Nephrostomy Tube Research Articles

Percutaneous nephrostomy tube versus double J ureteric stent for the management of non-septic calcular anuria in adults: Prospective randomized study

ABSTRACT Objective To compare the use of JJ and PCN tubes as initial urinary drainage methods in patients with obstructive calcular anuria. Methods Between January 2021 and January 2024, 239 eligible patients with obstructive calcular anuria were randomly classified into two groups. Group A (JJ group) included 121 patients and group B (PCN group) included 118 patients. Laboratory data, stone characteristics, and intraoperative and postoperative data were also collected. The time needed to normalize the serum creatinine levels, postoperative complications, and quality of life scores were assessed. Results The procedures had comparable success rates (86.8% vs. 90.7%; p = 0.9). The PCN group had a shorter operative time (p < 0.001). No significant differences were observed in the time required for serum creatinine to return to normal between the two groups (p = 0.669). Fever, haematuria, and LUTS were more evident in the JJ stent group. In the JJ group, the presence of upper ureteral stones and stone burden were risk factors for procedure failure, whereas the presence of upper ureteral stones and preoperative serum creatinine were risk factors for ureteral perforation. Mild hydronephrosis was a risk factor for procedural failure in the PCN group. Spontaneous stone passage was more common in the PCN group (p = 0.028). The Overall quality of life and general health scores were significantly better in the PCN group (p < 0.001). Conclusions Both PCN and JJ stents had comparable success rates. PCN was associated with a lower incidence of LUTS, higher incidence of spontaneous stone passage, and better quality of life scores than the JJ stent.

Outcome of Ultrasonography-Guided Percutaneous Nephrolithotomy for the Management of Pediatric Urolithiasis.

Objectives: This study aims to assess the outcomes of ultrasonography (US)-guided minimally invasive percutaneous nephrolithotomy (PCNL) in the treatment of pediatric urolithiasis. Methods: A retrospective analysis was conducted on 176 patients with pediatric renal and upper ureteral lithotripsy who underwent PCNL between August 2006 and July 2022. The cohort comprised 110 men and 66 women, with ages ranging from 6 months to 16 years. Postoperative stone clearance was evaluated using kidney, ureter, and bladder radiograph or US, categorizing stones less than 4 mm as clear. Postoperative complications were graded according to the Clavien-Dindo classification, with grades I and II considered minor and III and IV classified as major. Results: Among the patients, 152 underwent unilateral renal operation, whereas 24 underwent bilateral renal operation. The average operation duration was 67.41 minutes (range: 15-195 minutes). The mean duration of nephrostomy tube removal was 3.79 days, and the mean postsurgical hospital stay was 5.97 days. A total of 146 patients experienced a decrease in hemoglobin concentration post operation, with an average drop of 10.57 g/dL (range: 0.5-37.8 g/dL). Initial stone-free rate (SFR) was achieved in 85.5% (171/200) of cases, and the final SFR was 92.50% (185/200). The postoperative rate of minor complications was 8.54% (17/199), whereas major complications occurred in 12.06% (24/199) of cases. During the 6-month to 11-year follow-up period, 19 patients presented with combined stones, and of these 4 presented with ipsilateral stone recurrence who underwent PCNL treatment. Calcium oxalate was identified as the most common stone component. Conclusions: US-guided minimally invasive PCNL demonstrated excellent SFR and an acceptable complication rate in the management of pediatric urolithiasis. Furthermore, it offers the advantage of minimizing potential risks associated with radiation exposure during the procedure.

Kidney-Sparing Management of UTUC in Solitary Kidney Patients: A Retrospective Analysis and Narrative Review.

