Obstructive Uropathy Research Articles

#1761 Whole-genome sequencing reveals contribution of rare and common variation to structural kidney and urinary tract malformations

Abstract Background and Aims Structural kidney and urinary tract malformations are the commonest cause of kidney failure in children and young adults. Targeted and whole-exome sequencing has identified over 50 monogenic causes for these phenotypically heterogeneous conditions but have largely focused on cohorts enriched for familial, syndromic, or consanguineous disease. We sought to better characterise the genetic architecture of these conditions using whole genome sequencing (WGS) data from the UK's 100 000 Genomes Project. Method 992 unrelated individuals with structural kidney and urinary tract malformations were assessed using the Genomics England clinical interpretation pipeline to determine a genetic diagnosis. Statistically robust case-control association testing was performed using WGS data from a subset of 813 patients and 25 205 ancestry-matched unaffected individuals seeking enrichment of common and rare single-nucleotide and structural variants (SNV/SVs) on a genome-wide, per-gene, and cis-regulatory element basis. Heritability analysis was carried out in 623 cases and 20 060 controls of European ancestry with polygenic risk scores (PRS) derived for each of the six phenotypes. The PUV-PRS was validated in an independent cohort of 77 patients from the AGORA data- and biobank and an additional 2 746 European controls. Results The overall diagnostic yield was 4.3% (43/992; Fig. 1) with age < 18 years (P = 2.0 × 10−4), family history (P = 7.5 × 10−3) and extra-renal features (P = 1.9 × 10−4) all independent predictors of a genetic diagnosis. The diagnostic yield was higher in cases with cystic kidney dysplasia (10.7%) or kidney anomalies (5.9%). HNF1B was the most frequently identified cause. Exome-wide rare variant analysis identified enrichment of SNV/indels affecting AUTS2 (P = 3.7 × 10−6), ARHGAP5 (P=6.0 × 10−6), known kidney malformation gene HNF1B (P = 6.1 × 10−6), and ZNF879 (P=7.0 × 10−6), all of which have been previously implicated in developmental and/or cancer pathways. An increased burden of rare SVs affecting HNF1B (P = 3.1 × 10−4) was observed. There was no evidence of enrichment for cis-regulatory element disrupting SVs. Genome-wide testing of 19 million common and low-frequency variants (minor allele frequency > 0.1%) did not detect any individual variants that were significantly associated in the total cohort, but together these variants were estimated to contribute to 23% (standard error 11%) of the heritability of kidney and urinary tract malformations in cases with European ancestry. Comparison of phenotype-specific PRS showed considerable overlap between kidney anomalies, cystic kidney dysplasia, obstructive uropathy and vesico-ureteric reflux but the polygenic contribution to PUV and bladder exstrophy was distinct (Fig. 2). A PUV-PRS consisting of 36, 106 variants was validated in an independent European cohort of 77 cases and 2 746 controls (empirical P = 1 × 10−4). Conclusion We show that non-Mendelian genomic factors are important for the pathogenesis of structural kidney and urinary tract malformations, supported by the observation that a minority of patients in this large unselected cohort have a monogenic diagnosis. In addition, a significant proportion of heritability can be attributed to common and low-frequency variation and there is overlap in the polygenic contributors to upper urinary tract malformations with distinct polygenic signatures relevant to PUV and bladder exstrophy. Larger cohorts of patients are needed to increase power to detect variants contributing to this heritability and identify biological mechanisms and pathways important for kidney and urinary tract development.

#2289 Pregnancy outcomes in patients with congenital abnormality of the urinary tract: experience of a tertiary Portuguese center

