of spontaneous parenchymal kidney explosion in a patient with ureteral obstruction caused by a single stone. Urologia 2020; 88:386-388. [PMID: 33245029 DOI: 10.1177/0391560320975881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Spontaneous rupture of kidney may involve collecting system or parenchyma. Parenchymal rupture usually occurs in patients with renal cell carcinoma, angiomyolipoma, renal cysts, arteriovenous malformation or vascular diseases such as periarteritis nodosa. Collecting system rupture is usually a rare complication of obstructive urolithiasis. We describe the unusual cases of spontaneous kidney rupture in patients with acute urinary obstruction. CASE PRESENTATION The case report describes the left parenchymal kidney explosion related to ipsilateral ureteral obstruction caused by a single ureteral stone. The patient reached our emergency department with acute left flank pain and massive haematuria. At the moment of admission, the patient was in stage III hypovolemic shock and had a lower haematocrit (haemoglobin = 4.9 g/dL). Despite blood transfusions, emergency surgical exploration, extrafascial nephrectomy and intensive support care, the patient died twelve hours after surgery. CONCLUSIONS Parenchymal renal rupture can be a life-threatening emergency. Despite its rarity, in the differential diagnosis of acute abdomen, parenchymal renal rupture should always be considered in patients with abdominal pain and an anamnesis or history of urinary stones, pointing out the need of early diagnosis also in benign urological conditions.
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Affiliation(s)
| | | | - Maria Ferraiuolo
- Department of Anesthesiology, TIPO e OTI, Antonio Cardarelli Hospital, Naples, Italy
| | | | | | | | - Paolo Fedelini
- Department of Urology, Antonio Cardarelli Hospital, Naples, Italy
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Gupta S, Nicassio L, Junquera GY, Jackson AR, Fuchs M, McLeod D, Alpert S, Jayanthi VR, DaJusta D, McHugh KM, Becknell B, Ching CB. Impact of successful pediatric ureteropelvic junction obstruction surgery on urinary HIP/PAP and BD-1 levels. J Pediatr Urol 2020; 16:592.e1-592.e7. [PMID: 32278658 PMCID: PMC7529730 DOI: 10.1016/j.jpurol.2020.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/10/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION In the pediatric patient whose ureteropelvic junction obstruction (UPJO) is not always symptomatic, imaging is the most common means of detecting surgical success. There is interest, however, in other means of post-operative monitoring. A panel of antimicrobial peptides (AMPs) has been previously found to be elevated in UPJO, but the impact of surgical correction on these AMPs is unknown. OBJECTIVE To determine if elevated levels of candidate urinary AMP biomarkers of urinary tract obstruction decrease following UPJO repair. STUDY DESIGN Pediatric patients undergoing surgical correction of an UPJO were recruited for participation. Bladder urine from uninfected consenting/assenting patients was collected immediately prior to surgery and then at least 6 months afterward. Based on prior studies demonstrating significant elevation of beta defensin 1 (BD-1), hepatocarcinoma-intestine-pancreas/pancreatitis-associated protein (HIP/PAP), cathelicidin (LL-37), and neutrophil gelatinase-associated lipocalin (NGAL) in patients with UPJO versus control patients, we performed enzyme-linked immunosorbent assays on these four AMPs to compare their expression before and after surgical intervention. If found to significantly decrease, AMP levels were compared to healthy controls. AMP levels were normalized to urine creatinine. Results were analyzed with paired t test or Wilcoxon test using Graphpad software. Correlation was calculated using Pearson or Spearman correlation. A p-value of <0.05 was considered significant. RESULTS 13 UPJO patients were included in this study; 9 were male (69%). Age at surgery was a median of 4.3 years (average 6.1, range 0.4-18.4 years). Follow-up urine samples were collected a median of 27.4 months after surgery (average 27.4; range 7.8-45.3 months). All 13 patients had clinical improvement and/or signs of improved hydronephrosis on post-operative imaging. HIP/PAP and BD-1 significantly decreased in post-surgical samples compared to pre-surgical samples (p = 0.02 and 0.01, respectively); NGAL and LL-37 did not significantly change. Overall, HIP/PAP decreased in 12 patients (92%) and BD-1 decreased in 11 patients (85%). BD-1 levels after successful repair were not different from healthy controls (p = 0.06). DISCUSSION Urinary biomarkers of obstruction should detect significant obstructive pathology as well as reflect its resolution. This would enable their use in post-operative monitoring and augment current methods of determining successful surgical outcome through imaging. CONCLUSIONS The AMPs HIP/PAP and BD-1 are significantly elevated in UPJO but then significantly decrease after pyeloplasty, with BD-1 returning to healthy control levels. As a result, these AMPs could serve as markers of successful surgical intervention.
