double-J Catheter Research Articles

Particularities of Pyelonephritis With Multidrug-Resistant (MDR) Germs During Pregnancy: A Case-Control Study.

The aim of this study was to analyze the characteristics of pyelonephritis with multidrug-resistant (MDR) bacteria in pregnant women in comparison to pyelonephritis with multidrug-sensitive bacteria in this particular patient group. We conducted a retrospective study over a period of three years on a study group of 17 pregnant patients with pyelonephritis with MDR bacteria and on a control group of 52 pregnant patients with pyelonephritis with multidrug-sensitive bacteria. We analyzed the demographic data, the potential risk factors, aspects of the clinical picture, the incidence and type of bacteria involved, and their sensitivity spectrum. The patients in the study group had pyelonephritis on the right side (N=10, 58.83%), were in the second and third trimesters of pregnancy (N=16, 94.12%), and had a high percentage of anemia (N=9, 52.94%), as did the control group. Unlike the patients in the control group, the patients in the study group had a higher incidence of antibiotic treatment (N=17,100% vs. N=14, 29.92%, p<0.001), previous urological surgery, especially ureteral catheterization with insertion of double-J catheters (N=9, 52.94% vs. N=9, 17.30%, p=0.003), and an increased incidence of urosepsis on admission (N=11, 64.70% vs. N=11, 21.15%, p<0.001). E. coli (N=8, 47.05% vs. N=28, 53.85%, p=0.626) and Klebsiella pn. (N=5, 29.41% vs. N=12, 23.07%, p=0.598)were predominant in both study groups. Also, the hospitalization days were significantly higher in the study group compared with the control group (N=7.38±2,91 vs. N=5.02±1,87, p=0.002). The spectrum of microbial resistance was increased in favor of the study group for all antibiotics tested, with the exception of ampicillin, where resistance was increased in both groups. The Gram-negative bacteria responsible for the pyelonephritis in both groups retained 100% sensitivity to carbapenems and piperacillin/tazobactam. Pregnant women in the second and third trimesters of pregnancy who have undergone right-sided double-J catheter insertion during pregnancy and/or who have received antibiotic treatment in the past are at increased risk for pyelonephritis with MDR. E. coli and Klebsiella pn.,bacteria are most commonly involved and maintain susceptibility to carbapenems and reserve penicillins.

Risk and protective factors for secondary procedures after endoscopic dilatation of primary obstructive megaureters.

High-pressure balloon dilatation (HPBD) of the ureterovesical junction with double-J stenting is a minimally invasive alternative to ureteral reimplantation or cutaneous ureterostomy for first-line surgical treatment of primary obstructive megaureter (POM). The aim of our study was to identify the risk factors associated with the need for secondary procedures due to HPBD failure. Prospective data were collected from patients who underwent HPBD for POM between 2007 and 2021 at a single institution. The collected data included patient demographics, diagnostic modalities, surgical details, results, and follow-up. Multivariate logistic regression analysis was performed. Fifty-five ureters underwent HPBD for POM in 50 children, with a median age of 6.4months (IQR: 4.5-13.8). Nineteen patients (37.25%) underwent secondary ureteric reimplantation, with a median of 9.8months after primary HBPD (95% CI 6.2-9.9). The median follow-up was 29.4months (IQR: 17.4-71). Independent risk factors for redo-surgery in a multivariate logistic regression model were: progressive ureterohydronephrosis (OR = 7.8; 95% CI 0.77-78.6) and early removal of the double-J stent. A risk reduction of 7% (95% CI 2.2%-11.4%) was observed per extra-day of catheter maintenance. The optimal cut-off point is 55days, ROC curve area: 0.77 (95% CI 0.62-0.92). Gender, distal ureteral diameter, pelvis diameter, dilatation balloon diameter and preoperative differential renal function did not affect the need for reimplantation. The use of a double-J stent for at least 55days seems to avoid the need for a secondary procedure. Therefore, we recommend removing the double-J catheter at least 2months after the HBPD.

Efficacy and Safety of Extracorporeal Shock Wave Lithotripsy (ESWL) in Patients With Infected Ureterohydronephrosis Due to Ureteral Stones Following Double-J Catheter Insertion.

