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PubMed2002

[Pathologic horseshoe kidney. Report of 13 cases].

The authors report a series of 13 horseshoe kidneys observed over a 22-year period. All patients are men with a mean age of 39 years (20-65 years). The clinical features were dominated by abdomino-lumbar pain (nine cases). The horseshoe kidney was associated with renal stones in nine cases, uretero-pelvic junction syndrome in five cases and pyonephrosis in one case. The specific anatomic and surgical features of this rare malformation are emphasized and the therapeutic features of each uropathy associated with horseshoe kidney are discussed.

Abdominal Pain↗

PubMed2002

[Pathological pelvic kidney. Apropos of 11 cases].

The diseases ectopic kidney is a rare malformation. It can be associated with other urological or nonurological malformation. We report 11 cases observed between 1980 and 1998. They were five females and six males with a mean age of 28 years. The clinical symptomatology was dominated by pain and urinary symptoms. Diagnosis was based on the IVP data and ultrasonography. Renal stone and hynronephrosis were each associated in five cases and one patient had renal stone associated with hydronephrosis. The treatment consisted on a iliopelvic approach and extraction of the stone and or pyeloplasty. In three cases a nephrectomy was realised for muet kidney or pyonephrosis. The outcome was good in ten cases and one patient had a pyelo-ureteral secondary stenosis managed by endoscopy.

Adolescent↗

PubMed2002

[Genito-urinary malacoplakia. Report of 10 cases and review of the literature].

The malakoplakia is a rare and benign disease. Its urinary localisation is commonly known. It has no clinical particularity. The diagnosis is histological. The physiopathology is infectious associated with a local macrophage function failure. The treatment associates antibiotic and colinergic drugs. Surgical removal is necessary only when the organ is destroyed. We report 10 cases of urinary malakoplakia with 4 renal localisation's causing pyonephrosis in the majority of cases, 3 prostatic localisation's that were wrongly considered as prostatic adénocarcinoma after a rectal examination and finally 3 testicular localisation's causing a necrotic destruction of the testis. The urinalysis was positive in 4 cases. We did 4 kidney removals, 3 endoscopic prostatic resections and 3 testis removals. The diagnosis was made by the histological examination of the surgical products.

Adolescent↗

PubMed2003

[Renoduodenal fistula. A case report].

The fistula between kidney and duodenum is rare. It occurs mostly in case of pyonephrotic kidney. The authors report one case of renoduodenal fistula, discovered peroperatively in 41 years old man who underwent a subcapsular nephrectomy for right pyonephrosis upon pelvic lithiasis. Through a review of literature, the authors discuss diagnostic aspects of this complication.

Adult↗

PubMed1992

Case report: echogenic necrotic renal papillae simulating calculi.

Sloughed necrotic papillae usually show soft tissue sonographic characteristics. We report a patient who presented with septicaemia and pyonephrosis due to ureteric obstruction caused by shed necrotic papillae. These were echogenic on ultrasound, and resembled calculi.

Aged↗

PubMed1997

Genitourinary tuberculosis in pediatric surgical practice.

BACKGROUND: Genitourinary tuberculosis (GUTB) has been reported to account for 20% to 73% of all cases of extrapulmonary tuberculosis in the general population but is much rarer in children. GUTB is a form of secondary tuberculosis with vague symptoms. Surgical intervention is required in a minority of cases. METHODS: Nine cases of genitourinary tuberculosis (GUTB) were diagnosed and treated from 1988 to 1995. The age of the patients ranged from 5 to 12 years. There were five boys and four girls. Presenting features were diverse and included gross hematuria in 44% of cases and epididymoorchitis in 22% of cases. Rarer presenting features included acute renal failure, staghorn calculus, and pyonephrosis. Associated or past history of tuberculosis was present in three patients. Conclusive diagnosis was made on the basis of isolation of mycobacterium tuberculosis, histopathology, or cystoscopy in eight patients, whereas one patient was given a therapeutic trial based on clinical manifestations. RESULTS: Response to antitubercular drug therapy was gratifying. Excisional surgery in the form of nephrectomy was needed in one patient, whereas another underwent bilateral ureteric replacement with ileal loops for multiple ureteric strictures. CONCLUSIONS: The wide variety of presenting features and pathological lesions that result from GUTB are emphasized. The diagnosis of GUTB must be suspected in patients who present with hematuria (gross or otherwise), epididymoorchitis, and patients with long segment or multiple ureteric strictures. In view of the anticipated resurgence in tuberculosis caused by the prevalence of aquired immunodeficiency syndrome the pediatric urologist must be aware of the pathophysiology and clinical spectrum of this disease.

