Calculus anuria: a urological emergency with an excellent outcome

Calculus anuria is a catastrophic condition with dire consequences if not treated promptly. The purpose of this study was to identify factors which influence the short-term outcome of patients with calculus anuria. A retrospective analysis was conducted from January 2016 to December 2021, in children up to the age of 18 years, who presented with calculus anuria and required emergency decompression at Sindh Institute of Urology and Transplantation, Pakistan. One hundred and twenty-five children were included. Majority were born to consanguineous parents and a few of them had positive family history of stone disease. Severe illness was found in 25 (20%) patients and among them 8 (32%) required hemodialysis. Decompression by double J stenting is the preferred intervention in our institute and was done in 106 (85%) children, followed by percutaneous nephrostomy tube in 10 (8%) successfully. A small number of patients, 9 (7%) required both procedures to relieve their obstruction. A significant number of patients, about 115 (92%), attained normal renal functions after intervention. No pertinent factors were identified, relating to incomplete renal recovery in nine (7%) of the patients who unfortunately progressed to chronic kidney disease.

Percutaneous insertion of bilateral double J in pelvic cancer patients: Indications, complications, technique of antegrade ureteral stenting

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Anterograde percutaneous drainage is an alternative to retrograde drainage in failure.

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Anterograde double-J percutaneous implant is feasible with low complication rate.

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Distal ureteral obstruction, double-J antegrade implant to consider as the first choice.

Background

Antegrade percutaneous insertion of a double J seems to be a good alternative when retrograde insertion fails. Malignant ureteral obstruction occurs due to occlusion of the ureter secondary to tumor invasion, extrinsic compression, which prevents intermittent urine flow, leading to acute renal failure, increased morbidity, mortality and interruption of cancer treatment.

Case

A 26-year-old woman with endometrial carcinoma with internal invasion of pelvic structures due to urosepsis and acute renal failure. She underwent anterograde percutaneous double-J implantation by interventional radiology due to the failure of retrograde catheter implantation.

Conclusion

The antegrade double-J percutaneous implant technique is an alternative when the retrograde technique fails. This technique is feasible, with low morbidity and mortality and good quality of life for continuing cancer treatment.

Comparison of outcomes between 2 week versus 4 week stenting in pediatric pyeloplasty-A single centre observational study

Objective

To compare the surgical outcomes, improvement in renal function and complications between early stent removal (2 weeks) and late stent removal (4 weeks) after pediatric open pyeloplasty.

Methods

A total of 72 open pyeloplasty were included in the study. Forty-three underwent late stent removal (Group 1) and 29 underwent early stent removal (Group 2). Pre-operative and post-operative follow-up data were compared to see the effect of early stent removal on the postoperative drainage pattern at 6 months after surgery and improvement in split function of affected kidney. The complications between the two groups were also compared.

Results

Both the groups were matched with respect to age, sex, side and antero-posterior diameter of pelvis. Pre-operative mean split function in Group 1 was 42% (26%-54%) while it was 39% (19%-42%) in Group 2 (p=0.37). Postoperative improvement in drainage pattern was seen in 69 out of 72 (96%) patients, 41 out of 43 (95%) in Group 1 and 28 out of 29 (97%) in Group 2. Improvement in split function occurred in 35 of 38 (97%) in Group 1 and 23 of 26 (88%) patients in Group 2 (p=0.51). Complications were seen in nine out of 72 (12.5%) patients. Incidence of complication in Group 1 was 16% (7/43) and Group 2 was 7% (2/29), and relative risk was 2.36.

Conclusion

A shorter duration of double J stenting is as effective as a longer stenting period in terms of surgical success outcomes and improvement in split renal function along with a decreased risk of stent related complications.

Renal salvage, an achievable goal in patients with emphysematous pyelonephritis: Outcomes of an algorithmic renal preserving strategy

Introduction

Emergency nephrectomy has been the time-honored treatment of choice for emphysematous pyelonephritis (EPN), a fatal gas-forming necrotizing infection. Recent years have seen a shift toward nonextirpative approach aimed to achieve higher rates of renal salvage, limiting the indications for nephrectomy to severe grades of the disease. This study aimed at analyzing the role of initial renal preserving measures algorithmically applied across grades of EPN.

Materials and Methods

We prospectively analyzed the clinical data and outcome of 36 consecutive patients of EPN in 5 years' study period, treated by renal preserving measures, which include aggressive resuscitation, parenteral antibiotics, effective drainage of infected fluid/gas, and relieving the urinary tract obstruction. Huang-Tseng computed tomography-based classification system was used to categorize the patients as well as to employ suitable treatment modality.

Results

The mean age of the patients was 57.5 ± 12 years with female preponderance (2:1). Diabetes mellitus (97%) was the most common associated factor. Escherichia coli was (72%) the most frequent causative organism found. Urinary tract obstruction was seen in 27 patients (75%) attributable to ureteric calculi, renal papillary necrosis, ureteric stricture, and fungal bezoar in the descending order of frequency. Only 2 (6%) out of 36 patients managed according to our hospital renal salvage protocol required salvage nephrectomy. The overall survival rate was 94%.

