Acute Obstructive Pyelonephritis Research Articles

A clinical case of an atypical clinical pattern of renal colic in a nonverbal patient

Renal colic is a condition caused by the passage of a concretion from the kidney through the ureter into the bladder, which is accompanied by a pronounced pain syndrome. Patients with renal colic often seek emergency help with complaints of severe pain, nausea, dysuria. However, there is a category of people who, for various reasons, cannot verbally express their feelings. Such patients are called nonverbal. Nonverbal patients are people with severe cognitive impairments or those who are temporarily unable to speak due to surgery or illness, but they can still demonstrate pain using nonverbal signals.In this article, we present an observation of an atypical clinical picture of renal colic in a nonverbal elderly patient. In the observed woman, an acute attack of renal colic lasted 5 days and passed first under the «mask» of acute pancreatitis. Without receiving pathogenetic therapy, the patient developed acute obstructive pyelonephritis, septic shock, which was initially mistaken for an acute violation of cerebral circulation. The performed computed tomography (CT) helped to identify a concretion in the upper third of the ureter on the left, a violation of the outflow of urine from the left kidney. The patient urgently had a stent installed in the pelvis of the left kidney, urine outflow was restored, anti-inflammatory, detoxification, litolytic therapy was prescribed. After that, the patient's condition improved significantly, and after 3 months, a decrease in the size and fragmentation of the concretion was observed during the control CT scan.Conclusion. Nonverbal patients are a special group of patients whose clinical picture may be blurred or atypical. Assessment of pain symptoms in nonverbal patients is difficult, which can lead to an incorrect diagnosis and lengthen the period of diagnosis of the disease. The timely diagnosis of renal colic in nonverbal patients is also affected by the localization of pain, since its irradiating nature can direct the diagnostic search «on the wrong track».

Abordaje laparoscópico en pacientes con pielonefritis xantogranulomatosa y pionefrosis

IntroductionXanthogranulomatous pyelonephritis (XGPN) is a rare form of chronic renal inflammation, caused by long-term obstruction of the urinary tract. Pyonephrosis is a severe suppurative complication of acute obstructive pyelonephritis. Although minimally invasive approaches have many advantages, the safe dissection of the kidney may not be always achievable. Materials and methodsWe reviewed 27 cases diagnosed with either XGPN or pyonephrosis, who underwent laparoscopic total nephrectomy between October 2016 and March 2022 in our department. All interventions were performed using the Karl Storz 3D laparoscopic system. The surgical approach was standard transperitoneal nephrectomy for the majority of XGPN, while pyonephrosis cases were carried out in a retroperitoneally. All procedures were performed or supervised by the same surgeon. ResultsThe mean operative time was 269.85minutes (range 145–360). The mean hemoglobin drop after surgery was 1.41g/dl (range 0.3–2.3g/dl). Difficult dissection was encountered in 13 cases (48.14%). Nine out of 13 interventions were carried out in a complete intracorporeal fashion, while conversion to open surgery was needed in 4 cases. Vascular complications involving the major blood vessels comprised of one case of inferior vena cava (IVC) tear. Digestive tract-related complications comprised two fistulas of the descending colon and one peritoneal breach. Multiorgan resection was performed in 6 cases. ConclusionTotal nephrectomy in cases of XGPN and pyonephrosis is a challenging procedure. The laparoscopic approach is feasible, as most complications are resolved intracorporeally. However, it may remain reserved for large-volume centers with experienced surgeons.

UP18 - Factors associated with a severe form of acute obstructive pyelonephritis. Preliminary results from the RAMP multicenter cohort

UP18 - Factors associated with a severe form of acute obstructive pyelonephritis. Preliminary results from the RAMP multicenter cohort

