To determine an optimal invasive intervention for renal colic patients during pregnancy after conservative treatments have been found to be unhelpful. Among the available invasive interventions, we investigated the reliability of a ureteral stent insertion, which is considered the least invasive intervention during pregnancy. Between June 2006 and February 2015, a total of 826 pregnant patients came to the emergency room or urology outpatient department, and 39 of these patients had renal colic. The mean patient age was 30.49 years. In this retrospective cohort study, the charts of the patients were reviewed to collect data that included age, symptoms, the lateralities and locations of urolithiasis, trimester, pain following treatment and pregnancy complications. Based on ultrasonography diagnoses, 13 patients had urolithiasis, and 13 patients had hydronephrosis without definite echogenicity of the ureteral calculi. Conservative treatments were successful in 25 patients. Among these treatments, antibiotics were used in 15 patients, and the remaining patients received only hydration and analgesics without antibiotics. Several urological interventions were required in 14 patients. The most common intervention was ureteral stent insertion, which was performed in 13 patients to treat hydronephrosis or urolithiasis. The patients' pain was relieved following these interventions. Only one patient received percutaneous nephrostomy due to pyonephrosis. No pregnancy complications were noted. Ureteral stent insertion is regarded as a reliable and stable first-line urological intervention for pregnant patients with renal colic following conservative treatments. Ureteral stent insertion has been found to be equally effective and safe as percutaneous nephrostomy, which is associated with complications that include bleeding and dislocation, and the inconvenience of using external drainage system.
Analgesics ; Anti-Bacterial Agents ; Cohort Studies ; Diagnosis ; Dislocations ; Drainage ; Emergency Service, Hospital ; Hemorrhage ; Humans ; Hydronephrosis ; Nephrostomy, Percutaneous ; Outpatients ; Pregnancy Complications ; Pregnancy ; Pyonephrosis ; Renal Colic ; Retrospective Studies ; Stents ; Ultrasonography ; Ureter ; Ureteral Calculi ; Urinary Catheters ; Urolithiasis ; Urology

Adult ; Aged ; Animals ; Female ; Humans ; Kidney Calculi ; surgery ; Male ; Middle Aged ; Nephrostomy, Percutaneous ; instrumentation ; methods ; Pyonephrosis ; surgery ; Swine ; Swine, Miniature ; Ultrasonography, Interventional

PURPOSE: To review our experience with the management of fragmented and retained pigtail percutaneous nephrostomy (PCN) tubes and to explore the reasons for the fragmentation. MATERIALS AND METHODS: We retrospectively reviewed our institute database from January 2006 to December 2011 for patients who had undergone retrieval of fragmented PCN tubes. We assessed the preoperative factors, operative technique, and post-operative outcomes. RESULTS: A total of seven patients (4 males and 3 females) had been diagnosed with fragmented PCN tubes. The mean age of the patients was 41.5 years. Of the seven patients, five required antegrade instrumentation by way of a percutaneous tract to remove the foreign body, mostly along with stone retrieval. One patient underwent ureterorenoscopy and pneumolithotripsy for a ureteric stone along with ureteroscopic removal of the PCN fragment. Another patient underwent nephrectomy of the kidney containing the PCN fragment because it had become nonfunctioning. All patients were free of stones and symptoms on follow-up. CONCLUSIONS: A prolonged waiting period for definitive surgery, urinary infection, and associated stone disease are significant factors causing fragmentation of PCN tubes. Proper insertion techniques, regular timed changes of the PCN tube, appropriate care of the PCN tube, and early surgery for underlying stone disease are required to avoid this complication. Patients with retained PCN tubes can be managed effectively with antegrade or retrograde endoscopic techniques while definitive management of the primary pathology is carried out, without any additional morbidity.
Foreign Bodies ; Humans ; Kidney ; Kidney Calculi ; Male ; Nephrectomy ; Nephrostomy, Percutaneous ; Polyurethanes ; Pregnenolone Carbonitrile ; Pyonephrosis ; Retrospective Studies ; Ureter

Spontaneous ureteral rupture is rare, and refers to leakage in the absence of prior ureteral manipulation, external trauma, previous surgery, or any destructive kidney disease. It presents a major diagnostic challenge due to the diversity at presentation. Here, we present a rare case of spontaneous ureteral rupture in a 62-year-old man with a history of fungal pyonephrosis (Candida) on maintenance hemodialysis, causing a large infected urinoma and abscess and a review the literature.
Abscess ; Humans ; Kidney Diseases ; Middle Aged ; Pyonephrosis ; Renal Dialysis ; Rupture ; Ureter ; Urinoma

OBJECTIVETo investigate the feasibility of treatment for calculous pyonephrosis with first stage percutaneous nephrolithotomy under the standard access.