Abstract Background and Aims Congenital abnormalities of the urinary tract (CAKUT) represent a broad range of disorders that occur due to abnormal kidney development. Maternal, obstetric, and perinatal outcome in pregnant woman with CAKUT have not been extensively evaluated, although small series report an increased incidence of urinary tract infections (UTI) and obstructive uropathy. Method Retrospective analysis of maternal, obstetric, and perinatal outcomes in pregnant patients with CAKUT (including genetic cystic kidney disease) that were surveilled in our tertiary center by a nephro-obstetric team between 2011 and June 2023. Information was obtained from medical records. Results We evaluated 47 gestations in 41 patients, with mean age of 31 ± 5 years [17-40], 89% were Caucasian, 11% black; 40% were nulliparous, 36% had hypertension (HT) and 42% a previous history of UTI. Regarding CAKUT specificity, 17/41 patients had genetic cystic diseases, 10/41 ureteropelvic junction obstruction (UPJ), 4/41 duplicate collecting system, 5/41 vesicourethral reflux, 2/41 ectopic kidney, 3/41 renal hypoplasia. Genetic testing was done before, during or after pregnancy in 2/4/4 patients, respectively. Teratogenic therapy exposure occurred in 25% of gestations. Most patients were CKD stage 1 (33/41), with 2/4/1/1 with patients in CKD stage 2/3/4/5, respectively. Mean baseline SCr was 0.99 ± 0.8 mg/dL [0.4-4.6] and mean proteinuria was 194 ± 357 mg/g [22-1500]. Renal function (RF) deterioration occurred in 9/47 (19%) women due to pre-eclampsia (PE), pregnancy hyperfiltration (PH) and hydronephrosis in 3/3/3 patients, respectively. Urologic intervention was needed in 2 patients due to hydronephrosis, and one of the patients required transient dialysis. All patients fully recovered RF except for the 1 CKD stage 3 patients that had partial RF recovery. De novo and worsening proteinuria occurred in 7/47 gestations due to PE (3/7) and PH (4/7). De novo or aggravation of HTN occurred in 25% gestations, UTI in 19% and PE in 6% gestations. Regarding fetal outcomes, mean duration of gestation was 38 ± 2 weeks [32-41] and mean birth weight 2910 ± 634 g [1360-4600]. There was 1 miscarriage and 1 medical termination of pregnancy at 17 weeks (neural tube defect). Cesarean was performed in (8/47, 17%) gestations and 10/47 (17%) newborns were admitted to the neonatal care unit (NICU) mainly due to prematurity, sepsis and feeding intolerance. Conclusion Our cohort of CAKUT patients was very heterogenous and only 19.5% had CKD stage 2-5. Still, we found a significant incidence of maternal, obstetric, and perinatal complications, namely HT UTI, PE, and the need for NICU. UPJ obstruction can evolve with RF deterioration and the need for intervention during pregnancy. This study underlines the importance of the management of these patients by a multidisciplinary team.

Epidemiological Characteristics of Chronic Renal Failure Patients of Hodeidah, Yemen in 2023

Chronic renal failure (CRF) is an emergent worldwide public health problem. The increasing incidence of CRF warrants a need for an epidemiological approach to better understand the disease and its prevention. Therefore, the study aims to describe the epidemiological characteristics of chronic renal failure patients in Hodeidah, Yemen. The study included 560 patients with CRF in retrospective study (a case series based on medical files) in Center of Dialysis and Renal Diseases of Hodeidah, Yemen from 1st January 2023 to 31st December 2023. The patients were diagnosed based on evidence – based clinical practice guideline of all stages of CRF that was extracted from the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKFKDOQI). Epidemiological data were reported with ethical approval consideration, data obtained were analyzed. 560 cases were diagnosed with renal failure, 555 patients (99.107 %) of them were diagnosed with CRF and 5 patients (0.89 %) were diagnosed with acute renal failure (ARF). CRF patients was founded 61.81 % in the males while 38.11 % in the females. However, this difference was statistically significant (X2= 30.921; p < 0.00001). The age range of patients was from 5 to 95 years, where 54.64% of cases occurred more than 50 years then 39.28 % between 18 to 49 years and the lower frequency was in children less than 18 years (5.22%) with different significant ( X2= 226.314 ; p < 0.00001). In addition, 81.98 % of patients in rural and 18.02 % in urban. The maximum cases were reported in summer session namely 13.21 % in July and 11.25 % in August. On the other hand , the major causes were chronic diseases 406 case (73.14 %) that diagnosed and recorded , 161 case (29 %) of hypertension ,132 case (23.78 %) of diabetes , 113 (20.36 %) of inflammation nephrolithiasis obstructive uropathy , 8 cases (1.44 %) of genetic polycystic renal disease , and 4 cases ( 0.72 % ) of sedative narcotic addiction and 137 case (24.68%) of unknown causes with different significant ( X2= 119.00 ; p < 0.00001). The chronic diseases namely diabetes and hypertension were the major causes reported to develop the CRF, therefore, to prevent the development of CRF based on center for control diseases and control (CDC), managing risk factors.

