struvite and Postoperative-Complications

To report our experience with the management of encrusted cystitis and pyelitis (EC and EP) in the pediatric population. EC and EP are well-known entities in adults but are rarely identified in children. They consist of mucosal encrustations and are due to specific microorganisms.. Between 1996 and 2001, 4 children with a mean age of 9 years (range 4 to 13) were treated for EC (n = 2), EP (n = 1), and EC and EP (n = 1). The latter was a kidney transplant recipient. We retrospectively evaluated the clinical characteristics of the patients and the results of conservative management.. The delay between the beginning of the symptoms and the diagnosis was longer than 1 month in all cases. The diagnosis of EC was not evoked and was made during cystoscopy in all cases. EP was diagnosed during pyelotomy in 1 patient because it was evoked and confirmed by computed tomography scan in the kidney transplant recipient. Corynebacterium urealyticum was identified in the urine of all patients. EC was treated by antibiotics and endoscopic debulking, and EP was treated by antibiotics and local acidification. The duration of antibiotic therapy was between 1 and 6 months. The tolerance to local acidification of the kidneys was poor. Cure was achieved in 3 cases, but the treatment of EP failed in the kidney transplant recipient and graft removal was decided after 6 months of failed management because intractable febrile urinary tract infections became life threatening for the patient.. EC and EP are uncommon in children; however, these diseases must be considered. They must be diagnosed rapidly and require, if possible, conservative management. Nevertheless, kidney loss can occur in transplant recipients with EP.

Topics: Adolescent; Anti-Bacterial Agents; Child; Child, Preschool; Combined Modality Therapy; Corynebacterium; Corynebacterium Infections; Cystitis; Disease Susceptibility; Drug Therapy, Combination; Endoscopy; Female; Follow-Up Studies; Glycopeptides; Humans; Hydrogen-Ion Concentration; Isotonic Solutions; Kidney Transplantation; Magnesium Compounds; Male; Phosphates; Postoperative Complications; Pyelitis; Retrospective Studies; Struvite; Tomography, X-Ray Computed; Treatment Outcome; Urea; Urine

To define risk factors and perioperative outcomes for matrix stones and compare these outcomes with struvite and calcium stone cohorts.. A retrospective cohort study comparing matrix stones (n=32), struvite stones (n=23) and a matched, calcium stone control group (n=32) was performed. Two-way ANOVA was used to compare the groups for continuous variables. Chi-square tests were used to compare categorical variables. Significance was set at P <.05. All statistical tests were performed using R (v1.73).. We identified no differences in age, gender, or BMI between the three groups. Matrix and struvite stones were more likely to have a history of prior stone surgery and recurrent UTIs compared to calcium stones (P=.027 and P <.001, respectively). Struvite stones were more likely to present as staghorn calculi compared to matrix or calcium stones (56.5% vs 21.7% vs 18.8%, P=.006). There were no significant differences in postoperative stone free rates (P=.378). No significant differences in postoperative infectious complications were identified. Matrix stones were more likely to have Candida on stone culture compared to the struvite or calcium stones (P <.0001).. Matrix and struvite stones were more likely have a history of stone surgery and preoperative recurrent UTIs. Struvite stones were more likely to present as staghorn calculi. Matrix stones were more likely to have Candida present in stone cultures. However, no difference in postoperative infectious outcomes or stone free rates were identified. Further study with larger cohorts is necessary to distinguish matrix stone postoperative outcomes from struvite and calcium stones.

