Episodes Of Urinary Infection Research Articles

Vaginal Insertion of Ectopic Ureter Diagnosed in Adulthood, the First Case in Bosnia and Herzegovina

An ectopic ureter is defined as a ureter that does not insert into the normal anatomical position. The occurrence of ectopic ureters is 1/2,000 in newborns and 1/2,000–4,000 in the general population. In most cases the ectopic ureter is associated with a duplicated renal collecting system, while in 20% a single system is found. The majority of cases are diagnosed during childhood as a result of continuous urinary dribbling or recurrent urinary tract infections. In ectopic ureteral openings, diagnosis is often delayed because of inadequate evaluation; in addition, most diagnostic methods do not provide sufficient information about ectopic ureteral openings. In this particular case, we report on a patient with urinary incontinence and frequent episodes of urinary infections. In her childhood, she exhibited enuresis and was examined by a psychiatrist, followed by a neurologist and a gynecologist. CT urography revealed mainly hydronephrosis of the upper pole of the right kidney and a duplicate ureter on the right side, but not duplicate ureter insertion. Percutaneous nephrostomy was performed, with insertion of methylene blue into the collecting system. After the clinical investigation of the vagina with a speculum, a was observed blue dot at the vaginal fornix. Right partial upper pole nephrectomy and ureterectomy were performed. An ectopic ureter opening is a clinical entity, rarely observed in a small country such as Bosnia and Herzegovina, but should be kept in mind during clinical evaluation of patients with incontinence, irrespective of the patient’s age.

POS-710 KIDNEY TRANSPLANT RECIPIENTS WITH A PRETRANSPLANTATION CANCER HISTORY

Pretransplant malignancy (PTM) in remission has long been considered a relative contraindication for organ transplantation due to the heightened risk of cancer recurrence associated with immunosuppression used after transplantation. In recent years, older patients are being accepted for transplantation. The purpose of this study was to investigate overall and cause-specific mortality in kidney transplant patients with a history of malignancy, to evaluate overall survival and cancer-related outcomes. We conducted a retrospective descriptive study collecting all cases of kidney transplanted patient with cancer history in the nephrology department over a period of forty years A total of three patients with cancer history underwent a kidney transplantation Case 1. A 56-year-old man underwent kidney transplantation because of bilateral nephrectomy. Right nephrectomy indicated in front of non-functional lithiasis kidney and a left nephrectomy indicated in front of vesical tumor invasion. Sixteen years before the transplant he was diagnosed as having a vesical tumor GII PT1. During his nine years of follow up he has had an episode of urinary infection, an episode of rejection and an episode of endocarditis. There has been no recurrence of malignancy. Case 2. A 45-year-old women underwent kidney transplantation because of vascular nephropathy. Two years before the transplant she underwent a thyroidectomy as treatment of papillary thyroid carcinoma and since then he has been considered cured. During her three years of follow up she has had an episode of rejection, an episode of urinary infection, a serous cystadenoma after one year of transplantation indicated the switch by sirolimus and cortico-induced diabetes. There has been no recurrence of malignancy. Case 3. A 65-year-old women underwent kidney transplantation because of chronic glomerular nephropathy. Eleven years before the transplant she underwent a radical mastectomy followed by hormonal therapy as treatment for breast cancer. During her five years of follow up she has had many episode of urinary infection, cortico-induced diabetes and an episode of ischemic cerebrovascular accident. There has been no recurrence of malignancy. Our findings indicate that there is no significant morbidity from recurrence cancer and no development of secondary type of cancers in pre-existing malignancies. But we must be careful about risk of rejection. The factors that should be considered in each individual case are the type and extent of cancer and the duration between diagnosis and the proposed transplant.