#924 Characteristics and outcomes of emergency department patients with acute kidney injury (AKI) stage 2 and 3 electronic alerts at a single UK centre

Abstract Background and Aims The epidemiology of Acute Kidney Injury (AKI) in hospitalized and critically ill populations has been well described but less is known about AKI in the emergency department (ED) patients. Community-acquired AKI represents about a quarter of AKI events observed in the hospital, and its incidence is increasing. Our aim was to look at the characteristics, early management, triage and outcomes of patients with AKI stage 2 and 3 alerts from busy emergency department. Method A retrospective review of patients with AKI 2 and 3 alerts from ED at Doncaster royal Infirmary (DRI) and Bassetlaw sister units in England over a 2 month period from August - September 2022 was conducted. All alerts from Ambulatory/SDEC (Same day emergency care) units have been excluded from this study. Data was gathered from trust electronic health system and patient discharge summaries. Results 158 AKI stage 2 and 3 alerts were received from ED at DRI and Bassetlaw of which 91 (57.5%) were AKI 2 alerts and 67 (42.4%) were AKI 3 alerts. Average age of patients was 73 yrs. Median length of stay in ED was 9hrs (Range 3 hrs–41 hrs). 44 (28%) patients died during this hospital episode of which 28 (64%) died in medical wards, 10 (23%) in critical care unit, 5 died in ED and 1 patient died in surgical ward. Average age of patients who died was 70 yrs and Median length of stay in ED was no different at 9hrs. 23 (52%) had sepsis as primary cause of death. 8 (18%) who died had active malignancy. 9 (20%) had either end stage heart failure/Liver failure or primary lung condition. 8 (18%) had either Frailty, Old age and/or Dementia listed as contributing to death. 8 (18%) patients were discharged home from ED. Discharge diagnosis was Dehydration and/or Falls. Only 4 of the 8 patients had AKI communicated to Primary care on ED discharge letter. 3 of the discharged patients had hospital readmission within 30 days. Looking at the initial intervention in ED, all patients had early warning score and initial resuscitation documented however none of the patients had Fluid balance charted. Bladder scan was performed on 15 (34%) patients where there was high suspicion of obstructive uropathy. Medication as a contributing factor to AKI was commented in 7 (4%) cases. Out of 106 patients who were discharged from hospital wards, sepsis, community acquired pneumonia, urinary tract infection and gastroenteritis were the commonest discharge diagnosis. Median length of Hospital stay was 11 days. Only 2 patients were admitted to specialist Renal ward directly from ED. AKI was communicated to primary care in 70 (62%) patients at discharge. 13 (12%) patients were readmitted to hospital within 30 days of discharge. Conclusion AKI is a marker of severity of illness and we note significant mortality in patients who present to ED with stage 2 and 3 AKI. Sepsis was commonest cause of death but we note a significant proportion of patients had either active malignancy or severe underlying chronic health condition. With increasing waiting times in ED, early recognition and AKI focused management is a priority. AKI education for nursing and medical staff in ED and Pharmacy input for patients who spend long hours in ED might help reduce length of overall hospital stay.

Collagen 17A1 in the Urothelium Regulates Epithelial Cell Integrity and Local Immunologic Responses in Obstructive Uropathy

Collagen 17A1 (COL17A1), an epidermal hemidesmosome component, is ectopically induced in the urothelium of mouse and human renal pelvis (RP) in parallel with urinary tract-associated lymphoid structure development. Here, COL17A1 was induced in obstructive uropathy-prone ureter of humans and cats. To ascertain its function, murine urinary organs with unilateral ureteral obstruction (UUO) were analyzed during 1 week after surgery. One day after UUO, COL17A1 expression increased in urothelial cells of RP and ureter, and was positively correlated with renal tubulointerstitial lesions. A portion of RP where the smooth muscle layer from the ureter was interrupted was sensitive to urothelium deciduation and COL17A1 induction, showing urine leaked from the RP lumen into the parenchyma. After urine stimulation, cultured immune cells expressed Cxcl2, also up-regulated in CD11b+ cells following COL17A1 stimulation. One day after UUO, CXCL2+ CD11b+ cells infiltrated the urothelium-disrupted area. However, these numbers were significantly lower in Col17a1-deficient mice. COL17A1+ urothelial cells partially co-expressed cytokeratin-14, a progenitor cell marker for urothelium, whereas Col17a1-deficient mice had lower numbers of cytokeratin-14+ cells. Gene Ontology analysis revealed that expression of epithelial- and immune-associated genes was up-regulated and down-regulated, respectively, in the ureter of Col17a1-deficient mice 4 days after UUO. Thus, COL17A1 maintains urothelium integrity by regulating urothelial cell adhesion, proliferation, and differentiation, and activates local immune responses during obstructive uropathy in mammals.

