Obstructive Uropathy Research Articles

Urethral calculi: An uncommon but important cause of urinary retention in females

Urinary retention is a stressful situation that requires appropriate and prompt management [1]. When it occurs, it leads to anxiety, pain and lower abdominal discomfort [1]. When it is long-lasting, the backpressure of urine that results from the obstruction can lead to hydroureters and hydronephros is, which can lead to kidney injury. Urethral obstruction in females is caused by previous incontinence surgery, urethral stricture and external obstruction of the urethra, such as from pelvic tumours like uterine fibroids and cervical cancer, among others [2]. Urethral obstruction from urethral stones has an incidence of 1 -2% and is reported to be very rare in females due to their comparatively short and straight urethra[3-5]. Kyei [6], in this edition of the HSIJ, has clearly illustrated, using medical imaging, a case of urethral obstruction in a nulliparous lady caused by urethral obstruction from a calculus. This is instructive and provides several learning points. In terms of history, the young lady had no previous history that would point towards a urinary tract calculi, such as previous pelvic pain and haematuria, except for the two-day history of the frequency of micturition. Examination revealed a distended bladder. This may be a pointer to an obstructive uropathy. However, because urethral calculus is an uncommon cause in females, it is likely to be missed. Without paying close attention to examining the urethra, one can miss out on the diagnosis of pelvic examination. Investigations such as an abdominopelvic ultrasound scan and CT scan are helpful in the diagnosis of urethral obstruction from a stone as well as helping to assess the other parts of the urinary tract for more stones and also obtaining information regarding pelvic tumours causing urethral obstruction. Clinicians need to have the possibility of the diagnosis in mind to be able to clinch it at the examination. This is because, in spite of all the progress made in medical care in Ghana, some health centres may still lack or have faulty radiological equipment. Making the diagnosis early helps to relieve the obstruction early and helps to alleviate the uncomfortable symptoms of pain and anxiety. It also reduces the risk of urethral damage from a locally impacted stone and damage to the kidneys caused by backpressure from the obstructed urine. A urethral examination should, therefore, constitute an important part of the patient clinical evaluation in cases of urinary retention.

Use of artificial stones in training and laboratory studies, have we found the right material? Outcomes of a systematic review from the European School of Urology.

In this review, we investigated the current literature to find out which artificial stones (AS) are available in endourology, and in which experimental and training schemes they are used. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Twenty-one out of 346 studies met our inclusion criteria and are presented in the current review. The inclusion criteria were the existence of AS and their use for laboratory and training studies. There is a wide variety of materials used for the creation of AS. BegoStone powder (BEGO USA, Lincoln, Rhode Island) and plaster of Paris™ were used in most of the studies. In addition, Ultracal-30 (U. S. Gypsum, Chicago, IL) was also used. Other materials that were used as phantoms were AS created from plaster (Limbs and Things, UK), standardized artificial polygonal stone material (Chaton 1028, PP13, Jet 280; Swarovski), model stones consisting of spheres of activated aluminum (BASF SE, Ludwigshafen am Rhein, Deutschland), Orthoprint (Zhermack, Badia Polesine, Italy), and a combination of plaster of Paris, Portland cement, and Velmix (calcium sulfate powder). Many experimental settings have been conducted with the use of AS. Our research demonstrated nine studies regarding testing and comparison of holmium: yttrium-aluminum-garnet laser devices, techniques, and settings. Six studies were about extracorporeal shock wave lithotripsy testing and settings. Three experiments looked into treatment with percutaneous nephrolithotomy. Additionally, one study each investigated imaging perioperatively for endourological interventions, stone bacterial burden, and obstructive uropathy. AS have been used in a plethora of laboratory experimental studies. Independent of their similarity to real urinary tract stones, they present a tremendous potential for testing and training for endourological interventions.

