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PubMed1989

Percutaneous nephrostomy in pyonephrosis.

A series of 76 pyonephrotic kidneys in 73 patients were drained by percutaneous nephrostomy (PN) tube and examined to evaluate the contribution of this technique to the treatment of pyonephrosis. In 71 patients, clinical symptoms disappeared 24-48 h after the procedure. Two patients died from sepsis subsequent to anuria and underlying malignancy. Once the acute phase had remitted, interventional procedures were carried out in 39 cases, and constituted the definitive therapy in 36. In 32 cases, elective surgery was the definitive therapy, including the 3 cases not resolved after interventional procedures. Three patients in whom the obstruction cleared spontaneously following PN needed no additional treatment. Major complications included 6 cases of sepsis, all of which resolved satisfactorily with proper medical therapy.

Escherichia coli Infections↗
PubMedDate not supplied

Ureteral endometriosis and ovarian mucinous cystadenoma presenting with acute pyonephrosis.

BACKGROUND: Endometriosis is a common disease, but ureteral involvement is rare. Nonspecific clinical presentations of ureteral endometriosis may result in diagnostic difficulty. AIM: To discuss the diagnosis and management of such a case. METHODS: To report a case of ureteral involvement with endometriosis and review the literature. RESULTS: The case presented with right lower quadrant pain giving rise to initial diagnostic possibility of acute appendicitis. Subsequent evaluation revealed the diagnosis of right pyonephrosis due to midureteral endometriosis with right ovarian mucinous cystadenoma. CONCLUSION: The diagnosis of ureteral endometriosis requires a high index of clinical suspicion. The importance of ultrasound in the evaluation of acute abdomen in women can not be overemphasised.

Abdominal Pain↗
PubMed2005

A case of pyonephrosis secondary to ureteral stent calculus.

Ureteric stents, a good solution to many urologic problems, can lead to significant morbidity if left in situ longer than required. Our case is that of an elderly male with a history of intractable hypertension presenting with urosepsis, anemia, diabetes and chronic renal failure. His work-up revealed a stent in the right kidney with secondary staghorn calcification in the renal pelvis and a large vesical calculus. He had apparently undergone stent placement 12 years previously, but was lost to follow-up due to relocation. A nuclear scan revealed a complete loss of renal function. Cystoscopic stent removal was futile, so he underwent an elective right subcapsular nephrectomy. The specimen revealed pyonephrosis with loculations of pus. Postoperatively his course was uneventful, with the hypertension resolving in 4 weeks.

Device Removal↗
PubMed1980

Nephrobronchial fistula. Complication of perinephric abscess secondary to ureteral obstruction and pyonephrosis.

A case of nephrolithiasis complicated by obstruction leading to pyonephrosis, perinephric abscess, and nephrobronchial fistula is presented. The patient was treated successfully by nephrectomy and drainage of the subphrenic space and the pleural cavity. Nephrobronchial fistula, while a rare complication of perinephric abscess, should be considered when a patient presents with perirenal suppurative process and chest x-ray findings consistent with pleural effusion or pulmonary infiltrates.

Abscess↗
PubMed1976

Pyonephrosis.

The clinical and radiological features of pyonephrosis are reviewed, based on a consecutive series of 40 cases. There were 32 female and eight male patients, with a peak incidence in the 50-59 year age group. In 63% of cases the right kidney was involved. Almost all patients complained of loin pain and 48% had lower urinary tract symptoms. In 58% of cases a renal mass was palpable. An anaemia, pyuria and elevated blood sedimentation rate were usual. Plain films of the abdomen revealed enlargement of the outline of the involved kidney in 75%, ipsilateral absence of the psoas shadow in 63% and urinary tract calculi in 60%. At high-dose excretion urography a nephrogram was obtained in 58% of cases and a pyelogram produced in 34%. No single clinical or radiological entity emerged, there being an unbroken spectrum of disease ranging from infected hydronephrosis to xanthogranulomatous pyelonephritis. There is an increasing incidence of calculi, loss of the renal and psoas outlines and reduced renal function with increasing chronicity of disease. High-dose excretion urography is the investigation of choice since not only may the diagnosis be established but also there precise pathological state of the involved kidney. Further radiological investigation is infrequently required.