Background/Objectives: The aim of this study is the presentation of an endoscopic therapeutic approach for three patients with a solitary kidney who were diagnosed with urothelial cancer of the upper tract. Methods: This retrospective analysis included patients with solitary kidneys who suffered from high-grade UTUC (urothelial cancer of the upper urinary tract) and underwent conservative treatment. Results: The first patient was a 67-year-old male who had a prior history of a nephroureterectomy due to UTUC six years ago. The patient was diagnosed with high-grade UTUC in the contralateral kidney. The tumor has been managed with endoscopic ablation. The second patient was a 74-year-old male with a non-functional kidney and high-grade UTUC diagnosed in the contralateral side. The patient underwent endoscopic ablation for the tumor. The third case was a 68-year-old female patient who had a history of a nephroureterectomy due to UTUC. Afterward, she was diagnosed with high-grade UTUC in the contralateral kidney. The patient was treated with percutaneous tumor resection and the placement of a nephrostomy tube. The first patient was included in an immunotherapy program based on an oncologist consultation after laser ablation treatment for Ta high-grade UTUC, followed by the endoscopic management of two recurrences. Afterward, no recurrence was detected. The remaining two patients followed up without the detection of a new recurrence. Conclusions: The kidney-sparing approach (tumor laser ablation or resection) for high-risk UTUC treatment in selected patients with solitary kidneys seems to provide adequate early outcomes in relation to preserving renal function and effective disease management. It is important to personalize the way of treatment in every case after a thorough examination of the patient's data.

Identification of causative and non-causative microorganisms of nephrostomy tube-associated pyelonephritis among patients with malignancy

BackgroundProlonged installation of a nephrostomy tube causes colonization of various microorganisms within the lumen of the tube, leading to the development of nephrostomy tube-associated pyelonephritis (NTAP). Patients with malignancy, often necessitating long-term installation of a nephrostomy tube, are susceptible to NTAP. However, information regarding the characteristics of NTAP in this population is limited. MethodsWe reviewed 43 NTAP cases of patients with malignancy in a cancer center and examined causative and non-causative microorganisms among those detected in urine culture. Causative microorganisms were defined as (1) those detected simultaneously in urine and blood cultures or (2) those detected in monomicrobial urine culture and to which physicians administered active antimicrobials for ≥5 days. Non-causative microorganisms were defined as those to which active antimicrobials were given for a total of <5 days. ResultsPatients in 42 of the 43 NTAP cases recovered with antimicrobial therapy for ≥7 days. Causative microorganisms were identified in 25 cases, where Escherichia coli and Klebsiella pneumoniae were most frequent. All enterococci other than Enterococcus faecalis, Corynebacterium species, and Candida species other than Candida albicans and most of Stenotrophomonas maltophilia detected in urine culture were considered non-causative of NTAP. ConclusionE. coli was a common organism causing NTAP of this population. Several microorganisms resistant to cephalosporin were non-causative of NTAP, for which administration of antimicrobials may be unnecessary even if detected in urine culture.

Delayed Morbidity Associated with Surgical Management of Urosymphyseal Fistula

ObjectiveTo characterize and identify factors associated with long-term morbidity of definitive USF treatment. MethodsRetrospective chart review of a single institution database identified 57 patients who underwent operative treatment of USF between 2009-2022 with at least 90 days of follow-up. Delayed complications were considered those occurring ≥90 days following surgery. Morbidity related to surgery was assessed up to 10 years postoperatively. Statistical analysis was performed using Chi-Square, Fisher’s exact, and Mann Whitney-U tests. ResultsA total of 57 patients, median age of 71 years old, presented with USF. Delayed (>90d) postoperative complications requiring major intervention occurred in 26 (46%) patients at a median time of 11 months. Twelve (21%) patients required image-guided drain placement, 5 (9%) required nephrostomy tubes, and 14 (25%) patients required additional major surgery. The use of omentum, rectus, or no flap made no difference in hernia occurrence, or the type of hernia formed (p>0.05). Patients with recurrent osteomyelitis had smaller width of pubic bone resection (48mm vs 73mm, p=0.049). Delayed pelvic abscess formation was more common in patients who did not have flap interposition (40% vs 9%) (p=0.03). De novo or worsening sacral insufficiency (SI) fractures occurred in 14 (25%) patients. The width of pubic bone resection was not associated with developing new or worsening SI fracture (p=0.78). Durable resolution of pelvic pain was achieved in 40 (70%) patients and 49 (86%) patients were able to discontinue antibiotic therapy. ConclusionWhile definitive USF repair is associated with delayed morbidity most men are rendered free of infection and have resolution of pain following surgical treatment.

