1/36. Urosepsis associated with vaginal pessary use.Conservative management of genital prolapse in older women uses vaginal pessaries. Infectious complications of these devices, attributable in some instances to poor routine maintenance, are uncommonly reported. We present 2 cases of genitourinary sepsis associated with unsuspected pessary use and discuss the spectrum of complications reported with these appliances.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
2/36. Matrix calculi.Matrix calculi are an uncommon form of urinary tract concretion. They must be considered in the differential diagnosis of a radiolucent mass within the renal collecting system or ureter. The clinical and radiographic features of three cases are presented and the literature of matrix calculi is reviewed.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
3/36. Complications of transrectal aspiration biopsy of the prostate.Four cases of coli-sepsis, one with a fatal outcome have been observed after more than 14 000 transrectal aspiration biopsies (TAB) of the prostate performed at Karolinska Sjukhuset with Franzen's apparatus. A few cases of transient febrile reaction and urinary contamination after TAB of the prostate have also been recognised. One of the patients with sepsis and two with febrile reactions belonged to a relatively small group of patients referred from the Department of rheumatology. These observations prompted the present study. The records of all the patients referred for TAB of the prostate from the Department of rheumatology were reviewed. Four complications (three patients with febrile reaction and growth of E. coli in the urine and one case of sepsis) were observed after 63 biopsies in 51 patients (6.3%). The patient with sepsis and two other patients with complications belonged to a group of 32 patients with proven rheumatic disease (chronic polyarthritis): 42 biopsies had been performed in this particular group of patients, bringing the incidence of complication to 7.1%. For comparison the records of 294 patients from the Department of urology submitted to TAB of the prostate were also reviewed. Complications in the form of transient febrile reactions were found in five cases after 508 biopsies (1.0%). In addition, three cases of coli-sepsis not belonging to the above-mentioned groups are briefly described as case reports. patients with rheumatic disease (chronic polyarthritis) seem to run a higher risk of complications after TAB of the prostate. sepsis from E. coli is a rare but serious complication which can develop into, often fatal, endotoxin shock. TAB of the prostate should therefore be restricted to cases with clinical suspicion of prostatic malignancy.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
4/36. A rational approach to urinary tract infections in older patients.urinary tract infections (UTIs) occur more commonly in the elderly than in younger adults. The frequency of concomitant chronic illness and decreased resistance in this age group confers increased rates of morbidity and mortality, and manifestations are often atypical. diagnosis requires careful interpretation of urine culture results and a determination of the infection as asymptomatic bacteriuria, uncomplicated UTI, or complicated UTI. This, in turn, guides therapeutic measures, including the use of oral antibiotics.- - - - - - - - - - ranking = 4keywords = urinary (Clic here for more details about this article) |
5/36. Acute renal failure in adults with uncomplicated acute pyelonephritis: case reports and review.Acute renal failure is a rare complication of acute pyelonephritis in patients who do not have urinary obstruction. Although urinary tract infections are common in adults, pyelonephritis is rarely considered in the differential diagnosis of acute renal failure nor is renal failure considered a likely consequence of bacteriuria. In this review, the cases of acute renal failure caused by acute pyelonephritis that have been reported in the last quarter century are examined. Including two new cases reported, only 12 cases of acute pyelonephritis resulting in acute renal failure were found. Three of these occurred in patients with a solitary kidney. All cases occurred in individuals who had no history of urinary tract infections, and all were caused by escherichia coli. In several cases, the administration of non-steroidal antiinflammatory drugs contributed to disease. Three cases occurred after catheter-acquired bacteriuria. Acute renal failure is an uncommon but serious consequence of uncomplicated acute pyelonephritis in adults.- - - - - - - - - - ranking = 3keywords = urinary (Clic here for more details about this article) |
