Left Nephrostomy Tube Research Articles

Use of a Biologic Allograft to Treat Vesicovaginal Fistula in a Patient with Cervical Cancer.

<h3>Study Objective</h3> To demonstrate the robotic treatment of a vesicovaginal fistula that occurred after chemotherapy and radiation for cervical cancer with the help of a biologic allograft. <h3>Design</h3> Video demonstration. <h3>Setting</h3> Tertiary care center. <h3>Patients or Participants</h3> Forty-five-year-old post-menopausal female para three with a history of stage 3b squamous cell carcinoma of the cervix diagnosed in 2020 status-post treatment with cisplatin, pelvic external beam radiotherapy, and left nephrostomy tube placement for hydronephrosis. She subsequently developed a vesicovaginal fistula in early 2021, which was treated with total abdominal hysterectomy, bilateral salpingectomy, vesicovaginal fistula repair and bilateral ureteral stent placement. She was discharged with a foley catheter and the left nephrostomy tube still in place. She was subsequently seen at the Urogynecology office for leakage of urine. On exam, a two-three-centimeter persistent vesicovaginal fistula was noted. <h3>Interventions</h3> She underwent re-operation with robotic lysis of adhesions, vesicovaginal fistula repair, and placement of a biologic allograft. <h3>Measurements and Main Results</h3> Her post-operative course was uncomplicated. She was seen at three weeks post-operatively, and had intermittent leakage of urine, but was otherwise healing well. <h3>Conclusion</h3> Vesicovaginal fistula in the setting of gynecologic malignancy, especially following radiation, can be more complicated to treat and more prone to failure than other etiologies. Biologic allografts may be a viable alternative to autografts in these complicated cases given their favorable biochemical properties. Controlled trials should be performed to assess the benefit of using biologic allografts to enhance complicated vesicovaginal fistula repair, and possibly reduce the need for re-operation.

31 Pessary incarceration complicated by vesicovaginal fistula requiring ureteroneocystostomy: A video case presentation

This presentation discusses a rare case of pessary incarceration complicated by vesicovaginal fistula requiring ureteroneocystostomy. The patient is an 81-year-old who presented to the office with continuous leakage of urine. She had a history of pelvic organ prolapse that was treated with a Gellhorn pessary for the past 5 years, however, she was lost to follow-up 2 years ago. On physical examination and cystoscopy, the patient’s pessary was found to be eroded into the bladder near the trigone. Office removal of the pessary was not possible. The patient initially underwent pessary removal under anesthesia with repair of her vesicovaginal fistula. On cystoscopy prior to and after the procedure, no efflux of urine was seen from the left ureter. A CT urogram performed on post-operative day 1 demonstrated hydronephrosis with obstruction of the left ureter, so a left nephrostomy tube was placed. A second CT urogram several weeks later demonstrated recurrence of the vesicovaginal fistula. One month following the initial procedure, she underwent a robotic-assisted ureteroneocystostomy with psoas hitch and vesicovaginal fistula re-closure. A postoperative CT urogram demonstrated patency of both ureters without leakage. Three weeks post-operatively she had only minor complaints, and denied leakage of urine from the vagina. A plan was made to repeat the CT urogram in 3 weeks and hopefully remove the left ureteral stent placed during her second surgery. This video enforces the importance of regular pessary follow-up, and highlights a rare but serious complication that could develop. It also showcases careful technique for robotic-assisted ureteral re-implantation.

2558 Mesenteric Panniculitis in a Young Adult: Case Report and Literature Review

INTRODUCTION: Mesenteric Panniculitis (MP) is an inflammatory condition of adipose tissue located in the small bowel mesentery. The exact cause is unknown although current literature has described some associations that may lead to its development. These include infection, paraneoplasic syndrome, history of multiple abdominal surgeries and lymphoma among others. Here we present a rare case of mesenteric panniculitis accompanied by retroperitoneal fibrosis. CASE DESCRIPTION/METHODS: The patient is a 31 year-old female with a medical history of cholecystectomy, appendectomy and Roux-en-Y gastric bypass surgery who presented to our emergency department complaining of diffuse abdominal pain, lower back pain and non-bloody vomiting for one day. Physical exam was remarkable for a scar over her right lumbar area and splenomegaly. Notable laboratory workup included an alanine transaminase of 54 IU/L, aspartate transaminase of 192 IU/L, alkaline phosphatase of 154 IU/L, total bilirubin of 0.5 mg/dL and hemoglobin of 10 gm/dL. While in the emergency department the patient underwent computed tomography of the abdomen which showed retroperitoneal fibrosis with lymphadenopathy, left sided hydronephrosis and mesenteric panniculitis (Figures 1 and 2). The patient was then admitted for further management. During her admission the gastroenterology service was consulted and their impression was mesenteric paniculitis secondary to multiple abdominal surgeries. The rheumatology service was also consulted and recommended obtaining serologies for IgG-4; ANA; ANCA; ACE; and SPEP all of which returned within normal limits. During her course the patient underwent left nephrostomy tube placement to relieve the left hydronephrosis and was otherwise treated consertivately. She was then discharged home with pain medications and follow up appointments. DISCUSSION: Mesenteric Panniculitis is characterized by inflammation of the small bowel mesentery, specifically the adipose tissue that surrounds it. Current data suggests that MP is a male predominant syndrome with a ratio of 3:1 when compared to females. Symptoms of MP are non-specific and include abdominal pain, diarrhea, weight loss, and fever. Biopsy is the gold standard for diagnosis, but imaging such as CT scan may also aid in its identification. There is no consensus regarding treatment, but many cases have been successfully treated with prednisone. Prognosis of MP is usually favorable with no follow up required if it is not associated with malignancy.

