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Query: UMLS:C0034186 (pyelonephritis)
 6,144 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Fifty-seven patients, with prior cystectomy and continent urinary diversion for transitional cell carcinoma of the bladder, were evaluated with CT. Forty-two of them presented ureterosigmoidostomy and 15 orthotopic ileal bladder. The CT appearance of the normal post-cystectomy pelvis is emphasized. Both early and late surgical and neoplastic complications were detected. Early surgical complications, including urinary fistulae, urinomas, seromas, lymphoceles, and abscesses, were diagnosed over a 6-month postoperative period. Late surgical complications included hydroureteronephrosis, calculosis, and pyelonephritis. Hydroureteronephrosis, due to stenosis of the ureteral anastomosis, was the most frequent complication. All such neoplastic complications as local recurrence, lymphnode distant metastases, were identified. In 83% of cases they were observed over a 2-year postoperative period. Distant metastases in the upper abdomen were never detected. The authors' experience suggests the following as the optimal follow-up: a) CT examination over a 6-month postoperative period; b) yearly CT examinations and urography over 4 postoperative years; c) yearly US examination over the first 2 years after surgery, to depict renal pelvis dilatation. Skeletal scintigraphy is often necessary to detect metastatic bone lesions. It should be performed no later than 2 years after cystectomy.
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PMID:[Cystectomy and internal urinary diversion in bladder neoplasm. Role of CT in the follow-up]. 194 67

One hundred and thirteen cases of spina bifida treated with clean intermittent catheterization (CIC) were reviewed. There were 42 males and 71 females, ranging from 4 months to 50 years. The major reasons for CIC from other voiding methods were vesicoureteral reflux (VUR) (48/113) old, and residual urine (36/113). The most common type of neurogenic bladder was hypoactive detrusor-active sphincter, in 56.6% of patients (64/113). The grade of paralytic disability of lower limb (Sharrard's classification) was low (group IV-VI) in 84 patients and high (group I-III) in 29 patients. Hydroureteronephrosis and VUR improved 52.1% (37/71) and 57.1% (36/63), urinary tract infection and urinary incontinence improved 70.9% (39/55) and 81.7% (72/87). Major complications were pyelonephritis (12 cases) and urethral pain (5 cases). We discussed the choice of voiding method in the management of spina bifida.
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PMID:[Clean intermittent catheterization in the management of spina bifida: a review of 113 cases]. 204 90

Twelve of the 25 patients with chronic granulomatous disease treated at our institution between 1957 and 1987 were found to have urinary tract disorders. All 12 patients were male and 22 years of age or younger when chronic granulomatous disease was diagnosed. Six patients had hydroureteronephrosis in association with recurrent episodes of pyelonephritis, retroperitoneal lymphadenitis, and granuloma formation. The other six patients had genital lesions or dysuria. Among the six patients with hydroureteronephrosis, a nephrectomy was performed in two, ureterolysis was used to relieve obstruction in one, and hydroureteronephrosis resolved after antibiotic therapy alone in three. We conclude that complications involving the genitourinary system occur frequently in patients with chronic granulomatous disease. Periodic imaging of the urinary tract may detect asymptomatic hydroureteronephrosis or other treatable genitourinary abnormalities in these patients.
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PMID:Urinary tract disorders in patients with chronic granulomatous disease. 277 Aug 1

Cystectomy with ureterosigmoid anastomosis by modified Goodwin's technique was performed in 47 patients with local vesical cancer. Pre- and postoperative functional status of the kidneys was assessed by means of renography, excretory urography and laboratory tests. Unilateral or bilateral renal dysfunction developed within 12 to 18 months after surgery in 22.2% of patients with good pretreatment renal status. In cases of preoperative renal impairment, it improved postoperatively in just 35% of the patients. Rectoromanoscopy, contrast sigmoidography and excretory urography demonstrated pathological conditions in the area of ureterointestinal anastomoses (strictures, gaping or anastomositis) or sigmoid changes (sigmoiditis, kinking or stenosis in the perianastomosis area) in 83.3% of patients with impaired postoperative renal function. These conditions lead to hydroureteronephrosis, intestinoureteral refluxes and progress or development of pyelonephritis as a result. It is concluded that the state of ureterointestinal anastomoses and the sigmoid should be assessed specifically in postureterosigmoid anastomosis patients with impaired renal function. The surgical techniques and the degree of ureteral dilatation can make an important contribution to pathologic conditions developing around the anastomoses. Good functional activity of the kidneys and the absence of upper urinary dilatation are the principal prerequisite for ureterosigmoid anastomosis.
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PMID:[Causes of the functional disorder of the kidneys in patients with bladder cancer after cystectomy with ureterosigmoid anastomosis]. 280 77

Ureterocolonic anastomosis (UCA) was performed in 10 dogs with transitional cell carcinoma of the urinary bladder trigone or the urethra, or both. All grossly visible tumor was excised. All of the dogs recovered from anesthesia and surgery and had anal continence with no urine leakage. One dog died of undetermined causes 7 days after surgery. Nine dogs survived 1 to 5 months. The owners of eight of the dogs considered their dog's quality of life to be acceptable. Four dogs were euthanatized because of neurologic disease, three of which also had nausea and vomiting. The neurologic and gastrointestinal signs may have been caused by hyperammonemia, metabolic acidosis, and uremia. Blood ammonia levels were elevated in two dogs with neurologic signs. Hyperchloremic metabolic acidosis that was reversible with bicarbonate therapy was diagnosed in five dogs. All of the dogs were azotemic because of intestinal recycling of urea. Serum creatinine concentrations increased in four dogs after surgery. Drug-induced renal disease may have developed in two dogs. Pyelonephritis developed in five kidneys, two of which had outflow obstruction and two had bilateral hydroureteronephrosis before the UCA. In this small number of dogs, surgical excision of transitional cell carcinoma was not curative with six dogs having confirmed metastatic lesions at the time of death.
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PMID:Ureterocolonic anastomosis in ten dogs with transitional cell carcinoma. 323 87