METHODSThirty-six cases of calculous pyonephrosis and 36 cases of urolithiasis with no pyonephrosis were treated by percutaneous nephrolithotomy. In the nephrostomy, the caliber was dilated to F24. All the operations were preformed through the EMS lithotrity system. The intrapelvic pressure was detected in the operation. The hemoculture before and after operation, the germi culture of urine, and the temperature and blood leucocyte changes after operation were recorded. All the patients were treated by antibiotics before and after the operation.

RESULTSAll the patients were treated successfully. The average intrapelvic pressure were 23.2 cmH(2)O in non-pyonephrosis group and 22.8 cmH(2)O in pyonephrosis group. Both of the groups had 1 case of transient bacteremia after the operation. No significant difference was found in the other indices between the two groups.

CONCLUSIONEMS lithotrity system is safe and feasible for treating calculous pyonephrosis with stage I percutaneous nephrolithotomy via the standard access.

Adolescent ; Adult ; Aged ; Endoscopy ; Female ; Humans ; Kidney Calculi ; surgery ; Male ; Middle Aged ; Nephrostomy, Percutaneous ; methods ; Pyonephrosis ; surgery ; Treatment Outcome ; Young Adult

A nephrocolic fistula is uncommon complication resulting from chronic inflammatory processes in the kidney. We report here a case of nephrocolic fistula associated with staghorn calculi. A 61-year-old female with known renal stones for three years was admitted to our hospital because of left flank pain and gross hematuria. Abdominal CT scan showed pyonephrosis with staghorn calculi in the left kidney. We performed percutaneous nephrostomy because of pelvocaliceal dilatation and high fever. Leakage of contrast dye was also detected in antegrade pyelogram, and drainage of fecal contents from nephrostomy was noted, suggesting fistulous formation between left kidney and colon. Clinical and laboratory findings of the patient deteriorated rapidly in spite of conservative management including antibiotics administration, so we performed nephrectomy with excision of the fistulous tract and partial colectomy. However, she showed delirium and had several attacks of generalized seizure, and she died of sepsis and multiple organ failure on the 33rd hospital day. In conclusion, when a nephrocolic fistula develops in patient with renal stone, prompt investigation and appropriate surgical treatment should be considered to improve the clinical outcome.
Anti-Bacterial Agents ; Calculi* ; Colectomy ; Colon ; Delirium ; Dilatation ; Drainage ; Female ; Fever ; Fistula* ; Flank Pain ; Hematuria ; Humans ; Kidney ; Middle Aged ; Multiple Organ Failure ; Nephrectomy ; Nephrostomy, Percutaneous ; Pyonephrosis ; Seizures ; Sepsis ; Tomography, X-Ray Computed

PURPOSE: To determine the usefulness of unenhanced helical CT in patients with suspected renal colic. MATERIALS AND METHODS: One hundred and fourteen patients with suspected ureteral colic, referred by physicians, underwent unenhanced helical CT. Two radiologists prospectively interpreted the results, determining the presence or absence of ureter stone and other diseases that arise outside the urinary tract. In cases of ureteral stone, we retrospectively sought secondary signs of hydronephrosis, perinephric fat stranding, thickening of renal fascia, renal enlargement, and the tissue rim sign. RESULTS: Among the 114 patients, 57 were confirmed as having ureter stones. Unenhanced helical CT depicted 57 of 58 stones in 57 patients, producing one false-negative and one false-positive result. Overall, the results showed 98% sensitivity, 95% specificity, 98% positive predictive value, 95% negative predictive value, and 97% accuracy. The frequencies of secondary signs were as follows: hydronephrosis, 95% (54/57); perinephric fat stranding, 81% (46/57); thickening of renal fascia, 77% (44/57); renal enlargement, 65% (37/57); and the tissue rim sign 72% (21/29). In 20 patients, the diagnoses were not related to stone disease and included one falsenegative diagnosis of pyonephrosis. CONCLUSION: Unenhanced helical CT provides information which is valuable in the accurate diagnosis of ureteral stone as well as other diseases that arise outside the urinary tract in patients with suspected renal colic.
Diagnosis ; Fascia ; Humans ; Hydronephrosis ; Prospective Studies ; Pyonephrosis ; Renal Colic* ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, Spiral Computed* ; Ureter* ; Urinary Tract

