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Resumen Antecedentes: Los catéteres de nefrostomía percutánea (CNP) que se utilizan en algunos hospitales oncológicos condicionan un incremento en las infecciones del tracto urinario (ITU). Objetivo: Determinar el impacto de un programa estandarizado de atención en la incidencia de ITU que requiere hospitalización (ITU-RH). Material y métodos: Estudio retrospectivo que incluyó pacientes con un primer CNP. Se comparó la incidencia, riesgo relativo (RR), costos y evolución de los pacientes con ITU-RH durante el período previo a la intervención (P0) versus posterior a ella (P1). Resultados: Se instalaron 113 CNP durante P0 y 74 durante P1. Durante P0, 61 pacientes (53.9 %) presentaron 64 episodios de ITU-RH, en 22 557 días de uso de CNP. Durante P1, cuatro pacientes (5.4%) cursaron con ITU-RH en el transcurso de 6548 días de uso del CNP (razón de tasa de incidencia de 0.21, IC 95 % = 0.05-0.57). El RR fue de 0.09 (IC 95 % = 0.03-0.25). El costo mensual por día-cama fue de 3823 USD en P0 y de 1076 USD en P1; el de los antibióticos, de 790 USD en P0 y 123.5 USD en P1. Conclusiones: Este estudio resalta la importancia de un programa estandarizado del cuidado de los dispositivos permanentes, el cual disminuye el uso de antibióticos, la hospitalización y el costo de la atención.
Abstract Background: Percutaneous nephrostomy tubes (PNT), which are used in some cancer hospitals, are associated with an increase in the incidence of urinary tract infections (UTI). Objective: To determine the impact of a standardized care program on the incidence of UTI requiring hospitalization (UTI-RH). Material and methods: Retrospective study that included patients with a first PNT inserted. The incidence, relative risk (RR), costs and outcomes of patients with UTI-RH were compared during the period before (P0) vs. after the intervention (P1). Results: 113 PNCs were inserted during P0, and 74 at P1. During P0, 61 patients (53.9%) experienced 64 UTI-RH events in 22,557 PNT days. At P1, four patients (5.4%) had a UTI-RH in 6,548 PNT days (IRR: 0.21, 95% CI: 0.05-0.57). The RR was 0.09 (95% CI: 0.03-0.25). Monthly cost per day/bed was USD 3,823 at P0 and USD 1,076 at P1, and for antibiotics, it was USD 790 at P0 and USD 123.5 at P1. Conclusions: This study highlights the importance of a standardized care program for permanent percutaneous devices, since this reduces antibiotic use, hospitalization, and the cost of care.
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Objective To evaluate the predictive value of CT scan in the outcome of renal function after decompression procedures in patients with acute obstructive renal failure.Methods Retrospective analysis of clinical information of 76 patients with acute obstructive renal failure between January 2012 and August 2017 was performed.Clinical information included age,cause of obstruction,type of decompression procedures,total renal area and dominant side renal area measured by CT scan,serum creatinine(SCr) level before operation,SCr level in 3 months after decompression.Patients were divided into 2 groups according to creatinine clearance rate (CCr) in 3 months after decompression,including normal renal function group (26 cases,CCr ≥50 ml/min) and decompensated renal function group (50 cases,CCr ＜ 50 ml/min).The CCr of normal renal function group was (65.3 ± 12.8)ml/min,while the decompensated renal function group was (28.9 ± 11.9)ml/min.The average age of normal renal function group was 48.3 years old,the median value of serum creatinine before operation was 633μmol/L,while the average age of decompensated group was 63.8 years old,the median value of preoperative creatinine was 583 μmol/L.Renal area was measured in CT scan image which was performed when acute obstructive renal failure was diagnosed.Univariate analysis and logistic regression multivariate analysis was used to analyze these parameters.Receiver operating characteristic curve (ROC) was used to evaluate the performance of CT scan for renal function prediction.Results There were significant differences in the renal area between the normal renal function and decompensated renal function group,the total renal area were (3 765.5 ± 628.6) mm2 (range 2 375.3-4 853.6 mm2) and (2 493.0 ± 830.6) mm2 (range 476.9-4 225.1 mm2) respectively (P ＜ 0.001),while the dominant side renal area were (2 283.5 ± 430.2) mm2 (range 1 654.6-3 383.3 mm2) and (1 655.5 ± 496.2) mm2 (range 476.94-2 816.0 mm2) respectively (P ＜ 0.001).The integration area under the ROC curve of the total renal area to predict the outcome of renal function was 0.89.Conclusions The renal area measured in CT scan image might be useful for the early prediction of renal function outcome in patients with acute obstructive renal failure.