Renal carbuncle after SARS-CoV-2 infection in a pregnant woman

<b>Data:</b> Patient: Female, 21-year-old, and pregnant<br /> Final diagnosis: Carbuncle of the left kidney<br /> Symptoms: Acute pain in the lumbar region, radiating to the left inguinal region, and weakness<br /> Clinical procedure: Ureteroscopy with stenting of both kidneys and kidneys decapsulation.<br /> <b>Objective:</b> Rare coexistence of disease or pathology<br /> <b>Background:</b> Here we present a patient who was admitted with a clinical suspicion of urinary system infection during pregnancy and was finally diagnosed with Carbuncle in her left kidney.<br /> <b>Case report:</b> 21-year-old 26-week pregnant women with complaints of acute pain in the lumbar region radiating to the left inguinal region along with weakness was admitted to the Hospital No 7 Kalkaman Almaty on 18.05.2022. In her anamnesis, she was infected with SARS-CoV-2 infection prior to the admission. Based on the complaints, anamnesis and gynecological examination data preliminary diagnosis was made as urinary system infection at pregnancy 26 weeks. Further examination revealed that she had carbuncle of the kidney and perirenal tissue, carbuncle of the left kidney, paranephritis on the left, acute obstructive pyelonephritis on the right. Lab results showed elevated leukocytes, anemia, and lymphopenia.<br /> <b>Conclusions:</b> This case shows us how woman’s weakened immune system from COVID-19 along with pregnancy, which can further weaken the immune system made her susceptible to a kidney infection, which progressed to a kidney carbuncle and perirenal tissue involvement.

Acute obstructive pyelonephritis due to pyosalpinx: a case report

BackgroundA pyosalpinx is the acute inflammation of the fallopian tube, which fills up and swells with pus. It commonly results from inadequate or delayed treatment of pelvic inflammatory disease.Case presentationWe report the case of a 54-year-old Africain female patient, who presented with sustained high-grade fever, right flank pain, and severe acute storage low-urinary-tract symptoms. Computed tomography showed signs of acute obstructive pyelonephritis with a right tubular juxtauterine mass with complex internal fluid and thick enhancing walls exerting a mass effect on the right ureter. A drainage of the right excretory cavities by a JJ stent was performed. An ultrasound-guided aspiration of the collection was also performed.ConclusionA pyosalpinx can then exert a mass effect on the excretory cavities, thus causing an acute obstructive pyelonephritis. A double drainage coupled with an effective antibiotic therapy is then necessary.

The role of intestinal translocation of E.coli in the development of acute obstructive pyelonephritis in an experiment

<b>Aim:</b> To study the role of <i>E. coli </i>intestinal translocation in the development of acute obstructive pyelonephritis in an experiment.<br /> <b>Material and methods:</b> An experimental study was conducted on 60 male rabbits weighing 3000±500 g. The animals were divided into 3 groups of 20 animals each: experimental, control and intermediate control group. The acute obstructive pyelonephritis with the ureter blocking by laparotomy and introduction of the strain into the intestine were simulated in the animals of the experimental group. In the control group, the model was performed anologically as in the experimental group, but without the ureter blocking. In the intermediate control group, laparotomy was performed, the ureter was isolated without blocking and without the introduction of a bacterial strain. 10 animals of each group were removed from the experiment on the 3<sup>rd</sup> and 5<sup>th</sup> days, kidney tissue and urine were intake. As a reference marker strain, the laboratory strain <i>E. coli</i> No. 49579 was used, which was obtained from a patient with a urological infection and had resistance to cefepime, ciprofloxacin and tetracycline. Biomaterials were studied by microbiological examination and subspecific typing of strains using the MALDI-TOF MS method, antibiotic sensitivity was determined.<br /> <b>Results: </b><i>E. coli</i> strain was isolated in all animals of the experimental group and in 2 animals of the control group on the 5<sup>th</sup> day. During subspecific typing by the MALDI-TOF MS method, the isolated strains were identical in ribosomal proteins, and also had the same sensitivity to the said antibiotics. When analyzing the amount of lg CFU <i>E.coli</i> in urine after the experiment between the experimental and control group, we found that, on day 3, there were statistically significant differences between the groups (p=0.005), and on day 5, the amount of lg CFU <i>E.coli</i> was 13 times greater (p=0.004).A comparative analysis of the lg CFU <i>E.coli</i> index in kidney tissue on 3 (p=0.004) and 5 (p=0.003) days revealed statistically significant differences between the experimental group and the control group.<br /> <b>Conclusion:</b> The results of identification and subspecific typing of isolated microorganisms confirmed that the strains isolated from the urinary tract were identical to the reference strain introduced into the gastrointestinal tract during the experiment, which confirms the role of translocation of intestinal microorganisms in the development of acute obstructive pyelonephritis.