Adolescent↗
PubMed1979

Benign cholestatic jaundice after nephrectomy for pyonephrosis and sepsis.

Severe benign postoperative intrahepatic cholestatic jaundice appeared immediately after nephrectomy in a patient with nephrolithiasis and septicemia. Convalescence was uneventful and no treatment was necessary. This diagnostic possibility should be considered whenever jaundice appears postoperatively for pyonephrosis and septicemia.

Cholestasis↗
PubMed1978

Treatment of pyonephrosis: a comparative study.

Our study is a comparison of treatments used for 97 patients with pyonephrosis. The patients were divided into 3 groups: 1) cases in which a primary nephrectomy was done, 2) cases in which nephrectomy was secondary to drainage through a nephrostomy and 3) cases in which nephrectomy was secondary to drainage through a translumbar percutaneous puncture with an Ingram catheter indwelling. Patients in whom nephrostomy and puncture were used had the highest percentage of complications, while primary nephrectomy produced the best results. Therefore, we believe that primary nephrectomy is the procedure of choice, using drainage through a puncture only when the general status of the patient does not permit primary nephrectomy.

Drainage↗
PubMed1992

Pyonephrosis: diagnosis and treatment.

A series of 23 confirmed cases of pyonephrosis initially treated by percutaneous nephrostomy drainage were reviewed. Presentation was extremely variable, ranging from sepsis to asymptomatic bacteriuria. Fever, flank pain and leukocytosis were often absent. Ultrasonography was diagnostic in only 3 of 12 patients. In all, 17 patients had associated nephrolithiasis, and 5 patients ultimately required nephrectomy. Renal urine cultures were positive in 16 of 21 instances, with multiple organisms found in 8 of 21, and added bacteriological data not provided by bladder urine cultures in 11 cases. A pre-existing history of urinary tract infection, hypertension and malignancy was common. Percutaneous drainage was a safe, quick and effective diagnostic and therapeutic method.

Adult↗
PubMed1989

Ureterosciatic hernia. A rare cause of pyonephrosis.

A female patient presented as an emergency case with pyonephrosis and septicemia as a result of ureterosciatic hernia. Septicemia was treated successfully by immediate percutaneous nephrostomy tubing. After complete disappearance of symptoms, the hernia was closed operatively. Topographic anatomy of ureterosciatic hernia is presented.

Aged↗
PubMed1983

Extraurinary manifestations of chronic pyonephrosis.

Twenty-five patients who underwent nephrectomy for chronic pyonephrosis were studied retrospectively. Such patients may present with a wide range of symptoms. Marked haematological and biochemical abnormalities are found, the most striking being a gross elevation of plasma viscosity (or ESR) and a raised alkaline phosphatase. The resulting picture often suggests extrarenal disease, and diagnostic confusion occurred in a number of patients.

Adult↗
PubMed2001

[Septic shock due to pyonephrosis-calculosa: a case report].

A 69-year-old female was admitted to hospital with the complaint of high-grade fever and clouding of consciousness. Physical examination and laboratory data revealed septic shock, disseminated intravascular coagulation and multiple organ failure. Ultrasonography demonstrated left hydronephrosis and a cystic mass in peri-renal fatty tissue. KUB showed a left ureteral stone. A diagnosis of septic shock due to pyonephrosis-calculosa and peri-renal abscess was considered. A left nephrectomy, endotoxin removal therapy and continuous hemodiafiltration was performed. Thereafter all morbidities improved. A nephrectomy and intensive treatment are the good alternative method for such a case.

Aged↗
PubMed1999

[Rhabdomyolysis following nephrectomy for pyonephrosis: a case report].