Double-J ureteral catheters in patients with ureteral lithiasis undergoing extracorporeal shockwave lithotripsy (ESWL) procedures reduce the efficacy of the procedure or have no effect on the stone-free rate. However, the effect of double-J catheters on the patients in whom they were inserted for infected hydronephrosis is not known. The aim of our study was to evaluate the efficacy and safety of the ESWL procedure in patients with ureteral lithiasis and double-J catheters previously inserted for infected hydronephrosis. We conducted a comparative case-control, match-paired study in a group of patients with ureteral lithiasis treated by ESWL from January 1, 2018, to March 1, 2023, who were divided into two groups according to the presence of the double-J catheter. For each patient with the double-J catheter from the study group, we selected one patient for the control group without the double-J catheter and matched them in terms of size, location of stones, and body mass index (BMI). We analyzed the stone-free rate and complications that occurred in the two groups. Forty patients with ureteral lithiasis and a double-J catheter inserted for infected hydronephrosis were enrolled in the study group. The control group included 40 patients with ureteral stones without double-J catheters. The patients in the two groups were predominantly men with stones located in the lumbar region and on the right side and with a BMI between 25 and 30 kg/m2. The stones had an average size of 0.9+/-0.12mm and 0.89+/-0.15mm, respectively (p=0.624). There was no statistically significant difference in stone-free rate between the two groups after the first session of ESWL (47.5% vs. 52.5%, p=0.502), the second (70% vs. 75%, p = 0.616), and the third session (85% vs. 87.5%, p=0.761). The rate of complications was similar in both groups (7.5% vs. 5%, p=0.761). The presence of double-J catheters inserted in patients with ureteral stones who underwent ESWL for infected hydronephrosis does not affect the stone-free rate of the procedure or the complication rate. The procedure of ESWL in patients with ureteral lithiasis and double-J catheters inserted for infected hydronephrosis is a safe and efficient method that can be recommended as an initial treatment alongside retrograde ureteroscopy.

Factors Associated with Increased Risk of Urosepsis during Pregnancy and Treatment Outcomes, in a Urology Clinic.

Background and Objectives: Urosepsis is a significant cause of maternal and fetal mortality. While certain risk factors for urinary tract infections (UTIs) in pregnant women are well established, those associated with an elevated risk of urosepsis in pregnant women with upper UTIs remain less defined. This study aims to identify factors linked to an increased risk of urosepsis and examine urologic treatment outcomes in such cases. Materials and Methods: We conducted a retrospective analysis on 66 pregnant women diagnosed with urosepsis over a nine-year period. A control group included 164 pregnant women with upper UTIs, excluding urosepsis, admitted during the same timeframe. This study highlights factors potentially contributing to urosepsis risk, including comorbidities like anemia, pregnancy-related hydronephrosis or secondary to reno-ureteral lithiasis, prior UTIs, coexisting urological conditions, and urologic procedures. Outcomes of urologic treatments, hospitalization duration, obstetric transfers due to fetal distress, and complications associated with double-J catheters were analyzed. Results: Pregnant women with urosepsis exhibited a higher prevalence of anemia (69.7% vs. 50.0%, p = 0.006), 2nd-3rd grade hydronephrosis (81.8% vs. 52.8%, p = 0.001), and fever over 38 °C (89.4% vs. 42.1%, p = 0.001). They also had a more intense inflammatory syndrome (leukocyte count 18,191 ± 6414 vs. 14,350 ± 3860/mmc, p = 0.001, and C-reactive protein (CRP) 142.70 ± 83.50 vs. 72.76 ± 66.37 mg/dL, p = 0.001) and higher creatinine levels (0.77 ± 0.81 vs. 0.59 ± 0.22, p = 0.017). On multivariate analysis, factors associated with increased risk for urosepsis were anemia (Odds Ratio (OR) 2.622, 95% CI 1.220-5.634), 2nd-3rd grade hydronephrosis (OR 6.581, 95% CI 2.802-15.460), and fever over 38 °C (OR 11.612, 95% CI 4.804-28.07). Regarding outcomes, the urosepsis group had a higher rate of urological maneuvers (87.9% vs. 36%, p = 0.001), a higher rate of obstetric transfers due to fetal distress (22.7% vs. 1.2%, p = 0.001), and migration of double-J catheters (6.1% vs. 0.6%, p = 0.016), but no maternal fatality was encountered. However, they experienced the same rate of total complications related to double-J catheters (19.69% vs. 12.80%, p > 0.05). The pregnant women in both groups had the infection more frequently on the right kidney, were in the second trimester and were nulliparous. Conclusions: Pregnant women at increased risk for urosepsis include those with anemia, hydronephrosis due to gestational, or reno-ureteral lithiasis, and fever over 38 °C. While the prognosis for pregnant women with urosepsis is generally favorable, urological intervention may not prevent a higher incidence of fetal distress and the need for obstetric transfers compared to pregnant women with uncomplicated upper UTIs.

