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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

During the last 5 years 22 patients have been treated at our hospital for staghorn calculi and neurogenic bladder. In 17 patients an operation was done soon after discovery of the calculi, while 5 patients were followed non-operatively. The latter 5 patients had a rapid downhill course marked by sepsis and renal function deterioration and an operation was necessary in 4 of the 5 cases. Injudicious non-operative therapy only prolongs the relentless effects of staghorn calculi in patients with spinal cord pathology.
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PMID:Operative versus non-operative management of patients with staghorn calculi and neurogenic bladder. 3 47

The authors describe a highly selective transsacral microsurgical procedure for sacral nerve rootlet interruption in five patients with hypertonic neurogenic bladder. Magnification and systematic stimulation of sacral roots provided accurate identification of motor fibers supplying bladder detrusor muscle and differentiation of efferent components to the legs and anal sphincter. Although the technique prevented incontinence and adverse effects of nerve section on rectal and lower extremity function improvement in voiding patterns and diminution of urinary sepsis was of brief duration in three of the five patients. Physiological data from these procedures reaffirms the importance of S-3 and S-4 motor roots in detrusor innervation, but clinical responses bring into question the possibility of sustained improvement from such a highly selective procedure at the sacral level. The authors suggest that alternative pathways, not apparent on initial stimulation, may develop after section of sacral root components, and that dissection and stimulation of fibers at the level of the conus medullaris should be investigated as an alternative procedure.
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PMID:Selective sacral rootlet rhizotomy for hypertonic neurogenic bladder. 115 54

A family with autosomal dominant inheritance of sacral agenesis is described. Ten members were affected; four had associated presacral teratomas and anterior sacral meningoceles, giving rise to serious complications in three, including bacterial meningitis, local recurrence of teratoma and perianal sepsis. Three of those with presacral masses presented initially with anorectal anomalies. Other associated abnormalities included tethering of the cord, hydrocephalus, duplex ureter, hydronephrosis, vesicoureteric reflux, neurogenic bladder, bicornuate uterus, rectovaginal fistula and hereditary spherocytosis. Early diagnosis and surgical excision of a presacral mass is advised to prevent future morbidity and mortality.
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PMID:Hereditary sacral agenesis with presacral mass and anorectal stenosis: the Currarino triad. 205 99

To evaluate the significance of involvement of the genitourinary tract in adenocarcinoma of the colon and rectum, we received the records of 178 patients with adenocarcinoma of the colon and rectum admitted to the University of Massachusetts Medical Center from 1980 to 1985. Sixty-eight patients (38 per cent) had urologic manifestations categorized as ureteral obstruction or injury (34 per cent), invasion to the bladder or prostate, or both (10 per cent), isolated gross hematuria (18 per cent), radiation cystitis (6 per cent) and neurogenic bladder (26 per cent). Involvement of the genitourinary tract was more common among patients with recurrent versus primary carcinoma (53 versus 32 per cent) and among patients with high stage (Dukes' C and D) versus low stage (Dukes' A and B) carcinoma (48 versus 21 per cent). The survival rate was worse in patients with high stage compared with low stage disease and no patient with recurrent high stage disease survived beyond three years. Short term survival (less than two years) was not statistically different among patients with or without manifestations in the genitourinary tract: 63 and 45 versus 71 and 66 per cent at one and two years, respectively; however, the five year survival rate was worse among patients with genitourinary involvement (30 versus 54 per cent, p less than 0.05). Surgical and endoscopic intervention of the urinary tract was performed upon 36 patients with Dukes' C and D carcinoma because of life-threatening sepsis or azotemia, or both.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prognostic and therapeutic observations of manifestations in the genitourinary tract of adenocarcinoma of the colon and rectum. 281 67

Cutaneous vesicostomy was performed on 10 infants or young children with hydroureteronephrosis. The etiology of the upper urinary tract dilatation was neurogenic bladder dysfunction secondary to myelodysplasia in 8, and severe vesicoureteral reflux and urinary sepsis in 2. The vesicostomy resulted in marked improvement in the drainage and appearance of the upper urinary tract in each child. When other methods of managing the underlying lower urinary tract dysfunction were deemed more appropriate, the vesicostomy was closed. Cutaneous vesicostomy proved to be an effective, simple and easily reversible means of treating selected infants with lower urinary tract dysfunction.
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PMID:Cutaneous vesicostomy in infancy. 725 86

The diabetic neurogenic paralytic bladder is characterized by marked residual urine, secondary infection, pyelonephritis, sepsis, and azotemia. Initial manifestations were studied in diabetic patients with and without neuropathy and in nondiabetic controls, all without symptoms referable to the urinary tract. The nondiabetic controls and the diabetics without neuropathy were urologically normal. Eighty-three percent of the diabetic patients with neuropathy had objective evidence of neurogenic bladder involvement; however, there was no residual urine, infection, pyelonephritis, sepsis or azotemia. The disparity between early and late bladder involvement is determined by the factor of residual urine, which is the measure of advancing bladder neuropathy leading to decompensation. Progressive decompensation of the asymptomatic diabetic bladder may be a cause of the increased frequency of renal infection in diabetic patients.
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PMID:Development of urinary bladder dysfunction in diabetes mellitus. 735 22