Spinal muscular atrophy (SMA) from the urological point of view: Assessment of the urinary function in 38 patients

Abstract Spinal muscular atrophy (SMA) includes genetic heterogeneous diseases characterized by muscle weakness and atrophy. There are at least two risk factors for SMA patients to develop urinary dysfunctions: 1) the neural degeneration, that influences the pelvic floor and sphincters; 2) the disabilities that predispose to constipation and urinary incontinence and symptoms. Nevertheless, the true incidence of urological disorders remains unknown. The evaluation of urinary symptoms in SMA patients remains scarcely investigated. The aim of our paper is to assess the association between urological disorders and SMA. We worked out a questionnaire to assess the voiding habits of patients with SMA followed at a single Italian Centre. We collected demographic data and information regarding respiratory, orthopedic and gastrointestinal involvement. We excluded patients <5 years of age. 38 patients were evaluated at a mean age of 12 years. Twenty-five patients had Type 2SMA, 13 Type 1 SMA. The respiratory system was involved in 35 patients, PEG was performed in 7 for failure to thrive and 26 suffered from constipation. Fifteen out of 38 (39%) patients wear diapers for urinary incontinence or for convenience. Two patients presented recurrent urinary retention requiring catheterization. No episodes of urinary infections nor urolithiasis were observed. Urinary function parameters were within the normal range. Our results suggest that the urinary function of SMA patients seems good. Nevertheless, a thorough urinary assessment in early childhood is important to identify bad habits in order to reduce the daily discomfort improving the quality of life.

Infekcije urinarnog trakta kod žena u menopauzi

Urinary infections are, by frequency, in the second place, immediately behind respiratory infections. The prevalence of urinary tract infections is generally increasing. UTI (urinary tract infections) is more common in women and very young people. The rates of occurrence generally reflect predisposing factors such as congenital anomalies in childhood, the onset of sexual activity, especially in women, and, of course, postmenopausal changes in older women. It is assumed that 50-60% of women can expect an episode of urinary infection during their lifetime. In postmenopausal women, there is a deficit in estrogen. It is one of the important factors that indirectly protects the vaginal mucous membranes as well as the uroepitel from infection. Bacteria from the digestive tract colonize the skin of the perineum, then the vulva, the vagina and the outer opening of the urethra. Normal vaginal flora (lactobacilli) protects the vagina from colonization by fecal bacteria because it lowers pH and creates unfavorable conditions for survival of bacteria.

Research Concerning the Correlations Between Urinary Tract Infections and Congenital Malformations of the Renourinary System

Abstract Introduction: Congenital malformations of the urinary system are risk factors for the development of urinary tract infections (UTI). Besides the severity of the malformation, urinary infection is always associated with poor prognosis for these patients. Late discovery of the malformation background, after several urinary tract infection episodes, contributes to the development of chronic pyelonephritis that may lead to chronic renal failure. Material and method: The study involved patients with renal and urinary tract congenital malformations treated at the Pediatric Nephrology Department from Tîrgu Mureș over a period of 6 years, who associated urinary tract infection. Results: Out of the total of 432 patients with congenital malformations of the urinary system, 270 had had at least one or several episode(s) of urinary tract infections in their medical history. Vesico-ureteral reflux and obstructive lesions of the urinary tract were most frequently associated with urinary infections. During the time when no ultrasound screening had been performed, the malformation background was usually diagnosed at the time of the first urinary infection episodes. Conclusions: The incidence of urinary tract infections in patients with renal and urinary tract congenital malformations depends on the type of the underlying malformation, and the time of diagnosis of the malformation background. Prevention of irreversible complications requires early diagnosis of the urinary system malformations that can be performed through ultrasound screening in the neonatal period.

Urinary Tract Infections in polycystic Kidney Disease

The aim of this study was to evaluate the bacteriological findings and the frequency of urinary tract infections in autosomal dominant polycystic kidney disease and their impact on renal function. One hundred eighty patients with autosomal dominant polycystic kidney disease were studied from 2003 to 2008. Subjects were considered as having urinary tract infections if they had had one or more episodes of urinary infection. The antibiotic therapy for the treatment has been adapted according to the bacteriological findings. Urinary tract infections were observed in 60% of our patients (108 patients), and were more frequent in women than in men. The infections were typically caused by gram negative enteric organisms. Blood culture was positive in 10%, while urine culture was negative in 40%. The episodes of isolated cyst infections (negative urine culture and absence of white blood cell casts in urinary sediment) were more frequent than those of acute or chronic pyelonephritis (urinary sediment was positive for white blood cell casts). We conclude that urinary tract infections are frequent in our patients with autosomal dominant polycystic kidney disease. Distinguishing between cyst infection and acute or chronic pyelonephritis is often a challenge, and the diagnosis relies mainly on clinical and bacteriological findings.