Pyelocalicial Hematoma Simulating a Tumor of the Upper Excretory Tract

Haematoma of the upper excretory tract (UET) may be due to trauma to the bladder, ves tves, or may be favored by anticoagulant treatment. The main sign is hematuria. On CT scan, the hematoma presents as an irregular, spontaneously hyperdense lesion, and may mimic a Upper Excretory Tract Tumour (UETT), so a sound diagnostic strategy is essential. We report here a case of pyelocal hematoma in a 68-year-old patient, treated by simple drainage through a double-j catheter with adaptation of the anticoagulant dose.

Incidental Ureteral Complication in Single-Center Consecutive Oblique Lateral Interbody Fusion Cases.

Oblique lateral interbody fusion (OLIF) has recently gained widespread use as a minimally invasive surgical procedure for degenerative lumbar disease. OLIF has several advantages but can also lead to several possible complications. For example, although less common, access through the retroperitoneal cavity can cause ureteral injury. Here, we report two cases of ureteral complications that occurred during consecutive OLIF procedures. One involved a 77-year-old female patient who had a double-J catheter inserted due to ureteral injury during surgery, and the other involved a 69-year-old male patient suspected of having a ureteral stricture due to retractor compression. To prevent ureteral complications in OLIF, it is necessary to accurately identify the anatomy of the ureter through preoperative imaging and to pay special attention during surgery.

Resultados iniciales del tratamiento endourológico de la litiasis renoureteral mediante ureteroscopia flexible y cirugía percutánea en régimen de cirugía mayor ambulatoria en un centro de tercer nivel

ObjectiveUrinary lithiasis is a prevalent disease with a high socioeconomic impact, where endourological surgery has shown excellent results with minimal complications. For its part, outpatient surgery is an efficient, safe and quality care model. We present our experience in the outpatient endourological treatment of lithiasis and a review of the main series. Material and methodsProspective analysis of 85 flexible or percutaneous procedures for the treatment of lithiasis, carried out in our center between January 2021 and April 2022. The main objective was to analyze the rate of unplanned admission and the success and incidence of complications as secondary objectives. The patients were selected following the inclusion criteria of the care process. ResultsThe mean age was 56±14 years. Urine culture was positive in 13.9% of the patients, 38% had a pre-surgical double-J catheter. Median stone surface was 55 mm2 (961±323 Hounsfield Units). 73 flexible and 12 percutaneous procedures were performed. 8 patients required immediate unplanned admission and another 2 during the first month. 94% were stone-free at the third month. No intraoperative complications were detected, although 16.5% of the patients presented some type of postoperative complication. ConclusionIn our experience, with a strict selection of patients and following a care process with multidisciplinary participation, endourological procedures are feasible and safe in the outpatient setting. Periodic monitoring of the results is essential for the sake of a constant improvement of the process.

Initial results of endourological treatment of renoureteral lithiasis by means of flexible ureteroscopy and percutaneous surgery in an outpatient procedure in a tertiary care center

ObjectiveUrinary lithiasis is a prevalent disease with a high socioeconomic impact, where endourological surgery has shown excellent results with minimal complications. For its part, outpatient surgery is an efficient, safe and quality care model. We present our experience in the outpatient endourological treatment of lithiasis and a review of the main series. Material and methodsProspective analysis of 85 flexible or percutaneous procedures for the treatment of lithiasis, carried out in our center between January 2021 and April 2022. The main objective was to analyze the rate of unplanned admission and the success and incidence of complications as secondary objectives. The patients were selected following the inclusion criteria of the care process. ResultsThe mean age was 56 ± 14 years. Urine culture was positive in 13.9% of the patients, 38% had a pre-surgical double-J catheter. Median stone surface was 55 mm 2 (961 ± 323 Hounsfield Units). 73 flexible and 12 percutaneous procedures were performed. 8 patients required immediate unplanned admission and another 2 during the first month. 94% were stone-free at the third month. No intraoperative complications were detected, although 16.5% of the patients presented some type of postoperative complication. ConclusionIn our experience, with a strict selection of patients and following a care process with multidisciplinary participation, endourological procedures are feasible and safe in the outpatient setting. Periodic monitoring of the results is essential for the sake of a constant improvement of the process.