A review of the current treatment methods for retroperitoneal fibrosis with obstructive uropathy.

Retroperitoneal fibrosis (RPF) is a fibroinflammatory disease in which patients may suffer obstructive uropathy (OU). The optimum treatment strategy for RPF with secondary OU is currently unclear, and the aim of this literature review is to assess the methods used to treat this patient cohort. Medline, Embase, Cinahl, the Cochrane Library and PubMed were systematically searched to find studies assessing treatment outcomes in this patient cohort. After reviewing the studies' titles, abstracts and full texts, 12 were found that matched our search aims. Data from these publications were analysed and reported. The demographic and symptomatic features of patients across the 12 studies were representative of the general RPF population. No randomised control trials (RCTs) were found, and just one study formally compared outcomes between patients who underwent different treatment strategies. Many of the studies concluded that using medical and surgical methods in combination led to positive outcomes; whereas, others found positive outcomes following a variety of regimens. Many studies also highlighted, however, that significant minorities required further treatment after initial therapy. Conclusions regarding optimum treatment methods were limited as most publications did not formally compare outcomes following different strategies and had an observational study design. Although positive outcomes were commonly seen following medical, surgical and a combination of treatments, the literature currently lacks research formally comparing outcomes after assigning specific treatment protocols to groups of RPF patients. More research is therefore required to determine how to best manage RPF leading to secondary OU.

The efficacy and safety of retrograde ureteral stenting in the management of complicated cases of ureteral obstruction caused by urolithiasis.

To investigate the efficacy and safety of retrograde double J stent (RDJS) placement in the management of complicated obstructive uropathy caused by urolithiasis. An observational study done at a tertiary center was implemented in which a total of 27 patients (10 males, 17 females) with average age of 48.74 years (range: 15-88) who underwent RDJS or percutaneous nephrostomy (PCN) between 2017 and 2021 due to complicated obstruction caused by urolithiasis were included. A total of 27 patients (10 males, 17 females) with average age of 48.74 years (range: 15-88) who underwent kidney decompression between 2017 and 2021 due to complicated unilateral or bilateral kidney obstruction caused by ureteral stones were included. Twenty-two patients (81.48%) underwent successful RDJS placement, two patients had RDJS placement then PCN was also placed, and two patients underwent PCN placement. Three patients needed an intensive care unit "ICU" after intervention, two of them were in the ICU before intervention. All septic parameters were normalized within a short period postoperatively. Two patients with failed previous ureteroscopy had a successful RDJS placement. Retrograde DJS placement is a feasible option in the management of complicated cases of obstructive uropathy caused by urolithiasis. Short hospitalization period, low rate of complications and better quality of life are the most prominent advantages of RDJS placement. In the hands of experienced surgeons, RDJS should be offered as the first choice of decompression for obstructive uropathy caused by urolithiasis.

Prevalence and Survival Rate of Advanced Stage Cervical Cancer Patients with Obstructive Uropathy in a Tertiary Hospital

Introduction: This study aims to determine the prevalence and survival rate of advanced cervical cancer patients with obstructive uropathy based on grade of hydronephrosis, type of hydronephrosis, deobstruction action, type of deobstruction, clinical stage, and cancer cell type.Method: This research is a descriptive analytical study with a cross-sectional retrospective approach. Samples were obtained from medical records of patients with stage IIIB, IVA and IVB cervical cancer who were treated at RSUD Dr. Saiful Anwar Malang in 2016–2023. Sampling was carried out using the total sampling method.Result: Of the 171 patients, the majority of patients had stage IIIB cervical cancer (71.9%), moderate (72.5%) and bilateral (90.1%) hydronephrosis were found in the majority of patients. SCC dominated the sample (82.5%) and was followed by ADC (14.6%). Most patients underwent deobstruction (64.3%) with DJ stent insertion being the most common type of deobstruction (84.5%). Patients with stage IVB have a lower survival rate than IIIB and IVA (p>0.05). Patients with SCC had lower survival (3%) than ADC (5%). The average survival rate for the three grades of hydronephrosis was not significantly different (p>0.05). Patients undergoing deobstruction showed a higher survival rate (5%) (p<0.05). DJ stent, PCN, and UCS insertion showed similar survival rates in patients (p>0.05).Conclusion: Stage IIIB cervical cancer, moderate hydronephrosis, bilateral hydronephrosis, and SCC dominated the patients in the study. Patients with stage IVB cervical cancer, SCC, unilateral or severe hydronephrosis have a worse prognosis. The presence of deobstruction indicates a better prognosis and can be performed with PCN, DJ stent insertion, or UCS.