Topics: Calcium; Female; Humans; Kidney Calculi; Male; Phosphates; Postoperative Complications; Retrospective Studies; Staghorn Calculi; Struvite; Uric Acid

This study aims to identify clinical factors that may predispose struvite stone patients to urosepsis following percutaneous nephrolithotomy (PCNL).. A retrospective review was conducted on patients who received PCNL for struvite stones. The Systemic Inflammatory Response Syndrome (SIRS) criteria and quick-Sepsis Related Organ Failure Assessment (q-SOFA) criteria were used to identify patients who were at an increased risk for urosepsis. Statistical analysis was performed using Fisher's exactness test, Wilcoxon rank test, and logistic regression.. Chart review identified 99 struvite stone patients treated with PCNL. Post-operatively, 40 patients were SIRS positive (≥2 criteria) and/or q-SOFA positive (score ≥2). Using SIRS as an approximation for urosepsis, longer operative times (p<0.001), higher pre-operative white blood cell counts (p=0.01), greater total stone surface area (p<0.0001), and pre-operative stenting (OR, 5.75; p=0.01) were identified as independent risk factors for urosepsis. Multivariate analysis demonstrated pre-operative stenting (OR, 1.46; p=0.01) to be a risk factor. With q-SOFA, univariable analysis found that antibiotic use within 3 months prior to a PCNL (OR, 4.44; p=0.04), medical comorbidities (OR, 4.80; p=0.02), longer operative times (p<0.001), lengthier post-operative hospitalization (p<0.01), and greater total stone surface area (p<0.0001) were risk factors for urosepsis. Multivariate analysis revealed that bladder outlet obstruction (OR, 2.74; p<0.003) and pre-operative stenting (OR, 1.27; p=0.01) significantly increased odds of being q-SOFA positive.. Several risk factors for urosepsis following PCNL for struvite stones have been identified. These risk factors should be taken into consideration in peri-operative care to mitigate the risks of urosepsis.

Topics: Adult; Aged; Female; Humans; Kidney Calculi; Male; Middle Aged; Nephrolithotomy, Percutaneous; Postoperative Complications; Retrospective Studies; Risk Factors; Sepsis; Struvite; Urinary Tract Infections

To evaluate the association of clinical factors on outcomes in patients with spinal cord injury (SCI) undergoing ureteroscopy. Immobility, recurrent urinary tract infection, and lower urinary tract dysfunction contribute to renal stone formation in patients with SCI. Ureteroscopy is a commonly utilized treatment modality; however, surgical complication rates and outcomes have been poorly defined. Evidence guiding safe and effective treatment of stones in this cohort remains scarce.. Records were retrospectively reviewed for patients with SCI who underwent ureteroscopy for kidney stones from 1996 to 2014 at a single institution. Multivariate relationships were evaluated using a general estimating equation model.. Forty-six patients with SCI underwent a total of 95 ureteroscopic procedures. After treatment, stone-free rate was 17% and 20% with <2-mm fragments. The complication rate was 21%. On multivariate analysis, SCI in cervical (C) levels was associated with higher risk of complications (C3: odds ratio [OR] 3.83, 95% confidence interval [CI] 2.17-6.98; C6: OR 3.83, 95% CI 1.08-13.53). American Spinal Injury Association Scale A classification was associated with a lower probability of stone-free status (OR 0.16, 95% CI 0.03-0.82). Patients averaged 2.2 procedures yet more procedures were associated with lower stone-free status (OR 0.83, 95% CI 0.03-0.32). Chronic obstructive pulmonary disease and bladder management modality were not associated with stone-free status or complications.. In patients with SCI, higher injury level and complete SCI were associated with worse stone clearance and more complications. Stone-free rate was 17%. Overall, flexible ureteroscopy is a relatively safe procedure in this population. Alternative strategies should be considered after failed ureteroscopy.