The learning curve for retrograde intrarenal surgery: A prospective analysis.

retrograde intrarenal surgery (CRIR) is an evolving tool. Its learning curve is not well established, despite the common use of flexible ureteroscopes today. Our aim is to estimate the number of procedures needed for one to perform RIRS consistently. a urology resident had his first 80 RIRS for nephrolithiasis analyzed quantitatively and qualitatively. The procedures were divided into 4 groups containing 20 surgeries each (I to IV), according to their order, for comparison. there was no difference in stone sizes between groups. All qualitative variables varied significantly between groups (p<0.001), except between III and IV. In the quantitative analysis, there was a difference between groups I and IV in time for double-J catheter placement (p=0.012). There was an increasing difference in sheath placement time (p<0.001) and in total operative time (p=0.004). The time fot stone treatment (p=0.011) was significant only between groups I, II and III. There was difference in total sheath time only between groups I and III (p=0.023). Stone free status did not change between groups. the differences between the qualitative and quantitative variables show the relation between number of surgeries performed and proficiency in the procedure. Intergroup comparisons show sequential optimization of parameters. we found that 60 is a reasonable number of surgeries to be performed in order to reach the plateau of RIRSs learning curve.

Robotic-Assisted Laparoscopic Treatment of Bladder Endometriosis

<h3>Study Objective</h3> To show the combined surgical approach of cystoscopy and robotic-assisted laparoscopy for a complete and safe resection of bladder endometriosis. <h3>Design</h3> A clinical case and surgical cystoscopic and robotic approach of bladder endometriosis resection demonstrated by video. <h3>Setting</h3> Bladder endometriosis is defined as the presence of endometrial glands and stroma in the detrusor muscle and is the most common site affected in urinary tract endometriosis. Surgical treatment should guarantee complete removal of the bladder nodule to minimize recurrence, so transurethral surgery alone should be avoided in favor of segmental bladder resection. Robotic-assisted laparoscopy provides advantages as 3D visualization and facilitation of suturing techniques compared to conventional laparoscopy. <h3>Patients or Participants</h3> A 32-year-old nulliparous patient, complaining of sensation of incomplete emptying of the bladder and dysuria, with worsening in the menstrual period. Patient had been using combined oral contraception but reported worsening of symptoms since she stopped the use in 2019. During letrozole treatment for infertility she discovered a bladder nodule of probable endometriotic origin. MRI showed signs of deep endometriosis in the vesicouterine recess, with infiltration of the anterior uterine serosa and left round ligament, measuring around 3.0 × 2.0 × 0.9 cm, in addition to the nodular lesion that infiltrates and retracts the upper wall of the bladder, projecting to the bladder lumen of 3.8 × 2.5 × 2.1 cm. <h3>Interventions</h3> It was performed cystoscopy and bilateral double-J catheter passage, followed by robotic-assisted laparoscopic resection of bladder endometriosis with partial cystectomy. Surgical field was prepared and the paravesical accessed to the bladder nodule. Bladder was sutured with barbed thread and surgical specimen removed by colpotomy. <h3>Measurements and Main Results</h3> Anatomopathological exam confirms endometriosis. <h3>Conclusion</h3> Endometriosis of urinary tract can have an appropriate surgical resection by laparoscopic management with or without robotic assistance. Having knowledge of the surgical technique and the platform allows a safe and complete resection, minimizing complications.

