1/13. Silent hydronephrosis/pyonephrosis due to upper urinary tract calculi in spinal cord injury patients.STUDY DESIGN: A study of four patients with spinal cord injury (SCI) in whom a diagnosis of hydronephrosis or pyonephrosis was delayed since these patients did not manifest the traditional signs and symptoms. OBJECTIVES: To learn from these cases as to what steps should be taken to prevent any delay in the diagnosis and treatment of hydronephrosis/pyonephrosis in SCI patients. SETTING: Regional spinal injuries Centre, Southport, UK. methods: A retrospective review of cases of hydronephrosis or pyonephrosis due to renal/ ureteric calculus in SCI patients between 1994 and 1999, in whom there was a delay in diagnosis. RESULTS: A T-5 paraplegic patient had two episodes of urinary tract infection (UTI) which were successfully treated with antibiotics. When he developed UTI again, an intravenous urography (IVU) was performed. The IVU revealed a non-visualised kidney and a renal pelvic calculus. In a T-6 paraplegic patient, the classical symptom of flank pain was absent, and the symptoms of sweating and increased spasms were attributed to a syrinx. A routine IVU showed non-visualisation of the left kidney with a stone impacted in the pelviureteric junction. In two tetraplegic patients, an obstructed kidney became infected, and there was a delay in the diagnosis of pyonephrosis. The clinician's attention was focused on a co-existent, serious, infective pathology elsewhere. The primary focus of sepsis was chest infection in one patient and a deep pressure sore in the other. The former patient succumbed to chest infection and autopsy revealed pyonephrosis with an abscess between the left kidney and left hemidiaphragm and xanthogranulomatous inflammation of perinephric fatty tissue. In the latter patient, an abdominal X-ray did not reveal any calculus but computerised axial tomography showed the presence of renal and ureteric calculi. CONCLUSIONS: The symptoms of hydronephrosis may be bizarre and non-specific in SCI patients. The symptoms include feeling unwell, abdominal discomfort, increased spasms, and autonomic dysreflexia. physicians should be aware of the serious import of these symptoms in SCI patients.- - - - - - - - - - ranking = 1keywords = calculus (Clic here for more details about this article) |
2/13. Development of a large bladder calculus on sutures used for pubic bone closure following extrophy repair.bladder exstrophy is a rare congenital condition that occurs in 1 to 30,000 live births. Primary bladder closure is usually performed in the first days of life in conjunction with an iliac osteotomy in order to achieve a more secure bladder closure. We report a case of a large bladder stone with secondary right-sided hydronephrosis in a 3-year-old child who underwent exstrophy repair at the age of 7 months. During the exstrophy repair a no. 1 braided, polyester, non-absorbable suture was used to close the pubic bones and served as a nidus for intravesical stone formation. This case substantiates the lithogenic nature of non-absorbable sutures in contact with urine as well as the need for close post-operative follow-up in these patients.- - - - - - - - - - ranking = 1.3333333333333keywords = calculus (Clic here for more details about this article) |
3/13. Elevation of CA 19-9 in giant hydronephrosis induced by a renal calculus.CA 19-9 is a tumor marker of pancreatic and gastrointestinal cancer. Elevation in nonmalignant disease is rare. The case of a patient with a partial staghorn calculus, giant hydronephrosis, and elevated CA 19-9 serum levels is presented. Open transperitoneal right-sided nephrectomy was performed. In immunohistochemical analysis, CA 19-9 was expressed in the renal tubular epithelium and the renal pelvis. During postoperative follow-up, the CA 19-9 levels returned to normal. hydronephrosis might cause false-positive results when CA 19-9 measurement is used to screen for malignant disease. Posttreatment CA 19-9 levels of patients with hydronephrosis have to be monitored closely to safely exclude malignant disease.- - - - - - - - - - ranking = 1.6666666666667keywords = calculus (Clic here for more details about this article) |
4/13. Management of gestational nephrolithiasis in the presence of a bicornuate uterus and pelvic kidney.A 39-year-old para 0( 1) woman with known nephrolithiasis within a left-sided pelvic kidney presented with left-sided renal colic at 7 weeks gestation. She had a previous miscarriage due to a bicornuate uterus. Ultrasound and magnetic resonance urography confirmed an incomplete obstruction of the left upper renal tract which was relieved by percutaneous nephrostomy. She presented again at 14 weeks with renal colic and minimal output. An ultrasound confirmed recurrent hydronephrosis and a nephrostogram showed that the catheter had retracted almost completely from the collecting system. This was considered to be due to the upward pressure of the enlarging uterus on the catheter, which had been fixed externally to the skin. This problem was obviated by not securing the replacement nephrostomy tube to the skin. She developed pre-eclamptic toxaemia and gave birth at 35 weeks gestation by caesarean section. The calculus was later dissolved using extra-corporeal shockwave lithotripsy.- - - - - - - - - - ranking = 0.33333333333333keywords = calculus (Clic here for more details about this article) |