Obstructive Uropathy with Uremia due to Advanced Cervical Cancer

Obstructive Uropathy with Uremia due to Advanced Cervical Cancer

November 2023 Medical Image of the Month: Obstructive Uropathy Extremis

No abstract available. Manuscript truncated after 150 words. A 71-year-old veteran presented to the emergency department with two-weeks of progressive back pain radiating to the abdomen associated low-grade fever, nausea, and new lower extremity edema. The family reported confusion. His medical history was significant for chronic prostatitis and low-grade prostate cancer on biopsy that was lost to follow-up eleven years ago. His only reported medications were aspirin 81 mg daily and naproxen 500mg up to four times a day for his pain. Vitals were significant for a temperature of 36.1 C, initial blood pressure of 201/74, heart rate of 128/min, respirations at 18/min with a saturation of 97% on 2L NC. Physical exam demonstrated no difference in blood pressures between arms. No abnormal heart sounds. Clear breath sounds to auscultation bilaterally. Flank tenderness to percussion and significant abdominal tenderness over the epigastric and suprapubic region with 3+ pitting edema of the bilateral lower extremities. Screening labs were notable …

Large-Scale Exome Sequencing Analysis Implicates FOXQ1, FOXI2, EXOSC2, and MMP15 as Candidate Genes for Human Congenital Obstructive Uropathy

Large-Scale Exome Sequencing Analysis Implicates FOXQ1, FOXI2, EXOSC2, and MMP15 as Candidate Genes for Human Congenital Obstructive Uropathy

Clinical application of 99mTc-DTPA dynamic renal scintigraphy with consequent SPECT/CT imaging in patients with different nephrological conditions

Introduction: Dynamic renal scintigraphy with 99mTechnetium diethylenetriaminepentaacetic acid (99mTc DTPA) is a generally used imaging technique for evaluating renal function of patients with various nephro-urological conditions. Clinical application of SPECT/CT nephroscintigraphy has rarely been discussed. Objective: The aim of the study was to evaluate the added value of SPECT/CT imaging to dynamic renal scintigraphy with 99mTc DTPA. Materials and Methods: Thirty two patients (66% female and 34% male) who underwent dynamic nephroscintigraphy with subsequent SPECT/CT with mean age 55.9±18.25 years was observed. The CT scan was performed with a low dose protocol. A dose of 185MBq (5mCi) 99mTc DTPA was administered intravenously. Results: Our analysis demonstrated impaired relative renal function in various degrees of left kidney in 18 patients (56%) and of right kidney in 14 patients (44%). SPECT/CT imaging revealed the specific cause, responsible for the renal dysfunction in the cases. The hybrid imaging demonstrated urolithiasis in 11 patients, postopertative strictures of ureter in 5 patients, diagnosed urological cancer in 4 patients, external compression of ureter from ovarian cyst in 1 patient and compression of ureter due to nephroptosis in 1 patient as a possible obstructive cause. In 10 patients congenital renal anomalies were the identified causes of impaired renal function – hypoplastic kidney in 4 patients, duplex kidney in 2 patients, multiple cortical cysts in 2 patients, aberrant vessel obstructing the pyeloureteral segment in 1 patient and horseshoe kidney in 1 patient. Conclusion: The combination of conventional 99mTc DTPA dynamic renal scintigraphy with subsequent SPECT/CT could provide not only functional but also anatomical information of the urinary tract, especially in the evaluation of obstructive uropathies and congenital renal abnormalities, that can change the clinical management

Role of Multidetector Computed Tomography Urography in the Evaluation of Obstructive Uropathy: A Review.

Obstructive uropathy, a prevalent clinical problem, can irreparably harm the kidneys if not treated promptly. As a result, accurate diagnosis is necessary for prompt management. This study examines the utility of multidetector computed tomography (MDCT) urography in identifying obstructive uropathy. PubMed, Google, Embase, Medline, and other electronic databases were used to search the English-language literature. The search phrases were obstructive urinary infections or urinary bladder or kidneys or MDCT. The authors' expertise and experience in the subject area aided in archiving pertinent publications. Even though the dilated upper tract of the ureters can be seen, ultrasonography (USG) has limitations because it cannot show the middle portion of the ureters, even if they are dilated mostly due to bowel gas artifacts. The USG does not emphasize the functioning of the renal tract. To evaluate obstructive uropathy, MDCT urography plays a very important role. For speedy, effective therapy, it provides a quick diagnosis of the source of obstruction.