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Affiliation(s)
- Sudipti Gupta
- Division of Pediatric Urology, Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA; Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Lauren Nicassio
- Division of Pediatric Urology, Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Guillermo Yepes Junquera
- Division of Pediatric Urology, Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Ashley R Jackson
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Department of Biomedical Education & Anatomy, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Molly Fuchs
- Division of Pediatric Urology, Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Daryl McLeod
- Division of Pediatric Urology, Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Seth Alpert
- Division of Pediatric Urology, Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Venkata R Jayanthi
- Division of Pediatric Urology, Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Daniel DaJusta
- Division of Pediatric Urology, Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kirk M McHugh
- Department of Biomedical Education & Anatomy, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Brian Becknell
- Division of Pediatric Nephrology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Christina B Ching
- Division of Pediatric Urology, Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA; Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
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Guachetá-Bomba PL, Echeverría-García F, García-Perdomo HA. Predictors for failure of endoscopic ureteric stenting in patients with malignant ureteric obstruction: systematic review and meta-analysis. BJU Int 2020; 127:292-299. [PMID: 32916038 DOI: 10.1111/bju.15237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine the factors for failure of endoscopic ureteric stenting in patients with malignant ureteric obstruction. METHODS We performed a search strategy in the Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica dataBASE (EMBASE), the Literatura Latino-Americana e do Caribe em Ciências da Saúde database (LILACS), and the Cochrane Central Register of Controlled Trials (CENTRAL) databases. We included patients with malignant ureteric obstruction, who had a JJ catheter insertion. The studies reported the percentage of failure and risk factors, e.g. bladder invasion or deformity of the trigone, hydronephrosis, renal failure, previous radiotherapy, age, obstruction aetiology, and patient's health status. We performed a meta-analysis using R software ('meta' and 'metafor' libraries). RESULTS We included nine studies that met the inclusion criteria, with 761 patients and an average age of 60.5 years. The studies assessed the time to failure during the first 30 days. The reported failure rate was 32% (95% confidence interval [CI] 21-45%; I2 = 88%). Regarding risk factors for failure, bladder invasion or deformity of the trigone had a hazard ratio (HR) of 4.8 (95% CI 1.28-8.5; I2 = 97.4%); severe hydronephrosis had a HR of 3.92 (95% CI 0.32-7.52; I2 = 93.9%); and age <65 years had a HR of 0.93 (95% CI 0.8-0.9; I2 = 0%). CONCLUSIONS We found a high probability of failure for endoscopic urinary decompression in patients with malignant ureteric obstruction. Factors such as bladder invasion or deformity of the trigone and age >65 years had an increased risk of failure.