Factors impacting post-nephrostomy-tube removal urine leak after percutaneous nephrolithotomy: does the calyx of access make a difference?

BackgroundThe aim of this study was to identify the factors that impact the post- percutaneous nephrolithotomy (PCNL) urine leak (UL) following nephrostomy tube removal and to assess if the calyx of entry made any difference.Materials and methodsIn this retrospective study, from April 2016 to May 2019, all the patients undergoing conventional percutaneous nephrolithotomy by a single 24 Fr access with complete stone clearance were evaluated. Patients with urine leak for > 4 h after nephrostomy tube removal were included in the urine leak group (n = 18), while the non-urine leak group (n = 60) comprised patients with urine leak for < 4 h. These groups were compared for demographic, renal, stone-related and peri-operative factors with special stress on calyx of access.ResultsThe urine leak group had significantly older (mean 48 vs. 31 years, p = 0.003) patients with a higher proportion of diabetes mellitus (33% vs. 11%, p = 0.03). They also had a significantly greater (grade ≥ 3) hydronephrosis (55.5% vs. 10%, p < 0.001) and significantly reduced cortical thickness (mean 6.4 vs. 10.3 mm, p = 0.001). They had a nephrostomy tube in situ post-operatively for a longer duration (mean 52.3 vs. 34.5 h, p = 0.002). Interestingly 100% leaks happened from the middle/lower calyx tract and none from the upper calyceal access (p < 0.001). On multivariable regression analysis, grade ≥ 3 hydronephrosis with thin cortex, middle/lower calyceal access and keeping the nephrostomy tube for prolonged duration post-operatively were independent predictors of urine leak. There was no risk of leak from upper calyx access.ConclusionThere is negligible risk of urine leak from upper calyx access so the possibility of hydrothorax after nephrostomy tube removal is minimal.

International Alliance of Urolithiasis (IAU) consensus on miniaturized percutaneous nephrolithotomy

Over the past three decades, there has been increasing interest in miniaturized percutaneous nephrolithotomy (mPCNL) techniques featuring smaller tracts as they offer potential solutions to mitigate complications associated with standard PCNL (sPCNL). However, despite this growing acceptance and recognition of its benefits, unresolved controversies and acknowledged limitations continue to impede widespread adoption due to a lack of consensus on optimal perioperative management strategies and procedural tips and tricks. In response to these challenges, an international panel comprising experts from the International Alliance of Urolithiasis (IAU) took on the task of compiling an expert consensus document on mPCNL procedures aimed at providing urologists with a comprehensive clinical framework for practice. This endeavor involved conducting a systematic literature review to identify research gaps (RGs), which formed the foundation for developing a structured questionnaire survey. Subsequently, a two-round modified Delphi survey was implemented, culminating in a group meeting to generate final evidence-based comments. All 64 experts completed the second-round survey, resulting in a response rate of 100.0%. Fifty-eight key questions were raised focusing on mPCNLs within 4 main domains, including general information (13 questions), preoperative work-up (13 questions), procedural tips and tricks (19 questions), and postoperative evaluation and follow-up (13 questions). Additionally, 9 questions evaluated the experts’ experience with PCNLs. Consensus was reached on 30 questions after the second-round survey, while professional statements for the remaining 28 key questions were provided after discussion in an online panel meeting. mPCNL, characterized by a tract smaller than 18 Fr and an innovative lithotripsy technique, has firmly established itself as a viable and effective approach for managing upper urinary tract stones in both adults and pediatrics. It offers several advantages over sPCNL including reduced bleeding, fewer requirements for nephrostomy tubes, decreased pain, and shorter hospital stays. The series of detailed techniques presented here serve as a comprehensive guide for urologists, aiming to improve their procedural understanding and optimize patient outcomes.

