Hydronephrosis Research Articles

Prevalence of Enterotoxemia (Pulpy Kidney Disease) in Goat: A Comprehensive Review

Goat is considered as poor man’s cow and is among the earliest small ruminant species to be domesticated and are reared for meat and milk purpose, at least since 2500 B.C. in the Middle East. Goats contributes largely to the livelihood of livestock keeping households of low- and medium-input farmers, many of whom have few resources beyond their small holdings and livestock. It has been observed that maximum production can be obtained by protecting them from different prevalent diseases like enterotoxaemia. Enterotoxaemia is a fatal disease of small and large ruminant’s animal species; severe outbreak causes huge economic losses to livestock holders. This disease is also known as pulpy kidney disease due to systemic lesions observed on kidney as it causes nephritis and hydro nephrosis. Enterotoxaemia in goats occurs in four forms, i.e. Per acute, acute, subacute and chronic form. Severe outbreak of this disease observed in warm wet weather at the time of start of monsoon season every year and is having worldwide distribution. Factors which are responsible for exposing the animals towards the enterotoxaemia are sudden changing in diet as animals diet change from poor nutrient pastures to the rich nutrient pastures and changing in environmental temperature as warm wet weather is an ideal environment for the multiplication and toxins production of disease-causing microorganism. It can be diagnosed by detection of specific antibodies, clinical signs and post-mortem lesions. Infected animals can be treated by parental injection of specific chemotherapeutic agents or antitoxins and can be controlled by changing in dietary schedule and vaccination. Still, the pathology and pathogenesis of goat enterotoxaemia is not well understood, with limited studies available in goats. This review provides details information regarding the epidemiology, pathology and pathogenesis of enterotoxaemia in goat which might be helpful for future studies.

The Outcome of Posterior Urethral Valves among Children in Tertiary Care Hospital–A Prospective Study

Introduction: Posterior Urethral Valve (PUV) is the most common cause of lower urinary tract obstruction in male children. This obstruction in posterior urethra could lead to severe dilatation of upper urinary tract and functional impairment of one or both kidney. The presentations are not always same for all patients. Early diagnosis and appropriate treatment may reduce the progressive damage and helps in recovery. Aim of the Study: The aim of this study was to find out the presentation and to assess the short term functional outcome after fulgaration of the patients with PUV. Methods: This prospective study was conducted at Pediatric urology department, Bangladesh Shishu Hospital and Institute, Dhaka. We included fifty patients with Posterior urethral valve, who were treated at the pediatric urology department from Jan, 2019 to Nov, 2021. Result: Total 50 patients enrolled in the study. In our study we found 50% of our patients were aged between 1 month to 1 year, followed by 36% were more than 1 years old and 14% were less than 1 month old. 76% patients were presented with dribbling of urine. 40%,26%,10% and 6% patients had UTI, poor stream,, retention of urine and palpable bladder respectively. 45 patients had bilateral hydronephrosis ( HDN) at presentation and only 5 had unilateral hydronephrosis in USG. At follow up MCU, 14% patients had unilateral VUR and 10% patients had bilateral VUR. Mean postoperative serum creatinine was 0.585 mg/dl. We found residual Valve in 11(22%) patients during follow up who required repeat Valve ablation. Conclusion: In our study, we found that Cystoscopic valve ablation and follow up is the treatment of choice for PUV patients which may arrest the progressive damage of renal function and facilitate the improvement. Further multicenter study and long term follow up is necessary for understanding the ultimate outcome.