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Affiliation(s)
- Pedro Luis Guachetá-Bomba
- Department of Surgery/Urology, School of Medicine, Universidad del Valle, Cali, Colombia.,UROGIV Research Group, Universidad del Valle, Cali, Colombia
| | - Fernando Echeverría-García
- Department of Surgery/Urology, School of Medicine, Universidad del Valle, Cali, Colombia.,UROGIV Research Group, Universidad del Valle, Cali, Colombia
| | - Herney Andrés García-Perdomo
- Department of Surgery/Urology, School of Medicine, Universidad del Valle, Cali, Colombia.,UROGIV Research Group, Universidad del Valle, Cali, Colombia
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Parkin CJ, Acland G, Sulaiman B, Johnsun ML, Latif E. Malakoplakia, a malignant mimic. Bladder (San Franc) 2020; 7:e44. [PMID: 32934968 PMCID: PMC7483825 DOI: 10.14440/bladder.2020.818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/02/2020] [Accepted: 08/05/2020] [Indexed: 11/23/2022]
Abstract
Malakoplakia is a chronic inflammatory condition that affects multiple systems, most commonly the urogenital tract. Its clinical presentation is often non-specific, but is typically characterized by recurrent urinary tract infections and haematuria. We report a rare case of intravesical malakoplakia mimicking an aggressive transitional cell carcinoma both in its clinical presentation and in its macroscopic appearance on cystoscopy in an 82-year patient, the oldest reported case in the literature. Malakoplakia has been described in the literature as a benign disease process presenting typically in younger patients. This case demonstrates its ability to cause obstructive uropathy and affect elderly patients. Thus, this case serves as a reminder to consider malakoplakia as a differential in the evaluation of suspected bladder malignancy in patients of all ages.
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Affiliation(s)
- Cameron James Parkin
- Department of Urology, Gosford Hospital, Central Coast Local Health District, NSW, Australia
| | - George Acland
- Department of Urology, Gosford Hospital, Central Coast Local Health District, NSW, Australia
| | - Ban Sulaiman
- Department of Anatomical Pathology, Gosford Hospital, Central Coast Local Health District, NSW, Australia
| | - Mark Louie Johnsun
- Department of Urology, Gosford Hospital, Central Coast Local Health District, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, NSW, Australia
| | - Edward Latif
- Department of Urology, Gosford Hospital, Central Coast Local Health District, NSW, Australia
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Abstract
Zinner syndrome is a rare hereditary disorder of the mesonephric duct. The triad of the absence of one kidney, ipsilateral cystic dilatation of the seminal vesicle, and ejaculatory duct obstruction makes the diagnosis. Mostly, it is asymptomatic. However, genitourinary manifestations and workup for the incidental absence of one kidney often uncover the disease. Ultrasound and CT scan can identify the absence of a kidney and seminal vesicle cyst, while MRI is the gold standard for diagnostic elaboration of the pelvic anatomy. In this article, we have presented a 51-year-old male patient who presented with renal colic and hypertension. Radiological investigations for the renal colic uncovered the diagnosis of Zinner syndrome incidentally. This case highlights the incidental nature, variability in the clinical presentation, and the diagnostic challenges of this rare disorder. It also emphasizes on the radiologist for a careful evaluation of the pelvic images in patients with unilateral absence of a kidney.
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Affiliation(s)
- Amman Yousaf
- Radiology, Hamad General Hospital, Doha, QAT.,Radiology, Services Institute of Medical Sciences, Lahore, PAK
| | | | | | - Fariha Ghaffar
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Syeda Sabeeka Batool
- Internal Medicine, University of Alabama at Birmingham Huntsville Regional Medical Center, Huntsville, USA
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43
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Ozlu DN, Seker KG, Cetin Seker Y, Haciislamoglu A, Kalfazade N. Postrenal Acute Renal Failure Due to Giant Fecaloma-related Bilateral Hydronephrosis: A Case Report and Brief Literature Review. Cureus 2020; 12:e7815. [PMID: 32467791 PMCID: PMC7249776 DOI: 10.7759/cureus.7815] [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] [Indexed: 11/05/2022] Open
Abstract
An 88-year-old woman presented to the emergency department with abdominal distention, fever, and constipation of about a week's duration. Laboratory tests showed impaired kidney function tests and fluid electrolyte values. Bilateral hydroureteronephrosis was observed on non-contrasted abdominal CT. Imaging revealed no intrinsic urological pathology (ureteral stones, etc.) that could lead to obstruction in the urinary system; however, excessively dilated and feces-loaded rectum and colon were observed. The patient was treated with conservative methods. Unfortunately, she passed away due to general condition disorder.