Comparative Study between Outcome of Standard and Tubeless Percutaneous Nephrolithotomy (PCNL) at District Level Tertiary Hospitals in Bangladesh

Renal calculus is one of the commonest problems of the urinary tract. Surgical approach is more effective treatment option to remove it. Among all surgical procedures, Percutaneous Nephrolithotomy (PCNL) has gradually become a preferred option in last two decades for renal calculus that has largely replaced the open approach. Currently, it is the procedure of choice for renal calculus &gt; 2 cm, or those are refractory to ESWL. The crucial step in Standard PCNL is placing a nephrostomy tube. In recent years, it has been reformed as 'Tubeless' PCNL with some modifications in which a Double-J (D-J) stent is placed without any nephrostomy tube for internal drainage. This study was done to compare the outcomes of Standard PCNL and Tubeless PCNL at district level tertiary hospitals in Bangladesh among 46 patients with renal calculus up to 3 cm size. Many authors agree that Tubeless PCNL or its modifications are effective as well as safe. Although, nephrostomy tube is responsible for an increase of post- operative morbidity, in our study, we did not find any statistically significant difference between these two procedures.

Single-centre retrospective analysis: 16 cases of percutaneous nephrolithotripsy complicating hepatic puncture injury in a 7-year experience.

The aim of this retrospective analytical study was to investigate the diagnosis and management of liver puncture injuries caused by percutaneous nephrolithotripsy (PCNL). The clinical data of 1069 patients who underwent PCNL between Oct. 2017 and Apr. 2024 were analyzed. The diagnosis of liver puncture injury was confirmed by postoperative examination of three-dimensional reconstruction computed tomography (3D-CT) findings, and the data from these patients were statistically and retrospectively analyzed. A total of 16 cases were collected, including 9 males and 7 females, with an average age of 58.31 ± 14.30years, a mean body mass index (BMI) of 23.54 ± 3.88kg/m2. Liver puncture injury was identified and classified as tangential or penetrating according to the anatomy of the nephrostomy tube and liver. The average decrease in hemoglobin level after operation was 14.25 ± 11.97g/L. One patients received blood transfusions for preoperative anemia and postoperative blood loss, and all patients were cured and discharged after delaying the removal of nephrostomy tube under conservative treatment, the time of nephrostomy tube removal after a single PCNL procedure was 6.44 ± 1.26days. This article proposes a grading system for PCNL-complicated liver puncture injuries that will help physicians to better understand their characteristics and guide the development of management. In the absence of obvious signs of peritonitis and hemodynamic stability, conservative treatment of the liver puncture injury caused by PCNL is safe and effective.

Intelligent control of pressure based on ureteral access sheaths: renal pelvic pressure during flexible ureteroscope perfusion at different sites.

This study aimed to evaluate the accuracy and effectiveness of renal pelvic pressure (RPP) control during flexible ureteroscopic perfusion at various sites. Flexible ureteroscopy for the intelligent control of RPP was based on a ureteral access sheath (UAS) that integrated pressure measurement and suction functions (with automatic adjustment). Eleven consecutive patients with indurating nephrostomy tubes were enrolled. The nephrostomy tube was connected to a disposable invasive blood pressure sensor. The RPP was zeroed after the pressure stabilized. The flow rate and control value were set at 100ml/min and - 5 mmHg, respectively. An 8.5 Fr flexible ureteroscope was irrigated at the renal pelvis, as well as the upper, middle, and lower calyces of the kidney for 1min. All 11 patients with upper urinary tract calculi underwent successful UAS placement. Pressures measured by the sheath and fistula during perfusion were - 5.07 ± 1.41 and - 4.89 ± 1.07 mmHg at the renal pelvis, -5.16 ± 1.36 and - 5.12 ± 1.32 mmHg at the upper calyces, -4.98 ± 0.87 and - 5.39 ± 1.01 mmHg at the middle calyces, as well as -4.95 ± 1.56 and - 5.64 ± 1.24 mmHg at the lower calyces, respectively. There were no significant differences in pressure between the sheath and fistula groups or in sheath and fistula pressures among parts. The RPP fluctuated; however, all values were within the safe limit of 20 mmHg. The UAS-based pressure monitoring technology can accurately and reliably monitor and control RPP within a set range.

