Retrograde Ureteral Catheterization Research Articles

Sequential endoluminal gemcitabine and docetaxel vs. Bacillus Calmette–Guérin for the treatment of upper tract carcinoma in situ

IntroductionNephroureterectomy is commonly performed for high-grade (HG) upper tract (UT) urothelial carcinoma (UC). However, some patients may benefit from a de-escalation of surgical management, particularly for noninvasive disease and carcinoma in situ (CIS). Bacillus Calmette–Guerin (BCG) is currently the only guideline-recommended endoluminal treatment option. Gemcitabine/Docetaxel (Gem/Doce) has shown promising efficacy as a treatment for noninvasive HG UTUC, though a comparison to BCG is lacking. We report the outcomes of patients treated with endoluminal Gem/Doce vs. BCG for UT-CIS. MethodsA single-institutional retrospective review of patients treated with Gem/Doce vs. BCG for UT-CIS was performed. Treatment was instilled via nephrostomy or retrograde ureteral catheter. In both treatment groups, induction consisted of 6 weekly instillations. Maintenance was initiated if disease-free and consisted of 6 monthly instillations in the Gem/Doce group and a reduced dose (one-tenth) 3-week course at 3 months in the BCG group. Recurrence was defined as biopsy-proven disease or HG cytology. ResultsThe final cohort included 53 patients with 65 upper tract units; 31 received BCG and 34 received Gem/Doce. Median follow-up was 88 and 29 months in the BCG and Gem/Doce groups, respectively. Presenting pathology included biopsy-proven CIS and HG cytology in 9.7% and 90% of the BCG group, and 8.8% and 91% of the Gem/Doce group, respectively. The 2-year estimates for recurrence-free and nephroureterectomy-free survival were 61% and 89% for the BCG group and 54% and 100% for the Gem/Doce group, respectively. Upon multivariable analysis, instillation via percutaneous nephrostomy tube was associated with an increased risk of recurrence (HR 3.89, 95% CI 1.59–9.53). The development of any symptom was not statistically different between treatment groups (P = 0.12). There were 2 treatment-related deaths that occurred, 1 within each treatment group. ConclusionEndoluminal Gem/Doce and BCG have similar oncological outcomes and major adverse event rates in the treatment of UT-CIS. Further prospective evaluation is warranted.

Sequential endoluminal gemcitabine and docetaxel for the treatment of clinically non-invasive high-grade upper tract urothelial carcinoma

PurposeThere is an unmet need for effective renal sparing treatments for upper tract urothelial carcinoma (UTUC). Gemcitabine/Docetaxel (Gem/Doce) has shown favorable efficacy in nonmuscle invasive bladder cancer. We report the outcomes of patients treated with endoluminal Gem/Doce for noninvasive high-grade UTUC. MethodsA retrospective review of patients treated with Gem/Doce for clinically noninvasive high-grade UTUC with no radiographic or endoscopically visible disease, either at diagnosis or following ablation, was performed. Treatment was instilled via nephrostomy or retrograde ureteral catheter. Induction instillations were performed weekly for 6 weeks, followed by 6 monthly instillations if disease-free. Recurrence was defined as biopsy-proven disease or high-grade (HG) cytology. Progression was defined by development of muscle invasion, metastases, or death due to cancer. Survival was assessed with the Kaplan-Meier method. ResultsThe final cohort included 31 patients with 41 upper tract units, 51% of which would have been dialysis dependent with nephroureterectomy. Median (IQR) age was 74 years (68–81). Median follow-up was 29 months (IQR 20–58). Prior to treatment, 37 (90%) units presented with a localizing HG cytology (presumed occult CIS), and 4 (9.8%) with HG biopsy-proven disease. Sixteen (52%) patients reported any side effects; 5 were Grade 3 and 1 was Grade 5. Recurrence-free survival was 76%, 54%, and 40% at 1, 2, and 3 years, respectively. Five patients died from urothelial carcinoma. The 3-year progression-free and overall survival were 75% and 75%, respectively. ConclusionsGem/Doce demonstrates promising safety and efficacy as a renal-sparing treatment option for high-grade UTUC in appropriately selected patients.