6/36. Puerperal group A streptococcus infection: a case report.BACKGROUND: Group A streptococcus (GAS) sepsis is a rare event but carries a high risk of maternal mortality. CASE: A case of puerperal infection occurred with GAS. This patient had had an uneventful prenatal and intrapartum course. She was noted to have high, spiking fevers immediately postpartum, with minimal clinical symptoms. Her blood cultures were positive for GAS, most likely from a urinary tract infection. She was started on broad-coverage antibiotics and defervesced on postpartum day 4. She remained afebrile and was discharged on postpartum day 8. CONCLUSION: patients with puerperal GAS sepsis commonly appear well clinically, with minor somatic complaints. GAS bacteremia should be suspected and promptly treated in women with high, spiking fevers early in the postpartum period. There are currently no guidelines on preventing vertical transmission. It is unclear how a patient with a previous history of GAS should be managed. Prophylactic use of penicillin during future labor may be warranted.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
7/36. Functional urinary outlet obstruction causing urosepsis in a male multiple sclerosis patient.Detrusor-external sphincter dyssynergia (DESD) is a neuropathic disorder of micturition that exists when the simultaneous contractions of the detrusor muscle and external urethral sphincter oppose each other. When the external urethral sphincter contracts during a detrusor contraction, functional urinary outflow obstruction occurs by the increased urethral resistance. This loss of coordination between the bladder and its outlet is associated with a high risk for serious urologic complications, such as vesicoureteral reflux, hydronephrosis, and urosepsis. This report describes a male multiple sclerosis patient with DESD who developed functional outlet obstruction with urosepsis and discusses the diagnosis and treatment of this potentially life-threatening voiding dysfunction.- - - - - - - - - - ranking = 5keywords = urinary (Clic here for more details about this article) |
8/36. Intravesical foreign body after inguinal herniorrhaphy. Case report.A 36-year-old male teacher living on the Pacific Island of Tuvalu presented with a surgical gauze swab that had been left behind after an inguinal hernia operation. It had migrated into the urinary bladder where it had remained for 15 months.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
9/36. Urinary tract infection caused by corynebacterium group D2: report of 82 cases and review.corynebacterium group D2 (CGD2) is a slow-growing, urea-splitting, multiantibiotic-resistant microorganism that is frequently isolated from urine samples and that, in certain circumstances, produces infection of the lower urinary tract (acute and chronic cystitis) and the upper urinary tract (pyelonephritis). This paper analyzes (by means of a retrospective and partially prospective clinical protocol) our experience with 82 patients with CGD2 bacteriuria. The infection was symptomatic in 62% of cases, and the clinical diagnoses included acute and chronic cystitis and pyelonephritis with or without bacteremia. Because CGD2 infection of the urinary tract may require specific antimicrobial treatment and because CGD2 is a fastidious microorganism, we recommend prolonged incubation of urine cultures (up to 48-72 hours), especially if the routine culture is negative, when patients are symptomatic, have alkaline urine, or have struvite crystals in the urine sediment.- - - - - - - - - - ranking = 3keywords = urinary (Clic here for more details about this article) |
10/36. gardnerella vaginalis in infections of the urinary tract.During a period of 6 months, urine from 3576 patients was cultured for gardnerella vaginalis. Specimens from 32 patients yielded this species. Eleven (0.3%) of the isolates were judged to be of clinical importance. Seven were from women and four from men. Two of these patients, both women, suffered from spontaneous cystitis. Hence G. vaginalis is very unusual as a primary pathogen in the urinary tract. More often it may cause infections related to urological abnormalities or as a complication of urological procedures. Two of the men in our series had chronic prostatitis, one an infected urinoma. All six remaining patients had either undergone a urological procedure or had had an indwelling urethral catheter for more than 6 hours. A selective medium for G. vaginalis is recommended for screening cultures before urological procedures and when this species is suspected on microscopy. The role of metronidazole in extravaginal infections is discussed and the use of an antibiotic more active against G. vaginalis is recommended.- - - - - - - - - - ranking = 5keywords = urinary (Clic here for more details about this article) |
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