Antitubercular Agents↗

PubMed1999

Laparoscopic Anderson-Hynes dismembered pyeloplasty in children.

PURPOSE: The feasibility and results of laparoscopic Anderson-Hynes dismembered pyeloplasty in children were evaluated. MATERIALS AND METHODS: All laparoscopic Anderson-Hynes pyeloplasties performed by the author were retrospectively reviewed. A total of 18 children 3 months to 15 years old (mean age 17 months) with proved ureteropelvic junction obstruction underwent laparoscopic Anderson-Hynes dismembered pyeloplasty between August 1994 and June 1998. Of the 18 pyeloplasties 15 were performed in children who had not undergone previous upper tract surgery, and 3 had undergone previous upper tract surgery, including laparoscopic pyeloplasty in 2 and emergency percutaneous nephrostomy drainage of pyonephrosis 6 weeks earlier in 1. All operations were performed via a transperitoneal route. RESULTS: Postoperative evaluation is complete in 16 patients and pending in 2. Of the 16 patients 14 (87%) have no demonstrable evidence of obstruction. Two patients with persistent obstruction underwent repeat laparoscopic pyeloplasty. There was no conversion to open surgery. Mean operative time was 89 minutes. In 1 patient trocar hematoma resolved with bed rest. In another case the stent was misplaced with its distal end reaching the lower ureter, and was removed via ureteroscopy 6 weeks postoperatively. There was no other operation related morbidity. CONCLUSIONS: Laparoscopic Anderson-Hynes pyeloplasty represents an attractive alternative to conventional open pyeloplasty. It is technically challenging but with practice it may be completed in the same time as conventional open pyeloplasty. It offers results approaching those of conventional dismembered pyeloplasty.

Adolescent↗

PubMed1999

Strategies for managing upper tract calculi in young children.

PURPOSE: Pediatric urolithiasis is relatively uncommon and there is little information on the application of modern surgical procedures in young children. We present a single center experience with the surgical management of upper tract calculi in this age group. MATERIALS AND METHODS: We reviewed presentation, co-morbidity, treatment, outcome and complications in all prepubertal patients who required surgical treatment for ureteral or renal calculi during a 4-year period. The series consists of 24 girls and 17 boys 17 months to 14 years old (mean age 7.5 years). A total of 26 children were anatomically normal, and 4 had myelomeningocele, 4 had ureteropelvic junction obstruction (in a pelvic kidney in 1), 2 had cloacal anomalies, 2 had vesicoureteral reflux, and 1 each had nonrefluxing megaureter, orthotopic ureterocele and a functioning renal transplant. RESULTS: Extracorporeal shock wave lithotripsy was performed in 24 patients. Stents or nephrostomy tubes were only used in the 4 patients who presented with pyonephrosis. Of the 41 cases 17 were rendered stone-free, 3 had a decreased stone burden and 4 were failures. Ureteroscopic extraction of distal ureteral calculi was successful in 11 of 12 children, of whom the youngest was 2.5 years old. No child had postoperative infection or evidence of ureteral obstruction. Stent placement facilitated stone passage or dissolution in 2 patients, a renal calculus was percutaneously extracted in 2 and 7 required open surgery, mostly for correcting simultaneous anatomical abnormalities or after minimally invasive surgery failed. Some metabolic abnormality was detected in 80% of the children tested. CONCLUSIONS: The surgical management of upper urinary tract calculi in young children parallels that in adults. Minimally invasive surgical methods may be safely used even in young infants. Most children do not need elective stenting before lithotripsy. Open procedures are still required in 17% of cases. The majority of children have definable metabolic abnormalities.

Adolescent↗

PubMed1992

Giant ureteral stone.