PS-C26-6: HYPERTENSION DUE TO HYDRONEPHROSIS SECONDARY TO IGG4-RELATED DISEASE

Background: Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory condition that is capable of affecting multiple organs. It can present as an inflammatory pseudotumor in various organs. Patients may present with normo- or hypertension (HT) and urinary tract obstruction (UTO). Hydronephrosis (HN) leads to HT by overloading vessels or activating the renin-angiotensin system. Case presentation: A 53-year-old man presented with a two week history of abdominal pain. At admission, his blood pressure (BP) was 208/112 mmHg. His physical examination was otherwise unremarkable. Laboratory data and imaging revealed post-renal azotemia. HN was identified due to a mass around the aorta causing bilateral ureteric compression. The right ureter was considered to be more recently compressed because the left kidney cortex was more extensively thinned compared to the right kidney, respectively. Insertion of a double J stent in the right ureter led to improve urinary output with an attendant reduction of weight of 7 kg. Renal function also improved substantially (serum creatinine 5.66 mg/dL at admission; 1.34 mg/dL post-stent insertion). Initial treatment included intravenous nicardipine, followed oral nifedipine and telmisartan. With the above interventions, HT normalized to 132/71 mmHg in nine days. Finally, only telmisartan was required to maintain normal BP upon discharge. Biopsies of a salivary gland, the lip, and a cervical lymph node were non-diagnostic. The abdominal mass was not biopsied. Urine cytology was negative for malignancy three times. Serum lactate dehydrogenase was within normal limits, whereas soluble interleukin-2 receptor was elevated at 1,730 U/mL. IgG4-RD was considered as the likely cause. In accordance with current international diagnostic criteria for IgG4-RD, there was: 1) no exclusion criteria, 2) elevated serum IgG4 level, 3) hypocomplementemia, and 4) circumferential soft tissue around the infrarenal aorta. Oral corticosteroid therapy was prescribed. At 40 days post-discharge, follow-up imaging showed a slight reduction in the size of the soft tissue mass. Hypocomplementemia also showed improvement. Conclusion: HT was induced by UTO secondary to suspected IgG4-RD. It is reported that HT due to IgG4-RD occur in over one third of cases. Pathophysiology of HT includes renal parenchymal disease and HN. Laboratory data at admission revealed that the plasma renin activity and plasma aldosterone concentration were normal. His BP was ameliorated after urinary output improved, despite using antihypertensive monotherapy. Thus, we suspected that volume overload due to UTO led to HT. We suggest that HN should be considered as a differential diagnosis for the cause of HT.

Diagnostic Accuracy of Ultrasound in Detecting Ureteric Calculi as Compared to Computed Tomography taken as Gold Standard

Objective: To compare the radiological findings for ureteric calculi on Computed Tomography and Ultrasound. Methodology: In this cross sectional survey medical records of 51 patients, underwent CT KUB and Ultrasound KUB at Shalimar Hospital, visited during January 1st, 2021 to June 30th, 2021 were considered in the study. A comparison was done between the radiological findings of the USG and CT reports. CT was kept as a gold standard, and the detection of hydro-nephrosis, hydro ureter on USG was checked. Also a comparison was done on the number, size and location of stones detected on both modalities. Results: Among the patients 34 were males and 17 were female. The mean age of male patients was 42 whereas mean age of female patients was 40. The specificity and sensitivity of ultrasound for detecting ureteric calculi was 44.12% and 100%, hydronephrosis was 90% and 88% whereas for hydro ureter was 72% and 100% respectively as compared to Computed tomography. Conclusion: It can be concluded from this study that there is an agreement between USG and CT finding for ureteric calculi. USG is cost effective than CT and equally effective in detecting hydronephrosis, hydro-ureter and ureteric calculi. Keywords: Ureteric Calculi, Hydronephrosis, Hydroureter, Flank Pain, Computed tomography, Ultrasound.

Neuromyelitis optica presenting as neurogenic bladder

Neuromyelitis optica (NMO) is an immune mediated disease of central nervous system primarily affecting optic nerves, spinal cord and brain stem. This case report describes a 24-year-old male with no comorbidities presented with high grade fever followed by proximal lower limb weakness and bilateral hydrouretero nephrosis without any lower urinary tract obstruction. He had clinical features of conus- cauda lesion with MRI spine showing features of longitudinally extensive transverse myelitis (LETM) and brain MRI showing involvement of splenium of corpus callosum. He improved with steroid therapy with in a period of 2 weeks and oral steroid was tapered of and stopped within a period of two months. There was no relapse of symptoms so far.