Robotic buccal mucosal graft ureteroplasty using combination of posterior-inlay and anterior-onlay technique.

Buccal mucosal graft (BMG) ureteroplasty, particularly with the anterior-onlay technique, shows promise for treating complex ureteral strictures. However, long and circumferential strictures remain challenging. This study aimed to present the surgical technique of the posterior-inlay and anterior-onlay technique in robotic ureteroplasty with a BMG (RU-BMG). A 37-year-old male patient with a medical background of failed laparoscopic ureteroplasty and multiple endourological interventions was admitted to our hospital. Preoperative anterograde and retrograde pyelography revealed a 5-cm ureteral stricture. During the surgical procedure, the ureteral posterior wall was insufficient to facilitate a complete posterior augmented anastomosis, resulting in a posterior defect subsequent to the partial posterior augmented anastomosis. Ultimately, a BMG was utilized to address the posterior defect initially, followed by anterior-onlay ureteroplasty with a BMG. The Foley catheter was removed 2 weeks after surgery, while the nephrostomy tube was clamped on postoperative day 14. The double-J stent was removed 3 months after surgery. The preoperative serum creatine was 102.9 μmol/L. The surgery was performed successfully within 240 min, with estimated blood loss of 100 mL. The postoperative hospitalization was 4 days. Throughout the 12-month follow-up period, no symptoms or complications were observed, with a serum creatine of 82.0 μmol/L. Computed tomography urography indicated relieved hydronephrosis. In conclusion, RU-BMG using a combination of posterior-inlay and anterior-onlay technique is safe and feasible in the management of ureteral stricture. More cases and longer follow-up for this procedure are needed for better perfection of this procedure.

Muscle-Invasive Bladder Cancer in Non-Curative Patients: A Study on Survival and Palliative Care Needs.

To assess the survival outcomes of patients diagnosed with muscle-invasive bladder cancer (MIBC) who are not candidates for curative treatment and to identify the factors influencing these outcomes. We conducted an analysis of patients diagnosed with MIBC who were either unable or unwilling to undergo curative therapy. We evaluated overall survival (OS) and cancer-specific survival (CSS) and examined their associations with various clinical variables. Additionally, we assessed emergency department visits and palliative procedures. The study included 142 patients with a median age of 79.4 years and a Charlson Comorbidity Index of 9.8. At diagnosis, 59.2% of the patients had localized disease, 23.2% had metastatic disease, and 49.3% presented with hydronephrosis. Curative treatment was excluded due to comorbidities in 40.1% of cases and advanced disease stage in 36.6%. The 1-year and 2-year OS rates were 42.8% and 23.6%, respectively, with a median survival of 10.6 months. The 1-year and 2-year CSS rates were 49.6% and 30.2%, respectively, with a median survival of 11.9 months. Worse survival outcomes were associated with advanced disease stage and the presence of hydronephrosis. Patients excluded from curative treatment solely due to age had a relatively better prognosis. On average, patients visited the emergency department three times: 19% underwent palliative transurethral resection of the bladder tumor, 14.8% received radiotherapy to control hematuria, and nephrostomy tubes were placed in 26.1% of cases. Patients with MIBC who are unable or unwilling to undergo curative treatment have a median overall survival of less than one year, with worse outcomes observed in those with advanced disease stage and hydronephrosis.