Conclusion

Our hospital-based algorithmic renal preserving strategy not only improved the survival but also decreased the need for nephrectomy.

Urological disorders and pregnancy: An overall experience

AIM

Pregnancy is an anatomical and physiological altered state and the presence of various urological problems not only aggravates the disease itself, but also results in unfavourable pregnancy outcome. Aim is to highlight obstetric outcome in pregnant women with urological problems.

MATERIALS AND METHODS

Longitudinal prospective cohort study conducted in tertiary care hospital, IPGME and R, Kolkata from Jan 2011 to Dec 2012. All pregnant women with urological problems were included as subjects.

RESULTS

A total of 33 subjects were followed up throughout their antenatal period. Among them majority (72.72%) presented with hydro nephrosis followed by hydroureter (60.6%), PUJ obstruction and pyelonephritis each with incidence of 15.15%, then urolithiasis (12.12%), nephrolithiasis (6.06%) and renal abscess (12.12%). Interventions required were DJ stenting (72.72%), pyeloplasty (15.15%) and others were RURSL, abscess drainage and ATT. The pregnancy outcome was complicated with preterm labor in majority of patients (45.45%), oligohydramnious (18.18%), PIH (9.09%) and still birth (6.06%). Twenty four live birth were there. Majority required NICU admissions as predominantly prematurity was an important concern. Majority women with hydronephrosis underwent DJ stenting.

CONCLUSION

Preterm labor is an important obstetric concern. Vaginal delivery is the choicest mode of termination and LSCS can be reserved for obstetric reason. DJ stenting is safe and practical approach for continuation of pregnancy with hydronephrosis. Regular follow up, vigilant antenatal care and multidisciplinary approach from urologist, obstetrician and neonatologist will bring out successful pregnancy outcome.

Comparison of anti-reflux mechanism between Double-J-Stent and standart Double-J-Stent use for risk of BK nephropathy and urinary tract Infection in kidney transplantation

OBJECTIVES

There are studies that show that double J stenting (DJS) increase BK nephropathy (BKN) 4 fold. DJS may cause vesicoureteral reflux (VUR) with normal bladder contraction. The aim of this study is to comparison risk of BKN, urinary tract infections (UTI) and postoperative urologic complications with the use DJS with anti-reflux device (ARD-DJS) and standart double J stent (St-DJS). Matherial and methods: Ninety patients (male/female: 50/40) that had undergone kidney transplantations in Diyarbakır Training and Research Hospital and Dicle University, Faculty of Medicine Hospital between January 2012 and April 2015 were enrolled in the study. Demographic data, immunosuppression protocols, presence of rejection, graft loss, postoperative urologic complications, UTI, plasma BK levels of the patients were evaluated retrospectively.

RESULTS

Median and IQR follow up time for ARD-DJS and St-DJS patients were 14 (12-18) months and 25 (16-30) months respectively. Five cases (5.5%) had BK viremia (P=0.025). All 5 cases with BK viremia were St-DJS users.

CONCLUSION

As a result for postoperative UTI and postoperative urinary complication risk there were no statistically significant difference between ARD-DJS use and St-DJS use during ureteral anastomosis. BKN univariate analysis were significantly less than those st-DJS used. Risc factors were evaluated. But results were not statistically significant in the logistic regression analysis. We think that to demonstrate this benefit, we need randomized controlled studies with more patients and longer follow up.

Comparison between Double J (DJ) Ureteral Stenting and Percutaneous Nephrostomy (PCN) in Obstructive Uropathy

Objective: To compare the complications rate of percutaneous nephrostomy and double J ureteral stenting in the management of obstructive uropathy.

Methodology: Total number of 300 patients of age 20-80 years who underwent JJ stenting or percutaneous nephrostomy for obstructive uropathy were included in this study. Patients were divided in two groups i.e. A & B. In group A, 100 patients who underwent double J ureteral stenting while in group B, 200 patients who underwent percutaneous nephrostomy tube insertion were included. The stent was inserted retrograde by using cystoscope, under mild sedation or local anesthesia. While the percutaneous nephrostomy was done under ultrasound guidance by using local anesthetic agent. Complications were noted in immediate post-operative period and on follow up.

Results: Majority of the patients were between 36 to 50 years of age with male to female ratio was 2.6:1. The most common cause of obstructive uropathy was stone disease i.e. renal, ureteric or both. Post DJ stent, complications like painful trigon irritation, septicemia, haematuria and stent encrustation were seen in 12.0%, 7.0%, 10.0% and 5.0% patients respectively. On the other hand, post-PCN septicemia, bleeding and tube dislodgment or blockage was seen in 3.5%, 4.5% and 4.5% respectively. In this study, overall success rate for double J stenting was up to 83.0% and for percutaneous nephrostomy (PCN) was 92.0% (p<0.0001).

Conclusion: Percutaneous nephrostomy is a safe and better method of temporary urinary diversion than double J stenting for management of obstructive uropathy with lower incidence of complications.