rifampin and Ureteral-Obstruction

A 60-year-old man presented with ureteric obstruction secondary to a mycotic right common iliac artery aneurysm complicating methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. The diagnosis of MRSA was not known at the time of surgery, and in situ replacement of the aneurysm using a rifampicin-bonded prosthesis was performed. The patient made a full recovery, and to date there is no evidence of residual or recurrent infection. To our knowledge, this is the first reported case of mycotic iliac aneurysm infected with MRSA in the literature. We discuss the consequences and the considerable diagnostic and therapeutic problems that arise.

Topics: Aneurysm, Infected; Antibiotics, Antitubercular; Bacteremia; Humans; Iliac Aneurysm; Male; Methicillin Resistance; Middle Aged; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Ureteral Obstruction

Tuberculous ureteral stricture causing progressive obstructive uropathy commonly complicates renal tuberculosis. The aim of our study was to evaluate the effectiveness of early ureteral stenting or percutaneous nephrostomy (PCN) in patients with tuberculous ureteral strictures.. Seventy-seven patients (84 renal units) with tuberculous ureteral strictures were analyzed. We evaluated the final outcome of involved kidneys with three different managements: medication only (N = 37), medication plus ureteral stenting (N = 28), or medication plus PCN (N = 19).. The overall nephrectomy rate was 51%. In patients treated with medication only, the nephrectomy rate was 73%, whereas the nephrectomy rate was 34% in patients treated with medication plus early ureteral stenting or PCN. The rate of reconstructive surgery for ureteral strictures also was significantly different for patients treated with medication only (8%) and those receiving medication plus early ureteral stenting or PCN (49%). Spontaneous resolution of the strictures was noted in 6 of the 12 renal units that were managed with early ureteral stenting.. Early ureteral stenting or PCN in patients with tuberculous ureteral strictures may increase the opportunity for later reconstructive surgery and decrease the likelihood of renal loss.

Topics: Adolescent; Adult; Aged; Antibiotics, Antitubercular; Antitubercular Agents; Chi-Square Distribution; Constriction, Pathologic; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Male; Middle Aged; Nephrectomy; Nephrostomy, Percutaneous; Rifampin; Stents; Time Factors; Treatment Outcome; Tuberculosis, Renal; Ureter; Ureteral Obstruction

The current trend in South African health services is toward primary care. Pulmonary tuberculosis is well understood by the majority of primary care doctors and nurses, whereas genito-urinary tuberculosis may not be as easy to diagnose and treat. We reviewed our experience with this condition in 52 patients, who represented 0.74% of urology admissions between 1986 and 1991. There was a 3:2 male/female ratio, the age range was 7-76 years (mean 43 years), and the disease was more common among blacks and coloureds than among whites. Multiple sites of involvement were fairly common. Seventy-five per cent of patients had renal involvement and 17% epididymal involvement. The commonest presenting complaints were urinary frequency and haematuria, although flank and scortal pain were also reported by a number of patients. Physical examination seldom helped to suggest the diagnosis. On microscopic examination and culture of the urine, sterile pyuria was present in only 50% of our patients and 29% had positive cultures for a 'normal' coliform organism. Fifty patients underwent excretory urography and the findings were very varied. Patients were treated primarily with antituberculosis drugs, but 58% also required some form of surgery; nephrectomy was the commonest operation. Ureteral strictures developed in over 50% of cases with renal involvement. We conclude that the diagnosis of genito-urinary tuberculosis is not simple, and that treatment must include regular follow-up at a specialist institution.

Topics: Adolescent; Adult; Aged; Child; Female; Humans; Isoniazid; Male; Middle Aged; Pyrazinamide; Rifampin; Treatment Outcome; Tuberculosis, Urogenital; Ureteral Obstruction

Topics: Child; Colic; Granulomatous Disease, Chronic; Humans; Hydronephrosis; Male; Nephrostomy, Percutaneous; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination; Ureteral Obstruction

From our data urinary tuberculosis, clearly reduced as regards past decennia, now results constant in annual number of cases. The reduced frequency sometimes requires some problems of differential diagnosis. After a few considerations about anatomo-pathologic aspects, we examine the diagnostic procedures starting from that urinary tuberculosis has not pathognomic clinical signs, except identification of M. tuberculosis in urine. The medical treatment consists in administering three drugs (rifampin, isoniazid, ethambutol) for 3 months and then two drugs for 6-9 months, on the ground of clinical course. Surgical treatment can be divided in destroying and preserving surgery. At last, endoscopic treatment takes aim at dilating ureteral stenoses.

Topics: Calcinosis; Diagnosis, Differential; Endoscopy; Ethambutol; Female; Humans; Isoniazid; Italy; Male; Pyelonephritis; Rifampin; Tuberculosis, Urogenital; Ureteral Calculi; Ureteral Obstruction; Urinary Tract Infections; Urine

Topics: Adult; Antitubercular Agents; Cortisone; Ethambutol; Female; Humans; Isoniazid; Methods; Middle Aged; Rifampin; Tuberculosis, Urogenital; Ureteral Diseases; Ureteral Obstruction

Topics: Aminosalicylic Acids; Calcinosis; Drug Synergism; Epididymitis; Ethambutol; Female; Humans; Hypertension, Renal; Isoniazid; Kidney Calculi; Male; Mycobacterium tuberculosis; Nephrectomy; Prednisolone; Rifampin; Streptomycin; Tuberculosis, Urogenital; Ureteral Obstruction; Urinary Bladder; Urinary Diversion; Urine