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Affiliation(s)
- Deniz Noyan Ozlu
- Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, TUR
| | - Kamil Gokhan Seker
- Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, TUR
| | | | - Ahmet Haciislamoglu
- Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, TUR
| | - Nadir Kalfazade
- Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, TUR
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44
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Tkaczyk M, Stanczyk M, Krzeszowski W, Wojtera J, Litwinska M, Fortecka-Piestrzeniewicz K, Talar T, Pawlowska B, Olejniczak D, Podgorski M, Swiechowski R, Krygier A, Wosiak A, Szaflik K. Neonatal survival and kidney function after prenatal interventions for obstructive uropathies. Ginekol Pol 2020; 90:416-422. [PMID: 31392712 DOI: 10.5603/gp.2019.0071] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/03/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Prenatal interventions in LUTO (lower urinary tract obstruction) usually are still question of a debate between gynaecologist and paediatric nephrologist. We aimed the study to assess the early survival rate and renal outcome in LUTO foetuses. MATERIAL AND METHODS The study was a prospective data analysis of 39 foetuses from singleton pregnancies. All pregnant women with LUTO in the foetus were qualified for VAS based on a local practice. The mean time of first urine analysis ranged between 13-30 weeks of pregnancy. Primary end-point analysis included live birth, 28d-survival, pulmonary and renal function assessment in neonatal period. RESULTS From initial number of 39, six patients miscarried before the procedure was performed. Overall, 33 VAS were performer at the mean 21 week of pregnancy (range 14-30 weeks). 25/39 foetuses survived until delivery. Three neonates died in first 3 days of life. In the first month 3 children required peritoneal dialysis, but at 28 day all children were dialysis-free. Overall survival rate at 28 day was 56%. Renal function preservation of the initial group (39) turned out to be low - 18% (7/39). CONCLUSIONS Our study showed average survival curves and complications. LUTO in the foetus had mostly unfavourable outcome in the neonatal period. The prenatal intervention did not increase it significantly and did not guarantee the preservation of normal kidney function.
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Affiliation(s)
- Marcin Tkaczyk
- Department of Paediatics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute of Lodz, Lodz, Poland
| | - Malgorzata Stanczyk
- Department of Paediatics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute of Lodz, Lodz, Poland.
| | - Waldemar Krzeszowski
- Department of Gynecology, Fertility and Fetal Therapy, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Justyna Wojtera
- Department of Gynecology, Fertility and Fetal Therapy, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Magdalena Litwinska
- Department of Gynecology, Fertility and Fetal Therapy, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Katarzyna Fortecka-Piestrzeniewicz
- Department of Intensive Therapy and Congenital Malformations of Newborns and Infants, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Tomasz Talar
- Department of Neonatology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Barbara Pawlowska
- Department of Neonatology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Dariusz Olejniczak
- Department of Surgery, Urology and Transplantology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Michal Podgorski
- Department of Imaging Diagnostic, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Rafal Swiechowski
- Medical Laboratory Diagnostic Centre, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Adrian Krygier
- Medical Laboratory Diagnostic Centre, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Agnieszka Wosiak
- Institute of Information Technology, Lodz University of Technology, Lodz, Poland
| | - Krzysztof Szaflik
- Department of Gynecology, Fertility and Fetal Therapy, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
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Fiorini F, De Pascalis A, D'Amelio A, Di Iorio B, Abaterusso C, Granata A. [Native kidney ultrasound in obstructive uropathy]. G Ital Nefrol 2020; 37:37-01-2020-4. [PMID: 32068358] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The term "obstructive uropathy" refers to the complex structural and functional changes following the interruption of normal urinary runoff, which can occur at every level of the urinary tract. Depending on its origin, duration and severity, urinary tract obstructions can be acute or chronic, mono or bilateral, partial or complete. The obstruction can be localized or extended to the entire pielo-caliceal system and/or homolateral urethra. The term "hydronephrosis" indicates the dilation of the pelvis detected through imaging techniques. Among these, ultrasound is considered the gold standard in the diagnosis of obstructive uropathy: it allows to distinguish three degrees of urinary tract dilation, depending on the extent of the dilation itself and the thickness of the parenchyma. Nephrologists are confronted daily with patients who experience kidney failure and must be able to quickly distinguish between chronic and acute and, in the latter case, to discern between issues of nephrological or urological competence. This short review aims at helping them deal with this very common scenario, through the use of ultrasound.