5/13. The use of percutaneous diversion during pregnancy.Two patients with infected hydronephrosis and one patient with calculus anuria during pregnancy were managed initially by percutaneous nephrostomy. maintenance of percutaneous diversion allowed continuation of pregnancy to term and effectively preserved renal function. Definite surgical treatment for the obstructive pathology was done electively in the postpartum period.- - - - - - - - - - ranking = 0.33333333333333keywords = calculus (Clic here for more details about this article) |
6/13. Diagnostic ultrasound: its value in acute urinary tract infection in spinal cord injury.Two cases of acute urinary tract infection in patients with spinal cord injury highlight the complications of calculus and perinephric abscess. Rather than waiting the customary 48 hours to assess response to antibiotics before evaluation for secondary complications, diagnostic ultrasound is advocated upon diagnosis of pyelonephritis. The potential benefits of early imaging seem to far outweigh the negligible risk and expense.- - - - - - - - - - ranking = 0.33333333333333keywords = calculus (Clic here for more details about this article) |
7/13. Hereditary xanthinuria in 2 Pakistani sisters: asymptomatic in one with beta-thalassemia but causing xanthine stone, obstructive uropathy and hypertension in the other.We describe a 3-year-old Pakistani girl who presented with recurrent urinary infections. She had a nonfunctioning hydronephrotic right kidney and hypertension. At operation a calculus was impacted in the right ureter with dilatation of the pelviocaliceal system. nephrectomy was performed. histology revealed end stage pyelonephritis. The calculus consisted of pure xanthine. Further investigations demonstrated low serum uric acid and absent urinary uric acid with increased excretion of xanthine. Eight months after nephrectomy blood pressure had decreased to normal. Her 5-year-old sister, who has beta-thalassemia, also has a low serum uric acid concentration and xanthinuria. The treatment of choice is to increase fluid intake so that the urine xanthine concentration remains below the level at which xanthine crystallizes. This may require adjustment of the urine pH.- - - - - - - - - - ranking = 0.66666666666667keywords = calculus (Clic here for more details about this article) |
8/13. Spontaneous urinary extravasation in non-acute ureteric obstruction: a report of four cases.Four new cases of spontaneous extravasation of contrast medium during intravenous urography have been described. All were due to non-acute obstruction of the ureter. This is relatively uncommon as most of the cases previously described have been due to passage of a ureteric calculus. Two of the patients improved after relief of the obstruction. In one a nephrectomy was carried out, and one patient died of an unrelated cause before the obstruction could be relieved.- - - - - - - - - - ranking = 0.33333333333333keywords = calculus (Clic here for more details about this article) |
9/13. renal colic: the role of ultrasound in initial evaluation.A prospective sonographic study of 21 patients with suspected renal colic was undertaken to detect the presence or absence of urinary tract calculi. The presence of calculi was diagnosed sonographically by visualization of the calculus and/or unilateral hydronephrosis in all 18 cases in which presence of a calculus was subsequently proved by surgery, spontaneous passage and recovery, or intravenous urography. In the two cases in which the sonographic examination demonstrated neither calculi nor unilateral obstruction, further evaluation confirmed the absence of calculi. There was one false-positive examination in which unilateral hydronephrosis was detected secondary to a retroperitoneal tumor. There were no false-negative examinations. The results of this study support the use of ultrasound in the initial evaluation of renal colic.- - - - - - - - - - ranking = 0.66666666666667keywords = calculus (Clic here for more details about this article) |
10/13. Replacement lipomatosis of the kidney: diagnosis by computed tomography and sonography.The sonographic and computed tomographic features in a case of replacement lipomatosis of the kidney are presented, along with pathologic correlation. Computed tomography demonstrated a staghorn calculus and marked atrophy of the renal parenchyma, along with diffuse increase in renal sinus and perirenal fat. Sonography showed thinning of the renal parenchyma and high-amplitude echoes throughout the kidney, corresponding to the increase in renal sinus fat. The prospective diagnosis of replacement lipomatosis, and differentiation from other causes of nonfunction of the kidney due to staghorn calculus, can be readily made.- - - - - - - - - - ranking = 0.66666666666667keywords = calculus (Clic here for more details about this article) |
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