PURPOSE: Because the preoperative diagnosis of xanthogranulomatous pyelonephritis (XGP) is difficult due to its similarities to other renal diseases, the diagnosis is made postoperatively in most patients. The aim of this study was to improve preoperative diagnosis of this disease. MATERIALS AND METHODS: We reviewed clinical characteristics, laboratory and radiological findings, preoperative diagnoses, and operative methods of 6 patients with XGP who underwent operation from March 1991 to July 1998. Mean age was 49.8 years (range 28 to 80) and male to female ratio was 1 to 2. RESULTS: All 6 patients had flank pain and urinary tract infection. Among 6 patients, there were 3 patients (50%) with renal staghorn stone and 1 (16.7%) with ureteropelvic junction stricture. No patient was diagnosed as XGP preoperatively. Three patients (50%) diagnosed as pyonephrosis with staghorn stone preopratively underwent simple nephrectomy and 2 patients diagnosed as renal mass preoperatively underwent radical nephrectomy. One patient diagnosed as renal abscess extended to retroperitoneum and psoas muscle preoperatively was diagnosed as XGP through intraoperative frozen section biopsy of renal tissue and underwent partial nephrectomy and drainage. CONCLUSIONS: Preoperative diagnosis of XGP will be raised through better understanding of the clinical characteristics and radiologic findings of this disease.
Abscess ; Biopsy ; Constriction, Pathologic ; Diagnosis ; Drainage ; Female ; Flank Pain ; Frozen Sections ; Humans ; Male ; Nephrectomy ; Psoas Muscles ; Pyelonephritis, Xanthogranulomatous* ; Pyonephrosis ; Urinary Tract Infections

Xanthogranulomatous pyelonephritis is an atypical severe renal parenchymal infection, characterized macroscopically by a yellow lobulated mass, and microscopically by massive inflammatory cells and foamyhystiocytes. Preoperatively it can be confused with hypernephroma, pyonephrosis with stone or other renal inflammatory diseases, We present a case of xanthogranulomatous pyelonephritis associated with xanthogranulomatous epididymoorchitis. To our knowledge this is the first report of xanthogranulomatous pyelonephritis associated with xanthogranulomatous epididymo-orchitis.
Carcinoma, Renal Cell ; Pyelonephritis, Xanthogranulomatous* ; Pyonephrosis

Of 105 patients who underwent percutaneous nephrolithotomy (PNL) for 10 years, 22.9% had complications. Major complications were severe hemorrhage (6cases), renal pelvis perforation (2cases), ureteral perforation (1case) and pyonephrosis (1case). The patients with severe hemorrhage were treated with nephrectomy (1case), transarterial embolization (1case) and transfusion (4cases, 5pints or more). All the cases with pelvis perforation were treated with primary repair. And the patient with postoperative pyonephrosis required nephrectomy Minor complications included hemorrhage (4cases), urinary tract infection (5cases), paralytic ileus (2cases) and fever (3cases), which were treated with conservative managements. We compared the success and complication rates between early and late 5-year periods. The success rates in the early and late periods were 82.0% and 92.7%, respectively. On the other hand, the complication rates in the early and late periods were 30.0% and 16.4%, respectively Thus we conclude that PNL must be included in the effective treatment of upper urinary tract stone disease if experiences and operation technique for PNL were accumulated and appropriate therapy for the complications were taken.
Fever ; Hand ; Hemorrhage ; Humans ; Intestinal Pseudo-Obstruction ; Kidney Pelvis ; Nephrectomy ; Nephrostomy, Percutaneous* ; Pelvis ; Pyonephrosis ; Ureter ; Urinary Calculi ; Urinary Tract Infections