Intrarenal Artery Resistive Index – An Invaluable Tool In Detecting Obstructive Uropathy

Intrarenal Artery Resistive Index – An Invaluable Tool In Detecting Obstructive Uropathy

Hydrocolpos causing bowel obstruction in a preterm newborn: a case report

BackgroundImperforate hymen is the most common congenital defect of the female urogenital tract. The spectrum of clinical manifestations is broad, ranging from mild cases undiagnosed until adolescence to severe cases of giant intraabdominal masses. The most common complication of hydrocolpos is bladder compression, resulting in obstructive uropathy and hydronephrosis.Case presentationWe present here the case of a preterm neonate who was admitted to the surgical neonatal intensive care unit for bowel obstruction. The baby did not appear septic or unwell, a small amount of meconium passed frequently, and no bilious gastric residuals occurred. Based on these findings, acute abdominal obstruction was doubtful, and the surgeon chose a conservative (watch and wait) approach. Subsequently, we performed abdominal ultrasound and magnetic resonance imaging based on unclear information about a suspicious abdominal mass raised by the gynecologist shortly before the emergency C-section. The final diagnosis was congenital hydrocolpos due to imperforate hymen. The pediatric gynecologist indicated an incision of the imperforate hymen under general anesthesia. The incision resolved abdominal distention as well as the bowel obstruction.ConclusionThe presentation of hydrocolpos was not typical (no bulging in the vaginal introitus) in our case, and clinical symptoms implied acute bowel obstruction shortly after birth. The surgeon chose a conservative (watch and wait) approach as the baby did not appear unwell on the second day of life. Fortunately, diagnostic laparotomy was not required as the next step in bowel obstruction management. All clinical symptoms resolved after a minor surgical procedure.

Clinical epidemiology and outcomes of emergency department-acute kidney injury: A systematic review

BackgroundOver half of all community-acquired acute kidney injury (CA-AKI) initially presented to emergency department (ED), but emergency department acute kidney injury (ED-AKI) is poorly characterised, poorly understood with no systematic review, often under-recognized and under-managed. ObjectiveTo review the incidence, risk factors, and outcomes of ED-AKI, and risk factors of post-ED-AKI mortality globally. MethodsWe included published prospective or retrospective observational studies, controlled trials, and systematic reviews reporting AKI in adult ED attendees within 24 h of ED admission. Iatrogenic causes of AKI from medical interventions were excluded. We used PubMed to identify articles from 1996 to August 14, 2021, and adopted the National Heart, Lung, and Blood Institute (NHLBI) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies to assess risk of bias. We used a Forest plot to present pooled ED-AKI incidence rates and I2 statistics. Other parameters were summarized narratively. ResultsUsing 24 h from ED admission as the definition for ED-AKI we identified six articles from 2005 to 2018 in high-income settings and one article with a 48-h timeframe. The pooled incidence of ED-AKI was 20 per 1000 adult ED attendances. Risk factors for ED-AKI included increasing age, nursing home residence, previous hospital admission within 30 days, discharge diagnosis of diabetes, obstructive uropathy, sepsis, gastrointestinal medical conditions, high serum creatinine, bilirubin, C-reactive protein, white blood cell, alanine aminotransferase, low serum sodium or albumin on admission, poor premorbid renal function, antibiotic use, active malignancy, lung disease, hyperlipidaemia, and infection. Crude, all-cause 24-h mortality rate was 4.56 % and the one-year mortality rate was 35.04 %. Increasing age and comorbidities including cardiovascular disease and malignancy were associated with higher mortality rates. ConclusionThe review reveals a paucity of relevant literature which calls for further research, increased vigilance, red flag identification, and standardized management protocols for ED-AKI.

Transurethral water vapour therapy (Rezūm) for catheter‐dependent men secondary to benign prostatic hyperplasia: A retrospective study in a Hong Kong population

