Large bifid ureteric calculus in a patient with an ileal conduit

Urinary diversion after extirpative surgery of the bladder is done by various methods. Conduit urinary diversion is the most commonly practiced method of urinary diversion. It is relatively easy to perform and has a lower complication rate than other forms of diversion, e.g., orthotopic neobladder and continent cutaneous urinary diversion. Urolithiasis is a known and common complication of urinary diversion. Upper tract calculi in these cases often manifest symptomatically as occurs in the general population. Stones in the conduit can have a variable clinical presentation. Asymptomatic presentation is also noted in a few cases. We report a case of a large silent bifid ureteric calculus within an ileal conduit in a woman who had undergone urinary diversion 32 years earlier. Plain X-ray of the abdomen is the only investigation necessary to rule out urinary lithiasis in those who have had urinary diversion for a long time. This simple tool can diagnose the condition well in advance and aid in planning the management of this condition

Continuous ambulatory peritoneal dialysis catheter placement: is omentectomy necessary?

There are different methods of continuous ambulatory peritoneal dialysis [CAPD] catheter placement. Open surgical technique is a widely followed method. The complication rate following catheter placement varies and catheter blockage due to omental plugging is one of the main reasons. To analyze the need for routine omentectomy during CAPD catheter placement. This was a retrospective analysis of 58 CAPD catheter placements performed between July 2002 and June 2007. Tenckhoff double cuffed catheter was used in all. The postoperative complications were analyzed. There were 44 males and 14 females. The mean age was 51 years ranging from 15 to 76 years. Of these, 40 [69%] patients underwent omentectomy [group A] and 18 [31%] did not [group B]. Laparoscopic and open techniques were performed in 5 and 53 patients, respectively. Omentectomy was not performed in 13 patients with open technique and all the five in the laparoscopic group. One patient in group A developed hemoperitoneum which was treated conservatively. None from group A developed catheter blockage, whereas five [27.8%] from group B developed catheter blockage postoperatively. The median time interval between the primary procedure and development of catheter blockage was 45 days [ranged from 14 to 150 days]. Omentectomy during CAPD catheter placement prevents catheter blockage and secondary interventions

Role of Imaging in predicting Salvageability of Kidneys in Urinary Tract Tuberculosis

To study the role of imaging in predicting salvageability of kidneys and the role of early nephrectomy in urinary tract tuberculosis [TB]. This was a retrospective study of 103 cases managed between 1990 to1998. Intravenous urograms [IVUs] were reviewed and based on the IVU findings. Patients were stratified into three groups. Treatment consisted of immediate surgery, defined as nephrectomy within six weeks of starting anti-TB treatment [ATT] and delayed as nephrectomy done after completion of ATT. Chi square test was applied to find the significance of early nephrectomy. Logistic regression analysis model was used to identify factors predicting salvageabilty of the nephron mass. Of the 103 cases, 23 had early nephrectomy and all of them achieved cure and had good renal function at follow up. Of the 76 who received only ATT, 43 were cured and the remaining 33 deteriorated symptomatically with high serum creatinine and decreasing GFR. Of the 33 who deteriorated, radiological and biochemical deterioration was seen in 24, two developed flank sinus and one developed multi drug resistant TB. On sub-grouping of the patients based on IVU, it was found that those with major renal lesion alone [group A] or with bladder involvement [group C] required either early or delayed nephrectomy and those who had minor lesion [group B] or bladder involvement with or without minor lesion [group C] did well on ATT alone. Logistic regression model showed cavitory lesions, GFR<20ml/min/m[2] and gross hydronephrosis as statistically significant unfavourable factors and ureteric stricture as a favourable factor. In the era of modern ATT, nephrectomy is still an essential procedure. We recommend early nephrectomy for patients with major renal lesion with or without bladder involvement, gross hydronephrosis and for those who have GFR of <20 ml/min/m[2]. Lower ureteric strictures and renal units with GFR of >20 ml/min/m[2] are favourable factors and salvage procedures are successful in these cases. It is likely that nephrectomy removes a large focus of disease and possibly dormant bacteria. With continuance of ATT, this further helps in improved patient outcome