MP26-02 SURGICAL OUTCOMES OF RETROPERITONEOSCOPIC NEPHROURETERECTOMY FOR PATIENTS WITH SEVERE HYDRONEPHROSIS

You have accessJournal of UrologyCME1 Apr 2023MP26-02 SURGICAL OUTCOMES OF RETROPERITONEOSCOPIC NEPHROURETERECTOMY FOR PATIENTS WITH SEVERE HYDRONEPHROSIS Pei-Hsin Lee and Chien Hui Ou Pei-Hsin LeePei-Hsin Lee More articles by this author and Chien Hui OuChien Hui Ou More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003254.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: For upper tract urothelial carcinoma (UTUC), the severity of hydronephrosis was reported to be correlated to the advanced disease. Besides, previous studies revealed that retroperitoneal nephroureterectomy seemed to show better progression free survival than transperitoneal approach in patients with UTUC. However, when large hydronephrosis presented, the difficulty of retroperitoneal approach was elaborated. This study aimed to emphasize the efficacy of the pre-operative volume reduction procedures, which would make retroperitoneoscopic nephroureterectomy more feasible. METHODS: The 18 patients with severe hydronephrosis, who underwent retroperitoneoscopic nephroureterectomy performed by one experienced operator, from December 2005 to July 2022 in the tertiary center were retrospectively included. All the patients received the pre-operative volume reduction procedures. Primary outcomes, such as estimated blood loss, total operative time and hospitalized stay were documented. RESULTS: In our study, the three types of volume reduction procedures were implemented. In benign lesions, a percutaneous nephrostomy catheter would be inserted for drainage. For possible malignant lesions, intra-operative retrograde ureteral catheter insertion or incision at the proximal site of obstructive upper ureter was performed other than percutaneous approach, for minimizing the risk of tumor seeding. Under such managements, retroperitoneoscopic nephroureterectomy could be implemented with less blood loss (mean=25 ml, range<10 to 150), shortened operative time (mean=123.3 minutes, range 86 to 169) and lower hospital day (mean=7.2 days, range 5 to 10). Only one complication (5.6%, 1/18) was noted with hypovolemic shock. CONCLUSIONS: In the patients with severe hydronephrosis, retroperitoneoscopic nephroureterectomy might be a safe, low-risk and time-saving approach after pre-operative volume reduction of hydronephrosis. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e352 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pei-Hsin Lee More articles by this author Chien Hui Ou More articles by this author Expand All Advertisement PDF downloadLoading ...

Imaging-Guided De Novo Retrograde Ureteral Access and Stent Placement without Cystoscopy in Women

PurposeTo evaluate the feasibility of a new technique for imaging-guided de novo retrograde ureteral double J (DJ) stent placement without cystoscopy in women. Materials and MethodsEighty-four women referred for ureteral stent placement between April 2019 and January 2022 were included. In all the patients, the initial attempt for stent placement was performed in a retrograde fashion. Successful ureteral catheterization and DJ stent placement were considered as technical success. The fluoroscopy time required to catheterize the ureter and that for the entire procedure were recorded. Factors affecting the technical success rate and fluoroscopy time were examined. ResultsA total of 108 ureteral stent placement procedures in 84 women, with a mean age of 57.5 years (range, 19–85 years), were performed. The most common underlying pathologies were cervical (n = 33, 31%) and ovarian (n = 32, 30%) carcinomas. The most commonly involved segments of the ureter were the lower half (n = 44, 40%) and trigone (n = 39, 36%). The technical success rate was 81.5%, and it reached 93% in the case of lower-half ureteral obstruction. Distorted trigonal anatomy caused by external compression of the bladder wall by a mass was associated with a higher rate of technical failure (90.6% vs 47.8%; P < .001). The use of ultrasound guidance to guide the sheath to the ureteral orifice allowed for a significant decrease in the fluoroscopy time for ureteral catheterization (4.6 minutes ± 3.91 vs 2.26 minutes ± 2.32; P = .003) and that for the entire procedure (9.42 minutes ± 4.95 vs 5.93 minutes ± 4.06; P = .001). ConclusionsImaging-guided de novo retrograde ureteral catheterization and stent placement can be successfully performed in a high percentage of patients within a reasonable fluoroscopy time without the need for cystoscopy in women.