AbstractAimRezūm is a novel treatment for patients with moderate to severe lower urinary tract symptoms as a result of benign prostatic hyperplasia (BPH). Recently, it has expanded to patients with urinary retention causing catheter dependence and the results are promising in Whites. However, it is unclear how effective Rezūm is in the Chinese population. Here, we report our experience in performing Rezūm on catheter‐dependent Chinese men with BPH and evaluate its safety and efficacy.MethodsA retrospective review of catheter‐dependent patients with BPH who underwent Rezūm from January to August 2022 was conducted. We evaluated the success rate of trial without catheter (TWOC) and compared pre‐ and post‐operative (at 6 months) uroflowmetry results, International Prostate Symptoms Score (IPSS), IPSS Quality of Life Score (IPSS QoL), and prostate volume.ResultsSixty‐three patients had Rezūm performed (44 and 19 patients had refractory urinary retention and obstructive uropathy, respectively) with a mean age of 74 years and a mean prostate size of 53.9 mL. The first attempt at TWOC was successful in 53 patients (85.5%; range 15–44 days post‐operation). By 98 days after the operation, all patients could void spontaneously. The 6‐month follow‐up showed that IPSS and IPSS QoL scores decreased by a mean of 9.0 and 1.8 points, respectively (both P < .01). The mean pre‐operative post‐voided residual urine was reduced by 559 mL (P < .01), with a mean prostate size reduction of 9.4 mL (P < .01). Seven patients had non‐serious complications (Grade 1–2 Clavien–Dindo classification) within 30 days of operation.ConclusionRezūm was shown to be effective and safe in catheter‐dependent Chinese men with BPH.

Neonatal jaundice is associated with increased risks of congenital anomalies of the kidney and urinary tract and concomitant urinary tract infection

The link between neonatal jaundice and urinary tract infection (UTI) remains debated, with congenital kidney and urinary tract anomalies (CAKUT) potentially playing a role. This population-based study aimed to analyze the correlations between neonatal jaundice, CAKUT, and concomitant UTI. The study cohort consisted of 2,078,122 live births from 2004 to 2014. We linked several population-based datasets in Taiwan to identify infants with unexplained neonatal jaundice and their mothers. The primary outcome was the rate of CAKUT occurring within 3 years after delivery, and the presence of concomitant UTI during neonatal jaundice hospitalization. Infants with neonatal jaundice had a significantly higher risk of CAKUT (adjusted odds ratio [aOR] 1.24, 95% confidence interval [CI] 1.11–1.39) during early childhood. Among the subtypes of CAKUT, obstructive uropathy, vesicoureteral reflux and other CAKUT were associated with an increased risk of neonatal jaundice. Infants who underwent intensive phototherapy, had a late diagnosis (> 14 days of postnatal age) or underwent a prolonged duration of phototherapy (> 3 days) exhibited a higher risk of concomitant UTI compared to other infants with jaundice. Our findings indicate a notable association between neonatal jaundice and increased risks of UTIs in the context of CAKUT. This study underscore the importance of vigilant monitoring and timely interventions for neonates presenting with jaundice, while acknowledging the complexity and variability in the progression of CAKUT and its potential connection to UTIs.

Urosepsis: pathophysiology, diagnosis, and management-an update

Urinary tract infections vary widely in their clinical spectrum, ranging from uncomplicated cystitis to septic shock. Urosepsis accounts for 9-31% of all cases of septicemia and is often associated with nosocomial infections. Amajor risk factor for urosepsis is the presence of obstructive uropathy, caused by conditions such as urolithiasis, tumors, or strictures. The severity and course of urosepsis depend on both the virulence of the pathogen and the patient's specific immune response. Prompt therapy, including antimicrobial treatment and eradication of the infection source, along with supportive measures for circulatory and respiratory stabilization, and adjunctive therapies such as hemodialysis and glucocorticoid therapy, is crucial. Due to demographic changes, an increase in cases of urosepsis is expected-thus, it is of utmost importance for urologists to be familiar with targeted diagnostics and effective treatment.

Distal renal tubular acidosis as a rare complication of vesicoureteral reflux in children: a case report and literature review.

Distal renal tubular acidosis (dRTA) is a clinical picture of hyperchloremic hypokalemic metabolic acidosis with a normal anion gap. It can be caused by a variety of conditions including obstructive uropathy such as vesicoureteral reflux (VUR). We report a rare case of dRTA secondary to VUR in a 4-year-old girl with a history of meningomyelocele, neurogenic bladder and recurrent urinary tract infections. She was admitted to the hospital with complaints of polydipsia, polyuria, and inability to gain weight for the last 1year. She was on prophylactic antibiotic treatment with clean intermittent catheterization and anticholinergic drug. She had a history of subureteral injection of various agents and botulin toxin injection into the bladder. Her voiding cystourethrogram revealed grade 5 VUR in the left kidney, tortuosity in the left ureter, and the bladder had a dome-like appearance and was trabeculated. When all laboratory values of the patient since birth were examined, it was observed that urine pH was high despite hypokalemic hyperchloremic metabolic acidosis for the last year; these abnormalities became more severe in the last few months. In conclusion, the development of hypokalemia and nephrolithiasis/nephrocalcinosis along with metabolic acidosis in a patient diagnosed with VUR should be considered as an indicator of impaired tubular functions. Also, the possibility of an underlying VUR in the presence of recurrent urinary tract infection in a patient diagnosed with dRTA should not be ignored.