Five cases of severe vesico-ureteric reflux in a family with an X-linked compatible trait

Vesico-ureteric reflux (VUR) is one the most common inherited disorder in humans. Even though this defect is common among siblings and parents of index patients (27-40%), the mode of inheritance is not well defined. Parents and siblings (three female and two male) of a 13-year-old girl with end-stage renal failure (ESRF) due to reflux nephropathy were screened for VUR although they had not presented episodes of urinary tract infection. VUR was identified in the father (44 years old) and in all the three sisters (aged 15 years, 16 years and 18 years) while the two brothers (aged 5 years and 8 years) had normal renal ultrasonograms and cystograms. A technetium-99m di-mercapto-succinic acid ((99m)Tc-DMSA) scan demonstrated renal scars in the father and in two of the sisters with VUR. No episodes of urinary infection had been documented for any relatives. Haplotype analysis on the X-chromosome confirmed paternity. This is the first description of VUR compatible with an X-dominant trait. This mode of inheritance must be added to what is already known on familial VUR, and future studies should also consider this possibility.

Calidad de vida en las pacientes con incontinencia urinaria

ObjectiveTo assess the quality of life of female patients with urinary stress incontinence (USI) who were attended at the urology department of the University Hospital at Albacete. MethodBetween November 2001 and December 2005, 126 patients with USI were surveyed in our hospital using the King’s Health Questionnaire (KHQ), which is a specific instrument to measure the quality of life among female patients with urinary incontinence (UI). ResultsThe mean age of patients was 57.09 años (SD: 9.57) and the mean BMI was 28.14 Kg/m2 (SD: 4.66). The mean evolution of UI was 114.48 months, with a median of 96 months. During the last week of the study period, a total of 73 women (57.94%) had more than 10 urine leaks a day. As regards the number of sanitary towels used a day, 82.5% (104 cases) stated they used less than 6. The urodynamic diagnosis was described as normal in 8 cases (6.3%), 16 cases (12.7%) were diagnosed as mixed urinary incontinence and, finally, 102 cases (81%) suffered genuine USI. The best scores were presented in the Personal Relationships scale with a mean score of 26.8, whereas the worse scores were noted in that of Impact of Urinary Incontinence, whose mean score was 82.96. Generally, the lowest scores (better quality of life) were obtained in the youngest age groups. Scores in the scales of General Health, Impact on daily activities, Impact on physical activity, Impact on social activity and Emotions, were significantly higher in patients who had undergone a histerectomy. Patients whose evolution of urinary incontinence was longer presented lower scores in the Personal Relationships scale (r=0.179; p=0.045). ConclusionsThe quality of life of female patients with U.I. is affected, which limits both their physical activity and image. Their quality of life worsens with age, a greater extent of incontinence, greater urinary symptomatology and when episodes of urinary infection are associated.

Laparoscopy-Assisted Transperitoneal Percutaneous Nephrolithotomy for Recurrent Calculus in Isthmic Calix of Horseshoe Kidney

Management of urolithiasis in a horseshoe kidney (HSK) poses a unique challenge. Although most patients can be managed by a combination of percutaneous nephrolithotomy (PCNL) and extracorporeal shockwave lithotripsy (SWL), calculi in the isthmic calix remain difficult to treat, as this area is out of reach during rigid PCNL, and, owing to the poor evacuation of the fragments, the results of SWL are suboptimal. A 59-year-old man known to have an HSK presented with right-sided lower-abdominal pain and episodes of urinary infection. In the past, he had undergone pyelolithotomy and lithotripsy for lithiasis in the kidney. Imaging studies identified a large recurrent calculus in the anteriorly directed isthmic calix. This was treated successfully by a laparoscopy-assisted transperitoneal PCNL. The laparoscopic view allowed the bowel to be retracted away from the site of the HSK, and PCNL guided by fluoroscopy and laparoscopy was performed. Complete stone clearance was achieved in a single stage. The patient remains free of symptoms and recurrence 3 months later. We believe this to be the first report describing this novel approach to lithiasis in an HSK.