Topics: Adult; Aged; Apatites; Cardiovascular Diseases; Comorbidity; Diabetes Mellitus; Female; Humans; Kidney Calculi; Lithotripsy, Laser; Male; Middle Aged; Multivariate Analysis; Operative Time; Postoperative Complications; Renal Insufficiency, Chronic; Respiratory Tract Diseases; Spinal Cord Injuries; Struvite; Treatment Outcome; Ureteroscopy; Urinary Bladder, Neurogenic; Urinary Tract Infections

Computed Tomography (CT) is considered the gold-standard for the pre-operative evaluation of urolithiasis. However, no Hounsfield (HU) variable capable of differentiating stone types has been clearly identified. The aim of this study is to assess the predictive value of HU parameters on CT for determining stone composition and outcomes in percutaneous nephrolithotomy (PCNL).. Seventy seven consecutive cases of PCNL between 2011 and 2016 were divided into 4 groups: 40 (52%) calcium, 26 (34%) uric acid, 5 (6%) struvite and 6 (8%) cystine stones. All images were reviewed by a single urologist using abdomen/bone windows to evaluate: stone volume, core (HUC), periphery HU and their absolute difference. HU density (HUD) was defined as the ratio between mean HU and the stone's largest diameter. ROC curves assessed the predictive power of HU for determining stone composition/stone-free rate (SFR).. No differences were found based on the viewing window (abdomen vs bone). Struvite stones had values halfway between hyperdense (calcium) and low-density (cystine/uric acid) calculi for all parameters except HUD, which was the lowest. All HU variables for medium-high density stones were greater than low-density stones (p < 0.001). HUC differentiated the two groups (cut-off 825 HU; specificity 90.6%, sensitivity 88.9%). HUD distinguished calcium from struvite (mean ± SD 51 ± 16 and 28 ± 12 respectively; p = 0.02) with high sensitivity (82.5%) and specificity (80%) at a cut-off of 35 HU/mm. Multivariate analysis revealed HUD ≥ 38.5 HU/mm to be an independent predictor of SFR (OR = 3.1, p = 0.03). No relationship was found between HU values and complication rate.. HU parameters help predict stone composition to select patients for oral chemolysis. HUD is an independent predictor of residual fragments after PCNL and may be fundamental to categorize it, driving the imaging choice at follow-up.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Analysis of Variance; Calcium; Cross-Sectional Studies; Cystine; Female; Humans; Kidney Calculi; Male; Middle Aged; Nephrolithotomy, Percutaneous; Operative Time; Postoperative Complications; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Struvite; Tomography, X-Ray Computed; Uric Acid; Young Adult

Topics: Aged, 80 and over; Bacterial Proteins; Carcinoma, Transitional Cell; Catheter-Related Infections; Corynebacterium; Corynebacterium Infections; Crystallization; Cystitis; Disease Susceptibility; Female; Humans; Hydronephrosis; Male; Postoperative Complications; Prostatectomy; Prostatic Neoplasms; Struvite; Urease; Urinary Bladder Neoplasms; Urinary Catheterization; Urinary Retention

Struvite stones have been associated with significant morbidity and mortality, yet there has not been a report on the medical management of struvite stones in almost 20 years. We report on the contemporary outcomes of the surgical and medical management of struvite stones in a contemporary series.. A retrospective review of patients who were treated with percutaneous nephrolithotomy (PCNL) for struvite stones at Duke University Medical Center between January 2005 and September 2012 identified a total of 75 patients. Of these, 43 patients had adequate follow-up and were included in this analysis. Stone activity, defined as either stone recurrence or stone-related events, and predictors of activity were evaluated after combined surgical and medical treatment.. The study included 43 patients with either pure (35%) or mixed (65%) struvite stones with a median age of 55±15 years (range 21-89 years). The stone-free rate after PCNL was 42%. Stone recurrence occurred in 23% of patients. Postoperatively, 30% of patients had a stone-related event, while 60% of residual stones remained stable with no growth after a median follow-up of 22 months (range 6-67 mos). Kidney function remained stable during follow-up. Independent predictors of stone activity included the presence of residual stones >0.4 cm(2), preoperative large stone burden (>10 cm(2)), and the presence of medical comorbidities (P<0.05).. Struvite stones can be managed safely with PCNL followed by medical therapy. The majority of patients with residual fragments demonstrated no evidence of stone growth on medical therapy. With careful follow-up and medical management, kidney function can be maintained and stone morbidity can be minimized. Initial large stone burden, residual stones after surgery, and associated medical comorbidities may have deleterious effect on stone recurrence or residual stone-related events.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Calcium Citrate; Chlorthalidone; Comorbidity; Diuretics; Enzyme Inhibitors; Female; Humans; Hydroxamic Acids; Kidney Calculi; Male; Middle Aged; Nephrostomy, Percutaneous; Postoperative Complications; Potassium Citrate; Recurrence; Retrospective Studies; Sodium Bicarbonate; Struvite; Treatment Outcome; Young Adult