Imaging and video of late preterm delivery by midline laparotomy due to incarcerated uterus: A case report and literature review of a rare but morbid condition.

Incarcerated gravid uterus (IGU) is a rare and serious obstetric complication. IGU is defined as the entrapment of the gravid uterus between the pubic symphysis and the sacral promontory. The incidence of IGU is 1 in 3000-10 000 cases. IGU is associated with significant obstetric complications, including preterm labor, intrauterine fetal death, growth restriction, renal failure, uterine ischemia/rupture and thrombosis. Here, we present the case of a primigravida with urinary retention at 14 weeks. On transabdominal ultrasound at 19+5/7 weeks the cervix was difficult to visualize, and the anterior uterine wall appeared thickened. The bladder was elongated superior to the uterus and the placenta was low-lying. Initially the patient was managed with intermittent self-catheterization, and subsequently indwelling catheterization was required from 22 weeks. At 30 weeks, the patient was transferred to a tertiary center and magnetic resonance imaging (MRI) was preformed due to challenging visualization of the cervix on ultrasound and the patient's continued symptoms of constipation and recurrent urinary infections. The MRI found a retroflexed gravid uterus, with vagina and endocervix displaced anteriorly and compressed by the gravid uterus. The findings were consistent with an incarcerated uterus. The patient subsequently had positive urinary cultures for Pseudomonas and rising creatinine. Given the obstructive uropathy and associated morbidity and mortality, a plan for elective pre-term delivery at 33+6/7 weeks was made. Delivery was by midline laparotomy, normal anatomy was restored after manual evacuation of the fundus from below the sacral promontory, and an uncomplicated lower segment transverse uterine cesarean section was performed.

Laser Lithotripsy for the Management of Ureteric Calculus

Urinary calculi are important problem in urology field. Ureteral stones can cause obstructive uropathy and subsequent deterioration of renal function. The minimal invasive approaches become the major source of treatment modalities with the development of lithotripsy technology. A prospective cross sectional hospital study was conducted in the Urology Department of a tertiary care hospital in Kathmandu for a period of one year (September 2022 to August 2023). A total of 118 patients attending Urology OPD and undergoing laser lithotripsy were included in the study. Ureteroscopic procedure was done using a 6.5 Fr (Wolf Inc., Germany) semirigid ureteroscope under direct endoscopic vision and once the stone was visible, fragmentation was done using Ho-YAG laser. The mean age of the patients was 35.36 ± 11.65 years with male preponderance (58.5%). The common presenting symptom was flank pain and ureteric calculus was more common in the left side (49.2%). Upper ureteric calculus (60.2%) and single stone (83.9%) were more common. Stone size <10 mm (54.2%) and density more than 1000 HU (87.3%) were more common. Stone retropulsion was seen in 16.1% cases and 78% had no post operative complications. SFR in Xray KUB was 94.9% and in USG was 78.8%. The association of SFR in Xray KUB and USG among different variables - male and female patients, patients with stone size < and ≥ 10 mm, stone density < and ≥ 1000 HU and sites (upper, middle and lower) was statistically not significant. The laser lithotripsy technique was found to be effective and safe for ureteric calculus with high SFR.

Clinicopathological Study of Helicobactor Pylori Infection and Gastric Carcinoma at a Tertiary Care Hospital in Kathmandu

Urinary calculi are important problem in urology field. Ureteral stones can cause obstructive uropathy and subsequent deterioration of renal function. The minimal invasive approaches become the major source of treatment modalities with the development of lithotripsy technology. A prospective cross sectional hospital study was conducted in the Urology Department of a tertiary care hospital in Kathmandu for a period of one year (September 2022 to August 2023). A total of 118 patients attending Urology OPD and undergoing laser lithotripsy were included in the study. Ureteroscopic procedure was done using a 6.5 Fr (Wolf Inc., Germany) semirigid ureteroscope under direct endoscopic vision and once the stone was visible, fragmentation was done using Ho-YAG laser. The mean age of the patients was 35.36 ± 11.65 years with male preponderance (58.5%). The common presenting symptom was flank pain and ureteric calculus was more common in the left side (49.2%). Upper ureteric calculus (60.2%) and single stone (83.9%) were more common. Stone size <10 mm (54.2%) and density more than 1000 HU (87.3%) were more common. Stone retropulsion was seen in 16.1% cases and 78% had no post operative complications. SFR in Xray KUB was 94.9% and in USG was 78.8%. The association of SFR in Xray KUB and USG among different variables - male and female patients, patients with stone size < and ≥ 10 mm, stone density < and ≥ 1000 HU and sites (upper, middle and lower) was statistically not significant. The laser lithotripsy technique was found to be effective and safe for ureteric calculus with high SFR.