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Affiliation(s)
- Fulvio Fiorini
- UOC Nefrologia, Dialisi, AULSS5 Polesana, Rovigo. Scuola Nazionale di Ecografia Nefrologica, Società Italiana di Ultrasonologia in Medicina e Chirurgia (SIUMB), Rovigo. Commissione Didattica Iter Formativo in Ecografia Nefrologica Società Italiana di Nefrologia
| | | | - Alessandro D'Amelio
- UOS Dialisi, Gallipoli (LE). Commissione Didattica Iter Formativo in Ecografia Nefrologica Società Italiana di Nefrologia
| | | | | | - Antonio Granata
- UOC Nefrologia e Dialisi, A.O. "Cannizzaro", Catania. Scuola Nazionale di Ecografia Nefrologica, società Italiana di Ultrasonologia in Medicina e Chirurgia (SIUMB), Catania. Commissione Didattica Iter Formativo in Ecografia Nefrologica Società Italiana di Nefrologia
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46
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Uppal J, Trivedi H, Gupta ND, Bey A. Periodontal management of severe periodontitis and generalized gingival enlargement in a patient with chronic renal failure. J Indian Soc Periodontol 2020; 24:284-288. [PMID: 32773982 PMCID: PMC7307469 DOI: 10.4103/jisp.jisp_194_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 03/26/2019] [Revised: 06/04/2019] [Accepted: 06/13/2019] [Indexed: 11/04/2022] Open
Abstract
Gingival enlargement is a common periodontal pathology seen in medically compromised patients. Although it is not the disease itself, certain medications used to treat these chronic diseases are known to precipitate the gingival enlargement. Periodontitis (PD) and gingival enlargement have been reported increasingly in patients with chronic renal failure. Severe enlargement is detrimental to esthetics and function while having a negative impact on the overall oral health-related quality of life. Treatment of such cases requires comprehensive periodontal management by a specialist, keeping in mind the medically compromised state of the patient. This report presents a case of severe PD with generalized gingival enlargement in a 45-year-old male who was a known case of Stage 4 chronic kidney disease, obstructive uropathy, and hypertension. Gingival enlargement was managed by gingivectomy and gingivoplasty. Six months' follow-up showed no sign of recurrence.