Risk factors for Infectious Complications of Ureteroscopy after Obstructive Acute Pyelonephritis.

To identify risk factors for infectious complication of ureteroscopy after obstructive acute pyelonephritis (OAPN). This single-center, retrospective cohort study (#20200002, retrospectively registered in February 1st, 2020) included patients who underwent emergency drainage for OAPN and subsequently underwent ureteroscopic stone removal between January 2006 and December 2020. Multivariable analysis was conducted using demographic and stone-related factors to determine those that could predict postoperative febrile urinary tract infection (UTI). Overall, 432 patients underwent ureteroscopy after OAPN. The stone-free rate was 84.3%, whereas the overall and major complication rates were 17.6% and 3.2%, respectively. A total of 70 (16.2%) patient developed febrile UTI, among whom 34 (7.9%) and 11 (2.5%) developed sepsis and severe sepsis, respectively. Multivariable analysis identified diabetes mellitus [odds ratio (OR) 1.98, 95% confidence interval (CI) 1.05-3.74], duration from drainage to surgery >1 month (OR 2.28, 95% CI 1.20-4.74), and simultaneous retrograde intrarenal surgery (OR 2.96, 95% CI 1.35-6.48) as significant risk factors for UTI. After dividing patients into low- (0), intermediate- (1), and high- (2-3) risk groups according to the number of factors they had, the risk of postoperative UTI was 6.3%, 14.5%, and 27.7%, respectively (p for trend <0.001). Patients who underwent ureteroscopy after OAPN were at risk for postoperative UTI, despite its efficacy. Simultaneous retrograde intrarenal surgery should be carefully planned, especially for patients with diabetes mellitus or extended surgery wait times.

The microbial load and the severity of morphological changes in the prostate during infection with various titers of uropathogens: a comparison of data from an animal model study

