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Posterior urethral valves
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Fardod O'Kelly, Martin A. Koyle
A persistently elevated or rising serum creatinine following successful valve ablation may be the result of infection, hyponatremia, or even antibiotic toxicity (aminoglycosides). However, when these causes have been excluded, percutaneous nephrostomies should be considered. A subsequent fall in the serum creatinine will confirm the diagnosis of obstruction at the level of the ureterovesical junction. In the case of percutaneous nephrostomy, after approximately 2 weeks, the tubes are clamped. If the serum creatinine remains low, they are removed. When this results in a rise of the serum creatinine, Sober Y cutaneous ureterostomies should be carried out to provide optimal tube-free upper tract drainage. The cutaneous limb can then be tied off when the infant is ready to come out of diapers. Alternatively, the ureters may be remodeled and reimplanted, but this operation is rendered difficult by young age (Paquin's law), the thickness of the bladder wall, and trabeculation, and in inexperienced hands complications are common. Failure of the serum creatinine to fall after placement of bilateral percutaneous nephrostomies is indicative of irreversible renal dysplasia and is a poor functional prognostic indicator.
Unexplained Fever In Urology
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Obstruction of the kidney may result from a ureteral stone, ureteropelvic junction stenosis, malignancy (colon, uterus, ovary, bladder), retroperitoneal fibrosis etc. The classic form of pyonephrosis is still tuberculosis resulting in autonephrectomy. Intravenous pyelography will generally show a nonfunctioning kidney. Sonography and/or computerized tomography gives a prompt diagnosis if dilatation of the collecting system, and needle puncture of the kidney yields pus and establishes the presence of pyonephrosis.56 A percutaneous nephrostomy catheter is then inserted and serves for initial drainage of infected urine and for evaluation of residual kidney function before definitive surgery. Gallium-67 citrate has sometimes demonstrated a pyonephrosis, but it probably cannot distinguish pyonephrosis from pyelonephritis, renal abscess, or even renal tumor. The nephrostomy tube used for drainage can provide a direct evaluation of kidney function, diagnostic nephros-togram, dissolution of stones and permanent kidney drainage. The most common organisms cultured are Bac. Koch or Gram-negative bacteria.55,57
Elements of Case Analysis
Published in Julie Dickinson, Anne Meyer, Karen J. Huff, Deborah A. Wipf, Elizabeth K. Zorn, Kathy G. Ferrell, Lisa Mancuso, Marjorie Berg Pugatch, Joanne Walker, Karen Wilkinson, Legal Nurse Consulting Principles and Practices, 2019
Tonia Aiken, Phyllis ZaiKaner Miller, Marguerite Barbacci
A 47-year-old stay-at-home mother had a long history of painful uterine fibroid tumors and very heavy menstrual periods. She was prescribed iron supplements but remained anemic, which interfered with her ability to run marathons. The potential plaintiff sought definitive treatment and consented to undergo a hysterectomy as recommended by her gynecologist. The surgeon determined that an abdominal hysterectomy was the best option due to the likelihood of encountering pelvic adhesions from prior cesarean sections and other abdominal surgeries. The surgery was completed “without complication,” as documented by the surgeon in the operative report. On post-operative day three, the patient’s abdomen was distended, and she complained of severe abdominal pain. An ileus was suspected due to decreased bowel sounds and inability to pass flatus. Laxatives were prescribed, and ambulation encouraged. On post-operative day four, the patient was febrile with no discernible bowel sounds. A CT scan of the abdomen was performed and revealed an urinoma. The patient was returned to the operating room for an exploratory laparotomy, which revealed a severed right ureter. Surgical repair of the ureter was completed and included the placement of a percutaneous nephrostomy tube to drain urine from the kidney while the ureter healed. The patient was discharged home three days after her repair surgery with instructions to return for the removal of the nephrostomy tube in six weeks. Subsequent testing revealed normal kidney function with a functional right ureter.