Xanthogranulomatous Pyelonephritis as a Complication of Obstructive Uropathy: Clinical Case

Xanthogranulomatous Pyelonephritis as a Complication of Obstructive Uropathy: Clinical Case

Patterns of Utilization and Outcomes of Perioperative Chemotherapy in Patients With Locally Advanced-urothelial Bladder Cancer (LABC)-Real World Data From an Indian Tertiary Care Cancer Center.

Optimal utilization of perioperative systemic therapy in locally advanced bladder cancer (LABC) holds the key in improving the survival outcomes. We aim to analyze the oncological outcomes of clinically locally advanced urothelial bladder cancer patients treated with neoadjuvant (NACT) or adjuvant chemotherapy or without any systemic therapy in the perioperative period of radical cystectomy. We retrospectively analyzed the medical records of patients with cancer of the urinary bladder diagnosed between 2012 and 2020. The demographic profile, and the treatment received, was recorded for all patients. Oncological outcomes of the patients based on these variables were analyzed. Two hundred and twenty nine (229) locally advanced bladder cancer patients were included in the study. Eighty eight (38%) of them underwent upfront radical cystectomy and 141 (62%) received neoadjuvant chemotherapy (NACT). With a median follow-up of 27 months, the 2-year DFS in either of the groups was 65.4% and 67.1% respectively (P - 0.373). In the multivariate analysis, the pathological lymph nodal status and lymph vascular invasion (LVI) status influenced the DFS. The initial modality of management chosen did not affect the outcome. (HR - 0.688; 95% CI: 0.38-1.21). The commonest reason for not receiving NACT was Cisplatin ineligibility due to malignant obstructive uropathy and a subgroup analysis of this set of patients also did not show any significant difference in 2 year DFS compared to those who received NACT. A significant proportion of patients with LABC are unable to receive the recommended neoadjuvant chemotherapy and obstructive uropathy is the commonest reason for this in our centre. In our single centre series upfront radical cystectomy followed by adjuvant platinum based therapy had an outcome similar to neoadjuvant chemotherapy in LABC patients, in patients who were unable to receive the same due to various reasons.

MODY-5: A diagnosis more often missed than made

Abstract Maturity-onset diabetes of the young (MODY) is the most common cause of monogenic diabetes, having 14 subtypes. Amongst MODY, MODY-5 accounts for less than 5% of cases. Along with diabetes, it presents with a number of extra-pancreatic manifestations. We report a case of a 15-year-old boy with diabetes, renal dysfunction, and obstructive uropathy. This presentation along with lean phenotype, absence of ketosis, and features of insulin resistance with a relatively preserved beta cell function suggested a diagnosis of MODY. This was later confirmed by genetic analysis. The patient progressed to develop chronic kidney disease and was managed with insulin therapy with interventions for obstructive uropathy.

Anterior urethral valve with diverticulum in an adolescent

Abstract The anterior urethral valve (AUV) is a rare cause of obstructive uropathy in children; they are much rarer than posterior urethral valves. A 13-year-old male presented with obstructive and irritative lower urinary tract symptoms (LUTS). On urethrocystoscopy, an AUV with a diverticulum was noted in the ventral surface of the urethra. It was ablated endoscopically using the holmium laser. Postoperatively, the patient voided successfully without any immediate complications. AUV with diverticulum may occur in adolescents. Endoscopic holmium laser ablation of the valve and the diverticulum is associated with good outcome.