Introduction. It has been established in an animal model that coagulase-negative staphylococci (Staphylococcus haemolyticus) and anaerobes (Peptococcus niger) cause the development of an acute inflammatory process in the prostate when inoculated with 103 CFU/ml. At the same time, data have been published indicating the pathogenic potential of these microorganisms on a titer of 102 CFU/ml. But it was confirmed for the model of acute obstructive pyelonephritis. In addition, the characteristics of the formation of the inflammatory response at different times were determined, which require detailed verification and comparative characteristics with those during infection with a causative uropathogen (Escherichia coli).Objective. Based on the results of the experiment, to carry out: 1) an evaluation of the relationship between the dynamics of microbial load and the degree of pathomorphological changes in prostate tissues during infection with various uropathogens in a titer of 103 CFU/ml; 2) an evaluation of the degree of microbial load and severity of histological changes in prostate tissues on follow-up day 7 with transurethral infection with various uropathogens in a subpathogenic titer of 102 CFU/ml; 3) a fundamental comparative analysis of the indicators of contamination and the severity of inflammatory changes on follow-up day 7 after the inoculation of various uropathogens in titers of 102 and 103 CFU/ml.Materials and methods. The animal model was performed using the FELASA and ARRIVE guidelines. Lab animals: 20 New Zealand rabbits. Uropathogens: E. coli, S. haemolyticus, and P. niger. Infectious titers: 102.3 cfu/ml. Uropathogen inoculation technique: topical transurethral. Randomization: all laboratory animals were divided into 4 groups depending on the uropathogen (3 experimental, 1 control). Follow-up periods: day 1, 3, 7 and 14 for a titer of 103 CFU/ml, and day 7 for a titer of 102 CFU/ml. At the end of the follow-up, euthanasia and autopsy were performed with the extraction of the urogenital organ complex. Hereafter, biopsies were taken from various parts of the prostate. Cultural and histological studies of prostate tissues were carried out using standard methods. The results were analyzed using Statistica 10.2 (StatSoft Inc., Tulsa, OK, USA) and GraphPad Prism 9 (GraphPad Software Inc., Graphpad Holdings LLC, San Diego, CA, USA) programs through descriptive and nonparametric statistics.Results. Bacterial contamination of prostate tissue was determined in all cases of infection with differences (p &lt; 0.05) in some indicators between the E. coli and P. niger groups at different observation periods, but only in the case of inoculation of the test titer of 103 CFU/ml. Histological evaluation of prostate tissues after inoculation with 103 CFU/ml verified the presence of acute destructive changes in the prostate from the follow-up day 1, which were more pronounced in the S. haemolyticus and E. coli groups. However, similar characteristics of the development of the inflammatory process in the form of hyper-eosinophilic infiltration in the early stages and pronounced congestion of the prostatic glands were identified in the S. haemolyticus and P. niger groups. Comparison of trends in dynamic changes of microbial load (rise / decline) and severity of pathological changes (increase / resolution) in prostate tissues in established follow-up periods showed the presence of relative synchronization of trends (from days 1 to 7) in the S. haemolyticus and P. niger groups, and complete synchronization in the E. coli group. When comparing the median microbial load of the prostate on the follow-up day 7, no intergroup (p &gt; 0.05) differences were found both in cases of infection with a titer of 103 CFU/ml, and when compared with the data on contamination for a test titer of 102 CFU/ml, at the same time observations. At once, when E. coli and S. haemolyticus were infected at a subpathogenic titer of 102 CFU/ml, inflammatory changes were recorded that had a mild diffuse character, in relation to those after inoculation of these pathogens in a titer of 103 CFU/ml. In turn, P. niger induced the development of low-intensity focal alteration in isolated areas of prostate tissues.Conclusions. Detailed analysis of culture and histological data showed that E. coli, S. haemolyticus and P. niger have significant pathogenic potential at titer of 103 CFU/ml. In turn, when the titer decreases to 102 CFU/ml, E. coli and S. haemolyticus retain their pathogenic potential, but the severity of the inflammatory reaction is significantly reduced. It was also found that a change in bacterial contamination affects the severity of the inflammatory process in all groups during seven follow-up days at a given test titer.

MP14-20 COMPARISON OF THE EFFECT OF ACTIVE SURGICAL TREATMENT OF UROLITHIASIS IN PREGNANT PATIENTS COMPARED WITH SERIAL URETERAL STENTING ON THE PROBABILITY OF NATURAL DELIVERY

You have accessJournal of UrologyCME1 May 2022MP14-20 COMPARISON OF THE EFFECT OF ACTIVE SURGICAL TREATMENT OF UROLITHIASIS IN PREGNANT PATIENTS COMPARED WITH SERIAL URETERAL STENTING ON THE PROBABILITY OF NATURAL DELIVERY Pavel Nizin, Sergey Kotov, and Perov Roman Pavel NizinPavel Nizin More articles by this author , Sergey KotovSergey Kotov More articles by this author , and Perov RomanPerov Roman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002543.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The primary endpoint is to compare the frequency of natural childbirth in the groups undergoing active surgical treatment of urolithiasis and the group of serial ureteral stenting. METHODS: Criteria for inclusion of diagnosed urolithiasis at any stage of pregnancy in patients without abnormalities of the urinary system. Exclusion criteria, independent departure of the stone. The active treatment group underwent endoscopic surgery to get rid of the stone during gestation. The serial stenting group underwent drainage replacement every 4 weeks during the entire period of pregnancy, followed by operations to get rid of the stone after delivery. RESULTS: Active treatment group n=57 average age 27.2 years (±5.2). The average gestation period was 21.1 weeks (±6.8). Distribution by trimester: I-3.6%, II-73.8%, III–22.8%. The average rate of leukocytosis at admission was 10.9*10^9/l (±4.8*10^9/l). Serial stenting group n=56 average age 26.5 years (±6.1). The average gestation period was 20.2 weeks (±7.2). Distribution by trimester: I-3 (5.4%), II-43 (76.8%), III–10 (17.8%). The average rate of leukocytosis at admission was 11.6*10^9/l (±5.1*10^9/l). 7 (12%) patients from the first group were diagnosed with acute obstructive pyelonephritis. These patients were fitted with an internal ureteral stent. In 5 patients, there was an independent discharge of the concretion. These patients were excluded from observation. In the second group, 4 patients were diagnosed with acute obstructive pyelonephritis. An internal ureteral stent was installed in these patients. In 3 patients, against the background of a standing stent, the stone moved away on its own. These patients were excluded from observation. In the first group, the number of delivery was 35, caesarean section-17. In the second group, delivery-23, CS-30.The probability of delivery was estimated using χ2 is 6.070. The critical value of χ2 at the significance level p=0.05 is 3.841. Complications in the first group: grade I-5 (9%), II–7 (13%). Complications in the second group I degree 9 (17%), II – 8 (15%), IIIa - 9 (17%). Comparison of the development of complications was carried out. The value of the criterion χ2 is 12.724. The critical value of χ2 at the significance level p=0.01 is 11.345. CONCLUSIONS: Active disposal of the stone during pregnancy is safe and reduces the likelihood of delivery by cesarean section and the likelihood of developing stent-associated symptoms. Source of Funding: The study was not funded © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e240 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pavel Nizin More articles by this author Sergey Kotov More articles by this author Perov Roman More articles by this author Expand All Advertisement PDF DownloadLoading ...