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[Objective]To study the relationship between bridging septa thickening in the perinephric space and split renal function in acute unilateral upper urinary tract obstruction.[Methods]50 patients with acute unilateral upper urinary tract obstruction by calculus were analyzed retrospectively. According to the images of multi-slice spiral CT (MSCT)scanning,all cases were divided into thickened bridging septa group(n=25)and normal bridging septa group (n=25),The CT values of renal cortical in the plain(CTp)and renal cortical enhancing(CTe)phase were measured, the difference of increasement value(CTe-CTp)and the CT value ratio of the ipsilateral and opposite in renal cortical phase was analyzed by independent sample T test.[Results]The CT increasement value of bridging septa thickening and normal group were(103±30)HU and(128±24)HU respectively,the difference between the two groups was statistically significant(P<0.01);and CTac/CTuc were 0.81±0.13 and 0.96±0.06 respectively(P<0.01).[Conclusion]Thickening of bridging septa in the perinephric space with acute unilateral upper urinary tract obstruction will weaken the enhancement of renal cortical,and increased the likelihood of split renal function impairing.
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A obstrução do trato urinário baixo fetal (fetal lower urinary tract obstruction - LUTO) é uma patologia caracterizada por dilatação da bexiga e hidronefrose bilateral causada por obstrução do trato urinário inferior. Sua incidência é de 2,2 em cada 10.000 nascimentos. A etiologia da LUTO inclui a válvula da uretra posterior (VUP), atresia ou estenose uretral. O diagnóstico é feito por ultrassom, que mostra bexiga dilatada, com paredes espessas (megabexiga), e uretra posterior aumentada. O tratamento cirúrgico clássico (derivação vésico-amniótica guiada por ultrassom) estaria indicado quando o líquido amniótico normal começa a diminuir, com aumento da distensão vesical e da hidronefrose. O tratamento inclui a colocação de derivação vésico-amniótica guiado pelo ultrassom e fetoscópica com coagulação a laser. De acordo com a gravidade, a LUTO é classificada nos estágios 1,2 e 3.(AU)
The Fetal Lower Urinary Tract Obstruction (LUTO) is a spectrum of diseases characterized by bladder distension and bilateral hydronephrosis in consequence of the LUTO. The incidence is approximately 2.2 in 10,000 births and it is commonly diagnosed during the late first or early second trimester of pregnancy. The etiologies of LUTO include posterior urethral valves, urethral atresia and urethral stenosis. Complete bladder outlet obstruction (severe LUTO) is associated with high perinatal mortality due to pulmonary hypoplasia and severe renal impairment/damage. The prenatal intervention includes vesicoamniotic shunt placement guided by ultrasound and fetoscopic laser coagulation. It is suggested that LUTO patients could be categorized in three stages according to disease gravity: Stages 1, 2 and 3.(AU)
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Humanos , Embarazo , Diagnóstico Prenatal , Obstrucción Uretral/cirugía , Obstrucción Uretral/diagnóstico por imagen , Enfermedades Urológicas/diagnóstico por imagen , Enfermedades Fetales/fisiopatología , Obstrucción del Cuello de la Vejiga Urinaria , Coagulación con Láser , Dilatación Patológica , Mortalidad Perinatal , Sufrimiento Fetal , Líquido Amniótico , HidronefrosisRESUMEN
Abstract Objective: To investigate the influence of bladder fullness on the diagnosis of urinary tract obstruction during dynamic renal scintigraphy with a diuretic stimulator. Materials and methods: We studied 82 kidneys in 82 patients submitted to dynamic renal scintigraphy with a diuretic stimulator. We compared the proportional elimination of the radiopharmaceutical 99mTc-DTPA from the kidneys before and after bladder emptying in post-diuretic images, classifying each image as representing an obstructed, indeterminate, or unobstructed kidney. Results: The overall elimination of 99mTc-DTPA from the kidneys was 10.4% greater after bladder emptying than before. When the analysis was performed with a full bladder, we classified 40 kidneys as obstructed, 16 as indeterminate, and 26 as unobstructed. When the 40 kidneys classified as obstructed were analyzed after voiding, 11 were reclassified as indeterminate and 3 were reclassified as unobstructed. Of the 16 kidneys classified as indeterminate on the full-bladder images, 13 were reclassified as unobstructed after voiding. Conclusion: In dynamic renal scintigraphy with a diuretic stimulator, it is important to obtain images after voiding, in order to perform a reliable analysis of the proportional excretion of 99mTc-DTPA from the kidneys, avoiding possible false-positive results for urinary tract obstruction.