We present our experience with micropercutaneous cystolithotripsy (mPCCL) using transillumination-guided access in children with bladder stones and evaluate the safety and efficacy of this procedure.. Twelve children who underwent mPCCL for bladder stone removal in our department between January 2011 and September 2013 were included in this study. Percutaneous access was performed using the transillumination technique. The chief complaint, age and sex of the patients, stone size, operative time, complications, stone-free rate, and stone composition as determined by radiography diffraction analysis were recorded.. The mean age of the patients was 2.6 (1-7) years. One out of 12 patients was a girl. The mean stone size was 14 mm (7-32 mm). The mean mPCCL procedure time was 38.7 (15-65) minutes. The mean hospital stay was 1.4 (0.5-4) days. The stone-free rate after one mPCCL intervention was 91.6% and increased to 100% after two sessions of mPCCL. The notable complications were transient macroscopic hematuria in one patient, acute urinary retention in one patient, and the need for a second session of mPCCL in another patient. The stones were composed of calcium oxalate (3), ammonium acid urate (1), calcium phosphate (1), cystine (1), struvite (1), and unknown (5).. Transillumination-guided mPCCL is a safe and effective technique, does not require the use of ionizing radiation, is technically easy, and is a minimally invasive alternative for the management of bladder stones. It has many advantages, especially in pediatric patients, such as decreased urethral injury, no need for postoperative catheter insertion in most cases, and shorter operative time.

Topics: Calcium Phosphates; Catheterization; Child; Child, Preschool; Cystine; Female; Hematuria; Humans; Infant; Length of Stay; Magnesium Compounds; Male; Operative Time; Phosphates; Postoperative Complications; Struvite; Transillumination; Uric Acid; Urinary Bladder Calculi

Topics: Adult; Cystostomy; Female; Humans; Magnesium Compounds; Phosphates; Postoperative Complications; Skin Diseases; Struvite; Surgical Stomas

An 81-year-old man who had under gone two abdominal surgeries and temporary colostomy 30 years previously was admitted due to lower abdominal pain and vomiting. An abdominal X-ray film and abdominal CT scan showed intestinal distension and multiple calcareous deposits in the colon. Gastrografin enema examination revealed smooth stenosis at the sigmoid colon and many additional defects. Endoscopy could not be performed due to the stenosis. He did not agree to surgery. Seven months later, he was admitted again, due to colonic obstruction. Surgery was performed which revealed colonic obstruction as the source of post-operative stenosis of the sigmoid colon and multiple enteroliths. The stones consisted of a core and a hull and contained ammonium magnesium phosphate.

Topics: Aged, 80 and over; Calculi; Colonic Diseases; Constriction, Pathologic; Humans; Intestinal Diseases; Intestinal Obstruction; Magnesium Compounds; Male; Phosphates; Postoperative Complications; Sigmoid Diseases; Struvite

Topics: Anti-Bacterial Agents; Catheterization; Child; Endotoxemia; Endotoxins; Humans; Kidney Calculi; Magnesium Compounds; Male; Nephrostomy, Percutaneous; Phosphates; Postoperative Complications; Premedication; Struvite; Urinary Catheterization

To emphasize the importance of early diagnosis of encrusted pyelitis in kidney transplant patients.. We report one case of encrusted pyelitis in a 10-year-old girl with a kidney graft who was treated by means of nephrostomy tube irrigation with an acidifier liquid substance.. After 16 days of treatment there was a significant decrease of the size of the calcified pyelic plaque, keeping a good renal function afterwards.. This disease should be thought of in every case of kidney transplant patient with negative urine cultures and alkaline pH, and the microbiologist should be alerted of the possibility of urinary tract infection by Corynebacterium.