Comparative Analysis of Mean Hospital Stay in Patients Undergoing Percutaneous Nephrolithotomy (PCNL) With Versus Without Nephrostomy Tube

Background: Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgical procedure for the removal of large renal calculi. The use of nephrostomy tubes postoperatively is common; however, they may increase hospital stay and patient discomfort. Tubeless PCNL has emerged as a potential alternative.Objective: To compare the mean hospital stay in patients undergoing PCNL with and without a nephrostomy tube.Methods: A prospective cohort study was conducted on 60 patients undergoing PCNL at the Armed Forces Institute of Urology, Rawalpindi, from June to December 2020. Patients were divided into two groups: Group A (PCNL with nephrostomy tube) and Group B (tubeless PCNL). Both groups were assessed for mean hospital stay, postoperative complications, and stone size using SPSS version 25. Inclusion criteria were age ≥18 years, stone size of 2-3 cm, and ASA I-II. Exclusion criteria included prior renal surgeries and comorbidities.Results: The mean hospital stay was significantly shorter in Group B (1.90 ± 0.80 days) compared to Group A (2.46 ± 0.81 days, p=0.0001).Conclusion: Tubeless PCNL significantly reduces hospital stay compared to standard PCNL.

Impact of Coaching Intervention Program on Nurses' Performance Regarding Caring for Patients Undergoing Percutaneous Nephrostomy Tube

Impact of Coaching Intervention Program on Nurses' Performance Regarding Caring for Patients Undergoing Percutaneous Nephrostomy Tube

Comparative Feasibility Analysis of Retrograde Double J Stenting, Antegrade Double J Stenting, and Percutaneous Nephrostomy Tube Placement for Ureteric Obstruction Secondary to Pelvic Malignancies

Background: The management of ureteric obstruction secondary to pelvic malignancies (UOPM) presents a significant challenge. Objectives: Our study aimed to assess the factors affecting the feasibility of interventions for patients with UOPM - including retrograde and antegrade double J (DJ) stenting, and percutaneous nephrostomy (PCN) insertion. Methods: We conducted a retrospective analysis of patients who underwent intervention for UOPM over two years, from January 2022 to December 2023. Patients were categorized into groups based on intervention type: Group 1: Retrograde DJ stenting, group 2: Antegrade DJ stenting, and group 3: PCN insertion. Demographic, clinical, radiological, cystoscopic, and laboratory data were compared between the three groups. Analysis of Variance (ANOVA), logistic regression, and marginal mean plots were utilized for statistical analysis. Results: Fifty–nine patients were included in the study, consisting of 14 males and 45 females, and the mean age of the study population was 60.1 ± 10.8 years. Retrograde DJ stenting was successfully achieved in 59.3% of patients, with 10.2% undergoing antegrade DJ stenting and 30.5% needing PCN insertion. Serum albumin (P = 0.04), serum creatinine (P = 0.02), albumin creatinine ratio (P &lt; 0.001), and severity of hydroureteronephrosis (HDUN) (P = 0.02) were significantly associated with intervention outcomes. There was an increased likelihood of PCN insertion in higher serum creatinine and lower serum albumin levels. Multinomial logistic regression with univariate and multivariate analysis revealed significance among the above-mentioned variables. Conclusions: Even though DJ stenting remains common, a significant proportion of patients require PCN insertion. Serum albumin, serum creatinine, albumin creatinine ratio, and HDUN severity are significant predictors of intervention success. Further research is warranted to validate these findings and enhance management strategies for UOPM.

Interventional Radiology Awareness Among Family Physicians and General Practitioners in Jazan Region, Saudi Arabia.