A case report of left sided ureteric calculus cured by lycopodium clavam in lm potency

Uretric calculus or stone in ureter is one of an acute abdominal condition, if it not managed properly it may transferred to fatal condition. Calculus of ureter mainly originates from kidney & passes down to ureter. While passing down it may stuck in to the narrowest constrictions in Ureteric lumens, leads to obstruction of ureter results in Uretric colic & hydonephrosis. A case of 25yrs old male patient with of Left sided ureteric calculus of 5.6mm at Uretero-vesicular junction with ipsilateral hydro-uretero nephrosis has been successfully treated by Lycopodium as a constitutional medicine at LM potency for a duration of 50 days.

Surgical Intervention for Emphysematous Pyelonephritis – Our Experience

Introduction: Emphysematous pyelonephritis (EPN) is considered a rare renal infection. It is an acute severe necrotizing infection resulting in the production of gas in the renal parenchyma, collecting system or perinephric tissue. In this report, we describe the clinical, laboratory and imaging findings and in-hospital outcomes of EPN patients who underwent different surgical procedures. Method: This prospective observational study was carried out at BIRDEM General Hospital, Dhaka, Bangladesh between January 2018 and November 2021. Result:A total of 29 patients were recruited to the study (mean age 52.18 + 8.352 year; range 40 – 68 year) including female predominance (89.7%). Comorbidities includes diabetes (96.55%), hypertension (58.6%), acute kidney injury (58.6%), chronic kidney disease (37.9%), renal stones (20.7%), associated hydronephrosis (HDN) or hydroureteronephrosis (HDUN) (27.6%) and multiple comorbidities (93.1%). Neutrophilic leucocytosis with poor glycaemic status was common laboratory findings. CT scan used to confirm the diagnosis and classify EPN. Class 2 EPN (17%), class 3A EPN (26%), class 3B EPN (46%) and class 4 EPN (11%). Escherichia coli was the most common organism identified on urine culture (62%). Along with medical management, intervention includes DJ stenting (24.1%), incision drainage (I/D) with primary closure (65.5%), I/D with open wound (6.9%) and nephrectomy (3.4%). Mean + SD duration of drain tube was 12.36 + 4.83 days. Wound infection rate in I/D with primary closure was 15.8%. No patient died in our series. Conclusion: Multidisciplinary team approach with aggressive medical management and timely interventions are key to decrease mortality in management of EPN. The result of incision drainage with primary wound closure along with a drain tube in situ is promising. Bangladesh J. Urol. 2021; 24(2): 181-187

Predictors of successful emergency shock wave lithotripsy for acute renal colic

The role of emergency shockwave lithotripsy (SWL) in persistent pain control in patients with ureteral stones is not well established. The aim of this study is to evaluate efficacy as well as the predicting variables for successful early SWL patients with symptomatic ureteral stones. Eighty-six patients with a persistent renal colic secondary to single ureteral stone (6–12 mm) were prospectively enrolled in this study. SWL was performed within 24 h of the onset of flank pain. Pain control and stone-free rate after emergency SWL session were 58.1% and 44.2%, respectively. Seven patients required post-SWL ureteroscopy and ureteral stent placement for uncontrolled pain. The overall 3-month stone-free rate after SWL monotherapy was 83.7%. On multivariate analysis, predictors for pain relief after emergency SWL were lower Hounsfield (HU) stone density, mild hydronephrosis (HN) at presentation and presentation during the first colic episode. Lower HU stone density was the single predictor of successful stone clearance after single emergency SWL session on multivariate analysis. In conclusion, early SWL is feasible and effective in management of ureteral stones presented by renal colic with low HU.