1782P Prostate radiotherapy reduces long-term risk of obstructive uropathy in metastatic hormone sensitive prostate cancer (mHSPC): Results from the STAMPEDE M1|RT comparison

1782P Prostate radiotherapy reduces long-term risk of obstructive uropathy in metastatic hormone sensitive prostate cancer (mHSPC): Results from the STAMPEDE M1|RT comparison

HK-2 cell response to TGF-β highly depends on cell culture medium formulations

The immortalized human renal proximal tubular epithelial cell line HK-2 is most commonly used to study renal cell physiology and human kidney diseases with tubulointerstitial fibrosis such as diabetic nephropathy, obstructive uropathy or allograft fibrosis. Epithelial-to-mesenchymal transition (EMT) is the main pathological process of tubulointerstitial fibrosis in vitro. Transforming growth factor-beta (TGF-β) is a key inducer of EMT. Several pro-fibrotic gene expression differences have been observed in a TGF-β-induced EMT model of HK-2 cells. However, growth conditions and medium formulations might greatly impact these differences. We investigated gene and protein expression of HK-2 cells cultured in six medium formulations. TGF-β1 increased the expression of ACTA2, TGFB1, COL4A1, EGR2, VIM and CTGF genes while reducing PPARG in all medium formulations. Interestingly, TGF-β1 treatment either increased or decreased EGR1, FN, IL6 and C3 gene expression, depending on medium formulations. The cell morphology was slightly affected, but immunoblots revealed TGFB1 and vimentin protein overexpression in all media. However, fibronectin expression as well as the nuclear translocation of EGR1 was medium dependent. In conclusion, our study demonstrates that, using the HK-2 in vitro model of EMT, the meticulous selection of appropriate cell culture medium formulation is essential to achieve reliable scientific results.

Mouse and human studies support DSTYK loss of function as a low-penetrance and variable expressivity risk factor for congenital urinary tract anomalies

PurposePrevious work identified rare variants in DSTYK associated with human congenital anomalies of the kidney and urinary tract (CAKUT). Here, we present a series of mouse and human studies to clarify the association, penetrance, and expressivity of DSTYK variants. MethodsWe phenotypically characterized Dstyk knockout mice of 3 separate inbred backgrounds and re-analyzed the original family segregating the DSTYK c.654+1G>A splice-site variant (referred to as “SSV” below). DSTYK loss of function (LOF) and SSVs were annotated in individuals with CAKUT, epilepsy, or amyotrophic lateral sclerosis vs controls. A phenome-wide association study analysis was also performed using United Kingdom Biobank (UKBB) data. ResultsResults demonstrate ∼20% to 25% penetrance of obstructive uropathy, at least, in C57BL/6J and FVB/NJ Dstyk–/– mice. Phenotypic penetrance increased to ∼40% in C3H/HeJ mutants, with mild-to-moderate severity. Re-analysis of the original family segregating the rare SSV showed low penetrance (43.8%) and no alternative genetic causes for CAKUT. LOF DSTYK variants burden showed significant excess for CAKUT and epilepsy vs controls and an exploratory phenome-wide association study supported association with neurological disorders. ConclusionThese data support causality for DSTYK LOF variants and highlights the need for large-scale sequencing studies (here >200,000 cases) to accurately assess causality for genes and variants to lowly penetrant traits with common population prevalence.

Role of percutaneous nephrostomy in cancer patients

Ureteric obstruction is common in cancer patients, representing an unfavorable prognostic factor in this population. Percutaneous nephrostomy (PCN) is often performed in these patients to prevent renal dysfunction and potentially increase survival. However, this procedure may negatively affect patients’ quality of life, and its survival benefit is not established. The objective is to characterize the population of cancer patients undergoing PCN, assess complications related to PCN, and identify potential prognostic factors in this population. Ninety-two patients were included; the median age was 70 years (range: 26–85), and 55 (60%) were males. Most patients had metastatic disease (n = 51; 55%). Bladder (n = 24; 26%), prostate (n = 15; 16%), and rectum (n = 10; 11%) were the most frequent primary tumor topographies. Twenty-seven patients (29%) had NPC-related complications, 16 (17%) had more than one complication, and 20 (22%) required hospitalization. The most frequent complications were infection (n = 23; 25%) and obstruction (n = 14; 15%). In the multivariate analysis, malignant obstructive uropathy was the only independent prognostic factor post-PCN. After three years of follow-up, 70 patients (76%) had died, mainly from cancer progression, and 2 (2%) due to PCN-related complications. Given the potential benefits and burdens, patients and, in some cases, family members should be involved in the decision. The problem is not the efficacy of PCN but the adequacy of the decision in the face of a limited life expectancy.