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Affiliation(s)
- Jaiti Uppal
- Department of Periodontics, Dr. Ziauddin Ahmad Dental College, Faculty of Medicine, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Himanshu Trivedi
- Department of Periodontics, Dr. Ziauddin Ahmad Dental College, Faculty of Medicine, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Narinder Dev Gupta
- Department of Periodontics, Dr. Ziauddin Ahmad Dental College, Faculty of Medicine, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Afshan Bey
- Department of Periodontics, Dr. Ziauddin Ahmad Dental College, Faculty of Medicine, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Castagnetti M, Iafrate M, Esposito C, Subramaniam R. Searching for the Least Invasive Management of Pelvi-Ureteric Junction Obstruction in Children: A Critical Literature Review of Comparative Outcomes. Front Pediatr 2020; 8:252. [PMID: 32582587 PMCID: PMC7280432 DOI: 10.3389/fped.2020.00252] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/22/2020] [Indexed: 01/22/2023] Open
Abstract
Introduction: To review the published evidence on the minimally invasive pyeloplasty techniques available currently with particular emphasis on the comparative data about the various minimally invasive alternatives to treat pelvi-ureteric junction obstruction and gauge if one should be favored under certain circumstances. Materials and Methods: Non-systematic review of literature on open and minimally invasive pyeloplasty including various kinds of laparoscopic procedures, the robotic-assisted laparoscopic pyeloplasty, and endourological procedures. Results: Any particular minimally invasive pyeloplasty procedure seems feasible in experienced hands, irrespective of age including infants. Comparative data suggest that the robotic-assisted procedure has gained wider acceptance mainly because it is ergonomically more suited to surgeon well-being and facilitates advanced skills with dexterity thanks to 7 degrees of freedom. However, costs remain the major drawback of robotic surgery. In young children and infants, instead, open surgery can be performed via a relatively small incision and quicker time frame. Conclusions: The best approach for pyeloplasty is still a matter of debate. The robotic approach has gained increasing acceptance over the last years with major advantages of the surgeon well-being and ergonomics and the ease of suturing. Evidence, however, may favor the use of open surgery in infancy.
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Affiliation(s)
- Marco Castagnetti
- Section of Paediatric Urology, Department of Surgical, Oncological, and Gastrointestinal Sciences, University Hospital of Padova, Padua, Italy
| | - Massimo Iafrate
- Section of Paediatric Urology, Department of Surgical, Oncological, and Gastrointestinal Sciences, University Hospital of Padova, Padua, Italy
| | - Ciro Esposito
- Department of Paediatrics, Federico II University of Naples, Naples, Italy
| | - Ramnath Subramaniam
- Department of Paediatric Urology, Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, United Kingdom.,Department of Paediatric Urology, University of Ghent, Ghent, Belgium
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48
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Khotko AI, Khotko DN, Zakharova NB, Tarasenko AI, Popkov VM, Alekseev AV. [Nephroprotective effect of calcium channel blocker lercanidipine in treatment of patients with urolithiasis and urinary tract obstruction and monitoring of the serum cytokine profile]. Urologiia 2019:48-52. [PMID: 31808632] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE to evaluate the nephroprotective effect of lercanidipine, its effect on the dynamics of creatinine clearance and blood cytokine levels in patients with nephrolithiasis with obstructive uropathy during renal drainage. MATERIAL AND METHODS 66 patients were included in the study with concretions of the pelvic segment and the presence of obstruction according to instrumental methods of examination. In order to prevent the occurrence of infectious complications before lithotripsy patients the first stage was performed installation of nephrostomic drainage, followed by antibacterial, anti-inflammatory therapy. Patients were divided into 2 groups: the first (33 patients) received standard therapy, the second (33 people) additionally received lercanidipine at a dose of 10 mg per day for 1 month. Determined the concentration of IL-8, VEGF, MCP-1, G-CSF and GM-CSF in the blood serum by the method of solid-phase ELISA. The glomerular filtration rate was calculated using the CKD-EPI formula. All studies were performed at the preoperative stage, on 7, 14, 21 and 28 days after renal drainage. RESULTS In the appointment of lercanidipine, there was a more rapid decrease in levels of IL-8, VEGF, MS-1, GM-CSF in serum (21 days), and an improvement in renal function, compared with the group that did not receive nephroprotective therapy. CONCLUSION The administration of lercanidipine may contribute to a more rapid recovery of renal function and normalization of blood cytokine levels. This drug can be used in the complex treatment of patients with nephrolithiasis with obstructive uropathy.