Evaluation of renal function after pyeloplasty determined by 99mTc DTPA renogram

Background: Hydronephrosis (HDN) due to pelviureteric junction (PUJ) obstruction is a common congenital anomaly of urinary tract which is generally treated by pyeloplasty. But the extent of functional recovery is still debated. Considering the existing controversies, this study was designed to evaluate the changes of renal function after pyeloplasty measured by 99mTc-DTPA renography.
 Methods: This study was done in the department of urology, National Institute of Kidney Diseases and Urology (NIKDU) and Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital from July 2014 to December 2020. Sixty patients were included in this study and underwent Anderson-Hynes (A-H) dismembered pyeloplasty for PUJ obstruction. All patients were evaluated with diuretic 99mTc-DTPA renogoam before and at 3 and 6 months after pyeloplasty. Improvement of renal function was evaluated by comparing preoperative and postoperative differential renal function (DRF) and glomerular filtration rate (GFR).
 Results: Sixty patients (34 male and 26 female) with unilateral HDN due to PUJ obstruction were included in this study with mean age of 15.6 years (ranged from 3 – 38 years). Out of 60 patients, 56.7% had left sided HDN and 43.3% had right sided HDN. The mean preoperative DRF was 16.72 ± 8.35% at baseline which increased to 26.03 ± 7.08% at the end of 3rd month and 28.15 ± 5.84% at the end of 6th month. The mean preoperative GFR was 14.29 ± 6.73 ml/min/1.73 m2 at baseline which increased to 24.13 ± 5.31ml/min/1.73 m2 at the end of 3rd month and 27.38 ± 4.78 ml/min/1.73 m2 at the end of 6th month.
 Conclusion: The result demonstrates that, after pyeloplasty renal function improves. Highest recovery of renal function noted in patients with poor pre-operative DRF and GFR.
 BIRDEM Med J 2022; 12(2): 142-146

Frequency of Urinary Tract Abnormalities on Ultrasound with Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia is a common problem effecting the men with increasing age which can cause many complications. Objective: To find out the frequency of Urinary Tract Abnormalities on Ultrasound associated with BPH. Methods: Descriptive study with sample size of 230 patients, conducted at Gilani Ultrasound Centre Lahore and Sanabil Health Services From July to November 2021.All patients coming with BPH were included in this study and their KUB scan done to diagnosed any urinary tract abnormalities. A convex transducer with a frequency of 3.5 to 5MHz was used for transabdominal scanning. Results: There were total of 230 patients who were presented with Benign prostate hyperplasia on Ultrasound scan, the minimum age ranged was 26 and maximum age was 90. In this study, Normal patients was 77 with 33.3%, Bilateral Hydronephrosis was in 3 patients 1.3%, Bilateral hydronephrosis with right sided Hydro ureter was in 1 patient 0.4%, Bilateral renal stones was in 3 patients 1.3%,Cystitis was in 50 patients 21.6%, Left renal cyst was in 9 patients 3.9%. Conclusion: Our study concluded that the patients coming with BPH presented with different urinary tract abnormalities on Ultrasound. Vesicoureteral reflux may concur the extravasation of urine may rarely occur due to bladder outlet obstruction in patients with BPH. BPH is a risk factor to develop UTI, cystitis, hydronephrosis and hydroureter

Evaluating TIMP-2 and IGFBP-7 as a predictive tool for kidney injury in ureteropelvic junction obstruction.

ABSTRACTA major challenge in the management of ureteropelvic junction obstruction (UPJO) is the selection of patients who would benefit from surgical treatment. Tissue inhibitor metalloproteinase-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) indicate renal cell stress and are associated with cell cycle arrest. The [TIMP-2] [IGFBP7] ratio (Nephrocheck®) has been recently applied in patients in intensive care units patients to predict the development of acute kidney injury. In this study, we evaluated the performance of these biomarkers performance to distinguishing obstructive hydronephrosis (HN) from non-obstructive HN.Materials and Methods:Consecutive patients with UPJO were enrolled in this study. Urinary [TIMP-2] [IGFBP7] and clinical characteristics (hydronephrosis grade, differential renal function, and drainage half-time) were measured in the following groups: 26 children with obstructive HN at initial diagnosis (group 1A) and after six months of dismembered pyeloplasty (group 1B); 22 children with non-obstructive HN (group 2), and 26 children without any urinary tract condition, as the control group (group 3).Results:Comparing the initial samples, [TIMP-2] [IGFBP7] had higher levels in the HN groups and lower levels in the control group; however, no difference was observed between the HN groups (obstructive vs. non-obstructive). After six months of follow-up, patients who underwent dismembered pyeloplasty showed stability in the urinary concentration of [TIMP-2] [IGFBP7]. All patients with [TIMP-2] [IGFBP7] higher than 1.0 (ng/mL)2/1000 had diffuse cortical atrophy on ultrasonography.Conclusions:We showed that urinary levels of urinary [TIMP-2] [IGFBP7] are higher in children with HN than controls. Nephrocheck® is not reliable in predicting the need for surgical intervention for pediatric patients with UPJO.