A 33-year-old man with chronic alcoholism presented with left flank pain and a low-grade fever. He had a previous history of left renal calculi treated by extracorporeal shockwave lithotripsy 3 months previously at a local hospital. Since a stone was impacted at the ureteropelvic junction resulting in septic hydronephrosis, a D-J catheter was introduced to relieve the condition. He underwent fluid therapy with antibiotics. Elective pyelolithotomy was scheduled on day 10. However, persistent pyonephrosis necessitated the removal of the infected kidney. Hyperthermia over 40 degrees C continued after surgery and dark urine developed on postoperative day 2. Rhabdomyolysis was suspected because of myoglobulinemia with a high creatine phosphokinase level. Systemic cooling and treatment with fluid and diuretics saved his renal function. He survived episodic malignant hyperthermia and was discharged from intensive care unit on postoperative day 5.

Adult↗
PubMed2000

[Pyonephrosis: diagnosis and treatment: report of 14 cases].

Prior to the introduction of antibiotics, the treatment of pyelonephrosis frequently consisted of nephrectomy to remove the non-functional kidney, which was a potentially dangerous source of systemic infection. This approach was later modified as a result of the advances made in antibiotic therapy, and included vigorous antibiotic treatment and prompt drainage of the kidney. At present, percutaneous nephrostomy provides a means of draining off the pus and determining a possible residual renal function. In this study, 14 cases of pyonephrosis were observed over a 7-month period. Lumbar pain was noted in 70% of cases, painful lumbar contact in 5 cases and fever, shivering and pyuria in all cases. Cytobacteriological urine analysis showed the presence of Escherichia coli in 7 patients, Proteus in 4 patients, and in 3 cases abacterial leucocyturia; in 2 patients with only one functional kidney, renal insufficiency was observed. In all cases, the diagnosis was confirmed by ultrasonography. The main etiological factors were urinary lithiasis in 10 patients (71%), followed by uropathy of the pyeloureteral junction in 4 patients (29%). Treatment consisted of primary nephrectomy in 10 cases; in 3 cases, primary nephrostomy was performed with a positive outcome and recovery of renal function in 2 subjects; in one case of renal failure treated by nephrostomy followed by conservative surgery, the patient did not survive. In conclusion, nephrectomy is advocated as the treatment of choice in the case of a damaged kidney and a normal contralateral kidney. Conservative treatment should be envisaged particularly in the case of a single kidney, or if the patient's state of health is poor. The best treatment consists of the detection and cure of the lithiasis which is the main etiological factor in this pathology.

Adult↗
PubMed2001

[Transitional cell carcinoma on ureteral stump after nephrectomy for pyonephrosis].

The authors report a case of transitional cell carcinoma of the left ureteral stump in a 66-year old man treated by nephrectomy for pyonephrosis 6 years previously and cystoprostatectomy for bladder tumour 13 years previously. In the light of this case and based on a review of the literature, they essentially discuss the diagnostic and aetiopathogenic problems raised by this disease.

Aged↗
PubMed2001

[Massive pleural empyema caused by pyonephrosis].

The pleural empyema has unusual origin at extralung causes. Then, is essential to identify the primary process in order to obtain the clinical setting control. Previously described, but even exceptional, this case report show an empyema in which it's origin was an asymtomatic pyonephrosis, caused because of a big kidney calculus and it's discovery was suspected by the bacillus results. The treatment must include appropriate antibiotic therapy and thoracic drainage, and also the drain of the purulent accumulations at the kidney and perikidney area.

Adult↗
PubMed2005

[Primary transitional carcinoma of the remaining ureter after nephrectomy for pyonephrosis: a case report].

A case of primary carcinoma of the remaining ureter is reported. A 70-year-old man presented with asymptomatic gross hematuria. Three years ago, he had received right nephrectomy for pyonephrosis. Although drip infusion pyelography (DIP) and cystoscopy showed no abnormal findings, computed tomography (CT) and retrograde ureterography demonstrated the irregular thickening of the right remaining ureteral wall. He underwent right ureterectomy with bladder cuff resection. Pathological examination revealed transitional cell carcinoma of the remaining ureter. He has been free of disease for 3 years.

Aged↗