Kidney disease progression in pediatric and adult posterior urethral valves (PUV) patients.

Posterior urethral valves (PUV) is the most common cause of obstructive uropathy in boys; approximately 15% develop kidney failure by early adulthood. However, rates of kidney function decline are poorly defined in PUV children and adults, as is the impact of potentially modifiable chronic kidney disease (CKD) progression risk factors. We conducted a retrospective review of all PUV patients followed at our institution from 1995 to 2018. Inclusion criteria were estimated glomerular filtration rate (eGFR) > 20ml/min/1.73 m2 after 1year of age, no dialysis or kidney transplant history, and ≥ 2 yearly serum creatinine values after age 1year. eGFRs were calculated using creatinine-based estimating formulas for children (CKID U25) or adults (CKD-EPI). The primary outcome was annualized change in eGFR, assessed with linear mixed effects models. We also examined the association of acute kidney injury (AKI), proteinuria, hypertension (HTN), and recurrent febrile urinary tract infections (UTIs) with eGFR decline. Fifty-two PUV patients met the inclusion criteria. Median (interquartile range) eGFR decline was 2.6 (2.1, 3.1) ml/min/1.73 m2/year. Children (n = 35) and adults (n = 17) demonstrated progressive decline. Proteinuria and recurrent UTIs were significantly associated with faster progression; AKI and HTN were also associated but did not reach significance. PUV patients show progressive loss of kidney function well into adulthood. Proteinuria and recurrent UTIs are associated with faster progression, suggesting potential modifiable risk factors. This is the first study to report annualized eGFR decline rates in PUV patients, which could help inform the design of clinical trials of CKD therapies.

Neonatal Single-Stage Surgical Management of Complicated Distal Vaginal Atresia: Revisiting an Appropriate and Feasible Technique

Hydrometrocolpos is distension of the vagina and uterus with fluid other than pus or blood. It is due to distal vaginal obstruction, and one of its possible causes is agenesis of the distal vagina. Patients with distal vaginal atresia may present in the neonatal period due to stimulation of uterine and cervical glands by maternal estrogen. In this study, we presented our results in managing neonates with complicated hydrometrocolpos due to distal vaginal atresia through a single-stage abdomino-perineal pull-through vaginoplasty. During the period from July 2003 to June 2018, neonates presented to the Department of Pediatric Surgery, Faculty of Medicine, Ain Shams University with complicated hydrometrocolpos (complicated with obstructive uropathy, intestinal obstruction, urinary tract infection, or systemic sepsis) due to distal vaginal atresia were included in the study. All the patients underwent single-stage abdomino-perineal pull-through vaginoplasty with drainage of the accumulated fluid. The patients were followed up for re-accumulation of fluid or vaginal stenosis for at least 4 years after the procedure. During the specified period, 14 neonates with complicated hydrometrocolpos due to distal vaginal atresia (complicated with obstructive uropathy, intestinal obstruction, urinary tract infection, or systemic sepsis) presented to the Department of Pediatric Surgery, Faculty of Medicine, Ain Shams University and underwent single-stage abdomino-perineal pull-through vaginoplasty with drainage of the accumulated fluid. Their age ranged between 4 and 18 days (mean 10, median 8). Two patients (14%) developed vaginal stenosis, which responded well to dilatation, and none of the patients had re-accumulation of the fluid during the follow-up period. Single-stage abdomino-perineal pull-through vaginoplasty in neonates with complicated distal vaginal atresia (complicated with obstructive uropathy, intestinal obstruction, urinary tract infection, or systemic sepsis) is an appropriate and feasible technique with a satisfactory outcome. Treatment study. IV.