Prenatal hydronephrosis: Bridging pre- and postnatal management.

Urinary tract dilation (UTD), including hydronephrosis (HN) is the most common prenatally detected anomaly and affects up to 1%-2% of pregnancies. Postnatally, it resolves without surgical intervention in approximately 75%-80% of children, however this may take several years to occur, necessitating repeated clinic visits and additional invasive testing for many. For the remainder, a surgical intervention will be offered to relieve obstruction or to correct vesicoureteral reflux. During the monitoring period, many of these infants will be offered continuous antibiotic prophylaxis for the prevention of urinary tract infections, however this remains a controversial topic among pediatric urologists and nephrologists. Herein, we present an up-to-date review of the early management of prenatally detected UTD including timing of postnatal imaging, the use of antibiotics, when circumcision may be beneficial and long term outcomes of the most common HN etiologies. We also propose a decision making tool to help guide the care of infants with UTD.

Impact of hydronephrosis and kidney function on survival in newly diagnosed advanced cervical cancer

ObjectivesTo assess the impact of hydronephrosis and kidney function in newly diagnosed advanced cervical cancer patients. MethodsA retrospective cohort study of newly diagnosed cervical cancer stage IIIB to IVB was conducted in a tertiary hospital in Brazil. Data from clinical records between 2014 and 2018 were reviewed. ResultsA total of 285 women with advanced cervical cancer and no previous cancer treatment were included. 108 (37.9%) patients were diagnosed with hydronephrosis (HN) before or during the first treatment, 49 (17.2%) patients underwent ureteral obstruction relief, and emergency hemodialysis was performed in 17 patients due to uremia. The median overall survival (mOS) was 46.9 months for non-HN, 19.2 months for unilateral-HN, and 10.0 months for bilateral-HN (non-HN vs HN-groups, p = 0.0001). Patients with eGFR >= 60 mL/min/1.73 m2, before or during the first cancer treatment, had mOS of 46.9 months, 23.5 months, and 11.1 months for non-HN, unilateral-HN and bilateral-HN, respectively (non-HN vs bilateral-HN, p = 0.002). Patients with eGFR < 60 mL/min/1.73 m2 had mOS 23.4 months, 19.2 months, and 10.0 months for non-HN, unilateral-HN and bilateral-HN, respectively (non-HN vs bilateral-HN, p = 0.003). In the HN group, mOS was 11.2 months among those who underwent urinary diversion and 15.6 months among those who did not; p = 0.2. On multivariate analysis, cancer treatment, FIGO stage, and HN were prognostic factors for OS; however eGFR < 60 mL/min/1.73 m2 does not appear to be associated with worse survival by itself (p = 0.7). ConclusionHN seems to have a negative effect on survival of patients with cervical cancer even after adjustment for FIGO stage and cancer treatment. The mOS does not appear to be worse in patients with HN who required urinary diversion compared to those who did not.

Outcome of Patients with Antenatally Diagnosed hydronephrosis with Respect to Postnatal Diagnosis and Need for Surgical Intervention.