Retrograde ureteral catheterization under local anesthesia for emergency drainage in patients with infection and hydronephrosis secondary to ureteral calculi: Experience from a tertiary care hospital.

The aim is to evaluate the safety and efficacy of retrograde ureteral catheterization under local anesthesia in patients with urinary tract infections complicated by hydronephrosis caused by ureteral stone obstruction. From October 2020 to September 2021, a retrospective analysis of patients' medical records was performed. Records of past history, physical examination, laboratory tests, and imaging investigations were reviewed. Retrograde ureteric stent (RUS) was performed under local anesthesia using cystoscopes and guided by portable fluoroscopy. Real-time fluoroscopy was used to verify the double-J stent position and confirm a smooth process. The postoperative recovery and length of admission were also recorded. A total of 14 patients with ureteral stone obstruction with infective hydronephrosis received 15 total emergency RUS procedures (one bilateral). Intraoperative findings, operation times, and infection signs were recorded and analyzed. All patients met systemic infection criteria, with a mean body temperature of 38.7°C ± 1.7°C. Leukocytosis was noted in 8 (57.1%) patients. Elevated C-reactive protein (8.5 ± 6.3 mg/L) and procalcitonin (24.1 ± 22.0 ng/mL) were found in 13 (92.9%) and 9 (64.3%) patients, respectively. Mean stone size was 8.5 ± 6.3 mm, mostly localized to the upper ureter (upper: 12; middle: 0; lower: 3). Mean operation time was 14.1 ± 4.3 min. After emergency drainage, all patients improved and were discharged after infection was controlled. The average length of admission was 6.2 ± 2.2 days. RUS under local anesthesia is safe and effective for treating infective hydronephrosis due to ureteral stone obstruction. A randomized controlled trial with a large sample remains necessary to validate these findings.

Urosepsis secondary to ureterosciatic hernia corrected with ureteral stent placement: a case report and literature review

BackgroundUreterosciatic hernia is a rare type of pelvic floor herniation that occurs through the sciatic foramen. The resulting ureteral obstruction may lead to hydronephrosis and to further complications including urinary tract infection and urosepsis. There have been 30 reported cases of ureterosciatic hernia. Ureteral stenting and surgical repair have been used as treatment options.Case presentationWe report the case of an 86-year-old woman who was transferred to Tokyo Metropolitan Bokutoh Hospital with symptoms of fever and septic shock. Her computed tomography scan revealed left hydronephrosis and deviation of the left ureter into the sciatic foramen; she was therefore diagnosed with a left ureteral sciatic hernia and admitted in our intensive care unit for further treatment with resuscitative fluids, vasopressors, and antibiotics. Following a retrograde insertion ureteral catheter insertion, ureteral incarceration was relieved, and a double-J ureteral stent was placed in situ. Antibiotic treatment was initiated, and the patient’s hemodynamic status gradually improved.ConclusionsAlthough ureterosciatic hernia is a rare disorder, it is associated with serious complications including urinary tract infection with sepsis, which may warrant urgent corrective procedure to relieve the structural obstruction. Treatment may be conservative or surgical, though treatment with ureteral stent placement may be a favorable approach in elderly patients with multiple comorbidities presenting with urosepsis.

Pharmacokinetics of UGN-101, a mitomycin-containing reverse thermal gel instilled via retrograde catheter for the treatment of low-grade upper tract urothelial carcinoma