ERDHEIM-CHESTER DISEASE (ECD): A RARE ETIOLOGY OF OBSTRUCTIVE ACUTE ABDOMEN IN A YOUNG PATIENT

Erdheim-Chester disease (ECD) is a rare multisystemic disorder, classified as non-Langerhans histiocytosis according to WHO-2016. It is a malignant neoplasm derived from myeloid progenitor cells, particularly from monocytic/dendritic origin. Its actual incidence is unknown, and fewer than a thousand cases have been reported to date in the medical literature. Recurrent somatic mutations involving the BRAF gene (BRAF V600E) and other components of the MAPK signaling pathway play a central role in its oncogenesis. Although rare, cases in patients under 40 years-old are reported. Frequently the median age of ECD patients is around 50-60 years-old, with a predominance of males (3:1). The disease may have a polymorphic clinical presentation, usually involving bones, central nervous system (CNS), pituitary and peri-aortic or retroperitoneal fibrosis with ureteral stenosis. Several therapeutic options can be used to control the disease, including corticosteroids, radiotherapy, interferon-α, purine analogues (2Cda or DCF), mono/polychemotherapy, and targeted drugs such as vemurafenib and dabrafenib. To report one case of atypical presentation of ECD, manifested as acute obstructive abdomen in a patient under 20 years-old. An 18-year-old woman, with no previous comorbidities, sought medical service at the HC-FMUSP due to abdominal pain, abdominal distension, and stopping of the elimination of gases and feces. Abdominal ultrasound showed an extensive mass with a cystic/solid aspect in the pelvic region. Exploratory laparotomy revealed a large solid mass adhered to the wall of the small intestine and the lateral wall of the rectum. A 15-cm enterectomy, ileo-bowel anastomosis, protective distal colostomy and insertion of a double-J catheter into the urinary tract were performed. Histopathological examination revealed atypical cell proliferation with staining for CD68+, CD163+, Ki67+ (20-30%) on immunohistochemistry study. Molecular test in a sample fixed in formalin and embedded in paraffin (FFPE) revealed the presence of BRAF V600E mutation, confirming the diagnosis of ECD. She started therapy with cladribine (2-Cda) 5 mg/m 2 , I.V., D1-D5, 30/30 days, for six cycles. After the end of chemotherapy, 18-FDG-PETCT was performed, compatible with complete metabolic response. She is currently asymptomatic and with an excellent quality of life. ECD is a rare disorder that can present with atypical extra-osseous symptoms. We describe here an unusual case of a patient outside the usual age range for this disease, with intra-abdominal manifestation and a case of bowel occlusion, requiring exploratory laparotomy and extensive surgical resection. As this is a classically relapsing disease, it is known that isolated surgical resection is often ineffective. Although it has a mutation that works as a target for specific therapeutic intervention (BRAF inhibitors), these drugs are unavailable in the context of the Brazilian Public Health System. Thus, our patient underwent conventional cytotoxic treatment, with manageable toxicity and excellent therapeutic response.

A case report of non-functional ectopic left kidney obstructing the right kidney in crossed fused kidneys: A rare entity

Introduction and importanceCrossed fused renal ectopia is a rare congenital condition that might pose some diagnostic and therapeutic challenges to clinicians. We report a patient with a non-functional crossed fused ectopic left kidney that obstructed the orthotopic kidney in a rarely observed situation.Case presentationA 68-year-old male presented a right flank pain with fever. The diagnosis of right obstructive pyelonephritis was dressed, after biological and radiological investigations. The obstacle was a crossed ectopic left kidney in its inferior variety. The ectopic kidney was non-functional as result of an obstructive ureteral calculus. The patient had right ureteral stenting with a double-J catheter. Three months later, left nephrectomy was performed by lumbotomy. Per operative difficulties were mainly the infiltration of peri renal fat, the anarchic vascularization and the multiple small pedicles of the ectopic kidney that was also malrotated with the hilum facing anteriorly. Postoperative recovery was uneventful and the patient left the hospital after three days.Clinical discussionCrossed Fused renal ectopy is rare. As shown in this case, the ectopic kidney might cause damage to the orthotopic kidney, by compression to urinary ducts. Surgery is the main treatment option. Some difficulties related to aberrant vascularization and possible malrotation is to preview.ConclusionCrossed fused renal ectopia is uncommon renal anomaly, mostly asymptomatic. However, it may be responsible of some complications, sometimes severe. Surgery can be delicate due to vascular complexity.

Sexual dysfunction in patients after double-J catheterisation: A cross-sectional, prospective study.

This study was conducted to examine sexual dysfunction in patients after double-J catheterisation. This descriptive, cross-sectional and prospective study was conducted in a research and training hospital from June 2020 to February 2021. The data were collected from patients who visited the emergency clinic and were hospitalised in the urology clinic because of renal calculi. The study was completed with 192 patients. The data were collected using a patient introductory form, the International Index of Erectile Function (IIEF-15) and the 5-item Turkish version of the International Index of Erectile Function (IIEF-5). Then data were collected before double-J catheterisation, 1month after catheterisation and a month after the catheter was removed. The data were evaluated using means, numbers, percentile distributions and the paired samples t test. The patients' sexual function was negatively affected by double-J catheterisation, and this negative effect persisted for a month after removal of the double-J catheter. The differences in the patients' mean IIEF scores and sub-dimension scores before and after double-J catheterisation were statistically significant (P˂0.001). A month after the double-J catheter was removed, the difference between their mean IIEF-5 scores was statistically significant (P˂0.001). No erectile dysfunction was found in 50.0% of the patients before double-J catheterisation. A month after the catheter was removed, erectile dysfunction was found at different levels in 88% of the patients, and severe erectile dysfunction was found in 60.9% of the patients. This study found that double-J catheterisation negatively affects patients' sexual function. Patients experience sexual dysfunction while the double-J catheter is in place and for a month after it is removed.