Predictive Factors of Successful Double J Stent Insertion Among Advanced Cervical Cancer Patients.

Cervical cancer remains the most lethal and prevalent cancer among women. Obstructive uropathy is a common complication of advanced cervical cancer, caused by the expanding tumor. One of the recommended treatments for this condition is the implantation of a double J (DJ) stent. However, this procedure is challenging due to the unique characteristics of the patient. The objective of this study was to identify the variables that influence the successful insertion of a DJ stent in women with advanced cervical cancer. This retrospective study included women who attempted to have a DJ stent implanted at the General Hospital of Adam Malik in Medan, Indonesia, between January 2020 and December 2022, and were diagnosed with advanced cervical cancer. The inclusion criteria were limited to cervical cancer patients in stages III-IV, according to the International Federation of Gynecology and Obstetrics (FIGO) staging standard, who underwent an attempt at DJ stent insertion. Patients who underwent a nephrostomy and received a DJ stent were excluded from the study. The participants were divided into two groups based on the success of the DJ stent implantation. The analysis was conducted using the logistic regression test and the Chi-square test. The study included 88 patients with advanced-stage cervical cancer, of whom 45 underwent nephrostomy and 43 received a DJ stent. The analysis revealed that lower levels of hydronephrosis (odds ratio (OR): 18.203, P = 0.001), urea (OR: 4.207, P = 0.037), and creatinine (OR: 6.923, P = 0.004), higher levels of urine output (OR: 8.26, P = 0.003), and lower cervical cancer stage (OR: 4.125, P = 0.022) were all predictors of successful DJ stent insertion. For women with advanced cervical cancer, lower degrees of hydronephrosis, urea, and creatinine levels, higher urine output, and lower cervical cancer stage were all predictive factors for successful DJ stent implantation.

Educating patients about health helps slow the progression of chronic kidney disease in the eastern region of India

Abstract Background: Chronic kidney disease (CKD) poses a well-documented burden, necessitating patient awareness of the importance of healthy lifestyle modifications to mitigate co-morbidities and mortality risks. Objective: This study aimed to assess the effectiveness of education-based conservative management in mitigating disease progression among CKD patients in the eastern region of India. Materials and Methods: A total of 248 CKD patients receiving outpatient department and inpatient department care at the nephrology and dialysis department of Belle Vue Clinic, Kolkata, West Bengal, India, were included in the study. Comprehensive data encompassing demographic details, socioeconomic status, clinical co-morbidities, and conservative management interventions via patient education were examined. The study compared the rise in creatinine levels with adherence to five key factors: dietary restrictions, medication compliance, follow-up appointments with physicians, management of co-morbidities, and adherence to lifestyle modifications. Each strategy was graded on a scale of 0, 1, or 2 based on compliance, with 0 indicating minimal or no compliance, 1 indicating moderate compliance, and 2 indicating strong compliance. Results: In this study, several factors were linked to elevated creatinine levels among CKD patients, including being in the middle-age range, male gender, living predominantly in urban areas, and working in business or service occupations. Additionally, a higher prevalence of co-existing conditions such as diabetes mellitus and hypertension was noted among CKD patients, along with documented instances of polycystic kidney disease, obstructive uropathy, and renal cell carcinoma. After educating CKD patients, those who scored 8–10 on compliance exhibited a decrease in creatinine elevation (0.35 mg/dL) among 120 cases from January 2022 to June 2023. Conversely, those with scores ranging from 5 to 7 (81 cases) showed moderate creatinine elevation (1.24 mg/dL), while those with scores of 0–4 (47 cases) demonstrated higher levels of creatinine elevation (5.48 mg/dL). Conclusion: This study concludes that the conservative management of CKD patients educates individuals about primary prevention of the disorder and provides a comprehensive understanding of secondary and tertiary prevention strategies. This cost-effective approach significantly impacts physical, mental, social, and psychological adjustment behaviors.