PurposeTo evaluate the pharmacokinetic properties of UGN-101, a mitomycin-containing reverse thermal gel used as primary chemoablative treatment for low-grade upper tract urothelial carcinoma (UTUC), in a subset of patients participating in a phase 3 clinical trial.MethodsPharmacokinetic parameters (Cmax, Tmax, AUC(0–6), λz, t½, and AUCinf) were evaluated in six participants (male or female, ≥ 18 years) with biopsy-proven, low-grade UTUC who received the first of 6 once-weekly instillations of UGN-101 to the renal pelvis and calyces via retrograde ureteral catheter. Plasma samples were collected prior to instillation and 30 min, 1, 2, 3, 4, 5, and 6 h post-instillation. Safety was assessed by laboratory evaluations, physical exam, and adverse event monitoring.ResultsThe mean age of the six participants was 69 years; most were male (5/6) and Caucasian (5/6). Mean (SD) Cmax was 6.24 (4.11) ng/mL and mean Tmax was 1.79 (1.89) hours after instillation. Mean apparent t½ following instillation was 1.27 (0.63) hours. Mean total systemic exposure to mitomycin up to 6 h post-instillation was 20.30 (19.69) ng h/mL. At 6 h post-instillation, mitomycin plasma concentrations of 5/6 participants were < 2 ng/mL. There were no clinically important adverse events or changes in laboratory values in any participant after a single instillation of UGN-101.ConclusionThe reverse thermal gel formulation of UGN-101 is associated with higher concentration and extended dwell time of mitomycin in contact with the urothelium of the upper urinary tract while limiting systemic absorption of mitomycin.RegistrationNCT02793128; registered June 8, 2016.

The preliminary experience of methylene blue assisted laparoscopy in the treatment of renal parapelvic cysts

Renal cyst is a common disease in humans and laparoscopic renal cyst decortication is the gold standard for treatment. However, specialized surgical skills are required for the treatment of renal parapelvic cysts. In this study, we describe an improved laparoscopic method for the treatment of renal parapelvic cysts involving the use of continuous infusion of methylene blue. Sixteen patients with renal parapelvic cyst were enrolled in this study. All patients underwent retrograde ureteral catheterization, with continuous perfusion of the renal pelvis using a solution of 0.2% methylene blue and saline, during laparoscopic decortication of the parapelvic cyst. In one patient, the cyst communicated with the renal collection system which was injured, but this was immediately repaired intraoperatively. All operations were successful, and none was converted to open surgery. There were no occurrences of persistent urinary fistula, bleeding, or other complications postoperatively. All patients were followed-up for 3–24 months, and results of postoperative imaging investigations revealed that all of our patients experienced either complete recovery or a greater than 50% decrease in size of the cysts. Our study demonstrates that methylene blue-assisted laparoscopic treatment is a safe, effective and practical method for the treatment of renal parapelvic cysts.

Minimally invasive management of acute ureteral obstruction and severe infection caused by upper urinary tract calculi.

PURPOSETo evaluate therapeutic efficacy of two minimally invasive surgical methods in managing acute ureteral obstruction and severe infection caused by upper urinary tract calculi (UUTC).PATIENTS AND METHODSData of 47 patients diagnosed with acute upper urinary tract obstruction and severe infection caused by ureteral calculus using X-ray CT between September 2014 and January 2019 were retrospectively analyzed. All patients were treated with immediate renal drainage and, after infection and ureteral obstruction were relieved, UUTC removal. Renal drainage was performed by ultrasound-guided percutaneous nephrostomy and retrograde ureteral catheterization was performed using cystoscopy. Kidney and ureteral stones were removed; renal function and the urinary tract were examined by X-ray during follow-up.RESULTSPercutaneous nephrostomy was performed in 29 patients in a critical condition including intolerance to surgery, high-grade hydronephrosis, or failure of retrograde ureteric stent placement. In other 18 patients diagnosed with small stones (≤10 mm) and low-grade hydronephrosis, indwelling double-J ureteral stents were temporally installed by a cystoscope. Acute infection and ureteral obstruction were relieved; white blood cell counts returned to normal values within 3 to 7 days after drainage in all patients. In the second-stage treatment, percutaneous nephrolithotomy (PCNL), ureteroscopic lithotripsy, extracorporeal shock wave lithotripsy and nephrectomy were performed in 24, 10, 8 and 5 patients, respectively. No patients developed severe complication after stone removal surgery. All patients were followed up for 3 months to 4.5 years. Renal function was significantly recovered; 17/29 (59%) patients with elevated serum creatinine returned to normal and serum creatinine in 12/29 (41%) patients improved significantly after drainage, with a pre-operation level of 285±169μM vs 203±91μM post-operation (P = 0.014). Five patients were lost during follow-up.CONCLUSIONThis study demonstrated an optimal approach for relieving upper urinary tract obstruction and acute infection in which percutaneous nephrostomy drainage is preferred for patients with severe pyonephrosis, large stones (>10 mm) with high-grade hydronephrosis, steinstrasse, or failure in retrograde ureteric stent placement, while retrograde ureteral catheterization using cystoscopy is suitable for patients diagnosed with small stones (≤10 mm) and low-grade hydronephrosis.