A 58-year-old man presented with left flank pain and a high grade fever. Investigations revealed left pyonephrosis with a left renal stone and a giant left ureteral stone. Nephroureterectomy was performed. The ureteral stone measured 13 cm. long and weighed 90 gm.

Humans↗

PubMed1992

A comparison of the urological complications associated with long-term management of quadriplegics with and without chronic indwelling urinary catheters.

The primary objective of this retrospective study was to compare the incidence of urological complications and renal deterioration in post-traumatic quadriplegic patients managed with or without a chronic indwelling urinary catheter. The charts of 57 consecutive patients who sustained traumatic cervical spinal cord injury between 1970 and 1980 were reviewed. All of the patients received the initial management or rehabilitation therapy at our institution. The unique features of this clinical review are that a large cohort of patients was followed for a minimum of 10 years, none of the 57 consecutive patients was lost to followup and a yearly excretory urogram provided an objective assessment of the renal units. The followup, and mechanism, level and degree of injury for the 32 patients managed with and 25 managed without a catheter were similar. Overall, the incidences of renal and bladder calculi, pyelonephritis, gross hematuria, penile/urethral erosion, urosepsis, urethral stricture, epididymitis and pyonephrosis were not significantly different in the catheterized and noncatheterized groups. The Kaplan-Meier analysis of the most recent excretory urogram demonstrated that the incidence of renal deterioration was also equivalent in the catheterized and noncatheterized groups. Our study suggests that the decision to manage quadriplegics with or without an indwelling catheter should not be based on relative risk of complications or renal deterioration. The decision to avoid an indwelling catheter in these patients should reflect patient comfort, convenience and quality of life.

Adult↗

PubMed1991

Pararectus retroperitoneal radical nephrectomy.

We describe a new pararectus retroperitoneal approach to the kidney, which allows easy identification and occlusion of the renal vessels before mobilization of the kidney. This approach potentially reduces morbidity, hospital stay and cost. The technique has been used in 4 cases of radical nephrectomy for tumor and in 1 for pyonephrosis.

Carcinoma, Renal Cell↗

PubMed1982

Anaerobic bacterial infection and xanthogranulomatous pyelonephritis: a case report.

A young man presented with a history of uncorrected ureteropelvic junction obstruction 18 months in duration and clinical acute pyelonephritis. Retrograde pyelography showed unilateral pyonephrosis and cultures of purulent drainage proximal to the ureteropelvic junction revealed predominantly anaerobic bacteria and no aerobic gram-negative bacilli. Subsequent nephrectomy established a diagnosis of xanthogranulomatous pyelonephritis. Nephrectomy in combination with intensive antimicrobial therapy resulted in recovery. The contribution of anaerobic bacteria in the pathogenesis of xanthogranulomatous pyelonephritis is unknown. Anaerobic culture of urine and excised tissue in these patients may be indicated.

Adult↗

PubMed1982

Staghorn calculis: its clinical presentation, complications and management.

There were 95 patients (105 kidneys) with staghorn calculi evaluated clinically and 84 kidneys were studied on a pathologic basis. Only 1 percent of the patients could be defined as having a silent stone calculus. Clinical complications occurred in 53 per cent of the patients. Of 84 kidneys submitted for a pathoanatomic study (surgical evaluation and/or histopathology) pyonephrosis was found in 20 per cent, xanthogranulomatous pyelonephritis in 8 per cent, end stage pyelonephritic kidney in 6 per cent, end state hydronephrotic kidney in 7 per cent, severe pyelonephritic changes in 7 per cent and a perinephric abscess in 5 per cent. The kidney was considered to be relatively undamaged in 51 per cent of the cases. Complete removal of the calculus and appropriate medical adjunctive therapy should be done early in the course of the disease in an attempt to prevent complications and renal deterioration. The results of treatment are discussed and compared to those obtained in a group of patients who initially were managed conservatively.

Adolescent↗

PubMed1978

Posterior urethral valves managed by cutaneous ureterostomy with subsequent ureteral reconstruction.