ABSTRACTAims:This study aims to determine the etiology of antenatal hydronephrosis (ANH) and predict need for surgical intervention based on antenatal renal pelvis anteroposterior diameter (APD).Materials and Methods:Combined prospective and retrospective study (2012–2018) of ANH cases with postnatal follow-up. Surgical intervention was correlated with the degree of hydronephrosis (HDN) and pelvis APD measured at the 2nd trimester, 3rd trimester, and postnatal 6-week follow-up.Results:One hundred and sixty-five patients were studied with a total of 219 ANH units. Transient HDN was seen in 116 units. Surgical intervention included pyeloplasty (n = 76), sub ureteric dextranomer injection (n = 8) and nephrectomy (n = 1). Chances of requiring surgery based on the degree of HDN in 2nd and 3rd trimester respectively were mild: 11.32% and 9.52%, moderate: 34.21% and 37.03% and severe: 85.71% and 86.27%. The mean increase in APD between the 2nd and 3rd trimester (n = 50) was lesser in conservatively managed (3.548 ± 4.219 mm) than surgically managed (8.261 ± 5.857 mm) patients (P = 0.002). In another subset (n = 37), the mean increase in APD between the 2nd trimester and postnatal period was less in conservatively managed (1.432 ± 0.612 mm) (P = 0.088) than surgically managed patients (12.91 ± 3.247 mm) (P = 0.004). The area under the receiver operating characteristic (ROC) curve showed that an APD of 8.2 mm in the 2nd trimester and 12.85 mm in the 3rd trimester correlated with the requirement of postnatal surgery.Conclusion:Apart from the degree of HDN, significant changes in APD between 2nd and 3rd trimester and cut off value suggested by the ROC curve will help during antenatal counseling with regard to requirement of postnatal surgery.

УСОВЕРШЕНСТВОВАНИЕ МЕТОДА ЭКСТРАВЕЗИКАЛЬНОЙ РЕИМПЛАНТАЦИИ МОЧЕТОЧНИКА

Objective: To optimize the technique of extravesical ureteral reimplantation in experimental animals. Methods: Experiments were carried out on 21 Flanders rabbits. Initially, ureterohydronephrosis (UHN) was modeled by alcoholization of the ureter in its vesical part according to the method of Ya.V. Gudynsky. After 21 days, the animals underwent extravesical ureteral reimplantation using the technique optimized by the team of urologists. Results: The stents were removed endoscopically on the 20th day. In order to exclude vesicoureteral reflux, contrast cystography was performed, in which reflux was not detected. To exclude obstruction, on the 30th, 60th, and 90th days after the operation, an ultrasound scanning of the urinary system was performed, in which the presence of UHN was not noted. On the 90th day, the experimental animals underwent resection of the anastomotic zone for histological examination. It was found that the diameter of the transplanted segment corresponded to the normal size of the rabbit ureter, there was a slight thickening of the ureteric wall, its hypertrophy, and intracellular hyperplasia. Conclusion: The effectiveness and safety of the proposed method of extravesical ureteral reimplantation with antireflux protection has been experimentally proven. Keywords: Ureter, urodynamics, obstruction, ureterohydronephrosis, megaureter.

Correlation of Plasma Renin Activity Values and Resistive Index on Ultrasound Doppler with Findings of Renal Dynamic Scan in Patients with the Society of Fetal Ultrasound grades 3 and 4 Unilateral Hydronephrosis.