Lessons from Literature: Nephrostomy Versus Double J Ureteral Catheterization in Patients with Obstructive Urolithiasis-Which Method Is Superior?

Purpose: To review the literature on optimal methods of drainage for obstructive urolithiasis in adult patients, comparing percutaneous nephrostomy (PCN) with retrograde ureteral catheterization (Double J [JJ]) regarding success of procedure, efficacy, complications, quality of life (QoL), and costs. Methods: Web of Science and the Medline, Embase, Emcare, and Cochrane controlled trial databases were searched for all relevant publications until November 2018. A review protocol was created, using the PRISMA statement. Two reviewers independently screened the titles and abstracts in Endnote X8, using criteria as stated in the research protocol. A total of 1108 abstracts were screened of which 9 were included in the qualitative synthesis. Level of evidence of the studied articles varies between 1b and 2c. Results: Both JJ and PCN have high success rates (80%-100% and 99%-100%, respectively). No major complications were reported in both groups. Procedural and fluoroscopy times are significantly shorter for JJ than for PCN (31-33 minutes vs 35-49 minutes and 5 minutes vs 7 minutes, respectively). Time to clinical improvement did not differ. In the JJ group, analgesics were used more frequently than in the PCN group. Data regarding procedural costs were contradictory, but overall the PCN group was associated with higher costs. In pregnant women, PCN placement appears to be significantly more effective than placement of JJ. A significant decrease between pre- and postintervention QoL was found with patients receiving a JJ. Back pain was reported more frequently in the PCN group, urinary symptoms were more common in the patients with a JJ. Conclusions: Both PCN and JJ have comparable success rates for patients with obstructive urolithiasis and procedure-related complications are rare. Overall, higher rates of sepsis, longer hospital stay, and higher costs were found in the PCN group, but that could be explained by patient selection. Patients with JJ experienced a lower QoL and experience more lower urinary tract symptoms.

Comparison of the Modified Lateral Position and Prone Position Techniques in Percutaneous Nephrolithotomy

Objectives: To evaluate the feasibility, operative time, efficacy and safety of the modified lateral position in percutaneous nephrolithotomy (PCNL) for renal calculi, comparing it with the standard prone position PCNL. Material and Method: The patient is placed with the thorax in the lateral position and the pelvis in an oblique position. Then the lower limbs are split and bent in the lowest position. Initial placement of a retrograde ureteral catheter, tract formation, stone fragmentation and retrieval, and optional extra procedures were accomplished with the patient in the same position. Results: The study comprised 82 patients; 29 in split-leg modified lateral position (SL-MLP) group and 53in conventional prone position (PP) group. Three patients (all in PP group) underwent sequential bilateral percutaneous nephrolithotomy (PNL) during the study period and each procedure was considered as an independent case. So, the studied cases, according to the number of PNL procedures, were 85; 29 in SL-MLP group and 56 in PP group. Conclusions: split-leg modified lateral position in percutaneous nephrolithotomy (SL-MLP PNL) has significantly lower operative time compared with conventional PP PNL. The stone free rate, need for ancillary procedures and complication rate were equal in both groups.

Step sequential therapy for treating children with post-renal acute renal failure induced by Ceftriaxone