Six boys, 2 weeks to 5 years old, underwent cutaneous ureterostomy for massively dilated upper urinary tracts secondary to obstruction by posterior urethral valves. Cutaneous ureterostomies had been performed elsewhere in 2 patients. Two patients underwent transurethral fulguration of the valves initially with no improvement. Blood urea nitrogen, creatinine and serum electrolyte values continued to increase and, therefore, cutaneous ureterostomies were performed with dramatic improvement. Two patients presented with sepsis, one of whom had a positive blood culture. Both children had severe pyonephrosis and after the conditions improved with medical treatment cutaneous ureterostomies were done. The total number of surgical procedures required for all patients was 59, including renal biopsies, nephrostomies and cystoscopies. No kidneys, except for the severely dysplastic ones, were lost and all patients resumed normal growth rates and have had no urinary tract infections. All laboratory values are within normal limits.

Blood Urea Nitrogen↗

PubMed1976

The case for a more aggressive approach to staghorn stones.

The treat to the patient and kidney of leaving a large staghorn stone in situ in 60 cases is compared to the risk of operative removal in 125 cases. The over-all mortality rate in patients treated conservatively was 28 per cent, carcinoma developing in 4 cases and a life-threatening pyonephrosis in 16. Of patients treated by removal of the stone the mortality rate was 7.2 per cent (during 10 years of observation) and stones recurred in 21 cases. These studies refute the notion of the silent staghorn calculus and demonstrate that operative removal is safer for the patient and kidney.

Follow-Up Studies↗

PubMed1975

Elective transcatheter renal artery occlusion prior to nephrectomy.

An hour before nephrectomy 10 patients with hypernephroma and 2 with pyonephrosis underwent occlusion of the renal arteries with gelfoam via selective catheterization, using the Seldinger percutaneous technique. This technique facilitated the operation by collapsing the renal and perirenal veins, decreased blood loss and prevented the dissemination of tumor cells or septic emboli from organ manipulation.

Adenocarcinoma↗

PubMed1975

The place of diagnostic ultrasound in the examination of kidneys not seen on excretory urography.

An examination was done on 28 patients with renal failure, 20 with unilateral hydronephrosis, 8 with multicystic kidneys, 3 with hypoplastic or chronically infected kidneys, and single examples of renal vein thrombosis, renal artery occlusion, xanthogranulomatous pyonephrosis with perinephric abscess, trauma and tumor invading the whole kidney. The distinct ultrasonic appearances of the various conditions causing radiographic non-visualization of the kidney are described.

Abscess↗

PubMed2003

Transvascular ethanol embolization: first option for the management of symptomatic nonfunctioning renal allografts left in situ.

BACKGROUND: Transplantectomy has been the conventional therapy for symptomatic failed grafts left in situ (FGLIS). Graft intolerance syndrome (GIS) is a common complication after withdrawal of immunosuppression. Our group first reported transvascular ethanol embolization (TVEE) as an alternative for the management of GIS. OBJECTIVE: Our goal was to evaluate the efficacy and safety of TVEE in a large series of patients with symptomatic FGLIS. PATIENTS AND METHODS: From January 1989 to December 2001, 944 patients received cadaveric renal transplants in our center. During this period, 59 patients with FGLIS underwent TVEE (50+/-7 years, 71% men, 15% diabetics). TVEE was performed using a transfemoral approach. A balloon occlusion catheter was inflated in the renal artery before ethanol injection (10-12 cc). The position of coils completed the procedure. No systematic prophylactic antibiotic or steroid treatment was administered. RESULTS: The main indication for TVEE was GIS (51 patients, 86%). TVEE was initially successful in 39 patients (66%). A second TVEE, which was performed in 9 of 20 unresolved cases, was successful in six. After a second TVEE, the efficacy increased to 76%. The most frequent complication was postembolization syndrome (62%), which was manifested by fever, local pain, and inflammation that generally resolved in 48-72 hours. No major complications or deaths were observed. One of four patients underwent transplantectomy. Histologic examination of the removed graft showed renal tissue necrosis (10 cases) and pyonephrosis (4 cases). CONCLUSIONS: TVEE, a safe and effective technique, may be considered as the treatment of choice for symptomatic FGLIS.

Balloon Occlusion↗