Renal dynamic scans (RDS) despite being considered the gold standard for the diagnosis of pelvic ureteric junction obstruction (PUJO), fail to help resolve the dilemma about management issues in many patients. Multiple invasive and noninvasive methods are being studied to help the decision-making in these patients. We did this study to find correlation of plasma renin activity (PRA) values and resistive index (RI) on Doppler ultrasound with findings of RDS in patients with the Society for Fetal Urology (SFU) Grades 3 and 4 unilateral hydronephrosis (HDN) and also to determine the cut-off values of PRA and RI that could categorically acknowledge the success of pyeloplasty. Twenty patients with SFU Grades 3 and 4 unilateral HDN due to PUJO were enrolled. Demographic details were recorded. All underwent Anderson-Hynes dismembered pyeloplasty. Based on the follow-up RDS scans, these patients could fall into one of three categories- improved (successful), status quo, or deteriorated (unsuccessful). Outcomes were compared based on RDS (split renal function [SRF]), ultrasonography, and Doppler findings were done at 3 months of postoperative period. Follow up period was 3 months after Pyeloplasty. Seventeen patients had successful outcomes based on RDS findings, 12 had improvement in SRF (>5%), and 6 had normal drainage curves (t-t1/2<10 min). Three patients had indeterminate curves (t-t1/2between 10 to 20 min). Four had improvement on both the criteria, i.e., SRF and drainage curves. Among the three patients who showed no improvement in RDS, two were in "status quo" category and one patient showed deterioration. Seventeen patients also showed improvement in PRA and RI. No significant correlation between PRA and RI with SRF could be established. However, PRA was found to have good concordance with RDS (90%). No significant correlation could be demonstrated between SRF and the respective values of PRA and RI. However, PRA could act as an adjunct to predict the early success of pyeloplasty in view of good concordance with RDS. A larger trial with bigger cohort of patients is required to confirm our contention.

Leiomyosarcoma causing obstructive uropathy and acute renal failure

Abstract A 41-year-old nulliparous woman presented to the hospital with lower abdominal pain for 15 days and constipation since 1 week and acute retention of urine for 3 days. Ultrasound revealed enlarged uterus with a large posterior wall fibroid with degenerative changes and bilateral mild hydro ureteronephrosis and MRI pelvis with contrast showed 17 × 10 × 12 cm pelvic mass along the posterior wall of the uterus with cystic degeneration and necrosis minimal haemorrhage with multiple fibrotic strands. Enlarged bilateral external internal, right iliac and lymph nodes noted. Laboratory evaluation revealed an elevated urea 101 mg/dl and creatinine levels 9.4 mg/dL with normal myoglobin levels (39 ng/mL). The patient was haemodynamically stable with serum electrolytes and ABG normal. After taking a nephrologist and urologist opinion and proper counselling for exploratory laparotomy +/- hysterectomy, proceeded with total abdominal hysterectomy. Immediate improvement of renal parameters and reversal of renal failure was noted and

Autoaugmentation: A Feasible Option before Ileal Augmentation in Selected Cases

Abstract Purpose To evaluate the long-term outcomes of autoaugmentation (AA) in pediatric population. Materials and Methods The data of 59 patients (32 females and 27 males) who underwent AA between 1993 and 2018 were analyzed retrospectively. During postoperative follow-up, deterioration on renal scan and/or nonimproved hydronephrosis (HN) were described as upper urinary tract (UUT) impairment. Incontinence was described as use of diaper or pad. Preoperative urodynamic volume was divided into two as less than 50 and more than or equal to 50% expected bladder capacity (EBC). The effect of preoperative clinical factors on reaugmentation, incontinence, and UUT impairment was evaluated. Results The mean age and the median follow-up were 8.9 ± 3.6 years and 64 (12–218) months, respectively. Ten (16.9%) patients underwent reaugmentation (ureteral or ileal). UUT impairment and incontinence rates were 13.6% (8/59) and 30.5% (18/59), respectively. On multivariate analysis, less than 50% EBC was the only predictor of reaugmentation and incontinence (p = 0.013, odds ratio [OR]: 17.546 and p = 0.035, OR: 3.750, respectively). Preoperative HN was predictor of UUT impairment (p = 0.041, OR: 10.168). After AA, 51 patients used clean intermittent catheter and 27 (45.8%) patients discontinued the use of anticholinergic medication. At follow-up, eight (13.5%) patients underwent surgery after AA due to long-term complications, dissatisfaction, or poor functional results (bladder neck injection, cystolithotripsy, Mitrofanoff revision, dilatation, and injection). Conclusion AA is a viable option in selected cases with high pressure and low compliant bladders. Preoperative bladder capacity is significant for reaugmentation rate and continence. UUT impairment is related to preoperative HN.

Early diagnosis and management of maternal ureterohydronephrosis during pregnancy.