Objective To analyze the clinical characteristics and treatment of post-renal acute renal failure(ARF) induced by Ceftriaxone in children. Methods The clinical data of 7 cases of post-renal acute renal failure in children from June 2012 to June 2014 induced by Ceftriaxone were analyzed.According to the changes in urine volume, serum creatinine, blood urea nitrogen and serum potassium level, liquid therapy, retrograde ureteral catheterization(RUC) and peritoneal dialysis was performed by step sequential therapy respectively. Results Seven cases were given intravenous Ceftriaxone under the fluid loss state.Abdominal pain, sudden anuria or oliguria appeared in the children after 2.6 d on the average, B ultrasonography and CT scanning showed multiple calculus in the bilateral renal pelvis and ureteral calculi.Blood BUN was 15.2-37.9 mmol/L[(23.3±8.6) mmol/L], and blood Cr was 180-636 μmol/L[(378.9±148.4) μmol/L]. These indicators met the diagnostic criteria for acute renal failure.In 7 cases, 2 cases (28.6%) received fluid therapy of sodium bicarbonate alkalization and anisodamine spasmolytic, 4 cases (57.1%) received fluid therapy and RUC, and 1 case (14.3%) underwent fluid therapy and RUC and peritoneal dialysis.All of 7 cases (100%) were alive.In the average 4.4 days renal function of 7 cases was returned to normal, and urine volume and electrolyte were also restored. Conclusions Step sequential therapy including fluid therapy, RUC and peritoneal dialysis is effective with post-renal ARF in children induced by Ceftriaxone. Key words: Ceftriaxone; Acute renal failure, post-renal; Child

Easily Reproducible Technique to Identify Stricture Site During Laparoscopic Ureteral Reconstruction for Iatrogenic Ureteral Stricture: Retrograde Ureteral Catheter Method

Abstract Introduction and Objectives: Iatrogenic ureteral strictures have been on a rise. In the management of upper urinary tract stricture, open ureteroureterostomy is the gold standard in treati...

Advantages of ultrasound in the emergency room in a septic shock patient

Background Pyonephrosis (PN) is an uncommon disease that is associated with suppurative destruction of the renal parenchyma in adults. Obstruction and upper urinary tract infection play a role in its etiology. Fever, shivering, and flank pain are frequent clinical symptoms. If the pus detected as a result of the investigations is not surgically drained, antibiotics may not be effective. Septic shock and death can occur if the disorder is not treated with urgent surgery. In this context percutaneous or open nephrostomy or retrograde ureteral catheter insertion is appropriate, so it is a very serious disease and EP have a very important role in early diagnosis to start antibiotic treatment and early referral to surgery.

A Guide to Percutaneous Cryoablation of Renal Masses in Difficult Anatomic Locations

Purpose To discuss the pathophysiology of renal cell carcinoma, describe indications for treatment of small renal masses, present technical aspects of percutaneous cryoablation, and highlight adjunctive techniques used to improve success and safety during cryoablation of renal masses in more difficult anatomic locations. Material and Methods A case-based format will be utilized to highlight techniques to improve outcomes in cryoablation of renal masses in difficult anatomic locations. Four major topics will be presented, including maximizing position of the patient, utilization of retrograde pyeloperfusion, using hydrodissection to displace critical structures away from the zone of ablation, and angioplasty balloon interposition to displace adjacent structures from the ablation zone. In addition, combining ablation and embolization in the most difficult anatomic locations will be described. Results Utilizing adjunctive technique during cryoablation leads to successful cryoablation of renal masses in difficult anatomic locations. Placing patients in lateral decubitus position, with the affected side down, results in less aeration of the adjacent lung and reflex increased aeration of the contralateral lung. This allows for improved window to target upper pole renal masses. Retrograde ureteral catheter can be placed to infuse warm saline into the ureter and renal pelvis in an attempt to protect these structures during cryoablation. Hydrodissection can be used to infuse normal saline through a trocar to displace critical structures away from the zone of ablation. Similar to the concept of combining ablation and embolization for treatment of 3 to 5 cm liver tumors, one can combine therapies in an attempt to achieve a synergistic effect. This is particularly useful when there is concern that a complete ablation may not be possible given lesion location in a poor surgical candidate. Conclusions Nephron-sparing therapies have been increasingly utilized in treatment of renal masses. Lesions typically considered more difficult to ablate include central lesions, size larger than 3 cm, upper pole location, endophytic, and adjacent to ureter, colon, or other abdominal organs. Multiple techniques can be used to maximize the likelihood of successful cryoablation of masses in difficult anatomic locations, including hydrodissection, retrograde pyeloperfusion, maximizing patient positioning, and angioplasty balloon interposition.

