Case series to study the clinical features, risk factors, prognostic factors, and to assess the different management modalities of EPN and its outcomes

Background: Emphysematous pyelonephritis is an acute necrotising infection of the kidney, often associated with high rate of renal loss and mortality. EPN mostly present with triad of fever, flank pain and nausea. The diagnostic tool of choice is CT KUB. E. coli is the most common pathogen. Methods: It was prospective study done on 52 patients who were diagnosed to have EPN from department of nephrology and urology in Narayana Medical College, Nellore from March 2022 to January 2024. The diagnosis of EPN was confirmed by plain CT KUB scan. Results: Among 52 patients 48 patients had diabetes mellitus (DM). left kidney involved in 28 patients and right kidney involved in 16 patients and bilateral kidney involvement in 8. Fever (92%), flank pain (88%) are the most common presentation in patients. Shock during initial presentation was seen in 19.5% of patients. E. coli growth was seen in 26.9% cases. 8 patients were treated conservatively with antibiotics according to culture and sensitivity. 32 patients required double J stenting, 7 patients required percutaneous nephrostomy. Nephrectomy was done in 5 patients. Mortality rate in our study was zero. Conclusions: Nephrectomy should be promptly attempted for patients not responding to conservative methods. Pre-existing CKD status, shock at presentation and altered sensorium are the factors determining the prognosis and management.

Laparoscopic ureterolithotomy: a rare case report

In this era of endourology most of the ureteric calculi are managed by endourological technique. However, lap ureterolithotomy has a role in the management of large ureteric calculus with minimal complications, morbidity, early recovery and short hospital stay. Laparoscopic ureterolithotomy bridges the gap between open and endourologic procedures as it is minimally invasive and overcomes a few of the disadvantages of open ureterolithotomy. We report a case of our experience of impacted upper ureteric calculus done by laparoscopy. Here we present a case of 45 -year-old male with right loin pain with CT suggestive of impacted right upper ureteric calculus measuring 2.2󪻒.2 with moderate HDUN and good renal function. Patient underwent right transperitoneal laparoscopic ureterolithotomy and, the ureteric calculi was removed successfully. Hence, we can conclude that, laparoscopic uretrolithotomy is safe for large impacted ureteric calculus with early recovery and minimal morbidity to the patient with complete clearance.

Congenital distal ureteric stricture presenting as obstructive megaureter in an infant: a case report

Congenital distal ureteric stricture is a rare but most important cause of hydro ureteronephrosis in infants presenting as obstructive megaureter. A 8 months old child suffering from recurrent episodes of fever and poor growth had giant hydroureteronephrosis due to distal ureteric stricture. Often misdiagnosed as primary megaureter or pelviureteric junction obstruction, congenital ureteral strictures and valves are the main causes of congenital ureteric obstruction. He was treated with excision of narrow ureteric segment with tapering ureteroplasty and a ureteral reimplantation was performed. This case is presented and discussed with reference to etiology of this rather rare anomaly.

Single puncture percutaneous nephrolithotomy for large staghorn calculus: experience at a tertiary care center

Percutaneous nephrolithotomy (PCNL) is recommended procedure for stones greater than 2 cm This procedure is being used commonly by all urologists worldwide. With increasing using of imaging studies, the incidence of large staghorn calculus has been consistently decreasing because most of the stones are being detected while they are still small. In this case report we are presenting a case of a large staghorn calculus of size 6.7×5.2 cm which was completely cleared by PCNL with a need for relook procedure.

Single puncture percutaneous nephrolithotomy for large staghorn calculus: experience at a tertiary care center

Percutaneous nephrolithotomy (PCNL) is recommended procedure for stones greater than 2 cm This procedure is being used commonly by all urologists worldwide. With increasing using of imaging studies, the incidence of large staghorn calculus has been consistently decreasing because most of the stones are being detected while they are still small. In this case report we are presenting a case of a large staghorn calculus of size 6.7×5.2 cm which was completely cleared by PCNL with a need for relook procedure.