Obstructive Urinary Tract Infection Research Articles

Predictors of Repeat Surgery and Stone-related Events After Flexible Ureteroscopy for Renal Stones

To evaluate the risk of repeat surgery and stone-related events after flexible ureteroscopy (fURS) for renal stones, and to identify their predictive factors. This was a single-center, retrospective cohort study of patients (n=664) who underwent fURS for renal stones with or without concomitant ureteral stones between January 2012 and December 2019. The primary outcomes were time to ipsilateral stone-related surgical intervention and any stone-related event (including ipsilateral renal colic, symptomatic ureteral calculi, obstructive urinary tract infection, and surgical intervention). During median follow-up of 31.1 months, 103 (15.5%) and 135 (20.3%) patients experienced surgical intervention and any stone-related event, respectively. The estimated 2-year intervention-free survival and stone-event-free survival was 86.9% and 81.6%, respectively. On Cox multivariate analysis, younger age (hazard ratio [HR] 0.96), history of stone surgery (HR 2.17), larger preoperative stone burden (HR 1.03), and larger residual fragment (HR 1.09) showed an association with future intervention. Use of the four identified risk factors (age ≤60, history of stone surgery, stone burden ≥20 mm, and residual fragment ≥4 mm) allowed stratification of patients based on the risk of future intervention (low [score: 0-1], intermediate [2], and high [3-4] risk). The estimated 2-year intervention-free survival rates in low-, intermediate-, and high-risk groups were 96.2%, 86.4%, and 71.3%, respectively. Patients undergoing fURS are at risk of future ipsilateral surgical intervention and stone-related events. Our simple predictive tool can facilitate treatment decision-making by identifying patients who are at high risk of recurrence.

Outcome of Patients Admitted to a Tertiary Referral Intensive Care Unit with Urosepsis Needing Source Control.

Introduction:Urosepsis is one of the common causes of admission to the Intensive Care Unit (ICU). It has traditionally been treated with antibiotics, but surgical management with Double J [DJ] ureteral stents is gaining popularity. This study compares patients with complicated urosepsis who underwent surgical source control by ureteral stenting with those managed medically.Materials and Methods:The study enrolled patients admitted to a tertiary adult ICU with a diagnosis of urosepsis over a period of 2 years. The primary outcomes were renal replacement therapy (RRT) requirement and ICU mortality. The secondary outcomes were ICU and hospital length of stay, ventilator-free days, and inotrope free days. Patients were divided those with obstructive and nonobstructive urinary tract infection (UTI).Results:A total of 58 patients met the criteria, of who 32 had obstructive UTI and were included in Group A, with the remaining 26 with nonobstructive UTI comprised Group B. In Group A, 27 patients underwent source control with ureteral DJ stenting, three patients recovered with medical management, and two who were advised source control did not consent to the procedure. Seventeen patients in Group A and seven patients in Group B required RRT (P = 0.044). There was no significant difference in ICU mortality, hospital mortality, and 28 days survival between the two groups.Conclusion:With early source control, obstructive UTI outcomes were comparable to nonobstructive UTI. However, despite undergoing ureteric stenting, more patients with obstructive UTI required RRT than those with nonobstructive UTI.

Hyperammonemic encephalopathy with septic shock caused by obstructive urinary tract infection

A 61-year-old woman was evaluated because of 2 days of anuria, fever, anorexia, and progressive decline in mental status. On admission, she appeared confused with a GCS score of E2V2M4, and her blood ammonia level was elevated (176 μg/dL). Abdominal computed tomography showed bilateral hydronephrosis and bladder fullness with wall thickness in spite of indwelling bladder catheter. Her catheter was obstructed by blood clot. Blood cultures, blood clot culture, and one urine culture all yielded Proteus mirabilis. Obstructive urinary tract infection complicated with septic shock was diagnosed. After treatment, her ammonia level normalized.

Ultrasound-guided introital drainage of pyometrocolpos

Abstract Pyometrocolpos can be caused by congenital malformations such as distal vaginal atresia and imperforate hymen. Patients usually present with obstructive urinary tract infections, acute kidney injury, or sepsis. Percutaneous drainage of the infected fluid can help treat the patient; however, recurrence is of concern. In this case report, we present a case of a child with recurrent pyometrocolpos due to distal vaginal atresia despite initial percutaneous drainage. To our knowledge, this is the first report of ultrasound-guided introital drainage of pyometrocolpos with relief of symptoms obviating the need for repeat drainage or immediate surgery.