Ceftriaxone and Acute Renal Failure in Children

Our aim was to evaluate the clinical profile, treatment, and outcome of ceftriaxone-associated postrenal acute renal failure (PARF) in children. We retrospectively studied 31 consecutive cases from 2003 to 2012 for PARF after ceftriaxone treatment. There was no past history of urolithiasis or nephropathy in these children. The average time of ceftriaxone administration before PARF was 5.2 days. The major symptoms apart from anuria included flank pain (>3 years old, 25/25), excessive crying (<3 years, 6/6), and vomiting (19/33). Ultrasound showed mild hydronephrosis (25/31) and ureteric calculi (11/31). Nine children recovered after 1 to 4 days of pharmacotherapy. Twenty-one children who were resistant to pharmacotherapy underwent retrograde ureteral catheterization. After catheterization of their ureters, normal urine flow was observed, and the symptoms subsided immediately. Catheter insertion failed in 1 child who subsequently underwent 3 sessions of hemodialysis before normal urination was restored. Ceftriaxone was verified to be the main component of the calculi in 4 children by tandem mass spectrometric analysis. The recovery was complete in all cases. Ceftriaxone therapy in children may cause PARF. Early diagnosis and prompt pharmacological therapy are important in relieving the condition. Retrograde ureteral catheterization is an effective treatment of those who fail to respond to pharmacotherapy.

Radiotherapy combined with retrograde ureteral catheterization in treatment of cervical cancer complicated with ureteral obstruction

Radiotherapy combined with retrograde ureteral catheterization in treatment of cervical cancer complicated with ureteral obstruction

Secured closed system drainage of a retrograde ureteric catheter

Secured closed system drainage of a retrograde ureteric catheter

Secured closed system drainage of a retrograde ureteric catheter

Secured closed system drainage of a retrograde ureteric catheter

Temporal Trends, Practice Patterns, and Treatment Outcomes for Infected Upper Urinary Tract Stones in the United States

BackgroundThe incidence of infected urolithiasis is unknown, and evidence describing the optimal management strategy for obstruction is equivocal. ObjectiveTo examine the trends of infected urolithiasis in the United States, the practice patterns of competing treatment modalities, and to compare adverse outcomes. Design, setting, and participantsA weighted estimate of 396385 adult patients hospitalized with infected urolithiasis was extracted from the Nationwide Inpatient Sample, 1999–2009. Outcome measurements and statistical analysisTime trend analysis examined the incidence of infected urolithiasis and associated sepsis, as well as rates of retrograde ureteral catheterization and percutaneous nephrostomy (PCN) for urgent/emergent decompression. Propensity-score matching compared the rates of adverse outcomes between approaches. Results and limitationsBetween 1999 and 2009, the incidence of infected urolithiasis in women increased from 15.5 (95% confidence interval [CI], 15.3–15.6) to 27.6 (27.4–27.8)/100 000); men increased from 7.8 (7.7–7.9) to 12.1 (12.0–12.3)/100000. Rates of associated sepsis increased from 6.9% to 8.5% (p=0.013), and severe sepsis increased from 1.7% to 3.2% (p<0.001); mortality rates remained stable at 0.25–0.20% (p=0.150). Among those undergoing immediate decompression, 113 459 (28.6%), PCN utilization decreased from 16.1% to 11.2% (p=0.001), with significant regional variability. In matched analysis, PCN showed higher rates of sepsis (odds ratio [OR]: 1.63; 95% CI, 1.52–1.74), severe sepsis (OR: 2.28; 95% CI, 2.06–2.52), prolonged length of stay (OR: 3.18; 95% CI, 3.01–3.34), elevated hospital charges (OR: 2.71; 95%CI, 2.57–2.85), and mortality (OR: 3.14; 95%CI, 13–4.63). However, observational data preclude the assessment of timing between outcome and intervention, and disease severity. ConclusionsBetween 1999 and 2009, women were twice as likely to have infected urolithiasis. Rates of associated sepsis and severe sepsis increased, but mortality rates remained stable. Analysis of competing treatment strategies for immediate decompression demonstrates decreasing utilization of PCN, which showed higher rates of adverse outcomes. These findings should be viewed as preliminary and hypothesis generating, demonstrating the pressing need for further study.