Background Interventional radiology (IR) utilizes minimally invasive procedures guided by imaging to diagnose and treat various conditions, offering less invasive alternatives to traditional surgery. Despite its importance, awareness among family medicine practitioners can vary, affecting patient care. While IR has advanced in Saudi Arabia, there are limited data on family medicine practitioners' understanding of IR. This study assesses awareness of IR procedures among family medicine doctors in Jazan and their perceived need for further education. Methods A cross-sectional interview-administered survey was conducted online among family medicine doctors in Jazan via social media. The survey assessed demographic data, awareness of IR procedures, self-rated knowledge, and attitudes towards IR. Participants' understanding of IR training, hospital privileges, outpatient clinics, and recognition by the Saudi Commission for Health Specialties (SCHS) was evaluated. Data were analyzed using descriptive statistics and chi-square tests. Results Out of 395 respondents, the age distribution was as follows: 20-29 years (44.3%), 30-39 years (32.9%), and 40 years or older (22.8%). Gender distribution was as follows: females (44.6%) and males (55.4%). Specialties included family medicine consultants (10.6%), residents (32.4%), specialists (22.8%), and general practitioners (34.2%). Awareness of IR procedures varied: uterine fibroid embolization (58.7%), coronary angiography (57.5%), vascular angioplasty (63.5%), radiofrequency ablation (61.3%), peripheral vascular bypass (61.8%), brain biopsy (56.2%), nephrostomy tube placement (59.5%), varicose veins treatment (63.0%), and cystoscopic tumor resection (54.7%). Self-rated knowledge was as follows: poor (46.8%), adequate (27.1%), good (15.7%), and excellent (10.4%). Most believed that interventional radiologists' training was in radiology (62.8%), with fewer attributing it to vascular surgery (20.5%) or a combination (16.7%). Regarding privileges and facilities, 248 (62.8%) reported hospital admitting privileges for IRs, 251 (63.5%) reported outpatient clinics, and 45 (11.4%) were unsure about admitting privileges. SCHS recognition was confirmed by 267 (67.6%). Referrals to IRs were made by 283 (71.6%), and 260 (65.8%) would increase referrals with more knowledge. The perceived benefit of additional education was as follows: no benefit (48.4%), some benefit (30.6%), and significant benefit (21.0%). Conclusion The study reveals gaps in awareness and knowledge of IR among family medicine doctors in Jazan. While there is recognition of IR's value and a willingness to refer patients, variations in knowledge highlight the need for targeted educational interventions. Improving education on IR could enhance integration into patient care and optimize outcomes.

Obstructive Bilateral Renal Fungal Bezoars in an Extremely Premature Neonate Treated With Antifungals and Urokinase Irrigation: A Case Report and Review of the Literature.

An ex-27-week gestation female infant developed bilateral forearm nodules at 4 weeks of life during treatment for methicillin-sensitive Staphylococcus aureus bacteremia. A pure growth of Candida albicans was isolated on culture of both sterile aspiration of the forearm abscess and urine without evidence of methicillin-sensitive Staphylococcus aureus. The patient went on to develop bilateral obstructive renal fungal bezoars at 11 weeks of life. Bilateral nephrostomies were required to alleviate obstruction with the addition of local irrigation with amphotericin B deoxycholate. Two weeks later, urokinase via the nephrostomy tubes was added due to an unchanged appearance on ultrasound (US) and ongoing candiduria. A significant reduction in the size of bezoars was seen on US after 3 days. Sterilization of urine culture was achieved 7 weeks into treatment, and resolution of bezoars on US was seen 9 weeks after treatment began. No adverse events occurred from the use of local urokinase. Urokinase irrigation via nephrostomy is an effective and safe adjunctive treatment in refractory obstructive renal candidiasis in neonates.