Association Between the Placement of a Double-J Catheter and the Risk of Urinary Tract Infection in Renal Transplantation Recipients: A Retrospective Cohort Study of 1038 Patients

The incidence of urinary complications in transplantation is 2% to 20%, which can be decreased with the use of a double-J catheter. The objective of this study was to determine the association between the use of the catheter and the probability of urinary tract infection (UTI). We studied a retrospective cohort of 1038 patients divided into 2 groups: those treated with vs without a double-J catheter. Perioperative factors related to catheter use were analyzed. Second, whether the use of the catheter was associated with fewer other urinary complications was analyzed. Of the whole sample, 72 patients were eliminated from the study, and 358 (37%) received a double-J catheter. UTIs occurred in 190 patients (19.6%), of whom a greater proportion received a catheter: 88 of 358 (24.6%) vs 102 of 608 (16.8%) (odds ratio, 1.61; 95% confidence interval, 1.17-2.22; P=.003). The placement of a double-J catheter during transplant is associated with a higher proportion of UTIs, increasing their severity and the cost of care, without having a clear effect on other types of urinary complications.

Idarucizumab for Reversing Anticoagulation in Patients Treated with Dabigatran: Experience in Our Center

INTRODUCTIONPatients who are receiving oral anticoagulant therapy for the prevention of stroke or thrombosis may benefit from anticoagulant reversal if they present life-threatening bleeding or if they will be undergoing urgent surgery or intervention.Idarucizumab is a specific reversal agent for dabigatran. It is a humanized monoclonal antibody fragment (Fab) that binds dabigatran and its metabolites with a very high affinity, approximately 300 times more potent than the binding affinity of dabigatran to thrombin. It thus neutralizes its anticoagulant effect. It is indicated in adult patients treated with this direct oral anticoagulant when a rapid reversal of its anticoagulant effect is required, for surgical or urgent procedures and in the case of potentially fatal or uncontrolled bleeding.It is given intravenously. The recommended dose is 5 g administered in two intravenous infusions of 2.5 g every 5-10 minutes.OBJECTIVESThis is a descriptive study to determine whether darucizumab would be able to reverse the anticoagulant effect of dabigatran in patients who are about to undergo an urgent procedure.METHODSThe two clinical cases of patients treated with idarucizumab in this year are described.CASE 1A 70-year-old woman receiving anticoagulant Dabigatran 150mg/12h for Non-valvular Atrial Fibrillation (NVAF), who comes to the emergency due to abdominal pain of several hours of evolution. In the previous 24 hours, surgical hysteroscopy had been performed, due to postmenopausal metrorrhagia, in order to rule out the endometrial process.Complementary tests showed a drop in hemoglobin levels from 14.8 mg/dL to 12.3 g/dL, prothrombin activity 8%,INR 10.58, Prothrombin time (PT) 8%, activated partial thromboplastin time (APTT) 55 seconds. Thus, it is administered 10 mgr Konakion and 1200 IU Human Prothrombin Complex. Two hours later: PT 23%, INR 3.15, PT 2.7 ratio. Renal function was normal.An abdominal/pelvic CT scan was performed, where pneumoperitoneum was observed in an important amount as well as abundant hemoperitoneum, suggesting uterine perforation.The patient was moved over specialized hospital.The last dosis of Dabigatran had been 6 hours ago. Due to the need of urgent surgery, idarazizumab was given in two intravenous boluses of 2.5 g.Hysterectomy with a double annexectomy was made.12 hours after surgery, anticoagulant treatment with low molecular weight heparin was introduced. She also presented hemorrhagic subhepatic abscess as a surgical complication (not related to dabigatran) that required percutaneous drainage, with good evolution. The patient was discharged continuing treatment with Bemiparin. 20 days later, Dabigatran 150mg/12h was reintroduced without further complications till the present date.CASE 2A 55-year-old male receiving anticoagulant Dabigatran 150mg/12h for NVAF, who came to the emergency for pain located in the right renal fossa for the previous 24h, along with dysuria and pollakiuria.On examination he had signs of severe pain; He was hemodynamically stable with fever (38ºC). Complementary tests: leukocytosis 12000x10e3/mm3, creatinine 1.5 mg/dL, and positive hematuria, Prothrombin activity 96%, APTT 37 seconds. Abdominal ultrasonography and CT scan were performed, showing complicated renal colic.It was decided to implant double J-catheter, for which we had to reverse the anticoagulant effect of Dabigatran, whose last dose had been taken in the previous 12 hours. For this, idarazizumab was given in two intravenous boluses of 2.5 g, and the intervention was carried out without incident.24 hours later, after a good clinical evolution of his renal pathology, and before no evidence of bleeding was evident, Dabigatran was restarted at its usual dose of 150mg/12h, with no new complications thus far.RESULTSThe use of idarucizumab permitted rapid and safe intervention of patients. Both had normal hemostasis during the procedure. 5 g dose of idarucizumab was sufficient and reversal was maintained for 24 hours. One patient presented hemorrhagic complication related to the surgical procedure.CONCLUSIONSIdarucizumab is integrated into protocol for the emergency management of patients on dabigatran. Idarucizumab is effective for dabigatran reversal among patients who have uncontrolled bleeding or will be undergoing urgent surgery. Idarucizumab rapidly, durably, and safely reversed the anticoagulant effect of dabigatran. DisclosuresNo relevant conflicts of interest to declare.