Полное замещение облитерированного мочеточника сегментом подвздошной кишки

The article presents the experience of successful surgical treatment of a patient with complete ureteral obliteration after transurethral endoscopic pyelolithotripsy in the left renal pelvis with lithoextraction and stenting. Two months later the patient developed stent obstruction and underwent repeat stenting and insertion of a left nephrostomy tube. After another 1.5 months, he was found to have complete obliteration of the left ureter. Ileal substitution of the left ureter was performed with the formation of a pyelo-ileal anastomosis and antireflux ileo-cysto-anastomosis. Contrast-enhanced MRI-urography performed on the 21st day ascertained the complete patency of the anastomosis. The patient was discharged in a satisfactory condition. At a follow-up examination five months after hospital discharge, the patient was in satisfactory condition with no complaints. Renal ultrasound and MRI showed no signs of obstruction of the ileal autograft.

A case of urinary bladder agenesis and bilateral ectopic ureters: a case report

BackgroundUrinary bladder agenesis is a very rare congenital anomaly with very few cases reported in the literature.Case presentationWe report a one-month-old baby presenting with ambiguous genitalia and recurrent urinary tract infections. Her clinical course was complicated by renal impairment. Magnetic resonant imaging (MRI) revealed a diagnosis of bladder agenesis with bilateral ectopic insertion of the ureters into the vagina, associated with several other anomalies. The patient underwent bilateral high anterior ureterostomies in an hospital abroad at 5.5 months of age. She then developed ureteral necrosis that had to be corrected with left pyeloplasty and by placing a left nephrostomy tube for drainage. Eventually, the patient’s renal function declined, and she developed chronic kidney disease (CKD).The case with its imaging findings and pathogenesis as well as a review of the literature are presented.ConclusionsUrinary bladder agenesis is a rare congenital condition that can be associated with multiple anomalies. Early diagnosis and therapeutic intervention can prevent progression to chronic kidney disease.

Hydronephrosis Secondary to an Ectopic Decidual Reaction in the Urinary Bladder

A 28-year-old pregnant woman at 19 weeks gestation presented with dysuria as well as lower abdominal and left flank pain. Imaging revealed left-sided hydronephrosis and a mass invading the posterior bladder wall. Management included placement of a left nephrostomy tube and transurethral resection of ~25% of the mass. Microscopy showed an ectopic decidual reaction within the muscularis propria. The patient improved symptomatically and continued prenatal care. Complete resolution of her ureteral obstruction was demonstrated during the postpartum period. Ectopic decidual reactions involving the urinary bladder are extremely rare, and ureteral obstruction secondary to this phenomenon has not yet been reported.

Purple Urine Bag Syndrome May Not Be Benign: A Case Report and Brief Review of the Literature

Purple urine bag syndrome (PUBS) is a rare condition in which there is purple discoloration of the urine with its collecting bag and associated tubing occurs. It is considered a benign condition. We report an unusual case of PUBS in an 87-year-old female from nursing home who had a history of recurrent UTI. She also had a history of ureteral obstruction requiring left nephrostomy tube. She was brought to emergency department with altered mental status which developed five days after the occurrence of purple discoloration of the urinary bag. Her urine culture grew vancomycin-resistant Enterococci (VRE) and Pseudomonas aeruginosa. She died within three days of hospitalization despite intensive care in tertiary center. This case highlights that PUBS may not always be benign and should be approached on a case-by-case basis because it may signal the underlying UTI which might be very difficult to treat. Failure of recognition of this peculiar color early could delay the appropriate intervention leading to fatal complication. This case also represents the rare occurrence of PUBS in the setting of nephrostomy tube.

Muscle-invasive bladder cancer in a young adult: a case report and a review of the literature.

The peak incidence of bladder cancer (BC) is in the sixth decade of life. Muscle–invasive bladder cancer (MIBC) in young adults is extremely rare. We report a case of MIBC in a 28–year–old smoking male patient. The patient presented with hematuria and flank pain for which he underwent a computerized tomography (CT) scan of the abdomen and pelvis with and without contrast. The CT scan showed a 6 cm mass on the left side of the trigone extending to the left urteric orifice and left hydronephrosis, but no lymphadenopathy was noted. The patient then underwent a left nephrostomy tube placement followed by trans–urethral resection of bladder tumor (TURBT). The tumor involved both ureteric orifices and extended to the prostatic urethra. Complete resection was not feasible. Pathology showed high–grade T1 urothelial carcinoma. CT scan of the chest showed no distant lung metastasis. The patient then elected to undergo radical cystectomy with ileal conduit urinary diversion. Final pathology revealed T2a N0 urothelial carcinoma of the bladder. Our aim is to present our experience and review the literature for the natural history and oncological and quality of life outcomes of urothelial carcinoma of the bladder in young patients.