Resumo Objetivo: Verificar a influência da repleção vesical no diagnóstico da obstrução do trato urinário durante a cintilografia renal dinâmica com estímulo de diurético. Materiais e métodos: Foram estudados, retrospectivamente, 82 rins de 82 pacientes submetidos a cintilografia renal dinâmica. Compararam-se as porcentagens de excreção do radiofármaco DTPA-99mTc pelos rins antes e após o esvaziamento vesical nas imagens pós-diurético, classificando-os como obstruídos, indeterminados ou não obstruídos. Resultados: A avaliação da excreção do radiofármaco pelos rins mostrou que houve aumento de 10,4% na taxa de excreção global quando a bexiga foi esvaziada. Dos 82 rins estudados, 40 foram considerados obstruídos, 16 indeterminados e 26 como não obstruídos, na análise com a bexiga repleta. Na análise das imagens após micção, dos 40 classificados como obstruídos, 11 passaram a ser classificados como indeterminados e 3 como não obstruídos. Além disso, dos 16 rins apontados como indeterminados nas imagens com a bexiga repleta, 13 passaram a ser considerados não obstruídos com a bexiga vazia. Conclusão: É fundamental uma imagem após a micção na cintilografia renal dinâmica para uma análise fidedigna da porcentagem de excreção do radiofármaco pelo rim, evitando-se possíveis falso-positivos para obstrução do trato urinário.
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Objective To investigate the relationship between preoperative renal cortical thickness and glomerular filtration rate (GFR) before and after minimally invasive surgery in patients with unilateral upper urinary tract obstruction. Methods 63 patients with upper urinary tract obstruction from July 2015 to June 2016 were enrolled in the study, including 34 males and 29 females, age ranged from 22 to 73 years old (52.21 ± 11.56). Their operation methods included 24 cases of ureteroscopic lithotripsy and lithotomy, 21 cases with one-stage percutaneous nephrostomy + two-stage percutaneous nephrolithotomy (PCNL), 18 cases of PCNL. The abdominal enhanced CT and single photon emission computed tomography (SPECT) were measured to RCT and GFR. Then all cases were divided into group A (moderate renal impairment, 15.0 ml/min ≤ GFR < 30 ml/min), group B (severe renal damage, 7.5 ml/min ≤ GFR <15.0 ml/min) and group C (extremely severe renal injury, GFR < 7.5 ml/min) according to preoperative renal GFR, and changes of GFR before and after surgery were compared among three groups. Simple linear correlation analysis was used to analyze the correlation between preoperative RCT and other indexes in group A and B. Results 9 patients were not measured RCT because of serious hydronephrosis, 54 patients included 20 cases of RCT >10 mm, 23 cases of 5 ～ 7 mm and 11 cases of <5 mm, and the average value was (10.75 ± 4.91) mm. The preoperative RCT in group A was significantly higher than that in group B (P < 0.05). GFR at 1 and 9 months after operation in three groups were significantly higher than that before operation in the same group (P < 0.05). GFR at 1 and 9 months after operation in group A were significantly higher than that the other two groups, and GFR at 9 months after operation in group B was significantly higher than that in group C (P < 0.05), but there were no significant differences in GFR at 1 month after operation between group B and C (P > 0.05). GFR recovery value at 1 month after operation in group B was significantly lower than that in other two groups (P < 0.05), but there were no significant differences in GFR at 9 months after operation among three groups (P > 0.05). Preoperative RCT was positively correlated with preoperative GFR (r = 0.613), GFR at 1 month after operation (r = 0.697) and the recovery value (r = 0.552), GFR at 9 months after operation ((r = 0.589) and recovery values (r = 0.488), and the differences were statistically significant (P < 0.05). Conclusion Removal of upper urinary tract obstruction could recover the renal function to varying degrees, even for patients with extremely severe renal injury, who could retrieve their kidney. Preoperative RCT could be helpful in judging the renal function during operation, especially for the postoperative recovery of renal function.