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Affiliation(s)
- A I Khotko
- Saratov State Medical University named after V.I. Razumovsky of Ministry of Health of Russia, Saratov, Russia
- I.M. Sechenov First Moscow State Medical University of Ministry of Health of Russia, Russia
- GBUZ Republican clinical hospital named after G. G. Kuvatov, Ufa, Russia
| | - D N Khotko
- Saratov State Medical University named after V.I. Razumovsky of Ministry of Health of Russia, Saratov, Russia
- I.M. Sechenov First Moscow State Medical University of Ministry of Health of Russia, Russia
- GBUZ Republican clinical hospital named after G. G. Kuvatov, Ufa, Russia
| | - N B Zakharova
- Saratov State Medical University named after V.I. Razumovsky of Ministry of Health of Russia, Saratov, Russia
- I.M. Sechenov First Moscow State Medical University of Ministry of Health of Russia, Russia
- GBUZ Republican clinical hospital named after G. G. Kuvatov, Ufa, Russia
| | - A I Tarasenko
- Saratov State Medical University named after V.I. Razumovsky of Ministry of Health of Russia, Saratov, Russia
- I.M. Sechenov First Moscow State Medical University of Ministry of Health of Russia, Russia
- GBUZ Republican clinical hospital named after G. G. Kuvatov, Ufa, Russia
| | - V M Popkov
- Saratov State Medical University named after V.I. Razumovsky of Ministry of Health of Russia, Saratov, Russia
- I.M. Sechenov First Moscow State Medical University of Ministry of Health of Russia, Russia
- GBUZ Republican clinical hospital named after G. G. Kuvatov, Ufa, Russia
| | - A V Alekseev
- Saratov State Medical University named after V.I. Razumovsky of Ministry of Health of Russia, Saratov, Russia
- I.M. Sechenov First Moscow State Medical University of Ministry of Health of Russia, Russia
- GBUZ Republican clinical hospital named after G. G. Kuvatov, Ufa, Russia
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Morozova OL, Morozov DA, Lakomova DY, Severgina LO, Maltseva LD, Morozov KD. [Predictors of perioperative complications in children with obstructive uropathy]. Urologiia 2019:98-104. [PMID: 31808640] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIM To identify predictors of perioperative complications in children with obstructive uropathy. MATERIALS AND METHODS A total of 178 patients with obstructive uropathy were divided into 3 groups. In Group 1 there were 108 children with hydronephrosis, while Group 2 included 47 children with ureterohydronephrosis and Group 3 consisted of 23 children with bladder outlet obstruction according to the results of clinical, laboratory, microbiological, X-ray and pathologic study. The evaluation of the urine level of pro- (IL-8) and anti-inflammatory (IL-10) cytokines was performed at two timepoints, prior to treatment (1 point) and on the 3-5th day after the surgery (2 point) using "Vector - Best" (Russia, Novosibirsk) (IL-8), "Bender Medsystems" (Austria) (IL-10) on the enzyme immunoassay analyzer Stat Fax 2010 (USA). RESULTS The active phase of chronic pyelonephritis was shown in Groups 1, 2 and 3 in 38%, 36% and 100% of cases, respectively. Microbiological examination of urine allowed to identify a causative agent in 85% and 89% of biopsy specimens from the ureteropelvic and ureterovesical junction, respectively. In all groups, Escherichia coli was a main pathogen (40%). In 25% of patients of Groups 1 and 2, isolated pathogens in biopsy specimen and urine were different. According to the evaluation of cytokines in the urine, during the active phase of chronic pyelonephritis there was an increase in the level of IL8 (p<0.0001) at points 1 and 2 in all patients. In the latent phase of inflammation, there was an increase in the concentration of IL-8 (p<0.04) and IL-10 (p<0.002) at point 2 in Groups 1 and 2. Using the ratio of IL-8 and IL-10, an index of inflammation activity (IIA) was suggested, whose values were increased in all Groups at point 1 and 2. Based on the regression analysis of the changes in IIA level, a model for predicting perioperative complications and an algorithm for personalized patient management were developed. CONCLUSION Cytokines are indicators of latent inflammation in children with OU and may be predictors of perioperative complications.