From 1985 to 1991 the author operated on 21 bladder cancers, forming cross anastomoses on the upper urinary tracts. 19 patients underwent cystectomy. Stage T2, T3, T4 was diagnosed in 4.8%, 80.9% and 14.3% of the patients, respectively. Hydroureteronephrosis was detected in all the patients, chronic pyelonephritis developed in 16 (76.2%), chronic renal failure in 9 (42.9%). Upper and low transureteroureteronephrostomy (TUUN) was performed in 13 (61.9%), transureteropyelonephrostomy (TUPN) in 3 (14.3%), transureteropyelo-ureterosigmoidostomy in 5 (23.8%) patients. The latter technique implies successive connection of the kidneys with the sigmoid. This provided less exposure of one of the kidneys to the intestinal infection, urinary fistulas did not form. Two deaths in the postoperative period were due to metastases and thromboembolism. The authors believe that the best functional conditions for the kidneys are secured by upper TUUN, TUPN and transureteropyelo-ureterosigmoidostomy applicable in cystectomy and in normal tonicity of the upper urinary tracts.
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PMID:[Urinary diversion in cystectomy in bladder cancer patients]. 794 Nov 56

Hereditary nephrogenic diabetes insipidus is a rare disease. We describe here three brothers with this disease from a big family consisting of 10 siblings. The case is undoubtedly X-linked because the sufferers are only boys, one of them with a different father. The illness was noticed rather late, namely, at the ages of approximately 7, 6 and 5 years. Possibly, this is a particular characteristic of this family, because the disease is usually diagnosed before the age of two years. In the oldest brother (at present 15 years old) epicystotomy was performed at the time of diagnosis because of polyuria, hydroureteronephrosis and bladder hypotonia; the intervention caused a urinary tract infection leading to chronic pyelonephritis and renal scarring. No urologic intervention was necessary in the younger brothers, because their illness was noticed and treatment started somewhat earlier. This case shows that polydipsia and polyuria should always be assessed properly to disclose their causes.
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PMID:[Nephrogenic diabetes insipidus in a large family]. 1652 30

A 25-year-old male Nigerian undergraduate who had earlier been treated with praziquantel for schistosomal epidydymitis presented with clinical features of pyelonephritis, and radiological appearances of bilateral hydroureteronephrosis with fibrosis of lower ureters. Surgical resection of the ureters, Boari flap and Psoas hitch reconstruction were done. The histology of the resected ureters proved schistosomiasis. He was subsequently treated with praziquantel and artemether. This case highlights the insidious nature of schistosomiasis infection, possibility of progression of primary infection with complications or probable reinfection in a previously treated individual. In any case, surgical intervention may be necessary in those who present late with severe ureteric stricture and also to prevent progressive renal damage.
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PMID:Ureteric schistosomiasis with obstructive uropathy. 1957 59

We report a case of xanthogranulomatous pyelonephritis (XGP) complicated by shaped urolithiasis, severe hydroureteronephrosis and kidney exclusion treated by laparoscopic-assisted nephroureterectomy. A 9 year-old boy was referred to us for recurrent episodes of urinary tract infection, abdominal pain and severe hydronephrosis. Abdominal CT and a Tc-99m MAG3 scan showed a non-functioning obstructed kidney with shaped urolithiasis of the distal ureter. XGP was suspected, and nephroureterectomy was performed by laparoscopic distal ureterectomy and open extraperitoneal nephrectomy. This technique avoided the need for a more extended nephrectomy incision or even a second iliac incision. It also ensured complete excision of the distal ureter with minimal risk of developing the ureteral stump syndrome, which sometimes follows nephroureterectomy. We believe that laparoscopic-assisted nephroureterectomy may be a suitable technique in those cases of difficult nephrectomy where a ureteral stump syndrome is likely to develop.
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PMID:Laparascopic-assisted nephroureterectomy for shaped urolithiasis and xanthogranulomatous pyelonephritis: case report and review of literature. 2419 78

We describe a case of a young female with lupus that complained about suprapubic pain, dysuria, fever and vomits, symptoms first interpreted as pyelonephritis, despite negative cultures and imaging studies showing hydroureteronephrosis with inflammatory changes. When she developed malar rash, anasarca and nephrotic syndrome, the diagnosis of lupus cystitis with stage IV nephropathy was made, and she started immunosuppressive induction treatment with three pulses of corticosteroids followed by oral prednisolone (60 mg/d) and mycophenolate (1.5 g/d). One month later she was admitted again with blood exams compatible with thrombotic microangiopathy, requiring aggressive immunosuppression and plasma exchange. After overcoming multiple complications, the patient gradually improved, and was discharged with close surveillance. This case poses the question: if the urogenital involvement had been recognized and treated in time, would it prevent the onset of lupus nephritis and other complications?
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PMID:Lupus cystitis and repercussions of delayed diagnosis. 2535 85


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