Ongoing rehabilitation
Barbara A. Wilson, Samira Kashinath Dhamapurkar, Anita Rose in Surviving Brain Damage After Assault, 2016
The next problem encountered was that Gary started complaining about abdominal pain. This was thought to be due to a kidney stone, so, on July 31, 2013, Gary had further investigations. He was prescribed painkillers and was discharged back to the RMC with a tentative date for a nephrostomy in September. A nephrostomy is an artificial opening created between the kidney and the skin to allow for diversion of urine to a bag. Gary was further hospitalised for 10 days at a local hospital, as he pulled out a nephrostomy tube. On November 21, 2013, he was readmitted to the same unit for right ureteroscopy (an examination of the upper urinary tract) and laser removal of kidney stones. All patients with profound brain damage are unable to control their bladders. Urethral catheters are typically used to manage this, and such catheters encourage the development of kidney stones (Andrews, 2005).
Unexplained Fever In Urology
Benedict Isaac, Serge Kernbaum, Michael Burke in 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
Empyema from Misplacement of Percutaneous Nephrostomy Tube—A Diagnostic Challenge
Wickii T. Vigneswaran in Thoracic Surgery, 2019
Empyema is defined as an accumulation of purulent fluid in the pleural space and is most commonly secondary to pneumonia or a lung abscess. Empyema can however arise in other conditions as well. In this case report, we discuss the development of an empyema due to percutaneous nephrostomy tube placement. In this instance, the nephrostomy tube was found to be traversing the pleural space and diaphragm resulting in bacterial tracking from a chronically infected kidney into the pleural space with resultant empyema. Nephrostomy tube placement is a common procedure employed to manage several different types of ureteral obstruction. Complications of nephrostomy tube placement are rare and most commonly include bleeding, sepsis, organ injury, and death. Multiple reports appear in the literature describing these complications, but based on our literature review, no other cases were found in which a nephrostomy tube traversing the thoracic cavity en route to the kidney resulted in an empyema.
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).
Cumulative incidence of ureteroenteric strictures after radical cystectomy in a population-based Swedish cohort
Published in Scandinavian Journal of Urology, 2021
Jenny Magnusson, Oskar Hagberg, Firas Aljabery, Abolfazl Hosseini, Staffan Jahnson, Tomas Jerlström, Amir Sherif, Karin Söderkvist, Viveka Ströck, Anders Ullén, Christel Häggström, Lars Holmberg, Henrik Kjölhede
A weakness is the composite endpoint which may lead to both false positive events, e.g. in the case of placing a nephrostomy tube due to normal post-cystectomy CT-findings with hydronephrosis, and false negative results, e.g. if a patient was censored due to urolithiasis before a stricture occurred. Furthermore, there is no procedure code for removal of a nephrostomy tube, so whether this was a permanent or temporary procedure could not be determined. To adjust for the risk of overestimating or underestimating the incidence of strictures we separately analysed the subgroup with codes indicating stricture and intervention and the subgroup diagnosed with hydronephrosis but not followed by an intervention. In most other series the endpoint is intervention for stricture but this might lead to underestimating the incidence of strictures since some patients do not undergo intervention due to co-morbidity or high age.
Uretero-arterial fistula due to a hypogastric aneurysm
Published in Arab Journal of Urology, 2018
Augustin Pirvu
An 84-year-old hypertensive woman with no significant history was referred to our department for an intermittent macroscopic haematuria. A CT scan revealed a right hypogastric aneurism of 60 mm diameter, probably the cause of the uretero-vascular fistula (Fig. 1). The hypogastric aneurism was treated by embolisation and an external iliac endo-graft was deployed for complete exclusion of the aneurysm by covering the origin of internal iliac artery (Fig. 2 A and B). The haematuria disappeared immediately after the endovascular procedure. A percutaneous nephrostomy was placed for 3 months in order to allow for the healing of the fistula (Fig. 3).