[The Predictive Factors of Stent Failure in the Treatment of Malignant Extrinsc Ureteral Obstruction Using Internal Ureteral Stents].

In this study, we retrospectively reviewed the experiences at our single institute in the treatment of malignant extrinsic ureteral obstruction (MUO) using ureteral stents to investigate the clinical outcomes and the predictive factors of stent failure. In 52 ureters of 38 patients who had radiologically significant hydronephrosis due to MUO, internal ureteral stents (The BARD(R) INLAY(TM) ureteral stent set) were inserted. The median follow-up interval after the initial stent insertion was 124.5 days (4-1,120). Stent failure occurred in 8 ureters (15.4%) of the 7 patients. The median interval from the first stent insertion to stent failure was 88 days (1-468). A Cox regression multivariate analysis showed that the significant predictors of stent failure were bladder invasion. Based on the possibility of stent failure, the adaptation of the internal ureteral stent placement should be considered especially in a patient with MUO combined with bladder invasion.

[A Case of Emphysematous Cystitis with Bladder Diverticulum].

Emphysematous cystitis (EC) is a rare form of acute complicated urinary tract infection (UTI). We report a case of EC with bladder diverticulum. A 77-year-old man who had a medical history of diabetes mellitus was admitted to our hospital with the chief complaint of macrohematuria and pneumaturia. Based on the findings of an abdominal computed tomography and cystoscopy, the diagnosis of EC and bladder diverticulum was made with its characteristic feature being gas within the bladder wall and lumen and a cystic lesion from the bladder. His condition improved immediately with a combination of bladder drainage and appropriate antibiotics. The cystography revealed a very large diverticulum causing incomplete bladder emptying and stagnation of urine. We considered diabetes mellitus and a large amount of residual urine after urination due to bladder diverticulum and neurogenic bladder as the possible causal factors of EC in this case.

[A case of emphysematous pyelonephritis successfully treated by multiple CT-guided percutaneous drainage procedures].

A case of emphysematous pyelonephritis successfully treated by multiple, computed tomography (CT)- guided, percutaneous drainage procedures. A 63-year-old female with complaints of high-grade fever and vomiting was transferred to our hospital with leukocytosis and hyperglycemia. CT revealed a gas shadow widespread not only in the left renal parenchyma but also in the retroperitoneal space with extension to the right pararenal space. Under a diagnosis of emphysematous pyelonephritis, CT-guided percutaneous drainage was performed immediately, and a drainage catheter was placed in the retroperitoneal space. However, because a single drainage with medical management was not completely effective, a second drainage procedure was performed. She recovered, and the catheters were removed after four months. A left perinephric abscess and cutaneous fistula formation were localized and almost completely resolved after one year.