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Affiliation(s)
- O L Morozova
- Sechenov First Moscow State Medical University, Moscow, Russia
- Saratov State Medical University named after V.I. Razumovsky, Saratov, Russia
| | - D A Morozov
- Sechenov First Moscow State Medical University, Moscow, Russia
- Saratov State Medical University named after V.I. Razumovsky, Saratov, Russia
| | - D Y Lakomova
- Sechenov First Moscow State Medical University, Moscow, Russia
- Saratov State Medical University named after V.I. Razumovsky, Saratov, Russia
| | - L O Severgina
- Sechenov First Moscow State Medical University, Moscow, Russia
- Saratov State Medical University named after V.I. Razumovsky, Saratov, Russia
| | - L D Maltseva
- Sechenov First Moscow State Medical University, Moscow, Russia
- Saratov State Medical University named after V.I. Razumovsky, Saratov, Russia
| | - K D Morozov
- Sechenov First Moscow State Medical University, Moscow, Russia
- Saratov State Medical University named after V.I. Razumovsky, Saratov, Russia
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50
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Herbst KW, Tomlinson P, Lockwood G, Mosha MH, Wang Z, D'Alessandri-Silva C. Survival and Kidney Outcomes of Children with an Early Diagnosis of Posterior Urethral Valves. Clin J Am Soc Nephrol 2019; 14:1572-1580. [PMID: 31582461 PMCID: PMC6832049 DOI: 10.2215/cjn.04350419] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 04/08/2019] [Accepted: 08/14/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Posterior urethral valve is the most common cause of bladder outlet obstruction in infants. We aimed to describe the rate and timing of kidney-related and survival outcomes for children diagnosed with posterior urethral valves in United States children's hospitals using the Pediatric Health Information System database. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This retrospective cohort study included children hospitalized between January 1, 1992 and December 31, 2006, who were in their first year of life, had a diagnosis of congenital urethral stenosis, and underwent endoscopic valve ablation or urinary drainage intervention, or died. Records were searched up to December 31, 2018 for kidney-related mortality, placement of a dialysis catheter, and kidney transplantation. Cox regression analysis was used to identify risk factors, and Kaplan-Meier survival analysis used to determine time-to-event probability. Subgroup survival analysis was performed with outcomes stratified by the strongest identified risk factor. RESULTS Included were 685 children hospitalized at a median age of 7 (interquartile range, 1-37) days. Thirty four children (5%) died, over half during their initial hospitalization. Pulmonary hypoplasia was the strongest risk factor for death (hazard ratio, 7.5; 95% confidence interval [95% CI], 3.3 to 17.0). Ten-year survival probability was 94%. Fifty-nine children (9%) underwent one or more dialysis catheter placements. Children with kidney dysplasia had over four-fold risk of dialysis catheter placement (hazard ratio, 4.6; 95% CI, 2.6 to 8.1). Thirty-six (7%) children underwent kidney transplant at a median age of 3 (interquartile range, 2-8) years. Kidney dysplasia had a nine-fold higher risk of kidney transplant (hazard ratio, 9.5; 95% CI, 4.1 to 22.2). CONCLUSIONS Patients in this multicenter cohort with posterior urethral valves had a 5% risk of death, and were most likely to die during their initial hospitalization. Risk of death was higher with a diagnosis of pulmonary hypoplasia. Kidney dysplasia was associated with a higher risk of need for dialysis/transplant. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_10_03_CJN04350419.mp3.
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Affiliation(s)
| | - Paul Tomlinson
- Department of Pediatrics, University of Connecticut Health Center, Farmington, Connecticut.,Division of Nephrology, Connecticut Children's Medical Center, Hartford, Connecticut
| | - Gina Lockwood
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and
| | | | - Zhu Wang
- Department of Epidemiology and Biostatistics, University of Texas Health San Antonio, San Antonio, Texas
| | - Cynthia D'Alessandri-Silva
- Department of Pediatrics, University of Connecticut Health Center, Farmington, Connecticut.,Division of Nephrology, Connecticut Children's Medical Center, Hartford, Connecticut
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