Topics: Child; Female; Humans; Kidney Transplantation; Magnesium Compounds; Nephrostomy, Percutaneous; Phosphates; Postoperative Complications; Pyelitis; Struvite; Therapeutic Irrigation; Urothelium

29 patients suffering from recurrent struvite stones and/or persistent urinary tract infection were analyzed retrospectively with a follow-up time of 10 +/- 6 years. A sanitation of the urease-positive urinary tract infection was possible in 12 patients (41%). After 10 out of 53 operations (19%) rest stones were found. An unilateral nephrectomy was done in 3 cases. Despite rest calculi and persistent urinary tract infection no further calculus growth or deterioration of renal function was found in most patients.

Topics: Combined Modality Therapy; Female; Follow-Up Studies; Humans; Kidney Calculi; Kidney Failure, Chronic; Magnesium; Magnesium Compounds; Male; Middle Aged; Nephrectomy; Phosphates; Postoperative Complications; Recurrence; Retrospective Studies; Struvite; Urinary Tract Infections

We report the results of 1,000 consecutive patients who underwent percutaneous removal of renal and ureteral stones. Removal was successful for 98.3 per cent of the targeted renal stones and 88.2 per cent of the ureteral stones. Complications, evolution and technique are discussed. Percutaneous techniques are an effective way to handle the majority of renal calculi and these techniques will continue to be important as shock wave lithotripsy becomes more widespread in the United States.

Topics: Blood Transfusion; Cystine; Female; Hemorrhage; Humans; Intraoperative Complications; Kidney; Kidney Calculi; Length of Stay; Lithotripsy; Magnesium; Magnesium Compounds; Male; Nephrostomy, Percutaneous; Phosphates; Postoperative Complications; Struvite; Time Factors; Ureteral Calculi

Percutaneous nephrostomy and hemiacidrin were used as primary treatment of magnesium ammonium phosphate calculi in 32 surgical candidates. Of 28 patients who actually received hemiacidrin 24 (85 per cent) had successful treatment (no surgery necessary), including 19 (68 per cent) who had total stone dissolution. There were no significant complications. Patients have been followed for 3 months to 7 years. Percutaneous nephrostomy with hemiacidrin infusion is another possible treatment in the growing alternatives available for patients with urinary struvite calculi.

Topics: Citrates; Humans; Kidney; Kidney Calculi; Magnesium; Magnesium Compounds; Phosphates; Postoperative Complications; Punctures; Radiography; Solubility; Struvite; Therapeutic Irrigation

Urolithiasis is a rare complication following kidney transplantation. Experience with this complication in 6 of 426 transplantations performed from 1968 to 1979 is reviewed. The clinical symptoms are different from the disease in non-transplant patients. Three major predisposing causes for the development of calculi after kidney transplantation were found in our patients--urodynamic disorders following complications of the ureterovesical anastomosis, persistent bacteriuria and renal tubular acidosis and, less importantly, the presence of hypercalcemia and hypercalciuria as a result of secondary hyperparathyroidism. Crystal-optical and x-ray-diffraction studies contributed to the interpretation of the constituents and texture of the calculi and of the aetiological factors concerned.

Topics: Adolescent; Adult; Apatites; Calcium Oxalate; Carbonates; Female; Humans; Kidney Transplantation; Magnesium; Magnesium Compounds; Male; Phosphates; Postoperative Complications; Quaternary Ammonium Compounds; Struvite; Transplantation, Homologous; Uric Acid; Urinary Calculi