Comparison of Percutaneous Nephrostomy and Ureteral DJ Stent in Patients with Obstructive Pyelonephritis: A Retrospective Cohort Study
Published in Journal of Investigative Surgery, 2022
Hakan Anıl, Nevzat Can Şener, Kaan Karamık, İbrahim Erol, Ediz Vuruşkan, Hakan Erçil, Zafer Gökhan Gürbüz
When the times for infection parameters to return to normal in the postoperative period are investigated, WBC returned to normal range in mean 3.5 ± 1.3 days in the DJ stent group and 3.2 ± 1.1 days in the PCN group (95% CI: −0.76–0.21, P = .268). There were no statistically significant differences identified for the duration for WBC, CRP, PCT, and fever to return to normal range between the drainage methods. Comparison of the time to returned to the normal range of infection parameters is shown that using Kaplan–Meier survival analysis (Figure 1). The mean hospital stay was 7.3 ± 2.0 days for PCN group, and 7.8 ± 2.6 days for DJ stent group (95% CI: −1.4–0.4, P = .296). During follow-up, nephrostomy dislocation was occurred in two patients and these patients were managed by re-placement of the percutaneous nephrostomy. DJ stent migration was reported in one patient and DJ stent was re-placed to this patient. The complication rate was 15/49 (30.6%) in the PCN group versus 29/56 (51.8%) in the DJ stent group. This difference was statistically significant in favor of PCN group (P = .028). Table 3 lists detailed frequencies and grading of complications according to Clavien-Dindo classifications. In the multivariable regression analysis performed, the only factor that could predict the length of hospital stay was the baseline CRP level (95% CI: 0.007–0.20, P = < .001) (Table 4). The duration from emergency drainage method to definitive treatments were 29.2 ± 5.4 days in the PCN group and 29.5 ± 6.3 days in the DJ stent group (95% CI: −2.6–1.9, P = .782).
Survival following palliative percutaneous nephrostomy tube insertion in patients with malignant ureteric obstruction: Validating a prognostic model
Published in Progress in Palliative Care, 2022
Ben Gunawan, Karyn Foster, Janet Hardy, Phillip Good
Percutaneous nephrostomy (PCN) is a minimally invasive procedure to decompress ureteric obstruction that superseded open nephrostomy in the 1970s,3 with superior technical success rates and reduced morbidity.3 Along with retrograde stenting, it is one of the preferred techniques to manage MUO.4,5,7 Although the choice between stenting and PCN is often determined by institutional experience, availability and urgency of intervention, PCN is often preferred in the malignant setting due to higher success rates in advanced disease compared to retrograde stenting, particularly in cases of extrinsic obstruction11 Decompression of MUO with PCN is indicated for preservation of renal function to permit further oncological therapy and to palliate symptoms associated with obstruction, such as pain and recurrent infection.5 Although originally touted as a life-prolonging intervention, there are no prospective or retrospective data demonstrating a survival benefit for PCN in MUO. PCN is generally well tolerated, but can be associated with a number of complications including tube blockage and dislodgement,7 recurrent infection,6,7 and pain,9,12 which may result in recurrent hospital admission.5,6 Furthermore, it may have an adverse effect on psychosocial functioning, including effects on body image,9 social function9 mood12 and confidence.12
An adolescent girl with obstructive uropathy requiring nephro-ureterectomy was subsequently diagnosed with renal tuberculosis: case report
Published in Paediatrics and International Child Health, 2021
Özge Kaba, Manolya Kara, Zuhal Bayramoğlu, Emine Çalışkan, Bilal Çetin, Elnur Karimov, Ünsal Özkuvancı, Yasemin Özlük, Selda Hançerli Torun, Zeynep Nagehan Yürük Yıldırım, Hasan Orhan Ziylan, Ayper Somer
Three fasting gastric lavage specimens were negative on acid-fast bacilli stain. Contrast-enhanced abdominal magnetic resonance imaging (MRI) demonstrated left renal calyx dilation and blunting together with a hypo-intense signal and thickening throughout the ureter (Figure 3). Dimercaptosuccinic acid (DMSA) scintigraphy demonstrated a normal right kidney and impaired left kidney function (10%). The patient was commenced on anti-tuberculous therapy (ATT): isoniazid, rifampicin, pyrazinamide and ethambutol. One month later, cystoscopy and stent placement into the left ureter were planned. However, the ureteric stent could not be inserted owing to bullous oedema and erythematous bladder mucosa. Methylprednisolone (2 mg/kg/day, max 60 mg for 4 weeks, and then in decreasing doses) was added. After 8 weeks of corticosteroid therapy, another left ureteric stent was attempted but also failed. In the 12th week of ATT, she underwent percutaneous nephrostomy. Despite these interventions, repeat DMSA scintigraphy demonstrated diminished left kidney function (7%) and persisting hydronephrosis on ultrasound. Left nephro-ureterectomy was performed in the 28th week of treatment. Histology demonstrated focal necrotising granulomatous pyelonephritis (Figure 4). On follow-up, there were no complications in the right kidney and renal function remains normal.