前立腺肥大に伴う閉塞性尿路感染症から高アンモニア血症を来した1例

意識障害の鑑別疾患の一つに高アンモニア血症があり，その多くは肝疾患が原因である．しかし，稀にウレアーゼ産生菌による尿路感染から高アンモニア血症を来すことがあり注意を要する．今回，我々は前立腺肥大による排尿障害から著しい高アンモニア血症を来し，意識障害に至った1例を経験した．症例は89歳男性．発作性心房細動と脳梗塞，前立腺肥大症があるが肝疾患はない．意識障害を主訴に救急搬送され，前立腺肥大に伴う尿閉を認めた．尿道カテーテル留置により混濁したアルカリ尿（pH 8.0）を認め，尿ドレナージ，補液，抗菌薬（Ceftriaxone）2 g/日で速やかに意識レベルおよび高アンモニア血症は改善した．尿培養からStaphylococcus simulansとCorynebacterium urealyticumが検出され，いずれもウレアーゼ産生菌であり同菌の閉塞性尿路感染症による高アンモニア血症と診断した．肝疾患のない高齢者の高アンモニア血症の鑑別疾患として，ウレアーゼ産生菌による尿路感染症を考えることは重要である．

Hyperammonemia in a patient with obstructive urinary tract infection due to Corynebacterium urealyticum

Abstract A 93-year-old woman with neurogenic bladder was admitted to our hospital because of impaired consciousness. Her urine culture revealed urease-test-positive Corynebacterium urealyticum. She was diagnosed with hyperammonemia due to an obstructive urinary tract infection that was caused by urease-producing bacteria. The patient showed rapid improvement of impaired consciousness and hyperammonemia after urine analysis. It is necessary to consider obstructive urinary tract infection as a differential diagnosis of hyperammonemia, which commonly occurs in urinary tract infections owing to the presence of urease-producing bacteria. Relief from obstruction is the most important treatment for hyperammonemia caused by this mechanism.

A Case of Hyperammonemia due to Obstructive Urinary Tract Infection

A Case of Hyperammonemia due to Obstructive Urinary Tract Infection

Infección urinaria en el niño

SUMMARY 1.— A review of 200 patients suffering from urinary in-fection is presented.2.— Boys prcdomineted in the one years age group.3.— Urine samples were obtained by suprapubic punc-ture in 82% of childrens under 1 years of age and41% children between 12 and 24 months.4.— E. Coli was the most frequent infection agent atall ages.5.— When ever infection was caused by other than E.Coli urological malformation was presen in 83%to 88%.6.— When E. Coli was the cause of infection only a31% to 37% of malformations were found.7.— Diagnosis of malformation increased parallel to thenumber of infections in such a way that all patientswith 5 repeated infections had urinary malforma-tions.8.— Medical treatment is continued through 10 days witha culture 5 days after the discontinuation of thedrug. BlBLIOGRAFIA \.-Butler A. M. Chronic Pyelonephritis and arterialHypertensi6n, J. Clinic Invest 16-889, 1937.2.— Kass, Edward H. Progress in Pyelonephritis F. A.Davis Company Philadelpia, 1965.3.— Winberg, J. Renal Funtion Studies in infants andchildren with acute non obstructive urinary tractinfections. Acta Paediat. 48-577, 1959.4.— Kunin, C. M. 1. Southail, and A. 1. Paquin, J. R.Epidemiology of urinary tract infections. A. pilotstudy of 3067 school children. New Eng. J. Med.263-817, 1960.5.— Kunin, C. M. and N. E. Holmagyi. Urinary tractinfections in school children II. characterization ofinvanding organisms. New Eng. J. Med. 266-1297,1962.6.— Pryles, C. Percutaneus Bladder aspiration, andothers Methods of urine collection for bacteriolo-gical study. Pediatrics. 36-128, 1965.7.— Beresi, V. y Colabs. Estudio comparative de Pun-cion Vesical con otros metodos de diagnostico enInfeccion Urinaria Rev. Chilena Ped. 3-187, 1969.8.— Winberg, J. H. J. Anderson, L. A. Hanson, and K.Lincoln: Studies of urinary tract infection in infan-c y and chilhood. I: antibod response in differenttypes of urinary tract infections caused be coliformbacteria. Brit., Med. J. 2-524, 1963.51

The long term prognosis of non-obstructive urinary tract infection in infancy and childhood after the advent of sulphonamides.

SummaryOne hundred and seven cases of urinary tract infection in children, hospitalized during the years 1940‐1949, were reinvestigated with an observation time ranging from 15 to 24 years. Primary and late mortality was low. Non‐obstructive urinary infections in boys show a good prognosis, concerning recurrence as well as progressive renal disease.Non‐obstructive urinary tract infection in girls seems to be a potentially serious disease, where recurrence developed in half the cases in spite of the initial sulpha‐treatment given. A minimum of 19 % of the girls showed progressive renal disease according to radiological examinations. Early recurrence, according to the primary report, increased the risk of progressive renal disease from 4 to 30%. In 40% of the girls with late symptomatic recurrence, progressive renal disease could be diagnosed at about 20 years of age.The reinvestigation shows that in certain individuals the child's susceptability to recurrent urinary tract infection is retained even in the adult, in whom it manifests itself as acute pyelonephritis. It is of special interest to note that between one half to one third of those who had been pregnant had suffered from urinary tract infection of pregnancy.At about 20 years observation time negative results of single determination of blood pressure, sedimentation rate, haemoglobin, serum‐creatinine, protein or leucocytes or bacteria in the urine and maximal urinary concentration capacity does not seem to guarantee the ab‐scence of chronic or recurrent pyelonephritis. A thorough case history, including a paediatric history, is recommended in dealing with urinary tract infections in children and young adults.