The Model of Acute Obstructive Pyelonephritis for Studying Bacterial Translocation of E. coli from Gastroenteric Tract

BACKGROUND: The role of intestinal microflora translocation in the development of obstructive pyelonephritis has not been sufficiently studied. The urgency to develop a new model of acute obstructive pyelonephritis is due to the search for characteristics that are able to meet the criteria for reproducibility of microbial translocation from the intestine, the reversibility of the stages of the inflammatory process with further observation in the dynamics of development. AIM: The aim of the given research is to develop a model of acute obstructive pyelonephritis to study the pathogenetic role of bacterial translocation of Escherichia coli (hereinafter E. coli) from the gastrointestinal tract (GIT). METHODS: Twenty outbred male rabbits aged 3 months and weighing 3.0 ± 0.5 kg were used for the research. All the animals were randomly divided into two groups: Experimental (n = 10) and control (n = 10). In the experimental group, obstructive pyelonephritis was modeled by ligating the external opening of the urethra and injecting an antibiotic-resistant E. coli strain into the GIT using enteric capsules. In the control group, the strain was administered in the same way, but without forming a model of obstructive pyelonephritis. The animals were withdrawn from the experiment on the 3rd day by air embolism under general anesthesia. In both groups, the sizes of the kidney, pelvis, ureter, and the number of leukocytes in urine were assessed. RESULTS: In the experimental group, there was an increase in the size of the kidney, pelvis, as well as ureter with some pronounced leukocyturia observed, which indicates the development of obstructive pyelonephritis. In the control group, only one animal had leukocyturia. The statistically significant differences were revealed between the groups in all studied parameters. CONCLUSION: The results of this research demonstrated that the proposed model provided an opportunity to study the role of intestinal translocation of microorganisms in the development of acute obstructive pyelonephritis.

EVALUATION OF THE EFFECTIVENESS OF PYELOVESICAL BYPASS IN THE TREATMENT OF PYELONEPHRITIS

Based on the widespread incidence of acute pyelonephritis, which is one of the most common inflammatory diseases of the urinary system, it is important to conduct searching for improved treatment methods, which would ensure higher effectiveness of clinical regression of the process and minimize the extent of manipulations and pharmacotherapy. Pyelovesical bypass is one of these methods. The aim of this study is to investigate the efficacy of pyelovesical drainage of the urinary tract in the course of acute pyelonephritis in comparison with conservative methods of treatment in order to identify its advantages and disadvantages. To assess the effect of urinary tract drainage, we analyzed the clinical findings of patients with acute obstructive pyelonephritis, who underwent pyelovesical stenting and compared them with standard conservative treatment methods. According to the data obtained, we can conclude that pyelovesical stenting procedure in cases of acute obstructive pyelonephritis provides a statistically significant acceleration of the regression of clinical manifestations of kidney inflammation, such as hyperthermic reaction, pain syndrome, inflammatory changes in the blood and urine, parameters of ultrasonic dynamics. Thus, in the presence of clinical indications, appropriate technical conditions, devices and qualified surgeons to perform stenting, we can recommend this method as an effective means of integrated treatment for this renal pathology.