A randomized prospective study: assessment of transient ureteral stenting by mono-J insertion after primary URS and stone extraction (FaST 3)

To compare the outcome of a short-term insertion of a mono-J catheter for 6 h following ureteroscopic stone removal to a conventional double-J catheter. This single-center academic study (Fast Track Stent study 3) evaluated stenting in 108 patients with urinary calculi after ureterorenoscopy. Patients were prospectively randomized into two study arms before primary ureterorenoscopy: (1) mono-J insertion for 6 h after ureterorenoscopy and (2) double-J insertion for 3–5 days after ureterorenoscopy. Study endpoints were stent-related symptoms assessed by an ureteral stent symptom questionnaire (USSQ) and reintervention rates. Stone sizes and location, age, operation duration, BMI, and gender were recorded. Of 67 patients undergoing ureterorenoscopy, 36 patients were analyzed in the double-J arm and 31 patients in the mono-J arm. Mean operation time was 27.5 ± 1.3 min versus 24.0 ± 1.3 min, and stone size was 5.2 mm versus 4.5 mm for mono-J versus double-J, respectively (p = 0.06 and p = 0.15). FaST 3 was terminated early due to a high reintervention rate of 35.5% for the mono-J group and 16.7% for the double-J group (p = 0.27). One day after ureterorenoscopy, USSQ scores were similar between the study arms (Urinary Index: p = 0.09; Pain Index: p = 0.67). However, after 3–5 weeks, the Pain Index was significantly lower in those patients who had a double-J inserted after ureterorenoscopy (p = 0.04). Short-term insertion of mono-J post-ureterorenoscopy results in similar micturition symptoms and pain one day after ureterorenoscopy compared to double-J insertion. The reintervention rate was non-significant between the treatment groups most likely due to the early termination of the study (p = 0.27). Ethics approval/Trail Registration: No. 18-6435, 2018

Pathogen distribution and risk factors for urinary tract infection in infants and young children with retained double-J catheters.

ObjectivesTo investigate the pathogens and potential risk factors for urinary tract infection (UTI) in patients with retained double-J catheters (DJCs).MethodsIn total, 107 infants and young children with DJCs were included in this retrospective analysis. Patients were included in the infection group (n = 30) or non-infection group (n = 77), according to UTI presence or absence. The species and characteristics of pathogens were investigated, and the clinical features of the patients were recorded for further analysis.ResultsGram-negative bacilli were the most common causative pathogens (69.2%), among which Escherichia coli was most frequent (38.5%). The second most common causative pathogens were Gram-positive cocci (28.2%), among which Enterococcus faecalis was most frequent (10.3%). UTIs among patients in this study were associated with the following factors: catheter retention (long-term) (odds ratio [OR] = 2.514, 95% confidence interval [CI] = 1.176–5.373), sex (male) (OR = 2.966, 95% CI = 1.032–8.529), DJC retention (long-term) (OR = 1.869, 95% CI = 1.194–2.926), and DJC number (unilateral) (OR = 0.309, 95% CI = 0.103–0.922).ConclusionsInfants and young children with DJCs were likely to experience UTIs, mainly caused by Gram-negative bacilli. Long-term catheter retention or DJC retention, male sex, and bilateral DJC retention were risk factors for UTI.