Classical familial amyloid polyneuropathy may have a course with progressive renal impairment. We studied 62 patients (24 males, 38 females) with FAP, transthyretin variant V30M, and end-stage renal disease (ESRD) treated with hemodialysis, all referred to a single center over a period of 11 years. Clinical course, morbidity and survival after dialysis were analyzed. Patient's mean age at first dialysis was 51.5 +/- 10.7 years, and mean duration of neuropathy was 10.2 +/- 3.8 years. The most frequent form of presentation of FAP nephropathy was nephrotic proteinuria with renal dysfunction. In the year prior to dialysis, renal function declined rapidly, and fluid overload was the main indication to initiate treatment. The presence of decubitus ulcers, significant disability, venous catheter for definitive vascular access for long-term treatment, and permanent bladder catheter, were related to death during the first year of dialysis. The mean duration of renal replacement therapy was 21 months, with a 54.5% one year, and 38.4% two year treatment survival. However, when the duration of neurological symptoms at first dialysis exceeded 10 years, survival was significantly lower. Infections, (41% were decubitus ulcers with sepsis) were the cause of early, as well as late mortality. Early creation of vascular access for hemodialysis, surveillance of skin wounds, and intervention on neurogenic bladder are essential to improve the prognosis of ESRD in FAP.
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PMID:End-stage renal disease and dialysis in hereditary amyloidosis TTR V30M: presentation, survival and prognostic factors. 1518 96

One of the main complications of spinal cord injury is neurogenic bladder when the bladder fails to empty spontaneously. Urinary tract infection is the leading cause of morbidity and the second cause of mortality in these subjects. Patient education and personalized medical follow-up must ensure adapted management depending on the risk factors and the voiding mode. The risk of urinary tract infection can be decreased by perfect neurological control of detrusor activity combined with a method of drainage: intermittent self-catheterization. Despite these measures, many patients experience recurrent symptomatic urinary tract infections. Repeated antibiotic therapy increases the risk of selection of multiresistant bacteria without reducing either the incidence or the severity of symptomatic urinary tract infections. Asymptomatic bacteriuria is very frequent in patients treated by intermittent catheterization and does not justify antibiotic therapy, as antiseptics and urinary alkalinizers or acidifiers have been shown to be effective. "Antibiocycle" strategies could have a beneficial role by significantly decreasing the number of infections and hospitalizations with no major ecological risks, by using molecules that are well tolerated orally with a low selection pressure. All febrile urinary tract infections require rapid investigation and an urgent urological and infectious diseases opinion (abscess, severe sepsis, resistance). The SPILF-AFU 2002 consensus conference provided answers to major questions concerning the definition, treatment and prevention of nosocomial urinary tract infection, especially in a context of neurogenic bladder.
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PMID:[Urinary tract infection and neurogenic bladder]. 1762 75

A 20 years old girl, had undergone surgery for meningocele six weeks after birth, suffered from neurogenic bladder dysfunction. She underwent an augmentation ileocystoplasty and was trained to perform clean intermittent self catheterization (CISC). After two years she developed renal failure secondary to recurrent urinary tract infections and she was started on chronic hemodialysis. On account of repeated line sepsis, a live related donor renal transplant was performed. About three months after renal transplantation she reported in emergency with an episode of graft rejection secondary to severe infection and later on complicated by leakage of urine from the renal pelvis of the allograft into the peritoneal cavity suggestive of a rent. A percutaneous nephrostomy of the allograft was performed which facilitated healing of the rent in the renal pelvis. The nephrostomy was withdrawn and patient started voiding through urethral catheter and gradually returned to CISC.
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PMID:Renal transplant in a patient with augmentation cystoplasty. 1844 98

Since its introduction into the endourologist's armamentarium almost 40 years ago, percutaneous nephrolithotomy (PCNL) has become the standard of care for patients with large-volume nephrolithiasis. Postoperative infection is one of the most common complications of the procedure, and postoperative sepsis is one of the most detrimental. A number of factors have been found to increase the risk of postoperative sepsis. These include patient characteristics that are known preoperatively, such as urine culture obtained from the bladder or from the renal pelvis if percutaneous access to the renal pelvis is obtained in advance to the procedure. Neurogenic bladder dysfunction secondary to spinal cord injury and anatomical renal abnormalities, such as pelvicalyceal dilatation, have also been associated with increased incidence of fever and sepsis after the procedure. Several intraoperative factors, such as the average renal pressure sustained during PCNL and the operative time, also seem to increase the risk of sepsis. Finally, the contribution of postoperative factors, such as presence of a nephrostomy tube or a urethral catheter, has also been investigated. A short preoperative course of antibiotics has been found to significantly decrease the rate of postoperative fever and sepsis. Novel agents targeted at sepsis prevention and treatment, such as anti-endotoxin antibodies and cholesterol-lowering drugs statins, are currently under investigation.
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PMID:Risk factors for sepsis after percutaneous renal stone surgery. 2399 83


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