Prognostic Accuracy of the qSOFA Score for In-Hospital Mortality in Elderly Patients with Obstructive Acute Pyelonephritis: A Multi-Institutional Study.

Prognostic accuracy of the quick sequential organ failure assessment (qSOFA) score for mortality may be limited in elderly patients. Using our multi-institutional database, we classified obstructive acute pyelonephritis (OAPN) patients into young and elderly groups, and evaluated predictive performance of the qSOFA score for in-hospital mortality. qSOFA score ≥ 2 was an independent predictor for in-hospital mortality, as was higher age, and Charlson comorbidity index (CCI) ≥ 2. In young patients, the area under the curve (AUC) of the qSOFA score for in-hospital mortality was 0.85, whereas it was 0.61 in elderly patients. The sensitivity and specificity of qSOFA score ≥ 2 for in-hospital mortality was 80% and 80% in young patients, and 50% and 68% in elderly patients, respectively. For elderly patients, we developed the CCI-incorporated qSOFA score, which showed higher prognostic accuracy compared with the qSOFA score (AUC, 0.66 vs. 0.61, p < 0.001). Therefore, the prognostic accuracy of the qSOFA score for in-hospital mortality was high in young OAPN patients, but modest in elderly patients. Although it can work as a screening tool to determine therapeutic management in young patients, for elderly patients, the presence of comorbidities should be considered at the initial assessment.

Determinants of pyelonephritis onset in patients with obstructive urolithiasis.

Acute obstructive pyelonephritis due to urolithiasis represents a medico-surgical emergency that can lead to life-threatening complications. There are still no established factors that reliably predict progression toward acute pyelonephritis in patients presenting with a simple renal colic. To investigate clinical and paraclinical factors that are associated with the onset of acute obstructive pyelonephritis. Patients presenting to the emergency department for renal colic with obstructive urolithiasis on imaging were enrolled in the study. Demographic data, vital signs, medical comorbidities, blood test results, urinalysis, and radiological findings were recorded. Obstructive pyelonephritis was defined by the presence of two or more of the following criteria: fever, flank pain or costovertebral angle tenderness, and a positive urine culture. Seventeen patients out of 120 presenting with renal colic, were diagnosed with acute obstructive pyelonephritis (14%). Parameters that were associated with the onset of obstructive pyelonephritis were: diabetes (p = 0.03), elevated CRP (p = 0.01), stone size (>5 mm) (p = 0.03), dilatation of renal pelvis (p = 0.01), peri-renal fat stranding (p = 0.02), and positive nitrites on urinalysis (p < 0.01). Hyperleukocytosis, acute kidney injury, multiple stones, pyuria (>10/mm3), hypertension, and were not associated with the onset of obstructive pyelonephritis. This study showed that known diabetic status, elevated CRP, positive urine nitrites, stone size (>5 mm), pyelic dilatation, and peri-renal fat stranding were associated with the onset of pyelonephritis in patients presenting to the emergency department with obstructive urolithiasis.

Revealing obstructive acute pyelonephritis of horseshoe kidneys, about 2 cases

The horseshoe kidney is a malformation of the upper urinary tract where the kidneys have a U-shape.This is most often the result of the fusion of the lower poles of both kidneys on the median plane. Thiscongenital malformation can remain asymptomatic in 30% of cases and diagnosed incidentally during aradiological examination. The horseshoe kidney may increase the risk for occurrence of pyelonephritisor renal lithiases which may be accompanied by urinary tract dilation or vesicoureteral reflux (VUR).We reported two clinical cases consulting for a picture of obstructive pyelonephritic revealing horseshoekidneys.

