Differences between Risk Factors for Sepsis and Septic Shock in Obstructive Urolithiasis

Background@#Complicated acute pyelonephritis (APN) is a life-threatening condition that requires immediate intervention. This study examined the characteristics of APN occurring as a complication of ureteral stone. @*Methods@#We retrospectively reviewed 85 patients diagnosed with APN complicated by ureteral stone between December 2006 and July 2017 at our institution. Patients with concomitant renal stone, multiple ureteral stones, ureteral strictures, ureteral cancer, and urogenital anomalies, including vesicoureteral reflux were excluded. Clinical characteristics including age, sex, underlying disease, medical history, stone characteristics, initial laboratory data, and the procedure used to correct urinary obstruction were summarized, and the risk factors associated with sepsis and septic shock were analyzed. @*Results@#Sepsis was diagnosed at initial presentation in 62 patients, 17 of whom suffered from septic shock. Disease-related death did not occur in any patient. Previous history of stone (P = 0.015), leukocytosis (P < 0.001), elevated C-reactive protein levels (P = 0.006), and low albumin (P = 0.038) were significant risk factors for progression to sepsis. The absence of hypertension (P = 0.047), thrombocytopenia (P = 0.006), decreased erythrocyte sedimentation rate (ESR) (P = 0.003), elevated blood urea nitrogen (P = 0.016), and positive blood culture (P= 0.018) were significant predictors for progression to septic shock.Multivariate analysis revealed that previous history of stone (P = 0.015) was an independent risk factor for sepsis, while the absence of hypertension (P = 0.047), thrombocytopenia (P= 0.013), and decreased ESR (P = 0.009) were risk factors for shock. @*Conclusion@#The risk factors associated with the progression from APN to sepsis differed from those associated with the progression from sepsis to septic shock. Various factors should be considered while selecting treatment options based on the severity of APN associated with ureteral stone. It should be managed with aggressive treatment and close observation, especially in the presence of risk factors.

Role of Inducible Nitric Oxide Synthase as a Mediator of Renal Ischemia/Reperfusion Injury in the Rat / 대한비뇨기과학회지

PURPOSE: This study was undertaken to elucidate if nitric oxide (NO), produced by inducible nitric oxide synthase (iNOS) following renal ischemia/reperfusion (I/R), contributes to renal injury in rats, and if selective inhibition of iNOS prevents tissue injury following I/R. MATERIALS AND METHODS: Sprague-Dawley rats (male, 200-250gm, n=80) were divided into 4 groups. The groups were pretreated with L-arginine (L-ARG group), N-nitro-L- arginine methyl ester (L-NAME group), aminoguanidine (AG group) or normal saline (control group) before I/R. The renal blood flow was measured using laser Doppler at the left renal pedicle just before clamping the pedicle and at 15, 30, and 45 min after reperfusion. The HandE stain of nephrectomized tissues following I/R was performed for histological scoring of tubular damage and medullary vascular congestion. The expression of iNOS, using reverse transcription-polymerase chain reaction (RT-PCR), in the AG and control groups was determined in the kidney tissues following I/R. RESULTS: The recovery rate of the renal blood flow after I/R was significantly higher in the AG group compared to the controls. From light microscopy, the control group showed attenuated tubular lining epithelial cells, especially in the proximal tubules. However, Glomeruli and individual tubular cells showed no pathological changes. Mild congestion was noted in the medullary area. The L-NAME group showed marked tubular necrosis and medullary congestion. This tubular necrotic injury was compromised in the L-ARG group, but it was almost normal in the AG group. The medullary congestion was still severe in the L-ARG group, but was minimally present in the AG group. RT-PCR of the iNOS in the rat renal tissue revealed an iNOS band at 200bp. No significant difference in the density of the iNOS band was observed between the two groups. CONCLUSIONS: These results suggest that the NO, produced by iNOS following I/R, leads to renal tubular necrosis and medullary congestion, and selective inhibition of the iNOS may prevent renal tissue damage following I/R injury.

A Case of Renal Papillary Necrosis Associated with Diabetes Mellitus / 대한비뇨기과학회지

Renal papillary necrosis is rare. It usually occurs in association with diabetes mellitus, pyelonephritis, urinary tract obstruction, analgesic abuse and sickle cell hemoglobinopathies. The basic pathophysiologic process in renal papillary necrosis appears to be ischemic necrosis. We experienced a case of renal papillary necrosis associated with diabetes mellitus. This 59 years old female was diabetic for 10 years and had persistent pyuria, not controlled with antibiotics. The excretory urography showed nonvisualized left kidney and retrograde pyelography showed multiple irregular filling defect in pelvis and ureter. The nephrectomized kidney showed typical findings of papillary necrosis, grossly and microscopically.

The Results of Prostatectomy :The Use of the Flow Rate Nomogram / 대한비뇨기과학회지

The uroflowmetry was accurate, noninvasive method in the assessment of infravesical obstruction, but it was difficult to differentiate normal from obstructed individuals. The use of the flow rate nomogram appeared to differentiate reliably normal from obstructed individuals. The uroflowmetries using flow rate nomogram which was previously reported by our hospital, were performed on 35 BPH patients, 12 patients preoperatively and postoperatively (Group I) and 23 patients postoperatively only due to preoperative urinary retention (Group 2). The following results were obtained. 1. In group 1, the mean preoperative maximal flow rate was 9.4 (ml/sec) and the mean postoperative maximal flow rate was 15.3 (ml/sec). 2. In group 2, the mean postoperative maximal flow rate was 18.3 (ml/sec) 3. In group 1, nine of twelve patients (75%) were improved in the maximal flow rate. But six of twelve patients (50% ) were improved in the flow rate nomogram. 4. In group 2, fourteen of twenty-three patients (70%) were improved in the flow rate nomogram. In summary, this study shows much difference in the results between maximal flow rate and flow nomogram. So uroflowmetry using flow rate nomogram, we consider, will show more objective result in the evaluation of prostatectomized patient.

Liposarcoma of Spermatic Cord: Report of A Case / 대한비뇨기과학회지

Liposarcoma is the malignant tumor that can be originated from any adipose tissue. Spermatic cord liposarcoma are very rare. They are less than 4% of primary malignant tumor of spermatic cord. Radical orchiectomy appears to be adequate treatment. We report a case of liposarcoma of the left spermatic cord in 54 years old man which has presented as a slowly growing scrotal mass without metastatic evidence and radical orchiectomy were performed as a treatment. The iteratures were reviewed briefly.

A Case of Transverse Testicular Ectopia / 대한비뇨기과학회지

Transverse testicular ectopia is a rare anatomical abnormality in which both gonads migrate toward the same hemiscrotum. Herein we report a case of transverse testicular ectopia in a 4 years old boy with review of literature.