Altered expression, but small contribution, of the histone demethylase KDM6A in obstructive uropathy in mice.

Epigenetic processes have emerged as important modulators of kidney health and disease. Here, we studied the role of KDM6A (a histone demethylase that escapes X-chromosome inactivation) in kidney tubule epithelial cells. We initially observed an increase in tubule cell Kdm6a mRNA in male mice with unilateral ureteral obstruction (UUO). However, tubule cell knockout of KDM6A had relatively minor consequences, characterized by a small reduction in apoptosis, increase in inflammation and downregulation of the peroxisome proliferator-activated receptor (PPAR) signaling pathway. In proximal tubule lineage HK-2 cells, KDM6A knockdown decreased PPARγ coactivator-1α (PGC-1α) protein levels and mRNA levels of the encoding gene, PPARGC1A. Tubule cell Kdm6a mRNA levels were approximately 2-fold higher in female mice than in male mice, both under sham and UUO conditions. However, kidney fibrosis after UUO was similar in both sexes. The findings demonstrate Kdm6a to be a dynamically regulated gene in the kidney tubule, varying in expression levels by sex and in response to injury. Despite the context-dependent variation in Kdm6a expression, knockout of tubule cell KDM6A has subtle (albeit non-negligible) effects in the adult kidney, at least in males.

Paralytic Ileus During Treatment of Pulmonary and Renal Tuberculosis in a Non-Human Immunodeficiency Virus Patient: An Unusual Presentation of Tuberculosis-immune Reconstitution Inflammatory Syndrome.

Paralytic ileus as tuberculosis-immune reconstitution inflammatory syndrome (TB-IRIS) is extremely rare. We herein report a 44-year-old man with pulmonary and renal tuberculosis who developed paralytic ileus 14 days after starting antituberculosis therapy (ATT) despite an initial favorable response to ATT. Paralytic ileus was successfully managed with conservative care. He initially required hemodialysis because of obstructive uropathy due to renal tuberculosis, but he was able to withdraw from dialysis after placement of ureteral stents. TB-IRIS can affect organs other than the original sites of tuberculosis, and the combined use of steroids may be effective for its prevention and treatment.

Correlation between serum hepcidin level and stages of chronic kidney disease: A cross sectional study

Introduction: Chronic Kidney Disease (CKD) has been associated with significant mortality and morbidity. Despite significant numbers of cases, biomarkers related to iron status and development of anaemia in these patients has not been looked upon extensively. Few biomarkers have been studied, one of which is serum hepcidin levels. We aimed to estimate the serum hepcidin levels in patients with CKD and its correlation with its successive stages. Materials and Methods: The study design was cross-sectional observational study. 51 patients of CKD KDIGO stage II to V were included and patients of obstructive uropathy or malignancy or transplant recipient were excluded from the study. The aim of the study was to evaluate the association between serum hepcidin levels and Stages of CKD in terms of eGFR. Results: The mean serum hepcidin levels which were found in Stage II, III, IV and V of CKD patients was 65.48, 116.03, 136.61 and 160.37 ng/ml respectively. There was a strong negative correlation between eGFR and serum hepcidin level, and this correlation was statistically significant (r = -1.0, p = <0.001). The Krushkal-Wallis Test also provided p value of <0.001 when stages of CKD and serum hepcidin levels were correlated. Conclusion: There was significant positive correlation of serum hepcidin with the stages of CKD (P < 0.001) and the levels of serum hepcidin were found to be significantly higher as the stage increased. Thus, serum hepcidin may be used as a marker of iron metabolism, prognosis and progress of disease in the CKD patients.