A comparative evaluation of 0.25% bupivacaine and 0.25% levobupivacaine in peritubal infiltration in percutaneous nephrolithotomy

Background: Percutaneous nephrolithotomy (PCNL) is a routine endourologic procedure in patients with renal calculi. Although it is less painful than open surgery, pain around the nephrostomy tube is a clinical problem; therefore, good post-operative analgesia is required to alleviate pain. Peritubal infiltration can be one of the choices to alleviate pain around the nephrostomy tube. Aims and Objectives: The aim of this study was to evaluate the efficacy of peritubal infiltration of local anesthetics for post-operative pain following PCNL. Materials and Methods: A total of 60 patients with American Society of Anesthesiologists Grade I/II scheduled for elective PCNL surgeries were randomly allocated into two groups. Group L received levobupivacaine 0.25% (30 mL) and Group B received bupivacaine 0.25% (30 mL). The duration of rescue analgesia, total dose of tramadol consumption in 24 h, hemodynamic parameters, and adverse events during the post-operative period were noted. Results: The mean duration of rescue analgesia in Group L was 274.50±24.89 min and in Group B was 275.33±23.04 min which was not significant (P&gt;0.05). Conclusion: Peritubal infiltration of 0.25% levobupivacaine and 0.25% bupivacaine is efficient in alleviating post-operative pain after PCNL. Both drugs can be used for infiltration around nephrostomy tubes in PCNL surgeries safely and are associated with minimal side effects.

The diagnostic accuracy of urinary neutrophil gelatinase-associated lipocalin in assessing kidney function in severe hydronephrosis.

Up to now, there is no perfect indicator to evaluate the renal function of severe hydronephrosis, which poses difficulties in the selection of clinical treatment decisions. This study investigates the role of neutrophil gelatinase-associated lipocalin (NGAL) in urine drained from the nephrostomy tube shortly after nephrostomy to evaluate the renal function of patients with severe hydronephrosis caused by ureteral obstruction. The clinical data, and blood and urine samples of 24 patients with severe hydronephrosis due to ureteral obstruction were retrospectively collected. The NGAL in the urine drained from the nephrostomy tube on the morning of the first day after the procedure was measured. The glomerular filtration rate (GFR) was determined using a nuclear scan, and the clearance rate of creatinine was calculated based on nephrostomy drainage. The correlation between the NGAL level, urine volume post-nephrostomy, affected side GFR, and creatinine clearance rate (Ccr) was assessed. Moreover, the relationship between the urinary NGAL levels and prognosis was analyzed based on whether the patients underwent nephrectomy. There was a significant correlation between the urine NGAL from the nephrostomy of the affected side and the Ccr and urine volume post-nephrostomy (both P<0.05). Compared with the patients in the kidney preservation group, those who underwent nephrectomy had significantly increased NGAL levels, and significantly reduced Ccrs and nephrostomy drainage urine output. Through the receiver operating characteristic (ROC) curve evaluation, the efficacy of NGAL in predicting nephrectomy was found to be superior to both the Ccr and urine output, with an area under the curve (AUC) of 0.845. The NGAL in the urine shortly after nephrostomy may indicate severe renal functional deterioration.

Renal Function Tests (Blood Urea and Serum Creatinine) Pre-and Post-Operative Treatment for Tubeless Percutaneous Nephrolithotomies and Standard Treatment

From September 2016 to September 2019, this study was carried out at the Urology and Nephrology University Hospital at Assiut University in Assiut, Egypt. On sixty individuals were divided into two therapy groups, each comprising thirty patients. The first group underwent a traditional percutaneous nephrolithotomy (PCNL), while the second group underwent a tubeless procedure. The average blood loss before and after the procedure, changes in hemoglobin, and creatinine levels did not differ statistically significantly between the two groups, according to the results. These findings demonstrates that the tubeless group had a longer surgical length, a difference that was statistically significant (P-value = 0.034*). However, there were no significant differences between the two groups with respect to the number of tracts or methods of access. Following the procedure, the patient was randomly assigned to have either a nephrostomy tube or have the tract closed without the need for a tube. The patient was randomly assigned to get either a nephrostomy tube or have the tract closed without the need for a tube.