Causes and Risk Factors for Hospital Readmission in Patients with Ureteral Stones Treated With Transurethral Lithotripsy

Introduction: Urinary tract stones are recognized as the third most prevalent disease in urology. Transurethral lithotripsy (TUL) is the most prevalent surgical modality for ureteral stones. Some patients experience hospital readmission and possibly another surgical intervention after TUL. The present study aimed to assess the causes and risk factors of readmission in patients with ureteral stones treated with TUL. Materials and Methods: This cross-sectional study was conducted on all the patients who underwent TUL in Imam Reza Hospital in Mashhad, northeast of Iran, from March 2018 to September 2019. The case group consisted of 67 patients who were hospitalized due to primary urinary stone-related complications. The patients who were admitted for the removal of double J (DJ) catheter (n=118) were regarded as the control group. Results: The most common causes of hospital readmission were re-TUL for the removal of the remnant urinary stones when patients came back for DJ catheter removal (29.9%). The second and third causes of readmission were fever after DJ catheter removal (20.9%) and fever after TUL (14.9%). The main risk factors for hospital readmission were stone size, age, and male gender. Conclusion: As evidenced by the results of the present study, stone size, age, and male gender were the major risk factors for hospital readmission after TUL. The most common causes of readmission were re-TUL at the time of DJ catheter removal, fever after DJ catheter removal, and fever after TUL.

Pyonephrosis drained by double-J catheter.

An infectious disease with obstructive hydronephrosis, pyonephrosis causes suppurative destruction of the renal parenchyma. In such cases, retrograde ureteric stenting is considered a good choice for the drainage of pyonephrosis, as an alternative to percutaneous nephrostomy and nephrectomy. The complication rate is minimal in retrograde ureteric stenting compared with about 4% in percutaneous nephrostomy.

Manejo postoperatorio de catéter doble J en ureteroscopias, síntomas y complicaciones

Antecedentes: Actualmente el 70% de los pacientes operados de ureteroscopia reciben colocación de catéter doble j debido a que se cree que disminuye la obstrucción secundaria a edema ureteral o a fragmentos de lito, pero la colocación no es inocua, ya que conlleva una gran variedad de efectos secundarios como frecuencia, urgencia, hematuria, disuria y tenesmo, así como un impacto económico. Nuestro objetivo es evaluar el manejo actual del catéter doble j en pacientes posoperados de ureteroscopia y los síntomas posquirúrgicos asociados.&#x0D; Materiales y métodos: Estudio retrospectivo de ureteroscopias realizadas en el Hospital Dr. Manuel Gea González durante el 2017 en pacientes mayores a 18 años. Se analizaron las frecuencias en readmisiones al servicio de urgencias durante la primera semana posoperatoria y los síntomas asociados al uso de catéter doble j, así como complicaciones posoperatorias.&#x0D; Resultados: Se registraron 105 ureteroscopias. El sexo masculino fue el predominante en hasta 55%; las ureteroscopias semirrígidas fueron las más prevalentes con un 71%. Se colocó preoperatoriamente catéter doble j en 69 pacientes y posoperatoriamente se colocaron en 41 pacientes. Durante el seguimiento los pacientes con colocación de catéter jj refirieron síntomas asociados a la colocación del catéter, lo cual ameritó visita a urgencias, encontrando únicamente asociación significativa para polaquiuria (p=0.001). Se obtuvo un total de 95 pacientes libre de litiasis, de los cuales a 61 (64.2%) se les colocó catéter doble j y 2 quedaron con litiasis residual y sin catéter.&#x0D; Conclusiones: De los 61 pacientes que se les colocó catéter doble j, 57 (82%) presentaron al menos un síntoma relacionado con el catéter; el 64.2% fueron ureteroscopias no complicadas a las cuales se les colocaron catéter doble j, por lo que creemos necesario realizar un estudio prospectivo y aleatorizado con un mayor número de pacientes para confirmar los resultados previamente reportados y establecer de manera más clara y objetiva las indicaciones para el uso del catéter doble j en nuestro hospital.