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Miscellaneous Colorectal Conditions
Published in Marc A. Levitt, Pediatric Colorectal Surgery, 2023
A key determinant in the plan of care is the severity of hydronephrosis. Severe hydronephrosis can lead to renal dysplasia and a poor renal prognosis. Additionally, it is important to figure out if this condition involves an adrenogenital syndrome.
Surgery to Improve Reservoir Function
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
Results: All studies report significant increases in bladder capacity with decreased storage pressures. Stabilization of hydronephrosis is also reported, or no subjects report developing postoperative hydronephrosis. Continence was reported from 67% to 100%. The complication rate is reported up to 40%–45%, and complications occur either early (within 3 years) or late (after 10 years). In one study, 41% of subjects had recurrent UTIs. Bowel problems were reported in 18%–22% of patients. In 86%–92%, improved quality of life parameters were reported. In one study, 3/79 patients died within 1 year of the procedure. The follow-up period was 6–10 years.17–20
The urinary tract and male reproductive system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Luis Beltran, Daniel M. Berney
Stones in the renal pelvis may be single or multiple and in some instances a single calculus may grow to occupy the entire pelvicalyceal system, resulting in a so-called ‘stag-horn’ calculus. Small calculi may pass down the ureter to the bladder, giving rise to the clinical syndrome of renal colic with haematuria. They may arrest temporarily, usually at the narrower lower end of the ureter. When impaction is permanent, this occurs at one of three sites: the upper end of the ureter at the pelviureteric junction; the level of the pelvic brim; or the lower end of the ureter. This impaction and renal obstruction lead to hydronephrosis. When there is a urinary tract infection by urea-splitting bacteria such as Proteus spp., ammonia is produced and calculi or softer deposits composed of phosphates form within the resultant alkaline urine. These may be precipitated within the inflamed pelvicalyceal system. This combination of infection and calculus may result in pyonephrosis and ulceration. The chronic inflammation and epithelial regeneration resulting from calculi may give rise to squamous metaplasia of the lining of the renal pelvis, with a subsequent increase in the risk of development of squamous carcinoma.
Prophylactic ureteral catheter placement for minimally invasive colorectal surgery
Published in Baylor University Medical Center Proceedings, 2020
Katherine E. Dowd, Tommy O. Muse, Patrick S. Lowry, Rahila Essani
Staged removal of catheters was performed on postoperative days 1 and 2 and the patient was discharged on day 3 after voiding spontaneously. Urine output remained adequate and her creatinine was 0.98 mg/dL at discharge. Pathology revealed acute on chronic diverticulitis. On postoperative day 4 she returned to the emergency room with anuria for over 36 hours; repeat creatinine was 5.2 mg/dL, and a Foley catheter was placed with minimal output. A computed tomography scan revealed bilateral hydronephrosis with hyperattenuating material filling the bilateral renal pelvis and ureter (Figure 1). She was admitted to the hospital and underwent cystoscopy and bilateral catheter placement on postoperative day 5. During cystoscopy, she was found to have bilateral hydronephrosis on retrograde pyelogram, with filling defects in the renal pelvis consistent with clot and hematuria effluxing from both ureteral orifices. Double-J indwelling ureteral stents were placed bilaterally. Her creatinine was back to baseline by postoperative day 7, and she was discharged home. Ureteral stent removal in the clinic was planned 3 weeks after placement. She had minimal stent discomfort and full recovery at outpatient follow-up.
Management of ‘forgotten’ encrusted JJ stents using extracorporeal shockwave lithotripsy: A single-centre experience
Published in Arab Journal of Urology, 2019
Hasan El-Tatawy, Ahmed S. El-Abd, Tarek A. Gameel, Ahmed R. Ramadan, Mohamed O. Abo Farha, Magdy A. Sabaa, Shawky A. El-Abd
This is a retrospective study of 133 patients with forgotten ureteric stents treated in the Department of Urology, Tanta University, Egypt, between January 2015 and January 2018. In all, 103 patients were referred from other hospitals and centres. All patients had forgotten encrusted JJ stents that had been left in situ for a long time and managed initially by ESWL. The presenting symptoms were an association of symptoms in the form of attacks of fever in 100 patients, UTI in 92, recurrent attacks of renal pain and colic in 52, haematuria in 49, obstructed hydronephrosis in 20, and infected non-functioning hydronephrotic kidney in one. All the patients also had LUTS. The preoperative evaluation consisted of: urine analysis with antibiotic sensitivity test, serum creatinine level, complete blood count with coagulation profile, and plain X-ray of the abdomen and pelvis and non-contrast spiral CT to evaluate stone burden density and the sites of stent encrustation.
Nephroptosis: is body mass index (BMI) the key?
Published in Scandinavian Journal of Urology, 2018
David G. Bratt, Ata Jaffer, Lizzie Chandra, Chirag Patel, Chandra S. Biyani
A 30-year-old white, Caucasian, female patient presented to the outpatient department of a neighbouring hospital with intermittent right sided flank pain. On examination, the patient was of slim build, was tender in the right flank, with an otherwise soft abdomen. She was not taking any regular medication and had no significant past medical history, other than a BMI of 18.4. Her urine and blood results were normal. Initial imaging at the previous hospital included an ultrasound scan of the kidneys, which revealed a right-sided hydronephrosis. Subsequent Computed Tomography (CT) images revealed a narrowing at the pelvi-ureteric junction (PUJ) with a dilated renal pelvis and, therefore, she was suspected of having a PUJ obstruction. She underwent a retrograde pyelogram and insertion of a ureteric stent; however, she continued to have persistent pain. In view of this, the referring urologist removed her stent and referred us for further management.