Maternal ureterohydronephrosis (UHN) is a common anatomical change during the evolution of pregnancy, diagnosed especially after the 20th week of pregnancy. The aim of the present study was to evaluate the stages of UHN during pregnancy, depending on the gestational age, and to monitor the symptomatology and the adequate management. A total of 58 pregnant women with UHN, hospitalized in the Constanta County Emergency Hospital, were included in the present study, and had nephrological monitoring using ultrasound examination. Right UHN was observed in all cases and left UHN was observed in only 67.24% of the cases. Regarding the gestational age, right UHN grade III was most commonly seen between 27 and 31 weeks of pregnancy (48.6% of total right UHN grade III from the studied group). The data showed that gestational age and grade of UHN had a highly dependent association in the studied group. The majority of our patients (67.24%) were symptomatic, and the most common complaint on presentation was lumbar pain. According to the visual analog scale (VAS) of the lumbar pain, the group could be distributed as follows: 17.24% with severe pain, 36.21% with moderate pain and 13.79% with mild pain. Eight pregnant women (13.79%) from the present study developed UHN due to passage of a ureteral stone, although the majority of the patients experienced complications with urinary tract infection and acute kidney injury. In addition, 97% of the symptomatic UHN responded to conservatory treatment and only 2 patients (3.45%) with severe symptomatic UHN needed ureteral stent insertion. Data analysis was performed using IBM SPSS Statistics 23. The study highlighted the existence of an association between gestational age and UHN grading.

Urinary Tract Infections Spectrum During Pregnancy: Etiopathogenesis and Outcome

Abstract Background :The occurence of urinary tract infections (UTIs) in the course of a normal pregnancy should always be early diagnosed and treated, even asymptomatic as it could evolve to threatening pathological conditions, like sepsis with acute kidney injury, or preeclampsia. The aim of study was to establish a cartographic projection of the risk factors and etiopathogenesis of urinary tract infections diagnosed during pregnancy, with the purpose to control their severity and evaluate the therapeutic strategies used to reduce maternal and fetal risks. Material and methods: The study included 175 patients, pregnant women, diagnosed with UTIs hospitalized in the Nephrology Clinic and Obstetrics-Gynecology Clinic of the Emergency Clinical County Hospital of Constanta, in an interval of time of 4 years, between 2017-2021. Results: Out of the 247 patients recruited in our study, the distribution according to the trimester of pregnancy, there were : 72 pregnant women in the first trimester (41.14%), 35 in the second trimester (20.0%) and 68 in the third trimester (38.86%). The frequency of pregnant women who had other favorising conditions and detectable risk factors was 70.29%. The clinical manifestations of UTIs in our study group were distributed as follows : 36 (20.57%) asymptomatic bacteriuria, 56 (32.0%) acute cystitis, 44 (25.14%) recurrent lower urinary tract infections, and 39 (22.29%) acute pyelonephritis. There is an association (p ---lt--- 0.001) between the type of clinical form of UTIs and a certain trimester of pregnancy, for example the highest frequency of acute pyelonephritis (AP) was noticed in the third trimester of pregnancy (71.8%, 28/39). Out of 39 pregnant women with AP, 71.8% (28) had associated ureterohydronephrosis (UHN). E. Coli was present in 41.71% of pregnant women., followed by Klebsiella pneumoniae, Enterococcus faecalis and, less frequently, Staphylococcus aureus and Proteus mirabilis. The most frequently used antibiotics in pregnancy were: 2nd and 3rd generations of cephalosporins (42.29%), followed by ampicillin (34.29%); less used were amoxicillin with clavulanic acid (10.29%), quinolones (6.29%) and nitrofurantoin (6.86%). Most of the pregnant women (94.28%, 165/175) had remission of fever within 24-48 h of using appropriate antibiotic therapy. The recurrence rate was 22.28 %, (39/175). Conclusion All clinical forms of UTIs could be present during pregnancy, but the most common are lower urinary tract infections and the most involved germ is E. Coli. UHN is a factor that influences the occurence of UTIs, being the most common favorising condition.