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Objective To investigate the effect of ultrasound guided percutaneous nephrostomy combined with Mailuoning injection on renal function, TGF- β 1 and α -SMA in patients with obstructive hydronephrosis. Methods 37 cases with obstructive hydronephrosis treated in our hospital from June 2014 to December 2016 were enrolled as the research object, all patients after admission were perfect relevant examination, after exclude contraindications underwent ultrasound-guided percutaneous nephrostomy combined with Mailuoning injection treatment. The operative time, the success rate of first puncture, the amount of bleeding during operation, hospitalization time, incidence of complications, preoperative and postoperative 3 d, 7 d renal function preoperative, postoperative, 7 d urine transforming growth factor β 1 (TGF- β 1) and alpha smooth muscle actin (α -SMA) were observed. Results The operation time was 52~93 minutes in 37 patients, the average operation time was (62.31±8.26) minutes; One puncture was successful in 37 cases, the success rate of one puncture was 100%. The intraoperative blood loss was 51 ~ 102 mL, the average amount of bleeding was (80.27±18.15) mL. The hospitalization time was 3 ~ 9 d, the average time was (6.12±1.97)d.In 37 cases, three cases were blocked by ostomy, the incidence rate was 8.11 %; The fistula was removed in one cases, the incidence rate was 2.70%; seven cases with dermatitis around the fistula, the incidence rate was 18.92%. At 3 d after surgery, BUN and Cr were significantly decreased than before operation (P<0.05). At 7 d after surgery, BUN and Cr were significantly decreased compared with preoperative and postoperative 3 d (P<0.05). The levels of TGF-β1 and α-SMA in patients were significantly lower than those before operation at 7 days after operation (P<0.05). Conclusion Ultrasound guided percutaneous nephrostomy combined with Mailuoning injection in the treatment of obstructive hydronephrosis can timely drainage of urine, improve renal function, avoid ipsilateral renal interstitial fibrosis. The utility model has the advantages of high rate of success and safe operation.
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Objective To investigate the effect of ultrasound guided percutaneous nephrostomy combined with Mailuoning injection on renal function, TGF- β 1 and α -SMA in patients with obstructive hydronephrosis. Methods 37 cases with obstructive hydronephrosis treated in our hospital from June 2014 to December 2016 were enrolled as the research object, all patients after admission were perfect relevant examination, after exclude contraindications underwent ultrasound-guided percutaneous nephrostomy combined with Mailuoning injection treatment. The operative time, the success rate of first puncture, the amount of bleeding during operation, hospitalization time, incidence of complications, preoperative and postoperative 3 d, 7 d renal function preoperative, postoperative, 7 d urine transforming growth factor β 1 (TGF- β 1) and alpha smooth muscle actin (α -SMA) were observed. Results The operation time was 52~93 minutes in 37 patients, the average operation time was (62.31±8.26) minutes; One puncture was successful in 37 cases, the success rate of one puncture was 100%. The intraoperative blood loss was 51 ~ 102 mL, the average amount of bleeding was (80.27±18.15) mL. The hospitalization time was 3 ~ 9 d, the average time was (6.12±1.97)d.In 37 cases, three cases were blocked by ostomy, the incidence rate was 8.11 %; The fistula was removed in one cases, the incidence rate was 2.70%; seven cases with dermatitis around the fistula, the incidence rate was 18.92%. At 3 d after surgery, BUN and Cr were significantly decreased than before operation (P<0.05). At 7 d after surgery, BUN and Cr were significantly decreased compared with preoperative and postoperative 3 d (P<0.05). The levels of TGF-β1 and α-SMA in patients were significantly lower than those before operation at 7 days after operation (P<0.05). Conclusion Ultrasound guided percutaneous nephrostomy combined with Mailuoning injection in the treatment of obstructive hydronephrosis can timely drainage of urine, improve renal function, avoid ipsilateral renal interstitial fibrosis. The utility model has the advantages of high rate of success and safe operation.