Predictors for Retrograde Ureteral Stenting Failure as an Initial Drainage Method for Emergent Complicated Acute Calculus Obstructive Uropathy

Objective: To define predictors for initial retrograde ureteral stenting (RUS) failure with the need for the percutaneous nephrostomy (PCN) insertion as a drainage method in patients with complicated acute calculus obstructive uropathy. Methods: We undertook a retrospective evaluation of patients who presented with complicated obstructive calculus uropathy (acute renal failure or obstructive pyelonephritis) between January 2016 and January 2020. Patients in whom there was failure to visualize ipsilateral ureteric orifice and those with extrinsic ureteral obstruction were excluded. Patient demographics and radiological data including stone site, hydronephrosis grade, maximum transverse stone diameter, periureteral density (PUD) and pericalcular ureteric thickness (P-CUT) at the maximum transverse stone diameter were assessed using non-contrast computed tomography at the time of admission. Results: The study included 256 patients who were managed initially by RUS trial. Of them, 48 (18.8 %) had RUS failure. The presence of acute pyelonephritis, increased maximum transverse stone diameter ≥ 9.5 mm, P-CUT ≥ 7.5 mm, and PUD at stone level ≥ 17.5 HU were risk factors associated with RUS failure (P = 0.007, 0.002, &lt; 0.001, and &lt; 0.001, respectively). Conclusion: Initial radiological stone and ureteric characteristics, in addition to the clinical diagnosis of obstructive pyelonephritis, can be used to determine PCN insertion as the preferred option over RUS for urinary drainage.

An Italian multicenter analysis of emergency admissions and treatment of upper tract urolithiasis during the lockdown and reopening phases of the COVID-19 pandemic: Are we ready for a second wave of the outbreak?

ObjectivesTo assess if the lockdown period (March–April 2020) during the coronavirus disease‐19 outbreak in Italy influenced the number, presentation, and treatment of urgent admissions to the emergency department for ureteral lithiasis, and to evaluate the same variables during the reopening phase (May–June 2020).MethodsWe performed a retrospective analysis of patients admitted to the emergency department of three different hospitals (two coronavirus disease‐19 hubs). Demographics and data on acute pyelonephritis, acute kidney injury, urinoma, hematuria, inpatient admission/discharge home, and type of treatment were gathered and compared with the same periods in 2019.ResultsA total of 516 patients were admitted during the study period, of whom 62.4% were male. Their mean age was 58.86 ± 16.24 years. The number of admissions decreased significantly, by 51.25% (P = 0.003), during lockdown compared to 2019 (78 vs 160 admissions). The number of admissions in the reopening phase (May–June 2020) was in line with that in 2019 (n = 138). The number of hospitalizations (P = 0.005), acute obstructive pyelonephritis (P = 0.019), and complications (P = 0.02) was statistically significantly higher during lockdown compared to 2019. The increase in the rate of surgical procedures nearly reached significance (P = 0.059). The odds of having complications and being hospitalized were almost fivefold (odds ratio 4.68, 95% confidence interval 1.98–11.07) and twofold greater (odds ratio 2.39, 95% confidence interval 1.29–4.43) compared to the same period in 2019. No difference was noted between May–June 2020 and 2019.ConclusionThe coronavirus disease‐19 lockdown period provoked a meaningful reduction in symptomatic ureteral lithiasis admission. Most patients presented with complicated disease, which required an increased rate of interventional procedures compared to the equivalent period in 2019. Admissions reverted to normal levels during the reopening phase.