Pelvi-ureteric junction obstruction by crossing renal vessels: clinical and imaging features.

To present the characteristic clinical and imaging findings of pelvi-ureteric junction (PUJ) obstruction caused by crossing renal vessels (CRV), as it presents particular features within the spectrum of congenital hydronephrosis. Between April 1982 and December 2000, 384 children underwent surgery for PUJ obstruction. In 71 (18.5%; mean age 8.5 years, range 2 months to 14 years; 49 aged> 5 years), the obstruction was caused by CRV. The data collected from the medical records of these patients were analysed for their clinical presentation and imaging findings, i.e. ultrasonography (US), intravenous urography (IVU) and diuretic renography. The main presenting symptom was recurrent renal colic (pain, nausea, vomiting) in 59%, followed by urinary infection (UTI) in 20%, gross haematuria in 11% and an incidental diagnosis in 10%. By contrast, in the 313 children with intrinsic PUJ obstruction, renal colic was present in only 10.5%. Moreover, from 1991 to 2000, when the use of prenatal US became widespread, hydronephrosis was detected prenatally in 42 of 212 children (20%) with intrinsic PUJ obstruction, but in only two of 31 (6%) with obstruction by CRV. However, in 10 children with CRV operated on during this period, prenatal US had shown mild hydronephrosis (< 15 mm), which during the follow-up decreased until the children became symptomatic after 5-9 years (eight renal colic, two UTI). US during acute symptoms showed significant hydronephrosis (> 25 mm), and colour Doppler US of two patients directly showed the CRV. In all 71 children with CRV obstruction diuretic IVU and renography during the acute symptoms had an obstructive pattern, and in 24 renal colic was reproduced during the examination. The differential kidney function was < 40% in 11 children who presented with UTI; two required nephrectomy and in the remaining 69 an Anderson-Hynes pyeloplasty, after which none had an episode of renal colic or UTI during a mean (range) follow-up of 10.2 (2-20) years. PUJ obstruction by CRV should be suspected in older children presenting with recurrent renal colic and hydronephrosis. Good kidney function is expected in most of these children, despite their age, because the vascular obstruction is intermittent. Mild prenatal hydronephrosis that could decrease postnatally does not exclude the possibility of vascular obstruction, which may later become symptomatic. Imaging (US, diuretic IVU and renography) during an episode of pain is essential and colour Doppler US could help to establish the diagnosis in these cases. Knowing that a child has a CRV is important for choosing an open surgical approach rather than endoscopic pyelotomy, to avoid potential complications

Ano-Rectal Malformation and Recurring Orchioepididymitis in Infants

The case of a newborn boy is reported, incorrectly diagnosed as anal agenesis without urethrae fistula and treated by anoplasty. The patient later suffered several episodes of urinary infection and left epididymo-orchitis-orchioepididymitis, reflux of contrast being shown at micturating cystourethrography into the right vas deferens, the seminal vesicle, epididymis and left testicle. Rectal endoscopy revealed a rectourethral fistula, confirmed by fistulography. The patient improved after surgical removal of the fistula.

An unusual case of haematuria

A 40-YEAR-OLD MAN presented with a 3-month history of painless haematuria. He had been tetraplegic from the age of 21 following a road traffic accident, and had a neurogenic bladder with frequent episodes of urinary infection. He was otherwise well with no history of weight loss and no symptoms referable to the respiratory or cardiovascular systems. He was a life-long nonsmoker, lived with his wife and an adopted daughter. Despite his disability he was in full-time employment as a bank clerk. He had no prior exposure to chemicals or asbestos, and at presentation was taking only muscle relaxants for lower limb spasms. Examination on referral revealed that he was tetraplegic in keeping with his history of cervical trauma. He was otherwise well with no evidence of weight loss and no palpable lymphadenopathy. Examination of the chest and abdomen revealed no abnormality. At presentation he had an indwelling urinary catheter.