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Objective To investigate the recovery of affected side kidney function after upper urinary tract obstruction was relieved Methods 78 patients who had been diagnosed with upper urinary tract obstruction were enrolled from January to December of 2015 in our hospital.All patients received the surgery to relieve the obstruction.GFR of the affected side kidney was done after one months of the surgery.The average age was(51.3 ± 12.8)years old.The reason of obstruction was upper urinary tract calculi (72 cases) and upper urinary tract stenosis (6 cases) respectively.All the patients received CT and ECT before and after operation.All the patients was divided into 3 groups by the decreased degree of affected side kidney function,including moderately decreased group [15 rnl/min ≤ GFR ＜ 30 ml/min,n =43,mean value =(23.1 ±5.0) mL/min],severely decreased group [7.5 rnL/min≤ GFR ＜ 15 ml/min,n =23,mean value =(11.2 ± 2.3) ml/min],and extreme severely decreased group [GFR ＜ 7.5 ml/min,n =12,mean value =(4.3 ± 2.9)ml/min].Linear correlation analysis was used to analysis the relationship analysis between the GFR value (pre-operation,post-operation) and the renal cortical thickness.The follow up time of extreme severely decreased group extended to 8-12 months.Results The GFR of moderate decreased group recovered to(30.6 ± 8.5) ml/min,regained averagely (7.56 ± 7.62) ml/min;the severely decreased group recovered to (13.1 ± 4.5) ml/min,regain (1.94 ± 3.38) ml/min.Extreme severely decreased group recovered to (11.1 ± 3.4) ml/min,regained averagely (6.75 ± 4.76) rnl/min,the GFR mean value after operation 8-12 months recovered to (12.7 ± 3.6) ml/min.All groups got significant recovery of kidney function of the affected side.The correlation coefficient between GFR value and the renal cortical thickness was 0.59 (before the surgery) and 0.70 (after the surgery) respectively (P ＜ 0.05).Conclusions Most of affected side kidneys got different degree of recovery.Obstruction influenced the accuracy of ECT at the time of evaluating the actual renal function before operation.The kidneys which had been supposed should be resected in presurgical evaluation could recover to the level of kidney reserve after the surgery.
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Congenital lower urinary tract obstruction in the fetus and is rare in neonates,but it is identified in-creasingly in the era of prenatal sonography and resulted in substantial perinatal mortality with lifelong morbidity. Poste-rior urethral valves,urethral atresia,and prune - belly syndrome are the frequently reported causes of lower urinary tract obstruction. Despite the completion of a randomized trial,the benefit of prenatal intervention with vesicoamniotic shunt placement remains unclear. The management of these disease in fetus and newborns requires appropriate urinary tract decompression,subspecially support,and definitive diagnosis with endoscopy and radiography. Now,the recent progress of diagnosis and treatment of congenital lower urinary tract obstruction were reviewed.
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Objective To analyze the reasons and imaging features of acute urinary tract obstruction and perinephritis and to evaluate the diagnostic efficacy of CT and MR in this kind of patients.Methods Imaging features of 72 patients with acute urinary tract obstruction were analyzed.The advantages of CT and MR were evaluated in diagnosis of the diseases.Results In all 70 patients (72 sites)with ureteral calculus,the accurate rates of diagnosis were 100% on CT and 59.7% on MR.In the 72 patients with perinephritis,the detection rate of effusion in perinephric soft tissue on MR was better than that on CT.Conclusion CT or MR has individually diagnostic advantage in acute urinary tract obstruction and perinephritis,CT is better in ureteral calculus and MR in perinephritis.
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Objective To explore the clinical value of prenatal ultrasonography in the differentiation among the etiologies of fetal megacystis.Methods Twenty seven fetuses,diagnosed as fetal megacystis by prenatal ultrasonography,were retrospectively analyzed.The etiologies of fetal megacystis were presumed by such characteristics as keyhole sign,thickness of the bladder wall,amniotic fluid index,fetal sex and other combined signs.All fetuses were followed up until to the induction of labor or birth.Results Twenty seven singleton fetuses (19 males and 8 females) were diagnosed as megacystis.According to the characteristics and other combined signs,8 cases of posterior urethral valves (PUV),1 of prune belly syndrome(PBS),1 of megacystis-microcolon intestinal hypoperistalsis syndrome(MMIHS),1 of urethral atresia and 5 of chromosomal abnormality were presumed by prenatal ultrasound.Multiple malformations were found in 5 fetuses and there were also 6 fetuses with unknown reason originally.Among the 27 fetuses,21 were induced labor and 6 continued pregnancy to birth.Except for the 6 cases of unknown reason,etiologies of 17 fetuses with megacystis were confirmed by autopsy,genetic tests,surgery or further examination after birth.The accuracy rate of prenatal ultrasonography in the differentiation among the etiologies of fetal megacystis was 80.95％ (17/21).Conclusions On the basis of detailed prenatal ultrasonography and typical characteristics,it is reliable to differentiate the etiologies of fetal megacystis.Sometimes fetal megacystis may be one part of multiple malformations or complex syndrome,such as VACTERL syndrome.However,it is difficult for ultrasonography to diagnose vesicoureteral reflux(VUR)prenatally.