P0124 - The impact Of COVID-19 on acute obstructive pyelonephritis severity – 2020 and its unforeseen presentations

P0124 - The impact Of COVID-19 on acute obstructive pyelonephritis severity – 2020 and its unforeseen presentations

Pathogenic Mechanisms of Acute Obstructive Pyelonephritis

Among urological diseases, the most relevant is infection of the urinary tract. Pyelonephritis is on the 5th place in kidney diseases, and obstructive pyelonephritis occurs in 84% of all pyelonephritis. In the world, among the adult population, 100 people per 100,000 of the population suffer from pyelonephritis. In addition, from year to year, there is an increase in purulent forms of acute pyelonephritis by 4–5 times. This pathology is a separated manifestation of such an important urological problem as complicated urinary tract infection, which accounts for 84–86% of all infections. In acute obstructive pyelonephritis, more severe complications such as bacteriotoxic shock and urosepsis may develop. The mortality rate from these dangerous complications reaches 70–90%. In addition, the number of patients with urosepsis and bacteriotoxic shock has increased 4–6 times in recent years. The review presents current literature data on acute obstructive pyelonephritis. The main causes and pathogenetic mechanisms of the disease development are presented.

Optimal duration of preoperative antibiotic treatment prior to ureteroscopic lithotripsy to prevent postoperative systemic inflammatory response syndrome in patients presenting with urolithiasis-induced obstructive acute pyelonephritis.

PurposeThere is no consensus on the optimal duration of preoperative antibiotic treatment prior to ureteroscopic lithotripsy in patients presenting with urolithiasis-induced obstructive acute pyelonephritis (APN). We aimed to identify surgeon-modifiable, preoperative risk factors associated with postoperative systemic inflammatory response syndrome (SIRS) in these patients.Materials and MethodsThis multicenter retrospective study evaluated 115 patients who presented with urolithiasis-induced obstructive APN between January 2008 and December 2019. All patients were administered intravenous third-generation cephalosporin until culture sensitivity confirmation or until ureteroscopic lithotripsy. Data were collected for age, sex, diabetes mellitus, performance status, stone features, hydronephrosis grade, preoperative renal collecting system drainage, laboratory data, operative time, and duration of preoperative antibiotic treatment. Sensitivity analysis using Youden's index and logistic regression analysis were used to assess risk factors of postoperative SIRS.ResultsPostoperative SIRS was identified in 32 (27.8%) patients. The incidence of postoperative SIRS was higher in patients who received preoperative antibiotic treatment for fewer than 14 days (38.8% vs. 12.5%; p=0.001). Backward variable selection logistic regression analysis revealed maximal stone diameter ≥15 mm, duration of preoperative antibiotic treatment <14 days, and preoperative C-reactive protein (CRP) level ≥6.0 mg/L to be associated with higher risk of postoperative SIRS.ConclusionsPatients with urolithiasis-induced obstructive APN planned for ureteroscopic lithotripsy should be administered at least 14 days of preoperative antibiotic administration and achieve a serum CRP level ≤6.0 mg/L to minimize the risk of postoperative SIRS.

COVID-19 pandemic impact on clinical outcomes of patients with obstructive pyelonephritis.

PurposeObstructive pyelonephritis is a common urologic emergency that requires prompt decompression of the collecting system. The COVID-19 pandemic has changed patient flow and healthcare strategies at numerous emergency departments across Brazil with still unknown consequences for the population. This study sought to investigate the impact of the COVID-19 outbreak on clinical outcomes in patients with acute obstructive pyelonephritis at a tertiary academic center.Materials and methodsAfter Institutional Review Board approval, a retrospective chart review of patients who required decompression of the collecting system due to acute obstructive pyelonephritis from June 2019 to July 2020 was conducted. Basic demographic information, pre-operative, and peri-operative data were recorded. Patients were assigned in “Pre-Covid” and “Post-Covid” groups based on the admission dates.ResultsA total of 63 patients were included, with 40 patients in the Pre-Covid group and 23 in the Post-Covid group. Patients from the Post-Covid group presented at the ER later after symptoms onset (7.8 vs. 4.3 days; p = 0.012), had higher rates of SIRS (57% vs. 25%; p = 0.012), perirenal abscesses (13% vs. 0%; p = 0.019), overall complications (p = 0.047) and presented longer hospital length of stay (7.6 vs. 3.8; p = 0.007).ConclusionDuring the COVID-19 pandemic, patients with acute obstructive pyelonephritis presented later for evaluation at the ER, had higher disease severity and longer hospital length of stay when compared to the pre-COVID group of patients with the same pathology.