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Objective To investigate the treatment of urinary tract obstruction after kidney transplantation, and to introduce the novel ‘antegrade percutaneous urinary tract throughout guidance technique’ with guide wire in selected patients. Methods 43 cases of renal transplantation patients due to urinary tract obstruction (ureteral stenosis and hydronephrosis in 24 cases, urinary calculi with or not ureteral stenosis in 19 cases) received endourological treatment. Retrograde pathway was tried firstly, if failed, antegrade pathway was adopted with‘antegrade percutaneous urinary tract throughout guidance technique’, 18 Fr percutaneous tract was established if necessary, endoscopy was needed in antegrade or combine with retrograde pathway. Results Of the 43 patients, 9 (20.9 %) patients were managed directly through the retrograde ureteroscopy, 28 (65.1 %) patients were managed with anterograde percutaneous technique in 18 Fr tract, 6 (14.0 %) patients were treated with ‘antegrade percutaneous urinary tract throughout guidance technique’. Operation time was (72.0 ± 16.0) (45 ~ 95) minutes. Postoperative stone clearance rate of 89.5 % (17/19). Of 32 cases with ureteral stricture, 6 (6/32, 18.8 %) cases were cured after one time of dilation and JJ stent indwelling for 2 months, 18 (56.3%) cases with stable hydronephrosis after 2-3 times of dilation and JJ stent indwelling, 5 cases (15.6 %) needed long-term repeated stent indwelling for drainage, 3 (9.4%) cases required nephrostomy tube drainage. Conclusion Minimally invasive treatment of urinary tract obstruction after renal transplantation is effective. Antegrade percutaneous urinary tract throughout guidance technique provided a powerful guarantee for retrograde operation and avoided the bleeding risk following percutaneous renal surgery, when combined with flexible ureteroscopy, urinary calculi in patients with kidney transplantation can be effectively managed with little trauma.
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Objective To investigate the effects of the double J tube in treating drug -crystalline upper uri-nary tract obstruction.Methods There were 12 cases of drug -crystalline urinary tract obstruction,which were diag-nosed by CT for urinary tract obstruction.With the help of cystoscope,we retrograde placed the double -J tube in all the 12 patients who with persistently elevated serum creatinine in the next day of admission.Results Nine patients were successfully placed double J stent and serum creatinine of the patients decreased to normal rapidly.There were 2 patients with failed implantation and were with persistently elevated serum creatinine.1 patient with unilateral urina-ry tract obstruction was treated with conservative treatment and eventually cured.Conclusion Patients with drug -induced renal injury should have a routine bilateral ureteral CT scan,once they are clearly diagnosed as drug crystal upper urinary tract obstruction in them,timely placement of bilateral double J tube with the help of cystoscope,which was a simple and effective treatments.
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Autonomic dysreflexia is a clinical emergency syndrome of uncontrolled sympathetic output that can occur in patients who have a history of spinal cord injury. Despite its frequency in spinal cord injury patients, central nervous system complications are very rare. We report a man with traumatic high level incomplete spinal cord injury who suffered hypertensive right thalamic hemorrhage secondary to an episode of autonomic dysreflexia. Prompt recognition and removal of the triggering factor, the suprapubic catheter obstruction which led to hypertensive attack, the patient had a favorable functional outcome after the resorption of the hematoma and effective rehabilitation programme.
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Humanos , Disreflexia Autónoma , Obstrucción del Catéter , Sistema Nervioso Central , Hemorragia Cerebral , Urgencias Médicas , Hematoma , Hemorragia , Rehabilitación , Traumatismos de la Médula EspinalRESUMEN
<b>Background:</b> Urosepsis is a potentially fatal syndrome that is sometimes difficult to diagnose. Thus, the aim of the present study was to clarify the clinical and laboratory characteristics and pitfalls in the diagnosis of urosepsis.<br><b>Methods:</b> We enrolled the study participants based on clinical records of patients with urosepsis treated between January 2009 and April 2012 inclusive, in the Department of General Internal Medicine, Toyama University Hospital and retrospectively surveyed underlying diseases, clinical symptoms, physical findings, and laboratory data, respectively.<br><b>Results:</b> Ten definitive patients were selected (nine females and one male; age, 55–86 years). Fever was the most frequent symptom followed by nausea. Lower back pain was the chief complaint in only two patients. One patient complained of dysuria, and on examination half of the patients lacked costovertebral angle (CVA) tenderness. Five patients showed elevated liver enzymes without evidence of hyperbilirubinemia.<br><b>Conclusions:</b> There were no specific clinical characteristics of urosepsis, and symptoms in some patients resembled digestive diseases such as cholangitis. Our results demonstrate that use of dipstick urinalysis and microscopic urinalysis are essential for the diagnosis in patients with sepsis. Abdominal ultrasonography and/or computed tomography should also be considered to rule out false negative results of urinalysis related to urinary tract obstruction, and to detect other focal infections when appropriate.
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Objective To study the urodynamic change of young and middle-aged patients with chronic prostatitis,and provide reference for clinical diagnosis and treatment.Methods Seventy young and middle-aged patients with chronic prostatitis were selected,the bladder capacity,bladder stability,bladder compliance,detrusor pressure and bladder pressure volume curve etc were measured.Results Unstable of detrusor contraction of 20 cases (28.6％,20/70),bladder sensitivity of 35 cases (50.0％,35/70),detrusor underactivity of 46 cases (65.7％,46/70).In 70 young and middle-aged patients with chronic prostatitis,the maximum bladder capacity was 100-497 (380 ± 80) ml,the detrusor pressure at maximum flow rate was 11.2-112.2 (38.4 ± 3.9) cm H2O (1 cm H2O =0.098 kPa),the drop of maximum flow rate was (10.53 ± 1.92) ml/s.Conclusions Through the urodynamic examination,the lower urinary tract obstruction syndrome can be found in young and middle-aged patients with chronic prostatitis,especially who have no significantly improvement after drug therapy.Now,the urodynamic examination for the lower urinary tract obstruction is a credible way to diagnosis,which plays an important role in diagnosis of chronic prostatitis and is useful for clinical practice.
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Objective To study the diagnostic value of magnetic resonance urography (MRU) in the urinary tract obstruction(UTO) in children.Methods 65 children with UTO underwent intravenous pyelography(IVP),B-ultrasound(BUS) and MR urography(MRU) ,MRU using hearvily T_2-weighted fat suppression turbo echo sequence.MRU features were compared with that of operation.The accurate rate in diagnosis of UTO with MRU was analysed comparatively with that of IVP and BUS.Results The lesions diagnosed with MRU included stricture of ureteropelvic junction in 36 children,and duplication of renal pelvis in 3 children (diagnostic error in 1),primary megaloureter in 9,narrowing of cystic inlet of ureter in 4,cysts of cystic inlet of ureter in 3,solitary kidney in 2,nephrolith in 5,nervous bladder in 2 and congenital renal dysplasia in 1.The accuracy was 98.5% in defining the UTO with MRU(64/65),which was superior to that with IVP and BUS(P＜0.05).Conclusion MRU is of great value in the diagnosis of upper urinary tract obstruction in children.
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1?105/ml。These cases were assigned to A or B group randomly.The management of A group:double-J tubes were placed and retained for 2 weeks again,and used susceptible antibiotics for 2 weeks→ discontinued drugs for 1 week→urine cultured,PA(+)→used susceptible antibiotics for 2 weeks→discontinued drugs for 1 week→urine cultured,PA(+)→used susceptible antibiotics for 2 weeks;the management of B group:double-J tube(sCook,F6,America)were placed again,and used susceptible antibiotics for 2 weeks→discontinued drugs for 1 week→urine cultured,PA(+)→used susceptible antibiotics for 2 weeks,until the infection was cured,the double-J tube was removed after the infection was cured.Results:A group:double-J tubes were retained for 2 weeks additionally;4 patients were cured during the first two-week,2 patients were cured during the second two-week,the cure rate was 40%after two courses,one was cured during the third two-week,the cure rate was 46.7%after three courses.B group:double-J tubes was retained for 4～12 weeks(mean 8 weeks)additionally,3 patients were cured during the first two-week,9 patients were cured during the second two-week,the cure rate was 80%after two courses,2 patients were cured during the third two-week,the cure rate was 93.3%after three courses.The cure rate ofBgroup was significantlyhigher than Agroup after twocourses and three courses,the difference was significan(tP